CASE STUDY ON MEDICAL TOURISM IN INDIA INDIAN MARKET, GROWTH, OPPORTUNITIES AND COMPETITION

NMIMS Strategy Implementation Project 2014PT- MBA 2nd Year, Division A

Submitted by Ajay Kumar (A05) Ganapathy (A16) Saurab (A45) Subramanian (A51) Bankim (A09)

EXECUTIVE SUMMARYThe Medical Tourism Industry in India is poised to be the next big success story after software. India is perceived as one of the fastest growing medical tourism destination. According to a recent RNCOS report Booming Medical Tourism in India, Indian medical tourism industry is anticipated to register a compound annual growth rate (CAGR) of more than 20 per cent during 2013-2015, therefore, creating huge scope for investments. The key competitive advantages of India in medical tourism are due to the following factor: low cost advantage, Innovation in Health care, strong reputation in the advanced healthcare segment (cardiovascular surgery, organ transplants, eye surgery) and the diversity of tourist destinations available in the country. The key concerns facing the industry include: Strong Quality standards across the hospitals, absence of government initiative, lack of a coordinated effort to promote the industry and the lack of uniform pricing policies and standards across hospitals.Various renowned Indian hospitals like Apollo, Fortis and Max, NH Hospital, Arvind Eye Care, Asian Heart, Medanta Medicity contributes a lot to promoting India as a Medical Tourism Destination around the world. Various experts echoes that earlier around 80% of foreign patients coming to India belong to the neighbouring countries viz. Iraq, Afghanistan, the former Soviet Union. But now patients have been coming from the U.S. and Europe too. Medical tourists are coming for cosmetic and regenerative treatment, but the majority belongs to foreign tourists coming for treatment like knee replacement, cardiac treatment, cancer and other serious ailments. Pioneer of Medical Tourism in India, Apollo Hospital Group got many prestigious awards around the globe in the field of Medical Tourism. Apollo in its journey has touched and enriched 37 million lives that came from 120 countries. In the 30 years since its inception in 1983, it has scripted one of the most magnificent stories of success that India has seen. Dr Prathap C Reddy the visionary founder Chairman of Apollo Hospitals Group and architect of modern Indian healthcare - has pioneered Medical Tourism thus making India the Global Health Care destination.

TABLE OF CONTENTS

Introduction

Indian Tourism & Hospitality Sector Overview

Indian Healthcare Sector Overview

Indian Medical Tourism Sector OverviewGrowth Drivers for Medical Tourism in IndiaIndian Hospitals Ultralow CostsIndian Hospitals High QualityCost of LabourInnovation in Medical Procedures

Major Players comparison in Indian Market

Top 5 countries in Medical Tourism

CASES- Two Hospitals having Different strategy for Medical TourismNH hospitalManipal Hospital Goa

Company Overview Apollo HospitalVisionMissionHistoryPioneer of Medical Tourism in IndiaFinancials Management & Board of DirectorsCompetitors

Conclusion

References

ExhibitsA- Medical Treatment Cost ComparisonB- Balance Sheet Apollo HospitalC- P&L Apollo HospitalD- Net Sales Apollo HospitalE- EBITDA, PBT and PAT Apollo HospitalF- Key People Apollo HospitalG- Competitors of Apollo HospitalH- JCI Accredited Hospitals in IndiaI- Medical Tourism Industry Market Size and CAGRJ- Stakeholders Medical Tourism Sector K- Apollo Hospital Group CompaniesL- Case QuestionsIntroduction Just more than a decade ago India might be the last place on earth where people from around the globe will visit for undergoing medical procedure. In fact it was other way round that the rich and affluent class of people from India would visit a foreign country like UK and USA to get the best treatment for diseases like Heart surgery, cancer treatment, knee and joint replacement etc. Despite robust economic growth over the past two decades, the infant mortality rate is three times higher than Chinas and seven times greater than that of the U.S. Of the 2 million Indians in need of heart surgery, fewer than 5% get it. The majority of the countrys estimated 63 million diabetics and 2.5 million cancer sufferers havent been diagnosed, let alone treated. Seventy percent of Indias 12 million blind people could be cured by a simple surgeryif it were available to them. Government programs have finally brought some infectious diseases under control, but the nations ability to meet the basic medical needs of its citizens remains abysmal. So what has changed in the last decade that made India as one of the fastest growing nation for Medical Tourism? MEDICAL TOURISM is a term initially coined by travel agencies and the mass media. According to Mary Tabacchi, Health Tourism is any kind of travel to make oneself or a member of any family healthier. More recently the phrase "Global Healthcare" has emerged, and may replace the earlier terms. Such services typically include elective procedures as well as complex specialized surgeries such as joint replacement, cardiac surgery, dental surgery, and cosmetic surgeries. We define Medical Tourism as the term that describes people travel to foreign nations primarily for the purpose of getting medical treatment along with idea of holidaying in the foreign land.As per Grail Research Travelling to a destination in another country to receive medical, dental and Surgical care because the destination enables better access to care, provides higher quality care or offers the same treatment at a more affordable price is termed as Medical Tourism.

India Tourism & hospitality Sector OverviewThe Indian tourism and hospitality industry experienced a growth of 24.6% during 20092010 timeframe. The industry is the third-largest foreign exchange earner, accounting for 6.2% of Indias GDP and 8.8% of Indias total employment, according to a report by the Planning Commission. The sectors employment-generation potential has also been highlighted by the World Travel & Tourism Council (WTTC), which says Indias travel and tourism sector is expected to be the second-largest employer in the world, employing 40,37,000 people, directly or indirectly, by 2019 even in remotest places in the country. The tourism industry includes travel agencies, tour operating agencies and tourist transport operating agencies; units providing facilities for cultural, adventure and wildlife tourism; surface, air and water transport facilities for tourists; and convention/seminar units and organizations. The total tourist visits in India have been growing at a steady rate of about 16 per cent over the past five years. According to the World Economic Forums Travel and Tourism Competitiveness Report 2013, India ranks 11th in the Asia pacific region and 65th globally out of 140 economies ranked on travel and tourism Competitiveness Index.The Indian tourism sector also includes medical and healthcare tourism, adventure tourism, heritage tourism, ecotourism, rural tourism and pilgrimage tourism. Medical tourism also known as health tourism has emerged as an important segment in the country. Wellness tourism is regarded as a sub-segment of medical tourism and it involves the promotion and maintenance of good health and well being. India, with its widespread use of Ayurveda, Yoga, Siddha and Naturopathy, complemented by its spiritual philosophy, is a well-known wellness destination.The total market size of tourism and hospitality industry in India stood at US$ 117.7 billion (USD 32 billion for Travel & Tourism) and is anticipated to touch US$ 418.9 billion by 2022. Foreign tourist arrivals (FTA) during the period JanuaryDecember 2013 stood at 68.48 lakh as compared to FTAs of 65.78 lakh during 2012, registering a growth of 4.1 per cent. FTAs during December 2013 were 8.00 lakh as compared to 7.53 lakh during December 2012, growth of 6.3 per cent. Foreign exchange earnings (FEE) during JanuaryDecember 2013 stood at US$ 18.133 billion as compared to FEEs of US$ 17.737 billion during 2012, registering a growth of 2.2 per cent. FEEs during December 2013 were US$ 1.886 billion. The number of tourists availing of the tourist Visa on Arrival (VOA) Scheme during JanuaryDecember 2013 has recorded a growth of 26.2 percent. During the period, a total number of 20,294 VOAs have been issued as compared to 16,084 VOAs during the corresponding period of 2012. The foreign direct investment (FDI) inflows in hotel and tourism sector during April 2000 to November 2013 stood at US$ 6,825.56 million, as per the data released by Department of Industrial Policy and Promotion (DIPP). Govt Policy & PromotionThe government has permitted 100% FDI in the sector under the automatic route, FDI into all construction and development projects including construction of hotels and resorts, recreational facilities, and city and regional-level infrastructure. In terms of incentives, a five-year tax holiday is extended to organizations that set up hotels, resorts and convention centres at specific destinations. Besides this, the government has initiated measures to bolster the sector, such as provision of visa on arrival for tourists from Finland, Japan, Luxembourg, New Zealand and Singapore, and launch of several schemes that promote rural tourism and infrastructure related with the sector. The government has also launched campaigns such as Incredible India!, Colors of India, Atithi Devo Bhavah and the Wellness Campaign to promote the Indian tourism and hospitality industry.Indian Healthcare Sector OverviewHealthcare industry is the world's largest industry with total revenues of approx US$ 2.8 Trillion. In India as well, Healthcare has emerged as one of the largest service sectors with estimated revenue of around $ 30 billion constituting 5% of GDP and offering employment to around 4 million people. By 2025, Indian population will reach 1.4 billion with about 45% constituting urban adult (15 years+). To cater to this demographic change, the healthcare sector will have to be about $100 billion in size contributing nearly 8 to 10% of the then GDP. By then, the 10 large national healthcare networks would be able to absorb 30% of the market share. The key drivers for Indian Healthcare sector are: Medical Value Travel or Medical Tourism World class treatment and benefits at a fraction of the Cost (almost 1/10th) with no waiting time for surgeries as compared to advanced nations like UK and US where waiting period is substantially longer have been instrumental in a large number of foreign arrivals to access healthcare services in India. Indian Medical Tourism Sector OverviewIndia is perceived as one of the fastest growing medical tourism destination. The UK-based TransWorldNews in its Booming Medical Tourism in India report has revealed that irrespective of the global economic downturn, India has emerged as the fastest growing segment of tourism industry and seems to be the most promising medical tourism destination in the world. The report further said that by the end of 2013, its global medical tourism industry share would be around 3 per cent. Report further highlighted that Indian medical tourism in all likelihood would generate revenue to the tune of $3 billion by the end of 2015, growing at a CAGR of more than 20 per cent (Exhibit I). Moreover, the growth of Indias medical tourism market would be a boon for several other associated industries which includes hospital industry, pharmaceutical industry and medical equipments industry. Why India has been preferred as a world-class medical tourism country can be gauged by its low cost, scale and range of treatments available which differentiate from other medical tourism destinations. India boasts of more than 3,371 hospitals and more than 754,985 registered practitioners catering to the needs of traditional Indian healthcare. Indian hotel industry has already entered into the wellness sector and has been providing second to none range of wellness fields offering spas and ayurvedic massages. Exhibit J shows stakeholders in Medical tourism industry Government InitiativesIn a move to boost the medical tourism and health sector, Government has also introduced a new category of visa, medical visa (M-Visa), to promote medical tourism. In addition, Government of India has also requested the state governments to promote medical tourism by offering suitable packages of identified hospitals and price banding for specific treatments.Some of the Initiatives of Ministry of Tourism to promote Medical Tourism area) Dedicated exhibition space for Medical Tourism in ITB, Berlinb) Road shows focusing on Medical Tourism are a continuous process and are organized in consultation with the Stakeholdersfrom time to time. The last road show was organised in West Asia (Dubai, Riyadh, Kuwait and Doha) in October 2009 which was led by the Minister of State for Tourism.c) Production of Publicity Material like Brochure, CDs and other publicity materials to promote Medical and health tourism have been produced by Ministry of Tourism and have been widely circulated for publicity in target markets.d) Fiscal Incentives Provided by Ministry of Tourism for Development of Medical Tourism in India.e) For participation in approved Medical and other Tourism Fairs/Medical conferences/Wellness Fairs and its allied Road Shows, Ministry of Tourism provides Market Development Assistance. This scheme was extended to the Medical Tourism Service Providers and Wellness Tourism Serviceproviders during the year 2009. Financial support under the MDA Scheme is provided to approved medical tourism service providers, i.e. representatives of Hospitals accredited by JCI and NABH and Medical Tourism facilitators (Travel Agents/ Tour Operators) approved by Ministry of Tourism, Government of India and engaged in Medical Tourism.

Drivers for Growth of Medical Tourism in IndiaIndian Hospitals Ultralow CostsThe Indian hospitals treat medical conditions that range from problems of the eye, heart, and kidney to maternity care, orthopaedics, and cancer. Their charges for most procedures are as much as 95% lower than those at U.S. hospitals. That isnt because the Indian providers offer low-quality services; Many of the hospitals are accredited by either Joint Commission International (JCI), the international arm of the Joint Commissionan independent non-profit that certifies the quality of more than 20,000 health care organizations in the U.S.or its Indian equivalent, the National Accreditation Board for Hospitals & Healthcare Providers, which uses standards similar to those of JCI. Below chart shows the cost comparison between India, USA, Thailand and Singapore.

Innovation at Indian hospitals results not from a grand design but from constant experimentation, adaptationand necessity.Indian Hospitals High QualitySome of the hospitals in Indiafor instance, the Apollo Hospitals Groups flagship in Hyderabadhave recorded equivalent or better outcomes than the international standards for medical complications associated with knee, coronary, and prostate surgery as well as for infections related to the operating theatre and catheters. NHs 30-day post surgery mortality rate for coronary artery bypass procedures at its Bangalore hospital is below the average rate recorded by a sample of 143 hospitals in Texas. Similarly, the five-year survival rate for breast cancer patients at HCG Oncology is comparable to U.S. benchmarks. Deccans five-year survival rate for peritoneal dialysis patients is the same as that for patients in the U.S. undergoing haemodialysis, the more expensive treatment commonly used there. Rates of complications associated with eye surgery at Aravind Eye Care compare favourably with those of the best hospitals in the UKs National Health Service. (Source: Deccan and U.S. Renal Data System, 2012 Annual Report; 5-year survival rate for end-stage renal disease patients undergoing peritoneal dialysis)Cost of LabourCardiothoracic surgeons, nephrologists, ophthalmologists, and oncologists in India earn anywhere from 20% to 74% of what their American counterparts do. For instance, Arvinds ophthalmologists earn $50,000 annually compared with the $253,000 average for U.S. ophthalmologists. NHs cardiothoracic surgeons gross between $150,000 and $300,000, whereas the median income for their U.S. counterparts is $408,000. And the salaries of nurses, medical staff, and administrators in India are dramatically lower; some earn only 2% to 5% of what a U.S. hospital would pay. But the labour cost differential is just a small part of the story. The price of an open-heart surgery at NH after adjusting the salaries of NHs doctors and other staff to match U.S. levels even with the higher wages factored in; the cost was still only 4% to 18% of a comparable procedure in a U.S. hospital. Innovation in Medical ProceduresTo deliver on their dual commitments to high quality and ultralow cost, the Indian hospitals have developed three powerful organizational advantages: A hub-and-spoke configuration of assets An innovative way of determining who should do what A focus on cost-effectiveness rather than just cost cutting

Those process innovations allow the hospitals to lower their costs without compromising quality; in fact, the first two lower costs while simultaneously improving quality. The innovations result not from a grand design but from constant experimentation, learning, adaptation and necessity. Lets look at the process innovations in turn. A hub-and-spoke architecture helps create large volumes hence reducing cost. By reducing the barriers to treatment, NH now carries out more open-heart surgeries and Aravind does more eye surgeries than any other hospitals in the world. In turn, this has increased physician productivity: At NH, each surgeon performs from 400 to 600 procedures a year, compared with 100 to 200 by U.S. surgeons. Similarly, Aravind doctors each perform from 1,000 to 1,400 eye surgeries a year, compared with an average of 400 by doctors in the United States. Attracting and retaining doctors seeking to improve their skills rapidly. The high volume and sheer variety of cases attract talent to these hospitals; doctors can build their capabilities faster in them. Most of the big hospitals recruit many of their doctors from among their students. The calibre of the recruits, in turn, contributes to the high quality of outcomes at these hospitals. Developing and continually updating treatment protocols that reduce errors. Unlike many U.S. hospitals, the Indian health care providers have developed protocols for even relatively complex procedures, such as knee and hip replacements and cardiac and cancer surgery. For instance, at CARE Hospitals, angioplasty patients are assigned to one of three risk classes on the basis of objective criteria such as age, weight, medical history, and lifestyle, and a different protocol is followed for each, taking extra precautions for high-risk patients. (U.S. hospitals dont always develop or follow such protocols, which is one reason Atul Gawande, an American surgeon and journalist, wrote The Checklist Manifesto.) The results are impressive: Whereas data suggest that one in 200 angioplasty patients in the U.S. will require emergency surgery and half of those patients will die, only two out of 40,000 angioplasty patients at CARE Hospitals have required emergency surgery and just one has died on the operating table since the hospitals inception in 1997. Creating specialists in relatively rare subspecialties of medicine. The large number of patients that come for treatment enables hub doctors to focus on specific types of medical problems. As volumes increase, relatively rare conditions are treated often enough that doctors become world-class experts in those areas. Thats how NH has become a global leader in paediatric open-heart surgery, attracting patients from across Asia and Africa. High volumes have allowed Apollo to become a leader in organ transplant surgeries and made L V Prasad Eye Institute (LVPEI) a top provider in corneal transplants. Promoting innovation that suits local conditions. Doctors in India pioneered the beating-heart method of surgery, by which they can operate without shutting patients hearts down. This technique enables surgeons to perform the procedure without expensive heart-lung machines, which are rare in a developing economy. The method also leads to fewer complications, requires shorter hospital stays (which results in a lower incidence of hospital-related infections), and allows patients to recover faster. High patient volumes have allowed Indian doctors to master the technique over time. Major Players in Indian Medical Tourism Industry

Top Five Medical Tourism Destinations in the WorldMalaysiaMalaysia has built medical facilities that rival Singapore at much lower price points, and has set up agencies to attract hundreds of thousands of medical tourists for procedures from burns to heart conditions. Malaysia sees well over half a million medical tourists most from around Asia each year due to the countrys developed infrastructure and low costs. The general consensus is that, as Singapore gets more expensive, Kuala Lumpur is picking up the slack with facilities that are just as good. English is more widely spoken in Malaysia than in Thailand, and infrastructure is better than countries like India. Like other countries in Asia, Malaysia saw medical tourism as a way to diversify its economy during the Asian financial crisis. Prince Court Medical Center was ranked the number one hospital for patients without borders by the Medical Travel Quality Alliance. Malaysian hospitals offer services such as in vitro fertilization at around one-fifth the price of western facilities, as well as offering sophisticated treatment for burn victims. Malaysian hospitals also offer total physicals that would cost several thousand dollars in the US, with blood work, for a few hundred dollars.

ThailandThailand has long been one of the best medical tourism destinations in the world, with low health care costs and excellent service. Thailand is world-renowned for its medical tourism and expat health care services. So much so that medical tourism is growing by 16% a year. Bangkok is home to Bumrungrad Hospital, Ever since the crash of the baht in the nineties, Thailand used its currency crisis to attract medical tourists from around Asia, mainly for cosmetic surgeries. Today, Thailand is a haven for inexpensive plastic surgery, but also non-elective procedures. A facelift that might cost $15,000 in The Land of the Free would cost $2,500-3,000 in Thailand. Meanwhile, bypass surgery could cost around $25,000, an 80% discount over US prices.

IndiaIndia specializes in inexpensive bypass surgeries and other high-end medical procedures for medical tourists. India has become a top health tourism destination for high-end surgeries at inexpensive prices. Two of the top ten medical tourism hospitals are in India (Fortis Hospital, Bangalore & Asian Heart Institute, Mumbai). Stories of westerners travelling to India and savings of more than 75% over home country costs for large procedures travel costs included are not uncommon. India is anticipated to have a $2 billion industry serving overseas patients by 2015, thanks to well over 100,000 patients who visit each year. The Indian government is easing restrictions on citizens of many countries, making it easier for them to travel to India visa-free and with fewer restrictions (US citizens do need a visa to enter India, which costs $67 plus any agency service fees).

SingaporeSingapore, while expensive, has one of the most sophisticated hospital systems in the world. Cancer treatment is a top speciality here. Gleneagles Hospital was ranked in the top ten hospitals globally by a health travel group. The World Health Organization ranks Singapore the best health care system in Asia, and sixth in the world. You will pay more in Singapore than in places like Thailand, but the quality of life in Singapore is second to none. One US-based grocery chain had a policy of paying the entire hospital bill, with travel costs for two, for employees who got hip and knee replacements in Singapore. Life expectancy in Singapore is several years longer than that of the UK. By many standards, the city-state has the worlds lowest infant mortality rate.

BrazilBrazil is the world capital for plastic surgery medical tourism, owing to the countrys image-conscious culture. Up until recently, medical tourism in Brazil was largely relegated to elective procedures. However, the country has the first JCI-accredited hospital in the world outside of the United States Hospital Israelita Albert Einstein in Sao Paolo and now has more than 40 JCI-accredited hospitals. Brazil has the least efficient medical system on this list, although it is nearly tied with the United States in terms of medical efficiency. Costs for plastic surgery can be as much as 60% less than in western countries, and surgeons can handle just about any procedure you can dream up.CASES- Two Hospitals having Different strategy for Medical TourismNH Hospital- Low Cost High Volume Domestic Medical Touristshttp://www.bloomberg.com/news/2013-07-28/heart-surgery-in-india-for-1-583-costs-106-385-in-u-s-.htmlThe current price of everything that you see in health care is predominantly opportunistic pricing and the outcome of inefficiency, Devi Shetty, 60, said in an interview in his office in Bangalore, where he started his chain of hospitals, with the opening of his flagship centre, Narayana Hrudayalaya Health City, in 2001. Devi Shetty is obsessed with making heart surgery affordable for millions of Indians. NH hospital is a chain of 21 medical centers around India. By trimming costs with measures as buying cheaper scrubs and spurning air-conditioning, he has cut the price of artery-clearing coronary bypass surgery to 95,000 rupees ($1,583), half of what it was 20 years ago, and wants to get the price down to $800 within a decade. The same procedure costs $106,385 at Ohios Cleveland Clinic, according to data from the U.S. Centers for Medicare & Medicaid Services. It shows that costs can be substantially contained & at the same time deliver very high quality cardiac care Cutting costs is especially vital in India, where more than two-thirds of the population lives on less than $2 a day and 86 percent of health care is paid out of pocket by individuals. A recent study by the Public Health Foundation of India and the London School of Hygiene & Tropical Medicine found that in India non-communicable ailments such as heart disease are now more common among the poor than the rich. One in four people there die of a heart attack and per-capita health spending is less than $60 a year. Yet the country performs only 100,000 to 120,000 heart surgeries each year, well short of the 2 million Shetty estimates are needed. The mortality rate from coronary artery disease among South Asians is two to three times higher than that of Caucasians, according to a study published in 2008 in the journal Vascular Health and Risk Management. Hence NH hospital has a strategy of Low cost high Volume for a huge domestic population.

Manipal Hospital, Goa- Foreign Medical Touristshttp://timesofindia.indiatimes.com/city/goa/Manipal-hospital-to-focus-on-medical-tourism/articleshow/28807714.cmsIn Jan, 2014 Manipal hospital enterprises threw open its high tech multi-specialty facility at Dona Paula offering a complete range of preventive, curative and rehabilitative care. It has now added super-specialties services in cardiology, cardio-thoracic surgery, neurology, neurosurgery, nephrology, urology, high-end orthopaedics, gastroenterology and plastic surgery. Rajen Padukone, managing director and chief executive officer, Manipal Health Enterprises Pvt. ltd, said they would have tie-ups with travel agents and tour operators and market availability of their super specialties in Goa. He said patients mostly from countries like Middle East, South East Asia and Africa visit India for medical treatment. While presently, they visit metros of India for medical treatment, Padukone said they will now market Manipal hospital, Goa, in those countries, when pointed out medical tourism is yet to take roots in Goa though 4-4.5 Lakhs international tourists visit Goa every season.He also said they intend to expand both domestically and internationally. Hence Manipal hospital strategy is clearly focusing to tap the Foreign Tourists visiting Goa and rest of India

Company Overview - Apollo Hospitals, IndiaVision StatementApollo's vision for the next phase of development is to 'Touch a Billion Lives'.

Mission Statement "Our mission is to bring healthcare of International standards within the reach of every individual. We are committed to the achievement and maintenance of excellence in education, research and healthcare for the benefit of humanity".

HistoryDr. Prathap C Reddy is the founder of Landmark Apollo Hospital Enterprise. Below diagram shows some of the key the milestones.

In the 30 years since, it has scripted one of the most magnificent stories of success that India has seen. Not only is the Apollo Group one of the largest integrated healthcare groups in the region, it also did successfully catalyze the private healthcare revolution in the country. Along the way the journey has touched and enriched 37 million lives who came from 120 countries. Its presence encompasses over 10,000 beds across 61 hospitals, more than 1500 pharmacies, over 100 primary care & diagnostic clinics, 115 telemedicine units across 9 countries, health insurance services, global projects consultancy, 15 academic institutions and a Research Foundation with a focus on global clinical trials, epidemiological studies, stem-cell and genetic research. Apollo pioneered the concept - the group was the first to invest in the pre-requisites that led to international quality accreditation like the JCI and also developed centres of excellence in Cardiac Sciences, Orthopaedics, Neurosciences, Emergency Care, Cancer and Organ Transplantation.

Recognizing that the risk of heart disease can be significantly reduced, even reversed, Apollo Hospitals launched the path breaking Billion Hearting Beating, a campaign that empowers Indians with the knowledge to fight the common adversary - heart disease. Apollo Hospitals has always strongly believed in social initiatives that help transcend barriers. In keeping with this, the group has started several impactful programmes in this area. One among these initiatives is SACHi (Save a Child's Heart Initiative) - a community service initiative with the aim of providing quality pediatric cardiac care and financial support to children from underprivileged sections of society suffering from heart diseases. For his untiring pursuit of excellence in healthcare, Dr. Prathap C Reddy, was bestowed with the second highest civilian award, the 'Padma Vibhushan', by the Government of India. Pioneer of Medical Tourism in IndiaApollo Hospitals Group is at the Forefront of Medical Tourism in India to make India the Global Healthcare Destination. Led by Apollo Hospitals Group, Indian Healthcare today has developed International delivery capabilities and has demonstrated International excellence in all specialties with major cost advantages for people from overseas. Apollo Hospitals has successfully treated over 60000 foreign patients from across the world in last five years and the numbers are looking up every year. NHS, UK alone has over a million patients waiting to be treated. Thousands of uninsured Americans now have the option to come to Apollo Hospitals for tertiary care needs. Similarly Africa, Middle East, CIS Countries in Central Asia and South East Asia present huge opportunities. Indraprastha Apollo Hospital, New Delhi has been accredited by Joint Commission International (JCI) USA, as the first Internationally Accredited Hospital in India.

Few main achievements of the Apollo GroupLargest healthcare provider in Asia managing over 10000 beds and 50 HospitalsApollo Delhi is the first hospital in India to be accredited by Joint Commission International (JCI), USA. Apollo Chennai, Apollo Hyderabad and Apollo Bangalore have also received JCI accreditation.Done over 100000 cardiac surgeries with over 99.6% success rate.

AWARDS in Medical TourismApollo Health City, Hyderabad adjudged as the Best Medical Tourism Hospital in India by the Government of India! The award has been handed over by His Excellency The President of India on 18th March, 2013, in Delhi.

Apollo Health City, Hyderabad has been bestowed the prestigious 'INTERNATIONAL MEDICAL TOURISM AWARD' for Excellence in customer service, by the reputed International Medical Travel Journal, UK, in Dubai

Financial Information (B/S, P&L, and Net Sales) along with Key People and Competitors can be found from Exhibit B to G.

ConclusionThe medical tourism industry offers high potential for India primarily because of its inherent advantages in terms of cost and quality. However the competition is getting heated up and the success in future will largely be determined by development and implementation of a joint strategy by various players in the industry. The government should step in the role of a regulator and a facilitator of private investment in healthcare. An apex body for the industry needs to be formed to promote the India brand abroad and aid inter-sectoral coordination. Government also needs to provide a regulatory body for the healthcare sector and stringent quality standards for the entire medical and healthcare sector in India especially hospitals. Joint ventures with overseas partners and establishment of Medical cities like SEZs will help in India building a significant advantage and leadership position in the industry.ReferencesWebsites http://articles.economictimes.indiatimes.com/keyword/medical-tourism http://www.tourism.gov.in/TourismDivision/AboutContent.aspx?Name=Tourism+Infrastructure+Development&CID=18&INO=13 http://www.investindia.gov.in/?q=tourism-and-hospitality-sector http://www.ibef.org/industry/tourism-hospitality-india.aspx http://hbr.org/2013/11/delivering-world-class-health-care-affordably/ar/1 www.ssjournals.com http://hbswk.hbs.edu/item/5814.html http://m.firstpost.com/business/amri-verdict-india-could-cease-to-bemedical-tourism-destination--1194143.html?page=3 http://www.investindia.gov.in/?q=tourism-and-hospitality-sector http://www.apollohospitals.com/international_patient_services/ http://www.apollohospitals.com/news_detail.php?newsid=511 http://www.ibef.org/industry/tourismhospitality.aspx http://www.india-briefing.com/news/fdi-indias-tourism-industry-4657.html/ http://www.ibef.org/industry/tourism-hospitality-india.aspx http://www.dnb.co.in/Travel_Tourism/Chapter_4_Policies.asp http://nomadcapitalist.com/2014/01/05/top-5-best-countries-medical-tourism/ http://www.cii.in/Sectors.aspx?enc=prvePUj2bdMtgTmvPwvisYH+5EnGjyGXO9hLECvTuNu2yMtqEr4D408mSsgiIyM/ http://www.apollohospitalsnoida.com/medical-tourism.htmlGovernment Reports Ministry of Tourism, Government of India, 2010, Tourism statistics at a glance2009, New Delhi, India http://tourism.gov.in/writereaddata/CMSPagePicture/file/marketresearch/studyreports/Med.pdf http://tourism.gov.in/writereaddata/Uploaded/Tender/053120110313488.pdf

Papers/Private Research Reports http://www.deloitte.com/assets/DcomIndia/Local%20Assets/Documents/Medical_technology_Industry_in_India.pdf http://grailresearch.com/pdf/ContenPodsPdf/Rise_of_Medical_Tourism_Summary.pdf http://www.cci.in/pdfs/surveys-reports/Healthcare-Telemedicine-and-Medical-Tourism-in-India.pdf International Conference on Arts, Economics and Literature (ICAEL'2012) December 14-15, 2012 Singapore. Link http://psrcentre.org/images/extraimages/1212589.pdf http://www.cci.in/pdf/surveys_reports/tourism-hotel-industry.pdf http://www.dpncindia.com/news/Hospitality%20Industry.pdf http://sibresearch.org/uploads/2/7/9/9/2799227/riber_k2012-236_566-576.pdf

Books http://books.google.co.in/books?id=2nYdKQ9xKsQC&pg=PA181&lpg=PA181&dq=apollo+hospital+pioneer+of+medical+tourism+in+india&source=bl&ots=u9pOH6fjCo&sig=_8a0MDzPhkOmhBFK905pUr7a2no&hl=en&sa=X&ei=XJkwU7uCFuisiAeMmYDgDg&ved=0CEwQ6AEwBw#v=onepage&q=apollo%20hospital%20pioneer%20of%20medical%20tourism%20in%20india&f=false Mckinsey CII Study, Healthcare in India The Road Ahead, Mckinsey & Company, 2002EXHIBITSA- Medical Treatment Cost Comparison

B- Balance Sheet Apollo Hospital

C- P&L Apollo Hospital

D- Net Sales Apollo Hospital

E- EBITDA, PBT and PAT Apollo Hospital

F- Key People Apollo Hospital

Executive Chairman Prathap C Reddy

Managing Director Preetha Reddy

Joint Managing Director Suneeta Reddy

Executive Director (Operation) Sangita Reddy

Director Rajkumar Menon Rafeeque Ahamed N Vaghul Deepak Vaidya T K Balaji Khairil Anuar Abdullah G Venkatraman Habibullah Badsha

Executive Dir. (Special Init.) Shobana Kamineni

Company Secretary S M Krishnan

Additional Director Sanjay Nayar

G- Competitors of Apollo Hospital

NameLast PriceMarket Cap.SalesNet ProfitTotal Assets

(Rs. cr.)Turnover

Apollo Hospital863.9512,019.723,317.79309.123,625.31

Fortis Health954,396.47352.9717.254,203.04

Poly Medicure404.6891.46252.2424.03148.66

Opto Circuits28.6693.03696.98241.042,254.94

Indraprastha34.9319.94606.7228.76222.86

Kovai Medical160.6175.73297.1321.25269.54

Lotus Eye Care6.6513.8329.40.4251.44

H- JCI Accredited Hospitals in India

Ahalia Foundation Eye Hospital, Palakkad, KeralaApollo Gleneagles Hospitals, Kolkata Apollo Hospital, ChennaiApollo Hospital, HyderabadApollo Hospital, BangaloreAsian Heart Institute, MumbaiFortis Escorts Heart Institute, New DelhiFortis Hospital, MohaliFortis Hospital, BangaloreFortis Hospital, MulundGrewal Eye Institute Private Limited, ChandigarhIndraprastha Apollo Hospital, New DelhiMoolchand Hospital, New DelhiNarayana Hrudayalaya, BangaloreSatguru Pratap Singh Apollo Hospital, PunjabShroff Eye HospitalSri Ramachandra Medical Centre, Chennai

I- Medical Tourism Industry Market Size and CAGR

J- Stakeholders Medical Tourism Sector

K- Apollo Hospital Group Companies

Apollo Munich Health Insurance: Its a joint venture between Apollo Hospitals and Munich Health.Apollo Health Street Limited: Offers Business process outsourcing (BPO) and IT services internationally.Apollo Pharmacies: Largest retail pharmacy chain in India with over 1000 retail outlets in India along with e-prescription based services.Apollo Health & Lifestyle Limited: AHLL is engaged in establishing a network of clinics in India and neighbouring countries.MedVarsity Online Limited (MOL): MOL is promoted by Apollo Hospitals and NIIT Ltd. MedVarsity has developed over 1500 hours of medical content that is accessible to the medical community anytime and anywhere.Apollo Telemedicine Enterprises Limited (ATEL) : ATEL has developed the 'Apollo Telemedicine Network' that allows the participant sites to collaborate with institutions in the country and abroad and provides their clientele access to better healthcare in areas not adequately served by the medical community.Family Health Plan Limited (FHPL): The Company deals in the healthcare insurance sector and is the largest Third Party Administrator (TPA) in Asia.Equipment World: Equipment World sources and selects medical equipment, catalogues and provides advice and services on technology, techno-commercial issues.Keimed.com Limited: Keimed.com Limited is a unified national pharmaceutical procurement and supply chain management company for a wide range of medical goods, consumables, drugs, surgical, health and personal care products.

L- Case Questions

Q. Discuss the Medical Tourism Industry in India w.r.t. SWOT Analysis.Q. What strategy could be adopted to promote Medical Tourism in India?Q. What Role can Government play in promoting Medical Tourism in India?Q. How could India emerge as a Leader in Medical Tourism despite competition from USA, Europe, Singapore, Thailand, Mexico, and Malaysia etc?

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