History and record of medical tourism



The practice of travelling abroad to acquire medical and healthcare services is called as medical travel and leisure. The benefits of medical tourism are getting widely popular among people because people are getting aware of the advantages of medical tourism like the lower cost of the medical procedures and can enjoy their holiday in a unique location during the restoration period. This outsourcing for healthcare is expanded as a new tendency and many American and Western european tourists prefer medical travel and leisure for aesthetic and surgical procedure. The countries that happen to be insufficient advanced surgical procedure leads the people living there to fly in foreign countries to get appropriate medical services.

The practice of venturing overseas is a craze which developed from the old period and there is a long history of individuals going to other countries for health purposes. In Italy and throughout the Roman provinces, the Ancient Romans constructed resorts with thermal spas, and the Ancient Greeks would travel 'to [on the Saronic Gulf] to go to the sanctuary of the healing god, Asklepios, who uncovered remedies to them in their dreams' (Bookman and Bookman 2007: 4-5).

From the 15th to 17th decades, the indegent sanitary conditions in Europe prompted a pastime by the abundant with therapeutic spas, mineral springs and the seaside for health purposes. These prosperous individuals would also travel to renowned medical schools for medical attention (Swarbrooke and Horner 2007: 16, 33). This prolonged in to the 18th and 19th decades where spa towns, especially in the south of France, became popular for health remedies, sunlight, and escaping the frigid climatic conditions in the north of Europe (Holden 2006: 21-23). The swift urbanisation and public change experienced during Industrialisation aggravated the unsanitary and poor living surroundings in Britain and some sections of Europe, with anti-urban prices and an evergrowing concern for health growing because of this (Holden 2006: 30). The forming of the railways allowed increasing and diverse moves of folks to more distant seaside and coastal resorts, which provided a distinctive and escapist environment from urbanisation, and the opportunity to practice that which was seen as a healthy pastime of sun-seeking (Holden 2006: 30; Swarbrooke and Horner 2007: 16, 33)

Spa tourism and sun-seeking persisted in to the 20th century. Therapeutic springs, spas, Beaches and resorts, specifically in warm and dried climates, continued to be considered restorative through long exposures to the sun, oxygen and normal water (Swarbrooke and Horner 2007: 33). Thus it is not hard to comprehend that medical tourism is rolling out from the historical era with myths and values and as cure from natural resources to the current stage of various medical and surgical treatments and cosmetic remedies and for different treatments like yoga, naturopathy and ayurvedic medicine. Michael Moody (2007) shows that the medical travel and leisure trend began when residents of 1 country would go overseas to have aesthetic or dental types of procedures completed while on vacation or to recover from such strategies in a vacation like destination.

Today, countries like India, the East Indies, South America and South East Asia offer treatment facilities at par with international specifications at simply a small fraction of cost. The factors such as high cost of health care in developed countries, long waiting list in government medical facilities and the reduction of air fare will be the majority of reasons which contributed for the expansion of the medical tourism. The nursing homes in India, the East Indies, South North american countries and South East Asia provide a high quality health care which is par with international requirements in very cheap money in comparison to developed countries.

India is one of world's favorite holiday destinations and has many hospitals of international standard and English speaking staffs and therefore there are less likelihood of language barrier for the western patients. India has alternate therapies like Yoga naturopathy siddha and ayurvedic medical techniques. Among the recent survey conducted in India on the medical care implies that the medical tourism in India will grow to US $ 125 to 250 million in the entire year 2012. (CII McKinsey study). The low cost and high standard treatment and care are the reasons which accelerates the medical tourism in India. The next example will demonstrate about the cost-effective as well as holiday great things about medical tourism in India. Howard Staab, a self-employed carpenter from NEW YORK, flew to India for his medically necessary heart surgery, scheduled a side visit to the TajMahal, and returned home to work in NEW YORK. He spent a total of less than $10, 000, rather than the $200, 000 required from the neighborhood clinic ( Milstein and Smith 2006). This indicates that India has patients for methods like center surgery which requires condition of art facilities and very skilled medical team. Other than that it also shows the amount of money difference in comparison to developed nations. Kerala like any other state governments in India also offers lot of potential to be a market innovator in medical travel and leisure.

Kerala often referred to as "God's own country"is one of the favourite tourist destinations in India. The geography of Kerala is embellished with lush renewable coconut groves, scenic beaches, tranquil backwaters and enriched culture. There is a pride of place in the field of medicine because of this Indian talk about and medical tourism is the new element of Kerala.

Medical tourism is extremely popular in some claims of India which study focuses on a city of Kerala talk about. Kerala is known as one of the very most favorite tourist destinations in India because of its beaches, hills, lagoons, backwaters and enriched culture. This condition has tremendous potential to boom its medical travel and leisure and the travel and leisure industry is promoting itself with several ayurvedic and health plans.

This study focuses on the fads of medical tourism in metropolis of Trivandrum which is located on the southernmost status of India called Kerala. This city is the current capital of the condition of Kerala which is known because of its scenic beauties and beaches. This city also offers several international standard clinics and traditional ayurvedic resorts and treatment centers.

Objective of the Research Study

The principle goal of this review was to investigate and critically analyse the recent styles in the medical travel and leisure in the Trivandrum, the southernmost city of India. This analysis also analyses the habit of the medical tourist and their objectives in the assistance provided by the hospital or the medical center and the holiday operators or businesses. This review also focuses to address the a difference that is accessible in similar research conducted before. Desire to was to address the gap between available books and demand for further research about them by adopting a clearly defined and organized research design, utilizing both quantitative and qualitative research methods.

  1. Find the factors that drive Medical Tourism in Trivandrum
  2. Analyse the issues which determine success of medical tourism in Trivandrum
  3. Identify the problems experienced by Medical Travel and leisure in Trivandrum
  4. Make suitable suggestions for improvement of Medical Travel and leisure in Trivandrum


The first of all reason behind choosing this issue of the analysis is to construct before the visitors the express of the Indian medical travel and leisure sector at an instant in time when it is in great flux. Furthermore the writer was employed in one such clinic that was market head in medical tourism in metropolis of Trivandrum. The medical tourism sector is thought to be a great boon of inexpensive development in Kerala and for that reason by doing a study at this particular time can provide readers recognition about the situation challenges and scopes. Other than that medical tourism it is an market of the author as he wishes to analyse the movements and issues mixed up in medical tourism industry in Trivandrum city. The purpose of this research word is to describe some of the issues and opportunities ahead, as health tourism sees its prominence in the functional and conceptual domains of tourism. Further there are predictions for Trivandrum city to flourish with medical tourism in next five to a decade which is right time to analyse the obstacles and scopes forward.

Structure of the study

This review explores the developments of medical tourism in Trivandrum city and the issues around it. The need for further research on this issue has been set up with following a secondary research followed by principal research and by assessing evaluating the primary and supplementary research. Relating to McDaniels carrying out exploratory research will offered the researcher clarification to understand the magnitude of topic area and thereby allowed a clearer and stronger perception of the surroundings and the situation which occur within it. (McDaniels, 2001).



The medical tourism has an good thing about providing cost effective medical care collaborating with the health care industry and with the travelling industry to the patients who need medical treatment in a spot different to their house town. Thus medical tourism occurs with the combo of healthcare services and tourism and travel site. The facts that led the growth of the medical travel and leisure are the availability cheap and high quality health care in one geographical location and existence of long queue of patients for medical procedure and high prices of medical care in one geographical region. The outcome of the factors is the expansion of medical tourism resulting in people moving to some other geographical location for health care.


The term medical tourism is a term coined in recent period however the practise seems to exist from ancient period and the developments in medical travel and leisure have evolved with the time.

The health tourist travel to their favourite vacation spot for different medical and surgical treatments, cosmetic surgeries, alternative drugs, and spas and health resorts. The factors and risk for different steps vary appropriately. The medical tourism has gained interpersonal, economical and political interest but it offers gained scant attention in travel and leisure literature generally.

Bookman and Bookman (2007) define medical travel and leisure as travel with the purpose of enhancing one's health, and also an monetary activity that entails trade in services and symbolizes the splicing of at least two sectors: medicine and tourism. Medical tourism is seen as means of leisure focused and stress alleviation as many folks select for sun and spas. Although there is no single classification for health travel and leisure, maybe it's broadly defined as people traveling using their company place of residence for health reasons (Ross 2001). Several demographic, economical, and lifestyle factors are generating such tourism (Handszuh and Waters 1997; Ross, 2001). Bennett et al. (2004: 123) acknowledge a liberal meaning of health travel and leisure would be 'any pleasure-orientated tourism that involves an element of stress relief', indicating it is an enjoyable and calming activity

Pollock and Williams (2000: 165), Regulations (1996 in Henderson 2004: 112) and will try to start to see the health travel and leisure with the view that it is a separation between your normal and the astonishing; the everyday world of work and home versus the mixture of health insurance and travel and leisure in 'leisure, recreational and educational activities'. Then Schofield has a view that health travel and leisure is a means to achieve improvement in physical, mental and communal health. (Schofield 2004: 137). The above all definitions try to define health travel and leisure as a way to escape from every day boring and improve stress free healthful life.

Henderson (2004: 113) insists that health tourism as 'travel where the primary goal is treatment in search of better health' which could involve 'hedonistic indulgences of spas and substitute therapies', while medical travel and leisure 'comes with health screening, hospitalization, and surgical operations. Ross (2001) after analysing various factors and books tries to explain health tourism as almost any tourism that involves a person or his family member for the purpose of wellbeing and he considers that health travel and leisure mainly focuses on two main domains as pampering and wellness. Pampering are services like massage, organic and natural wraps and exfoliating scrubs whereas wellbeing involves with improving physical and mental state and sometime it may involve with the procedure.


The idea of medical tourism have undergone many changes recently and there's a change in the fads like people from developed countries moving to growing countries for surgical procedure for the difference in the price. The global medical expectations and restrictions have been carried out in several countries and this in turn raises the number of folks seeking cost gain and best treatment in their preferred vacation spot. The marketplace of medical travel and leisure depends on understanding and program of significant issues such as public diversities, consumer benefits, branding of products, legal structure work infrastructure, goal markets, the actual product and communication programs (Dannell & Mugumba). Therefore it is understood that the folks from developed countries choose their destination after analysing various features and therefore there are present high competition between your countries to promote medical tourism.

The one more key component in this medical travel and leisure is the medical concierge services. They are medical travel agents offering service to the traveller plus they act as a link between tourist and the vacation spot (Lagiewski, 2007). They have a essential role in the holiday experience from planning, stay, and post periods of the trip. The medical travel guide fits the visitor at the airport and he is the local agent who works as interpreter, guide and assists the tourist to stay in communication along with his family members in his home. (Smith and Forgione, 2007).

According to Connell (2006) the ability to the countries to ensure the medical holiday that health care is of safe quality is a essential factor which will be the primary hurdle for a vacation spot to market itself because so many favourite destination To be able to combat this concern, international accrediting companies are in the process of certifying the quality and safety of global medical delivery. The visitor decides to activate in medical travel and leisure on the basis of five a factor discovered by Lagieweskii. Her analysis identifies the above all as the choice healthcare facility with their country's facility that ought to be of high standard and at affordable cost. This factor is the key factor so when the traveler is content with first factor the next will be cost of treatment and travel of great importance. The holiday may seek other country as a result of e big waiting list in their house country. There could be some reasons like distant destination for visitor for certain cosmetic procedures. The type of the country is also a key point because tourist looks for a country free from risk factors associated with safe practices, security and actability. ( Lagiewski, 2007).

The country aiming to make itself because so many preferred destination for medical travel and leisure it should stress on the fact that its overall charm and the encounters wanted to the other rivalling places. (Dwyer and Kim 2003). Dwyer and Kim insists that the destination must have the competitive edge to be successful in the medical travel and leisure industry. Regarding to Dwyer and Kim the living of two type of resource group may lead to achieve competitive advantage. They are the endowed resources and created resources. Endowed resources are natural traditions and cultural traits to a specific destination and created resources are services from the traveler such as accommodation, food and beverage institutions, and manmade attraction. There can be created resources such as special events entertainment and shopping which provides additional value to he vacation spot. There may be supporting factors such as standard infrastructure; quality of service; convenience of the vacation spot; hospitality of the variety inhabitants; and market ties.

Growth has been facilitated by the climb of the Internet, and the introduction of new companies, that are not health specialists, but brokerages between international patients and hospital sites. It has also grown because of speedily improving health care systems in a few key countries, where new technology have been implemented. Above all it offers followed the deliberate marketing of healthcare (in colaboration with tourism) as health care has gradually transferred away from the public sector to the private sector, making certain a growing majority of people, especially in the richest countries, and specifically in the United States, must pay-often considerably-for health care

Finally, the factors like development in medical tourism is done by the changing life style where people will be ready to undergo cosmetic surgery, affecting such elective techniques as rhinoplasty, liposuction, breasts enhancement or lowering, LASIK attention surgery etc, or more simply the removal of tattoos, have created new demands. Various varieties of oral surgery, especially plastic dental surgery, are not included in insurance in countries like the united kingdom and Australia; hence dental care tourism is becoming particularly common. In Asia these movements are 'the unlikely child of new global realities: the fallout of terrorism, the Asian financial downturn, access to the internet to price information, and the globalisation of health services' (Levett, 2005)

India and medical tourism

India is a country of rich culture and traditions and one of the most favorite locations for tourism. It really is one of the prevailing oldest civilizations on the globe for an interval of more than 4000 years and they have fusion of customs, customs and diversity. (myindia). The study conducted by lonely world about the world's favorite tourist vacation spot among 134 countries ranks India as one on the list of world's top 5 holiday destination. (lonelyplanet)

There are similar surveys and ranks for India as Country wide Geographic explains India as "Land of puzzle and majesty". The company i - explore also rates India as one of the tp 5 destinations in world. The Forbes traveller state governments India as one the fast growing travel markets. (ICRImedical tourism)

A range of areas within India developed as havens for snooze and recuperation such as hill stations at Darjeeling and the lakes in Kashmir where through the colonial era people of British time would retreat for cool breeze and a change of scenery. Late through the 19th century people started travelling India in search of alternative life style often concentrating on yoga or meditation and following footsteps of celebrities. India is building on these traditions as a wellness destination with a developing competence in medical tourism (Garcia Altes 2005: conell 2006a).

The main marketing sections for medical travel and leisure in India are patients from USA and European and middle east countries, while growing niche market is shaped by Indian expatriates, particularly those live in USA and the UK. (Conell 2006), who incorporate medical treatment with visits to relatives and buddies.

Medical tourism as a distinct segment has surfaced from the fast progress of what is becoming a business, where people travel often long distances to international countries to obtain medical, dental care and surgical good care while concurrently being holidaymakers, in a more typical sense. It has grown dramatically lately primarily due to high costs of treatment in rich world countries, long holding out lists (for what's not always seen institutionally as concern surgery), the comparative affordability of international air travel and favorable economic exchange rates, and the ageing of the often affluent post-war baby-boom technology. Growth has been facilitated by the go up of the Internet, and the emergence of new companies, that aren't health specialists, but broker agents between international patients and hospital sites. It has also expanded because of speedily improving healthcare systems in some key countries, where new solutions have been implemented. Above all it has followed the deliberate marketing of health care (in association with tourism) as medical care has gradually moved away from the public sector to the private sector, ensuring that a growing majority of people, especially in the richest countries, and especially in the United States, must pay-often considerably-for health care

"Medical tourism" is an important area of the Indian travel and leisure industry and keeps immense growth potential. The medical tourism sector experienced experienced a extraordinary development in the movement of medical tourists - from10, 000 patients in 2000 to stupendous 180, 000 by 2005. (Source: RNCOS statement on 'Indian Tourism Industry Forecast (2007-2011)

The Indian federal government takes careful steps to advertise medical tourism and it will try to increase the growth of foreign medical tourist by giving medical visas called M visas. These M visas are valid for one year which is granted for the accompanies and Indian ministry of tourism has stocked its 13 international office buildings with information regarding these visas. ( Meleigy)

In 2002, 2. 2 million foreigners been to India :those volumes increased by 20 percent the next year(Mathew 2004). The traveler literature produced by the Indian government portrays India as a country rooted in custom and also sufficiently modern to provide western style amenities (Bandyoupdhay and Morais 2005) A study by McKinsey and Confederation of Indian Industry says that at its current rate of progress, healthcare tourism exclusively can rake over 8, 000 crore additional revenue by 2012. (cii mckinsey review)

There are several says in India and the private hospitals in India goal for the medical holiday other than the house patients. The southern condition of Kerala which is very abundant with culture and history and traditional medical practice like Ayurvediac, Siddha and Yoga leads in bringing in the foreign tourist for medical health insurance and leisure travel and leisure.


Kerala is a bizarre anomaly among developing nations, a place that offers real expect the future of the 3rd World. Consider: This small status in India, though very little bigger than Maryland, has a populace as large as California's and a per capita gross annual income of significantly less than $300. But its baby mortality rate is low, its literacy rate among the highest on Earth, and its birthrate below America's and slipping faster. Kerala's residents live nearly so long as People in the usa or Europeans. Though mainly a land of paddy-covered plains, statistically Kerala stands out as the Support Everest of sociable development; there's truly no place like it. The Country wide Geographic Tourist, which once made Kerala the cynosure of all eyes on the globe travel circuit by talking about it as one of the 50 paradises on the planet. (National Geographic)

Kerala is one of the very most visited tourists vacation spot of India. It is globally well-known for its enchanting vacationers' attractions that are off beat than some other travelers' places on the globe. Each year hundred and a large number of tourists from worldwide come to Kerala to take pleasure from holidays in splendor. Their state is endowed with palm fringed beaches, verdant hill stations, captivating beaches, emerald paddy fields, historical churches and much more of all picturesque backwaters. This makes the marketing medical travel and leisure easier in Kerala.

Accreditation of health centers

The quality of the medical care is the first of all factor considered by the medical holiday. According to the medical tourism connection the accreditation is the means of way to attain safety and overall excellent results to the patients who travel in one country to another for treatment purposes. The medical holiday can look into the accreditation to guarantee the safety of the treatment in a healthcare facility. The accreditation program is very essential to help patients, employers and insurance companies who can look into the accreditation position and thereby can find the hospitals with highest quality of care throughout their entire patient experience. The medical tourism industry grows day by day and therefore there is a requirement to ensure that clinics, clinic and treatment centers stepping into medical tourism posses proper infrastructure to meet up with the medical tourist. There is a need to certify that the center has proper communication facilities, transparency in quality and pricing, prepared consent, proper health care and further follow-up facilities. The accreditation is targeted on the fact that international patients have special needs and requirements than local patients. The accreditation is usually given by bodies which might by federal government or non administration with the panel of expert people to examine and discover whether the firm meets certain requirements. (medical tourism association)

The accreditation to the allopathic medical practice in Trivandrum is provided by the international accreditation systems such as Joint Commission International (JCI), ISO 9001 - 2000 etc. Apart from the international physiques Trivandrum city has hospitals accredited by NABH, a panel setup by authorities of India. (See appendix). They are the major accreditations of medical service in India. The ayurvedic practice is the initial specialty and most popular medical practice in India and they have accreditation done by Body setup by Administration of Kerala as "Green leaf" and "Olive leaf" and green leaf is the highest degree of accreditation and its accompanied by olive leaf and these accreditation ensures the grade of ayurvedic treatment in Kerala. (expresshealthcare)

Ayurvedic travel and leisure in Kerala

Kerala is usually sold as a health vacation spot for its ayurveda packages. Medical travel and leisure is sold along with ayurveda and other health deals. Kerala ayurveda tourism has becoming a huge selling point for Kerala tourism industry. Express promotes Kerala ayurveda tourism as part of medical travel and leisure to the entire world. Today acceptance of Kerala ayurvedic treatment has gained such a momentum that traveler from around the world come to Kerala to rejuvenate and for healing treatment.

Ayurvedic medical practice is the most historic medical system originated in India before 10, 000 years ago and in India the ayurvedic practice is popular in kerala where it is used in traditional way. As per ayurveda specialists, the rainy season (June - August) is the best time for ayurvedic treatments as the atmosphere remains dust free and cool, which helps open up the skin pores of the body to the utmost. (Messerli and Oyama 2004)

Ayurveda is convinced in the treatment of not only the influenced part, but the individual all together. Kerala ayurvedic treatments and rejuvenation therapies are natural way to renew and eliminate all poisonous imbalances from the body also to regain level of resistance and well being. Most of the ayurvedictherapies help to strengthening the immune system, preventing and treating diseases without any side results.

There are range of resorts and clinics throughout state which can be integral parts of Kerala ayurveda tourism and offering customized ayurveda vacation packages which help you to rejuvenate your body and soul also to take up a fresh life. Kerala ayurveda provides range of treatments ranging from de-stressing, anti-ageing, weight loss, joint pains and general rejuvenation.

Elements of medical tourism in Trivandrm

Review of similar studies.

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