Medical tourism occurs when patients travel internationally to obtain privately funded medical care. Medical tourism is a global practice, with hospitals and clinics in a diverse array of destination countries vying to treat such international patients. India is one of these destination countries. In this document we provide an overview of Bangalore, India’s nascent medical tourism industry. This overview has been generated based on information gleaned from media and policy sources, field notes taken during site visits to public and private health care facilities in the country, immersive observational research,
and informal conversations with various stakeholders in Bangalore’s medical tourism industry.
Our research group is interested in developing a better understanding of the health equity impacts of medical tourism on destination countries. In other words, we are interested in understanding if and how medical tourism is helpful and/or harmful to people living in destination countries and their health. India is one of four countries that our work is focused on, which is why we have produced this profile. The medical tourism industries in Barbados, Guatemala, and Mexico are also being examined. We are studying the medical tourism industries and their impacts in these countries as part of an international grant funded by the Canadian Institutes of Health Research. You can learn more about our research
In the sections that follow we offer some general information on Bangalore and its health system before going into detail about key developments in its medical tourism industry. Complementing the main text, five Appendices provide additional detailed insights. Appendix 1 offers a content analysis of the media coverage of medical tourism in Bangalore. In Appendix 2 we provide a narrative synthesis of policy documents regarding medical tourism in Bangalore, Karnataka and India. Appendix 3 is a summary of key agencies and actors involved in medical tourism development in Bangalore and India. Appendix 4 is a map of the medical tourism facilities in Bangalore, and Appendix 5 offers the trade and investment treaties in India.
1.0 THE CONTEXTUAL SETTING
1.1 The Karnataka State
Bangalore is the capital city of the state of Karnataka, one of the four southern states of India. The state has a geographical area of 191,791 km2, or 5.83% of
India’s total geographical area, making it the eighth largest Indian state. Karnataka has a very diverse set of cultures, geographies, and languages, and is known for its emphasis on intellectual capital. It is also the only state which shares borders with all the other southern states. It has four natural regions –
the coastal region, the Western Ghats Region, the northern plains and the southern plains (Planning and Statistics Department, Government of Karnataka [PSD-GOK], 2006).
Karnataka has 30 districts, 176 sub-districts and 29,340 villages (Government of India, Ministry of Home Affairs [GOI-MOHA], 2011). It has a total population of 61,130,704. The population density is 319 people per km2. The rural population of Karnataka comprises nearly 62% of the population, Figure 1 – Location of Karnataka State although this is down from nearly 66% in 2001, indicating increasing urbanization in the region. The literacy rate in the state is 75.6% (Government of India, Ministry of Home Affairs, 2011). The sex ratio is one of the most balanced in the country (968 females for every 1,000 males) in comparison with the national sex ratio (933 females for every 1,000 males). The Gender Equity Index (GEI) for education enrolment in Karnataka in
Figure 2 – Location of Bangalore
2009-10 was .9882, where 1 equals perfect equality in male and female education. For India the GEI for education was .66 in 2012 (Social Watch, 2012). Karnataka is ranked 12th in India on the Human Development Index (HDI) at 0.519; higher than the overall HDI for India at 0.467 (Gandhi, et al., 2011). The life expectancy at birth (projected for 2011-2015) is 68 years for males and 72.3 years for females (Central Bureau of Health Intelligence [CBHI], 2011).
Bangalore, officially named Bengaluru, lies in the southern part of Karnataka It has a pleasant climate throughout the year, with moderate temperatures ranging from 18°C to 32°C. It is the fifth largest metropolis in India, with a total population of 9,588,910 in Greater Bangalore, nearly 91% of whom reside in the urban area. Population growth in Bangalore was 46.68% over the past decade. The sex ratio is less balanced with 908 females for every 1,000 males. The literacy rate in Bangalore is 84% (GOI-MOHA, 2011). Bangalore is also a knowledge hub, with premier institutes like the Indian Institute of Science, National Institute for Advanced Studies, Tata Institute of Fundamental Research, Indian Institute of Management, Indian Space Research Organization, and many more housed in the city. Also, due to its prominent IT industry it is also known as the ‘Silicon City’ of India. Due to its greenery, parks, and tree lined streets, it is also called the ‘Garden City’ of India. In 2000, Wired magazine identified 46 global hubs of technological innovation; Bangalore ranked 11th and was given a score of 13 out of a possible 16 points (United National Development Programmed, 2001).
1.3 Economy of Karnataka
Karnataka’s Gross State Domestic Product (GSDP) for 2012-2013 (at constant prices) was 56 billion USD with a per capita income of 818 USD, and a growth rate of 5.9% over the previous year. The three most important sectors contributing to the state GSDP were the agriculture sector with 15.3%, the industry sector with 25.9%, and the service sector with 58.8%, which has become increasingly important in recent years owing to the IT sector boom. In 2009-2010, the overall unemployment rate in the state was 4.2% and the youth unemployment rate was at 7%, comparing favorably with overall figures from India of 6.6% and 9.4% respectively. In 2009-2010, 23.6% of the population (14.2 million people) lived below the poverty line, even though there was an improvement of 9.7 percentage points when compared with the 2004-2005 data (Planning, Programmed Monitoring & Statistics Department, Government of Karnataka, 2012-13). The Gini coefficient of consumption, an equality measure where 0 equates to perfect equality (all persons have an equal portion of what is being measured) and 1 equates to perfect inequality (one person has all of what is being measured), for Karnataka in 2004-2005 was 0.23 for rural areas and 0.36 for urban areas (PSD-GOK, 2006).
1.4 Health Indicators
The infant mortality rate in 2011 for Karnataka was 35 per 1,000 live births, while the corresponding figure for India was 44 (Sample Registration System [SRS], 2012). The maternal mortality ratio in 2007-2009 was 178 maternal deaths for every 100,000 live births, while for India the ratio was 212 (Office of Registrar General, 2011). The crude birth rate for Karnataka was 18.8 per 1,000 people, while India’s was 21.8; the crude death rate was 7.1 for both Karnataka and India; the natural growth rate for Karnataka was 11.7 per 1,000 people, India’s rate was 14.7 (SRS, 2012). Table 1 provides an overview of the various indicators for Karnataka and India.
In Karnataka, 71.6% of births were attended by skilled personnel, both within institutions and home deliveries, in 2007-2008; while for India overall it was 52.3% (International Institute for Population Sciences [IIPS], 2010). Karnataka has a high level of childhood immunization, with 76.7% of children having complete immunization, 85.1% immunized for measles, and 84.8% for diphtheria, pertussis, and tetanus; compared to 54%, 53.5%, and 63.4% in India overall, respectively (IIPS, 2010). In 2011, among children less than 5 years of age, there were 49 deaths from acute diarrheal disease (out of 591,989 cases), 182 deaths due to pneumonia (out of 1,629,997 cases), one death each due to diphtheria and measles, and no deaths due to neonatal tetanus or whooping cough (CBHI, 2011). Overall, Karnataka’s health indicators are in the middlegame in comparison with the other 27 Indian states.