MEDICAL TOURISM IN INDIA: A CASE STUDY OF APOLLO HOSPITALS
Babu P George, PhD University of Southern Mississippi, Hattiesburg, MS, USA Email:
[email protected]
Introduction
Medical Medical tourism tourism is a silent silent revolut revolution ion that has been been sweepin sweeping g across across the healthca healthcare re landscape of India for almost a decade. According to the Confederation of Indian Industries (CII), (CII), India India is unique unique as it offers offers holist holistic ic medicin medicinal al service services. s. With With yog yoga, a, meditat meditation, ion, ayurved ayurveda, a, allopat allopathy, hy, and other other sys system temss of medicin medicines, es, India offers offers a unique unique basket basket of service servicess to an individu individual al that is diffic difficult ult to match match by other other countri countries. es. Also, Also, clinica clinicall outcomes in India are at par with the world’s best centers, besides having internationally qualified qualified and experienced experienced specialists. specialists. With the international international media constantly constantly telecasting scenes of white people getting knees replaced, hips resurfaced, and dental works done here by the West-trained West-trained doctors at throw-away throw-away prices, prices, that too in the ambience ambience of a five star resort, the demand from the nationals of Western Europe and the US for medial treatment in India is on an ever-increase.
The domestic medical industry in India is trying all out to grab its pie from the evolving global health bazaar. Statistics suggest that the medical tourism industry in India is worth $333 million. According to the Government of India, India's $17-billion-a-year health-care
industry industry could grow 13 per cent in each of the next six years, boosted boosted by medical tourism, tourism, which industry watchers say is growing at 30 per cent annually. It is forecasted that medical tourism tourism will fetch India $2.3 billion by 2012. If not many things go wrong, it will become a major driver of the Indian economy along with information information technology, technology, biotechnology, biotechnology, and technology technology enabled enabled consumer consumer services. services. Probably Probably realizing realizing the potential, potential, major corporate groups in the healthcare business have made significant investments in setting up modern hospitals in major cities. Many have also designed special packages for patients, patients, including including airport airport pickups, pickups, visa assista assistance nce and board board and lodging. lodging.
In the recent past, the health care sector in India has witnessed an enormous growth in infrastructure in the private and voluntary sector. The private sector which was very modest in the early stages has now become a flourishing industry equipped with the most modern state-o state-of-t f-the-a he-art rt technol technology ogy at its disposal. disposal. It is estimat estimated ed that that 75-80% 75-80% of health health care care services and investments in India are now provided by the private sector. An added plus had been that India has one of the largest pharmaceutical industries in the world. It is self sufficient in drug production and exports drugs to more than 180 countries. Unlike many of its competitors in medical tourism, India also has the domestic technological sophistication and infrast infrastruct ructure ure to maintai maintain n its market market niche, niche, and Indian Indian pharmace pharmaceutic uticals als meet meet the stringent requirements of the U.S. Food and Drug Administration.
The Apollo Group
The Apollo Hospitals Group, the largest healthcare group in Asia, is today recognized as the Architect of Healthcare in India. With over 7000 beds in 38 hospitals, a string of nursing and hospital management colleges, and dual lifelines of pharmacies and diagnostic clinics providing providing a safety safety net across Asia, Apollo may be rechristened rechristened metaphoricall metaphorically y as a healthcare healthcare powerhouse. powerhouse. Its history history of accomplishments, accomplishments, with its unique ability of resource resource management and able deployment of technology and knowledge to the service of mankind, justifies justifies its recognition recognition in India and abroad. Apollo has got one of the largest and the most sophisticated sleep laboratories in the World. It has pioneered orthopedic procedures like Total Total Hip and Knee Knee Replace Replacemen ments, ts, the Illizar Illizarov ov procedu procedure, re, and the Birming Birmingham ham Hip Hip Resurfacing technique. Its mission is to bring healthcare of international standards within the reach of every individual. According to Apollo, it is committed to the achievement and mainte maintenan nance ce of excel excelle lence nce in educa educati tion, on, resea researc rch h and and healt healthca hcare re for for the benef benefit it of humanity.
Apollo's business began to grow in the 1990s, with the deregulation of the Indian economy, which drastically cut the bureaucratic barriers to expansion and made it easier to import the most modern medical equipment. The first patients were Indian expatriates who returned home for treatment; major investment houses followed with money and then patients from Europe, the Middle East and Canada began to arrive. Services provided by the International Patient Service Centers of Apollo Group, located within India and Abroad, include: local trav travel el
arra arrang ngem emen ents ts,,
airp airpor ortt
tran transf sfer ers, s,
co-o co-ord rdin inat atio ion n
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doct doctor or's 's
appo appoin intm tmen ent, t,
accommodation accommodation for relatives relatives and attendants, attendants, locker facilities, facilities, provision of cuisine options,
provision provision of interpreters interpreters,, arrangements arrangements with leading resort resort chains for post-operative post-operative recuperation, among others.
Apollo: A SWOT Analysis
The major strengths of Apollo are listed below:
Apollo is one of the earliest entrants into the medical tourism business in India and has got the associ associate ated d first first mov mover er advantag advantages. es. Almost Almost 70% of the Apollo Apollo doctors doctors have been been trained, have studied or worked in institutions and hospitals in the West. Apollo has recorded exceptionally good clinical outcomes and post-treatment success rates. Apollo conduc conducts ts itse itself lf in a consc conscie ienti ntious ous manne mannerr in all all trans transact action ionss and deal deal with with peopl peoplee professionally professionally and and transparently transparently,, while maintaining maintaining privacy privacy and confidenti confidentiality ality deserved deserved by its customers. Over the years, Apollo has successfully engineered trust, integrity, and confidentiality to its unique advantage. Wherever admissible, Apollo tries to integrate the diverse ancient healing traditions with the latest in modern medicine and this holistic approach as got it a great deal of acclaim. With over 7000 beds in 38 hospitals, Apollo has hospitals spread across the length and breadth of the country. Treatment can be arranged in a particular unit which is geographically closer to a particular destination type which the patient or the ones accompanying accompanying may want to see. Apollo offers unraveled unraveled price-value price-value advantage, too.
Apollo’s investment in the best and latest technology in the world is well appreciated. Apollo Telemedicine Networking Foundation (ATNF), established in 1999, is the pioneer in launching the first rural telemedicine center in the country. The telemedicine initiative can in fact be employed to boost its medical tourism business. At this stage, Apollo should try to integrate its medical tourism activities with the telemedicine initiatives since the tele teleme medi dici cine ne offe offers rs a very very good good alte altern rnat ativ ivee for for prel prelim imin inar ary y and and post post-t -tre reat atme ment nt consultations. It will give a big positive push to its patient relationship management too. The Virtual Patient Visit scheme at Apollo offers the friends and relatives of patients opportu opportunity nity to gather gather freque frequently ntly updated updated informa informatio tion n about about treatm treatment ent progres progress, s, the consultant’s opinion about the patient, patient’s remark, and a multi-media rich medium to convey the messages to and fro both the sides. If the Virtual Patient Visit scheme and the telemedicine initiative could somehow be integrated, the friends and relatives of the patient can better understand the stage and the result of treatments being undergone.
However, However, it suffers suffers from from the followin following g weaknesses: weaknesses:
Apollo’ Apollo’ss patient patient relatio relationshi nship p manage management ment progra program m is almost almost flawle flawless. ss. However However,, one signif significa icant nt weakn weaknes esss affl afflic icti ting ng Apoll Apollo o is its its rela relati tive ve lack lack of und under erst stand anding ing of the accompanying persons also as customers to deal with. While the Virtual Patient Visit scheme permits remotely located persons to get to know about the patient’s recovery status, managing the experience of those physically accompanying and those who visit from the host country in between are almost neglected. neglected. Apollo Apollo should either establish establish a travel-cumtravel-cumhospitality desk to provide hospitality and excursion facilities for these groups or get into a
suitable partnership scheme with an external service provider for the same. Competitors have already identified this as an area of opportunity and have begun to come forward with bundled offers offers for for the accompanying accompanying persons as well. well.
To successfully run the medical tourism business, it is high time Apollo realizes that it requires employees with domain expertise in tourism in addition to the traditional medical support staff. However, this is a weak spot with Apollo and people with qualifications in the areas of tourism and hospitality have to be recruited and assigned important roles in medical tourist relations management.
If it wants wants to make make a further further positive positive difference, difference, the opportunitie opportunitiess for Apollo Apollo are: are:
Apoll Apollo o has got the the pione pioneer ering ing stat status us in attr attract acting ing medic medical al tour touris ists ts to Indi Indiaa and has developed over time unassailable brand equity. Now, it is faced with a great opportunity, both to enrich and to expand the medical medical tourism tourism business. business. Apollo should establish establish offcampus centers equipped with telemedicine facilities, especially in countries like the US and Canada from where it receives the majority of patient inflows. These off-campus centers would be the preliminary points of contact between the patients and the hospital. These contact centers, in addition to giving elementary care and clinical information, can help to process the travel documentation, including arranging visas for the patients and the ones ones accom accompan panyi ying ng them. them. For exam example ple,, hos hospit pital alss like like Crom Cromwe well ll in the the UK have have representatives in India and Pakistan, while hospitals in Singapore are also setting up offices such as in Indonesia and the Middle-East. These agents help establish and maintain
relationships such as with local hospitals, doctors, embassies, sponsor corporations, or insurers. Apollo can get into deals with middlemen agencies like Global Health Tours (GHT) who help people decide and manage their treatments abroad.
E-marketing of medical tourism services provides an opportunity for Apollo to reach the customer directly, bypassing the middlemen. This will help the firm to provide services at a lower price, on-time, and in a highly customized manner. E-marketing clubbed with the marketing initiatives though the patient contact centers to be established in the important medical tourist originating countries can do a successful brick and mortar marketing job for the Apollo. The staff at the various contact centers should ideally have sufficient training in the cultural norms and expectations of the medical tourists of the respective countries to tailor-make the service offerings. Since medical service is a credence service, long term relationship building and maintaining the same will be the key to sustained business. No firm that wants to continue in this business should look towards one-time transactionspecific approaches. Firms should tap on referrals, positive words of mouth, etc since these carry more credential that an impersonal advertisement.
Apollo has thus far concentrated upon curative medical care for the medical tourists. While specia speciali lizat zation ion has has its its own own adva advanta ntage ges, s, there there is a lucra lucrati tive ve mark market et out out ther theree for for the preventive preventive cure as well. Research Research has revealed revealed that especially especially those who accompany a curative patient would like to undergo preventive treatment during their stay in India. Significantly enough, preventive medical treatments given in the alternative tradition like ayurveda and homoeopathy are the ones utmost in demand. If Apollo cannot cater to this
demand, it should further examine the potential of outsourcing the same to another provider under a licensing agreement. Yet, it seems fairly feasible for Apollo to manage itself the demand for allopathic preventive medical treatment.
Another lucrative opportunity waiting to be exploited by Apollo is to get into the area of medical insurance. Critics of medical tourism warn that traveling patients put themselves at risk. Should complications arise, patients might not be covered by insurance or be able to seek adequate compensation via malpractice lawsuits. This decision, again, depends upon whether it wants to get into an altogether different business. It may be noted that a sister concern of Apollo, Apollo Health Street already is in the business of remotely executing the non-core health information management activities of foreign healthcare groups such as medical transcription, coding, revenue cycle management and claims processing.
Yet Apollo faces the following threats:
One of the major threats for Apollo, like any other large scale private initiative in India, comes from citizen’s groups: a widely held perception is that it does not care for the disadvan disadvantag taged ed section sectionss of the society. society. Many critics critics cite cite that that medica medicall tourism tourism by the corporate hospitals like Apollo has unleashed a range of unhealthy and unethical practices. Apollo rebuffs the criticism raised by various groups that it has neglected India's millions of poor. The official website says that it has set aside free beds for those who can't afford care, has set up a trust fund and is pioneering remote, satellite-linked telemedicine across India. Even from a purely rational economic point of view, it is in the interest of Apollo to
cater to the needs of the bottom of the pyramid, since the economies of scale derivable from the same can make it a cost leader as well.
Of course, Apollo face stiff competition from hospital groups like the Escorts, Wockhardt, Fortis, Manipal, Christian Medical College, Tatas, Birlas, Aravind, Leelavati, and so on. Some of these competitors have specialized in certain sub-domains like eye care, dental care, knee care, heart care, etc and hence offer superior treatment for these diseases. The benefits of comprehensive comprehensive care offered offered by Apollo are somehow somehow to be blended with the advantages of specialization to successfully overcome the threat factor.
The threat from the public sector hospitals that strive to fill the deficit caused by reduced governmental funding is also significant. For example, public sector hospitals like All India Institute of Medical Sciences (AIIMS) have been receiving patients from over 16 countries including European nations and there is a steady increase in the number of patients, mainly for complex surgical procedures. The AIIMS has also initiated a dedicated International Healthcare Service team, which will take care of the patient right from arrival till their departure coordinating all aspects of medical treatment.
Conclusion
Apollo's capabilities have received international acclaim resulting in the replication of its India Indian n mo mode dels ls at inter internat nation ional al locat location ions. s. Apoll Apollo o grou group p is also also in talk talkss with with priva private te healt healthca hcare re grou groups ps and gover governme nment nt autho authori riti ties es in Nige Nigeri ria, a, Sout South h Afri Africa ca,, Tanza Tanzania nia,,
Mauritius, Yemen, Muscat, Bahrain, Vietnam, Malaysia, Thailand and other neighboring countries to establish its presence in world class clinical efficiencies. The question now is from here to where?
Since competitive advantages for the different components of the medical tourism system lie with different players, forming inter-organizational networks with a common marketing front might turn out to be a great idea for Apollo. This coordinated move will synergize the operations and minimize the scope of service failures. For example, with the objective of promoting promoting and establishing establishing Kerala, Kerala, one of the most sought after tourist tourist destinations destinations in India India,, as a medic medical al touri tourism sm dest destina inati tion, on, Keral Keralaa To Tour uris ism m Devel Developm opment ent Corp Corpor orat ation ion (KTDC), Amrita Institute of Medical Sciences and Intersight Tours have already signed a MoU. The consortium plans to promote Kerala as a medical tourism destination, where medical treatment will be provided at AIMS, holiday options will be provided by KTDC and the logistics of travel will be provided by Intersight. Cooperation often is a more sustainable strategy than a confrontational approach.
What is called International Patient Care is already a seamless process, with the guests buying inclusive inclusive arrangements arrangements that feature air travel, travel, local transportation, transportation, translation translation services, services, air-conditioned air-conditioned five-star accommodation, accommodation, together together with their personalized personalized choice of global cuisine. To attract foreign patients, healthcare providers may consider leveraging on both business and clinical considerations. Also, well coordinated efforts among the travel, the hospitality, and the healthcare trade are imperative for the sustainable growth of this business. A sincere commitment to these coordinated moves allows each stakeholder to
focus on its own competencies and may even alleviate the level of competition – allowing for better long run revenues throughout the entire sector.
