Medical Tourism: A global stampede for affordable care


If you’re considering surgery and a vacation this year, you may want to combine the two.

Medical tourism is booming, thanks to the massive savings that can be had if you’re willing to trust in foreign doctors.

In India, angioplasties go for around US$11,000, one-ninth the going rate in the United States.

The facelift that rings in at around US$12,000 in the United Kingdom can be had for US$1,800 in Brazil.

These are the benefits medical tourists are increasingly discovering, a result of the growing awareness that no one country has a monopoly on health care and that cheap doesn’t necessarily mean poor quality.

“Medical tourism has grown significantly in the last 10 to 15 years, especially in the developing world,” says Harvard law professor Glenn Cohen, author of “Patients with Passports: Medical Tourism, Law, and Ethics” and “The Globalization of Health Care.”

“The revenues generated by this trade are staggering.”

According to the World Travel & Tourism Council (WTTC), medical tourism contributed 9 percent of global GDP (more than US$6 trillion) and accounted for 255 million jobs in 2011.

Now, even small countries such as Mauritius and Jamaica want to get involved.

After JAMPRO, Jamaica’s investment and promotion agency, concluded that the average medical tourist spends US$5,000, double the amount of a vacationing tourist, a commission was established to investigate the building of offshore medical facilities and recruitment of U.S. doctors for month-long stints.

For the medical consumer, the benefits are clear.

Cost savings of up to 90 percent. Fast service. And, for some, a rare opportunity to receive experimental medical care that might not be available in their own country.

When life kicks, kick back


Amy Scher, 33, couldn’t find anyone in the United States to conduct the stem cell treatment she needed to treat her Lyme’s disease, which caused nerve and muscle damage, brain lesions and near-constant pain.

Despite the advice of her American doctor (“He thought it would kill me”) and her own reservations (“The game of tug of war with myself began the moment I hung up the phone with the doctor in India”), she took three trips to New Delhi between 2007 and 2010 to receive a controversial and experimental embryonic stem cell therapy program.

Today, she says she’s completely healed of all effects of the autoimmune illness and works as an energy therapist in San Francisco.

“Western medicine failed me,” she says in, “This is How I Save My Life: A True Story of Embryonic Stem Cells, Indian Adventures, and Ultimate Self-Healing,” an “Eat Pray Love”-style memoir that debuted in January.

“I agreed to be a guinea pig, because it offered the most potential for regeneration. It was my best shot at saving my life,” says Scher.

She also fell in love with New Delhi.

“It offered exactly what my life needed. It offered hope,” she says.

And in the process, she saved US$60,000.

A stem cell treatment program at Northwestern Memorial in Chicago can cost US$90,000.

Because it required immunosuppressant drugs, “physicians told me I’d not likely survive the drugs even in the unlikely chance I were approved.”

In India the program cost Scher US$30,000 and “it included room and board.”

“Other countries are astounded at our medical costs,” she says. “Brain scans that are US$250 in India are US$1,500 in the states.

“Lab work, easily US$50-plus in the states, cost only US$5-10 there. And don’t get me started on affordable medication. I brought a whole suitcase back.”

But it’s not just the cost, she says.

The service is efficient and the labs and pharmacies often delivered results and medication to her hospital room for free.

Queues, what queues?

In Britain and Canada, hip replacement waiting lists stretch to a year, while at Bangalore’s Apollo Hospitals, patients can land in the operating room the morning after getting off a plane.

In 2010, Brit Angela Chouaib, 36, had gastric bypass surgery. She lost 140 pounds and was put on a three-year wait list for the surgery to tidy up the excess skin.

She decided to take the matter into her own hands.

She researched alternatives for the surgery that was going to cost nearly US$32,000 in the United Kingdom and found a doctor in Poland who could do it for less than US$8,000.

“I was trapped in a deflated fat suit and didn’t want to put my life on hold for another three years,” Chouaib says. The surgery was a success.
“I felt like a new woman,” she says.

Chouaib started setting up similar trips for friends of friends because, “I wanted to help others feel as good as I do.”

After nine months and 50 success stories, Chouaib quit her job in London and in November 2010 started Secret Surgery LTD, organizing overseas cosmetic surgery, mostly to Poland.

In December 2012, she sent 30 women to Wroclaw, a girlfriends’ getaway that had some surgical procedures thrown in.

The women, between the ages of 19 and 60, enjoyed lavish dinners, escorted tours to a Christmas market, personal shopping with an image stylist and late-night chats that they’d started months earlier on Facebook.

Scottish mom Marie Ferguson took her two daughters for “a Christmas treat” after having a mini-facelift and liposuction in April.

“Being a medical tourist has enough to focus on without worrying how to get from A to B,” Chouaib says. “I arrange flights, transfers, luxury accommodations, surgery stay, procedure and the little things (grocery delivery and massage).”

Would you like a hotel room with that mastectomy?

Medical tourism is lucrative and sophisticated enough to support booking websites offering trips, pointers and rating systems.

The number of companies acting as medical travel agents is ballooning, marketing the idea that recuperation happens quicker in sunny climes. These include Med Retreat andInternational Medical Travel Journal.

By combining a little R&R with a rhinoplasty, so goes the thinking, you kill two goals with one trip.

To some, it might sound risky, but according to Nathan Cortez, associate professor at Southern Methodist University Law School, who researches medical tourism, “Hospitals that market to foreign patients go out of their way to make materials available in English and to employ English-speaking doctors and nurses.

“I encourage people to do their homework, understand whatever waivers or contracts they are asked to sign by foreign doctors and hospitals and visit credible hospitals, preferably those accredited by Joint Commission International (JCI) or another international hospital accreditation body.”

By the end of 2012, more than 350 international hospitals had been awarded JCI accreditation, most of which, along with their respective countries, are aggressively courting international patients.

Medical tourism around the world


Brazil is top dog when it comes to cosmetic surgery, with more than 4,500 licensed cosmetic surgeons, the highest per capita in the world.

Newsstands in Rio and Sao Paulo sell magazines such as “Plastica & Beauty” next to “Marie Claire”; and Dr. Ivo Pitanguy, a popular plastic surgeon, is often honored at Carnival with samba dancers praising his “scalpel guided by heaven.”

Prices in Brazil are two-thirds the typical prices in the United States.

Alexander Edmonds, assistant professor of anthropology at the University of Amsterdam and author of “Pretty Modern: Beauty, Sex and Plastic Surgery in Brazil,” tells the story of a domestic servant who, after reading up on prosthetic materials at an Internet cafe, paid US$900 for a mid-cost model of breast implant. The same procedure averaged US$3,694 in the United States in 2011.


Between 2010 and 2014, Thailand is expected to rake in US$8 billion in medical tourism dollars.

Bangkok’s Bumrungrad International Hospital, a gleaming 22-floor facility with more than 554 beds and 30 specialty centers, sees more than a million patients per year, 40 percent of which come from 190 foreign countries.

There’s a Starbuck’s off the lobby and a four-star hotel and shopping mall on the campus.


At last count, this island state of 5 million had 13 JCI-accredited hospitals, many of which are affiliated with well-known institutions.

Singapore Medicine, a government-industry partnership since 2003, promotes members to international tourists and requires compulsory posting of all costs associated with health care.

Singapore spends less than 4 percent of its GDP on health care. By 2019, health care in the United States is expected to consume 20 percent of GDP.


“Ahithi devo bhavha,” a Hindu phrase that means “the guest is God,” is the guiding principle of health care in India.

It’s also the only Sanskrit patients are likely to encounter here — English is the language of choice throughout the country’s extensive hospital system.

Surgery in India is often one-tenth the going rate in the United States.

A heart-valve replacement that runs around US$200,000 in the States goes for US$10,000-14,000 at Apollo Indraprastha in New Delhi.

Lasik Eye Surgery costing US$4,000 in the U.S. is available at Apollo Hospitals, Hyderabad for US$300.

Costa Rica

In Costa Rica, dental care can cost as much as 70 percent less than in the United States. More than 40,000 medical tourists visited Costa Rica in 2011, a third for dental care.

The country that’s a short trip from the United States also offers orthopedics, cardiology, spine, cosmetic and bariatric surgery.

Source: ​

India’s Healthcare Industry

Healthcare has become one of India’s largest sectors – both in terms of revenue and employment. The industry comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment. The Indian healthcare industry is growing at a tremendous pace due to its strengthening coverage, services and increasing expenditure by public as well private players.

The Indian healthcare delivery system is categorised into two major components – public and private. The Government, i.e. public healthcare system comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of primary healthcare centers (PHCs) in rural areas. The private sector provides majority of secondary, tertiary and quaternary care institutions with a major concentration in metros, tier I and tier II cities.

India’s primary competitive advantage lies in its large pool of well-trained medical professionals. Also, India’s cost advantage compared to peers in Asia and Western countries is significant – cost of surgery in India is one-tenth of that in the US or Western Europe.14890-world-map-on-hands-1280x800-digital-art-wallpaper
Market Size

According to estimates, the overall Indian health care market today is US$ 65 billion, of which the hospital supplies and health care equipment segment is believed to be only around US$ 4.5-5 million. Health care delivery, which includes hospitals, nursing homes and diagnostics centres, and pharmaceuticals, constitutes 65 per cent of the overall market.

India requires 600,000 to 700,000 additional beds over the next five to six years, which potentially throws an opportunity of more than US$ 25-30 billion. While the existing hospitals would look at expanding their capabilities, a lot of new properties would also come up.

india-300x300Overall the number of transactions in the healthcare space is going to grow as companies are seeking growth capital. The average investment size by private equity funds in healthcare chains has increased to US$ 20-30 million which was around US$ 5-15 million, said Mr Abhishek P Singh, Associate Director for Healthcare, PricewaterhouseCoopers (PwC).

The Indian medical tourism industry is pegged at US$ 1 billion per annum, growing at around 18 per cent and is expected to touch US$ 2 billion by 2015.

There is a significant scope for enhancing healthcare services considering that healthcare spending as a percentage of GDP is rising. Rural India, which accounts for over 70 per cent of the population, is set to emerge as a potential demand source. Only three per cent of specialist physicians cater to rural demand.

The hospital and diagnostic centres attracted foreign direct investment (FDI) worth US$ 2,793.72 million between April 2000 and January 2015, according to data released by the Department of Industrial Policy and Promotion (DIPP).

Some of the major investments in the Indian healthcare industry are as follows:

  • Mylan Inc has signed a deal to acquire the female health care businesses of Famy Care Ltd, a specialty women’s health care company, for US$ 750 million in cash and additional contingent payments of up to US$ 50 million.
  • Sanofi-Synthelabo (India) Ltd had invested Rs 90 crore (US$ 14.47 million) in Apollo Sugar Clinics Ltd (ASCL), a unit of its subsidiary Apollo Health and Lifestyle Ltd.
  • Apollo Hospitals Enterprise (AHEL) plans to add another 2,000 beds over the next two financial years, at a cost of around Rs 1,500 crore (US$ 241.24 million), as per Mr Prathap C Reddy, Founder and Executive Chairman, Apollo Hospitals.
  • Temasek Holdings Pte Ltd has acquired the entire 17.74 per cent stake of Punj Lloyd Ltd in Global Health Pvt Ltd, which owns and operates the Medanta super specialty hospital in Gurgaon, Haryana.
  • CDC, the UK’s development finance institution, has invested US$ 48 million in Narayana Hrudayalaya hospitals, a multi-speciality healthcare provider. With this investment, Narayana Health will expand affordable treatment in eastern, central and western India.
  • Apollo Health and Lifestyle Ltd (AHLL), a wholly-owned subsidiary of Apollo Hospitals Enterprise, has acquired Nova Specialty Hospitals at an estimated cost of Rs 135-145 crore (US$ 21.71-22.32 million).EMPOWERING-WOMEN-WITH-INNOVATIONS-IN-HEALTHCARE-featured-image

Government Initiatives

India’s universal health plan that aims to offer guaranteed benefits to a sixth of the world’s population will cost an estimated Rs 1.6 trillion (US$ 25.73 billion) over the next four years.

Some of the major initiatives taken by the Government of India to promote Indian healthcare industry are as follows:

  • The Competition Commission of India (CCI) in its meeting has approved the proposed merger between Sun Pharma and Ranbaxy, subject to the parties inter alia carrying out the divestiture of their products relating to seven relevant markets for formulations.
  • India and Sweden celebrated five years of memorandum of understanding (MoU). The cooperation in healthcare between India and Sweden will help in filling gaps in research and innovative technology to aid provisioning of quality healthcare.
  • Generic drug maker Mylan Inc and the US-based Abbott Industries have received the CCI’s nod to proceed with their merger.
  • Mr J P Nadda, Union Minister for Health & Family Welfare, Government of India has launched the National Deworming initiative aimed to protect more than 24 crore children in the ages of 1-19 years from intestinal worms, on the eve of the National Deworming Day.
  • Under the National Health Assurance Mission, Prime Minister Mr Narendra Modi’s government would provide all citizens with free drugs and diagnostic treatment, as well as insurance cover to treat serious ailments.
  • All the government hospitals in Andhra Pradesh would get a facelift with a cost of Rs 45 crore (US$ 7.23 million), besides the establishment of 1,000 generic medical shops across the State in the next few months.

Road Ahead

India is a land full of opportunities for players in the medical devices industry. The country has also become one of the leading destinations for high-end diagnostic services with tremendous capital investment for advanced diagnostic facilities, thus catering to a greater proportion of population. Besides, Indian medical service consumers have become more conscious towards their healthcare upkeep.

Telemedicine is a fast emerging sector in India. In 2012, the telemedicine market in India was valued at US$ 7.5 million, and is expected to grow at a CAGR of 20 per cent to US$ 18.7 million by 2017.

India’s competitive advantage also lies in the increased success rate of Indian companies in getting Abbreviated New Drug Application (ANDA) approvals. India also offers vast opportunities in R&D as well as medical tourism.


There are vast opportunities for investment in healthcare infrastructure in both urban and rural India. About 1.8 million beds are required by the end of 2025. Additionally, 1.54 million doctors and 2.4 million nurses are required to meet the growing demand.

References: Department of Industrial Policy and Promotion (DIPP), Union Budget 2012-13, RNCOS Reports, Media Reports, Press Information Bureau (PIB)


Ready for power Nap ?


Napping can be done anywhere where it’s comfortable, be it a parked car, under your desk or a chair. For some, a quiet, dark place may be necessary but for others a subway or airplane seat works just as well. One tip: If you’re trying to stick to a short nap it may help to be partially upright. Studies have found that if you lie supine you’re more apt to fall into a deeper sleep.

Catch yourself dreaming during a short power nap? That’s a sign that you’re sleep deprived because you’re quickly slipping into rapid eye movement sleep, which is supposed to be the final stage of the roughly 90-minute sleep cycle.

Try getting more sleep at night but make sure you take the poll before that.