Booster Shot For Medical Tourism

SINCE THE PANDEMIC, Harinder Singh Sidhu, senior vice president, corporate development and head of international business, Apollo Hospitals, is going through one of the busiest phases in his career. Sidhu is busy travelling the world to add more to the 20 outreach offices of Chennai-based Apollo, the pioneer of medical tourism in India.

At Panchgani, the Bel-Air hospital campus spread over 44 acres with centuries-old trees, has a 200-bed hospital of 58 British-era heritage bungalows. In the last five-six months, Bel-Air has treated over 100 international patients, and the numbers are increasing every month.

Down South at the Uday Samudra Leisure Beach Hotel and Spa at Kovalam in Thiruvananthapuram, numerous foreigners are checking in, a rarity during the monsoon off-season. The property is one of the prime five-star hotels in Kovalam, with an Ayurveda and Panchakarma centre.

India’s medical tourism sector, which, in the past, failed to capitalise on the huge potential the country offers, is making a comeback after the pandemic. “In the next few years, India will be the medical destination of choice, even for people from developed economies,” says Prathap C. Reddy, founder-chairman, Apollo Hospitals Group, and pioneer of corporate hospitals and medical value tourism in India. Over 200 million people from across the world, including Oceania (Fiji, Samoa and Tonga), ASEAN, SAARC, CIS, West Asia, Africa, Europe, and Americas, have come to various Apollo Hospitals in India in the past for medical requirements, says Reddy.

“The medical tourism segment in India is growing at over 25% compound annual growth rate (CAGR), despite patients having stopped coming from traditional markets such as Afghanistan,” adds Abhay Soi, CMD, Max Healthcare Institute.

People are prioritising their health and well-being more than ever post Covid, says Sidhu. "The pandemic has highlighted the importance of accessible, high-quality medical care, leading many to explore treatment options abroad." Among new patients, many are from Bangladesh, Myanmar, Tanzania, Kenya, Somalia, Oman, Ethiopia, Mauritius, Cambodia, Nepal, DR Congo and Iraq. Major treatment areas include cancer, organ and bone marrow transplant, heart-related diseases, orthopaedics, and neurosciences specialities. "International medical travel revenue saw an increase of 18% in FY24 against the previous fiscal," adds Sidhu.

Bel-Air was gifted by Dorabji Tata in 1914 to Rustomji Bomanji Billimoria to start a TB Sanatorium. Billimoria and his son turned Bel-Air into one of Asia’s finest TB Sanatoriums and later transferred it to the Indian Red Cross Society in 1964. But TB patients vanished from Bel-Air after effective medicines were developed to cure the disease. When AIDS became a serious threat early this century, the centre was changed to one of the main anti-retroviral therapy and rehabilitation centres in India. Once AIDS became a lesser threat and the pandemic broke out, Bel-Air was converted into a Covid centre for the Satara district. After Covid, Bel-Air remained almost deserted.

But all that is set to change now. “We have started a Kerala Ayurveda hospital and will soon convert the entire campus into a world-class centre for medical value tourism and preventive healthcare,” says Tomy Kariyilakulam, director, Bel-Air hospitals.

“We regularly campaign about preventive Ayurveda treatments during monsoon, and post Covid, footfalls are increasing at all our properties in Kerala,” says Raja Gopaal Iyer, CEO, UDS Group of hotels.

The Big Growth

According to Bureau of Immigration data, foreign tourist arrivals in India for medical purposes rose 34.5% in two years, from 4.95 lakhs in 2017 to 6.97 lakhs in 2019. Then came the pandemic, halting growth. Arrivals for medical purposes fell to 1.83 lakh in 2020 and then recovered to 3.04 lakh in 2021. In 2022, medical arrivals grew to 4.75 lakh, but in January-October 2023, they had already crossed 5.04 lakh, G. Kishan Reddy, former tourism minister, informed Parliament, clarifying, since purpose-wise data for states/UTs are not maintained by the Ministry of Tourism, the data may not be fully accurate. Rating agency Crisil estimates that 7.3 million medical tourists are expected to visit India in CY2024.

The medical tourism industry in India, valued at $8.7 billion in 2023, is projected to grow to $10.4 billion in 2024, according to a Fortune Market Intelligence report. The industry will grow to $50,671 million by 2034 at a 17.2% CAGR from 2024 to 2034, the report says.

The Medical Tourism Index of the Medical Tourism Association ranks India at the 10th position out of 46 global destinations in 2020-21, in its latest edition. The world’s most attractive countries for medical tourism include Canada, the U.K., Israel, Singapore, and Costa Rica. India ranks third in medical tourism costs with 69.8 points, after Canada (76.47) and Costa Rica (71.73) and ahead of the Philippines (64.99) and Colombia (64.95). In facility and services, India’s global rank is fourth with 69.8 points, after Canada (76.47), Singapore (76.43) and Israel (70.78).

Broadly, medical tourism in India can be categorised into four types — chronic diseases and transplants (heart, kidney, liver etc); patients coming for cost-effective treatments (such as eyecare, joint and hip replacements, IVF etc); cosmetic surgeries (including dental care, plastic surgery, skin treatment etc.); and wellness tourism (spas, stress relief and rejuvenation and treatments in Indian systems of medicine such as Ayurveda, Siddha, Yoga and Naturopathy).

Of the country’s total medical tourism revenue, about 60% comes from wellness tourism. The U.S, Germany, China, France, Japan, Austria and India are ahead as leading global destinations for wellness tourism.

The India Advantage

Cost-effective quality treatments make India a major destination. Medical treatment plus travel costs to India is only one-tenth of that in the U.S. For example, if a hip replacement surgery costs $50,000 in the U.S., $14,120 in Korea, $12,000 in Singapore and $7,879 in Thailand, the cost in India is only $7,000, according to a presentation by Apollo Hospitals. For a knee replacement surgery, one has to pay $50,000 in the U.S., $19,800 in Korea, $13,000 in Singapore and $12,297 in Thailand, vis-à-vis $6,200 in India. A heart bypass requires $144,000 in the U.S., $28,900 in Korea, $18,500 in Singapore, $15,121 in Thailand, and only $5,200 in India (See graphic: Treatment costs). Indian hospitals ensure state-of-the-art infrastructure similar to developed countries such as robotic surgeries, AI and digital-driven treatments and healthcare delivery.

Other factors, including skilled medical professionals, cost-effective options and initiatives of corporate hospitals to expand their global outreach offices make India an attractive destination, according to Crisil. The National Accreditation Board for Hospitals & Healthcare Providers (NABH) has accredited nearly 1,600 healthcare facilities across the country, including AYUSH and dental facilities. NABH also provides accreditation to facilitators, a largely unregulated segment within the medical tourism sector.

The Joint Commission International, a US-based independent global leader in care and patient safety, has accredited 55 hospitals in India, one of the largest outside of the U.S.

“But we are still far below the potential opportunity in this space,” adds Soi of Max. Vishal Bali, executive chairman, Asia Healthcare Holdings (AHH) and former Group CEO of hospital businesses of Wockhardt and Fortis, says India itself is a huge market and as a reason, large hospitals have not been concentrating on tapping opportunities from abroad. “India is at a massive inflection point as far as healthcare delivery is concerned. It is largely a post-Covid phenomenon. The concept of wellness and going in early for treatment is getting more deep-rooted in the Indian population,” he adds. A recent ICRA estimate says India’s leading hospitals plan to add 30,500 beds over the next three to five years to meet rising demand.

Rising Revenue For Hospitals

Rating agency Crisil says medical tourism currently accounts for 10-12% of revenues of major corporate hospitals and is expected to grow at almost twice the overall industry growth rate in the near to medium term. “International patients contribute about 9% of our revenues (net revenue of ₹5,406 crore in FY24). We are setting up our own and partner offices in identified target countries,” says Soi. Max recorded a 27% YoY growth in international patient revenue in FY24.

Fortis Healthcare says revenues from medical travel grew 12.2% to ₹479 crore in FY24, contributing 8% to the hospital’s overall revenue of ₹5,686 crore. International patient revenue increased 24% YoY to ₹194 crore in FY24, driven by increased patient admissions and higher realisations, says Medanta.

To ensure medical tourists receive seamless care, Apollo, Fortis, Max, Medanta and Aster offer various amenities such as airport transfers, visa support, health checkups, insurance facilitation, doctor appointments, treatment plans, language interpretation and accommodation arrangements for both patients and their families. “International patients are looking for seamless medical journeys, from visa assistance and airport transfers to comfortable accommodations and language interpreters who bridge communication gaps,” says Sidhu.

An industry estimate says the healthcare delivery industry in India has grown at a CAGR of 10-12% over FY17-22 and is expected to reach `8.6 lakh crore by FY27 (CAGR of 10-12%). Experts point out that in the past most international patients coming to India were mainly from Bangladesh, Pakistan, Myanmar, West Asia and Africa, countries that lacked high-quality healthcare infrastructure. Crisil estimates the breakdown of medical tourists to India by major region of origin as 70% from South Asia, 16% from West Asia, 8% from Africa and 6% from other nations. However, post pandemic, U.S. and European travellers are flying down to experience holistic healing in centres such as Rishikesh, Haridwar and other Himalayan valley destinations, say experts.

Government Initiatives

In March 2023, the Ministry of Tourism formulated a ‘National Strategy and Roadmap for Medical and Wellness Tourism’ to boost medical tourism in the country. It aims to develop a brand for India as a wellness destination, strengthen the ecosystem for medical and wellness tourism, enable digitalisation by setting up an online medical value travel (MVT) portal, enhance accessibility for medical value travel, and create a governance and institutional framework.

In 2018, the government established a dedicated $641 million fund to enhance 12 champion services sectors, with medical value travel being one of them. The e-tourist visa launched in September 2014 was subsequently expanded to include medical visits. In the case of an e-medical visa and an e-medical attendant visa, triple entry is permitted and extension may be granted up to six months on a case-to-case basis on the merits of each case by the Foreigners Regional Registration Officer/Foreigners Registration Officer concerned.

In August 2023, the Ministry of Home Affairs introduced a new category of Ayush visa for foreign nationals for treatment under Ayush /Indian systems of medicine, as part of the government’s roadmap for Heal in India initiative.

The Ministry of Ayush and the Ministry of Health & Family Welfare are developing a one-stop Heal in India portal to promote India as a medical tourism destination. Data from the portal says around 825,795 medical visas were issued from 2019 to 2021 and 165 countries have been listed for e-medical visas.

The government also offers working capital or personal loans to companies operating in the tourism industry to restart post Covid. The tourism ministry also runs media campaigns overseas, under ‘Incredible India’, to promote various tourism destinations and products of the country. Digital promotions are also regularly undertaken through the ministry’s social media accounts.

With the government’s support and private initiatives, the Indian medical tourism market is sure to grow as one of the largest in the world, from its 10th ranking currently.