Dental Tourism; Enough Reasons for Smile

Bringing robustness to economic growth and regional development, tourism speedy becomes the largest industry in the world. However, there are certain fertile areas in tourism which are not yet utilized its potential fully. Being a country offers quality services at cheap rates, India entices a large number of travelers seek benefits from Medical Tourism. Also, our country is blessed with state of art infrastructure and qualified medical practitioners especially experienced professionals in dentistry that certainly gives us a competitive edge. When travelers prefer destinations to enjoy their holidays along with fulfilling medical requirements at reasonable cost, Kerala emerges as a hub for travelers.

Tourism is often being considered as the largest export industry in the world and an agent for economic and regional development. According to World Travel and Tourism Council (2013), India is ranked third among countries with the fastest growing tourism industries over the next decade. It is estimated that 6.97 million foreign tourists arrived in India in 2013, an increase of 5.9%. Domestic tourist visits to all states and Union Territories numbered 1145 Million at an annual growth rate of 9.6%. The most represented countries are the United States (16%) and the United Kingdom (12 %). The World Tourism Organization reported that India's receipts from tourism during 2012 ranked  16th in the world and 7th among Asian and Pacific countries. Also, India has a large medical tourism sector which is expected to grow at an estimated rate of 30% annually to reach about 95 billion by 2015. Being many travelers explore opportunities for better health in India, the same has been identified as a potential area in tourism. In this context, potentials and opportunities of dental tourism in India is worth discussing.

Medical Tourism

World Tourism Organization (WTO) defined medical tourism as “Tourism associated with travel to health spas or resort destinations where the primary purpose is to improve the traveler‟s physical well being through a process comprising physical exercises and therapy, dietary control, and medical services relevant to health maintenance”. According to Mary Tabacchi, Health Tourism is “any kind of travel to make yourself or a member of your family healthier”. 

(ASSOCHAM report                             2011      850,000        medical tourists                            India and          projected that by 2015 this number  would                           to 3,200,000.              Indian  medical  tourism  sector is                    about  Rs.7500 crore                       is likely to                                 Rs.12000 crore this year                    expect          an annual growth rate of 30%. According to CII, medical tourism industry is expected to be worth US$ 4billion by 2017. Also, India has a potential to attract 1 million health tourists per annum which likely contribute US$ 5 billion to the economy. Study estimates that a good proportion of travelers from Middle East (24%), U                   K                      (18%),   Germany   (13%),  U                    S                            A (12%) and Maldives (11%) avail medical service facilities.

Triggering Factors

As  technology  and  medical facilities,  medical  tourism   witnessed  a  flow of people from developed to developing countries. During the last two decades countries like India, South Africa, Hungary, Thailand and Turkey emerged as the hubs of medical tourism; now medical service is a part of tour packages. The flow of medical tourists increased by an industry approach of uninsured and underinsured consumers from industrialized countries seek first-class quality at developing country prices, a phenomenon commonly referred to as „medical outsourcing‟.

The key factors make India dearer for west are low cost health care facilities, compliance with international quality standards, short waiting lists for treatment, good English speaking community, availability of latest medical technologies, and minimal insurance coverage in developed countries. An emerging trend in vogue is that corporate in developed countries are increasingly sending their employees to low cost healthcare destinations to reduce expenditure on healthcare for their employees. Removal of visa restrictions to Gulf countries and the visa- on-arrival scheme for tourists from select countries have also made reasonable contributions to medical tourism. US health-care system became very expensive after the worldwide recession and the subsequent revision of healthcare cost by US insurance companies. In 2005, approximately 500,000 Americans travelled abroad for medical treatment and by 2007 this number increased to 750,000 which is expected to increase to more than 15 million Americans annually by 2017.

Traditional medical services as complementary in Asian countries significantly contributed for increased travelers movements. Estimates invariably claim that treatment cost in India is at around tenth of the price of USA or Britain. Also, telemedicine programs give ease to outbound patients. During this period, Chennai emerged as the health capital of India with its multi- and super-specialty hospitals. It is estimated that Chennai attracts about 45 percent of health tourists from abroad arriving in the country and 30 to 40 percent of domestic health tourists.

Dental Tourism

Dental tourism involves individuals seeking dental care outside of their local healthcare systems and may be accompanied by a vacation. According to Frost & Sullivan, dental  tourism constitutes 10 percent of the total medical tourism industry in India; this is projected to grow at 30 percent per annum, into an INR 9,500 Crore (US $ 179.500) industry by 2015.

Taking into consideration of 290 dental colleges AND over 1,25,000 dental practitioners, every year 20,000 fresh graduates entering the workforce which is expected to swell to 225000 shortly. The market for dental equipment and material in India is estimated to be around US$ 38 million annually with an increase of 25 – 30% (Indian Dental Association).   There are more than 1,

25,000 dental professionals, 292 Dental Institutes, and 5000 Dental Laboratories in  India. Around 292 institutes offer dentistry qualifications for 80,000 students in India,  producing 20,000 dental graduates per year. The Indian health care market is considered to be among the world‟s top ten markets and   dental care services market is estimated at about US$ 600 million. Additionally, dental equipment and appliances market is around US$ 90 million which is growing at a rate of 10% per annum. Currently, there are more than 10,000 dental clinics in India. Indian dental care services market, constituted by dentists and ancillary services, was estimated to be US $ 739 million in 2010 and is expected to reach US $ 1302.5 by 2015 at a CAGR of 12 percent. Additionally, to set up new dental practice in the service sector, the subsidies range between 15% and 25% subject to a limit of US $ 20,000. Financial assistance from nationalized banks is provided at 9% to 10% interest for such new dental practices.

It has also been observed that there is an increasing demand for cosmetic dentistry  like whitening, chipped teeth, tooth reshaping etc. which hints that the awareness level of individuals is increasing being people are more conscious about the appearance. Considering it as an opportunity, several foreign companies start investing in the Indian dental market by establishing their production units. Subsequently, India is becoming a manufacturing hub by supplying dental equipment and material to less developed countries.

A study (2010) of more than 1,800 potential medical tourists from the US found that dental procedures are the most frequent type of healthcare procedure in which potential travelers were interested. Ministry of Economic Development in Costa Rica reported that 60% of the medical tourism in that country is dental tourism. More than 75% of the potential travelers in a study (2013) said they would use the Internet to research potential medical tourism providers, and about 50% said they would book the travel on their own (and another 27.7% through the facility or provider). At the same time, Cherukara and James (2008) found that word of mouth and own website are the major sources of information for tourists.

It is reported that only a very few percentage of Americans are equipped with dental insurance. A report to Congress in 2012 called it „Dental Crisis in America‟; being 130 million Americans live without dental insurance. This forces them to visit India where the cost of the treatment is almost one third of that in the United States. According to „Patients Beyond Borders‟, an American could save over 70 percent on dental procedures such as crowns and root canals, if visit another country. For instance, an implant in India is around 70% lower than in Europe and USA. In the UK, the National Health Service (UK‟s public health care system) covers only part of the dental care costs whereas in Australia even for people with insurance, dental work can get quite expensive. Estimate that in 2012, 400,000 Americans crossed international borders for dental care.

A 2008 survey by Intuition Communication, a UK-based consultancy specialized in medical tourism showed that 90 percent of the respondents wanted to go abroad to avail cheaper dental care. Many opined that the National Health Service waiting list was long and if they needed quick relief, they‟d prefer going abroad. Josef Woodman, CEO of Patients Beyond Borders says that the most-searched-for destinations for Americans seeking dental care are Mexico, the U.K., Costa Rica, and India. Also, dental implants, crowns, and dentures are the most  popular searches. One in three patients reported using the internet to research their dental / oral condition or procedure online.

Along with Kerala and Goa Jaipur now becomes a hub dental tourism. New Delhi has emerged as a prime destination for cardiac care whereas Chennai is popular for eye care, and Kerala and Karnataka have evolved as destination for state- of- the- art Ayurvedic healing. Experienced health practitioners, good English speaking medical staff, combination of allopathic with alternative systems of medicine, the availability of super speciality centres, advanced diagnostic equipment and the availability of these premium services at comfortable cost make Kerala an attractive place for travelers. With over 3000 dentists and 1200 dental clinics Kerala has a distinct advantage in dental tourism. Kerala expects around one lakh medical tourists in this year.

As far as dentistry is concerned, most of the local dentists are reluctant to treat foreign patients considering problems associated with care provided by dentists in another country and multiple dental procedures to be performed within a short period of time. At the same time many foreign tourists look for health care organizations accredited by agencies like The Joint Commission International (JCI), Indian Dental Association (IDA), the International Organization of Standardization (ISO) etc while selecting offshore medical facilities. It is not very heartening to learn that only 28% hospital authorities in Kerala find opportunities in medical tourism. Among these, only less than half among them were found to take some initiative to help patients to club their medical travel with tourism. Also, only 33% of the hospitals were making some initiatives on their own to market their services and only 31% of them were participating in any collective effort for marketing. At the same time 64% of them claimed that they were taking initiatives for marketing their services in foreign countries even though in actual practice they were not doing anything more than relying on word of mouth publicity.

Need of this Hour

What is a call of this hour is achieving synergy among industry partners, government, and policy makers to reap maximum benefits from tourism. Despite we have myriad opportunities in this sector, it still unutilized. We have lessons to learn from others. The government of Singapore has formed a collaboration of industry and government representatives to create a medical hub in Singapore. The Malaysian government is aggressively promoting medical tourism. It has extended the visa period for health tourists from one month to six months. China has  announced a $318 million project to help further developed countries medical services. Though a latecomer, Korean government is promoting the nation‟s growing medical tourism industry. Thailand now emerges as the last word in medical tourism

A collective effort to take leverage from tourism sector is a need of this hour. Possibilities of collaboration with national and international tour agencies, insurance service providers, and corporate, and effectively utilizing marketing venues like travel mart, road shows can bear fruitful results. Medical Tourism Festivals like Dubai Shopping Festival Model can be sought of. Efforts to provide telemedicine facilities and acquiring quality certifications may entice travelers. Ultimately, it is all about knowing our customers.

(Paul V Mathew is a Research Scholar, School of Management Studies, Cochin University of Science and Technology (CUSAT). He was also served as Sate Team Leader, Responsible Tourism, Kerala. Currently he works with the Department of Higher Education, Government of Kerala. )

Copyright@Dentcare Magazine; Published in the Dentcare Magazine, Muvattupuzha