The Comparative Costs between India and other developed countries like US, UK, and Singapore Approximate Figures In US Dollars.

Note: Commercial Dealing In Human Organs Is Prohibited In India Under Transplantation of Human Organs Act, 1994. Chapter VI Section 19 (c) of the Act, "Whoever offers to supply any human organ for payment, shall be punishable with imprisonment" for two to seven years "and shall be liable for fine" of Rs.10,000 to Rs. 20,000.

E-mail: vprajrathnam@yahoo.co.in

Country Reports

A Glance of Nuclear Medicine Service Costs in India*

C.T. Scan Costs in India*

India

Rest-Redist. Thall/Rest Gated SPECT/Infarct lmaging: $100

Singapore

Thallium Stress Myocardial Perfusion Scintigraphy:  $175

Malaysia

Brain SPECT/First-Pass C.B.F. with Brain Scan:  $175

Thailand

Gallium Scanning:   $175

Whole Body Bone Scan:$ 75

99m Tc-Sesta MIBI tumor imaging: $100

Dynamic Hepatobiliary study: $75

Russia

So, health tourism or medical tourism is a good business proposition by providing affordable cost-effective treatment.

What are the challenges before the countries to develop as health tourism or medical tourism destination?

The biggest challenge is to position themselves as a favourable health care destination by setting high standards and work in association with the government and the medical council to see to it that all hospitals keep up to those standards. There is a huge market for health tourism in Africa. But it would not be possible to reach out to those markets without direct flights.

How is the healthcare industry in respective countries promoting their country as health tourism or medical tourism destination?

Thailand, for instance, has just one world-class hospital, and they are already hot on medical tourism destination. Singapore too has seen this opportunity early and their public health system is being accessed by medical tourists from many countries.
Australia has also set up a huge health care infrastructure for health tourism or medical tourism. The Indian Health Care Federation is now working along with different industry chambers to promote medical tourism in the country.

Medical Tourism In India

Indraprastha Apollo Hospital (IMCL) received recommendation for accreditation by Joint Commission International (JCI) of the US on 17th June 2005. Among other hospitals on the way to receive accredition are: Wockhardt Mumbai, Apollo Chennai, Manipal Hospital Bangalore and Sri Ramachandra Medical Centre (SRMC) Chennai.

Government of India has introduced a `medical visa' for foreigners who come to India for medical treatment and are here for an extended period. The medical visa" would be admissible to all foreigners seeking medicare in recognised specialty hospitals or treatment centres. The initial period of such a visa will be one year or for the period of treatment whichever is less. Unlike the tourist visa, this can be extended and the State Governments and FRROs have been given the powers to extend such a visa.

Under the medical visa rules, patients will have the facility to bring two attendants -- spouse and blood relations. They will be allowed two entries in a year, which means patients can change attendants.

This visa will enable international patients to have access to medical care in the recognised and specialised hospitals of the country.

In addition to the basic documentation required of all visa applicants, those seeking a visa for medical treatment should submit at the time of the visa interview, a description by a reputable physician or medical facility, of the disease, defect or disability for which treatment is being sought. Medical records detailing past treatments received for the condition.

When baby Noor Fatima, a two-and-a-half- year old Pakistani girl, successfully underwent an open heart surgery in India, she opened news vistas reminding the potential of medical toursim and affordable cost-effective treatment.

India offers world class medical facilities in world class hospitals and the doctors are comparable with any of the doctors in western countries. India also offers the most competitive prices.

Medical tourism is the buzzword now. The government as well as private players are keenly assessing the potential and means to tap the same. The boom in state-of-the-art hospitals and well-qualified doctors, have attracted the patient population from neighbouring countries, the Middle East and the West who are looking for quality affordable cost-effective treatment.

The equation is ‘First World treatment’ at “Third World prices”. A CII-McKinsey report last year, postulating the opportunities in medical tourism, states that the medical tourism market in the country pegged a 30 per cent growth in 2000 and it has been growing at the rate of 15 per cent for the past five years.

If industry estimated are to be believed, the size of the medical tourism industry stands at Rs 1,200-1,500 crore (Rs 12-15 billion), growing at the rate of 30 per cent. Health industry is beginning to see scale of opportunity for medical tourism.

A recent CII-McKinsey study on healthcare says medical tourism alone can contribute Rs 5,000-10,000 crore (Rs 50-100 billion) additional revenue for upmarket tertiary hospitals by 2012, and will account for 3-5 per cent of the total healthcare delivery market delivering affordable cost-effective treatment.

India, has many world-class hospitals and medical facilities at its disposal. They definitely have an advantage over others, as apart from the cost factor, most foreign nationals are used to getting treated by Indian nationals abroad. Indian medical professionals settled abroad are associated with high quality care.

Nearly seven per cent of patients at Apollo Hospitals today come from countries in the Middle East. They have now gone on to set up offices in various countries to channelise patients to their hospitals. With telemedicine, it has become easier for patients to keep in touch with them and facilitates their transfer to hospitals in India. Apollo Hospitals currently devotes nearly 10 per cent of its health care infrastructure for medical tourism purpose.

They have already invested around Rs 250 crore in 2003 with the idea to attract medical tourists. They have set up a hospital in Ahmedabad with the intention of attracting non-resident Gujaratis from the world over. They also have put in place medical infrastructure in Sri Lanka to attract tourists who come to that country. They will be soon putting up a combination of a Spa and a hospital in Goa , with focus on non-electric surgeries as well.

"Compared to countries like the UK or the US, minor treatments like those for dental problems or major procedures like bypass surgery or angioplasty come at a fraction of the cost in India, even though the quality of doctors and medical equipment is comparable to the best in the world," says K K Aggarwal, executive vice-chairman of the Heart Care Foundation of India.

A bypass surgery in India costs $2,000-5,000, while in the US it costs between $15,000 and $40,000. That's really affordable cost-effective treatment.

No wonder corporate hospitals like Apollo and Escorts Heart Institute and Research Centre are working towards capturing a larger share of the pie with their cost-effective treatment.

Escorts is in the process of arranging travel and lodging facilities for its overseas patients/medical tourists. In less than two years, Escorts has doubled its number of overseas patients from 675 in 2000 to around 1,200 till date this year.

"Almost 10 per cent of our patients/medical tourists come from Sri Lanka, Bangladesh, Nepal and West Asia," Naresh Trehan, executive director of Escorts, said.

The Mohali-based Fortis Hospital has already entered into a mutual referrals arrangement with Partners Healthcare System, that has hospitals like Brigham Women's Hospital and Massachusetts Hospital, Boston, under its umbrella. "We will soon launch a defined programme for the two-way flow of patients," Harpal Singh, chairman of Fortis, said.

The Apollo Hospitals Group is also holding discussions with the National Health Scheme, UK, to bring patients/medical tourists from the UK to India, highlighting their affordable cost-effective treatment.

"The waiting period for surgeries such as knee replacement is too long in the UK. We are working on a plan for getting those patients/medical tourists to India," Yogi Mehrotra, managing director of Apollo Hospitals, said. The hospital is also working on attracting patients/medical tourists from African countries and is in talks with the authorities concerned.

The Indian Healthcare Federation, an association of the healthcare delivery sector that includes the Apollo Hospitals Group, Mumbai's Hinduja Hospital, Max Healthcare, the Fortis Heart Institute among others, has also decided to project India as a healthcare destination with its affordable cost-effective treatment.

Among private players, Apollo has been a forerunner in health tourism. It has been a choicest destination for patients/medical tourists from Southeast Asia, Africa, and the Middle East. The group has tied up with hospitals in Mauritius, Tanzania, Bangladesh and Yemen besides running a hospital in Sri Lanka, and managing a hospital in Dubai.

In 2002, the number of patients who visited the hospital was 3001 and about 700 were hospitalised. Along with providing treatment, the stay of the foreign medical tourist is taken care of by the hospital itself. The group has tied up with hotels in Delhi for this purpose. According to Dr Chabra, additional medical director, ISIC (Indian Spinal Injury Centre), ISIC is another destination for patients/medical tourists from neighbouring countries, Gulf and a few NRIs from the US.

Now, to attract more people, the emphasis is on vacation plus treatment and special packages have been planned for this. On the anvil is another plan to make the medical tourists and their relatives stay in the hospital complex with all the luxuries a hotel provides. Dr Shakti Gupta, AIIMS, stresses on the need to export health care services. According to him, Indian doctors, medical services, and hospitals are at par with good hospitals in Europe and the US.

AIIMS is a destination for medical tourists from Nepal, Bangladesh, Bhutan, Myanmar, Mauritius, Malaya and Pakistan. Besides regular medical tourists from the Middle-East, an occasional patient/medical tourists from the US drops in for health care. Medical tourists from Pakistan, especially children with heart afflictions, have been regularly coming to AIIMS’ heart centre. According to Dr Gupta, AIIMS was made for the helath care of entire south-east Asia populace and since it is a government institute there are no plans to attract more foreigners.

The attractions for affordable cost-effective treatment at AIIMS include cardiac surgery, neurosurgery, cancer treatment and ophthalmic procedures. “The services are charged on actuals and ours being a government institute we are not angling to make money but are here to serve the people,” stressed Dr Gupta.

The Metro hospitals and Heart Institute, Noida, also manages to attract medical tourists from Nepal, Bhutan, Sri Lanka, Bangladesh and a few from Maldives and the Gulf region. Their motto is to extend excellent health services to medical tourists who travel here for health care and also for tourists who need health care while their stay in India.

Indian hospitals getting recognition from international insurance companies will bring in more patients/medical tourists from abroad, says Anil K Maini, head, marketing, health care and medical tourism business, Escorts Heart Institute and Research Centre. The centre is emerging fast as a favourite destination for patients/medical tourists from neighbouring countries, Africa and CIS. With BUPA recognition, patients/medical tourists from the UK are coming here for treatment. About 1,000 medical tourists from abroad are treated in Escorts on an annual basis.

Although only a few hospitals are making conscious efforts to increase the existing inflow of health tourists, nobody denies the huge potential medical tourism has. And it will not be long before its full potential is realised, provided we cultivate the service mind-set or attitude, put in place an accreditation system and project our capabilities overseas through multiple media.

List Of Private Hospitals In India With World Class Clincal Facilities

• All India Heart Foundation, 4874, Ansari Nagar, 24, Dariya Ganj, New Delhi - 110002
  
• Apollo Heart Hospitals, 21 Greams Lane, Off Greams Road, Channai - 600006., Tel: 91-11-8277447, 8240200. Fax: 91-44-8324429,
  
• Apollo Hospitals, Jubilee Hills, Hyderbad - 500034, Tel: 91-40-238050.
  
• Bangalore Hospital Ltd. Vijaya Mallaya Hospital, No. 2 Vittal Mallaya Road, Bangalore - 560001
  
• Batra Hospital & Medical Research Centre, 1, Tughlakabad Institutional Area, M.B. Road, New Delhi - 110062. Tel: 91-11-6983747, 6982455.
  
• Breach Candy Hospital & Research Centre, 60, Bhulabhai Desai Road, Bombay - 400028
  
• Calcutta Imaging Institute, 54, Jawahar Lal Nehru Road, Calcutta - 700071
  
• CDR Groups of Hospitals, CDR heart Institute, Hyderabad - 500029
  
• Chaitram Hospital & Research Centre, Manik Bagh Road, Indore - 452001
  
• Chandigarh Neurological Research Centre, 156-158, Sector 170C, Chandigarh.
  
• Christian Medical College Heart Research Centre, Christian Medical College, Ludhiana - 141008
  
• Christian Medical College 7 Hospital, Vellore - 362004, Tel: 91-416-22102
  
• East Coast Hospital Ltd.133, Hundred Feet Road, Natesan Nagar, Pondicherry
  
• Dayanad Medical College & Hospital, Post Box No. 265, Ludhiana - 141001
  
• Deccan Hospitals, Deccan Hospital Corporation Ltd. 1-11-252/11/1, Begumpet, Hyderabad - 500016
  
• Diwan Chand Satya Pal Aggarwallmaging Research Centre, 10-B, Kasturba Gandhi Marg, New Delhi - 110001
  
• Down Town Hospital Pvt. Ltd. Gaha Lodge, Guwahati - 781001
  
• Dr. Balabhai Nanavati Hospital, S.V.Road, Vile Park (West), Mumabi - 400056
  
• Dr. Babasaheb Ambedkar Vaidyakiya Pratishthan's Dr. Hedgewar Hospital, Sindhuteer, Bhagyanagar, Aurngabad - 431001
  
• Guwahati Neurological Research Centre Pvt. Ltd. Dispur - Guwahati, Assam - 781006
  
• Indian Cancer Society, Delhi Branch, B-82, Defence Colony, New Delhi - 110024
  
• Institute of Cardio-Vascular Diseases, 4-A, Jayalalitha Nagar, Mogappair, Chennai - 600050, Tel: 91-44-6259801 (10 lines). Fax: 91-44-6259804.
  
• Jaslok Hospital & Res, Centre, 15, Dr. Go Deshmukh Marg, Mumbai - 400026
  
• Kasturba Medical College, Madhava Nagar, Manipal, Karnataka - 576119
  
• Kasturba Medical College, Manipal, Udupi Distt. 576199.
  
• Key Pee Kay Medical Services (P) Ltd. 43, Second Main Road, Raja Annamalai Puram, Madras - 28
  
• Lady Willington Nursing Home, 21, Pycrofts Garden Road, Chennai-06
  
• Lion's Cancer Detection Centre Trust, Govt. Medical College Campus, Majura Gate, Surat - 395001
  
• Madras Medical Mission, Instt. Of C.V. Diseases, 180-N.S.K., Salai, Chennai-26
  
• Manipal Hospital, 98, Rustom Bagh, Airport Road, Bangalore - 560017
  
• Medwin Hospitals, Jaya Diagnostic & Research Centre Ltd. 100, Raghave Ratna Towers, Chirag Ali Lane, Hyderabad - 500001
  
• Meenakshi Mission Hospital and R.C. Lake Area, Malur Road, Madurai-01
  
• Meherbai Tata Memorial Hospital, Stocking Road, Jamshedpur - 8310001
  
• M.I. Diagnostic and Research Centre. B-22, Kailash Colony, New Delhi - 110048
  
• Nanda Hospital and Scan Research Centre Pvt. Ltd. 0/63, Doctor's Coloney, Kankar Bagh, Patna - 20
  
• National Heart Institute, 49, Community Centre, East of Kailash, New Delhi - 65
  
• Navin Chand Nanda National Instt. Of Echo-cardiology and Cardiac Research, Mool Chand, R.R. Research, Hospital, Lajapat Nagar-III, New Delhi - 110024
  
• P.D. Hinduja National Hospital And Medical Research Centre, Veer Sayarkar Marg, Mahim, Mumbai - 400016
  
• Parent's Association Thalassemic Unit Trust (Regd.), St. George's Hospital, Mumbai-400001
  
• Peerless Hospital and Research Centre Ltd. 360, Panchasayar, Garia, Calcutta-84, West Bengal
  
• Ramachandra Educational & Health Turst, 25, Sir C.V. Raman Road, Alwarpet, Madras - 600018
  
• Ramakrishan Mission Hospital, OP RK Mission, Itanager - 791113, Arunachal Pradesh.
  
• Sir Gangaram Hospital, Sir Gangaram Hospital Marg, New Delhi - 110060
  
• St. John's Medical College Hospital, Sarjah Pur Road, Bangalore - 5600034
  
• St. Stephen's Hospital, Tis Hazari, Delhi - 110054
  
• Suniti Devi Singhania Hospital & MRC, New Hind House, N. Morarjee Marg, Ballard Estate, Mumabi - 400038
  
• Tamil Nadu Hospital Ltd. No. 18th East Street, Kamraj Nagar, Thiruvamayur, Madras-41
  
• The Heart Instt. Vijaya Health Centre, Vijaya Gardens, N.S.K. Salai, Vadapalani, Madras - 26
  Vijay Mallaya Hospital Ltd. Mc.Dowell, No. 17, Richmond Road, Bangalore - 25

Bone Marrow Transplant

Major hospitals in India have oncology units comprising surgical oncology, medical and radiation therapy as well as the crucial Bone Marrow Transplantation (BMT). The BMT unit with high pressure hipa filters has helped achieve a very high success rate in the various types of transplantation.

Cord Blood Transplant and Mismatched Allogeneic Stem Cell Transplant have been performed successfully, a feat that is remarkable and significant, considering the fact that the treatment costs one-tenth of what it does in the west. Special surgeons are available for individual organs. Plastic surgeons of repute provide treatment for head and neck cancer, breast cancer and other malignancies. Facilities offered include tele-therapy which includes simulation work stations to ensure high precision and safety during treatment at the 18 MV linear accelerator or telecobalt machines, brachy therapy and 3-D planning systems. In orthopaedics, the Ilizarov technique is practised for the treatment of limb deformities, limb shortening and disfiguration.

Cosmetic Surgery

A new dimension of the medical field taking off in India is cosmetic surgery which utilises some of the latest techniques in corrective procedures. Some disfigurations corrected include hair restoration (hair implants, hair flaps, and scalp reductions), rhinoplasties (reshaping or recontouring of the nose), stalling of the aging process (face life, cosmetic eyelid surgery, brow lift, sub-metal lipectomy for double chin), demabrasions (sanding of the face,) otoplasty for protruding ears, chin and cheek enlargement, lip reductions, various types of breast surgery and reconstruction and liposuction.

Non-invasive surgical procedures like streotactic radiosurgery and radiotherapy for brain tumours are practised successfully.

Dialysis and Kidney Transplant

Common diseases like diabetes, hypertension and chronic glomerulo-nephritis can lead to permanent loss of renal functions - with dialysis and renal transplantation being the frequent outcome. The emergence of new therapeutic interventions has created opportunities in India to manage the progression of renal diseases. Major hospitals in India like Holy Family Hospital, Jaslok Hospital, Apollo Hospital, Sir Ganga Ram Hospital, Batra Hospital, Bombay Hospital and Hinduja Hospital have departments of Nephrology and Organ Transplant equipped with the latest computerised dialysis machines, reverse osmosis water plant to provide pure and trace element-free water supply, as well as state-of-the-art facilities in the operating rooms and Transplant Intensive Care Units.

For those who need renal replacement therapy, services like Hemodialysis, Chronic Ambulatory Peritoneal Dialysis (CAPD) and Transplantation are also available. In addition to the basic haemodialysis facilities, the patients' requirements for other modalities of treatment such as Continuous Arterio-Venous Haemofilteration (CAVH), Continuous Veno-Venous Haemofilteration (CVVH), Continuous Cycler-Assisted Peritioneal Dialysis (CCPD) are also available. Patients can also avail of the bicarbonate dialysis facility at these centres. Round the clock service is available at these hospitals for the critically ill patients in the intensive care units who may need fluid, electrolyte management and renal supportive therapy. The cost of getting a dialysis is around Rs. 1,700 to Rs. 1,800 per dialysis whereas the same costs about $ 300 in the U.S.A. Similarly a kidney transplant package in India is available for around Rs. 3 lakh which is comparatively much cheaper than what it would cost abroad.

Gynaecology & Obstetrics

Leading Indian hospitals with gynaecology departments and women's hospitals have facilities for the prevention and early detection of gynaecological disorders. Many hospitals have women check-up programmes designed to detect the earliest signs of disorders of the breast and the organs of reproduction as well as catering to the contraceptive needs of women. A mammogram, an ultrasound of the pelvis and a pap-smear of the cervix are an integral part of any good medical check-up for women. Specialist medical as well as surgical care is available for all types of gynaecological problems like menstrual abnormalities, prolapse, fibroids and other tumours of the uterus and ovaries, tubal recanalisation by microsurgery and care of the infertile couple. State-of-the-art gynaecological surgery is available with world class equipment and expertise using minimally invasive techniques.

Ectopic pregnancies, overian cysts and tumours, fibroids endometrosis, tubal blocks and even hysterectomies can be performed laproscopically. Hospitals like Apollo have state-of-the-art IVF labs backed by highly experienced doctors who have been involved in the field of infertility and assisted Reproductive Technologies (ART). A full range of diagnostic procedures are available for infertile couples. Treatment for the disorders of ovulation, controlled ovarian stimulation, controlled ovarian stimulation, Intra-Utrine Insemination (IUI), Intra-Fallopian Tubal Insemination (IFI), In Vitro Fertilization (VF) and Gamete Intra-Fallopian Transfer (GIFT), Embryo Transfer (ET), Zygote Intra-Fallopian Transfer (ZIFT), sperm donation, freezing egg/oocyte donation, replacement of frozen embryos, full range of treatment of male infertility including micro-manipulation technology - Intra Cytoplasmic Sperm Injection (ICSI) and surrogacy. The emphasis is on optimizing each couple's chance of achieving a pregnancy by combining the best scientific and medical practice with the highest standard of care.

Joint Replacement Surgery

Shoulder/hip replacement and bilateral knee replacement surgery using the most advanced keyhole or endosopic surgery and anthroscopy is done at several hospitals in India including the Apollo Hospital, Sir Ganga Ram Hospital and Holy Family Hospital in Delhi, Bombay Hospital, Leelavati and Hinduja Hospital in Mumbai and the Madras Institute of Orthoepaedics and Trauma Sciences. Some hospitals like Apollo in Delhi have Operation Theatres with Laminar Air Flow System which compares with the best in the USA and the UK. A knee joint replacement costs about Rs. 2.50 Lakh in India wheras in the UK, a similar surgery using the same implants and medical consumables costs around 10,000 pounds.

Neurosurgery & Trauma Surgery

Other routine procedures performed with excellent results are replacement arthroplasties, diagnostic and operative arthoscopy, spinal surgeries including. Harrington Rod Instrumentation for scoliosis, corrective and reconstructive procedure for poliomyelitis and cerebral palsy, micro-cascular surgical procedures and automated percutanneous lumbar discectomy.

In addition, the advanced Luque technique is employed for the correction of complex scoliosis, and decompression and stabilisation of fractures of dorsal and lumbar spine with paraplegia, by neurosurgeons with excellent training and background.

Many super-speciality hospitals in India like AIIMS, Manipal Hospital, Ram Manohar Lohia Hospital, Vidya Sagar Institute of Mental Health and Neuro Sciences, Bombay Hospital, Jaslok Hospital, Nizam Institute of Mental Health and Neuro Sciences and Apollo Hispitals have advanced faculities devoted to the treatment of the entire renge of brain and spinal disorders with highly experienced neurosurgenons, neurologists, neuro-anaesthetists and neuro-radilogists. Treatment of intra- and juxta-cranial, spinal tumours and vascular malformations, aneurysms and thrombolysis for brain attacks are done at these centres. Hospitals like Apollo employ state-of-the-art LINAC-based stereotactic radiosurgery system outside the USA. The Clinac 6000SR Linear Accelerator with XKNIFE system is a highly sophisticated computer-driven technology used for removal of appropriately selected brain tumours, arteriovenous malformations and other abnormalities.

Osteoporosis

Several drug therapies now easily available in the market have been shown to be clinically effective in slowing down or reversing the bone-loss process. Leading hospitals in India are well equipped to detect and treat bone loss in its earliest states, so as to prevent the disease or lessen its impact. Doctors in leading hospitals have the expertise for the diagnosis and treatment of osteoporosis that involves an objective, quantifiable measurement of the patient's bone mass or bone density. Advanced technology called the DXA for bone densitometry is available. During a comprehensive bone valuation with DXA, the patient lies comfortably still on a padded table while the DXA unit scans one or more areas, usually the fractured spine or the hip. The entire process takes only minutes to scan depending on the number of sites scanned. It involved no injections or invasive procedures and the patient remains fully clothed.

Preventive Health Care

Preventive health care has been introduced for the first time in the country by Apollo Hospitals with hospitals in the metros of Hyderabad, Chennai and Delhi, within easy international air access. The professional chain also pioneered the concept of lifestyle clincs, established the first organ registry in the country and introduced non-invasive technique for treatment of lesions and tumours of the brain - Stereotactic Radio Surgery and Radio therapy in the country. It recently installed a state of the art Cobalt Unit. Apollo Heart Hospital provides a complete network for cardiac patients. It has a total bed capacity of 500 beds distributed between Apollo Chennai, Hyderabad and Delhi. Apollo is linked to the Mayo Clinic and the Minneapolis Heart Institute, a premier heart institute led by the team of doctors who pioneered the Jarvik artifical heart.

Refractive Surgery

Refractive surgery is gaining popularity in India both among the public as well as among ophthalmologists. Till a few years ago only a few centres performed high volume radial keratotomy. Today, the highest international quality of eye care for cornea, cataract, squint and glaucoma is available in over 40 centres all over India. When it comes to reliability, India has the best ophthalmic surgeons with clinico-academic expertise honed to perfection in the best possible institutions. Apollo Hospital, Gurunanak Eye Centre, Dr. Rajindra Prasad Centre For Ophthalmic Sciences and Mohan Eye Centre in Delhi, Shankar Naytralaya in Chennai, L. V. Prasad hospital in Hyderabad are just some of the more popular eye care hospitals. The No Stitch Cataract Surgery with the most modern way of removing cataract through the use of Phacoemulsification procedure can be performed in India for as little as Rs. 20,000, for both the eyes, whereas the same surgery costs $ 45,000 in the USA. Facilities for PRK, myopia and astigmatism are now available in almost all parts of the country. Hyperopics and LASIK are available and even supra hard cataracts are treated using just 1 mm incision instead of the 3 mm incision size. Photorefractive keratectomy or PRK treats the surface of the cornea with the Excimer laser while LASIK treats the inner tissue of the cornea. For this reason, with LASIK there is less area to heal, less risk of scarring, less risk of corneal haze, less post-operative pain and vision often returns very rapidly.

Vascular Surgery

Removal of the gall bladder, the spleen, the bowel and other organs like the adrenals, an operation for prolapse rectum and hiatus hernia repair have become fairly commonplace in almost all the major speciality hospitals in India. Experts are easily available and accessible and the workload at most of these hospitals ensures that the doctors have enormous experience. High intensive care treatment at much cheaper rates than in the west is available at most of these centres.

Cardiac Care

Cardiac care has become a speciality in India with institutions like the Escorts Heart Institute and Research Centre, All India Institute of Medical Sciences and Apollo Hospital becoming names to reckon with. They combine the latest innovations in medical electronics with unmatched expertise in leading cardiologists and cardo-thoracic surgeons. These centres have the distinction of providing comprehensive cardiac care spanning from basic facilities in preventive cardiology to the most sophisticated curative technology. The technology is contemporary and world class and the volumes handled match global benchmarks. They also specialise in offering surgery to high risk patients with the introduction of innovative techniques like minimally invasive and robotic surgery.

Renowned Indian hospitals like Apollo and Escorts Heart Institute are equipped to handle all phases of heart diseases from the elementary to the latest clinical procedures like interventional cardiac catherisation and surgical cardiac transplants. Their success rate at an average of 98.50% is at par with leading cardiac centres around the world.

Leading heart centres like The Escorts Heart Institute have Cardiac Care Units with sophisticated equipment and investigative facilities like Echocardiography with coloured Doppler, Nuclear Scanning and Coronary Angiography. The Jayadeva Institute of Cardiology in Bangalore, the Cardiology Hospital in Kanpur, the Heart Hospital in Calicut and the Sree Sudihindra Medical Mission Hospital in Cochin are some hospitals in India devoted exclusively to cardiac treatment.

Nuclear Medicine

Nuclear medicine is now commonplace. As it involves use of radioactive isotopes in very small doses in diagnosing and treatment of diseases, radioactive medicine injected or administered orally and the distribution in the organ is scanned using a Gamma camera. Tariffs are low starting from Rs. 4,000 for Thalluim rest (SPECT), Rs. 1,800 for lung perfusion and venogram of upper or lower limbs, Rs. 14,000 for Ventilation study, Rs. 1,500 for a whole body skeletal study and Rs. 700 for Tc-99m Thyroid scan. Various non-cardiac planar/SPECT studies for bone, thyroid, liver and lungs scanning functions are performed at specialised centres in India. Diagnostic imaging of the brain, stomach, kidneys, heart, adrenal glands as well as sites of occult infection with the help of sophisticated Gamma Camera with tomographic facilities linked to computer systems can also be performed at many of these centres.

Privatization of the Medicare sector

The privatization of the medicare sector has brought with it five-star facilities and world-class treatments. The country can now boast of a number of corporate hospitals. India is a source market for professionals in the medical field for many renowned hospitals around the world. Hi-tech medical facilities have become a necessity following consumer demand among the world's fastest growing middle class. India offers a range of world quality hospitals and treatments at a fraction of world costs, with comparable success rates and service levels directly in proportion to the high-value system and natural caring that comes with its heritage. Indian hospitals are becoming known internationally for standards of health care delivery comparable to the best in the world. India has the technology and the skilled super-specialists coupled with sound infrastructure and professional management, nurses and paramedical staff to take on international competition.

Major hospitals in Chennai, Mumbai, Hyderabad and New Delhi have recorded a 12% patient flow from neighbouring and South East Asian countries. This is because people have realised that they can now have access to international quality medicare in India, at 10% of the international cost. The average cost of a cardiac surgery at the best hospital is only US$ 4,500 with a success rate of 98.5% which is comparable to the best institutions in the world. A bone marrow transplant costs an unbelievable US$ 20,000.

Technologies for the new millennium including electrocardiography through conferencing will soon be introduced in India, making it feasible for doctors to benefit from the advice of other experts.

Indian doctors recently performed the country's first robot-assisted heart surgery which reduces the risk and trauma associated with critical conditions. This operation, performed at The Escorts Health Institute and Research Centre (EHIRC) is incidentally, the first of its kind in any developing nation.

Urology

Sveral superspeciality hospitals in India offer comprehensive Urological services to diagnose and treat stone disease, urological cancer, incontinence, infertility, impotency and other urinary difficulties. Advanced methods such as lithotripsy for treating kidney and ureteric stones without surgery are available with complementary methods of treating stones endoscopically. Advanced machines like the Lithostar obvert the need for anaesthesia in the treatment of kidney and ureteric stones. High tech facilities for the treatment of prostate, bladder cancers, urethral strictures are also available. Investigation and treatment facilities for impotence and male/female infertility exist with specialised facilities for pharmacotherapy, cavernosometry and cavernosography, in addition to doppler studies for the assessment of blood flow.

Medical Tourism Council Of Maharashtra Launched

The Maharashtra government in collaboration with FICCI (Western Region Council) has launched the Medical Tourism Council of Maharashtra (MTCM). This council will operate as a nodal agency responsible for smooth operations in the medical-tourism sector besides promoting Maharashtra's affordable cost-effective treatment and health-care facilities and also the medical tourism attractions in India.

Medical tourism, as such started with Western health care workers providing short-term medical work in many countries around the world. Medical tourism was in the form of consultancy, relief or aid work in volunteer health programs.

Medical students constituted a significant proportion of those interested in medical tourism, through various elective programs, and these electives were often the gateway to future careers in international health.

Medical Tourism In Thailand

Thailand which made its name as a medical destination in the 1970's offers top-quality medical care, extremely low cost and a free trip to the beach.

Open-heart surgery, which costs about $7,000 at Bumrungrad, rather than the tens of thousands of dollars it might cost in the United States. An outpatient consultation is generally less than $10. A complete cardiac examination, including a full range of tests, costs about $100. The average hospital bed costs $50 a night.

Thailand is known for sex-change operations known more formally as gender reassignment surgery, or G.R.S. and a favourite place for people who want to look like Bo Derek. Thailand has turned to what it calls comprehensive medical tourism, offering services that range from dental care to cancer treatments.

Thai Chamber of Commerce has established its own health-care promotion agency. The key to this new promotion is the high level of medical care that has emerged here in the past decade or two. The top private hospitals in Bangkok boast foreign-trained and certified doctors and modern medical equipment. They offer an inexpensive alternative to visitors who may need procedures not covered by health insurance or who live in countries with long waiting lists for national health care.

"We thought, listen, we have really excellent medical facilities here and we have excellent holidays," said Teerapol Chotichanapibal, director of Royal Orchid Holidays. "If you can come and get a clean bill of health and then go and enjoy your holiday, what could be better?"

So, in Royal Orchid's glossy "Discover Thailand" brochure, a traveler can choose from options that include a performance of classical dance, a visit to the River Kwai, a Thai cooking class or a seven-hour "Comprehensive Health Examination for Women or Men."

"They'll come for hip replacement or knee replacement or cataracts and, yup, while they're here they'll take a vacation," said Ruben Toral, director of international programs at Bumrungrad Hospital in Bangkok. "They get their cosmetic surgery or their dental work and, boom, they're off to the beach."

On its Web site, Bumrungrad describes the procedures it offers, then adds: "Many Bangkok G.R.S. Center patients extend their visits to include the many sites of Thailand including Bangkok, the northern hilltribe areas of Chiang Mai/Chiang Rai and the beautiful southern islands of Phuket and Koh Samui."

Or it is possible to go directly to Phuket, one of Thailand's premier beach resorts, and check in to the Phuket International Hospital, which advertises, "Bright sun, blue sea, cosmetic surgery."

Curtis J. Schroeder, an American who is Bumrungrad's chief executive officer, said 225,000 foreigners visited the hospital last year, about half of whom live in Thailand. Americans made up 29,000 of the outpatients and more than 30,000 of the inpatients, he said.

With its 554 beds, air of luxury and aggressive marketing, Bumrungrad now dominates Thailand's medical tourism industry and has almost single-handedly shifted the regional hub for medical care from Singapore.

Though two-thirds of its patients are Thais, the hospital caters to foreigners with a concierge service that handles such things as airport transportation, bank transactions, visas and airline tickets.

Since Sept. 11, Mr. Schroeder said, there has been a flood of Middle Eastern patients who now avoid the United States for fear of discrimination. In response, the hospital has hired extra Arabic interpreters, stocked up on Muslim prayer rugs and opened a kitchen serving religiously acceptable halal food.

Bumrungrad has made a deliberate effort not to look or smell like a hospital, softening its decor and filtering its air. Its gigantic, carpeted lobby with deep sofas, potted trees and a blonde-wood reception desk has the look of an expensive hotel.

As much as anything, it is the Starbucks coffee shop that draws comment, along with the McDonald's, the Au Bon Pain, the Japanese restaurant and the mezzanine food court. A bed-ridden patient can order from any of these outlets through room service.

Mr. Schroeder, who was previously the administrator of USC University Hospital in Los Angeles, has been an enthusiasic booster of Thailand's medical tourism.

Medical cost in  Thailand is 15% of identical medical care in the west. American and European educated doctors, using the most modern diagnostic equipment provide the medical plan.

The country has 208 private hospitals, of which only 16 are recommended as suitable for foreigners, though the number is expected to grow. Visa procedures are simple for patients coming for medical treatment, though visitors from many countries are admitted without visas.

A range of services including comprehensive check-ups, hip replacements, kidney or liver transplants, assisted reproductive technology, Lasik surgery, plastic (including cosmetic) surgery and other elective procedures is promoted internationally.

Thailand is now treating about one million patients from countries such as Japan, Bangladesh, Indonesia, China and the U.S., generating close to $ one billion in revenue. Apart from the U.S., where procedures and hospitalization typically cost four to 10 times as much, patients come from developed countries in Europe. Australians, come mostly for cosmetic surgery which are often combined with a conventional vacation.

Medical Tourism In Hong Kong

Hong Kong has a reputation for high standards, but the fees are relatively high.

Though Hong Kong has long been a destination of choice, lower costs are making increasing numbers opt to travel to other countries like India, Thailand and Malaysia.

Medical Tourism In Singapore

Singapore, a regional leader in medicine, received the most foreign patients a decade ago. Indonesians, Malaysians and Bruneians came here for treatment in large numbers. But the island republic's increased prosperity has also increased the fees. It is now working on gaining status as a reliable venue for complicated rather than routine procedures. Singapore Medicine, is a new government agency dedicated to promoting the city-state as a destination for medical treatment.

Despite the setback of rising costs, Singapore is adapting. It aims to reinforce perceptions that it is the leading provider of sophisticated medical care in the region, even if patients wanting routine care opt to go somewhere less expensive.

According to Khaw Boon Wan, acting minister for health and senior minister of state in the ministry of finance, "In three specialties alone, heart, eye and cancer, I see millions of middle-class patients within a seven-hour flying radius, waiting to be served,"

He added Singapore's long-held ambition of becoming a regional medical hub had not yet fully blossomed, and acknowledged that meeting the government's new target—five times the number of patients who currently visit annually—will be a challenge.

With a healthcare delivery system ranked sixth by the World Health Organisation (WHO), Singapore has stepped on the accelerator to aggressively market itself as a healthcare destination in the region, including India. Its top-rung hospitals have India circled in red, as a destination to market its healthcare services. And this, even as India itself hard-sells "medical tourism." 

More than two lakh international patients travel to Singapore every year, say representatives of SingaporeMedicine, a multi-agency government initiative aimed at making Singapore a medical hub for global patients. Neighbouring Indonesia and Malaysia account for a lion's share of these numbers, but patients from India are on the rise, they observe.

"There is enough room for both Singapore and India, and the two countries can complement each other's medical specialities," points out Ms Jeannie Lim Suet Ying, Assistant Director, SingaporeMedicine. "Besides, Singapore is looking to wean away the outbound Indian patient who goes to the US or the UK for medical treatment," she adds.

"Medical costs in Singapore are about 40 per cent less than in the US and 60 per cent less than in the UK," says Mr Debanjan Sen of Tan Tock Seng, the public hospital designated to handle the volumes of patients during the SARS crisis. According to officials, Indian patients are sizeable enough to go out and generate more interest in the Indian market.

Another "public hospital" with designs on India is the National University Hospital (NUH). "We already have about 180 in-patients and another 2,649 outpatients from India in 2002. We should be going into India, with marketing offices, later this year," says NUH's Mr Kamaljeet Singh Gill.

Singapore's private healthcare providers are no different. The Parkway Group Healthcare already has a presence in India through one of its three group-hospital Gleneagles, which has a joint-venture project, Apollo Gleneagles, in Kolkata.

Similarly, RafflesMedicalGroup (RMG) has plans to expand into India and the region through marketing initiatives and alliances, says RMG's Mr Saw Chit Aung. It is in discussion with tour operators Jet Air to design packages for medical tourists.

"Hospitals in Singapore have been inward looking till now. But we are increasingly looking to bring in international patients since we can offer them quality services," sums up Dr Fidah Alsagoff, with Singapore General Hospital, the country's public sector flagship hospital.

Singapore aims to bring in one million foreign patients by 2012, adding S$3 billion to the government kitty.

Medical Tourism In Malaysia

Malaysia's lucrative new business is to lure European clients to hideaway holidays for bigger breasts or a facelift. Malaysia's other major selling point is its ability to perform difficult treatments. Among the most popularly requested operations are cardiac bypass surgery—the National Heart Institute is a leading center in the region—and fertility treatments, with the country's premier Damansara Fertility Centre claiming in vitro success rates that match top U.S. clinics'.

According to Azilina Zainal, a Tourism Malaysia official. "Hospitals catering to foreigners are not just in Kuala Lumpur but also in cities such as Melaka (formerly Malacca) that are close to Singapore." She said, "We see medical tourism, which is fast-growing, as a niche with vast still-to-be-tapped potential."

Price and privacy are the big drawing cards, says Marloes Giezenaar, a 26-year-old MBA who has reshaped 65 clients since setting up "Beautiful Holidays" on Penang island off Malaysia's north-west coast.

For around the same cost as cosmetic surgery in their home countries her clients get the surgery plus the chance to recuperate during a two-week holiday in a four-star hotel far from the prying eyes of acquaintances.

The most popular treatments, in order, are breast augmentation, liposuction, tummy tucks, facelifts and nose jobs.

"In Britain a breast augmentation with implants is between £3000 and £5000 pounds, depending on what kind of clinic you go to. "With us, including the flight from Britain, two weeks in a four star hotel, plus the surgery, all the transport, all our advice, it comes to about £3000 — £3200 pounds."

"I have a lot of friends in Europe who had cosmetic surgery and I always thought the recovery was very slow — weeks of sitting at home, but they still had to go to the supermarket and do domestic chores while they were healing.

"When I came to Asia I found that many wives of expats had things done here because it was so cheap and the results were practically the same as in Europe. They also recovered a lot faster because they all had maids so could sit around doing nothing.

Giezenaar works with a Malaysian plastic and cosmetic surgeon who practised for several years in Britain. She does the marketing — mainly through her website, word of mouth and brochures at European beauty salons and gyms — arranges the consultations, flights and accomodation.

Several Asian countries, including Singapore and Thailand are are targeting "medical tourism" as a growth area, and Giezenaar is co-chairman of the Health Tourism Promotion Taskforce of the Penang Tourism Council.

"Malaysia's got big potential for medical toursim. The hospitals are very good, spoken English is better than in many countries and a lot of Malaysian doctors trained in the UK and Australia."

"We've had clients who didn't tell their husbands or boyfriends — just said they were going on holiday — and presented a surprise when they came home." Others bring their husbands along for the golf.

Giezenaar says although Europe is her main market, she is receiving an increasing number of clients from Asia, mainly Singaporeans and Hong Kongers looking for double eyelids and Indians seeking nose jobs.

"They don't like talking to their families about it so if they just tell them they're going on holiday to Penang that's fine."

Most of her clients are women, but she has had several men seeking liposuction, breast reduction and nose jobs. Her youngest patient was 19, for breast augmentation, and the oldest was 62, for a tummy tuck.

Giezenaar believes cosmetic surgery is about to boom in Asia, with women having increasing disposable income and a desire matching their European counterparts to improve on what nature has given them.

A full facelift with all the endoscopic forehead lift and double eyelids is about 18,000 ringgit (nearly $5000).

Pantai Medical Centre, Kuala Lumpur
Posh patients can enjoy deluxe accommodation at Pantai's Royal and Premier Suites. This includes the services of a bow-tied butler, satellite TV and digs more Regent Hotel than recovery room. Some even have a one-way mirror for your personal security guard to check up on you.

Mahkota Medical Centre, Melaka
This 356-bed hospital offers homely hostel rooms in the same block for visiting family members. The center's specialties include affordable caesarean delivery and open-heart surgery. Outpatients might want to consider Mahkota's three-day/two-night health-screening packages, which include tours of the historic town and even transportion to a local golf course.

Beautiful Holidays, Penang
Marketed to Europeans through the Internet, Beautiful Holidays (beautiful-holidays.com) is a tour company providing plastic-surgery packages in conjunction with the Loh Guan Lye Centre, a 25-year-old private hospital in Penang. The most popularly requested operations: liposuction and tummy tucks. "Our customers enjoy the anonymity," says Marloes Giezenaar, Beautiful Holidays' managing director. "They fly in, recuperate around the pool, and fly out again without anyone noticing they've been under the knife." The company can also arrange postsurgery tours of Penang.

Country Heights Medical Tourism (CHMT), Kuala Lumpur
The country's only medical screening center within a five-star resort, CHMT offers patients a battery of diagnostic tests (including fluoroscopy and abdominal ultrasounds) and the results five hours later. Pass the time by taking a water taxi to the neighboring Mines Shopping Fair for a bout of retail therapy.

Medical Tourism In Philippines

Philippine Health Tourism Programme (PHTP) aims to target both the wellness/spa and medical tourist markets.

Tourism Secretary Roberto Pagdanganan, said that health holidays are significantly growing outside Europe and in other parts of the world - “If the growth of health resorts in Asia, including the Philippines, is anything to go by, there would seem to be a huge potential to develop health tourism as a great come-on since health and wellness using traditional healing methods, such as massage, healing and herbs is very much part of the Asian culture.”

Under the Philippine Health Tourism Program (PHTP), DOT and its partner agencies such as the Department of Health–Philippine Institute of Traditional and Alternative Health Care (DOH-PITAHC) and the Department of Energy (DOE) are jointly offering cost-effective medical treatments combined with special itineraries that will showcase some of the best tourist attractions the country could offer.

The new program will be offered to tourists whose main purpose for visiting the Philippines is to undergo “minimally invasive medical procedures and treatments.” Specially-designed tours integrated with the medical programs by accredited hospitals and healthcare establishments will then be offered to suit the needs of these identified market segment.

Philippines is one of the few countries in Asia to offer such specialized medical or health tour offerings, with only Thailand, Malaysia, Singapore and India as competitors.

The DOT, DOH-PITAHC and DOE have already come up with rules and regulations for the accreditation of health establishments, wellness centers and hospitals in the country, using DOT’s standards for hotels as the benchmark. Currently, only St. Luke’s Medical Center remains the only hospital that has met these standards.

Hospitals such as the Asian Hospital in Alabang, Capitol Medical Center in Quezon City and Medical City in Mandaluyong City are gearing up to offer world class facilities. Surgeons in the Philippines, routinely perform kidney transplants and complicated cardiac procedures.

The country’s bid was also reinforced during the state visit of President Gloria Macapagal-Arroyo in Bahrain last December when the Bahraini government expressed interest to send medical tourists to the Philippines. Now underway are a Medical Tourism Forum and modules for the implementation of a “Mabuhay Host Training Program” for healthcare frontliners of accredited hospitals, all to strengthen the country’s readiness as a health vacation destination.

The DOT is also spearheading the establishment of the Spa Philippines Association (SPA), an organization to be composed of accredited firms and individuals who are directly or indirectly engaged in the spa business.

The SPA, which will be DOT’s ally in promoting the Philippines as a spa holiday destination in Asia, aims to uphold the standards and ethics of the Philippine spa industry and strive towards its professionalization, ensure the highest standards of services and facilities for clients, and develop a unique branding or image for the Philippine spa industry.

One of the most active participants in the DOT’s Philippine Health Tourism Program, The Farm at San Benito—Hippocrates Health Resort of Asia, a world-class alternative medical resort in Lipa City Batangas, holds healthful activities for the whole family.

Called “Family Week at the Farm,” this series of activities is part of the health resort’s commitment to the DOT to help in promoting the country as a health vacation destination in Asia. Activities which a family will surely enjoy include kite flying, arts and crafts, massage lessons for kids, face painting, yoga, conscious walking exercise, swimming, seed planting, healthy food preparation, etc. The Farm includes a fully integrated medical facility specializing in alternative preventive health and natural healing.

Health Tourism in Russia

(From Heritage of Spa and Health Tourism in Russia: Inna Petroun, Dr., Vice-Director of Sochi branch of Moscow International University, national coordinator of the Black Sea Tourism Education network and Elena Yachina, Dr., Director of Institute of Rehabilitilogy under Sochi State University for Tourism and Recreation, Vice-Director of Sochi Research Institute of Balneology).

Healthy Health Spas Passed on to Health Tourism

The average age of spas' customers is 30-50 years. About 40% of guests are regular clients. The most popular seasons are spring (when chronical health problems acute) and summer (period of holidays and traditionally preferable season for travel in Russia). Spas offer tremendous discounts in winter, but because of low occupancy many of summer conveniences do not pay back, and hence - are not available. As Russian spas now have to face competition in the national market with outbound trips, standards of comfort will have to be urgently introduced at spas - to improve design and to upgrade services.

Obviously, it's too early to make any conclusions on the future of Russian resort heritage. However, there is a strong chance for its development and rediscovery on the basis of health tourism.

Health treatment at spas as an applied area of knowledge, dedicated to the aims of improvement and rehabilitation of health and based on the studies of curative properties of natural factors, refers to obvious achievements of Russian Medicine and health care. No wonder the current initial stage of the new UNESCO project ARTHUR on global Heritage sites might extend its concept of Heritage through a study of Sochi, the core health resort of Russia. Indeed, the large-scale development and popularity of resorts was a remarkable feature of the XX century in Russia. Yet, in the 1990s this sphere was practically ignored by the market reforms. Neither the new Law on Resort Destinations, nor the hectic adjustments introduced by the examples hardly valid in other sectors of the national economy, were adequate to reconsider the spas' mission and operations in a new systems approach and to reroute health resorts' development into the appropriate health tourism industry. While the new concepts of health tourism and resort business are in the air, some local initiatives are growing into good practices, while the immediate priorities are being researched and addressed by education.

Resort destinations in Cyprus, Malta, Italy, Greece, Spain, Bulgaria, Tunisia, France, Thailand, that do not provide the quality of Russian treatment at spas, yet offer more affordable prices and luxury. Domestic tourism is in the crises in the 1990s, and the most notable decay is in the sphere of health resorts, though recreation at spas used to be the most popular purpose and motivation for travel till 1980 in Russia, and though there is the tremendous and still growing need for health tourism.

Interviews taken by experts of the TACIS EDRUS project in 1997 at a number of enterprises revieled, that people still tend to dream about recreation in the sun on the Black Sea, mountain skiing and hiking in Central Russia, relaxation on the Baikal lake, visiting cultural heritage sites around Moscow and St. Petrsburg. yet they both dream of and need the spa treatment and recreation in Southern resorts and in a number of other regions. Unfortunately, between the categories of "a need in" and "the demand for" health tourism there is a gap of economic indices, social policies, political priorities and conceptual approaches. Those are to be understood from the perspective of tourism and resort historical development in Russia.

Is Heritage a Threat to Resorts?

For 280 years Russia has been developing and advancing spa treatment. It was Peter the Great who constructed the first resort in Russia (in 1719 in the suburbs of Petrozavodsk in the Russian NW) and issued a Statement, according to which development of treatment facilities and spas became an item on the state list of priorities. Russian aristocracy supported the idea, and Russian resorts leveled and up-scaled the West European kurorten in style, mannerism and fashion.

In 1917 there were 36 resorts in Russia, with 60 spas providing treatment with natural water springs, baths and curative mud. Their total capacity was 3000 beds.

After the revolution the resorts fell under rule of Narkomzdrav (Committee for Health Care). According to data of 1928, about 242 000 people per year enjoyed treatment at resorts in Russia. In 1940 there were 3600 spas and rest homes in the Soviet Union - with the total capacity for 470 000 guests.

The Soviet government took it as a challenge to select and finance the most creative ideas for further developments of national resorts. In 1985 there were 14 000 spas in the Soviet Union, with the capacity of 2mln 250 beds.

Since 1960 they were run by Trade Unions, different ministries, solid organizations.

Before the 1990s health tourism was a half-social, and half-ideological program, with highly subsided resort facilities and travel, and the Constitution rights of all citizens to enjoy leisure and recreational opportunities. Three organizations had their share in tourism until 1989: the state-owned "Goskomintourist" for international tourism, the Komsomol - owned "Sputnik" for youth travel and the State Council for Travel and Excursions - for incentive tourism. Besides, Trade Unions and the Communist Party were active owners and distributors of incentive travel. The major decisions regarding construction, transportation, distribution of trips and strategic developments were taken by the Government through the above-mentioned three major organizations.

The indispensable role of spas in Russian health service has always been based on rehabilitation of people who had suffered

• myocardial infarction,
• cardio surgery,
• reconstructive surgical operations on kidney and peripheral vessels,
• acute condition of cerebral vessels,
• neurosurgery on innocent tumor,
• operations on ulcerative disease of the stomach or duodenum,
• chronical pneumonia,
• nonspecific deseases of lungs.

During the 1990s particular attention has been given to hydrobalneotherapy, due to which for quite a number of diseases and health problems there are well-established recommendations/prescriptions of spa types (climatic, or balneological, or local) and the desired season (depending upon specific manifestation and phase of the disease, form of the disease, etc.).

The main objectives of spa treatment are:

Preventive treatment:

• impact on risk factors (excessive weight, etc.),
• improvement of physical ability to work,
• improvement of psychic state;

Treatment:

• impact on pathogenetic links of the developing disease,
• improvement of the patent's functional condition of organs and systems,
• improvement of the clinical condition of the patient,
• decrease of resistance to medicine taken for treatment, decrease of medical treatment;

Rehabilitation:

• restoration of physical functions damaged by a disease,
• liquidation of consequences of traumas and operations,
• full or partial resoration of ability to work,
• physical and psychic rehabilitation,
• improvement of life quality.

Health Tourism in Saudi Arabia

Saudi Arabia is set to enhance its position as an international leader in the field of health tourism as a result of The Supreme Commission for Tourism's promotion of public-private sector partnerships.

In the case of health tourism, this will ultimately provide a 'one-stop-shop' for the thousands of people who visit the Kingdom each year to receive medical treatment.

Saudi Arabia is renowned for providing sophisticated healthcare services for the treatment of all general as well as highly specialised medical conditions.

'We are committed to enhancing our medical care services by offering complete arrangements through co-operation between health practitioners, hotels, travel agencies and tour operators, all of which can be tailored to suit a range of budgets,' said His Royal Highness, Prince Abdul Aziz bin Fahad bin Abdulla, Deputy Secretary General of Saudi Arabia's Supreme Commission for Tourism (SCT) for Investment and Marketing.

'Such arrangements will ensure comprehensive packages which will include accommodation, transportation and optional tours to complement world-class medical treatment facilities and expertise,' he added.

Saudi Arabia's plans to enhance its health tourism product were endorsed by its participation in the First International Health Tourism and Holidays Exhibition which is currently taking place in the Kingdom of Bahrain. Led by the Supreme Commission for Tourism, delegates included some of Saudi Arabia's largest hospitals and medical centres. These are King Faisal Specialist Hospital and R.C, King Abdul Aziz Medical City, Mouwasat Hospital, Dr Erfan and Bagedo General Hospital, Dallah Hospital, Riyadh-Al-Kharj Hospital, Specialised Medical Center Hospital, Sultan Bin Abdulaziz Humanitarian City, as well as the Ministry of Health.

The hotel, travel agencies and tour operators also participating entities include Al-Mutlaq Hotel, Menhal Travel & Tourism, National Company for Tourism and Sunset Beach.

The medical insurance industry in Saudi Arabia is also of great strategic relevance to health tourism, and Methaq Insurance - one of the participants at the event - announced that is now offering policies to religious pilgrims as part of religious travel packages, to provide medical insurance coverage in case of any injuries during pilgrimage trips. Methaq's policies are accepted at the best hospitals and medical centers in the Kingdom.

'Combined, these co-participants – under the umbrella of The Supreme Commission for Tourism – have affirmed their commitment to partnerships in the area of health tourism to promote and serve the best interests of health tourism visitors to the Kingdom, 'explained Prince Abdul Aziz.