Medical Tourism Care Beyond Boundaries Mr Abhay Soi

Medical Tourism: Care Beyond Boundaries Mr. Abhay Soi - Chairman & Managing Director & Confidential Private & Confidential 1

Thoughts for discussion • • • What is Medical Tourism (‘MT’) What drives MT Global Trends Case Study: Bumrumgrad Competitive landscape Challenges for MT MT India Advantage India Key Challenges Way ahead for MT in India & Confidential Private & Confidential 2

What is Medical Tourism: Medical Tourism refers to people travelling beyond their boundaries, to obtain healthcare solutions, preventive and curative in nature. Part of our civilization for a long time & Confidential Private & Confidential 3

What drives MT: Unavailability of Quality Healthcare driving people to travel • • Most of Africa Afghanistan Iraq CIS countries like Kazakhstan, Uzbekistan, Kyrgyzstan KPMG in India Analysis, 2014 & Confidential Private & Confidential 4

What drives MT: Other Features Affordability & Cost Unavailability of experts – doctors, nurses, etc. High Cost of service in countries with Govt. funded health programs Unavailability of Advanced Technology Immediate service (vs. long queues) Below par Quality of care Privacy / Anonymity Developing / third world problems developed county problems & Confidential Private & Confidential 5

Global Trends: Sudden Rise in MT, Globally, with supernormal growth rate AGR C % 8 1 d e t ec Exp Top 5 specialties: • Cardiac Sciences • Orthopedics: Joint replacements & Spine • Neuro Sciences • Oncology • Transplant programs: Liver, Kidney, Bone Marrow & Confidential Private & Confidential Source: KPMG FICCI Heal 2014 6

Global Trends: Sudden Rise in MT, Globally, with supernormal growth rate US, EU, Canada, MEA Japan, Korea, Australia, NZ Africa South America SAARC China Russia • • 15% of world population 85% of world population Ageing population Increased Awareness Improved Physical Connectivity Seamless Digital Connectivity Globally & Confidential Private & Confidential 7

Global Trends: MT leading to growth in other associated sectors • Spill‐over impact on other sectors… Hospitality Tourism Aviation Medical Tourism Forex Earnings Travel Retail Logistics Many countries and private hospitals run focused programs to attract medical tourists from around the world: Turkey, Thailand, Singapore, Malaysia, India & Confidential Private & Confidential 8

Global Trends: Choice of Destination determined by … Hospital specific Systemic • Availability of relevant expert Doctors • Credibility of the Hospital Credibility of the Country: • Overall perception about people • Cultural acceptability Support and facilitation provided by the Hospital • Proximity to Visitor, physical connectivity • Facilitation by the Govt / country Comfort with the pre‐visit services provided by the hospital: Tele‐ consults with doctors, diagnosis, counselling, etc Ease of process to take regulatory approvals Cost benefit to the MT visitor vis‐à‐ vis other options Cost of living (travel, acco, food, etc) for family members & Confidential Private & Confidential 9

Challenges for MT • • • Developing world’s MT Visitors’ challenge First world’s MT Visitors’ challenge Affordability Language Barriers Cultural Differences Regulatory process for Med‐Visa Market infested by unorganized intermediaries: leading to increase in cost and misinformation to patients • Insurance Portability across jurisdictions • Unavailability of outcome data • Poor perception of Hygiene • Lack of awareness • Poor perception and understanding of quality of care in evolving MT hubs • Regulatory process for Med‐Visa Concerted effort by government and private hospitals in developing countries is essential to achieve the purported super‐normal growth in MT & Confidential Private & Confidential 10

Competitive Landscape: Top 5 countries cater to over 75% of Global MT DESTINATION NO. OF MVT PATIENTS THAILAND 2, 500, 000 MEXICO 1, 000 USA 800, 000 SINGAPORE 500, 000 INDIA 200, 000 MALAYSIA 200, 000 BRAZIL 180, 000 TURKEY 110, 000 TAIWAN 90, 000 COSTA RICA 50, 000 & Confidential Private & Confidential • 60% MT driven by lack of relevant expertise and technology in own country • 15%+ MT driven by cost benefit 11

Medical Tourism in India Majority driven by SAARC and Middle East countries • $ 250 million market in India, set to grow @ 20%+ y‐o‐y • Majority from Bangladesh, Maldives, Afghanistan, Iraq, Nigeria & Confidential Private & Confidential 12

Medical Tourism in India Anchored in Metro cities Spread over 4 to 5 hospitals Spread over 2 to 3 hospitals Spread over 3 to 4 hospitals & Confidential Private & Confidential 13

Medical Tourism in India Case Mix change over the years Specialties Then Now Cardiac Sciences • Primarily CABG, Valve surgeries • Angioplasties • Min. Invasive Cardiac Surgeries • Ventricular assist devices; • TAVI: Valve replacement without surgeries Solid Organ Tx • Primarily Kidney Transplants • Mainly Liver, Bone Marrow Tx • Kidney Transplants Ortho. • Spine Surgeries • Joint Replacement • Minimally invasive spine surgeries • Joint Replacement Neurology • Brain tumors • Spinal deformities • Functional neuro‐surgeries • Interventional neuro‐surgeries Oncology • Medical, Surgical, Radiation onco • Cyberknife, Robotic surgeries • Targetted chemotherapies • Organi specific onco programs Early 2000’s & Confidential Private & Confidential 2010 till 2016 14

Advantage India Strengths / Competitive Advantages • Medical Talent: – Doctors: amongst the best globally – Excellent Nursing care – Education system provides 30, 000 doctors and nurses each year – India is the largest exporter of medical talent to the world – Quality of Care: at par with the best • Culture: – English speaking population in general – Acceptance of patients from all races: Absence of racial discrimination (especially relevant for African travelers) & Confidential Private & Confidential 15

Advantage India Strengths / Competitive Advantages • Technology: Latest Technology, Equipment, Facilities and Infrastructure: Int’l standards • Holistic Offer: Options for multiple Alternative Systems of Medicine like Ayurveda, Yoga, Unani, Siddha, Homeopathy, etc. • Unmatched Cost Advantge: @ 10% cost of developed world – Cheap cost of living for long stay visitors, attendants, family members • Access: Within 7 hours flying time from 70% of world’s population • Tourism: Exotic tourism circuit around all metro cities & Confidential Private & Confidential 16

Advantage India Government Support & Confidential Private & Confidential 17

Advantage India: Price Advantage: Cost of healthcare delivery: % discount to cost of service in USA 90% 80% 65% 75% 65% 55% 45% 40% ey rk Tu nd la ai Th iw an Ta th Ko re a re po So u Sin ga ico ex M al ay sia a Ko di a In re M Co st a. R az Br ica 30% il 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% India: Amongst the cheapest and the best provider of ‘quality healthcare’ & Confidential Private & Confidential 18

Key Challenges India still lags behind Competition!!! Regulatory support Public and Private Infrastructure • Regulatory process flow for issuing M‐visas: ‐ No separate fast track process for M visas; common queues for Med & other Visitors @ airports; • Public / Civil infra. lags even some developing countries • Limited number of quality tertiary / quaternary care facilities • Majority of MVT flow is from non‐English speaking countries: ‐ • Need trained linguists to assist Arabic, African, CIS visitors While cost of treatment is less in India, ancillary costs may be high, especially for visitors from low income economies Market Structure • Patient flow driven by unorganized middle‐men • Few players have formal, transparent protocols for patient counselling and communication for MT visitors • & Confidential Private & Confidential Competition from other Asian countries 19

Way forward for MT in India Aspect Issues Plan Regulatory framework • Complicated visa regulations • Stringent laws for surrogacy, organ donation • Ease the medical visa policy • Streamline norms around organ transplant, surrogacy, etc. PR & Marketing • Inadequate PR backed by government • Adequately promote India’s competitive advantages: Price, Talent, Quality of Care • Structured promotion program with marketing by govt. forum Quality of healthcare • Limited number of high‐end • Government support to facilities facilitate greenfield facilities dedicated for MT Hospitality • Lack of quality affordable • Dedicate health cities for MT accommodation in MT hubs visitors providing space for like Mumbai, Delhi developing all ancillary services like accommodation for long stay patients & family members & Confidential Private & Confidential 20

Way forward for MT in India Aspect Issues Plan Public Infrastructure • Poor quality public infrastructure hampering overall service quality and perception • Develop and connect micro‐ markets in each healthcare hub with key public utilities like airport, train, BRTS, etc. Beyond Allopathy • Inadequate promotion of alternative treatments • Canvas all alternative treatment systems under one roof and take them to international markets: Unani, Naturopathy, Siddha, Yoga, Homeopathy, Ayurveda, Government Initiatives • Below‐par use of digital campaigning, promotion • Absence of single nodal agency for promoting healthcare to MT visitors • Budget level allocation to establish India as MT hub with global footprint. • Engage experts to take India to the world via multiple marketing platforms & Confidential Private & Confidential 21

Our Experience BLK Super Specialty Hospital, Delhi • Dedicated End‐to‐End Eco‐system: – Annual traffic: – Tie‐ups: 40, 000+ OPD & 3, 000+ IPD MT visitors 15+ Health Ministries, 3 Universities, 15 AGR C % 30 embassies, Int’l TPAs – Website: Multi‐lingual website for target nations – International OPDs: Teams of 2‐ 5 doctors travel every week: From ‘Fiji to Finland’ – Pre‐Travel support: Tele‐consults, Skype calls, diagnostic support – Translators: Pool of translators supporting 18 different languages – Logistics: Direct pick‐up from the Tarmac for Int’l patients – Visa & currency: End‐to‐end handholding for entire travel schedule – Food: Dedicated Chefs for 12 different cuisines, prepared every day – Quality of care: International patients lounge, in‐room admission & discharge – Accommodation: Tied‐up hotels at affordable rates for attendants – Tourism: Packages via hospital vendor network & Confidential Private & Confidential 22

Thank You!!! BLK Super Specialty Hospital, Delhi & Confidential Private & Confidential Nanavati Super Specialty Hospital, Mumbai 23

Global Trends: Case Study of MT oriented business: Bumrungrad, Bangkok • One of the largest private hospitals in Southeast Asia • Most popular MT destination • Of the 1 million patients/ yr, 50% are foreign nationals • Marketing offices in 16 countries (Australia, Bangladesh, UAE, China) • Multi‐lingual website – End‐to‐end online assistance to patients – Pre & post consults, Appointment, travel, stay, etc. • Medical coordination office, dedicated team of 30+: – Collaborates with patient’s primary doctor, even after the patient is discharged • Wide range of accommodations from low‐priced four‐bed rooms to suites • 51 room serviced apartment complex, for inbound long stay patients – Patients can rent this accommodation for a day, a week, or a month. & Confidential Private & Confidential 24