Project Report, 2013
34 Pages, Grade: A-
Chapter-1: Background Context with Aims & Objectives
1.1. Background Context
1.3. Research Objectives
Chapter-2: Literature Review
2.1. Globalisation of Healthcare
2.2. Analytical Framework
2.3. What is Medical Tourism?
2.4. Indian Medical Tourism Sector
2.4.1. Opportunities for Indian Medical Tourism Sector
2.4.2. Challenges for Indian Medical Tourism Sector
Chapter-3: Case Studies
3.1. Apollo Hospitals
3.1.1. Company Profile
3.1.3. Effect of Globalisation
3.2. Max Healthcare
3.2.1. Company Profile
3.2.3. Effect of Globalisation
3.3. Medanta Medicity
3.3.1. Company Profile
3.3.3. Effect of Globalisation
Chapter-4: Discussion & Conclusion
4.2.1. Origin of Indian Medical Tourism Sector
4.2.2. Effect of Globalisation
4.2.3. Opportunities for Indian Medical Tourism Sector
4.2.4. Challenges for Indian Medical Tourism Sector
4.3.1. For Indian Healthcare Policy Makers
4.3.2. For Future Research Studies
This theory into practice report is intend for exploration of influence of globalisation on the healthcare delivery in Indian Medical Tourism industry. The scope of this report is broad as it critically analyse Indian Medical Tourism industry with the means of theoretical frameworks and case studies based on 3 famous Indian Hospitals. The core objective of this report is to determine the impact of globalisation on the Indian Medical Tourism sector, It has been discovered that India is regarded as the most favourite destination from the perspective of medical tourists and all this possible due to several factors (low treatment cost, capitalisation of superior medical technology and highly skilled paramedical and medical staff who got initial training from Developed countries). The globalisation of healthcares services had been began after the signing of General Agreement on Trade Services (GATS) which thereafter directed Indian economy towards the opening up especially in relation to inflow of advanced medical equipment, pharmaceuticals and implants from other countries and also resulted in the enhancement of quality standards which were guided through the development of clinical governance and competitive benchmarking system. Indian Medical Tourism sector has been offering qualitative and comparatively affordable healthcare services through highly skilled personnel, increasing Indian foreign revenue, expanding job opportunities within healthcare sector, augmenting the global standing of India, encouraging investors to make more investment with healthcare sector and corresponding is promoting reverse brain drain. The major challenge which is a threat to Indian healthcare services due to the globalisation factor is the increasing inequity between Indian public and private sector and is hence resulted in the form of brain drain. The second challenge is related with ethical issues in response to certain procedures (reproductive tourism & organ transplantation). Professionals of Indian public healthcare sector should come up with regulatory policies in the align with strict governance policies for India private healthcare in order to overcome certain challenges occur after the brain drain of doctors from public healthcare to private sector.
This report has been written on the topic of ‘Influence of Globalisation on the Healthcare Delivery within Indian Medical Tourism Sector’.The scope of this report is broad has it accumulates high qulaity reseach material and also include the case studies of 5 major players in the Indian Medical Tourism sector. According to Stiglitz (2003), the term globalisation is determine as a close integration between different countries and communities of the world which has been resulted in reducing the cost communication and transportation by enormous strength and also outcome in offsetting the barriers in regard to the flow of market offering (goods & services), capital knowledge and human resource across the borders. It has been observed that the theoretical frameworks proposed by Appadurai (1990), Giddens (1990) and Woodward, et al. (2001) have been capitalized extensively for the brief understanding of globalisation expanse and also for the analysis of relationship between gloablisation & healthcare. However, it has been seen that the proponents of globalisation aspect are focused more on its potential for the purpose of initiating improvement in the healthcare provision which would be resulted in increasing foreign trade and wealth creation, directing the countries towards decreasing the poverty factor and also would increase the revenue stream which could be invested in the major health determinants: health services, gender-equity and education (Dollar & Kraay, 2002). Moreover it has been inclined that with the enhancement of trade liberalization, the word is seemed to become flatter as information technology, people and innovative ideas are frequently crossing the national boundaries (Fried & Harris, 2007). But on the other hand, the critics have raised concerns over the shortcomings of consistent empirical evidence of growth factor and have also questioned that either the policies that are designed for promoting economic growth in developing countries have actually produced satisfactory outcomes (Cornia, 2001) or have increased disparities and have also imposed threat for these countries’ major health determinants as a result of improving economic globalisation (Weisbrot, et al., 2002).
There had been a case that in 2004, a carpenter named Howard Staab from North Carolina had been recommended by the doctors to undergo heart surgery for the purpose of replacement of mital valve (Singh & Datta, 2005). But the real concern for Staab was that had no medical (health) insurance. Moreover, he had been informed that he would $200,000 for the successful completion of all stages. As a carpenter, that amount was considered to be too much for him so after analysis it was decided by him to go to Delhi (India) where he paid around $10,000 which also covered the expense for three weeks stay along with the surgery cost. It has been discovered that this example also point out the era of 1990s when patients from under develop countries to developed countries for the significant medical treatment. Additionally, it had also been observed that after 2001, there were many wealthy patients that had preferred to go to certain developing countries (India, Singapore, Thailand and Malaysia) for undergoing even severe medical surgeries. It has also been analysed that there have been 5 major players in these countries, names of these players are listed below:
Fortis-Escortis Heart Institure (India) Appollo Group of Hospitals (India) Sunway Medical Center (Malaysia) Bumrungrad Hospital (Thailand) Raffles Hospital (Signsapore)
Ironically, all of these players have been seemed to adopt the approach of providing first world class health services to western countries patients (specifically uninsured and under insured) at much lower price (Gopal, 2010). In short one can say that through Medical Tourism the consumers from developed countries would be able to seek world class health services of distinguish quality at economical rate (Turner, 2007).
The main motive behind the selection of this topic is my aspiration towards working in the Hospital which would be actively participating in the Indian Medical Tourism sector. I’m willing to work in such hospital because I wanted to work the diverse environment in order to keep myself motivated and satisfied with the current job and I think that by pursuing career in Medical Tourism hospital I would fancy my chance accomplishing my aspiration. So that is only reason that I have choose this topic.
This theory into practice report would be intended to explore the influence of globalisation on the healthcare delivery in Indian Medical Tourism industry. The report would critically analyse Indian Medical Tourism industry with the means of theoretical frameworks and case studies based on 3 famous Indian Hospitals. The core objective of this report is to determine the impact of globalisation on the Indian Medical Tourism sector, other associated objectives have been outlined below:
-To clarify that what is meant by the globalisation of healthcare market.
-To identify the opportunities & challenges of globalisation in relation to the Indian Medical Tourism industry.
-To discover the key factors which attract medical tourists towards India.
-To propose changes in the existing business model of Indian Hospitals offering healthcare services to medical tourists and it would also have positive influence on the healthcare revenue generated by Indian Medical Tourism sector.
This theory into practice will be based on the secondary research so the case study approach has been preferred for this purpose. In this report, 5 hospitals will critically be evaluated on the basis of four aspects (Origin, Effect of Globalisation on their healthcare policies and revenue, Opportunities and Challenges). It has been believed that by this approach it would be possible to create a link between the Literature Review and Case Study section and then to make ground for the Discussion & Conclusion section.
According to various analysts the process of globalisation is regarded as close interaction between human activities over a range of domain (including political, economical, cultural and social) which usually occurs globally at three dimensions: cognitive, temporal and spatial (Lee , 2000). But according to Labonte & Torgerson (2003) this such detail is unsuccessful in adressing the contemporary globalisation’s major drivers and these drivers are inclined as associated policies at marco level and the alteration in the context of global capitalist organisation and moreover these sources are the major cause or source of increasing inequalities in thhe world in an economic term. However, Robertson (1992) described it as a term which represents two aspects: world’s compression and world’s intensified consciousness. Together both of these aspects focused on the global interdependence & consciouness. This seems to be a useful illustration of concept called as globalisation and is also helpful for the brief understanding of healcare concept especially during the current era of decreasing national, mental, techonologican and phyical boundaries with respect to the delivery of superior healthcare services.
Generally there are three significant institutions (World Bank, International Monetary Fund and World Trade Organisation) which are governing this globalisation factor (Chanda, 2001). In addition to this there are also some globally recognized trade agreements that are fostering this cross border patients’ traffic (Mutchnick, et al., 2005), these agreements are: GATS (General Agreement on Trade Services) and the Treaty of World Trade Organisation (WTO). Siddiqi, et al. (2009) outined four modes of General Agreement on Trade Services and its implications to the Trade in Health Services (THIS). These modes are listed below:
First Mode is concerned more on the cross border supply with respect to the delivery of electronic and telephonic healthcare services.
Second Mode emphasized more on the Medical Tourism which observe the movement of patients to other countries for diagnosis and treatment purposes. Third Mode represents the existence of foreign direct investment in relation to the delivery of healthcare services.
Fourth Mode concentrated on natural persons’ movement including the trading of healthcare services through the health personnel migration on the basis of different social, economical and legal implications for both host and source country.
Sharpley (2002) contended that globalisation and the enhancement in communication have assisted the initiation of second mode of Medical Tourism as now potential medical tourists have better access to the information on the healthcare treatment existed abroad (Sharpley, 2002). It has been determined that Medical Tourism is best example to depict that how the globalisation forces have reformed localised health services and medical treatments into a global market.
Generally, there are three frameworks: Appadurai (1990), Giddens (1990) and Woodward et al (2001) which have been used extensively for exploring the linkage between globalisation & healthcare services and also on their reciprocal influence. According to Giddens (1990), globalisation is basically an intensification of global social relations which connects the distant locations in a manner that the things happening at local level are shaped because of events taking place in the other regions (Giddens, 1990). More precisely, Giddens (1990) describes that it as uneven development process and is seemed to be an opposite of healthcare in response to the increasing medicines’ specialisation. But it failed to address the interdependence and interlocking nature of economic organisations within global healthcare industry.
On the other side Appadurai (1990) listed out five ‘scapes’ for proving fundamental framework for the purpose of analysis of globalisation (Appadurai, 1990). These scapes are mentioned below:
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