TOURISM- CAN GOA DO IT?
Dr Pascal Pinto, Goa, (March 2005)
Together with the IFFI, horticulture, eco-tourism etc.
medical tourism seems to be the new mantra to boost the
state’s economic potential. This may be strange
given the tendency of Goans to travel to centers outside
the state for specialist medical treatment.
What is Medical Tourism?
Patients’ traveling to other countries for medical
treatment for a variety of reasons is termed as medical
The reasons may be varied -
Long waiting lists in their own
countries that provide health care free of cost such
as the National Health Service (NHS) in Britain.
Patients from developed countries
whose citizens are not covered by social security and
insurance seek medical and dental care in countries,
which offer much cheaper treatment than in their own
Well to do patients from countries
in the Middle East travel to the U.S/UK when they need
top class treatment.
Patients from poor developing nations
such as Nigeria / Bangladesh travel to the neighboring
countries as there are not enough facilities in their
By itself traveling abroad for health care
is not a new phenomena, but in the last 5 years the momentum
has accelerated, and, for two critical reasons - 1st is
the demography’s of the developed nations and the
problems that are cropping up in their health care system.
In the US / UK / Japan, the proportion of elderly people
vis-à-vis the total population is increasing rapidly
and the biggest chunk of the population have either hit
retirement age or are heading towards it. The number of
people aged 65 years and above is expected to double in
the next 15 years – and in the UK, people aged 60
years and above will form 25% of the population in the next
30 years. The health system in these countries has begun
to creak due to these demographic changes.
The total global medical tourism market is approx. $ 40
billion and growing at the rate of 20% every year. Of this
chunk approximately $ 27 billion alone are spent by the
Arabs in various countries, the major component being spent
in Britain / US and a relatively minor percentage in other
countries. British and American tourists in turn contribute
to the medical tourism market but India’s share is
but $ 0.25 billion of this market. A recent survey in the
UK by the British Medical Journal indicated that up to 41%
of the NHS-its National Health Service, patients were prepared
to travel long distances in order to jump the long waiting
lists. India has big plans to become a global center for
healthcare services by combining treatment - that compares
with that in, say, London or Los Angeles - with tourism.
Offering such ‘medical packages’ where the patient
is offered world-class healthcare combine with convalescence
at tourist hotspots in Goa or Kerala -all at a fraction
of what it costs in the West, is one of the suggestions
of the Confederation of Indian Industry-McKinsey study on
healthcare. Medical tourism can contribute Rs 5,000-10,000
crore (Rs 50-100 billion) additional revenue to the up market
tertiary hospitals by 2012, and will account for 3-5 per
cent of the total healthcare delivery market, according
to this study.
Treatment Cost in
Dollars (Average Estimates)
|8,000 to 20,000
|5,000 to 10,000
Victor Apollo Group
has immense potential in medical tourism as medical costs
skyrocket in the developed countries, the
study said. Dr Naresh Trehan, chairman, CII national healthcare
committee, said: "In comparison to most developed
countries such as the United Kingdom or the United States,
treatments like those for dental problems or major procedures
like bypass surgery or angioplasty come at a fraction
of the costs in India."
The current market for medical tourism in India is small
and is mainly limited to patients from the Middle Eastern
and South Asian economies. However, it could grow rapidly
if the industry re-orients itself to attract foreign patients,
the study pointed out. It estimates that the market could
grow to about 100 billion $ in the next few years. Joint
replacement, cardiac care, cosmetic surgery, ophthalmology
and dental procedures coupled with complementary medicine
like ayurveda and homeopathy could be India’s ticket
to medical outsourcing.
have already tapped into the market and attract several
patients from the Middle-East and other neighboring countries.
Heart care service provider Escorts has doubled its number
of overseas patients from 675 in 2000 to around 1,200
in 2003. Almost 10% of Escort’s patients come from
Sri Lanka, Bangladesh, Nepal and West Asia.
our planners have visions of charter loads of British
pensioners hobbling of the plane to get their hips and
knees fixed ‘dirt cheap’ in India, then they
better think again. The Indian healthcare industry has
failed to impress the British government's National Health
Service (NHS) to outsource its patients to India. Sources
attribute this to Indian hospitals' lacking accreditation
from Joint Commission on Accreditation of Healthcare Organisations
(JCAHO), lack of standards in terms of quality and rates
for healthcare procedures, absence of gradation system
and the far from perfect insurance sector here. Experts
say that acquiring JCAHO accreditation is a costly and
a continuous process, costing around 50,000 to 200,000
USD. It takes around two years to get accredited by JCAHO.
The Medical Tourism Council of Maharashtra is trying for
it, so if 10 hospitals get together to get accredited,
the cost incurred by each hospital would be much less.
Hospitals have tried getting rated by CRISIL and ISO but
the problem is that such ratings are just not recognized
in the UK, none of the hospitals in India, Goa included
are JCAHO-accredited--an imperative to win outsourcing
contracts. Also, NHS patients are insured and the total
health care expenditure is borne by the government, which
does not apply here. Therefore, the NHS is sending its
patients to Spain and Germany, which also offer free bed
facilities. Also the political imperative would be to
out source the NHS patients to member EEC states. With
the recent increase in the EEC membership the NHS mangers
would be looking at the newer states like Estonia etc
to outsource their patients if required.
In stark contrast
to the UK healthcare scenario, where hospitals are standardized,
audits regularly performed and hospitals graded, the systems
are completely absent in Indian hospitals. Top Indian
hospitals have high infection and mortality rate, and
do not want to share their data regarding these. Concurs
Sushil Jiwarajka, chairman, Federation of Indian Chambers
of Commerce and Industry (FICCI), “NHS has a long
waiting list of patients. Even for a small cataract operation
there are patients waiting since two years.
Besides the cost at which healthcare services are offered
here, are a fraction of the cost in UK, but our record
keeping, software, and systems are not up to the mark.”
If India wishes
to get patients from the United States where private players
run healthcare, the problems will be much the same. In
India, only five per cent Indians are insured and they
are corporates. Less than 0.5 per cent individuals are
insured. Awareness about healthcare is poor. Rules of
reimbursement are stringent, performance of third party
administrators (TPAs) are not satisfactory. Discharge
details, disease codings, ICD codings and handling of
medical records are not in place, making it difficult
to get outsourcing contracts from the US.
the CII-McKinsey study found that there is a tremendous
stock of intellectual capital in Indian healthcare and
that state-of-the-art treatment/world class surgeries
are available in India, the system faces some lacunae.
There is a pressing need for qualified specialist nurses
and paramedics and qualified hospital administrators.
Several private hospitals have invested in nursing education,
but are concerned about loyalty: trained nurses often
leave India, attracted by the higher wages offered in
the Gulf countries. The study says that specialist nurse
training will become vital as the number of single-superspeciality
and multisuperspeciality hospitals increase.
also points out that Indian healthcare is plagued by a
lack of standardisation and accreditation, highlighting
the need for information management expertise. This nebulous
aspect of the market covers a variety of sectors including
public health, insurance, hospital management, clinical
research and clinical trials. Information Technology,
a core competence of the southern and western region,
facilitates management of information. There is a considerable
scope for partnership in the field of Health Informatics
(the application of IT to health data), in the collection
of information to established standards in both public
and private sectors would be valuable asset in India,
says the study.
–A medical Mecca?
Can Goa, which is firmly on the international map as a
holiday destination, attract the medical traveler? ‘‘Definitely!”
feels Victor Albuquerque owner of Victor Apollo hospital
and Victor Exotica and Dona Sylvia resorts who has a number
of health tourism projects in the pipeline. He opines
that Goa’s famed hospitality industry combined with
India’s top hospital group should be able to lure
the international patient here. “It needs some time”
cautions Dr Digamber Naik MD owner of Vrundhavan Hospital
–Goa’s only ISO2001 certified hospital which
has been catering to the tourists of the North Goa beach
belt for the past decade. He feels that infrastructure
needs to be put in place but once that is done Goa will
automatically reap from the efforts of the big players
in the health industry. With the facilities at the Goa
Medical College stretched to breaking point and daily
reports of outbreaks of malaria, dengue, hepatitis etc
. the man of the street feels that the public health status
of Goa has detoriated . One undisputable fact is that
the all the key
players US, UK, South Africa etc involved in health tourism
have excellent facilities with universal comprehensive
health coverage. Even Cuba with its low per capita income
has basic health indicators that are comparable to the
achievements of welfare systems in Western Europe. Dr
Dubashi FRCS, UK based surgeon and Director of Vintage
Hospitals UK which provides medical cover for Western
tourists -laments about the erratic power supply in the
capital city Panaji and agrees that no standards are followed
in Goa for either doctors or hospitals. He feels that
given the international standards of healthcare Goa would
only qualify for backpacker tourism.
International recognition as a holiday destination
Goa being the numero uno state boasts of good health indices
and basic health infrastructure compared to the rest of
A raft of legislation that regulates clinics, hospitals,
nursing homes and pharmacies
A mediclaim facility, which allows any resident of Goa
to seek super specialty reatment inside or outside Goa.
Goan diaspora that can be tapped for faculty, funding
has a small, predominantly middle class, English speaking,
A good supply of trained health care workers ie doctors
,nurses and pharmacists.
A thriving pharma industry
An informal medical tourism as attested by the growing
number of optometrist, dental and complementary medical
establishments operating on the beach belt.
Infrastructure – Goa has a number of 5 star resorts
but not one 5 star hospital. Connectivity ie good roads
to the beach belt from airports. ports and cities is still
Paramedics and specialist nurses. India and Goa continue
to loose trained specialist nurses to the West and the
Universal comprehensive quality health cover.
Enforcement of various public health related legislation
A medical tourism policy
A standardization and accreditation policy of health
establishments willing to offer their services to medical
The reference to five star hospitals would appear extravagant
to a lot of Goans who have to put up with dirty and crowded
OPD’s, overworked doctors and depleted hospital
drugs store. But the fact is that hospitals in the west
are increasingly being operated as hotels with patients
being referred to as clients and menus and plush waiting
lounges being the norm. Mr. Manohar Parrikar would have
to invest in infrastructure that would dwarf even the
investment in IFFI. The medical Tourism policy would have
to address the investment in the government hospitals
and medical education. The policy would have to envisage
the creation of health parks where subsidized land ,water
and power be given to the private sector to set up multispeciality
hospitals and research labs. Parrikars efforts to
replace the existing mediclaim with a sort of universal
health insurance which allows a citizen of Goa to chose
his health provider in the private or public sector within
or outside the state, is an interesting step in the right
direction. It would reduce the burden on GMC allowing
it to concentrate on medical training and would encourage
the private sector to invest in better and bigger hospitals
in the state. It would also pave the way for standardisation
and accreditation of medical establishments in the state,
use of ICD codings and software etc.
This of course could expose Mr Parrikar to charges of
misplaced priorities and neglect of public health. With
the change in dispensation at the Center he would be reluctant
to take such a gamble. Medical tourism would boost employment
and increase revenues. In the long term the people of
Goa would be able to assess premium healthcare at local
prices. But if medical tourism continues to remain a subject
of discussion only then Goa could very well miss the bus
as it has happened in the area of IT.
The author is currently a visiting consultant KLES Hospital
& MRC, Belgaum and a cleft surgeon with a New York
based charity SMILE TRAIN. He has worked and trained in
the NHS in UK and Belgium and maintains a private practice
in Goa. He can be contacted at email@example.com.
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