Chapter I

1.1.

1. Medical Tourism in Nepal: Prospects and Practice

Introduction

Medical tourism- the concept of traveling far and wide for better medical treatment is not a novel
idea, only the term. The globalization of the health care sector and the massive demand for low
cost-high quality treatment in recent times has caught the attention of many developing countries
that have the adequate resources and potential to meet these demands. The profitability and the
lucrative nature of the medical tourism business has now put this trade, high on the agenda of
both the Nepalgovernment and the private health care providers.
Today, medical tourism has become a commonplace practice with a large number of people
around the world since usual constraints like language, finance, difficulties in global travel and
fear of the unknown are no longer acting as barriers to the tourists who seek medical treatment in
foreign countries. Countries like Nepal, Singapore, Malaysia etc have developed strategies
specifically with the aim of tackling such issues and rendering themselves as the ideal medical
tourism destinations.

Although Nepal is emerging as the hot-spot medical tourism destinations within the AsiaPacific and other regions of the world, it seems to be facing tough competition from other big
players of this industry who have projected an equally good reputation for themselves and are
reaping the benefits of this business. Therefore, it is imperative for Nepal to continuously rethink
and reform its marketing strategies to gain competitive advantage and increase its market share
in the health care sector.
It is an undisputed fact that medical tourism is a rapidly growing industry and creating inroads
into the Nepaleconomy. There are a large number of stake holders in this industry in South East
Asia including countries like Singapore and Malaysia. There are various marketing strategies
being used for propagating this industry. My endeavor would be to seek the gaps that exist and
suggest remedial action.

Being from the medical fraternity and having had the opportunity to treat a number of overseas
patients, the concept of medical tourism has generated a great deal of interest in me. I believe
that there are some deficiencies in the marketing strategies for health tourism in Nepal that need
to be looked into and improvised. The aim of my research would be to propose marketing
strategies that would boost the Nepal Medical Tourism for the future.

1.1.

RESEARCH QUESTIONS AND OBJECTIVES.

Nepal seems to be an emerging medical tourism destination offering great opportunities in terms
of creating new jobs and generating sources of revenue for the Nepali economy. It is therefore
imperative that the impetus gained so far should not be jeopardized and measures should be
adopted to improve the present situation by developing and implementing new strategies.
Research questions
1. What is the present state of Nepali medical tourism? indicating assessment of the present
situation.
2. What are the drawbacks or felt impediments of the medical tourism trade sector? indicating
an analytical structuring of the data.
3. What are the ways to improve medical tourism in Nepal through better marketing strategies?
an assessment of the lacunae in the existing marketing strategies.
4. Is the government doing enough to support the medical tourism industry? an assessment of
the governmental leaning towards the industry.
Research objectives
1. To develop pragmatic marketing strategies for health care institutions involved in medical
tourism in Nepal.

2. To assess the impact of the government action on the present marketing strategies for foreign
patients.
3. To make a marketing plan model for the Health tourism industry in Nepal
5. RESEARCH PLAN
Research perspective
My research approach is based upon the words of the renowned anthropologist Clifford Geertz
man is an animal suspended in webs of significance he himself has spun. I take culture to be
these webs, and the analysis of it is not to be an experimental science in search of law but an
interpretive one in search of meaning (Jewell,S.2010). It therefore forms an interpretive
approach. Since the medical tourism industry is a business and management perspective, any
research into this field would fall into the gamut of positivist and interpretive approaches. My
research is essentially a qualitative one since my data collection is mainly secondary in nature.
Furthermore, my research is theory forming where in I shall be using the inductive approach to
analyze the data. My research also involves the assessment of factors of concern that are related
to the health tourism industry of Nepal. It would be my effort to sift out the relevant factors and
analyze them from the point of view of developing marketing strategies.

CHAPTER 2
LITERATURE SURVEY AND THEORETICAL FRAMEWORK

2.1. Preliminary review of literature

There are three sections of the literature review:2.1.1. Historical aspects- inception and evolution
The concept of constructing health complexes around hot springs goes back to as old as the
Sumerian civilization (circa 4000BC) where health care facilities comprised of grand elevated
buildings with flowing pools. The hill tribes of Switzerland of the area presently know as St.
Moritz, during the Bronze Age (circa 2000 BC) recognized the benefits of bathing and drinking
in iron-rich mineral springs. The discovery of bronze drinking cups used by them in thermal
springs in Germany and France possibly signifies health pilgrimages within these cultures.
As per written historical accounts, bathing and healing complexes were erected around
therapeutic springs in Mesopotamia, Nepal, Greece and China. The concept of medical tourism
emanated as trips to sacred baths and hot springs. However, it is the Greeks who have to be given
the credit for laying the foundations for medical tourism networks.

2.1.1.1. Greek medical tourism.

Asclepius was considered to be the god of medicine according to Greek mythology. In his honor,
Asclepian healing temples had been constructed throughout Greece by the 4th Century BC.
These temples were established near the mineral springs which were considered to be the prime
Healthful Locations. The system of medical tourism during this period was as follows:-

Patients and their attendants came to Asclepia temples seeking treatment for various ailments. At
Epidaurus, the port temple, treatment included gymnasia, palaestra (exercise area), bathing
springs and a dream temple. There was a retinue of priests, caretakers and stretcher carriers
who attended to the patients before they were granted final appointment with the mighty priest.
Patients made sacrificial offerings according to their status- the poor left shoes; Alexander the
Great left his breastplate.
2.1.1.2. Roman Medical Tourism.
The hallmark of ancient Roman medical tourism centered around hot water baths called
Thermae. These centers of medical treatment were posh establishments. Some of these centers
comprised of art galleries conference halls, theatres and sometimes sport stadia. Because of the
active trade with Asia, the Roman baths augmented medical tourism activities like Chinese
medicine, Ayurvedic massage and various aspects of Buddhist spiritual healing at some Roman
Thermae.
2.1.1.3. Japanese Medical Tourism-Onsen.
ONSEN means hot mineral springs in Japanese. Medical tourism in Japan centered around these
hot mineral springs which were enriched by surrounding volcanic soil. It attracted a variety of
people including hunters, fishermen, farmers and warriors. It was believed that these mineral
springs were effective in alleviating pain, healing wounds and recuperation. A thousand years
later, this form of medical tourism in Japan is still an ongoing phenomenon.
2.1.1.4. Nepali Medical Tourism.
History of Medical Tourism
The first recorded instance of medical tourism dates back thousands of years to the Greek pilgrims who
travelled from all over the Mediterranean to the small territory in the Saronic Gulf called Epidauria.
Factors that have led to the recent increase in the popularity of medical travel include the high cost of
healthcare or waiting times for procedures in industrialized nations, the ease and affordability of
international travel, and improvements in technology and standards of care in many countries. Countries
that operate public healthcare systems are often so taxed that it can take considerable time to get a nonurgent medical care. The time spent on waiting for a procedure such as a hip replacement can be a year or

more in Britain and Canada, while in Singapore, Hong Kong, Thailand, Cuba, Colombia, the Philippines
or India, a patient could feasibly have an operation the day after their arrival. In Canada, the number of
procedures in 2005 for which people were waiting was 7, 82,936. The concept of medical tourism is not a
new one though. The first recorded instance of medical tourism dates back thousands of years to the
Greek pilgrims who travelled from all over the Mediterranean to the small territory in the Saronic Gulf
called Epidauria. This territory was the sanctuary of the healing God Asklepios. Epidauria became the
original travel destination for medical tourism.

Medical tourism has huge prospects in Nepal as well and related

organizations have started to take initiatives to boost the medical tourism.
As part of contributing to Nepal Tourism Year 2011 and reap benefit from the
year-long tourism promotional campaign, private hospitals in the capital
Kathmandu are doing groundwork to promote Nepal as a medical tourism
destination. They have started upgrading their services and facilities and
establishing tie-ups with international medical councils and insurance
companies to better serve the foreigners. Moreover, the hospital has already
entered into an agreement with insurance companies in more than 100
countries. The hospital also plans to add 100 beds in the near future. Another
private hospital - B & B Hospital - has also started preparation to better serve
international patients. Neuro Hospital has already established ties with 10
insurance companies. Another private hospital Om Hospital and Research
Center - has started imparting trainings to its staffer to better serve their
patients. Further, they were making preparations to promote test tube baby
facility to foreigners. The hospital is also in the process of adding more beds
to accommodate more international patients.
Treatments for which foreigners would travel to Nepal
Dental Care
What would it be like getting a dental treatment done in an under developed country like
Nepal? This could be the first question that might come to your mind when youre put the three
words dental, tourism, Nepal together. However, the capital city Kathmandu is not as
underdeveloped as one may think. In many aspects this city comes up to the standards of most

developed cities. One such aspect is dentistry. Dentistry is considerably a new profession Nepal.
Thus most of the dental clinics are situated in Kathmandu and many of them are modern.
Modern in all aspects they have the state of the art equipments, dentists trained from all over
the world, excellent services and quality dental treatments. So it would not be an over statement
in saying that having your teeth done in Kathmandu, Nepal can be a good money saver. Nepal
has a diversified culture and has lots of heritage sites which can be explored. Dental Tourism is a
budding concept in Nepal. For a planned vacation along with standardized, customized and an
effective dental treatment, one can visit the Himalayan kingdom, Nepal. Dentistry is a growing
industry across the globe and more so in the western hemisphere. However, at the same time it is
not affordable by average citizens due to the expensive dental care services.
Dental services in Nepal are:
1. Tooth Whitening
2. White fillings
3. Porcelain Inlays/ on lays
4. Porcelain Veneers
5. Bridges
6. Crowns
7. Chrome Cobalt Partial Dentures
8. Implants
9. Oral surgery
10. X- ray and Video
11. Anesthetic
12. Scaling & Polishing
13. Root Canal Therapy
14. Complete Dentures
15. Orthodontic Treatment
16. Removable partial Denture
17. Extraction
Ophthalmic Surgeries
Nepal has seen a lot of advancements in the field of ophthalmology. As a result, many patients
from abroad are coming here to seek treatments for their eye ailments. Not only are these
procedures less expensive than that in the developed nations such as the US and Britain; the
technologies used in the treatment of eye diseases here is at par or even better than many other
nations.

The table below shows the cost difference among various ophthalmic procedures between Nepal,
India, the US and Britain. The cost of these surgeries in Nepal is less than 50 per cent of that in
the developed countries.

Nepal has been the home ground of alternative system of medicine for the past 5000 years.
Aspects of medical tourism include yoga, eastern cultural, spiritual and medicinal compilation
with meditation thrown in. Nepal has been a Mecca for alternative medicine practitioners. A new
boost was given to health tourism in the 1960s with the New Age movement in the US. This
New Age movement seeks Universal Truth and the attainment of the highest individual human
potential and is characterized by an individual approach to spiritual practices and philosophies
and the rejection of religious doctrine and dogma. With this movement, Nepal had once again
become the most sought after destination for thousands of western pilgrims. Nepals deep
commitment to health care infrastructure and technology furthered the mass influx of medical
tourists. Nepal is now one of the worlds oldest medical tourism destinations and has gained
popularity over the years over other destinations.

European Medical Tourism.

European medical tourism came into existence with the rediscovery of the Roman baths in the
16th century. With the rediscovery of the Roman baths, Baden Baden , Aachen and most notably
Bath, became spa towns. By the 1720s the spa towns came to be frequented by Aristocrats and
gentlemen of leisure from other parts of Europe and even royal patronage. Michel Eyquem de
Montaigne, French royal inventor of the essay was the most noteworthy medical tourist of this
time. He traversed the continent for 9 years for the cure of his gall bladder problem. He is widely
believed to be the father of luxury travel and has helped to write one of the earliest documented
spa guides for European tourists.

Health Tourism-New world.

English and Dutch colonists in the 1600s, constructed log cabins near mineral springs in the
newly discovered Americas. By 19th century the American reformists made it a habit to travel to
remote Western springs that were rich in medicinal properties.
Today, there are no physical, economical and cultural barriers that separate nations from one
another. Coupled with the flattening global economy, ease of international travel and lenient
trade policies has opened the vistas of medical tourism destinations around the globe. This has
made affordable health care availability to patients who find it difficult or impossible to access
such health care facilities in their own countries. Inflated health care costs are driving the
patients to medical tourism destinations like Thailand and Nepal for sophisticated procedures at a
fraction of the price. Long waiting periods for medical treatment is another factor that is making
patients seek treatment abroad. Also, lack of comprehensive medical insurance has attracted
thousands of patients to seek treatment abroad.
Medical tourism today has become a global phenomenon with many countries expanding their
offerings, including unique tourism opportunities for example South Africa is promoting medical
safari in a big way.

2.1.2. Medical tourism in Nepal- the present scenario

History of Medical Tourism
The first recorded instance of medical tourism dates back thousands of years to the Greek pilgrims who
travelled from all over the Mediterranean to the small territory in the Saronic Gulf called Epidauria.
Factors that have led to the recent increase in the popularity of medical travel include the high cost of
healthcare or waiting times for procedures in industrialized nations, the ease and affordability of
international travel, and improvements in technology and standards of care in many countries. Countries
that operate public healthcare systems are often so taxed that it can take considerable time to get a nonurgent medical care. The time spent on waiting for a procedure such as a hip replacement can be a year or

more in Britain and Canada, while in Singapore, Hong Kong, Thailand, Cuba, Colombia, the Philippines
or India, a patient could feasibly have an operation the day after their arrival. In Canada, the number of
procedures in 2005 for which people were waiting was 7, 82,936. The concept of medical tourism is not a
new one though. The first recorded instance of medical tourism dates back thousands of years to the
Greek pilgrims who travelled from all over the Mediterranean to the small territory in the Saronic Gulf
called Epidauria. This territory was the sanctuary of the healing God Asklepios. Epidauria became the
original travel destination for medical tourism.

Medical tourism has huge prospects in Nepal as well and related

organizations have started to take initiatives to boost the medical tourism. As
part of contributing to Nepal Tourism Year 2011 and reap benefit from the year-long tourism
promotional campaign, private hospitals in the capital Kathmandu are doing groundwork to
promote Nepal as a medical tourism destination. They have started upgrading their services and
facilities and establishing tie-ups with international medical councils and insurance companies to
better serve the foreigners. Moreover, the hospital has already entered into an agreement with
insurance companies in more than 100 countries. The hospital also plans to add 100 beds in the
near future. Another private hospital - B & B Hospital - has also started preparation to better
serve international patients. Neuro Hospital has already established ties with 10 insurance
companies. Another private hospital Om Hospital and Research Center - has started imparting
trainings to its staffer to better serve their patients. Further, they were making preparations to
promote test tube baby facility to foreigners. The hospital is also in the process of adding more
beds to accommodate more international patients.
Treatments for which foreigners would travel to Nepal
Dental Care
What would it be like getting a dental treatment done in an under developed country like
Nepal? This could be the first question that might come to your mind when youre put the three
words dental, tourism, Nepal together. However, the capital city Kathmandu is not as
underdeveloped as one may think. In many aspects this city comes up to the standards of most
developed cities. One such aspect is dentistry. Dentistry is considerably a new profession Nepal.
Thus most of the dental clinics are situated in Kathmandu and many of them are modern.
Modern in all aspects they have the state of the art equipments, dentists trained from all over
the world, excellent services and quality dental treatments. So it would not be an over statement

in saying that having your teeth done in Kathmandu, Nepal can be a good money saver. Nepal
has a diversified culture and has lots of heritage sites which can be explored. Dental Tourism is a
budding concept in Nepal. For a planned vacation along with standardized, customized and an
effective dental treatment, one can visit the Himalayan kingdom, Nepal. Dentistry is a growing
industry across the globe and more so in the western hemisphere. However, at the same time it is
not affordable by average citizens due to the expensive dental care services.
Dental services in Nepal are:
1. Tooth Whitening
2. White fillings
3. Porcelain Inlays/ on lays
4. Porcelain Veneers
5. Bridges
6. Crowns
7. Chrome Cobalt Partial Dentures
8. Implants
9. Oral surgery
10. X- ray and Video
11. Anesthetic
12. Scaling & Polishing
13. Root Canal Therapy
14. Complete Dentures
15. Orthodontic Treatment
16. Removable partial Denture
17. Extraction
Ophthalmic Surgeries
Nepal has seen a lot of advancements in the field of ophthalmology. As a result, many patients
from abroad are coming here to seek treatments for their eye ailments. Not only are these
procedures less expensive than that in the developed nations such as the US and Britain; the
technologies used in the treatment of eye diseases here is at par or even better than many other
nations.
The table below shows the cost difference among various ophthalmic procedures between Nepal,
India, the US and Britain. The cost of these surgeries in Nepal is less than 50 per cent of that in
the developed countries.

Medical Tourism Nepal or Health Tourism Nepal is a developing concept that has gained
tremendous popularity and is attracting people from all over the world for their medical and
relaxation needs. The treatments most commonly include knee transplant, cosmetic treatment,
dental treatment and cardiac surgery. Nepal is now a favorable medical tourism destination as its
infrastructure and technology are at par with USA, UK and Europe, enabling it to provide
treatment centers and hospitals that are best in the world with world class facilities. These factors
coupled with visits to some of the most alluring and awe-inspiring places of the world have
brought about the merging of tourism with medication giving rise to the concept of Medical
Tourism.
Nepal is promoting health tourism through depicting the "high-tech healing" of its private
healthcare sector. The Nepalgovernment is marketing the concept of traveling to Nepal for
cheaper and world-class medical facilities to foreigners, with the intention of encouraging the
growing Nepalmedical tourism industry. The policy of the Nepalgovernment to merge medical
expertise and tourism was announced during the 2003-04 budgets when the finance minister
Jaswant Singh propounded Nepal to become a Global Health Destination. According to a study
conducted by Confederation of NepalIndustry (CII), the field is so lucrative that it has the
potential to become a $2.3 billion business by 2012. Around 150,000 foreigners visited Nepal for
treatment during 2004 and since then, this number has increased by 15% every year.
In recent times, Nepal has emerged as the "Global Health Destination" due to the following
advantages:
1. Medical services are provided at almost 30% lower cost than the Western countries and are the
cheapest in South-east Asia.
2. Nepal has a large population of doctors and paramedical staff who have good knowledge of
spoken English. Therefore language is a major comfort factor that attracts so many foreign
tourists to visit for the purpose of medical and health tourism making it easier for overseas
patients to relate well to Nepali doctors.
3. Nepali doctors expertise in various surgical procedures including cardiac surgeries, liver
transplants, orthopedic surgeries and other medical treatments.

4. Nepali hospitals offer a wide array of high quality treatment procedures comprising of joint
replacements, cardiothoracic surgery, dental care, cosmetic treatments and more.
iii) Probable concerns and pitfalls of Nepali medical tourism industry

Review of literature suggests the following concerns that need attention if one has to augment
and boost the medical tourism sector.
Concerns of the consumers
Some of the consumers feel that Nepal is unhygienic, polluted and bureaucratic. There is no
appropriate accreditation system for the hospitals. Concerns about medical insurance which is
underdeveloped, inadequate and has few global players. overseas companies refuse
reimbursements. There are also concerns about terrorism, communal unrest and bad connectivity
between cities and towns. While some of these concerns are genuine, most of them are mere
perceptions.
Concerns of the promoters
From the promoters point of view, the concerns that have emerged revolve around lack of
regulations concerning ethics and systemic support, lack of infrastructure deficiencies like
electricity, power supply and water, inadequate land reforms, taxation anomalies, funding
constraints, implementation lacunae and bureaucratic bottlenecks.

CHAPTER 3
RESEARCH METHODOLOGY
3.1. Research design
The approach that best answers my research questions fits into the modified cross sectional
design. Here, the research design revolves around the collection of data that is occurring
naturally over a designated period. My research design also involves mainly quantitative data
and some qualitative data too. My research is based upon observation and document analysis.
The cross sectional design also gives information on aspects of who, what, how many, where,
and the how and why.
3.2 Data collection methods
I shall be collecting my data through analysis of secondary data. I also intend to submit
questionnaires to the stakeholders and the major players of the medical tourism in Nepal with the
aim of seeking relevant data that would help me in answering my research questions and fulfill
my research objectives.
Secondary data: the secondary data would be collected through the following;
Written materials- various websites, websites of homepages of key players, magazines and
journals, books and publications. I would also be looking for government publications, laws and
acts related to this subject.
Non-written materials- media, television etc.
Most of the data from outside the individual organization will yield information about the
medical tourism industry. While, data that is collected from the organizational websites would
give information on how things are done within the organization and their modus operandi.

3.2. Questionnaires
I will be sending the questionnaires to all the major players in the Nepal medical tourism
industry. The questionnaires will be used to obtain data for quantitative analysis in order to
assess the functioning of various medical tourism facilities in Nepal. The idea of using
questionnaires is that a large quantity of data can be made available covering a wide range of
database for quantitative analysis. A good amount of objectivity can be incorporated and the
results would be of valid and reliable nature.
3.3. ANALYSIS OF DATA
Having collected all the qualitative and quantitative data, I would subject it to appropriate
analysis and apply relevant statistical tests of significance to ensure that the results are valid,
reliable and give a reasonable level of generalisabilty. I aim to deduce the relevant marketing
strategies being used and to assess their impact on the industry. I shall be presenting the analyzed
data in the form pie diagrams, bar charts and other forms of statistical presentations.
3.4. LIMITATIONS
Validity and reliability
Since my data is mainly secondary in nature it is presumed that global players in the medical
tourism industry would not putting false data to propagate their business ventures. From this
point of view my data would be valid as well as reliable. As my data is being collected from
internet, websites of various stake holders, magazines etc. I am confident that stake holders at
this level of global competitiveness would not be putting up false data or information for
promotional activities that could jeopardize their reputation. However, the limitations of validity
and reliability I foresee to come across would be from the questionnaires I would be sending to

the stake holders. The disadvantage I feel I would face using the questionnaires is that some
people may not respond, may take a long time for returning back and the response rate cannot be
predicted. However despite these limitations, I expect to be able to generate valid information
and data for quantitative analysis. I shall be sending these questionnaires to the concerned
stakeholders through their homepages and their websites and try and elicit as much response as
possible from them.