Module no.

Introduction to Medical Tourism

Q1. Define medical tourism and describe about the cost and quality of the
services rendered. What are the treatment types in medical tourism?

Definition:
According to Medical Tourism Association the Medical Tourism is where people who live in one
country travel to another country to receive medical, dental and surgical care while at the same
time receiving equal to or greater care than they would have in their own country, and are
traveling for medical care because of affordability, better access to care or a higher level of
quality of care.

Cost of medical tourism:

Medical tourism generally involves transporting patients from developed countries to
developing countries where they can get treated at lower expense. These patients do not
necessarily belong to the highest social bracket in their own countries, but they (and their
insurers) generally have greater purchasing power than most patients in the destination
countries. Most developing country governments see medical tourism as an opportunity to
generate more national income and therefore support it strongly. For people who wish to
benefit from abroad health services, cost is the most critical factor for their decision. In light of
this, the employers and insurance companies, particularly in developing countries, are trying to
lower the treatment costs. Medical tourism has emerged as a multi-dollar market encouraging
many countries to provide best medical care at very low prices compared to countries like US.
A broad overview of difference in costs of various types of treatment in different countries can
be concluded from the following table. It is obvious that countries promoting medical tourism
give cost cutting in the range of 30 to 70% compared to the countries that do not.

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Source of the information in the table: Lunt N, Smith R, Exworthy M, Green ST, Horsfall D,
Mannion R. Medical Tourism: Treatments, Markets and Health System Implications: A scoping.

Quality in medical tourism:

Patient satisfaction with provided services is used as an indicator of health care quality. Patient
satisfaction as a key factor of health services quality, an important criteria for performance-
based payment, and a health policy is emerging worldwide.

The construct of quality as conceptualized in the service literature and as measured by

“SERVQUAL” involves perceived service quality. The SERVQUAL model defined perceived quality
as the customer’s judgment about an entity’s overall excellence or superiority. Another
approach stated that quality is whether the customer perception has met his/her expectation
or not. This is in strict conformance with the models in the literature on service quality, which
describes it as the ability to consistently meet external an internal customers’ needs, wants and
expectation involving procedural and personal encounters. A further review of literature

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reveals that service quality has been described by various researchers as a form of attitude,
related but not equivalent to satisfaction, which is reflected in the gap between expectations of
customer and service providers’ performance. According to the proposed model, service
providers must be concerned with four characteristics of services which are:

 Intangibility:
Intangible services are performances and experiences rather than objects and intangibility
means that the buyers normally cannot see, feel, smell, hear or taste a service before they
conclude an exchange agreement with a seller

 Perishability:
Because of service’s perishability service providers neither can ‘keep’ nor ‘store’ the service
because it has to be consumed or encountered on the spot

 Inseparability:
The inseparability aspect of services means customers can never separate the service provider
from the service itself.

 Heterogeneity:
This variability of service performance occurs at various levels.

 The quality of service performance varies from one service organization to another.
 The quality of service performance varies from one service performer to another;
 The quality of service performance varies for the same performer on different
occasions.

Types of treatments in medical tourism

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Treatments for medical tourists range from cosmetic, organ transplants, cardiac, and
orthopaedic treatments to dental and cardiac surgeries. Treatments also include spa, physical
and mental therapies.

Following are the medical treatments commonly marketed for medical tourism:

• Cosmetic surgery (e.g. breast augmentation, facelifts and liposuction)

• Dentistry (e.g. dental implants, dentures, crowns and whitening)

• Cardiology/cardiac surgery (e.g. bypass and valve replacement)

• Orthopaedic surgery (e.g. hip replacements, resurfacing, knee replacement and joint
surgery)

• Bariatric surgery (e.g. gastric bypass and gastric banding)

• Fertility/reproductive system (e.g. in vitro fertilization and gender reassignment)

• Organ, cell and tissue transplantation (e.g. organ transplantation and stem cell therapy)

• Ophthalmological procedures (e.g. laser eye surgery and lens implants)

• Diagnostics, check-ups and other treatments

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Q4. What is the status of medical tourism in India and steps taken to promote
India as a medical tourism destination?
The main government machinery behind tourism development is the Ministry of Tourism.
Indian Tourism industry recorded fluctuations, both cyclical and seasonal, in the arrival of
foreign tourist due to downturn. Industry of tourism is one of the most dynamically developing
sectors of economy. Tourism is the complex of relations, connections and phenomena,
accompanying a journey and stay of people in places which are not their permanent or
prolonged residence and unconnected with their labour activity. Medical tourism is a new kind
of tourism that has been speedily growing during the recent years. The term Medical tourism
describes tourists, who travel to overseas countries to obtain healthcare services and facilities
such as medical, dental and surgical care whilst having the opportunity to combine it with
visiting the tourist attractions of that country.
Medical tourism is the manifestation of globalization and booming on the basis of competitive
cost advantage as compared developed nations. Already in 2004, India has received 150,000
medical tourists and this number has grown by a whopping 33% by 2008 to 200,000 inbound
medical tourists. MT offers as an internationally competitive industry for emerging markets and
in particular for four Asian countries – Thailand, India, Malaysia and Singapore that are fast
developing players in the industry. It has been estimated that by the year 2015, India will
receive over half a million annual medical tourists and India’s medical tourism sector is
expected to experience an annual growth rate of 30%, making it a Rs. 9,500-crore industry by
2015.
Medical tourism is a growing sector in India. India’s medical tourism sector is expected to
experience an annual growth rate of 30%, making it a Rs. 9,500-crore industry by 2015.
Horowitz and Rosenweig (2007) have documented the countries like China, India, Israel,
Singapore, Malaysia, Philippines, United Arab Emirates, Argentina, Bolivia, Brazil, Colombia,
Costa Rica, Cuba, Jamaica, Mexico, Belgium and Hungary being medical tourism destination. In
India, the foremost service suppliers in health tourism are Apollo Hospitals, Escorts Hospital,
Fortis Hospitals, Breach Candy, Hinduja, Mumbai’s Asian Heart Institute, and Max Hospitals etc.
Moreover, AIIMs, a public -sector hospital is also within the fray. In terms of locations, urban

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centers like Chennai, Delhi and Mumbai cater to the most variety of health tourists and
quickly rising as medical tourism hubs. One-stop centres in key international markets help to
facilitate patient flow and stream lining immigration for health care are envisaged.
Consequently, with safety, trust and excellence, the CII, in conjunction with Indian Health Care
Federation (IHCF), needs to ascertain an Indian health care brand.

Table 1 Products offered

Countries Products/ Treatment offered Accreditation Affordable /Non-

Affordable countries

Thailand Kidney Transplant, Organ 37 Affordable

Transplantation, Heart Surgery,
Eye Surgery etc.

Singapore Heart Surgery, Hip and Knee 21 Affordable

replacement, Cancer Therapy
etc.

Costa Rica Plastic Surgery 2 Least Affordable

India Heart Surgery, Hip and Knee 22 Affordable

replacement, Cancer Therapy,
Cosmetic Surgery, Surrogacy
etc.

South Africa Cosmetic Surgery Zero Least Affordable

Hungary Breast Replacement and Hip 2 Affordable

Replacement, Tooth whitening
and dental implants

Malaysia Cosmetic Surgery 13 Affordable

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Korea Heart Bypass 30 Least Affordable

Mexico Cosmetic Surgery 9 Least Affordable

Gulf Cosmetic Surgery Least Affordable

Countries
181

Source: Indian Medical Tourism Association and JCI

As a locality of medical tourism industry, India has supported surrogacy and recognized as a
prominent destination for test tube babies. Over than these, India offers advanced internal
organ, pediatric, dental, cosmetic and orthopedic surgical services and ancient healing systems.
Hospitals conjointly advertise for preventive medical examination for companions of the
patient additionally to medicine services. Table 1 depicted the treatments offered by the India
and competitive countries. Table 2 illustrated the accreditation of hospitals and affordability
level of patients corresponds to different countries. Indian hospitals have 22 JCI accreditation
and having low priced products offered to medical tourists, therefore affordable very well. Gulf
countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and UAE) having 181 JCI accreditation in
all but not as affordable as desirable. That’s the reason that Indian hospitals attract a huge
number of gulf patients’. Affordability of Indian medical services has been confirmed the higher
competitiveness of Indian medical tourism over others.
During the recent years, Indian medical tourism is being endorsed as country providing world-
class treatment at third world cost abides by patients. India has been promoted for its cultural
heritage and scenic beauty and is being positioned as a heaven for medical tourists, those who
hunt for quality care at reasonable prices. With 50 million Americans without health insurance
and the waiting lists for state-run facilities often endless in the UK, Canada and Europe,
foreigners are increasingly flocking to India because it offers quality treatment at a fifth of the
cost abroad.

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Table 2 Cost Structure

Treatments USA India Korea Mexico Singapore Thailand Jorden

Heart Bypass $1,44,000 $8,500 $24,000 $20,000 $13,500 $24,000 $10,000

Heart valve $1,70,000 $1,200 $36,000 $30,000 $13,500 $22,000 $12,000

Replacement

Hip $50,000 $8,000 $16,450 $13,125 $11,100 $14,000 $8,000

Replacement

Hip $50,000 $8,000 $20,900 $12,800 $12,100 $16,000 $8,000

Resurfacing

Dental $2,000- $12,000 $3,400 $9,10 $2,900 $3,000 $5,00

Implant 1,000

Face Lift $15,000 $7,000 $3,000 $7,200 $4,000 $6,600 $3,000

Knee $50,000 $7,000 $17,800 $10,650 $10,800 $12,000 $7,000

Replacement

Source- Indian Medical Tourism Association, 2011

In India, sophisticated surgical procedures are being done at 1/10th the value as compare with
the procedures within the developed countries (Table 2). Not solely this, the hospitals are well
equipped to handle the information and knowledge through processed Hospital information
Systems.

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Table 3 Medical Tourists and Revenue

Year 1st Scenario (10% growth) 2nd Scenario (20% growth) 3rd Scenario (30% growth)

Medical Revenue Medical Revenue Medical Revenue

Tourists Tourists Tourists
(million $) (million $) (million $)
(million)
(million) (million)

2010 .75 1067.5 .75 1067.5 .75 1067.5

2011 .83 1174.3 .90 1281.0 .98 1387.8

2012 .91 1291.7 1.08 1537.2 1.27 1804.1

2013 1.00 1420.8 1.30 1844.6 1.65 2345.3

2014* 1.10 1562.9 1.56 2213.6 2.14 3048.9

2015* 1.21 1719.2 1.87 2656.3 2.78 3963.6

Source: Compiled from various reports of Ministry of Tourism

Since the data on the exact number of medical tourist arrivals and revenues are not readily
available, number of medical tourists and earnings has been projected and earnings from them
till 2015. According to the data compiled by the Ministry of tourism from major airports, 0.75
million are medical tourists in India in 2010 and Revenue earned from them is US $1067.5
million. Further, there are an outsized variety of patients from abroad as well as NRIs who
come back for alternative functions, however use wellness tourism like Yoga and Ayurveda.
These classes of tourists add up to a higher number of foreign patients. The estimated total
spending incurred by FTAs visiting for medical purpose works out to be US $ 400 million. Table
3 has given the projected number of medical tourists in India and revenues from them up to
2015. 1st Scenario believes 10 percent growth due to global slowdown in recent years, while
2nd Scenario presumes 20 percent growth that is on the basis of past 9 years growth and 3rd
Scenario assumes 30 percent growth. The projected number of medial tourists in India in 2015

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would be stuck between 1.21 million and 2.78 million. In 2015, the projected revenue would lie
between US $ 1719 million to US $ 3964 million.
Advanced communication technology created crucial changes within the development of
medical tourism industry because it becomes quite simple to find the most effective medical
facility over the world. So, to push the positioning of India as a Medical destination and increase
the presence of the medical fraternity within the international travel exhibitions, an obsessive
area of four sq.m. was provided to the medical fraternity among the India marquee at ITB
Berlin. Show specializing in Medical tourism may be a continuous method and is organized in
consultation with the Stakeholders from time to time. In 2009, show was organized in West
Asia (Dubai, Riyadh, Kuwait and Doha) that was led by the Minister of State for tourism.
Brochure, CDs and alternative message materials to push Medical and health tourism are
created by Ministry of tourism and are wide circulated for message in target markets.
For participation in approved Medical and different tourism Fairs/Medical
Conferences/Wellness Fairs and its allied Road Shows, Ministry of tourism provides Market
Development assistance. This theme was extended to the Medical Tourism Service Providers
and Wellness Tourism Service throughout the year 2009. Funding underneath the MDA theme
is provided to approve medical tourism service providers, i.e. representatives of Hospitals
accredited by JCI and NABH and Medical tourism facilitators (Travel Agents/ Tour Operators)
approved by Ministry of tourism, Government of India and engaged in Medical Tourism.
Language is additionally an enormous hurdle for medical tourists to enter in an exceedingly
foreign country. To beat this example, variety of hospitals have employed language translators
to form patients from Balkan and African countries feel more well-off whereas at identical
times serving to within the facilitation of their treatment.
Soaring medical prices, high insurance premiums, long waiting lists, sizable amount of
uninsured/under insured and insured in several advance nations force individuals in those
nations to be medical tourists. Insurance companies and employers also prefer to send patients
to India in order to reduce health care expenses. Large Indian community living abroad also
makes use of significant part of medical tourism in India. Although, medical tourism industry in
India has been hit badly by the political scenario in countries like Iraq from where a large

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number of patients comes in India. The Ebola outbreak in Africa has also served a blow to the
industry as India has a huge inflow of patients from the African continent. The political situation
in Pakistan has also affected the inflow of patients to India.
Expansion of medical tourism faces several challenges as well as providing progressive health
care quality at low prices, accessibility of insurance, and of enfranchisement. Most significantly,
it’ll demand coming up with well-defined methods and policies that guarantee effective
cooperation between the public and private sectors. Finally, analysis on medical tourism
continues to be in its infancy. It’s vital to gather comprehensive, reliable and internationally
comparable information likewise by undertaking analytical studies on the event of the
development and on its impact on the economy.

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Q5. What are the pre-travel advice and risks for medical tourists?
Patients who elect to travel for medical reasons should consult a travel health provider for
advice tailored to individual health needs, preferably ≥4–6 weeks before travel. In addition to
regular considerations for healthy travel related to their destination, medical tourists should
consider the additional risks associated with surgery and travel, either while being treated or
while recovering from treatment. Flying and surgery both increase the risk of blood clots and
pulmonary emboli. Air pressure in an aircraft is equivalent to the pressure at an altitude of
approximately 6,000–8,000 ft (1,829–2,438 m). Patients should not travel for 10 days after
chest or abdominal surgery to avoid risks associated with this change in pressure.
The American Society of Plastic Surgeons advises people who have had cosmetic procedures of
the face, eyelids, or nose, or who have had laser treatments, to wait 7–10 days before flying.
Patients are also advised to avoid “vacation” activities such as sunbathing, drinking alcohol,
swimming, taking long tours, and engaging in strenuous activities or exercise after surgery. The
Aerospace Medical Association has published medical guidelines for airline travel that provide
useful information on the risks of travel with certain medical condition.
There is a small but quantifiable incidence of adverse events or complications associated with
any medical or surgical treatment and/or anaesthetic procedure, even in the best of centres
internationally. This may range from anaesthetic recovery and surgical healing to
impairment/disability or, rarely, death from complications of the medical or surgical treatment.
Complications can often be minimised by adequate follow-up, but this may be limited in the
treatment centre abroad.
The public health consequences of medical tourism are poorly described but include the
potential for the spread of pathogenic microorganisms via the patient from the overseas
provider to medical services at home, as well as the spread of resistant strains of
microorganisms and, occasionally, the spread of emerging infectious diseases. Infection is a
common complication of surgical treatment and may be localised in the surgical wound or be a
systemic infection. Patients may also be at risk of exposure to infectious diseases that are more
prevalent in countries such as South-East Asia with potential exposure to hepatitis B and C and

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human immunodeficiency virus through percutaneous needlestick injuries involving local health
staff.
The scope of resistance in microorganisms is very broad. Most physicians will be familiar with
the perennial problem of hospital- and community-acquired methicillin resistant
Staphylococcus aureus, but medical tourism has raised the issue of emerging resistance in
enterobacteriaceae. The New Delhi metallo-ß-lactamase gene (NDM-1) also confers almost
complete ß-lactam resistance. NDM-1 is highly transferable and has been identified in a broad
range of Gram-negative bacteria including Actinetobacter spp and Klebsiella pneumonia.
Almost all isolates are also resistant to aminoglycosides, fluoroquinolones and other classes of
antimicrobials. Of concern, some isolates showed resistance to the drugs representing the last
line of defence, tigecycline and colistin. In a couple of cases, so-called legacy, often toxic
antibiotics (eg fosfomycin in Australia), were used to treat NDM-1 harbouring
Enterobacteriaceae infections. The NDM-1 gene was first described in Sweden and the United
Kingdom, and was strongly associated with healthcare received on the Indian subcontinent.
Subsequently, imported cases associated with healthcare contact in India and Bangladesh have
been reported in a number of countries and regions, including Australia.
Medical tourists should not overlook the destination and medical treatment risks associated
with travel. For example, deep venous thrombosis and venous thromboembolism (DVT/VTE)
are potential risks for those having major surgery, especially for procedures such as joint
replacement surgery. GPs will also need to make the patients aware of the general travel health
risks to the medical tourism destinations in the region.

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6. Short notes:

a. History of medical tourism in renaissance and post-renaissance period.

Before the advent of complex technology in medicine, much of medical tourism consisted of
mineral thermal springs and baths. As historian George Weisz states, “True mineral waters
were very much connected with place and were frequently thought to lose their therapeutic
powers if they were moved to another location.” Perhaps during no time in history was this
statement more true than the ancient times when many baths were considered sacred. When
the Greek empire was at the height of its power, tourists from across the world flocked to its
healing temples. These included the Asclepia Temples, constructed in honour of the god of
medicine Asclepius, as well as the Sanctuary of Zeus in Olympia and the Temple of Delphi. Some
of these temples also contained gymnasiums and places of prayer. Aside from commercial
purposes and the demonstration of Greece as a superpower, such sacred healing centers
undoubtedly promoted the popularity of the deities that they represented. medical tourism
from the renaissance to the 19th century The use of mineral waters, often as a component of
high-altitude “climatic resorts”, as a mainstay of healing and prophylaxis remained popular well
into the 19th century, although its association with religion lessened. Hydrotherapy was
thought to be beneficial in a wide range of ailments such as pimples, gonorrhea, rheumatic
diseases, and nervous conditions. In 1326, iron-rich hot springs were discovered near Ville
d’Eaux (Town of Waters), France, making the little village famous. It was here that the word
spa, derived from the Roman phrase salude per aqua (“health through waters”), was first used.
The spa of Ville d’Eaux would later serve as host to historical giants such as Peter the Great and
Victor Hugo. In the 1720s, the English city of Bath was one of the richest and most
technologically advanced, being the first city in England to receive a covered sewage system.
This dramatically advanced its spa tourism industry, and the economic benefits to the city were
enormous. These included paved roads, streetlights, hotels, and beautified restaurants. With
the widespread popularity of spas, it is not surprising that the financial stakes attached to them
became increasingly high, with competition between spas. Many spas added other services,
such as walks, music, dance, theatre, socializing, and gambling to their repertoire in order to
attract customers. As technology became more advanced, various methods of delivering water
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healing were offered in addition to bathing, including vaporization, showering, and more. In
France, an entire academic discipline on “medicalized thermalism” was established to promote
the spa industry by adorning it with a “scientific” appearance. Funded directly by the spa
industry, a large body of literature was produced on the basic chemistry of spa healing and the
potential benefits it exerts on human health. Such research proved to be so convincing that
following World War II, French spas obtained reimbursement from the social insurance system.
Naturally, as spas became more touristic and commercial, suspicions concerning whether they
were truly dedicated to the promotion of health began to arise in the medical community.2
Furthermore, as advances in medical sciences during the 20th century produced more effective
treatments, interest in spa healing declined. Previous basic science research on spas was
discarded as academic attention turned more towards clinical trials. This signalled the end of
the spa industry, an industry that existed since the dawn of mankind, as a provider of medical
therapy. Many spas consequently left the medical business in search of other opportunities.
Some began to advertise themselves as alternative therapy (which needs not to be shown as
medically effective). Others moved into the wellness business, complementing mineral waters
with other modalities such as perfumed baths, facials, massage, and physiotherapy.
Until the late 20th century, the notion of medical tourism remained within the realm of
patients migrating to other countries in pursuit of health care not available domestically.
Hence, for a lengthy time the United States maintained its status as a popular destination, due
to its rapid technological advances in medical care. Some exceptions to this rule existed, such as
the revived interest in yoga and Ayurvedic medicine in India with the onset of the flower child
movement in the United States and the United Kingdom. In the 1980s and 1990s, Cuba initiated
programs for foreigners seeking eye, heart, and cosmetic procedures. These programs were
cheaper and involved shorter wait times than the equivalent in the foreigners’ own countries.
Other Caribbean countries, such as Jamaica, Barbados, and Puerto Rico, followed suit. Each
country established its own niche in the medical field in order to minimize competition. Jamaica
specialized in plastic surgery, Barbados infertility, and Puerto Rico cardiovascular surgery,
orthopedic surgery, neurology, and oncology. These programs were largely geared towards
patients from North America and Europe. The year of 1997 marked the beginning of the Asian

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economic crisis. Among its many coping mechanisms, Thailand invested heavily in a medical
tourism industry for foreigners hoping to obtain affordable access to plastic surgery. It also
offered sex-change operations with looser presurgical psychological requirements than those in
Western countries. Furthermore, it established touristic medical centers, such as the
Bumrungrad International Hospital, featuring interpreters and an airline ticket counter. During
this period of time, many other Asian and Latin countries founded their own touristic medical
programs in the hope of attracting foreigners from Western countries desiring to circumvent
lengthy wait times, formidable costs, and convoluted legal restrictions. Westerners, especially
those seeking reproductive health treatments, can also use these oversea opportunities to
maintain their social privacy. Initially such options were only available to wealthy Westerners
able to afford the additional costs of travel and luxurious accommodations, but as the trend
progressed, middle-class citizens were also able to take advantage of these programs.8 Medical
tourism as we know it was now truly underway, and as expected, it carried with it both benefits
and drawbacks. Proponents argue that medical tourism, aside from improving availability of
health care, also promotes patient choice, fosters global competition, places pressure on
expensive health care facilities to lower prices, and drives social and economic development.
The last point can be clearly seen in Cuba, where medical tourism is a governmental program
and revenues generated used to fund its own public health care system. Critics attack medical
tourism’s role in furthering the divide between social classes, with the wealthy possessing more
opportunities and higher-quality opportunities than the less well off. This applies not only to
tourists, but also to residents of the destination countries themselves. Many concerns have
been raised on whether destination countries are diverting medical resources from serving
their own population to the tourism industry. This is especially a problem in countries where
medical tourism is a private business. As well, there are always concerns regarding the quality
of care received in the destination countries. Furthermore, legislation and ethical policies differ
internationally. Consequently, patients travelling to international clinics may not be fully
informed of the risks and benefits of their treatments, and may find it difficult to obtain legal
redress if harm results. To address issues of quality, the Joint Commission International (JCI), an
accreditation body for international medical institutions, was established in 1997. However, this

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has the potential of furthering inequalities in the health care systems in destination countries,
where the higher-income medical tourism physicians would be able to provide higher-quality
care than those serving the local population. As well, tackling the problem of quality may not
solve the disadvantage concerning continuity of care. Some patients return to their home
countries without any documentation regarding the care they received abroad, making it
difficult for their physicians to provide appropriate care in the case of complications. As an
example, Canadian data from 1998 to 2005 revealed that 22 Canadians received transplants
internationally. One third of these patients had no records upon returning, and complications
included 52% with opportunistic infections, 38% with pyelonephritis (including multidrug-
resistant Escherichia coli), and 27% with systemic sepsis. Compared with Canadians who
received transplants at home, inferior graft survival at 3 years was shown for patients with
international transplants (98% and 86% survival for biologically-related and emotionally-related
donors in Canada, respectively, versus 62% for international transplants).
Current and future trends in medical tourism Currently, 28 countries across North America,
South America, Asia, and Europe market their medical services internationally. More than 375
hospitals in 47 countries in facilities across Europe, the Middle East, Asia, and South America
have been accredited by the JCI, and there are 12 million medical tourists globally. Although the
United States is still the most common destination for Canadian medical tourists, there are a
small number of Canadians traveling into developing nations for health care. Medical tourism
brokerages exist in Canada, with at least 15 companies acting as middlemen in organizing
hospitals, physicians, flights, and hotel reservations for Canadians seeking to receive health care
abroad. However, these agencies are not required to verify credentials or licensing of facilities
or physicians. In 2006, the American Medical Association issued a new set of guidelines listing
certain factors that patients should carefully consider when entertaining the idea of medical
tourism. This was also the year when the American insurance company Blue Ridge Paper
Products, Inc introduced a medical tourism incentive into its employee benefit plan. Since then,
many insurance plans and brokerage companies have been founded to capitalize on this
increasingly popular and lower-cost health care option. Unfortunately, the paperwork can be
extremely complicated, deterring some patients from consulting these companies. Certain

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companies link family physicians to specialists in foreign countries as a way of maximizing
continuity of care. However, family physicians in the Western world should not automatically
assume that this service has been provided, and should take medical tourism into account
when working with any patient. The 21st century is expected to see an expansion in medical
tourism as the demand for health care in Western countries surpasses the capacity that these
countries are able to provide. Both advantages and drawbacks can stem from this rapidly
growing phenomenon, and as health care providers it is important to be able to counsel and
manage patients who have pursued or who are considering to pursue this seemingly attractive
option so that hopefully, the advantages can outweigh the drawbacks.

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d. Legal and ethical issues in medical tourism.
Despite the benefits of lower cost and decreased waiting periods for medical tourists, ethical
dilemmas associated with this tourism must be acknowledged. Despite the benefits of lower
cost and decreased waiting periods for medical tourists, ethical dilemmas associated with this
tourism must be acknowledged. One of the most significant of these dilemmas may be the
disproportionate siphoning of technology to the private sector for the care of international
patients. When this happens, the local population does not benefit from the currency injected
into the system because those funds must be used to continue to support the care required for
international patients. The ethical principle of respect for persons may thus be violated.
A legal concern may be the lack of legal resources available to the medical tourist patient.
Should a patient experience a preventable, adverse event as a result of receiving care overseas,
there may be limits to the damage award the patient can receive. In such cases, the hospital
staff may be protected from any litigation and the patient will suffer the damage with no legal
recourse and no financial compensation. The principle of nonmaleficence, primum non nocere,
commonly translated as "first, do no harm," is called into question in these situations.
Expansion of medical tourism raises several ethical and legal issues, which might affects further
development of the industry. The legal issues are lack of legal recourse and regulations that
regulate medical tourism. The solutions for these issues are to introduce methods of alternative
dispute resolution in the existing laws on medical tourism and to establish a uniform regulation
that governs countries in cases involving medical tourism. By having the alternative dispute
resolution, patients may be able to be compensated without having to endure the cumbersome
proceedings in courts. The uniform regulation is needed to assist patients and to give
awareness about their rights and ability to sue in cases of medical injuries arising from medical
tourism. Patients’ use of medical tourism also raises important ethical issues, ranging from
issues about patients’ safety and the impact of medical tourism on the patients’ home countries
and destination countries. First, the quality of care for some treatment provided by medical
providers is questionable due to the difference in the standard of determining it. Next, medical
treatment and the follow up care that is given after returning home is ethically problematic
because the cost of this treatment falls on the home countries of the patient. To make things

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worse, medical tourism may exacerbate health inequalities for the local poor people at the
destination countries. Lastly, the ethical issue that arises from medical tourism is when patients
travel for receiving treatment that is illegal in their home countries. The resolution is to have a
uniform accreditation system that is responsible to determine the quality of care for all medical
providers. A uniform regulatory framework should also be introduced to ensure that the
upgrading healthcare is accessible to all patients and to regulate the treatment that is illegal.

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7. Fill in the blanks:
a. Medical expenses are less than the expenses in country of origin of the traveler.
b. In the health care sector the service quality is based on two major components which are
technical quality and functional quality.
c. The Ancient Greeks were the first to lay foundation for a comprehensive medical tourism
network.
d. Thailand, Singapore and India became legitimate medical destinations due to Joint
Commission International (JCI) accreditation.
e. “Exotica” is the word that the tour operator and hospitals use to market the product of
medical tourism in India.

8. Write ‘True or False’

a. National health policy was launched in the year 1983. Ans.: True
b. Goa is famous in world map for spas and heritage living destination. Ans.: True
c. According to visa rules and regulations, medical visa allows three entries per year. Ans.:
True
d. KTDC is not responsible for development of Medical tourism in the state. Ans.: False
e. Government has untaken measures to promote India as a global health destination. Ans.:
False

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