Impact of Medical Tourism on Countrys Economic Growth

FARHEEN BANU
BBA Travel & Tourism Preston University Ajman, United Arab Emirates

Submitted to: Dr. Reji Johnson Submitted by: Farheen Banu Registration Number 5012-108059

Acknowledgements
A number of people have contributed with comments, suggestions, and input at different stages of writing this thesis.

First and foremost, I would like to thank my professor Dr. Reji Johnson for his challenging supervision, extensive guidance, cooperation and valuable support. His patience, knowledge and understanding were much appreciated.

I would also like to express my grateful appreciation to all those who kindly took part in and supported this thesis by participating in the survey questionnaire.

Also; a big note of thanks to all my teachers, faculty members and fellow students and friends at Preston University; whose comments and suggestions were helpful in revising this paper.

Finally, I wish to express my gratitude to my family for their unconditional support and to all those who have in one way or other helped me in the successful completion of my project.

Farheen Banu

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Abstract
This research paper discusses some of the forces driving Medical Tourism. The study attempts to systematically evaluate the phenomenon of medical tourism from an economic standpoint.

The primary objective of the study is to examine and highlight the significance and impact of the medical tourism industry on countrys economic growth.

The study is exploratory in nature and data is gained through a combination of qualitative (case study) and quantitative (questionnaire survey) methods. The study focuses on the medical tourism trend that will have an increasing impact on the healthcare landscape in industrialized and developing countries and their economic growth.

This study utilizes both quantitative and qualitative data collection tools. The main data collection techniques used in this research study were documentation analysis and questionnaire surveys. Data collection sources also include articles in academic journals, blogs, online report publications, magazine articles, research papers and book references.

Research results conclude that the combination of three key factors quality, availability and cost have been key in fuelling the phenomenal growth witnessed in the medical tourism industry. Furthermore, medical tourism presents important concerns and challenges as well as potential opportunities. Both positive and negative impacts of medical tourism on healthcare, economic, social and environmental sectors create opportunities and challenges for this growing industry.

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Table of Contents
Contents
Acknowledgements . Abstract .... Chapter 1: Introduction ... 1.1. Overview ..... 1.2. Statement of the Problem ..... 1.3. Objectives of the Study ..... 1.4. Scope and Limitations of the Study .... 1.5. Significance of the Study ... 1.6. Definition of Terms .... Chapter 2: Review of Related Literature ...... 2.1. Theoretical/Conceptual Literature ... 2.2. Related Studies ..... 2.3. Synthesis Chapter 3: Research Methodology ... 3.1. Research Design 3.2. Respondents of the Study .... 3.3. Research Instrument .... 3.4. Validity of the Research Instrument ... 3.5. Data Collection Procedure .. 3.6. Statistical Tool Analysis ...

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1 1 3 4 5 6 7

8 8 11 15

22 22 22 23 24 24 25

Table of Contents
Contents
Chapter 4: Presentation, Analysis and Interpretation of Data ..... 4.1. Demographic information ..... 4.1.1. Breakdown by Gender . 4.1.2. Breakdown by Age Group .. 4.1.3. Breakdown by Nationality .. 4.2. Medical Tourism Questionnaire Survey Result ... Chapter 5: Summary of Findings, Conclusions and Recommendations.... 5.1. Summary of Findings .... 5.2. Conclusion ...... 5.3. Recommendations . Bibliography .. Appendix A

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List of Tables
Table No. and Name 2.1 5.1 Cost comparison for selected surgeries..... Economic impact of medical tourism on a nation...... Page No. 17 49

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List of Figures

Figure No. and Name 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 Gender distribution... Age composition....... Nationality chart.... Medical Tourism First knowledge source... Medical Tourism Preferred research source..... Medical Tourism Frequency of travel.. Medical Tourism Motivation factor.. Medical Tourism Type of procedure... Medical Tourism Duration of stay... Medical Tourism Total expenditure budget... Medical Tourism Traveling ..... Medical Tourism Performed tourist activities.... Medical Tourism Hospital rating.. Medical Tourism Facilitator used.... Medical Tourism Facilitator service rating..... Medical Tourism Communication problem.... Medical Tourism Personalized service... Medical Tourism Malpractice concern....

Page No. 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43

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Farheen Banu Chapter 1 Introduction

1.1. Overview

Tourism as an industry has huge economic benefits. At present, tourism does not limit itself merely to hotels, restaurants and site-seeing; but has also created a link with the health sector (Medical Tourism) and environment (Eco-tourism) as well. The significance of tourism as a factor for economic growth and employment generation is now acknowledged globally.

The health

care

industry,

or medical

industry,

is

segment

of

the economic system that offers goods and services to treat patients with therapeutic, preventive and rehabilitative care. Medical tourism is

basically different from the usual form of global medical travel, where patients normally travel from less-developed countries to major medical centers in highly-developed nations for medical treatment that is not available in their own region.

In contrast, medical tourists are normally people who are residents of the developed countries who travel to nations, which are usually lessdeveloped. The medical tourism industry is a productive source of acquiring hard currency for host countries.

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Popular medical tourist destinations include developing countries such as India, Philippines, South and Central American countries, as well as fairly developed countries, such as Singapore and South Korea.

A blend of various factors has led to the present increase in recognition and popularity of the medical tourism phenomenon. These factors include soaring costs of healthcare in developed countries, ease and affordability of international travel, favorable currency exchange rates in the global economy, rapidly improving technology and standards of care in numerous countries world-wide.

Medical tourism has had large economic impacts on various geographical regions which particularly include developing nations. The goal of this industry is to increase jobs, income, and quality of life of the medical tourism host country.

Medical tourism offers countries, hospitals and clinics, new sources of business. There are enormous global opportunities for property investors, travel agents, hotels and other services. When medical tourists travel for their medical treatment, they also often take the chance and opportunity to participate and engage in tourist activities in the country they are visiting and enjoy what the host country has to offer. Thus, medical tourists may combine their vacation and medical care into one venture.

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Medical tourism consists of three fundamental features: hospital/health services, hotels and travel/leisure. Therefore, along with attractive policies and accurate planning and marketing approach, this upcoming industry may witness extensive opportunity for economic growth and infrastructure development for participating countries.

This research paper is an attempt to put forth the role and impact of Medical Tourism on countrys Economic Growth, with particular emphasis on India.

India is one of the most profitable medical tourism markets in the world and has seen an incredible growth during the recent past. This is due to many reasons; such as low cost, less waiting time and government support through policies and schemes. India also has a huge potential for future growth and development.

1.2. Statement of the Problem

Beside prospective opportunities, medical tourism also brings forth significant concerns and challenges as well. Globalization has formed a basis for various nations to re-examine their economical strengths and weaknesses, as well as reassess what products or services can deem beneficial in which countries.

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One such product and service that has surfaced in the recent past is Medical Tourism. However, this trend has only occurred in certain, specific geographical regions mainly due to the nature of its practice and policies. These regions and countries have attractive policies regarding medical tourism and have applied exclusive marketing strategies that promote the medical tourism industry. This in turn has resulted in having a great impact on these nations economic health. In contrast, other nations, like US and UK, have not been as successful in attracting the medical tourism business. Hence, the subject matter is to analytically understand, through the analysis of other countrys practices, policies and marketing strategies, as to why the United States and other similar nations should take benefit of the opportunity to further partake in this promising industry.

1.3. Objectives of the Study

This research paper discusses some of the forces driving Medical Tourism. The study attempts to systematically evaluate the phenomenon of medical tourism from an economic standpoint.

The primary objective of the study is to examine and highlight the significance and impact of the medical tourism industry on countrys economic growth.

Farheen Banu

The study is exploratory in nature and data is gained through a combination of qualitative (case study) and quantitative (questionnaire survey) methods.

1.4. Scope and Limitations of the Study

The scope of this thesis is to offer an enhanced perception and understanding of the current situation of the Medical Tourism Industry. This study focuses on the phenomenon of medical tourism which will consequentially have a growing impact on the healthcare sector in industrialized and developing nations and on their economic growth.

Additionally, study limitations also exist. The lack of literature covering the aspects of the study posed some difficulties in gaining better background information. This led to the collection of large amounts of external secondary data obtained from different sources of information, which were combined in order to gain an insight into the topic.

Medical tourism is an emerging industry, extensive research for any particular country or on any individual branch of medical tourism, its policies and marketing strategies was not available.

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Reliable and solid medical tourism statistics are hard to find since the emergence of medical tourism phenomenon is recent; it is a topic that remains fairly un-researched. Optimistically, further academic research is being performed in this area, and with proven infrastructure, the medical tourism industry can look forward to updated, accurate, and transparent data within the near future.

1.5. Significance of the Study

Medical Tourism is an immense revenue generating sector. On the economic front, medical tourism is quickly emerging into an important and vital revenue generator for countries such as Thailand, Singapore, India and Malaysia.

This study may be viewed of substance by various groups having interest in the field of medical tourism. It can also deem to be highly significant for companies operating in the tourism industry. Moreover, this research study can ultimately help in understanding the patients experience. So far, the subject of medical tourism has been left fairly ignored by academic researchers. Amongst the outbreak of business consultations, industry reports and news media coverage that have addressed the quick growth of the industry, only a limited number of articles from an academic perspective exist.

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1.6. Definition of Terms

Technical terms used within this research are mentioned below. These terms are operationally defined.

1. Medical Tourism: the act of people travelling to another country to obtain treatment for a disease, ailment, or condition, and who are seeking higher quality of care at lower costs than they could receive at home; while at the same time touring, vacationing and experiencing the attractions of the countries that they are visiting.

It can be broadly defined as travel undertaken for the purpose of availing cost effective healthcare that meets international standards of care and comfort.

2. Economic Growth: An increase in the capacity of an economy to produce goods and services, compared from one period of time to another. Economic growth can be measured in nominal terms, which include inflation, or in real terms, which are adjusted for inflation. The growth of an economy is thought of not only as an increase in productive capacity but also as an improvement in the quality of life to the people of that economy.

Farheen Banu Chapter 2 Review of Related Literature

This chapter presents a review of literature and research which is related to the study.

2.1. Theoretical/Conceptual Literature

Connell (2006) defines medical tourism as a popular mass culture where people travel often-long distances to overseas destinations (India, Thailand, Malaysia) to obtain medical, dental and surgical care while simultaneously being holidaymakers, in a more conventional sense.

Medical tourism has become a US$60 billion dollar-a-year business and is growing by 20% each year (Jones & Keith, 2006; MacReady, 2007). The booming industry is expected to maintain its growth in future as well, since more people are accessing the Internet to gain information related to care and health services being offered abroad at affordable rates.

According to Connell (2011), there is a more prosaic and less glamorous explanation for the growth of medical tourism including: rising cost of health care, weakened status of the public health sector, long waiting lists for some procedures and the inability of many to pay for necessary medical treatment.

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The fundamental premise of medical tourism is that the same care, or even better quality of care, may be available in other countries, and obtained at a more affordable cost than in the home country (Medical Tourism Association, 2008). This lower cost is especially important for a patient who does not have health insurance and for whom a procedure may be financially crippling in the home country, but affordable in another one. One such example is coronary artery bypass surgery. The estimated cost of this surgery in the United States (US), one of the countries for which such statistics are available, is US$150,000, while the total cost of surgery and a 20 day stay in India, is cited as US$10,000 (Herrick, 2007).

Experts pinpoint that another advantage of medical tourism is that it is non-seasonal therefore it is unlikely that medical procedures will have different prices depending on the time of the year summer or winter prices (Nautiyal & Dogra, 2005).

Connell (2006) states that another feature of medical tourism, namely distance from home, may offer desired anonymity. Some medical procedures, such as gender changes, have become small but significant parts of medical tourism, especially in Thailand, where recuperation and the consolidation of a new identity may be better experienced at a distance from standard daily life.

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Various countries engage in medical tourism in order to strengthen their Gross Domestic Product (GDP) as foreign patients bring in needed cash to pay for procedures and other activities. GDP is defined as the primary indicator used to measure the health of a country's economy.

Most countries that engage in delivering care to medical tourists do so to increase the level of direct foreign exchange earnings coming into their country; to improve their balance-of-payments position (Timmermans, 2004, Ramrez de Arellano, 2007, Turner, 2007). To some extent this might be income thought of as accruing directly to the health system. For instance, foreign patients purchase health care services, and hence provide an income that can be used within hospitals to cross-subsidize care for domestic patients, or could be used to help fund capital investment, such as MRI scanners, that are then used by all patients in the hospital.

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2.2. Related Studies

The Medical Tourism Association (MTA) provides the following statistics for a June 2009 MTA Patient Survey:

Almost 83% of patients traveled with a companion. Almost 70% of patients rated their medical care as excellent. Almost 90% of patients or their companions engaged in tourism activities.

Almost 85% of US patients found they received more personalized medical care in comparison to their home country.

Almost 86% of US patients said they would travel again overseas for medical care.

According to the National Coalition on Health Care (NCHC), long waiting lists serve as a catalyst for many citizens to seek care overseas. For that reason approximately 500,000 Americans alone traveled overseas in 2007 for medical treatment (NCHC, 2007). Moreover, this phenomenon is not exclusive to the US alone. Large numbers of Britons also seek care overseas (Terry, 2006). Donnelly and Sawer (2007) reported that, in 2007, 70,000 Britons traveled overseas for treatment for diverse surgical procedures including cataracts, hip operations, and cardiac surgery.

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As a consequence of the development of medical tourism, a number of countries actively advertise their services and have companies that specialize in arranging overseas medical care (Cortez, 2008). These countries market various procedures as an attractive package that combines both hospital care and also tourist activities. They are aware of the fact that medical tourists and/or their accompanying family members may spend extra money on recreation and tourist activities both while during the treatment period and even after the care has been concluded.

Additionally, according to Gopal (2008) many governments have started an aggressive promotion to boost the sector in the respective countries:

Malaysia plans to develop itself as a medical tourism center. The country has outstanding infrastructure and also English is widely spoken. Malaysia has its own national accreditation scheme (MSQH). The Association of Private Hospitals in Malaysia is working to develop medical tourism.

New Zealand is a comparatively new participant in the medical tourism industry focusing mainly on non-acute surgical procedures and fertility treatment. The cost of treatment in New Zealand (inclusive of Air travel, accommodation etc) is estimated to be around 40% of the cost of the US and the UK.

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Philippines is another country that is increasingly leaping forward in the area of medical tourism. The medical centers in Metro Manila are complied with ISO standards and have received accreditations from the Philippines Department of Health, Joint Commission International (JCI) of USA etc.

Singapore Medicine is a multi agency government initiative that aims to develop Singapore into a top destination for health care services. In 2005, approx. 374,000 medical tourists visited the country.

According to experts, medical tourism is considered to have a positive impact on the economies of destination countries and will also promote skilled and unskilled trades. The medical tourism trend may also deem beneficial for foreign investors who hold an interest in those countries.

India varies greatly from other destinations in terms of cost, infrastructure, human resources, patient perceptions, competencies, and the level of government support. India has allotted excellent budgetary amounts for diverse policies and initiatives. The Indian medical tourism sector is experiencing swift growth, with approximately 500,000 foreign patients travelling to India for medical care in 2005, compared to an estimated 150,000 patients in 2002, according to experts quoted in the University of Delawares UDaily news.

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In financial terms, experts estimate that medical tourism could fetch India as much as $2.2 billion per year by 2012.

India has a reputation for high quality care in a number of major hospitals. Medical tourism is growing and diversifying in India. Estimates vary, but McKinsey & Company and the Confederation of Indian Industry put gross medical tourism revenues at more than $40 billion worldwide in 2004. 1 Others estimate the worldwide revenue at about $60 billion in 2006. 2 McKinsey & Company projects the total will rise to $100 billion by 2012.3

1. McKinsey & Company and the Confederation of Indian Industry, cited in Laura Moser, The Medical Tourist, Slate, December 6, 2005, and Bruce Stokes, Bedside India, National Journal, May 5, 2007. 2. See Dudley Althaus, More Americans Seeking Foreign Health Care Services, Houston Chronicle, September 4, 2007. 3. McKinsey & Company and the Confederation of Indian Industry, cited in Laura Moser, The Medical Tourist, and Bruce Stokes, Bedside India.

Farheen Banu 2.3. Synthesis

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Research affirms the fact that the economic revenue that the medical tourism industry adds to the nations gross domestic product (GDP) is considered as a determinant of success. This monetary revenue can be calculated by healthcare incomes, as well as earnings gained from tourism related pursuits and activities. Besides the financial value that is calculated, countries can evaluate the affects of this industry by the boost in number of tourists, as well as creation in the number of new jobs and career openings. Countries are also able to establish numerous influences and impact that the medical tourism industry has on its economic growth.

Medical tourism normally provides various types of services. Basically, medical tourism offers a medical tourist with the healthcare service that they need or desire. Additionally, it also provides the consumer with relevant accommodation services that they need. Often consumers also participate and engage in some leisure, recreational or tourist activities during their visit. Therefore, it can be stated that the tourism industry also indirectly provides services to these consumers as well.

Medical tourism benefits everyone involved: patients of all ages benefit by receiving immediate treatment at very affordable prices from the best medical attention available in the world; doctors in foreign countries receive more patients; local governments benefit from lower health costs;

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insurance companies can offer their clients the opportunity of quality treatment at great savings for both; service providers benefit from added business: airlines, transportation, hotels, tourist destinations, etc.

Patients who do not have much knowledge regarding medical tourism and those who are not familiar with specific medical facilities being offered abroad can organize their treatment through medical travel mediators or facilitators. These service providers work similar to specialized travel agents. Their job is to investigate health care providers to ensure quality treatments and screen customers in order to assess those who are physically capable to travel. They often also have doctors and nurses on staff to assess the medical efficiency of procedures and assist medical tourist in selecting appropriate physicians and medical centers.

Due to the increasingly high cost of health care in developed countries like the United States, some individuals have no other choice but to go abroad for surgery because the surgery or procedure they will undergo is considered cosmetic or elective (and thus not covered by insurance), or is only partially covered by medical insurance or is considered experimental. In some cases, even if medical insurance does provide coverage, the cost of paying the deductible and non-covered portion of a surgery performed in the U.S. is more expensive than paying for the entire procedure in a foreign country.

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The following table gives a very brief comparative picture of the price of the treatment.

Table 2.1 Cost comparison for selected surgeries

Regardless of the economic recession, the medical tourism sector in India is the most rapidly emerging and growing segment of the tourism industry. Factors such as low cost, range and quality of treatments provided in the country add to its appeal as a medical tourism destination. In spite of the lengthy travel time, India is a trendy spot for medical tourists. It possibly, has the lowest cost and highest quality of all medical tourism destinations, according to a report on medical tourism published by the National Center for Policy Analysis (NCPA) in 2007.

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Rates for medical treatments can be acquired in advance and numerous hospitals bundle services and offer package deals that include the cost of medical procedure and the cost of treating any complications. Moreover, hospitals also often have lodge rooms or can offer discounts for hotel accommodation in close proximity.

Indias medical tourism industry is a significant and an increasing source of foreign exchange in addition to positive reputation and goodwill outside the country. Moreover, India government has also effectively introduced a new category of Medical Visa (M-Visa), which is issued for a specific time period to foreign tourists coming to India for medical care and treatment.

Thus, healthcare industry has shown significant growth in recent years in India. The development of outstanding hospitals and constant efforts for enhancement of quality of care has placed Indian healthcare in a top position globally.

The immense growth of the medical tourism trend has had a huge impact not just for the patient alone but it has also influenced economic, social, environmental, business and medical sectors.

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Positive impacts of Medical Tourism on a country

It adds not just in terms of improved, quicker or affordable healthcare, but also contributes to infrastructural enhancements.

It creates more employment opportunities with an increased tendency towards overall wealth creation.

Numerous industries that are closely associated with the global health tourism sector are extensively impacted by its growth and

development.

It acts as a major source of revenue for the tourism industry and outlines a segment of total earnings of the industry. Numerous medical tourists do not visit a country with the sole intention of only receiving treatment or surgery. They also plan to engage in other attractions the host country has to offer. This trend is growing as tourists have a tendency to spend the amount they saved in healthcare on tourist activities.

The pharmaceutical industry is highly associated with the field of medical science. When medical tourists undergo treatment or surgery,

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they are also bound to take over-the-counter drugs sold in the same area. As a result, this increases the sale of medicines in a directly proportional manner such that, the number of surgeries or treatment carried out directly adds to the earnings of the pharmaceutical company of the host country.

Negative impacts of Medical Tourism on a country

In the midst of high rate of patient travels, there is a considerable amount of risk of corresponding bacterial travel. The recent superbug research has also produced a significant alert regarding this issue. It is essential that all the related industry professionals should recognize and comprehend the negative impact of communicable diseases.

The natural environment and habitat is compromised in order to accommodate more buildings, hospital facilities, roads, treatment or diagnostic centers etc. Moreover, there is a constant expulsion of impure air, solid toxic medical waste, liters of contaminated sewage. Architectural, noise and visual pollution also has a direct negative impact on the environment.

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Health tourism may also produce a shortage of local resources like power, food stock, fuel and other non-renewable natural resources, which could already be in short supply within the host country. Water is usually misused in hotels, spas and swimming pools because of careless personal use by tourists. This not only produces large amount of waste water but also leads to water shortages and exhaustion of natural water sources.

In the midst of growing number of medical tourists, the hospital implements the strategy and standards of being paid in as per the international foreign system. Such a structure and policy, even though economical to a foreigner, appears to be expensive for the local resident. Consequently, numerous people within a particular country are not able to benefit from the advance treatment opportunities available within their own country. This in turn creates a negative impact on the health care system of a country.

Legal issues and problems are also expected to arise as this industry tenders to unique problems and challenges for both consumers as well as providers.

Farheen Banu Chapter 3 Research Methodology

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3.1. Research Design

Descriptive research design (also known as statistical research) and a combined methodology have been adopted for this study. A preliminary qualitative study is combined with a main quantitative study in order to yield a project that will help to describe the subject matter of this thesis efficiently. Furthermore, a case study approach is used to recognize, understand and present the context in an enhanced form. The in-depth case approach was adopted based on extensive secondary research, which include literature review, research of online articles and reports.

The questions contained within the survey were developed to provide valuable information that could be used to benefit the individual consumer as well as the industry as a whole.

3.2. Respondents of the Study

Respondents were chosen based on the Convenience Sampling method (also referred to as availability sampling method). Moreover, the respondents were selected on the basis of their closeness to the topic of the study and their level of experience in Medical Tourism.

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A questionnaire survey was conducted over the Internet on a sample size of 100 respondents. The survey was designed to have an international reach; hence the questionnaire was posted on various social media websites and forums and was also electronically sent to parties in America, Africa, Europe, Asia, the Middle East and Gulf regions.

The questions designed, were clear and transparent in meaning and vocabulary so that respondents can understand them easily and avoid response bias. The research was conducted respecting confidentiality of all collected primary data and strict ethical rules were applied for the entire time of research and analysis.

3.3. Research Instrument

For this research, two methods were selected to be the most appropriate instruments with the purpose of collecting authentic and helpful data case study approach and questionnaire survey.

Since the aim of this research is to examine the impact of medical tourism on countrys economic growth; the questionnaire survey was chosen as an instrument because it allows to measure perceptions and attitudes of the respondents/patients mindset.

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The questionnaire is divided into two parts. The first part gathers demographic information and the second part examines and estimates the usage and effects of medical tourism in terms of revenues from medical services and value added gained from the activities of patients and the companions travelling with them before and after medical treatment.

3.4. Validity of the Research Instrument

Techniques such as cross-case examination and within-case examination along with literature review are adopted to ensure external validity.

The questionnaire that appears in Appendix A comprised of fifteen questions. The design of the questionnaire was based on the literature review analysis and as per the sample model patient survey formulated by the Medical Tourism Association.

3.5. Data Collection Procedure

This study utilizes both quantitative and qualitative data collection tools. The main data collection techniques used in this research study were documentation analysis and questionnaire surveys.

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Data collection sources also include articles in academic journals, blogs, online report publications, magazine articles, research papers and book references.

3.6. Statistical Tool Analysis

Within-case and cross-case analysis of data are selected as analysis techniques. Quantitative data that has been collected is used to corroborate and support the qualitative data which is most useful for understanding the rationale of theory.

Statistical tools include descriptive analysis in forms of tables and graphs.

Farheen Banu Chapter 4 Presentation, Analysis and Interpretation of Data

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This research paper is a combination of survey report and intense research done over a two month period. The questionnaire (Appendix A) comprised of fifteen multiple choice questions. A sample of 100 respondents was used and therefore the number of respondents also symbolizes the percentage of total respondents.

Details of findings from the research questionnaire are presented below.

4.1. Demographic information The information about demographics was taken from the first part of the questionnaire that covered aspects such as the respondents gender, age and nationality.

4.1.1. Breakdown by Gender Figure 4.1 Gender distribution

Figure 4.1 shows that the gender distribution was almost equal in ratio. However, majority of the respondents were male.

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4.1.2. Breakdown by Age Group

Figure 4.2 Age Composition

Figure 4.2 shows that 47% of the respondents were aged between 50-64 years, 26% were aged between 30-49 years, 17% were aged between 1829 years, and the remaining 10% were aged 65 and above.

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4.1.3. Breakdown by Nationality

Figure 4.3 Nationality chart

Figure 4.3 shows that majority of the respondents (21%) were Americans, 19% were GCC Arabs, 17% were Europeans, 15% were Asians, 13% belonged to the Mid-East region, 9% were Africans and 6% were Australians.

Farheen Banu 4.2. Medical Tourism Questionnaire Survey Result

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1. How did you find out about medical tourism (travelling internationally for medical care)?

Figure 4.4 - Medical Tourism - First knowledge source

Figure 4.4 reveals how the respondents first gained knowledge about medical tourism. The print media (Newspaper, Magazine and Book) was clearly the leading media for 37% of the respondents, followed by Internet at 21%. Friend and My Doctor were the next highest factors with a score of 19% and 15% respectively. Only 6% of the respondents first learned about medical tourism through TV, Radio and the remaining 2% via Other Conferences.

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2. How did you research your information for medical tourism on country destinations and hospitals?

Figure 4.5 - Medical Tourism - Preferred research source

Figure 4.5 depicts how the respondents gained research information for medical tourism on country destinations and hospitals. A huge number of respondents (61%) selected Internet followed by Asked a Friend at 19% and Medical Tourism Facilitator at 11% as their choice of research source. Only 9% of the respondents consulted Magazines, Books.

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3. How many times have you travelled as a medical tourist?

Figure 4.6 - Medical Tourism - Frequency of Travel

Figure 4.6 exhibits respondents frequency of visit as a medical tourist. Majority of the respondents (64%) have travelled only once whereas 36% of respondents have travelled more than once.

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4. What motivated you in deciding to travel for medical purpose?

Figure 4.7 - Medical Tourism - Motivation factor

As shown in figure 4.7, Lower costs was the leading motivational factor for 42% of respondents in deciding to travel for medical purpose. The next top factors were Medical procedure combined with relaxation/leisure and Better quality services with subsequent results of 24% and 21% respectively. Access to alternative/different services was seen as a motivation factor by 13% of the respondents.

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5. What type of procedure did you travel for?

Figure 4.8 - Medical Tourism - Type of procedure

Figure 4.8 shows the type of procedure the respondents traveled for. Results clearly show that the most popular procedures were Cosmetic and Surgical or invasive procedures with subsequent respondent results of 36% and 26% respectively. The next top procedures sought-after were Rehabilitation at 16% and Medical spa services at 13%. Only a small percentage of respondents travelled for Elective procedures and Preventive services (6% and 3% respectively).

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6. What was the duration of your stay period?

Figure 4.9 - Medical Tourism - Duration of stay

Figure 4.9 shows the duration of the respondents stay period abroad as a medical tourist. 46% of the respondents stayed for one month, 33% stayed for less than one month and 21% of the respondents stayed for more than one month.

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7. What was your total expenditure budget for the entire stay period?

Figure 4.10 - Medical Tourism - Total expenditure budget

Figure 4.10 depicts the total expenditure budget of the respondents for their entire stay period abroad as a medical tourist. For 42% of the respondents it was USD 10,000, for 38% of the respondents it was more than USD 10,000 and for 20% of the respondents it was less than USD 10,000.

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8. Did you travel alone or with a companion?

Figure 4.11 - Medical Tourism - Traveling

Figure 4.11 shows whether the respondents traveled alone or were accompanied with a companion. A whooping number of respondents (79%) travelled along with a companion and only 21% opted to travel alone.

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9. Did you or your companion do any tourism such as site-seeing, shopping, fine-dining or enjoying the local culture?

Figure 4.12 - Medical Tourism - Performed tourist activities

Figure 4.12 shows whether the respondents and/or their companions engaged in tourism activities such as site-seeing, shopping, fine-dining or enjoying the local culture. Results from the survey show that a huge majority of the respondents (97%) were involved in tourism activities and only a small number of respondents (3%) did not partake in any extra activities.

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10. How would you rate the hospital you received medical care at?

Figure 4.13 - Medical Tourism - Hospital rating

Figure 4.13 shows how the respondents rated the hospital they received medical care at. Results from the survey show that 48% of the respondents rated the hospital as very good, 36% of the respondents rated the hospital as excellent and a small number of the respondents rated the hospital as average (9%), below average (4%) and poor (3%).

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11. Did you use a medical tourism facilitator (a company that was an intermediary and helped coordinate your care)?

Figure 4.14 - Medical Tourism - Facilitator used

Figure 4.14 shows whether the respondents used a medical tourism facilitator to help coordinate with care. 45% of the respondents gave an affirmative response whereas 55% of the respondents didnt use the services of a medical tourism facilitator.

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12. How helpful did you find the medical tourism facilitator?

Figure 4.15 - Medical Tourism - Facilitator service rating

Figure 4.15 shows how the respondents rated the services of their medical tourism facilitator. Results from the survey show that 21% of the respondents rated the facilitator as Extremely Helpful, 19% of the respondents rated the facilitator as Helpful and a small number of the respondents rated the facilitator as Somewhat Helpful (3%) and Not Helpful (2%).

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13. Was there a language barrier or communication problem at the hospital?

Figure 4.16 - Medical Tourism - Communication problem

Figure 4.16 shows whether the respondents faced any language barrier or communication problem at the hospital. A whooping number of respondents (82%) didnt face any communication problems at all. However, 15% of the respondents faced occasional problems, but that did not significantly affect their experience whereas 3% of the respondents felt significant language barrier which also affected their experience.

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14. Do you feel the service you received was more personalized compared to your country?

Figure 4.17 - Medical Tourism - Personalized service

Figure 4.17 shows whether the respondents received more personalized service compared to their country. Results from the survey show that a huge number of respondents (94%) gave an affirmative response whereas only a small number of respondents (6%) didnt find the service they received being more personalized compared to their country.

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15. Were you concerned about medical malpractice and the possibility of having to sue in a foreign country in the event of an adverse result?

Figure 4.18 - Medical Tourism - Malpractice concern

Figure 4.18 demonstrates whether the respondents were concerned about medical malpractice and the possibility of having to sue in a foreign country in the event of an adverse result. Results from the survey show that 49% of the respondents were concerned; for 36% of the respondents it was a matter of small concern and 15% of the respondents were not concerned at all. This shows the confidence level of tourist in the services they are being offered and the overall system.

Farheen Banu Chapter 5 Summary of Findings, Conclusion and Recommendations

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This chapter presents the synopsis of the findings of the research. Furthermore, this chapter also includes conclusions derived from the study and presents few recommendations related to the field of medical tourism. The substantial results of the research have been generalized. They are analyzed according to the theoretical knowledge concerning basics of medical tourism.

5.1. Summary of Findings

People seek medical tourism for various reasons. For many cost is the key factor, for others convenience and quality of healthcare service are the leading aspects. People are drawn to certain countries because they have some of the most high-esteemed hospitals and proficient healthcare professionals. Presently, the most sought-after purpose for medical tourists who seek treatment abroad is for cosmetic surgeries and for procedures which are often significantly cheaper in a foreign country. This is especially true for US, Western European patients and GCC Arabs.

For numerous medical tourists, the availability and ease of access to certain medical procedures and treatments is an extremely important consideration.

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Moreover, the quality of healthcare treatment and services being offered at a destination is also deemed to be of great significance and value.

Advance and sophisticated technology in combination with contemporary medical science and the capacity and capability to provide a high success rate and a pleasing and satisfying overall experience are fundamental components for the development and popularity of a top sought-after medical tourism destination.

Planning for medical tourism can certainly prove to be a challenging task for a prospective medical tourist. It involves vital arrangements, such as locating reliable providers, ensuring hassle-free travel arrangements and having a complete understanding of any pre-operative and post-operative requirements, amongst many others.

For many patients, using a facilitator is more suitable and convenient rather than planning on their own. Facilitators have crucial experience in the medical tourism field and are able to offer expert advice and are capable of proficiently handling patients concerns and queries. They can also offer support with logistics and travel plan arrangements. Moreover, another added advantage of using the services of medical facilitators is that patients might be able to obtain lower rates from clinical programs abroad rather than if they approached directly.

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The health care industry is one of the world's largest and fastest-growing industries. The medical tourism industry can be a product for any country. However, numerous nations have significantly benefited from this business more than others.

Generally, Medical Tourism is a fairly new concept, where two essential service industries are coming together to catch the attention of people who are seeking healthcare services located out of their own country. Moreover, attractive tourism packages make the entire offer more appealing to people who plan to travel for their healthcare treatment.

5.2. Conclusion

Medical tourism is frequently recognized as an industry where developing countries, such as India, possesses enormous potential due to their relative advantage based on providing outstanding treatments at low prices along with attractive resorts for the period of recovery. Hence, the added benefit of a luxurious vacation and recovery in an exotic locale are also part of the appeal.

A blend of three key factors quality, availability and cost has been vital in fuelling the exceptional growth observed in the medical tourism industry.

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Nations offering Medical Tourism are increasingly dedicated to providing top-notch services at affordable prices. Sophisticated and superior healthcare services are now easily available without compromising on the quality and standards of the medical treatment and care.

Medical tourism is not only beneficial to international patients; it also presents a broad range of benefits to numerous other industries such as the pharmaceutical industry, travel and tourism sector, commercial sector, amongst others.

Both positive and negative impacts of medical tourism on healthcare, economic, social and environmental sectors generates opportunities and challenges for this budding industry which in turn also requires organized and effective mutual work between various stakeholders associated with the medical tourism industry.

Overall, medical tourism is considered to have a positive impact directly due to improvements in the health care system within a country, and indirectly because of all the new related economic activity that is generated and the prospects for growth are immense.

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Numerous

governments

and

service

providers

have

promptly

acknowledged and recognized the prospects and potential of medical tourism and are using firm schemes to structure it as a key revenue generator for their countries' economies. Many developing countries are pursuing medical tourism as an economic growth strategy.

Three players dominate the medical tourism sector, namely Tour Operators Hotels Hospitals and medical centers

Medical tourism is expected to boost further over the next decade as more individuals are able to access the Internet and obtain information related to medical care being offered world-wide at an affordable price within their budget.

The following Table 5.1 - summarizes the impact of medical tourism on a countrys economic growth.

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Table 5.1 Economic impact of medical tourism on a nation Directly Related to Product: The revenue that is generated from medical tourists who are traveling to the host country for their treatment and healthcare requirements goes into developing and building the nations healthcare system and tourism infrastructure. Indirectly Related to Product: Since medical tourism is associated with various other types of businesses, the revenue generated also ultimately aids these other sectors indirectly as well. While this practice mainly promotes the healthcare and housing industries, the service and leisure industries also profit immensely. Not Related to Product: Medical tourism industry offers extensive results and provides a substantial increase in the nations economic health on the whole. Revenue generation associated with this industry aids in increasing the countrys Gross Domestic Product (GDP). This consequential growth supports the development of the countrys infrastructure and its residents quality of life. Related to Process: Revenue generation associated with this industry is expected to promote further expansion and improvement of the related infrastructure. Development of the healthcare system, as well as the travel and tourism infrastructure, will overall benefit the country and its citizens.

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5.3. Recommendations

The term Medical Tourism is often switched and exchanged with other terms such as 'Medical Travel', 'Health Travel', 'Healthcare Travel', 'Health Tourism' and 'Global Healthcare'. This results in a conceptual confusion and hence hinders the growth of the medical tourisms industry by inconsistent, confusing terminology and conceptual intermingling.

There is an immediate need to establish clear, reliable and consistent definition worldwide. Furthermore, cultural barriers and language, including medical terminology, may be challenging even with the aid of interpreters. Severe error and confusion may arise between the patient and the provider. It is imperative that both the parties should share amongst each other all the essential information before starting the procedure in order to obtain quality outcomes.

Furthermore, another matter of concern is the quality of the hospitals environment. Medical tourists should cautiously evaluate the quality and the standards that they expect and have been promised. This evaluation should take account of the environment and atmosphere outside the hospital. In some countries the quality of water and air, as well as hygienic standards, may be quite different from patients' expectations and may hinder their period of recovery.

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One of the enormous challenges faced by the medical tourism industry is to reach prospective patients by creating marketing strategies that will effectively extend to those who require medical attention and are eager to learn about receiving medical treatment in a foreign country.

Medical tourism marketers need to capitalize on/promote their true medical specialties. Medical facilitators should function actively in tackling this challenge. This can be done by creating and launching effective marketing campaigns in order to gain prospective benefits of this industry.

Additionally, facilitators should offer services that are attractive and tempting to international patients. Facilitators should be capable of offering all the assistance and support that a traveling patient needs and must do everything on behalf of the patient.

Facilitators should also focus on developing relationships with other key industry players to create mutually beneficial joint ventures. This will help in promoting business opportunities for local companies who are engaged in activities related to medical tourism.

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There are some obstacles in promoting medical tourism in developing countries. International regulations and international standards for accreditation and licensing are problems around which countries will have to navigate.

Countries should establish regulatory boards for monitoring the standard of care in their hospitals and the professional quality of their medical practitioners when possible.

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Bibliography

Books / Periodicals

Connell, J. (2006) Sun, Sea, Sand &Surgery. Tourism Management, School of Geosciences, University of Sydney, Australia.

Connell, J. (2011) Medical Tourism. Wallingford: CABI.

Cortez, N. (2008). Patients without borders: The emerging global market for patients and the evolution of modern health care. Indiana Law Journal, 83, 1-24.

Donnelly, L., & Sawer, P. (2007). Record numbers go abroad for health, The Telegraph.

Gopal, R. (2008).The Key Issues and Challenges in medical tourism sector in India (A Hospital Perspective). Presented at the Conference on tourism in India-Challenges Ahead.

Herrick, D.M. (2007). Medical tourism: Global competition in health care. Dallas, TX: National Center for Policy Analysis.

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Jones, C.A., & Keith, L.G. (2006). Medical tourism and reproductive outsourcing: the dawning of a new paradigm for

healthcare. International Journal Fertility Women's Medicine, 51, 251255.

MacReady,

N.

(2007).

Developing

countries

court

medical

tourists. Lancet, 369, 1849-1850.

Medical tourism association. (2008). www.medicaltourismassociation.com/

Nautiyal S. & Dogra S. (2005). Medical tourism set to take off in a big way. Pharma Pulse Express: Indias No. 1 Weekly For The Pharmaceutical Industry, Mumbai/New Delhi.

Ramrez de Arellano, A. B. (2007), Patients without borders: the emergence of medical tourism. International Journal of Health Services, 37, 193-8.

Terry, N.P. (2006). Under-regulated health care phenomena in a flat world: Medical tourism and outsourcing. Western New England Law, 26, 421-426.

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Timmermans, K. (2004), Developing countries and trade in health services: which way is forward? Int J Health Serv, 34, 453-66.

Turner, L. (2007), 'First World Health Care at Third World Prices': Globalization, Bioethics and Medical Tourism. BioSocieties, 2, 303-325.

Electronic Resources

http://en.wikipedia.org/wiki/Medical_tourism http://www1.american.edu/ted/medical-tourism.htm http://www.drprem.com http://www.frost.com/prod/servlet/cpo/175354611 http://www.growthconsulting.frost.com http://www.investopedia.com/terms/e/economicgrowth.asp http://www.medicaltourismassociation.com http://www.medicaltourismmag.com http://www.merinews.com/article/medical-tourism-and-its-impact-on-ourgdp/130884.shtml

http://www.nursingworld.org http://www.reportlinker.com/p0349309/Booming-Medical-Tourism-in-India.html

Medical Tourism - Survey Questionnaire As part of the evaluation of the impact of Medical Tourism, please complete the following questions. Information will be treated confidentially. Please be objective all comments will be taken into account. I. General Questions (Please choose one answer only and mark the appropriate boxes with) GENDER: M F AGE: 18 29 years 30 49 years 50 64 years 65 and Above NATIONALITY: ASIAN EUROPEAN AMERICAN AUSTRALIAN AFRICAN MID-EASTERN GCC ARAB OTHER:

II. Questions related to Medical Tourism (Please choose one answer only and mark the appropriate boxes with) 1. How did you find out about medical tourism (travelling internationally for medical care)? Internet Newspaper, Magazine, Book TV, Radio My Doctor Friend Other conferences

2. How did you research your information for medical tourism on country destinations and hospitals? Internet Magazines, Books Medical Tourism Facilitator Asked a Friend Other Page 1 of 4

Medical Tourism - Survey Questionnaire

3. How many times have you travelled as a medical tourist? Once More than once

4. What motivated you in deciding to travel for medical purpose? Lower costs Access to alternative/different services Medical procedure combined with relaxation/leisure Better quality services

5. What type of procedure did you travel for? Cosmetic procedures Surgical or invasive procedures Preventive services Medical spa services Rehabilitation Elective procedures

6. What was the duration of your stay period? Less than one month One month More than one month

7. What was your total expenditure budget for the entire stay period? Less than USD 10,000 USD 10,000 More than USD 10,000

8. Did you travel alone or with a companion? Alone Companion

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Medical Tourism - Survey Questionnaire

9. Did you or your companion do any tourism such as site-seeing, shopping, fine-dining or enjoying the local culture? Yes No

10. How would you rate the hospital you received medical care at? Excellent Very Good Average Below Average Poor

11. Did you use a medical tourism facilitator (a company that was an intermediary and helped coordinate your care)? Yes No

12. How helpful did you find the medical tourism facilitator? Extremely Helpful Helpful Somewhat Helpful Not Helpful Not Applicable

13. Was there a language barrier or communication problem at the hospital? Not at all Occasional problems, but did not significantly affect my experience Yes, significantly affected my experience

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Medical Tourism - Survey Questionnaire

14. Do you feel the service you received was more personalized compared to your country? Yes No

15. Were you concerned about medical malpractice and the possibility of having to sue in a foreign country in the event of an adverse result? Yes, I was concerned I was not concerned at all It was a small concern

FURTHER COMMENTS / OPINIONS

Thank you very much for taking the time to fill out this survey!

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