MEDICAL TOURISM HOSPITAL & EXECUTIVE RETREAT, KOCHI

1. MEDICAL TOURISM HOSPITAL &EXECUTIVE RETREAT, KOCHI

2. Integrated Multi-Sector Project Health Care + IT + Tourism • Digital Hospital • Medical Tourism Clinics • Medical Tourism SPAs • Telemedicine Net • Medical Call Center • Medical Outsourcing • Theme Holidays • Business Holidays • Time share club

3. Malayala Manorama Dated - 7/12/2008 Time Share Club in Health Care Malayala Manorama Dated - 7/12/2008

4. World Tourism Scenario • As per WTO 700 million tourists travel every year. • They spend more than $300 billion, accounting for 8% of worlds exports & 30% of International trade services providing more than 1 billion Jobs • In Florida (USA) 41 million people visit for Medical Treatment

5. Indian Tourism Scenario • Number of Domestic Tourists = 400 millions (approx.) • Number of foreigner visitors in 2007 = 5 Millions (including NRI’s, PIOS & Pakistanis) • Average Tourist stay in Singapore 5 days • Average Tourist stay in India 26 days • A foreign Tourist spends in Goa Rs. 1000/day • A Domestic Tourist Spends in Goa Rs. 2600/day • Tourism Ministry Proposes to spend Rs. 42,000 Crores for developing 20 tourist spots. • As per Mckinsey study revenue for medical tourism = 100 billion by 2012 in India. • India’s Tourist are 90% Domestic, out of this 80% are Pilgrimage Tourists

6. Medical Tourism is the Mother Of Tourism (365 days of Tourism without seasons)

7. WHY MEDICAL TOURISM? • If 20th Century Brought Software Revolution in India – Software Cost 1/5th of that of USA • 21St Century –Will bring Medical Tourism Revolution in India – Medical Cost 1/5th of that of USA

8. IT Revolution Recession in the West Affects IT Exports from India $ 50 Billion IT - 5 % GDP in USA Medical Tourism Revolution Recession Proof- Recession reinforces need for cost cut in Health care Health Outsourcing from USA $60 Billion Health care -16 % of GDP Medical Tourism Scenario , Health Care & Medical Tourism in India ,

10. An overview of world Medical Tourism

11. Road Blocks to Medical Tourism in India • Developing Country - Negative perception • about India- poor Hygiene and sanitation • Low Penetration of Medical insurance • Flight connectivity and infrastructural problems

12. Road Blocks to Medical Tourism in India • lack of knowledge among foreigners -world of mouth or internet savvy • lack of trust - no personal or local contacts • lack of follow up – No Follow up and Suffering from Complications • lack of Medical liability • No Integrated Medical tourism project - Top hospital’s me too approach . Depends on government initiatives

13. Achievements in Medical Tourism in India Actual (1 Lakh) Potential (10 Lakhs) • 1 lakh foreign patients visit India/year for medical tourism, compared to the potential of 10 lakhs Profile of Patients • Heart Related - 30% • Bones & Joint - 15% • Renal, Eye, Kidney etc - Balance

14. Achievements in Medical Tourism in India Profile of Countries • Middle East - 40% • South Asia - 35% • US & UK - 25%

15. Potential Medical tourists • 47 million Americans not Health Insured • Consultation cost in USA = $50 to $150 for insured and $250 to $450 for non insured with 1 week waiting time • Diseases for which no Allopathy treatment is available – Ayurveda, Homeo, Holistic treatments • For unique preventive Health Treatments – Foreign Tourists are even ready for $1 million tourist packages Not Insured Insured $50 to $150 $250 to $450

18. Potential Medical tourists • For Infertility treatment. For Infertility Treatment In UK Rs. 8 Lakhs with 8 months waiting period. India Rs. 1 Lakh: no waiting period • Egg donors and surrogate mothers readily and economically available in India • Patients from 160 Countries can take Ayurvedic and Holistic treatments UK( Rs.8 Lakhs) India (Rs.1Lakh) Ready Mothers Ayurveda

19. Can Kerala be the No 1 Medical Tourism destination in the world? YES !! • World Medical Tourism Centres • Florida – Miami (USA) • Thailand • Singapore • South Africa • Jordan • Philippines • Hungary

20. How kerala can be World’s No.1 Destination for Medical Tourism For Beautiful Smile & Better Teeth To avoid Heart attack & for better heart health For Ayurveda Treatments To control/Cure Diabetes Kerala For Anti-aging & Rejuvenation For No Pain/Better Bones & Joints For Detoxication & De-stressing For Organ Transplants For Beauty & Youth For Sure Child Kerala Astrology & Meditation Obesity Treatment Organic farming, Akshaya & Kudumbasree Medical & Dental Check-Ups For best budget Treatment & For Non-health insured To avoid spectacles For Confidential Treatments For European SPA Akshaya, Kudumbasree Medical Banks Medical & Other Tourism Circuits For Non-cured Diseases

21. How kerala can be World’s No.1 Destination for Medical Tourism BUMRUNGRAD Hospital (Thailand): 1. Thailand population is 63,121,000 2. 3 Lakhs Foreign patients from 130 nations Treated In one year 3. 25% of patients treated are foreigners 4. Helpdesk In 12 Countries 5. Assistance in 13 languages 6. Medical Helicopter for Foreign patients Medical Tourism Hospital (Kochi) 1. Indian population is 1,128,000,000 2. NRK Ambassadors in 160 countries 3. Cost of treatment is 30% of that of Thailand 4. Only state in India with four International Airports 5. Ayurveda -5000 years old tresure of Kerala 6. NRI Doctors can work during holidays in India

22. How kerala can be World’s No.1 Destination for Medical Tourism • Kerala can be treatment destination for all Chronic Diseases • Chronic diseases like Diabetes, BP, AIDS, Cancer are causing • 65% deaths in India.Mortality due to Diabetes & Heart diseases to cost • Rs. 210 billions every year, expected to increase to Rs. 235 billions by next 10 years • India will have 30million Diabetes patients by 2020, out of which 25% suffering from complications, And Ayurveda is a Good remedy for Diabetes Complications • India will have 213 million BP patients in 2025 compared to 180 millions in 2010. Ayurveda is a Good remedy for Blood pressure • In India 10% of adults suffer from Hypertension while the country is home to 25-30 million diabetes.3 out of every 1,000 people suffer a stroke. The number of deaths from heart attack is projected to 2 million in 2010.6 million people have coronary artery diseases & 5 million have Rheumatic Heart diseases. Ayurveda is a remedy for all these diseases

23. How kerala can be World’s No.1 Destination for Medical Tourism (Kerala Medical Banks) Lever Heart 1. Organs Banks Eye Lungs Knee & Hands 2. Bone Marrow Register Face & Hair 3. Semen & Egg Bank 4. Stem Cell Bank 5. Surrogate Mother Register 6. Skin Bank Skin Bank 7. Kidney Register

24. How kerala can be World’s No.1 Destination for Medical Tourism • Kerala Achieved the same health index as western world - Infant Mortality 12,Maternal mortality 2/1000 , Life Expectancy – 75 Years , Compared to Kerala’s Per Capita Income $ 355 (0.38 % of that of New York $93377 ) • Abundant Trained Health Manpower • NRK population as Kerala Ambassadors in 160 Countries • IT advantage and Tourism advantage - Two Under water cable terminate at Kochi: Skilled IT / ITES Personnel; Kerala has become one of the world tourism destinations

25. How kerala can be World’s No.1 Destination for Medical Tourism • Medical Tourism Cost at Kochi 30 to 50 % of that in Thailand. If Integrated treatment Approach is adopted the cost will be 10 to 20% of Cost • Americans Spent $25 billion on CAM Therapies Last Year. This can be Increased to $100 billion if we globalize and Modernize Ayurveda • Worlds No 1 Medical tourism Hospital, BUMRUNGRAD International Hospital, Thailand tried to takeover, Lakeshore Hospital, Kochi Two Months back, showing the Importance of Kochi in World Medical Tourism. Lakeshore Hospital

26. Globalization of Ayurveda • Kerala Ayurveda World’s Best Ayurveda Brand • But It confines to Musculoskeletal Diseases • Kerala Ayurveda + Vedic (North Indian) Ayurveda = Metabolic Diseases + Musculoskeletal diseases + Other diseases = A Total System of Medicine • Homeopathy is only 230 Years old , but it is catering to patients to 152 Countries from India (Dr Rajesh shah – www.lifeforce.com and Dr Batra’s Positive Homeopathy , Dr Bakon’s Homeopathy etc) • Ayurveda is 5000 Yrs old – Waiting for Globalization to 160 Countries through a Telemedicine Net

27. Project 28

29. Brief Description About the Project: Setting up a Medical Tourism Hospital in the periphery of Kochi with specialized departments like 1. Heart Surgery 2. Joint Replacement, Microdesectomy& Spinal Fusion 3. Cosmetic Surgery 4. Eye Surgery (Lasik, Cataract, Glaucoma, Refractive Surgery, Vitreoretinal Surgery) & Ear (Cochlear Implant) 5. Major Surgeries & Organ Transplants 6. Infertility Treatment, Fibroid and Women's Disease

30. Brief Description About the Project: 7) Obesity Treatment & Interventional Cardiology 8) Comprehensive Health Check Up 9) Rehabilitation, Psychology & Geriatrics 10) Ayurveda, CAM Therapies & Non-Cured Diseases 11) Multi specialty Dental Clinic 12) Anti Aging Clinic and European Spa.

31. Brief Description About the Project: • This Hospital will be connected through a Telemedicine Net to Medical Tourism Super Clinics in 60 cities in India and places like Gulf (Dubai, Saudi-Arabia, Qatar, Oman, Bahrain, Kuwait) Maldives, Colombo, Malaysia, Indonesia, Singapore, Philippines, Dhaka, USA, UK, etc, • Further it will be connected through a Telemedicine Net to Medical Tourism Spas in tourism centers like Kovalam, Fort Kochi, Mahabalipuram, Bangalore, Goa, Mumbai, Jaipur & New Delhi. • 36 disease management clubs like Diabetes club Heart Club etc, will be conducted on an all India basis through Tele-Medicine Net and Medical Call center at Kochi. • Medical Audit & Medical research will be conducted continuously through Tele-Medicine Net and Medical Call center at Kochi • Home Health care services (National & International) Will be conducted through Medical Call Centre & Telemedicine Net, so that Hospital admission and stay of the patient in the hospital will come down • A Multi-Cuisine Health Food Court , Digitized Business center and Digitalized NRI Center will be attached to the hospital. • Chief Executives who are under going Rejuvenation in this IT Resort can control his organization from the hospital, Similarly, NRIs can be digitally connected to their relatives in India.

32. Highlights 1. First Hospital: It will be the first integrated Medical Tourism hospital in the world which specially cater to Medical Tourism. 2. Unique Marketing: a) Medical Tourism Clinics and Medical Tourism Spas all over India will bring large number of Medical Tourists to Kerala. b) A Medical Tourism Club will be promoted on time share basis all over India and abroad in which there will be a facility for members to come to Kerala every year and enjoy 15 days free stay for treatment (chargeable). 3. Centers of Excellence: a) All the departments of the hospital will be the centers of excellence as the best doctors from different parts of India Mumbai, Delhi, Chennai, Bangalore, Pune, Kolkata, etc.. will be taken on visiting basis in addition to the core team at the hospital. b) Through the Tele-Medicine Net the tourist can consult the best doctors in different parts of India, with whom hospital will have contract arrangement.

33. Highlights 4. Technological Excellence: a) As far as possible the best medical equipments on lease will be installed and every 5 years there will be replacement of better technology equipments. b) Medical Automation – It will be fully Digitalized hospital with facilities like Pharmacy Robot, Robotic Surgery, Fully Automated Laboratory, Picture Archive & Communication Systems (PACS), 4D Ultra Sonography, Wi-Fi connection, 128-bit CT-Scan, Pet Scan & MRI, etc,. 5. Minimum Cost: a) All the rooms and suites will be given on time share basis to NRIs, Foreigners and High Net worth Individuals (HNI)s. Every year they can use the facility free for 15 days, for their parents or for friends. If they do not avail the facility the hospital will rent to other patients and 50% of room charges will be given to the owners and hospital will guarantee return not less than the prevailing bank interest. b) Non core activities will be given on contract to reduce the operational cost. c) As it is 100% digital hospital, there will not be any paper work and cost of operation will be minimum. d) All Medical Tourism clinics in 60 cities in India and Medical Tourism Spas will be run on franchise basis which will reduce the cost of investment & operation cost. 6. Tele-Medicine Net: A Tele-Medicine net supported by Medical Call Center not only will make the operation of hospital online but also it will enable NRIs to see their parents online when they are in hospital or in their house. Medical Automation

34. Highlights 7. Integrated treatment: Any patient can get integrated treatment of Allopathy, Ayurveda, Homeopathy and CAMTherapies 8. Immediate Start: The project can be started immediately without waiting for the construction of the hospital using the facilities in other super specialty hospitals at Kochi. Thus the gestation period of the project will be minimum . 9. International Treatments: In Ayurveda and CAM Therapy all the holistic treatments as existing in “Dubai Herbal Treatment center” like Ayurveda, Traditional Chinese Medicine, Colon Hydro Therapy, Chiro Practice, Ozone Therapy, Manual Lymphatic Drainage, Taichai, Yoga, Nutrition, Beauty Care, etc, will be introduced . 10.Digital Marketing: A dynamic web site will be developed for the hospital and it will be translated into Chinese, Spanish, Japanese, German, French, Korean, Italian, Deutsch, Arabic and Indian languages like Hindi .

35. Highlights 11. Hub & Spoke System: For Medical tourism services to the tourists, for the facilities which are not installed in our hospital, we will be utilizing the facilities of other hospitals in Kerala. Thus we will be able to operate the project with minimum capital cost and minimum operational cost, which will lead to the high profitability of the project . 12. Medical Insurance: Company has formulated a unique Medical insurance scheme called "Medilife 100". It is the world's first total health insurance scheme as it covers Allopathy, Ayurveda, Homeo, Pregnancy, Infertility, Beauty and Dental Treatments. It is also the only double money benefit Health Insurance in India. Company is in discussion with STAR HEALTH  AND ALLIED INSURANCE COM. LTD to implement the same all over India and for starting CRYSTAL STAR (Medical Tourism) Super clinics all over India.  Hub & Spoke System

36. Highlights 13. Organic Spice & Flower Tourism Afterconstructing the building for the hospital, the extra space will be utilized to develop an organic spice & flower farm. In this farm all the spice plants and special flower plants like Orchid, Anthurium etc., will be grown for demonstration to Tourists. This will be an additional income for the project.

37. Highlights 14. Mother Tourism Project – A Big Boost to Kerala Tourism: Through our all India and International Marketing, we will bring large number of Indian & International Medical Tourists to Kerala. (Only 5 Lakhs Foreign Tourists (10%) of the 5 Million Tourists Visiting India, Come to Kerala) 365 days of the year. As our Board & Lodging Facilities are limited, these tourists will be staying in other resorts near Kochi. Thus our Medical Tourism Project will be a big boost for tourism in Kerala. Similarly, due to operation of Executive Retreat, there are possibilities of many Professional meetings and Business Conventions conducted at Kochi. The latest trend is that tourists enjoy dynamic holidays. In our organic demonstration farm and IT Resort we will arrange classes in Organic Agriculture, Culinary Arts, Management, Advance Technology and Yoga. So this Medical Tourism project will give a boost to MICE Tourism, Agriculture Tourism, Business Tourism and Holiday Tourism in Kerala.

38. Highlights 15. Mother project – Boost To Kerala Industries A number of Industries (Like Tiptop Furniture etc,) developed at Kottackal. The Patients and their relatives use to do shopping when they come for Treatment at Kottackal Nursing Home. Similarly this project will give a boost to Kerala Industries like Health Mattress (Rubber), Health Chappals, Health Foods, Medical Implants, Ayurveda Medicines, Kudumbasree Products, Organic Agricultural Products, Handicrafts, Hospital Furniture etc

39. Project Details • 1. Land Required: 3 acres • Note: • In the original proposal there was provision for a small Organic Agriculture farm surrounding the Hospital. This was a good revenue earning project, as we have seen in a spice farm at Goa, where, 1000 tourists visit everyday.  With an entry tickets of Rs 300 and profit from selling species the annual income from the organic farm is about Rs 12 crores. • b) So also for a hospital, Floor Space Index (FSI or FAR) is more in Kerala Development Control Regulations. Hence the land required is only 3 acres instead of 5 acres. • 2. Land identified: • We have identified necessary land at Ankamaly, Perumbavoor, Kumbalangy etc. for the Hospital

40. Project Details 3. Building: In 1st stage, the requirements of building is cut down to 60,000sq.ft. Out of the 12 departments in the Hospital, 40,000 Sq ft will be allocated to Allopathy departments and 20,000 will be allocated to Ayurveda and Holistic departments. Telemedicine Net, Medical call center and NRE services center will be operated from our existing office at Kochi city. Note: 1. Medical Tourists will be accommodated in the hotels and resorts near Kochi, when our facilities become inadequate 2. Construction of the building will be done by us instead of giving   to the contractors. Thus the construction cost will be reduced from Rs 1000 to Rs 800 Per Sq. ft.

41. Project Details Cost of Project 1. Land        (3acres)                             Rs   3.00 Crores 2. Building ( 60,000 sq ft )                                     Rs    4.80 Crores 3. Medical equipments                                          Rs     6.00 Crores 4. Telemedicine  & Medical call center.               Rs     0.25 Crores 5. Working Capital                                                 Rs     0.25 Crores                                                                                 Rs    14.30 Crores Note: 1. Maximum number of equipments will be taken on lease. 2. Working capital required will be much less as Medical Tourism clinics and Medical Tourism Spas, (all of them will be on franchise basis) will be operational before the hospital is ready.

42. Project Details 4. Equipments: Some of the equipments like MRI, CT Scan etc are cut down in 1st stage, as this facility can be availed from other centers at Kochi. 5. Working capital: The working Capital requirements is reduced as the Medical Tourism Hospital is conducted as pact of existing nursing homes at Mumbai. 6. Means of Finance: Promoters additional contribution to equity                       0.90 Crores N R I Contribution                                                                    4.00 Crores Time share contribution (30.000 Sq ft at Rs 1000)                 3.00 Crores Team Loan from financial institution                                       6.40  Crores                                                                                                 ----------------------                                                                   Total        14.30 Crores    ----------------------

43. Project Details 7. NRI contribution: 1 Lakh shares (face value Rs.10) will be given to NRIS at Rs.40/ share. This will form about 48% of equity Capital of Crystal Hospitals Ltd., This can be given to two NRIs as strategic investors with Board representation. 8. Benefits to NRIs: a) They can participate in an existing project b) The income from a Medical tourist will be approximately 3 times from that of an general tourist. Hence very high profitability for the project. c) As there is shortage of 80,000 beds in India, a chain of 100-bedded Digital hospitals can be started in other tourism cities & all over India. Thus they can take part in tremendous growth prospects of the hospital project. d) As a forward integration, Medical Outsourcing,. Which is the world's largest outsourcing after Manufacturing  Outsourcing, can be started. e) Promoters will guarantee minimum return of 12% on the face value of share for second and third years of operation. f) As it is a very promising project, high appreciation of share price can be expected before public issue with in 3 years. So NRI can reap handsome profit

44. Project Details 9. Mode of NRI Financing: 1. Authorized. Share Capital  Rs 5.5 Crores     2. Paid up Capital                    Rs 2.1 Crores    3. Promoters holding     Rs 1.1 Crores   4. NRI Holding             Rs 1.0 Crores

45. Project Details Working Results: Revenue (On Full Operation) 1. Patients Income: (1800 * Rs.2 lakhs) Rs 36.00 crores 2. Medical Tourism clinics Income: Rs 9.00 crores (10 Indian clinics monthly income Rs. 5 lakhs; 50 Indian clinics monthly income Rs.3 lakhs; 10 foreign clinics monthly income Rs. 10 lakhs; Hospital share 25% of income as Franchiser ) 3. Medical Tourism Spa Income: (0.25 x 8 x 6 x 8) + (0.25 x 2 x 6 x 8) Rs 1.20 crores 4. Tourism Operation Income: (5000 Tourists x Rs 5000) Rs 2.50 crores 5. Medical Tourism club Income: (50,000 members x Rs 1000)Rs 5.00 crores ------------------------Total Revenue Rs 53.70 crores ------------------------ Expenditure 80% of the Income (Estimated) Rs. 42.96 crores Profit ---------------------------------------------------------------------------- Rs. 10.74 crores

46. Project Details Employment Potential Direct: -------------------------------------------------------------- 360 Indirect: ------------------------------------------------------------ 1800 (Other Tourist resorts will be taken on management contract to accommodate more medical tourists) Land Requirement & Land Available Total requirement: 3 Acres In your possession: Nil (An office of 1100s.ft which will act as Tele-Medicine Center and Package tour operation center at kochi is owned by us. Further space for Medical Tourism clinics is available at Mumbai, Pune, Coimbatore and Bangalore) To be acquired: 3 acres Has any work been started? Yes We are operating Medical tourism clinics and Medical Tourism Spas at Mumbai and Kochi. Specify assistance required ? Tie up Needed for the project • One strategic investor, NRK or group of investor NRKs to contribute 48% of equity • Term loans from financial institutions. • Government Land on lease basis, if available (Near IT Park, Chertala)

47. Other Relevant Details We have launched a no of Medical and Dental Tourism Services through our portals • www.medicaltourism.org • www.keralaayurvedashram.com • www.hitechdental.org • www.germanhomeopathy.org

48. www.allgooddoctors.com • www.internationalmedicaltourism.org • www.tourismhomestay.com • www.beautiful-indians.com • www.surechild.com • www.tourwell.com

49. THANK YOU For your valuable time with us