MT.ME -GPS DIAL REMEDY-NRIBULLS HEALTHCARE

1. MT.ME-GPSDIAL REMEDY-NRIBULLS HEALTHCARE Promoting economical ways in the medical industry Source: International Marketing Conference on Marketing & Society, 8-10 April, 2007, IIMK National Center for Policy Analysis

2. What is Medical Tourism? • Medical Tourism can be broadly defined as provision of cost-effective private medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment, being facilitated by the corporate sector involved in medical care as well as the tourism industry- both private and public. It aims at broad spectrum of medical services consolidating leisure fun, rejuvenation and clean up processes on all levels related to physical, mental and emotional well being. This urgent or elective medical procedure is now emerging as a multibillion dollar industry.

3. Origin and Evolution of Medical Tourism Medical tourism is actually thousands of years old. In ancient Greece, pilgrims and patients came from all over the Mediterranean to the sanctuary of the healing god, Asklepios, at Epidaurus. In Roman Britain, patients took the waters at a shrine at Bath, a practice that continued for 2,000 years. From the 18th century wealthy Europeans travelled to spas from Germany to the Nile. Since the early nineteenth century, when there were no restrictions on travel in Europe, people visited neighboring countries in order to improve their health. At first, mere traveling was considered to be a good therapy for mental and physical well being. In the 21st century, relatively low-cost jet travel has taken the industry beyond the wealthy and desperate. Later, mostly wealthy people began traveling to tourist destinations like the Swiss lakes, the Alps and special tuberculosis sanatoriums, where professional and often specialized medical care was offered. In this century, however, medical tourism expanded to a much larger scale.

4. Origin and Evolution of Medical Tourism Thailand, followed by India, Puerto-Rico, Argentina, Cuba and others quickly became the most popular destinations for medical tourists. Complicated surgeries and dental works, kidney dialysis, organ transplantation and sex changes, topped the list of the most popular procedures. It was estimated that in 2002, six hundred thousand medical tourists came to Bangkok and Phuket medical centers in Thailand, while approximately one hundred and fifty thousand foreign patients visited India during that time. From Neolithic and Bronze age wherein people used to visit neighboring countries for Minerals and Hot Springs , Today we have reached the era where Hospitals are more like Spas and Spas more like hospitals.

5. Projections for India World Tourism Indicators suggest that in 2002, number of International tourists reached the 700 million mark with arrivals to Asia and the Pacific 18.7%. Europe saw highest number of tourists. At that time, India did not figure in the top 10 international tourist destinations because India’s share in Asia & Pacific region stands at a mere 1.8% India is a recent entrant into medical tourism. As per research reports, approx. 150,000 medical tourists came to India in 2004 and according to a study by McKinsey and the Confederation of Indian Industry, medical tourism in India could become a $1 billion business by 2012. The report predicts that: "By 2012, if medical tourism were to reach 25 per cent of revenues of private up market players, up to 2,297,794,117 USD will be added to the revenues of these players". The Indian government predicts that India's $17-billion-a-year health-care industry could grow 13 per cent in each of the next six years, boosted by medical tourism, which industry watchers say is growing at 30 per cent annually. This projection is largely based on the assumption that six hundred thousand Baby Boomers from the United States, Europe and Australia will age and seek medical care by that time.

6. The Great Indian Advantage Quality and Range of Services India has number of hospitals offering world class treatments in nearly every medical sector such as cardiology and cardiothoracic surgery, joint replacement, orthopedic surgery, gastroenterology, ophthalmology, transplants and urology to name a few. The various specialties covered are Neurology, Neurosurgery, Oncology, Ophthalmology, Rheumatology, Endocrinology, ENT, Paediatrics, Paediatric Surgery, Paediatric Neurology, Urology, Nephrology, Dermatology, Dentistry, Plastic Surgery, Gynaecology, Pulmonology, Psychiatry, General Medicine & General Surgery. For its quality of services and the infrastructure available, India is attracting a vast pool of tourists from the middle east, Africa etc.

7. The great Indian advantage cont….. As Indian corporate hospitals like Apollo, Max HealthCare, Fortis etc. are on par with the best hospitals in Thailand, Malaysia and Singapore there is scope for improvement, and the country is becoming a preferred medical destination. Manpower India has a Large pool of doctors (approx 600000), nurses & paramedics with required specialization and expertise and the language advantage (English speaking skills). The medical education system caters to the ever-increasing demand for the delivery of the quality health care services all over the country.

8. The great advantage cont…. The Price Advantage For long promoted for its cultural and scenic beauty, India is now being put up on international map as a heaven for those seeking quality and affordable healthcare. With 50 million Americans without health insurance and the waiting lists for state-run facilities often endless in the UK, Canada and Europe, foreigners are increasingly flocking to India because it offers quality treatment at a fifth of the cost abroad. In India, complicated surgical procedures are being done at 1/10th the cost as compare with the procedures in the developed countries. Not only this, the hospitals are well equipped to handle the data and information through computerized Hospital Information Systems. The hospitalization and the procedural price advantage also is supported by Lower Medication cost. If a liver transplant costs in the range of 137,867 USD - 160,845 USD in Europe and double that in the US, a few Indian hospitals have the wherewithal to do it in around 34,466 USD - 45,955 USD. Similarly, if a heart surgery in the US costs about Rs 45,955 USD, a leading Indian hospital will do it in roughly 4,595 USD.(approx prices , varies according to medial conditon)

9. The great advantage cont……. Tourism Attraction India has a 5000 year old civilization and is known for its cultural and religious diversity with Diverse geographical landmarks. The traditional arts and crafts add to its appeal as a tourists favorite. Along with this Indians enjoy freedom, vibrant democracy and women empowerment. Alternative Therapy India offers not just treatment but spiritual and mental healing as well. India needs to club together a couple of 'pathies' because it has a very strong base of alternative healing therapies like yoga, naturopathy, ayurveda Kerala’s health retreats,etc. No Waiting In addition to the increasingly top class medical care, a big draw for foreign patients is also the very minimal or hardly any waitlist as is common in European or American hospitals. hospitals now are starting to attract foreign patients from industrialized countries, and especially from Britain, U.S.A, Canada, where patients are becoming fed up with long waits for elective surgery under overstretched government health plans.

10. The great advantage cont…. Industrial Analysis The Industry can be broadly classified into: • The Alternative Therapy Service which is available exclusively to India namely • Yoga • Naturopathy • Ayurveda • Yunani Medicine • Kerala Health Retreats • Meditation 2. The Corporate Health care Services

11. How Patients Obtain Treatment Abroad Patients who aren’t familiar with specific medical facilities abroad can coordinate their treatment through medical travel intermediaries. Many intermediaries use the Internet to recruit patients. These services work like specialized travel agents.(Medical Tourism Facilitators) Intermediaries investigate health care providers and screen customers to assess those who are physically well enough to travel. Some intermediaries are affiliated with specific medical providers and send patients exclusively to those providers. But most intermediaries seek to create a broad network of providers and destinations to meet the diverse needs of patients. For instance, some patients might prefer to pay a higher fee in exchange for less travel time, while others might be willing to travel greater distances to save money. In addition, intermediaries often have doctors and nurses on staff to assess the medical efficacy of procedures and help patients select physicians and hospitals.

12. Why Treatment Abroad Costs Less • Prices for treatment are lower in foreign hospitals for a number of reasons. Labor costs. • In the United States, labor costs equal more than half of hospital operating revenue, on the average. Wage rates and other labor costs are lower overseas; specifics were not available, but as one example, at Fortis hospitals in India • Doctors earn about 40 percent less than comparable physicians in the United States. • Median nurses’ salaries are one-fifth to one-twentieth of those in the United States. • The wages of unskilled and semiskilled labor, such as janitors and orderlies, are also much less. These lower labor costs make it much less expensive to build and operate hospitals in other countries

13. Why treatment abroad cost less cont… • Less (or No) Third-Party Payment. Markets tend to be bureaucratic and stifling when insurers or governments pay most medical bills.40 In the United States, third parties (insurers, employers and government) pay for about 87 percent of health care.41 So patients spend only 13 cents out of pocket for every dollar they spend on health care. As a result, they do not shop like consumers do when they are spending their own money, and the providers who serve them rarely compete for their business based on price. A much higher percentage of private health spending is out of pocket in countries with growing, entrepreneurial medical markets. For instance, patients pay 26 percent of health care spending out of pocket in Thailand, 51 percent in Mexico and 78 percent in India.

14. Why treatment abroad cost less cont… When patients control more of their own health care spending, providers are more likely to compete for patients based on price. Consequently, these countries have more competitive private health care markets. In the United States, the markets for those medical services for which patients usually pay out of pocket, such as elective cosmetic surgery or vision correction (Lasik), are much more entrepreneurial and competitive. Patients control the dollars that pay for these procedures, so physicians compete with one another on price. For example, the cost of standard Lasik has fallen about 20 percent over six years.

15. Why treatment abroad cost less cont… • Price Transparency and Package Pricing. One criticism of American hospitals and clinics is that prices are difficult to obtain and often meaningless when they are disclosed.43 Patients who ask potential providers to quote a price are likely to be disappointed.44 In fact, many people have little idea of the cost of medical treatments. A recent Harris Poll found: l Consumers can guess the price of a new Honda Accord within $1,000, but when asked to estimate the cost of a four-day hospital stay, those same consumers were off by $12,000! l

16. Why treatment abroad cost less cont… Furthermore, 68 percent of those who had received recent medical care did not know the cost until the bill arrived, and 11 percent said they never learned the cost at all. In the international health care marketplace, the situation is quite different. Package prices are common, and medical travel intermediaries help patients compare prices. Even providers who do not offer fixed pricing will provide reasonably accurate price quotes. As a result, medical centers and clinics that treat large numbers of medical tourists routinely quote prices in advance and look for ways to reduce patients’ costs.

17. Why treatment abroad cost less cont.. • Few Cross-Subsidies. In American full-service nonprofit general hospitals, revenues from treatments for some patients are used to cover the costs of providing treatments to other patients. This cross-subsidization is possible because some medical procedures produce more revenue than it costs to provide them. For example, the revenue from routine heart catheterization procedures or diagnostic imaging systems in a community hospital might be used to subsidize indigent health care or the cost of operating the emergency room. This means that a hospital’s charges for the heart procedure more than cover its costs, but its charges for emergency room care do not cover those costs. If there is no competition for the business of heart patients in the hospital’s service area, it can cross-subsidize without losing revenue.

18. Why treatment abroad cost less cont… However, a provider who does not cross-subsidize could offer the cardiac treatment for a lower price or could make a profit charging the same price. In the United States, such providers have emerged in the form of highly efficient specialty hospitals. Nonprofit community hospitals complain that specialty hospitals skim off lucrative surgeries but do not provide the services that community hospitals do, such as emergency departments and charity care for the uninsured. This has led to a moratorium on new specialty hospitals in the Medicare program

19. Why treatment abroad cost less cont…. • Streamlined Services. Some foreign medical providers operate highly efficient “focused factories.” These are specialty clinics and hospitals where tasks and procedures have been streamlined for the highest efficiency — similar to the way a Toyota automotive plant operates. For example, Fortis Healthcare’s in New Delhi uses a business model that combines the personalized service of the hotel industry with the industrial processes of an automaker — both industries in which its senior executives have experience. • Limited Malpractice Liability. Malpractice litigation costs are also lower in other countries than in the United States. While American physicians in some specialties pay more than $100,000 annually for a liability insurance policy, a physician in Thailand spends about $5,000 per year. Thailand does not compensate victims of negligence for noneconomic damages, and malpractice awards are far lower than in the United States.

20. Why treatment abroad cost less cont.. • Fewer Regulations. Excessive health care regulations in the United States prevent American hospitals from making the sort of collaborative arrangements many international hospitals use. For instance, facilities abroad can structure physicians’ compensation to create financial incentives for the doctors to provide efficient care, whereas American hospitals usually cannot. The reason: Physician compensation arrangements in American hospitals cannot violate the Stark (anti-kickback) laws. • Foreign hospitals can also employ physicians directly — a practice prohibited by many states. For instance, physicians in India contract with hospitals to provide a certain number of hours per month in return for a guaranteed fixed fee. Patients select the hospital based on reputation and then choose an appropriate doctor who works with the hospital. In this regard, physicians depend on hospitals for business rather than the other way around.

21. Hospital Accreditation. More than 120 hospitals abroad are accredited by the Joint Commission International (JCI), an arm of the Joint Commission for the Accreditation of Hospitals that accredits American hospitals participating in Medicare. The International Standards Organization (ISO) also accredits hospitals that meet internationally agreed-upon standards. Nearly 150 foreign hospitals are accredited by ISO and JCI. In addition, some countries are adopting their own accreditation standards. For instance, the Indian Healthcare Federation is developing accreditation standards for its members in an attempt to reassure potential patients about India’s high quality health care

22. Hospital Affiliation. • Some foreign hospitals are owned, managed or affiliated with prestigious American universities or health care systems: • l The Cleveland Clinic owns facilities in Canada and Vienna, Austria; and in Abu Dhabi, the clinic already manages an existing facility and is building a new hospital. • l Wockhardt (India) is affiliated with Harvard Medical School. • l Hospital Punta Pacifica in Panama City, Panama, is an affiliate of U.S.-based Johns Hopkins International. • l JCI-accredited International Medical Centre in Singapore is also affiliated with Johns Hopkins International. • “Some American hospitals have foreign affiliates.”Medical Tourism: Global Competition in Health Care • l Dallas-based International Hospital Corp. is building and operating hospitals in Mexico that meet American standards.73 • l Bumrungrad International Hospital in Thailand has an American management team to provide American-style care.

23. Physician Credentials. Foreign health care providers and medical travel intermediaries also compete on quality by touting the credentials of the medical staff. These physicians are often U.S. board-certified, while others have internationally respected credentials. Many of the physicians working with medical tourists were trained in the United States, Australia, Canada or Europe.

24. ABOUT US: MT.ME(Medical Tourism.me) DIAL REMEDY-NRIBULLS Healthcareis a Dallas based medical tourism company. A company who is committed provides a world class, high quality, customized medical care at affordable cost. We help US/UK/UAE/CANADA patients to connect with leading Indian hospitals to provide outstanding care along with the rich cultural heritage and historical facets of the hosting country. Low cost Medical Treatment Services for Tourists Health Tourism Medical Surgery Packages in India Traveling to new places and finding suitable hotel to stay and a right physician to get treated is very difficult and challenging issue.MT.ME-GPSis started with an aim to help visiting parties manage all their basic requirements quickly and on budget. MT.ME-GPS alliances with top healthcare institutions, leading tour operators to make your stay easy and comfortable without any hassle. We will be committed to making our clients’ trip as smooth and rewarding as possible, while assuring that the best possible medical treatment is given.

25. SERVICES WE ARE OFFERING • Doctor Care Coordination Before and After • Flight Arrangements & Extensions / Visa Assistance • Airport transfer Service Scheduling of all medical appointments • Coordination of the admissions process Cost estimates for anticipated treatment • Processing of medical second opinions • Booking of Hotel/Service Apartments Special dietary needs / religious arrangements • Providing news & information of patient's relatives back home • Remote Consultations via Telemedicine • Local Sightseeing • Foreign Exchange • Insurance Services • Financial Services

26. Roy MalkisonFounder/PresidentDIAL REMEDY NRIBULLS HEALTHCAREPhone : 972.965.6464Fax : (855)965-6464E-mail: mt.me@nribullshealthcare.comWebsite:-www.dialremedy.comwww.nribullshealthcare.com www.medicaltourism.me