Chapter 1


The pattern of going abroad to obtain medical and wellness attention services is called as medical touristry. The benefits of medical touristry are acquiring widely popular among people because people are acquiring cognizant about the benefits of medical touristry like the lower cost of the medical processs and can bask their vacation in a alien location during the recovery period. This outsourcing for wellness attention is grown as a new tendency and many American and European tourers prefer medical touristry for decorative and medical processs. The states which are deficiency of advanced medical processs leads the people populating at that place to wing abroad to acquire appropriate medical services.The pattern of going abroad is a tendency which developed from the ancient period and there is a long history of people going to other states for wellness intents. In Italy and throughout the Roman states, the Ancient Romans constructed resorts with thermic wellness watering place, and the Ancient Greeks would go ‘to [ on the Saronic Gulf ] to see the sanctuary of the healing God, Asklepios, who revealed redresss to them in their dreams ‘ ( Bookman and Bookman 2007: 4-5 ) .From the 15th to 17th centuries, the hapless healthful conditions in Europe prompted an involvement by the rich in medicative watering place, mineral springs and the seaboard for wellness intents. These affluent persons would besides go to renowned medical schools for medical aid ( Swarbrooke and Horner 2007: 16, 33 ) .

This continued into the 18th and 19th centuries where watering place towns, peculiarly in the South of France, became popular for wellness remedies, the Sun, and get awaying the cold climatic conditions in the North of Europe ( Holden 2006: 21-23 ) . The rapid urbanization and societal alteration experienced during Industrialisation aggravated the insanitary and hapless life environments in Britain and some subdivisions of Europe, with anti-urban values and a turning concern for wellness development as a consequence ( Holden 2006: 30 ) . The formation of the railroads allowed increasing and diverse flows of people to more distant seaboard and coastal resorts, which provided a typical and escapist environment from urbanization, and the chance to pattern what was viewed as a healthy interest of sun-seeking ( Holden 2006: 30 ; Swarbrooke and Horner 2007: 16,33 )Spa touristry and sun-seeking persisted into the twentieth century. Medicative springs, watering place, Beaches and resorts, peculiarly in warm and dry climes, continued to be considered curative through long exposures to the Sun, fresh air and H2O ( Swarbrooke and Horner 2007: 33 ) .

Thus it is easy to understand that the wellness touristry has developed from the ancient age with myths and beliefs and as remedy from natural resources to the current phase of assorted medical and surgical processs and decorative therapies and for alternate therapies like yoga, naturopathy and ayurvedic medical specialty. Michael Moody ( 2007 ) indicates that the medical touristry tendency began when occupants of one state would travel to another state to hold decorative or dental processs completed while on holiday or to retrieve from such processs in a holiday like finish.Today, states like India, the East Indies, South America and South East Asia offer intervention installations at par with international criterions at merely a fraction of cost. The factors such as high cost of health care in developed states, long waiting list in authorities medical installations and the decrease of air menu are the bulk of grounds which contributed for the growing of the medical touristry. The infirmaries in India, the East Indies, South American states and South East Asia offer a high quality medical attention which is par with international criterions in really inexpensive money compared to developed states.

India is one of universe ‘s favourite tourer finishs and has many infirmaries of international criterion and English speech production staffs and hence there are less opportunities of linguistic communication barrier for the western patients. India has alternate therapies like Yoga naturopathy siddha and ayurvedic medical patterns. One of the recent study conducted in India on the health care indicates that the medical touristry in India will turn to US $ 125 to 250 million in the twelvemonth 2012. ( CII McKinsey survey ) .The low cost and high criterion intervention and attention are the grounds which accelerates the medical touristry in India. The undermentioned illustration will exemplify about the economical every bit good as tourer benefits of medical touristry in India. Howard Staab, a freelance carpenter from North Carolina, flew to India for his medically necessary bosom surgery, scheduled a side trip to the TajMahal, and returned place to work in North Carolina.

He spent a sum of less than $ 10,000, alternatively of the $ 200,000 required from the local infirmary ( Milstein and Smith 2006 ) .This indicates that India has patients for processs like bosom surgery which requires province of art installations and extremely skilled medical squad. Other than that it besides shows the money difference when compared with developed states. Kerala like any other provinces in India besides has batch of possible to be a market leader in medical touristry.Kerala frequently described as “ God ‘s ain state ” is one of the favourite tourer finishs in India. The geographics of Kerala is embellished with exuberant green coconut Grovess, scenic beaches, tranquil backwaters and enriched civilization. There is a pride of topographic point in the field of medical specialty for this Indian province and medical touristry is the new aspect of Kerala.

Medical touristry is really popular in some provinces of India and this survey focuses on a metropolis of Kerala province. Kerala is considered one of the most favourite tourer finishs in India because of its beaches, hills, lagunas, backwaters and enriched civilization. This province has enormous potency to din its medical touristry and the touristry industry is advancing itself with several ayurvedic and wellness bundles.This survey focuses on the tendencies of medical touristry in the metropolis of Trivandrum which is located on the southernmost province of India called Kerala.

This metropolis is the current capital of the province of Kerala and it is known for its scenic beauties and beaches.This metropolis besides has several international criterion infirmaries and traditional ayurvedic resorts and clinics.

Aim of the Research Study

The rule purpose of this survey was to look into and critically analyze the recent tendencies in the medical touristry in the Trivandrum, the southmost metropolis of India. This survey besides analyses the behaviour of the medical tourer and their outlooks in the services provided by the infirmary or the clinic and the tourer operators or bureaus. This survey besides focuses to turn to the a spread that exists in similar survey conducted before.

The purpose was to turn to the spread between available literature and demand for farther research on the topic by following a clearly defined and structured research design, using both quantitative and qualitative research methods.

  1. Find the factors that drive Medical Tourism in Trivandrum
  2. Analyse the issues which determine success of medical touristry in Trivandrum
  3. Identify the jobs faced by Medical Tourism in Trivandrum
  4. Make suited suggestions for betterment of Medical Tourism in Trivandrum


The first and first ground for taking the subject of the survey is to put out before the readers the province of the Indian medical touristry sector at a minute in clip when it is in great flux. Furthermore the writer was working in one such infirmary which was market leader in medical touristry in the metropolis of Trivandrum.

The medical touristry sector is believed to be a great blessing of economical growing in Kerala and hence by making a survey at this peculiar clip may give readers awareness about the state of affairs challenges and Scopess. Other than that medical touristry it is an country of involvement of the writer as he wants to analyze the tendencies and issues involved in the medical touristry industry in Trivandrum metropolis. The intent of this research note is to sketch some of the challenges and chances in front, as wellness touristry finds its prominence in the practical and conceptual spheres of touristry. Further there are anticipations for Trivandrum metropolis to boom with medical touristry in following five to ten old ages and it is right clip to analyze the challenges and Scopess in front.

Structure of the survey

This survey explores the tendencies of medical touristry in Trivandrum metropolis and the issues around it. The demand for farther research on the subject has been established with transporting out a secondary research followed by primary research and by comparing measuring the primary and secondary research.

Harmonizing to McDaniels transporting out explorative research will gave the research worker elucidation to understand the magnitude of topic country and thereby permitted a clearer and stronger perceptual experience of the environment and the state of affairs which arise within it. ( McDaniels, 2001 ) .

Chapter 2


The medical touristry has an advantage of supplying cost effectual medical attention join forcesing with the wellness attention industry and with the going industry to the patients who need medical intervention in a location different to their place town.

Thus medical touristry occurs with the combination of health care services and touristry and travel sphere. The facts that led the growing of the medical touristry are the handiness cheap and high quality medical attention in one geographical location and being of long waiting line of patients for medical process and high monetary values of medical attention in one geographical part. The result of these factors is the growing of medical touristry ensuing in people traveling to another geographical location for wellness attention.


The term medical touristry is a term coined in recent period but the practise seems to be from ancient period and the tendencies in medical touristry have changed with the clip.The wellness tourer travel to their favorite finish for different medical and surgical processs, decorative surgeries, alternate medical specialty, and watering place and wellness resorts. The considerations and hazard for different processs vary consequently.

The medical touristry has gained societal, economical and political involvement but it has gained light attending in touristry literature by and large.Bookman and Bookman ( 2007 ) specify medical touristry as travel with the purpose of bettering one ‘s wellness, and besides an economic activity that entails trade in services and represents the splice of at least two sectors: medical specialty and touristry. The wellness touristry is seen as agencies of leisure oriented and stress alleviation as many people opt for Sun and watering place. Although there is no individual definition for wellness touristry, it could be loosely defined as people going from their topographic point of abode for wellness grounds ( Ross 2001 ) . Several demographic, economic, and lifestyle factors are driving such touristry ( Handszuh and Waters 1997 ; Ross, 2001 ) .

Bennett et Al. ( 2004: 123 ) acknowledge a broad definition of wellness touristry would be ‘any pleasure-orientated touristry which involves an component of emphasis alleviation ‘ , intending it is an gratifying and restful activityPollock and Williams ( 2000: 165 ) , Laws ( 1996 in Henderson 2004: 112 ) and tries to see the wellness touristry with the position that it is a separation between the ordinary and the extraordinary ; the mundane universe of work and place versus the combination of wellness and touristry in ‘leisure, recreational and educational activities ‘ . Then Schofield has a position that wellness touristry is a agency to accomplish betterment in physical, mental and societal well being.

( Schofield 2004: 137 ) . The above all definitions try to specify wellness touristry as a agency to get away from every twenty-four hours modus operandi and better emphasis free healthful life.Henderson ( 2004: 113 ) insists that wellness touristry as ‘travel where the primary intent is intervention in chase of better wellness ‘ that may affect ‘hedonistic indulgences of watering place and alternate therapies ‘ , while medical touristry ‘incorporates wellness showing, hospitalization, and surgical operations. Ross ( 2001 ) after analyzing assorted factors and literature attempts to specify wellness touristry as any sort of touristry that involves a individual or his household member for the intent of well-being and he considers that wellness touristry chiefly focuses on two chief spheres as indulgence and health. Pampering are services like massage, herbal wraps and exfoliating gowns whereas wellness involves with bettering physical and mental province and sometime it may affect with the intervention.


The construct of medical touristry have undergone many alterations in recent times and there is a alteration in the tendencies like people from developed states traveling to developing states for medical processs for the difference in the cost. The planetary medical criterions and ordinances have been implemented in different states and this in bend raises the figure of people seeking cost advantage and best intervention in their preferable finish. The market of medical touristry depends on consciousness and application of important issues such as societal diversenesss, consumer benefits, stigmatization of merchandises, legal frame work substructure, mark markets, the existent merchandise and communicating channels ( Dannell & A ; Mugumba ) .Therefore it is understood that the people from developed states choose their finish after analyzing assorted characteristics and hence there exist high competition between the states to advance medical touristry.The one more cardinal constituent in this medical touristry is the medical concierge services. These are medical travel companies that provide service to the traveler and they act as a nexus between tourer and the finish ( Lagiewski, 2007 ) .They have a critical function in the tourer experience from planning, stay, and station phases of the trip. The medical travel usher meets the tourer at the airdrome and he is the local agent who works as translator, usher and assists the tourer to remain in communicating with his loved 1s in his place.

( Smith and Forgione, 2007 ) .Harmonizing to Connell ( 2006 ) the ability to the states to guarantee the medical tourer that health care is of safe quality is a critical factor and this will be the chief barrier for a finish to advance itself as most favorite finish In order to battle this concern, international accrediting bureaus are in the procedure of attesting the quality and safety of planetary health care bringing. The tourer decides to prosecute in medical touristry on the footing of five a factor identified by Lagieweskii.Her survey identifies the first and first as the option health care installation to their state ‘s installation which should be of high criterion and at low-cost cost.

This factor is the chief factor and when the tourer is satisfied with first factor the following will be cost of intervention and travel of great importance. The tourer may seek other state because of the vitamin E large waiting list in their place state. There may be some grounds like distant finish for tourer for certain decorative processs. The nature of the state is besides an of import factor because tourer seeks a state free from hazard factors associated with safety, security and actability. ( Lagiewski,2007 ) .The state seeking to do itself as most preferable finish for medical touristry it should stress on the fact that its overall entreaty and the experiences offered to the other viing finishs.

( Dwyer and Kim 2003 ) .Dwyer and Kim insists that the finish should hold the competitory advantage to go successful in the medical touristry industry. Harmonizing to Dwyer and Kim the being of two type of resource group may take to accomplish competitory advantage. They are the endowed resources and created resources. Endowed resources are natural heritage and cultural properties to a specific finish and created resources are services associated with the tourer such as adjustment, nutrient and drink constitutions, and manmade attractive force. There can be created resources such as particular events amusement and shopping which adds excess value to he finish.

There can be back uping factors such as general substructure ; quality of service ; handiness of the finish ; cordial reception of the host population ; and market ties.Growth has been facilitated by the rise of the Internet, and the outgrowth of new companies, that are non wellness specializers, but agents between international patients and hospital webs. It has besides grown because of quickly bettering wellness attention systems in some cardinal states, where new engineerings have been adopted. Above all it has followed the deliberate selling of wellness attention ( in association with touristry ) as medical attention has bit by bit moved off from the populace sector to the private sector, guaranting that a turning bulk of people, particularly in the richest states, and peculiarly in the United States, must pay-often considerably-for wellness attentionFinally, the factors like growing in medical touristry is done by the altering life manner where people are ready to undergo decorative surgery, affecting such elected processs as nose job, suction lipectomy, chest sweetening or decrease, LASIK oculus surgery and so on, or more merely the remotion of tattoos, have created new demands. Assorted signifiers of dental surgery, particularly decorative alveolar consonant surgery, are non covered by insurance in states like the UK and Australia ; hence dental touristry has become peculiarly common. In Asia these tendencies are ‘the improbable kid of new planetary worlds: the radioactive dust of terrorist act, the Asiatic economic downswing, internet entree to monetary value information, and the globalization of wellness services ‘ ( Levett, 2005 )

India and medical touristry

India is a state of rich civilization and heritage and one of the most favourite finishs for touristry. It is one of the bing oldest civilisations in the universe for a period of more than 4000 old ages and it has merger of traditions, imposts and diverseness.

( myindia ) .The study conducted by alone planet about the universe ‘s favorite tourer finish among 134 states ranks India as one among the universe ‘s top 5 tourer finish. ( lonelyplanet )There are similar studies and rankings for India as National Geographic describes India as “ Land of enigma and stateliness ” . The company i – explore besides ranks India as one of the tp 5 finishs in universe. The Forbes traveler provinces India as one the fast turning travel markets. ( ICRImedical touristry )A figure of finishs within India developed as oasiss for remainder and convalescence such as hill Stationss at Darjeeling and the lakes in Kashmir where during the colonial epoch members of British epoch would withdraw for cool zephyr and a alteration of scenery. Late during the nineteenth century people began going India in hunt of alternate life manner frequently concentrating on yoga or speculation and following the footfalls of famous persons.

India is constructing on these traditions as a health finish by a underdeveloped expertness in medical touristry ( Garcia Altes 2005: conell 2006a ) .The chief selling sections for medical touristry in India are patients from USA and European and in-between east states, while turning niche is formed by Indian exiles, peculiarly those unrecorded in USA and the UK. ( Conell 2006 ) , who combine medical intervention with visits to household and friends.Medical touristry as a niche has emerged from the rapid growing of what has become an industry, where people travel frequently long distances to abroad states to obtain medical, dental and surgical attention while at the same time being tourists, in a more conventional sense. It has grown dramatically in recent old ages chiefly because of the high costs of intervention in rich universe states, long waiting lists ( for what is non ever seen institutionally as precedence surgery ) , the comparative affordability of international air travel and favourable economic exchange rates, and the ripening of the frequently flush post-war baby-boom coevals.

Growth has been facilitated by the rise of the Internet, and the outgrowth of new companies, that are non wellness specializers, but agents between international patients and hospital webs. It has besides grown because of quickly bettering wellness attention systems in some cardinal states, where new engineerings have been adopted. Above all it has followed the deliberate selling of wellness attention ( in association with touristry ) as medical attention has bit by bit moved off from the populace sector to the private sector, guaranting that a turning bulk of people, particularly in the richest states, and peculiarly in the United States, must pay-often considerably-for wellness attention“ Medical touristry ” is an of import portion of the Indian touristry industry and holds huge growing potency. The medical touristry sector had experienced a phenomenal growing in the flow of medical tourers – from10,000 patients in 2000 to colossal 180,000 by 2005.

( Beginning: RNCOS study on ‘Indian Tourism Industry Forecast ( 2007-2011 )The Indian authorities takes punctilious stairss in advancing medical touristry and it tries to increase the growing of foreign medical tourer by supplying medical visas called M visas. These M visas are valid for one twelvemonth and it is issued for the accompanies and Indian ministry of touristry has stocked its 13 abroad offices with information sing these visas. ( Meleigy )In 2002,2.2 million aliens visited India: those Numberss increased by 20 per centum the undermentioned twelvemonth ( Mathew 2004 ) .

The tourer literature produced by the Indian authorities portrays India as a state rooted in tradition and besides sufficiently modern to offer western manner comfortss ( Bandyoupdhay and Morais 2005 ) A survey by McKinsey and Confederation of Indian Industry says that at its current gait of growing, healthcare touristry entirely can rake over 8,000 crore extra gross by 2012. ( cii mckinsey survey )There are several provinces in India and the private infirmaries in India mark for the medical tourer other than the place patients. The southern province of Kerala which is really rich in civilization and heritage and ancient medical pattern like Ayurvediac, Siddha and Yoga leads in pulling the foreign tourer for medical wellness and leisure touristry.KeralaKerala is a eccentric anomalousness among developing states, a topographic point that offers existent hope for the hereafter of the Third World. See: This little province in India, though non much larger than Maryland, has a population every bit large as California ‘s and a per capita one-year income of less than $ 300. But its infant mortality rate is low, its literacy rate among the highest on Earth, and its birth rate below America ‘s and falling faster. Kerala ‘s citizens live about every bit long as Americans or Europeans.

Though largely a land of paddy-covered fields, statistically Kerala stands out as the Mount Everest of societal development ; there ‘s genuinely no topographic point like it. The National Geographic Traveler, which one time made Kerala the cynosure of all eyes in the universe travel circuit by depicting it as one of the 50 Edens in the universe. ( National Geographic )Kerala is one of the most visited tourers finish of India. It is globally celebrated for its enrapturing tourers ‘ attractive forces that are off round than any other tourers ‘ topographic points in the universe. Every twelvemonth hundred and 1000s of tourers from all over the universe semen to Kerala to bask vacations in luster. The province is endowed with thenars fringed beaches, verdant hill Stationss, capturing beaches, emerald paddy Fieldss, historical churches and more of all picturesque backwaters.

This makes the selling medical touristry easier in Kerala.Accreditation of wellness centresThe quality of the medical attention is the first and first factor considered by the medical tourer. Harmonizing to the medical touristry association the accreditation is the agencies of manner to achieve safety and overall positive consequences to the patients who travel from one state to another for intervention intents.

The medical tourer can look into the accreditation to guarantee the safety of the intervention in the infirmary. The accreditation plan is really indispensable to assist patients, employers and insurance companies who can look into the accreditation position and thereby can happen the infirmaries with highest quality of attention during their full patient experience. The medical touristry industry grows twenty-four hours by twenty-four hours and hence there is a necessity to guarantee that infirmaries, clinic and rehabilitation centres come ining medical touristry posses proper substructure to run into the medical tourer. There is a demand to attest that the centre has proper communicating installations, transparence in quality and pricing, informed consent, proper medical attention and farther follow up installations. The accreditation is focused on the fact that international patients have particular demands and demands than domestic patients. The accreditation is normally given by organic structures which may by authorities or non authorities with the panel of adept members to analyze and happen whether the organisation meets the demands. ( medical touristry association )The accreditation to the allopathic medical pattern in Trivandrum is provided by the international accreditation organic structures such as Joint Commission International ( JCI ) , ISO 9001 – 2000 etc. Other than the international organic structures Trivandrum metropolis has infirmaries certified by NABH, a board set up by authorities of India.

( See appendix ) .These are the major accreditations of medical service in India. The ayurvedic pattern is the alone forte and most popular medical pattern in India and they have accreditation done by Body set up by Government of Kerala as “ Green foliage ” and “ Olive foliage ” and green foliage is the highest grade of accreditation and its followed by olive foliage and these accreditation ensures the quality of ayurvedic intervention in Kerala. ( expresshealthcare )Ayurvedic touristry in KeralaKerala is normally marketed as a wellness finish for its Ayurveda bundles. Medical touristry is marketed along with Ayurveda and other wellness bundles. Kerala ayurveda touristry has going a immense merchandising point for Kerala touristry industry. State promotes Kerala ayurveda touristry as a portion of medical touristry to the universe.

Today popularity of Kerala ayurvedic intervention has gained such a impulse that tourer from across the universe semen to Kerala to rejuvenate and for curative intervention.Ayurvedic medical pattern is the most ancient medical system originated in India before 10,000 old ages ago and in India the ayurvedic pattern is more popular in kerala where it is practiced in traditional manner. As per Ayurveda specializers, the rainy season ( June – August ) is the best clip for ayurvedic interventions as the ambiance remains dust free and cool, which helps open the pores of the organic structure to the upper limit. ( Messerli and Oyama 2004 )Ayurveda believes in the intervention of non merely the affected portion, but the person as a whole. Kerala ayurvedic interventions and greening therapies are natural manner to review and extinguish all toxic instabilities from the organic structure and to recover opposition and good wellness. Most of the ayurvedictherapies help to beef uping the immune system, forestalling and bring arounding diseases without any side effects.

There are figure of resorts and infirmaries throughout province which are built-in parts of Kerala ayurveda touristry and offering customized Ayurveda vacation bundles which help you to rejuvenate the organic structure and psyche and to get down a fresh life. Kerala ayurveda provides figure of interventions runing from de-stressing, anti-ageing, weight loss, joint strivings and general greening.

Elementss of medical touristry in Trivandrm

Review of similar surveies.

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