Almost a decade after it was originally envisioned as a major phenomenon, medical tourism in India is beginning to take off. More and more people across the globe are eschewing expensive treatments or long waits at hospitals at home for the benefits offered by cheaper countries like India, Thailand, Philippines and Singapore and combining a tummy tuck, say with a visit to the Taj Mahal or the beaches and misty mountains of Kerala.

Although India had fallen behind other countries after the initial promise, two studies say health tourism is projected to be the next big thing after India's IT outsourcing boom. A 2009 report by the Confederation of Industries (CII)-McKinsey forecasts that, medical tourism will generate US$2.4 billion during 2009–2012 for India by attracting 1.1 million health tourists, up from 150,000 in 2002.

Though the Indian segment is still a sliver of the US$60-billion global medical tourism market, the consultancy firm Deloitte estimates the country's business will grow at a robust clip of 27 per cent each year. The reason for its attraction for Indian industry and turismis not far to seek. According to the Ministry Of Tourism, as against an ordinary vacationer per-capita spend of US$3,000 per visitor, the average medical tourist in India puts out more than $7,000 per visit.

Leading Indian medical experts ascribe this exponential growth to demand. "With health care costs going north," says Dr Alok Roy of Fortis Hospital, one of the leading service providers in the medical tourism sector, "patients are compelled to look at cost-effective destinations for medical treatments. And what could be better if they can combine that with sightseeing at scenic locations?"

Delhi-based physian Narottam Puri believes the current expensive and overburdened health care system in the US is not sustainable due to a variety of factors.

"India, on the contrary," Puri says, "is a value-for-money destination for health care because we produce over 30,000 new doctors each year combined with a diverse genetic pool for drug testing."

Ironically, despite India's abysmal spend of 4.9 per cent of its GDP on healthcare -- as compared to America's 15.3 percent, Switzerland's 11.3 percent or France's 11.1 percent – the country is well poised to become a frontrunner in the global medical tourism market.

For starters, India's pricing of its medical services is lower than in comparable countries. A report by the Planning Commission points out that while a heart bypass surgery may cost a patient $6,000 in India, the same surgery will set him back US$7,894 in Thailand, US$10,417 in Singapore and almost quadruple or $23,938 in the US and more.

Similarly, heart valve replacement surgery for US$10,000 in Thailand, $12,500 in Singapore and US$200,000 in the US can be carried out in India for $8,000. According to the American Medical Association data, as against a charge of $5,000 for a spinal fusion in India, a patient will pay $62,000 in the US, $9,000 in Singapore and $7,000 in Thailand.

India also offers an impressive scale and repertoire of treatments, qualified, English-speaking doctors and a varied landscape in which medical tourists can recuperate – from the beaches of Goa to the deserts of Rajasthan.

"The essence of medical tourism is a combination of quality healthcare across a range of disciplines coupled with visits to scenic locations to recuperate or rejuvenate oneself," says Pradeep Thukral, Executive Director, Indian Medical Travel Association (IMTA) which works with Indian hospitals and tourism bodies to promote health tourism.

Experts say India also has a reputation for world-class expertise in cardiac care, cosmetic surgery, joint replacements, neurological and orthopedic treatments and dentistry. "The capacity in super specialty segment Indian hospitals is expanding fast and – unlike the US or the UK -- there is no waiting period for local or overseas patients," explains Dr. Roy.

Infrastructure spending for health care has also surged. The private sector especially has flourished, equipped with state-of-the-art technology. Top Indian corporate hospitals like Apollo, Fortis, Wockhardt, Max and Manipal have stepped in to provide quality healthcare and technology. A large number of new private specialty hospitals and integrated health cities coming up in the top metropolitan areas are adding further heft to India's medical tourism offerings.

It is estimated that nearly 75 per cent of health care services and investments in India are now provided by the private sector. Coupled with this is the fact that India has perhaps one of the largest pharmaceutical industries in the world which is not only self-sufficient in drug production but also exports them to over 180 countries at a fraction of the price of US pharmaceuticals.

According to Vishal Bali, CEO, Wockhardt Group of Hospitals, Indian clinical and paramedical talent is globally accepted as high standard. Also, many hospitals now carry Joint Commission International accreditation which puts them at par with the world's best. "Third-party intervention through health insurance," adds Bali, "has also given Indian medical tourism a fillip."

To tap the commercial potential, the Indian hospitality industry too is venturing into the market. Spas at star-rated hotels have jumped onto the wellness bandwagon to offer a smorgasbord of traditional treatments like ayurvedic massages and recuperative therapies.

"Traditional Indian treatments cover every aspect of medicine at a reasonable cost. This provides the perfect impetus for overseas patients to come to India," explains Dr Jairam Nair, Director Spas, Amatrra Spa, New Delhi. In addition to traditional medicine, adds Nair, India offers many more relaxing and rejuvenating treatment options like yoga, ayurveda, meditation and naturopathic medicine.

The Ministry of Tourism's Market Development Assistance scheme to cover Joint Commission International and National Accreditation Board of Hospitals certified hospitals which have a rigorous evaluation process has also helped bolster the wellness sector.

The MDA scheme offsets overseas marketing costs for travel companies earning foreign exchange. By opening up the MDA, hospital groups will be made eligible for financial assistance, including publicity through printed material, travel and stay expenses for sales-cum-study tours and participation fees for trade fairs and exhibitions.

The government is also lending support, investing about $6.5 billion in medical tourism infrastructure over the next two years. India has also launched an accreditation program for secondary and tertiary hospitals by the National Accreditation Board for Hospitals and Healthcare Providers, which works with qualified assessors to grant accreditation to hospitals through a stringent evaluation process.

The government has also been working towards providing priority medical visas for. "However the main bottleneck for medical tourists coming from the UK and US for major surgeries is that the insurance companies are not willing to cover treatment in India. Although this scenario is changing, the process is painfully slow," said a joint secretary at the Ministry of Health.

Travel companies are also liaising with hospitals to facilitate travel, arranging phone consultations with physicians in India to help the overseas patients save time and money once they get to India. Most Indian hospitals also allow the patients' personal physicians to consult with Indian doctors from overseas. Western patients usually get an all-inclusive package that includes flights, transfers, hotels, treatment and often a post-operative vacation.

The tourism ministry is prompting all players to form a government-industry partnership on the lines of NASSCOM to strengthen the Indian healthcare brand overseas. Efforts will be made to launch uniform pricing bands and to combine medical packages with innovative travel products, according to Pradeep Thukral, executive director of the Indian Medical Travel Association.

In fact to cater to the burgeoning demand, India is now diversifying into a new area of "medical outsourcing" where subcontractors provide services to the overburdened medical care systems in western countries. This initiative has the support of the National Health Policy which declares that treatment of foreign patients is legally an "export" and deemed "eligible for all fiscal incentives extended to export earnings."

"However, the biggest challenge for India to emerge as a top medical tourism destination is on the non-medical side," Thukral cautioned. "The marketing, the infrastructure and services to support the growth of medical tourism are still at a nascent stage in the country. Till that is shored up, India can't hope to be a frontrunner in the field."

Neeta Lal is a New Delhi-based freelance journalist contactable at neetalal@hotmail.com