medical tourism guidelines

AAPI Summit Jaipur 4th January 2011

Medical Tourism

Dr Vijay AgarwalExecutive Director


Wikipedia Says:

• India’s medical tourism sector is expected to experience an annual growth rate of 30%, making it a Rs. 9,500-crore industry by 2015.

• Estimates of the value of medical tourism to India go as high as $2 billion a year by 2012.

• Advantages for medical tourists include reduced costs, the availability of latest medical technologies and a growing compliance on international quality standards, as well as the fact that foreigners are not likely to face a language barrier in India.

• The Indian government is taking steps to address infrastructure issues that hinder the country's growth in medical tourism.

• Most estimates claim treatment costs in India start at around a tenth of the price of comparable treatment in America or Britain.

• Ministry of Tourism India(MoT) is planning to extend its Market Development Assistance (MDA) scheme to cover Joint Commission International (JCI) and National Accreditation Board of Hospitals (NABH) certified hospitals. A policy announcement of this effect is likely soon.


• Since International Patients are More Vulnerable

• As National Pride is at Stake

• To Educate/Inform All Stakeholders

•To avoid mismatch of expectations and delivery

Why Guidelines?


Selection of the Hospital/ Specialist

•For a higher level of reliability and good quality medical care, patients are encouraged to gain as much information as possible about a hospital and treating specialist before zeroing on any one.

•It is advisable to go for a hospital which has been accredited by ISQUA.


1. Obtain details of patient’s history, previous examination and checkups

2. Conduct, if possible, a tele/video conference with the patient/ patient’s doctor to help in the formulation of a plan of care and follow-up

3. Share the Plan of Care

4. Do not offer false promises/ guarantees

Create Treatment Plan


•The initial assessment and discharge summary should contain details about the rehabilitative/preventive precautions to be followed during travel including immunization and chemo-prophyalxis (e.g.against malaria)

•Procedure wise checklist must be developed to take care of specific needs during travel and during convalescence

•Issuance of a “Fitness to fly certificate” is a must for patients on either side

Travel Advisory


Meningococcal Recommended for all travelers to the states of Meghalaya, Tripura and Mizoram in the northeast

Hepatitis A Recommended for all travelers

Typhoid Recommended for all travelers

Polio One-time booster recommended for any adult traveler who completed the childhood series but never had polio vaccine as an adult

Yellow fever Required for all travelers arriving from or transiting through a yellow-fever-infected area in Africa or the Americas. Not recommended otherwise.

Japanese encephalitis For travelers who may spend a month or more in rural areas and for short-term travelers who may spend substantial time outdoors in rural areas, especially after dusk

Hepatitis B Recommended for all travelers

Rabies For travelers spending a lot of time outdoors, or at high risk for animal bites, or involved in any activities that might bring them into direct contact with bats

Measles, mumps, rubella (MMR) Two doses recommended for all travelers born after 1956, if not previously given

Tetanus-diphtheria Revaccination recommended every 10 years

Pre-arrival Vaccinations


Personal Details

• Language• Diet• Internet• Currency• Passport Copy and Visa• In case of need; Contact Numbers and Details of

Next of Kin


• All Foreign Nationals who intend to avail treatment in India should carry a Medical Visa. Similarly, accompanying Foreign Nationals should also carry a Medical X visa.

• Foreign nationals desirous of obtaining treatment on tourist visa must obtain a sanction for the same from the visa issuing authorities in their respective country. Converting a Non–Medical Visa to a Medical visa / Medical X visa is not possible in India.

• Primary responsibility for the above activity lies with the patient. The hospital may assist them in carrying out these formalities. In such a case, treatment plan from the treating consultant is also required for FRRO intimation.

Statutory Regulations: Arrival


Ensure Safe Transportation


a) Original valid Passport and Visa

b) Letter from concerned hospital (should be an eminent and recognized hospital) where treatment is being taken along with supportive medical documents/Diagnostic test reports (with tentative period of treatment)

c) Copies of passport (photo page) and (page indicating validity), bearing arrival stamp of Indian Immigration

d) Apart from the above documents additional supportive documents can be asked for in certain cases

e) The copy of the intimation to the local Police Station, if the applicant is residing in private House/Flat in a Building/Society as a Tenant or as a Paying Guest

Documents for FRRO


Complaint Redressal

• The patient must be given the contact number of the Medical Superintendent/ Medical Director of the hospital at the time of admission

• Escalation matrix from their immediate care taker/mentor to the hospital’s Medical Superintendent/ Medical Director must be made absolutely transparent and clear to them


•It is preferable that the agents engaged in the activity of referring patients for medical care to various hospitals need to be registered and certified by some agency of national repute.

•This will help create more awareness and sense of responsibility among these agents and will help them to look beyond mere economics for patient’s well being.

Health Care Facilitators (HCFs)


Statutory Regulations: Death

• An intimation to this effect must be sent to the local police so that a No Objection certificate may be obtained to enable the attendants carry the body outside.

•Clearance also needs to be obtained from the FRRO and the embassy of the patient’s country in India. Embassy will also cancel the passport of the deceased patient. Documents needed are: Original + copy of the passport- Death summary- Death certificate- FRRO letter- Police intimation letter

•Embalming is to be carried out in the nearest and authorized Govt centre

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Most hospitals have a mark-up on their rack rates for international clientele keeping in view the following factors:

-Customized meals and needs

-Local transportation requirements

-Marketing

Pricing Issues:Transparency Needed


Legal Rights

• In case of issues not being resolved at the level of hospital authorities, patient’s must be made aware of their right to escalate the same to the Medical Council, Civil, Criminal or Consumer Courts.

• Foreign nationals have equal rights in the court of law

• The process for this remains same as that for local patients. Representation by foreign nationals may be made by their counsel


Road Map

• Develop consensus guidelines as there will be danger of too many guidelines

• Different guidelines for different systems• Work towards endorsement by Ministry of

Tourism and Health• Make a time bound schedule• Work towards disseminating the guidelines


Need Database

• Source• Disease Pattern• Feedback


Give Inputs: Draft Guidelines

Thanks