Medical Tourism: Care Beyond Boundaries Mr. Abhay Soi - Chairman & Managing Director

1. Medical Tourism: Care Beyond Boundaries Mr. Abhay Soi - Chairman & Managing Director

2. Thoughts for discussion • What is Medical Tourism (‘MT’) • What drives MT • Global Trends • Case Study: Bumrumgrad • Competitive landscape • Challenges for MT • MT India • Advantage India • Key Challenges • Way ahead for MT in India

3. What is Medical Tourism: Medical Tourism refers to people travelling beyond their boundaries, to obtain healthcare solutions, preventive and curative in nature. Part of our civilization for a long time

4. What drives MT:Unavailability of Quality Healthcare driving people to travel • Most of Africa • Afghanistan • Iraq • CIS countries like Kazakhstan, Uzbekistan, Kyrgyzstan KPMG in India Analysis, 2014

5. What drives MT:Other Features Affordability & Cost Unavailability of experts – doctors, nurses, etc. High Cost of service in countries with Govt. funded health programs Unavailability of Advanced Technology Immediate service (vs. long queues) Below par Quality of care Privacy / Anonymity Developing / third world problems   developed county problems

6. Global Trends:Sudden Rise in MT, Globally, with supernormal growth rate Expected 18% CAGR • Top 5 specialties: • Cardiac Sciences • Orthopedics: Joint replacements & Spine • Neuro Sciences • Oncology • Transplant programs: Liver, Kidney, Bone Marrow Source: KPMG FICCI Heal 2014

7. Global Trends:Sudden Rise in MT, Globally, with supernormal growth rate • Ageing population • Increased Awareness • Improved Physical Connectivity • Seamless Digital Connectivity Globally 15% of world population US, EU, Canada, MEA Japan, Korea, Australia, NZ Africa South America SAARC China Russia 85% of world population

8. Global Trends:MT leading to growth in other associated sectors • Spill-over impact on other sectors… Hospitality Tourism Medical Tourism Aviation Retail Forex Earnings Travel Logistics Many countries and private hospitals run focused programs to attract medical tourists from around the world: Turkey, Thailand, Singapore, Malaysia, India

9. Global Trends:Choice of Destination determined by … Hospital specific Systemic • Availability of relevant expert Doctors • Credibility of the Hospital • Credibility of the Country: • Overall perception about people • Cultural acceptability Support and facilitation provided by the Hospital • Proximity to Visitor, physical connectivity • Facilitation by the Govt / country Comfort with the pre-visit services provided by the hospital: Tele-consults with doctors, diagnosis, counselling, etc Ease of process to take regulatory approvals Cost benefit to the MT visitor vis-à-vis other options Cost of living (travel, acco, food, etc) for family members

10. Challenges for MT Developing world’s MT Visitors’ challenge First world’s MT Visitors’ challenge • Affordability • Language Barriers • Cultural Differences • Regulatory process for Med-Visa • Market infested by unorganized intermediaries: leading to increase in cost and misinformation to patients • Insurance Portability across jurisdictions • Unavailability of outcome data • Poor perception of Hygiene • Lack of awareness • Poor perception and understanding of quality of care in evolving MT hubs • Regulatory process for Med-Visa Concerted effort by government and private hospitals in developing countries is essential to achieve the purported super-normal growth in MT

11. Competitive Landscape:Top 5 countries cater to over 75% of Global MT • 60% MT driven by lack of relevant expertise and technology in own country • 15%+ MT driven by cost benefit

12. Medical Tourism in IndiaMajority driven by SAARC and Middle East countries • $ 250 million market in India, set to grow @ 20%+ y-o-y • Majority from Bangladesh, Maldives, Afghanistan, Iraq, Nigeria

13. Medical Tourism in IndiaAnchored in Metro cities Spread over 4 to 5 hospitals Spread over 2 to 3 hospitals Spread over 3 to 4 hospitals

14. Medical Tourism in IndiaCase Mix change over the years Specialties Then Now Cardiac Sciences • Primarily CABG, Valve surgeries • Angioplasties • Min. Invasive Cardiac Surgeries • Ventricular assist devices; • TAVI: Valve replacement without surgeries • Mainly Liver, Bone Marrow Tx • Kidney Transplants Solid Organ Tx • Primarily Kidney Transplants Ortho. • Spine Surgeries • Joint Replacement • Minimally invasive spine surgeries • Joint Replacement Neurology • Brain tumors • Spinal deformities • Functional neuro-surgeries • Interventional neuro-surgeries Oncology • Medical, Surgical, Radiation onco • Cyberknife, Robotic surgeries • Targetted chemotherapies • Organi specific onco programs Early 2000’s 2010 till 2016

15. Advantage IndiaStrengths / Competitive Advantages • Medical Talent: • Doctors: amongst the best globally • Excellent Nursing care • Education system provides 30,000 doctors and nurses each year • India is the largest exporter of medical talent to the world • Quality of Care: at par with the best • Culture: • English speaking population in general • Acceptance of patients from all races: Absence of racial discrimination (especially relevant for African travelers)

16. Advantage IndiaStrengths / Competitive Advantages • Technology: Latest Technology, Equipment, Facilities and Infrastructure: Int’l standards • Holistic Offer: Options for multiple Alternative Systems of Medicine like Ayurveda, Yoga, Unani, Siddha, Homeopathy, etc. • Unmatched Cost Advantge: @ 10% cost of developed world • Cheap cost of living for long stay visitors, attendants, family members • Access: Within 7 hours flying time from 70% of world’s population • Tourism: Exotic tourism circuit around all metro cities

17. Advantage IndiaGovernment Support

18. Advantage India: Price Advantage: Cost of healthcare delivery: % discount to cost of service in USA India: Amongst the cheapest and the best provider of ‘quality healthcare’

19. Key ChallengesIndia still lags behind Competition!!! Regulatory support • Regulatory process flow for issuing M-visas: • No separate fast track process for M visas; common queues for Med & other Visitors @ airports; • Public / Civil infra. lags even some developing countries • Limited number of quality tertiary / quaternary care facilities • Majority of MVT flow is from non-English speaking countries: • Need trained linguists to assist Arabic, African, CIS visitors • While cost of treatment is less in India, ancillary costs may be high, especially for visitors from low income economies Public and Private Infrastructure • Patient flow driven by unorganized middle-men • Few players have formal, transparent protocols for patient counselling and communication for MT visitors • Competition from other Asian countries Market Structure

20. Way forward for MT in India

21. Way forward for MT in India

22. Our ExperienceBLK Super Specialty Hospital, Delhi • Dedicated End-to-End Eco-system: • Annual traffic: 40,000+ OPD & 3,000+ IPD MT visitors • Tie-ups: 15+ Health Ministries, 3 Universities, 15 embassies, Int’l TPAs • Website: Multi-lingual website for target nations 30% CAGR • International OPDs: Teams of 2-5 doctors travel every week: From ‘Fiji to Finland’ • Pre-Travel support: Tele-consults, Skype calls, diagnostic support • Translators: Pool of translators supporting 18 different languages • Logistics: Direct pick-up from the Tarmac for Int’l patients • Visa & currency: End-to-end handholding for entire travel schedule • Food: Dedicated Chefs for 12 different cuisines, prepared every day • Quality of care: International patients lounge, in-room admission & discharge • Accommodation: Tied-up hotels at affordable rates for attendants • Tourism: Packages via hospital vendor network

23. Thank You!!! Nanavati Super Specialty Hospital, Mumbai BLK Super Specialty Hospital, Delhi

24. Global Trends:Case Study of MT oriented business: Bumrungrad, Bangkok • One of the largest private hospitals in Southeast Asia • Most popular MT destination • Of the 1 million patients/ yr, 50% are foreign nationals • Marketing offices in 16 countries (Australia, Bangladesh, UAE, China) • Multi-lingual website • End-to-end online assistance to patients • Pre & post consults, Appointment, travel, stay, etc. • Medical coordination office, dedicated team of 30+: • Collaborates with patient’s primary doctor, even after the patient is discharged • Wide range of accommodations from low-priced four-bed rooms to suites • 51 room serviced apartment complex, for inbound long stay patients • Patients can rent this accommodation for a day, a week, or a month.