Opportunities Challenges Of Medical Tourism

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Opportunity and challenges for Medical tourism in India Prasad Begde* Ayurveda- the science of life, the origin of most forms of natural and alternative medicine—has its mention in one of the oldest (about 6,000 years) philosophical texts of the world, the Rig Veda. The Sutrasthana of Charaka Samhita, a much referred ayurvedic text, says; "The three—body, mind and soul—are like a tripod, the world stand by their combination; in them everything abides. It is the subject matter of ayurveda for which the teachings of ayurveda have been revealed." (1.46-47) In its broader scope, ayurveda in India has always sought to prepare mankind for the realization of the full potential of its self through a psychosomatic integration. A comprehensive health care is what this natural and alternative medicine prescribes for the ultimate self-realization. "Life (ayu) is the combination (samyoga) of body, senses, mind and reincarnating soul. Ayurveda is the most sacred science of life, beneficial to humans both in this world and the world beyond." —Charaka Samhita, Sutrasthana, 1.42-43. The verses of Rig Veda, the earliest source of ayurveda, refer to panchamahabhut (five basic elements of the entire creation), and the three doshas or primary forces of prana or vata (air), agni or pitta (fire) and soma or kapha (water and earth) as comprising the basic principles of ayurveda. One branch of Indian philosophy—Sankhya states that there are 24 elements, all of which constitute the foundation of the gross world: earth, water, fire, air and ether. These five elements in different combinations constitute the three body types/doshas—vata dosha (air and ether), pitta dosha (fire) and kapha dosha (earth and water). The panchamahabhut and the dosha theories are the guiding factors of ayurveda as a therapeutic science. The Rig Veda also mentions organ transplants and herbal remedies called soma with properties of elixir. This science or knowledge of healing, as mentioned in the Rig Veda, was revealed to Rishi Bharadvaja from the great Cosmic Intelligence. The knowledge consists of three aspects known as the Tri-Sutras of ayurveda, which are—etiology or the science of the causes of disease, symptomatology or the study and interpretation of symptoms and medication and herbal remedies. Approximately, during 4,000 to 3,000 BC, Sam Veda and Yajur Veda, the second and third Vedas came into being. Chanting of mantras and performance of rituals were, respectively, dealt in these two Vedas. And, during 3,000 to 2,000 BC Atharva the fourth Veda was authored, of which ayurveda is an upaveda (subsection). Though it had been practiced all along, it was around this time that ayurveda in India, was codified from the oral tradition to book form, as an independent science. It enlists eight branches/divisions of ayurveda: Kayachikitsa (Internal Medicine), Shalakya Tantra (surgery and treatment of head and neck, Ophthalmology and Otolaryngology), Shalya Tantra (Surgery), Agada Tantra (Toxicology), Bhuta Vidya (Psychiatry), Kaumarabhritya (Pediatrics), Rasayana (science of rejuvenation or anti-aging), and Vajikarana (the science of fertility). The oldest treatise available on this codified version is Atreya Samhita. The most fascinating aspect of ayurveda is, it was using almost all methods of healing like lifestyle regimen, yoga, aroma, meditation, gems, amulets, herbs, diet, jyotishi (astrology), color and surgery etc. in treating patients. Though ayurveda came into being as an independent upaveda of Atharva Veda, it has close links with other Vedas also. The Yajur Veda, which recommends rituals to pacify the panchamahabhuts in a view to heal both the Cosmic Being and the individual soul, is related to ayurveda in its principles and regulations of lifestyle. The upaveda called Dhanur Veda or the martial arts and ayurveda both refer to each other in the treatment of marmas or sensitive points in the body. Ayurveda recommends specific ayurvedic massages, exercises and bodywork for this purpose. Around 15,00 BC ayurveda was delineated into to two distinct schools: Atreya—The School of Physicians, and Dhanvantari—The School of Surgeons. This made ayurveda a more systematically classified medical science, hereafter. Dhanvantari, who is considered to be a reincarnation of Lord Vishnu, was the guiding sage of ayurveda. He made this science of health and longevity popular and widely acceptable. In fact, these two schools of thought led to the writing of two major books on ayurveda—Charaka Samhita and Susruta Samhita. These two Samhitas were written in the early part of 1000 BC. The great sage- physician Charaka authored Charaka Samhita revising and supplementing the text written by Atreya, which has remained the most referred ayurvedic text on internal medicine till date. Susruta, following the Dhanvantari School of

*Lecturer, GSIMR (SGSITS), Indore

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Thought, wrote Susruta Samhita, comprising the knowledge about prosthetic surgery to replace limbs, cosmetic surgery, caesarian operations and even brain surgery. He is famed for his innovation of cosmetic surgery on nose or rhinoplasty. Around 500 AD, Vagbhatt compiled the third major treatise on ayurveda, Astanga Hridaya. It contained knowledge comprising the two schools of ayurveda. From 500 AD to 1900 AD, sixteen major Nighantus or supplementary texts on ayurveda like Dhanvantari Bhavaprakasha, Raja and Shaligram among others were written incorporating new drugs, expansion in applications, discarding of old drugs and identification of substitutes. These texts mention about 1814 varieties of plants in vogue. Evidences show that ayurveda had nurtured almost all the medical systems of the world. The Egyptians learnt about ayurveda long before the invasion of Alexander in the 4th century BC through their sea-trade with India. Greeks and Romans come to know about it after the famous invasion. The Unani form of medical tradition came out of this interaction. In the early part of the first millennium ayurveda spread to the East through Buddhism and greatly influenced the Tibetan and Chinese system of medicine and herbology. Around 323 BC, Nagarjuna, the great monastic of Mahayana Buddhism and an authority on ayurveda had written a review on Susruta Samhita. In 800 AD ayurveda was translated into Arabic. The two Islamic physicians Avicenna and Razi Serapion, who helped form the European tradition of medicine, strictly followed ayurveda. Even, Paracelsus, considered to be the father of the modern western medicine toed the line of ayurveda, as well. In the postmodern age, the popularity of this vibrant tradition of ayurveda lies in its, subtle yet scientific, approach to heal a person in its totality. It aims, not only at healing the body, but also the mind and spirit, at one go. Its unique understanding of the similarities of natural law and the working of human body, as well as its holistic treatment methods, help it to strike a balance between the two. This gives ayurveda an edge over other healing systems. Perhaps that's the reason behind ayurveda being the longest unbroken medical tradition in the world, today Charaka Samhita Charaka Samhita is considered to be the most ancient and authoritative writing on ayurveda available today. It also explains the logic and philosophy on which this system of medicine is based. The detailed biography of the composer of this treatise—that is, sage Charaka—is not known to the posterity. Interestingly, it is not an original writing of a single person rather like all Vedic knowledge it is a continuation and renewal of that ancient knowledge system. In fact, Charaka had redacted the Agnivesa Samhita (an edited version of Atreya Samhita). The available form of Charaka Samhita was again worked upon by Drdhabala (living in about 400 AD) long after sage Charaka. According to Charaka, science is dependent upon yukti—a quality of the intellect that enables it to perceive phenomena brought into existence by a multiplicity of causes. Thus, it's not surprising that much of the treatise of Charaka Samhita is in the form of a symposium wherein groups of ayurvedic scholars take up a series of topics for discussion. This gives indication that the science of ayurveda is a product of constant verification, fine-tuning and authentication by an active community of physicians. The samhita mentions about the gradual development of the fetus within the womb in minutes that equals the modern medical version in accuracy. The language is Sanskrit and is written in verse form. The style is in keeping with the Vedic oral tradition of conserving knowledge. The samhita contains 8,400 metrical verses. Charaka followed the Atreya School of Physicians, which predominantly deals with treatments through internal and external application of medicine. Though the samhita contains all the theoretical knowledge of ayurveda it's focus is on healing the body, mind and soul of a patient in the minimum invasive manner that's Kayachikitsa. Hence, he placed great emphasis on the diagnostic part of the treatment. So much so that he classified everything from solar calendar to topography to the timing of the birth of a child. He identified eight stages of a disease from its inception to the culmination. Charaka also laid great emphasis on the timing and manner of the collection of medicinal plants. Charaka sought to correct the element of fire or the digestive function in a body. It sought to alter the chemical processes in the cells by purification methods and medicinal application. From a greater perspective Charaka laid emphasis for health and longevity to strike a balance between one's corporeal and spiritual being. That is the reason why Charaka went so detail into the diagnosis of a disease's origin Susruta wrote his samhita, the most authentic text on the practice of ayurvedic surgery around the sixth century BC Susruta is, also, renowned as the father of plastic surgery. He represents the Dhanvantari Conference on Tourism in India – Challenges Ahead, 15-17 May 2008, IIMK

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School of surgeons. His samhita discussed in minute details on how to perform prosthetic surgery to replace limbs, cosmetic surgery on nose and on other parts of the body, cesarean operations, setting of compound fractures, and even brain surgery. Susruta's original work seems to have been revised and supplemented by Nagarjuna between the third and fourth centuries AD. This branch of medicine is believed to have arisen in part from the exigencies of dealing with the effects of war. Epic Ramayana, mentions remarkable feats of surgery having taken place in the past. We have reference to the transplantation of an eyeball and a head in epics. The style Susruta Samhita is both prose and poetry with poetry being the greater portion. This work, also, is said to be a redaction of oral material passed down verbally from generation to generation. This work is unique in that it discusses blood in terms of the fourth doshic principle. This work is the first to enumerate and discuss the pitta subtypes. Susruta details about 125 surgical instruments used by him mostly made of stones,wood and other such natural materials. The Susruta Samhita presents many innovations in ayurvedic surgery. Use of shalaka—meaning foreign body (here, rods or a probe etc.) is mentioned by Susruta. Some of the classifications found in the Susruta Samhita are not even traced by the modern medical science. It described five types of pterygium, and the prognosis it made about glaucoma has not been improved since. In fact he is the first surgeon in medical history who systematically and elaborately dealt with anatomical structure of eye. Susruta has discussed about 72 diseases of the eye. He has stipulated drug therapy for various types of conjunctivitis and glaucoma along with surgical procedures of the removal of cataract, pterygium, diseases of ear, nose and throat. The Susruta Samhita, besides being the most authentic text on practice and theory of surgery, is also the most commonly quoted text on health Astanga Hridaya is accepted as the third major treatise on ayurveda. Around 500 AD, Vagbhatt compiled this samhita. It contained knowledge comprising the two schools of ayurveda—the school of surgery and the school of physicians. There is another similar work called the Astanga Sangraha belonging to the same period. It is slightly bigger in size than the Astanga Hridaya, and is written in verse form whereas the later text was in prose form. It is believed either there are two works by a person or two persons with the same name. However, both the works came into being after the Charaka and Susruta Samhitas. The Astanga Hridaya primarily deals with kayachikitsa besides, discussing in detail about various surgical treatments. The kapha subtypes are first listed and described in this samhita, completing exhaustive explanation of vata, pitta, kapha with their five subtypes. Astanga Hridaya seems to emphasize on the physiological aspect of the body rather than the spiritual aspects of it like its counterparts—Charaka and Susruta Samhitas. Despite that, the quality and range of its discussions about ayurveda makes it a work to reckon withYoga and Meditation

These are among the best alternative processes used in the healing of various diseases, be it physical or mental. Yoga is regarded as the oldest therapy that can cure many complicated diseases. It has been proved by history that through the regular practice of yoga and meditation, any volatile and restless mind can undergo a welcome transition with wonderful results. Yoga Yoga is gaining more and more attention with every passing day. However, it must be mentioned that the aim and motto of yoga can differ from person to person. Physical fitness, flexibility and spiritual growth are Conference on Tourism in India – Challenges Ahead, 15-17 May 2008, IIMK

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the main bases of yoga. This holistic approach goes a long way in achieving excellent results. A stress-free, calm, balanced and fit body adds up as the reward for regular practioners of yoga. Meditation Meditation is a part of yoga that soothes the mind in an unbelievable manner. The art of meditation should be practiced with a well-trained guru. Its practice will not only calm the senses but also help in honing the power of concentration. Meditation can increase your patience besides making you view life in a new dimension altogether. The disturbed mind, the restless psyche can be well treated by this ancient therapy without the help of any medicine. A balanced mind is what meditation propagates and helps every practitioner achieve Opportunity of medical tourism in India Country’s cost-effective and efficient medical sector has made it a favored destination for healthcare. The Indian systems of medicine like Ayurveda, Yoga, Panchakarma, Rejuvenation Therapy are among the most ancient systems of medical treatment, of the world. Southern states of India, especially, Kerala has developed Health Tourism as one of the products for the promotion of tourism in Kerala. most hotels and resorts are coming up with the spas and Ayurveda Centers as an integral part in Kerala. India has an international reputation of being a knowledge-based economy.” The available talent base of over 500,000 doctors and seven 700,000 nursing professionals, India can provide Medical and Health care of international standard at comparatively low cost. Many surgical procedures are available at one-tenth the cost of those in developed countries and “there is no waiting period for elective surgery. However, the situation should not make authorities neglect the healthcare for Indians. There are many areas in which public healthcare needs to advance in order that India’s workers can be a productive force for the global economy. nearly 80 per cent of spending on healthcare is now in the private sector. India’s pharma sector has done commendable work in bringing low-cost essential drugs to the market, including international markets. There is a need to promote India as the new emerging Medical Value Travel destination abroad. The private and public hospitals need to synergize their efforts to promote India as the Healthcare destination worldwide. The Healthcare Industry will also have to standardize their processes and make its functioning more transparent and accountable. India’s healthcare sector has emerged as the largest in the service sector. Indians now spend over Rs. 1, 00,000 Crore a year on healthcare, and the sector contributes 6.2 percent to the GDP. Experts project that by 2012; it will contribute 8 percent to the GDP and employ 9 million people. But one of the many challenges it faces is to provide good quality, affordable healthcare to all. For this, there is a need to reduce inequalities, imbalances that exist between regions, cities and villages and different socioeconomic groups. India has done exceptionally well in the last three years in the tourism sector, with overseas footfalls expanding at near 20% average every year. By January this year, 3.3 million travelers had already visited India, spending close to $ 5 billion. The domestic travel is also witnessing rapid growth. Some 368 million Indians are venturing out of their homes, based on rising incomes, lower aviation costs, and more leisure time. The World Travel and Tourism Council have forecast that tourism will grow at a rapid rate of 8.8% per year for the next ten years, the highest in the world. The Industry is projected to attract a capital investment of $21 billion by 2014, up from about $10.2 billion estimated in 2004, according to a WTTC survey. Equally significant is the impact this growth will have on employment. The travel and tourism industry already accounts for one of every nine job opportunities created in India, currently aggregating over 20 million employees. It is estimated that this industry generates more jobs per unit investment than any other sector. Seeing the huge potential in the sector, the government has also started issuing M (medical) visa to the medical patients, and MX visas to the spouse accompanying him, which are valid for year.Two lakh medical tourists, visited India last year, and the figure will grow by 50% this year. India is being promoted as a healthcare destination in the ongoing 'Incredible India campaign,' being run by the tourism ministry. The campaign would promote Indian hospitals abroad as centers offering best medical services. In addition, availing medical services in India costs about a tenth of what it is in US, and one-sixth in UK.Not only this, the National Accreditation Board for Hospitals (NABH), a body set up to ensure safety and hygiene norms for hospitals, has already started the process of granting accreditation with 70 hospitals in the process of getting approval, India now offers the latest techniques such as robotic Conference on Tourism in India – Challenges Ahead, 15-17 May 2008, IIMK

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surgery, and gamma-knife treatment for brain tumors. The efficacy of treatment compares with that in the West, with the death rate from coronary bypasses at 0.8% compared to 2.35% in the US. Union health minister A Ramadoss stated the government is considering the Clinical Establishment Bill that would mandate accreditation for hospitals down to the district and village levels. Indian corporate hospitals excel in cardiology and cardiothoracic surgery, joint replacement, orthopedic surgery, gastroenterology, ophthalmology, transplants and urology to name a few. The various specialties covered are Neurology, Neurosurgery, Oncology, Ophthalmology, Rheumatology, Endocrinology, ENT, Pediatrics, Pediatric Surgery, Pediatric Neurology, Urology, Nephrology, Dermatology, Dentistry, Plastic Surgery, Gynecology, Pulmonology, Psychiatry, General Medicine & General Surgery Some points describe the opportunity and attraction Cost Effectiveness Important cost difference subsist between U.K. and India when it comes to medical treatment tourism packages. Every year innumerable number of alien visitors from different parts of the world visits India for its historical escapade. Moreover, many a time some of them fall ill as illness knows no place. India is not only cheaper in respect of medical treatment packages but the waiting time is almost zero. This is due to the explosion of the private sector, which comprises of hospitals and clinics with the up-tothe-minute technology and best practitioners. Procedure Charges in India & US (US $): Procedure Cost (US$)United States India Bone Marrow Transplant

2,50,000 69,000

Liver Transplant

3,00,000 69,000

Heart Surgery

30,000 8,000

Orthopedic Surgery

20,000 6,000

Cataract Surgery

2,000 1,250
Here is a brief comparison of the cost of few of the Dental care package procedures between USA and India Dental procedure Cost in US ($) Cost in India ($) General Dentist Top End Dentist Top End Dentist Smile designing

8,000 1,000

Metal Free Bridge

5,500 500

Dental Implants

3,500 800

Porcelain Metal Bridge

1,800 3,000 300

Porcelain Metal Crown

600 1,000 80

Tooth impactions

500 2,000 100

Root canal Treatment

600 1,000 100

Tooth whitening

350 800 110

Tooth colored composite fillings Tooth cleaning

200 500 25 100 300 75

These costs are a standard and might not have been the real cost to be incurred. Robert Walter Beeney was not competent to walk due to a stiff hip when he landed in India January 24. Twenty days afterward, he not only improved after a atypical hip substitution surgery at Apollo Hospital here but also visited the famous Tag Mahan in Agra after that. So India is now becoming well known for its medical tourism. The 64-year-old real estate expert from San Francisco underwent flourishing surface substitution surgery using the anatomic surface replacement (ASR) hip system January 27, purportedly becoming the first US national to come to India for the cure.

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A medical team of doctors, headed by orthopaedic surgery treatment specialist Vijay Bose, sustained the procedure for Beeney. Jayaramchander Pingle, a member of the medical team, told a news seminar that while in the usual hip replacement surgery, the total hip was replaced, in the new system, the patient's unique head and neck of femur were conserved and only their surface is replaced with metal on metal enunciation. All these depict that India is now emerging as a medical treatment hub also. Cost Comparison with other countries Procedure Charges in India & US (US $) Procedure

Cost (US$) United States

India

Bone Marrow Transplant

2,50,000

69,000

Liver Transplant

3,00,000

69,000

Heart Surgery

30,000

8,000

Orthopedic Surgery

20,000

6,000

Cataract Surgery

2,000

1,250

Here's a brief comparison of the cost of few of the Dental treatment procedures between USA and India Dental procedure

Cost in US ($)*

Cost in India ($)*

General Dentist

Top End Dentist

Top End Dentist

Smile designing

-

8,000

1,000

Metal Free Bridge

-

5,500

500

Dental Implants

-

3,500

800

Porcelain Metal Bridge

1,800

3,000

300

Porcelain Metal Crown

600

1,000

80

Tooth impactions

500

2,000

100

Root canal Treatment

600

1,000

100

Tooth whitening

350

800

110

200

500

25

100

300

75

Tooth fillings

colored

composite

Tooth cleaning

* These costs are an average and may not be the actual cost to be incurred.

Procedure Charges in India & UK Procedure Nature of Treatment

Approximate Waiting Cost in other Major Approximate Periods in USA / UK (in Healthcare Destination ($) India months) * ($) *

Open heart Surgery

9 - 11

> 18,000

4,500

Cranio-facial Surgery and skull 6-8 base

> 13,000

4,300

Neuro-surgery with Hypothermia 12 - 14

> 21,000

6,500

Complex spine surgery with 9 - 11 implants

> 13,000

4,300

Simple Spine surgery

> 6,500

2,100

9 - 11

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Simple Brain Tumor -Biopsy

6-8

-Surgery

> 4,300

1,000

> 10,000

4,300

> 6,500

2,100

> 26,000

17,000

> 13,000

4,300

Parkinsons -Lesion

9 - 11

-DBS Hip Replacement

9 - 11

* These costs are an average and may not be the actual cost to be incurred.

Hospitals For last few years India has been depicting its proficiency in medical treatment packages. The major USP of medical tourism India is its cutthroat price of the treatment packages. The visitors can get world class treatment services at their expediency at cost which is 30% to 70% less as weighed against the cost of treatment in USA or Thailand. The medical packages range from health check up packages to posh heart surgery packages. Moreover, the uses of radioactive isotopes and scanning through Gamma camera have added matchless features to Medical Tourism India. Some of the leading hospitals and their forte areas are discussed below.

Andromeda Andrology Centre centre for impotence, infertility, sex change, sex disarray Apollo Family Health Plan managed care provider run through Apollo Hospitals. Apollo Hospitals Center of superiority in Healthcare. B M Birla Heart Research Centre Conference on Tourism in India – Challenges Ahead, 15-17 May 2008, IIMK

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Heart care and surgery packages are prodived with a difference. Belle Vue Clinic Calcutta's leading medical treatment package institute. Bhatia General Hospital (MRI Centre) information on MRI with an emphasis on teaching files. Brahmaputra Hospitals Limited CSR Memorial Hospital Calcutta Medical Research Institute leading hospital Charakas Ayurveda Nursing Home an Ayurvedic specialty hospital & health spa in Thodupuzha, Idukki Choithram HospitalIt is a complete institution for care of whole society. Cancer Patients Aid Association (CPAA) It mainly works to alleviate the suffering of the underprivileged and needy cancer patients by providing total management of the ailment. Down Town Hospital a well outfitted hospital in Guwahati, Assam Dr. Agarwal's Eye Hospital offers ophthalmic care package, probe into and education. Jilla Hospital offers contemporary amenities, also have guidance amenities. Emmanuel Hospital Association working together to form a network of christian hospitals and health check up packages throughout North India. Escorts Heart Research Institute provides cardiac care packages to patients Hindu Mission Hospital – It is a charitable trust hospital in Chennai. Indo-American Cardiovascular Centre – It provides world class cardiovascular heed. Indraprastha Apollo Hospitals, New Delhi Institute of Cardiovascular ailment Institute of Dental & Orthodontic Radiography computerized facial correction & orthognathic surgery package K.G. Hospital, Coimbatore King Edward Memorial Hospital information about the hospital in Mumbai Lifeline Group of Hospitals provide health services & medical facilities in Calcutta M.V.Diabetes Specialities Centre (P) Ltd. provide all-inclusive and entire diabetic care. MIOT Hospital – It is a leading centre in orthopaedics surgery package and traumatology in India. Mansarovar Eye Hospital, Lucknow Well outfitted eye research centre Neeraj Clinic a hospital devoted to treatment of epileptic patients PVS Memorial Hospital Shantiniketan Nature Cure Hospital offers naturopathy treatment, drugless therapy etc. Shusrusha Nursing Home Private limited Sir Ganga Ram Hospital It is a modern, multi-specialty, private hospital. Specialty Ranbaxy limited Conference on Tourism in India – Challenges Ahead, 15-17 May 2008, IIMK

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provide cost-effective, diagnostically insightful, medical services. Sri Jayadeva Institute of Cardiology leading heart care package hospital in Bangalore Surya Medical Trust Burns Centre,Pune hospital for burns patients and research in burns areas Suyash Hospital well outfitted hospital in Indore with contemporary medical treatment packages. The Advanced Medicare Research Institute This hospital is situated in Calcutta. The Eye Research Foundation enthusiastic in providing eye care services Vardaan Hospital and Medical Research Centre a multi-disciplinary treatment package hospital in New Delhi Vellore Hospital Vimhans health care services for people suffering from brain and backbone ailment. Wockhardt Hospital And Heart Institute – It provides heart care package to patients of all age groups. Woodlands Hospital and Medical Research Institute leading hospital and research institute positioned at Calcutta Medical facilities The medical treatment tourism India has depicted a massive growth in infrastructure in the private and voluntary sector. The private sector, which was very unpretentious in the early stages, has now become an affluent industry prepared with the most modern state-of-the-art technology at its disposal. It is expected that 75-80 percent of healthcare services and investments in India are now provided by the private sector. In addition to that India has one of the largest pharmaceutical industries in the world. It is self-sufficient and self- reliant in drug production and exports drugs to more than 180 countries. Using the latest technical apparatus and the services of highly expert medical personnel, these hospitals are in a position to provide a spectrum of general as well as specialist's services These services are offered at awfully cutthroat prices; cheering patients not only from developing countries but even from a number of developed ones to come to India for medical treatment packages. Amidst varied general and specialty medical treatment packages the noteworthy packages are as beneath1. Bone Marrow Transplant 2. Cardiac Care and surgery package 3. Cosmetic Surgery package 4. Dialysis and Kidney Transplant package 5. Gynaecology & Obstetrics 6. Healthcare facilities 7. Joint Replacement Surgery package 8. Neuro-surgery & Trauma Surgery treatment package 9. Osteoporosis medical treatment package 10. Refractive Surgery package 11. Urology 12. Vascular Surgery package 13. Dental care medical package As far as the cost of medical treatment packages are concerned, India offer the most competitive treatment package price to the world with its up- to- the- minute medical devices. The prices of different pathological tests range from Rs.50 to 3000. And that depends upon the nature of the test. Now, the specialty hospitals are using Nuclear medicines for treatment. Here radioactive isotopes are injected or administered orally and that is again scanned by sophisticated Gamma camera. So for high quality treatment at lowest possible cost one must select India as his medical treatment destination. Conference on Tourism in India – Challenges Ahead, 15-17 May 2008, IIMK

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- Hospitals in New Delhi Indraprastha Medical Corporation Indraprastha Medical Corporation in Delhi is among the many feathers in India's cap. It is India's first corporate hospital and the third largest corporate hospital outside the USA. It is recognized as a centre of excellence by the Ministry of Health and Family Welfare, Government of India and by the Royal College of Radiologists, UK for training for the first and final fellowship examinations. A.I.I.M.S. AIIMS' contribution in the fields of medical education, research and specialized treatment is widely acknowledged. The main object of the institute is to demonstrate high standard of medical education, training of personnel and conduct experiments and research in various disciplines of medical sciences. The Escorts Hospital The Escorts Hospital and Research Centre Limited (EHRCL) at Faridabad is a 150-bed facility providing a whole gamut of specialized medical services. The hospital is reputed for tertiary care services such as cardiology, neurology, neurosurgery, plastic surgery and urology Medical as tourism in India It can be generally defined as provision of 'cost effective' personal health care in association with the tourism industry for patients needing surgical healthcare and other forms of dedicated treatment. This process is being facilitated by the corporate sector concerned in health care as well as the tourism industry - both personal and public. Medical or Health treatment package tourism has become a recurrent form of vacationing, and covers a broad range of medical services. It mingles free time, amusing and recreation together with wellness and healthcare packages Medical or Health treatment package tourism has become a recurrent form of vacationing, and covers a broad range of medical services. It mingles free time, amusing and recreation together with wellness and healthcare packages Many people from the urbanized world come to India for the upgrading promised by yoga and Ayurvedic massage, but few consider it a target for hip substitute or brain surgical procedure. However, a nice blend of top-class medical expertise at attractive prices is helping a rising number of Indian corporate hospitals attract foreign patients, including from developed nations such as the UK and the US. As more and more patients from Europe, the US and other well heeled nations with high Medicare package costs look for effectual options; India is rutted against Thailand, Singapore and some other Asian countries, which have good hospitals, salubrious climate and visitor destinations. While Thailand and Singapore with their advanced medical amenities and built-in medical tourism options have been drawing foreign patients of the order of a couple of lakhs per annum, the quickly growing Indian corporate hospital sector has been able to get a little thousands for cure. But, things are going to change radically in favor of India, particularly in view of the high eminence expertise of medical professionals, backed by the fast improving tools and nursing amenities, and above all, the cost-effectiveness of the pack Ayurveda tour Day 01:Arrive Chennai On arrival at the airport Indian Horizons representative would welcome you and transfer to the hotel. Overnight at Chennai Day 02: In Chennai Morning after breakfast full day excursion to Mahabalipuram and Kanchipuram. Overnight at Chennai Day 03: Chennai-Trichy Morning after breakfast drive to Trichy. On arrival check-into the hotel. After fresh-up proceed for sightseeing tour of Trichy. Overnight at Trichy Day 04: Trichy-Tanjore-Trichy Morning after breakfast full day excursion to Tanjore. Overnight at Trichy

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Day 05: Tanjore-Madurai Morning after breakfast drive to Madurai. After check-in proceed for sightseeing tour of the city. The highlight of the tour is the visit to Meenakshi Temple. Overnight at Madurai Day 06: Madurai-Periyar Morning after breakfast drive to Periyar. On arrival check in the hotel. Afternoon boat rides on Lake Periyar for the game viewing. Overnight at Periyar Day 07: Periyar-Kumarakum Morning after breakfast drive to Kumarakom. On arrival check-into the backwater resort. Evening boat ride on the backwaters. Overnight at Kumarakom Day 08: In Kumarakum Day free to relax. Overnight at Kumarakom Day 09: In Kumarakum Day free to relax. Overnight at Kumarakom Day 10: Kumarakom-Cochin Morning after breakfast drive to Cochin. On arrival check-into the hotel. Overnight at Cochin Day 11: In Cochin Morning after breakfast proceed for a full day city tour exploring the city. Overnight at Cochin Day 12: Cochin-Marari Beach After breakfast drive to Marari Beach. Overnight at Marari Beach Day 13: In Marari Beach Explore ayurvedic message and treatment. Overnight at Marari Beach Day 14: In Marari Beach Explore ayurvedic message and treatment. Overnight at Marari Beach Day 15: Departure Cochin Morning after breakfast transfer to the Cochin airport for your flight back home Key reasons for growing medical tourism in India India has been the most attractive destination for the visitors around the glob. But the recent trend in the tourism sector shows a propelling growth in the travel & tourism industry. This is not only due to the heritage attraction of the country but the medical tourism India which has depicted a steady southward movement, of late. Now the question arises, why should people rush India for treatment? The simple equation is that the medical treatment package price in India is 35% to 40% lesser than the treatment cost in USA or Thailand. Not just because of the discount but the superiority concern also. India has got the specialist in around the world and in India as well and also has got the world eminent doctors & hospitals where all the services are provided to the patients. So when you can get the best health care in India then why not opt for India as the destination for medical treatment tourism. A number of specialty hospitals in India are – • All India Institute of Medical Science • Apollo Hospitals • B.M.Birla • C.M.C Vellore • Tata Memorial Hospital • Indraprastha Medical Corporation • Institute of Cardiovascular Diseases • Escorts Heart Institute and Research Centre • Kalra Hospitals • Dr. U Mohan Rau Memorial Hospital • Institute of Child Health and Hospital for Children

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The tale does not cease here. In India the use of radioactive isotopes in small quantities and scanning of the same through the sophisticated Gamma camera has uplifted the standing of India in the medical care community of the world. The medical services range from dental care to cardiology surgery packages. Competitive pricing is another unique selling proposition (USP) for India. >> All India Institute of Medical Science (A.I.I.M.S) in Delhi >> Apollo Hospitals >> B.M.Birla Heart Research Centre >> Christian Medical College Vellore >> Tata Memorial Hospital >> Indraprastha Medical Corporation >> Institute of Cardiovascular Diseases >> Escorts Heart Institute and Research Centre >> Kalra Hospitals >> Dr. U Mohan Rau Memorial Hospital >> Institute of Child Health and Hospital for Children Main Medical treatment in India Heart care in India Cardiac concern has become a specialty in India with names such as the Escorts Heart Institute and Research Centre, All India Institute of Medical Science and Apollo Hospital becoming names to consider with.

They mingle the latest innovations in medical electronics with unparalleled proficiency in leading cardiologists and cardio-tho-racic surgeons. These centers have the characteristic of providing Ample cardiac care spanning from basic services in precautionary cardiology to the most complicated healing technology. The technology is modern and world class and the volumes handled match international benchmarks. They also specialize in offering surgery to

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high risk patients with the preamble of innovative techniques of plainly insidious and robotic heart surgery package India Principal heart centers like The Escorts Heart Institute have Cardiac Care Units with urbane equipment and investigative facilities like Echocardiography with colored Doppler, Nuclear Scanning and Coronary Angiographies.

The Jayadeva Institute of Cardiology in Banglore, the Cardiology Hospital in Kanpur, the Heart Hospital in Calicut and the Sree Sudihindra Medical Mission Hospital in Coaching are some hospitals in India dedicated utterly too cardiac treatment package India. Heart care package India includes the following - Stress/Resting Thallium - Cardiac CT-Calcium Scoring - Coronary MR Angiography - Multi-Gated Radio nuclear Ventriculography - Dual Head Gamma Camera Interventional Cardiology - Coronary, Carotid, Renal, Peripheral Angiography - Coronary, Carotid, Renal, Peripheral Angioplasty - Stenting - Balloon Mitral, Aortice & Pulmonary Valvuloplasty - Rotational and Directonal Artherectomy For check up packages the following tests are conducted . ECG • Doppler Studies • TEE Echo • Stress Echo • TMT • Holter Foot surgery Advances in technology in all fields, especially medical field is happening at a very fast rate in India. As a result various surgeries and medical procedures which were earlier not possible in India are taking place with surprising regularity in the country. Foot surgery in India can be taken as an example of that trend which has just been mentioned above.

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This surprising and astonishing change has been made possible by exponential development and improvement in infrastructure in India. Development has become multi faceted which was very much essential because if just health care had improved it would not have served any purpose with all other amenities lagging behind. It is because of these all round developments that India has become a global hub of medical tourism and due to which foot surgery in India and many other such complicated surgeries have become a daily affair for most medical practitioners While we are discussing on topic of foot surgery in India it is imperative for us to discuss a bit further about foot surgeries themselves so that one can gain a comprehensive or holistic knowledge about these surgeries. Foot surgeries are usually conducted to correct some physical deformities which in most cases are hereditary in nature and are usually present from time of birth of patient Hammertoes and toe shortening are two such diseases to correct which foot surgery in India takes place. In case of former shape of toes is deformed, while in case of latter one toe is longer than another leading to formation of painful corns on feet. Bunion is another common foot deformity which is more often found in women. Bunion is an example of a hereditary foot deformity. Foot surgery in India is conducted which can cure all of above mentioned deformities as well as many other which have not been mentioned here. But one might wonder why would people from developed countries, which themselves have high quality medical practitioners as well as world class infrastructure, would opt out of their own will to get done a foot surgery in India. Main reason behind most people making such a decision is cost effectiveness of treatment in India. Foot or any other surgery, if conducted in India, cost a lot less than it would have in patient’s own country. And it is to gain advantage of this cost effectiveness that patients opt to come to India and return after getting treated with complete peace and satisfaction of mind and heart. Eye care Eye is one of the most important organs in the body. It is the only source of visual experience. Any kind of carelessness can be extremely harmful to this vital organ. Therefore when ever you find problems in sighting then you should rush to an eye-specialist without any further delay. But there is one thing that may stop you is the cost of eye treatment. Sad, yet very true. Any ophthalmologist in Europe or America will charge a whopping amount as their bill. Add to that the cost of treatment or surgeries (if required). On the other side of the globe, Eye care India can do the same at remarkably low costs. You’ll be shocked to know about the huge difference in the eye treatment expenditures in foreign countries and India is huge to say the least. Eye care India can cost you eight to ten times less than opting for an eye treatment in Europe or U.S.A.

What are the eye care treatments available here? Now that you know that Eye care India is cheaper than the rest of the world, it is only natural to ask what are the kinds of eye care treatments that you can avail of once you’re here. To start off the list is huge and can be summed up as the followingƒ Lasik Treatment and Lasik Eye Surgery ƒ Laser Refractive Surgery ƒ Refractive Eye Correction ƒ Natural Eye Care Treatment and the list just goes on, Conference on Tourism in India – Challenges Ahead, 15-17 May 2008, IIMK

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In short, it wouldn’t be wrong to suggest that if you’ve got the disease these Indian ophthalmologists have the cure. Not only do you get all these eye cures, Eye care India is know to have the support of some of the best equipments used by leading ophthalmologists in the world. But irrespective of the quality of the equipments or technology that is used for Eye care in India, until and unless they are used by experts they can be of no use. Indian doctors and ophthalmologist have been ruling the medical scene for quite some time now and they could do so for a reason. Yes, these doctors have it all- the degrees, the knowledge and the experience that makes Eye care India better than the best. So what are you waiting for? Get the best possible treatment for your eye while you get to explore the cultures and sceneries of the country of India Skin treatment Do you want to remain beautiful? DO you wish to stay young forever? Botox may not be enough. The best way to take care of this is follow some basic steps of skin care. If that fails it is time to get some skin treatment. Why Skin treatment India? India has had a very rich history. One of the biggest exponents of this is probably the ayurvedic treatment. Ayurvedic has been a storehouse of natural skin treatments. With the help of this treatment procedure, you can get hold of all skin ailments. However, as time moved on and new and better ways of treating skin problems, the popularity of these treatments slowly decreased. However, this does not mean that the popularity of Skin treatment India has decreased in any way In fact, Skin treatment India has become even more popular than ever before. The reasons are many and may be summed up as the followingThe efficiency of the dermatologists- The medical scenario of the country is headed by a pack of highly renowned dermatologists. These skin specialists have the knowledge and the experience to care the biggest of the skin problems. What is encouraging is that more and more promising dermatologists are coming up by the day. The result is that these doctors have taken over the cream of international dermatologist. So getting your skin treatment in a country of thriving dermatologists is not a bad idea. The low cost of treatment- Low cost of treatment is the key phrase that has made Skin treatment India what it is today.

Most skin specialists of the world charge ludicrous amounts as their fees. To be more specific, the cost of skin treatment in Europe and America can have you in splits. However, it does not stop here only. Add to that the cost of medication makes it even worse. However Skin treatment in India, can save you a lot of money as neither is the cost of treatment high, nor do the doctors extract loads of money form their patients. However, what has really done the trick for Skin treatment India is the intervention of companies in ensuring an easy and safe trip for international patients. These companies will arrange all your medical appointments and accommodations once you hire their services. However, you need to pick the right company before you plan to take a Skin treatment to India. Cataract is quite a common eye disease which usually affects the aging population.

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In the condition of a cataract, with age, the lens of the eye loses its ability to see and a coating develops over it which makes it difficult for the person with the disorder to see properly. The disease advances with time and worsens leading to reduction in eyesight. Initially, partial sight is available but with passing time surgery is the only recourse. The lens of the eye is crystalline and a metabolic change of the fiber of the lens over time leads to the development of cataract and loss of transparency of the lens. In a cataract surgery the natural lens is surgically removed and an artificial intraocular lens is inserted If we wish to talk about cataract eye surgery in India, we must remember that the medical Council of India and the Ministry of Health, Government of India has started a train which moves around through the rural heartland of India operating on patients in villages and rural areas who have been suffering from cataract. In India, especially in the rural areas, modern equipment to conduct cataract eye surgery in India is a dream. This train has made that dream possible. Many old people who have been affected by cataract have got new lease of life after being operated upon by leading ophthalmologists and famous doctors from all over India. Many clubs and other voluntary organizations like the Rotary Club and the Lions Club who operate in the realm of healthcare organize camps in different parts of the country to conduct surgery on cataract patients at subsidized rates and thus give them back the vision they have lost. Cataract eye surgery in India is conducted in these camps and sometimes imported, high quality equipment for surgery is used but sometimes indigenous equipment is used. Imported equipment makes the surgery more efficient and quicker. In these camps, sometimes imported equipment is used. Otherwise, imported equipment to conduct cataract eye surgery in India is only available in private hospitals and health clinics. These are sometimes beyond the reach of the common Indian. Cataract eye surgery in India is conducted in government hospitals but it is seen that they use indigenous machines. Surgery using modern equipment and well qualified doctors is becoming available because of certain non governmental organizations, the initiative of certain organizations operating in the realm of healthcare and sometimes the government to provide quality cataract eye surgery in India at subsidized rates to the poor and the needy Liposuction It does not take the place of a diet. If someone is obese, gains and loses weight frequently, or has an eating disorder, he or she is not a candidate for liposuction Techniques Many different tools and techniques are used for liposuction ranging from ultrasound-assisted to tumescent procedures. Initially the method involved simply inserting a cannula (vacuum device) into an area and sucking out some of the fat. This “dry method” required general anesthesia. Now, several other methods are more widely used, including tumescent liposuction, which involves injecting a sterile saline solution into the area about to be worked on. Ultrasound-assisted or Ultrasonic liposuction uses high-pulse sound waves to liquefy excess fat, which is then removed by the same vacuum device used in other liposuction procedures. Ultrasonic liposuction is thought to be more effective for loosening the fat cells attached to muscles or organs and is also useful in breaking down fat cells so they are easier to suck up into the cannula Risks Most patients are pleased with the outcome of their liposuction surgery. However, like any other medical procedure, there are risks involved. That's why it is important for you to understand the limitations and possible complications of liposuction surgery. Decide for yourself whether you are willing to take the risks involved in liposuction: Infections: Infections may happen after any surgery and may occur after liposuction. It is important to keep the wound(s) clean but even if you do, infections may sometimes occur from the surgery. Nerve Compression and Changes in Sensation: You may experience "paresthesias" which is an altered sensation at the site of the liposuction. This may either be in the form of an increased sensitivity (pain) in the area, or the loss of any feeling (numbness) in the area. .

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Swelling: Swelling or may occur after liposuction. In some cases, swelling may persist for weeks or months after liposuction. Skin Necrosis (skin death): The skin above the liposuction site may become necrotic or "die." When this happens, skin may change color and be sloughed (fall) off. Burns: During ultrasound assisted liposuction the ultrasound probe may become very hot and can cause burns. Fluid Imbalance: Fat tissue, which contains a lot of liquid, is removed during liposuction. Also, physicians may inject large amounts of fluids during liposuction. This may result in a fluid imbalance. Some packages With today’s sedentary and unhealthy lifestyle, man is getting prone to number of ailments and diseases. Diseases like diabetes, hypertension, oral and lung cancer and osteoporosis can directly be attributed to the modern way of living. With being in the pink, turning out to be the latest fad, people are getting more and more conscious about their health and lifestyle. This is where the hospitals and health care centers come into the picture. Apollo Hospitals recognizes the importance and need for preventive health care and for the purpose have launched various health Cheq programs and Health Checkup Packages. Medical India Tourism offers to give you online information on Health Checkup Packages in Apollo hospital in India, India. Health Checkup packages of the Apollo hospitals in India consists of a range of checks to determine and prevent the occurrence or presence of signals indicating ill health and paving way for the wellness. There are various preventive healthcare and health checkup program’s introduced by the Apollo hospitals that you easily avail at nominal prices. Health Checkup Packages in Apollo Hospitals in India are differently designed for different groups keeping in mind their requirements. Apollo Executive Health Cheq is especially designed and recommended for men and women above thirtyfive years, who are living a stressful life leading to mental and physical illness. For men and women below thirty-five years of age, Apollo Master Health Cheq package is the right solution for a healthy life ahead. Then there are other health checkup packages like the Apollo Heart Cheq for persons with cardiac symptoms, Whole Body Cheq, Diabetic Cheq etc. Apollo Hospital also provides special health checkup packages for children and women. The health checkup packages in Apollo Hospitals are reasonably charged and therefore attract lot of domestic and foreign tourists thereby giving a boost to the medical tourism industry in India. Gynecology Infertility brings an enormous toll on both the affected individuals and on society. Couples in their most active and productive years are distracted by the physical, financial and emotional hardships of this disease. For these couples, infertility is more than a disease, it is a devastating life crisis which can greatly impact the couple's general health, marriage, family relationships, job performance and social interactions. Added to the emotional and physical toll brought by infertility is the financial burden carried by some couples seeking treatment for their disease. We aim to ease this burden by assisting in provision of comprehensive information and alternative options for making your infertility affordable. Indiahealthtour.com represents the hospitals and a specialty Fertility centre which has been in the field of infertility for the past ten years. It is one of the leading fertility units in India. The specialty Fertility centre is located in the city of Mumbai, the financial capital of India. Besides that, Mumbai boasts of some the leading Medical Schools as well as leading Hospitals, offering hi-tech and hicaliber medicare to patients, both from within and outside the country At the Indiahealthtour.com represented Hospitals and Fertility Centre , our aim is to offer the most advanced and globally competitive ART programs and services Both these centres are equipped with the state-of-the-art 'Embryology Laboratory' and staffed with the team of highly trained professionals. The aim is to offer the latest services, with success rates equivalent to the West, at very affordable costs, but without compromising on quality. This has been possible by making use of the latest equipment, best quality disposable and culture media imported from the West, high-class competent service and very economical professional fees. This objective has enabled our unit to be at the forefront of offering fertility services in India. During the past ten years, we have treated numerous patients from India, Middle East, Africa, UK & USA, enabling them to have babies and bringing joy to their lives.

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The Indiahealthtour.com represented Fertility Centre been one of the pioneers in the techniques of ICSI , having done more than 900 cycles with success rates reaching nearly 30%. We were the first unit in India to initiate the technique of Assisted Laser Hatching , to improve pregnancy rates in elderly patients and in previously failed cycles. The unit has started performing Blastocyst Cultures and recently has also introduced the new methods of Preimplantation Genetics which are available in few centres, over the globe. The Centre also specialise in the area of Egg Donation and Embryo Donation , which is a boon to elderly and menopausal women. Indiahealthtour.com is pleased to represent the first clinic in India to offer a Money Back/ Shared Risk payment option (which is very popular in the US) Orthopedic Surgery A number of orthopedic procedures are available such as hip and knee replacement, the Illizarov technique, limb lengthening, Birmingham Hip resurfacing technique (which scores over conventional hip replacements and is still unavailable even in the US) etc. Many hospitals specialize in latest techniques and treatments such as minimal invasive surgery, cartilage and bone transplantation, spine surgery and limb sparing surgery. All kinds of musculo- skeletal problems ranging from Arthiritis to sports injuries, to complex broken bones, bone tumors and childhood conditions like scoliosis are treated most effectively. A wide range of spinal surgeries including fixation, stabilization and fusion are regularly undertaken. Bone Marrow Transplant Major hospitals in India have oncology units comprising surgical oncology, medical and radiation therapy as well as the crucial Bone Marrow Transplantation (BMT). The BMT unit with high pressure hipa filters has helped achieve a very high success rate in the various types of transplantation. Cord Blood Transplant and Mismatched Allogeneic Stem Cell Transplant have been performed successfully, a feat that is remarkable and significant, considering the fact that the treatment costs one-tenth of what it does in the west. Special surgeons are available for individual organs. Plastic surgeons of repute provide treatment for head and neck cancer, breast cancer and other malignancies. Facilities offered include tele-therapy which includes simulation work stations to ensure high precision and safety during treatment at the 18 MV linear accelerator or telecobalt machines, brachy therapy and 3-D planning systems. In orthopaedics, the Ilizarov technique is practised for the treatment of limb deformities, limb shortening and disfiguration. Joint Replacement Surgery Shoulder/hip replacement and bilateral knee replacement surgery using the most advanced keyhole or endosopic surgery and anthroscopy is done at several hospitals in India including the Apollo Hospital, Sir Ganga Ram Hospital and Holy Family Hospital in Delhi, Bombay Hospital, Leelavati and Hinduja Hospital in Mumbai and the Madras Institute of Orthoepaedics and Trauma Sciences. Some hospitals like Apollo in Delhi have Operation Theatres with Laminar Air Flow System which compares with the best in the USA and the UK. A knee joint replacement costs about 3000 pounds in India wheras in the UK, a similar surgery using the same implants and medical consumables costs around 10,000 pounds. Neurology It is perhaps the rule of nature that as we go on inventing ways of tackling the most notorious of ailments, newer forms of diseases take the centre stage. Today, with life attaining a lightening fast pace, the neurological problems have become an order (or should I say ‘disorder’!) of the day. The number of people who need neuro surgery is ever increasing. In this context, the number of people opting for a neuro surgery in India too is ever on the rise. Let’s look into the reasons why so many people from near and far off lands are coming all the way to this country for a neuro surgery in India. Though the life expectancy, rate of mortality, etc. do not give a picture which the country can boast about, the health industry in India is really seeing an unprecedented boom since the last few years There are several forms of physical malfunctioning that fall under the neuro sciences. For instance there are the diseases like essential tremors, Parkinson's’, epilepsy, Trigeminal neuralgia, and so on. Neuro surgery

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in India is performed by application of the Gamma-knife technique for countering these problems where you do not need a scalpel. There is high quality of microscopic surgery for all possible types of brain surgery such as pituitary tumors, acoustic tumors, skull tumors, intra ventricular tumors, glioma, and so on. There are also several medical institutions that offer neuro surgery in India and specialize in several vascular surgeries such as those for aneurysms of all sizes, arterial bypass, carotid endarterectomy, and other related neuro complications. The same also applies for various forms of spinal surgeries. Another reason for such an immense popularity of the neuro surgery in India is the great level of pediatric neurosurgery One may contemplate as to why choose India and travel so long a distance for such a complicated treatment as neuro surgery. The answer is rather simple and obvious. The sudden boom in the health industry of the country has resulted in a huge number of medical practitioners who are highly competent. And the cost involved in eth total treatment too is highly competitive. As a result you need less than 50% of what you would need to spend somewhere else. Hence, neuro surgery in India has turned out to be so popular. Challenges of medical tourism in India The trend is still in its early stages. Most of the foreigners treated in India come from other developing countries in Asia, Africa or the Middle East, where top-quality hospitals and health professionals are often hard to find. Patients from the United States and Europe still are relatively rare -- not only because of the distance they must travel but also, hospital executives acknowledge, because India continues to suffer from an image of poverty and poor hygiene that discourages many patients. Taken as a whole, India's health care system is hardly a model, with barely four doctors for every 10,000 people, compared with 27 in the United States, according to the World Bank. Health care accounts for just 5.1 percent of India's gross domestic product, against 14 percent in the United States. Conclusion The countries where medical tourism is being actively promoted include Greece, South Africa, Jordan, India, Malaysia, Philippines and Singapore. India is a recent entrant into medical tourism. According to a study by McKinsey and the Confederation of Indian Industry, medical tourism in India could become a $1 billion business by 2012. The report predicts that: "By 2012, if medical tourism were to reach 25 per cent of revenues of private up-market players, up to Rs 10,000 crore will be added to the revenues of these players". The Indian government predicts that India's $17-billion-a-year health-care industry could grow 13 per cent in each of the next six years, boosted by medical tourism, which industry watchers say is growing at 30 per cent annually. In India, the Apollo group alone has so far treated 95,000 international patients, many of whom are of Indian origin

Apollo has been a forerunner in medical tourism in India and attracts patients from Southeast Asia, Africa, and the Middle East. The group has tied up with hospitals in Mauritius, Tanzania, Bangladesh and Yemen besides running a hospital in Sri Lanka, and managing a hospital in Dubai. Another corporate group running a chain of hospitals, Escorts, claims it has doubled its number of overseas patients - from 675 in 2000 to nearly 1,200 this year. Recently, the Ruby Hospital in Kolkata signed a contract with the British insurance company, BUPA. The management hopes to get British patients from the queue in the National Health Services soon. Some estimates say that foreigners account for 10 to 12 per

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cent of all patients in top Mumbai hospitals despite roadblocks like poor aviation connectivity, poor road infrastructure and absence of uniform quality standards. Analysts say that as many as 150,000 medical tourists came to India last year. However, the current market for medical tourism in India is mainly limited to patients from the Middle East and South Asian economies. Some claim that the industry would flourish even without Western medical tourists. Afro-Asian people spend as much as $20 billion a year on health care outside their countries - Nigerians alone spend an estimated $1 billion a year. Most of this money would be spent in Europe and America, but it is hoped that this would now be increasingly directed to developing countries with advanced facilities. The key "selling points" of the medical tourism industry are its "cost effectiveness" and its combination with the attractions of tourism. The latter also uses the ploy of selling the "exotica" of the countries involved as well as the packaging of health care with traditional therapies and treatment methods. Price advantage is, of course, a major selling point. The slogan, thus is, "First World treatment' at Third World prices". The cost differential across the board is huge: only a tenth and sometimes even a sixteenth of the cost in the West. Open-heart surgery could cost up to $70,000 in Britain and up to $150,000 in the US; in India's best hospitals it could cost between $3,000 and $10,000. Knee surgery (on both knees) costs 350,000 rupees ($7,700) in India; in Britain this costs £10,000 ($16,950), more than twice as much. Dental, eye and cosmetic surgeries in Western countries cost three to four times as much as in India. The price advantage is however offset today for patients from the developed countries by concerns regarding standards, insurance coverage and other infrastructure. This is where the tourism and medical industries are trying to pool resources, and also putting pressure on the government. We shall turn to their implications later. In India the strong tradition of traditional systems of health care in Kerala, for example, is utilised. Kerala Ayurveda centres have been established at multiple locations in various metro cities, thus highlighting the advantages of Ayurveda in health management. The health tourism focus has seen Kerala participate in various trade shows and expos wherein the advantages of this traditional form of medicine are showcased. A generic problem with medical tourism is that it reinforces the medicalised view of health care. By promoting the notion that medical services can be bought off the shelf from the lowest priced provider anywhere in the globe, it also takes away the pressure from the government to provide comprehensive health care to all its citizens. It is a deepening of the whole notion of health care that is being pushed today which emphasises on technology and private enterprise. The important question here is for whom is 'cost effective' services to be provided. Clearly the services are "cost effective" for those who can pay and in addition come from countries where medical care costs are exorbitant - because of the failure of the government to provide affordable medical care. It thus attracts only a small fraction that can pay for medical care and leaves out large sections that are denied medical care but cannot afford to pay. The demand for cost effective specialized care is coming from the developed countries where there has been a decline in public spending and rise in life expectancy and noncommunicable diseases that requires specialist services. India is considered the leading country promoting medical tourism-and now it is moving into a new area of "medical outsourcing," where subcontractors provide services to the overburdened medical care systems in western countries. India's National Health Policy declares that treatment of foreign patients is legally an "export" and deemed "eligible for all fiscal incentives extended to export earnings." Government and private sector studies in India estimate that medical tourism could bring between $1 billion and $2 billion US into the country by 2012. The reports estimate that medical tourism to India is growing by 30 per cent a year. India's top-rated education system is not only churning out computer programmers and engineers, but an estimated 20,000 to 30,000 doctors and nurses each year. ... References Websites www.medical-tourism-india.com www.health-tourism-india.com News papers The Hindu Times of India Conference on Tourism in India – Challenges Ahead, 15-17 May 2008, IIMK

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Financial express Economic times Books and journal Journal a day Medical tourism in India-Raj Pruthi Ministry of tourism Marketing management-philip kotler

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