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US → India MVT
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Market Feasibility · May 2025

The US → India Medical Value Travel Opportunity

Strategic Feasibility, Competitive Landscape, Insurance Integration & Regulatory Risk Analysis. A data-first, source-cited assessment of the 17-year structural gap in US patient access to JCI-accredited Indian hospitals — and the conditions under which a compliance-grade facilitator can capture it.

1.8M
US patients abroad / yr
Patients Beyond Borders
$11B
India MVT market 2025
Mordor Intelligence
65–90%
Cost savings vs. US
Hospital + FAIR Health
63%
US workers in self-funded plans
KFF 2024
Prepared for
Interested Strategic Partner / Investor
Classification
Confidential — Discussion Draft
Version
v1.0
Begin briefing
02Executive Snapshot

A conditional GO — high-margin, high-risk, narrow-window.

The opportunity is real and structurally underserved. Capturing it requires legal, clinical, and trust infrastructure that few existing competitors have built.

Feasibility Scorecard

Weighted avg 5.7 /10
Market Demand (US)
7
1.8M Americans/yr travel abroad; India underpenetrated
Cost Arbitrage
9
60–90% savings; structural and persistent
Patient Willingness to Travel to India
4
Trust deficit vs. Mexico/Thailand is real
Competition Intensity
6
Few India-specialist US-domiciled facilitators
Legal / Regulatory Risk
5
HIPAA, telehealth licensing, malpractice all material
Operational Complexity
5
Visa, travel, clinical protocol, aftercare
Insurance / Payment Integration
5
Self-funded ERISA real but slow; Medicare excluded
Scalability
6
AI-assisted scalable; concierge model not
Profitability (Unit Economics)
6
GM 35–55% achievable; commission + ticket dependent
Reputational Risk
4
One adverse media event can derail
Verdict
Conditional GO
Subject to capital, legal setup, and disciplined Phase-1 procedure scope.
Window
2025–2026
Bangladesh collapse + 17-yr ERISA gap = exceptional partnership leverage.
Capital floor
$75K liquid
Legal $25K + insurance $15K + Y1 marketing $20K + buffer $15K.
Reasons to proceed
Structural cost arbitrage is irreversible

India JCI hospitals deliver 65–90% savings on major elective procedures. Cardiac bypass: $4,500–$8,000 vs. $70,000–$150,000 in the US. Savings survive even with full travel layered on.

Bangladesh concentration collapse → Western urgency

India's #1 source (Bangladesh, ~75% of 2024 medical FTAs) dropped 43–59% YoY in late 2024. Apollo, Fortis, Medanta, Narayana are urgently diversifying — exceptionally favourable negotiating environment in 2025–26.

ERISA self-funded employer channel structurally available

63% of US covered workers are in self-funded plans (KFF 2024). ERISA preempts state mandates. No major new US employer program to India since 2008 WellPoint–Serigraph — a 17-year gap with vastly higher ROI today.

Reasons to pause
Patient willingness to travel to India is lower than to closer destinations

Mexico, Costa Rica, Thailand benefit from proximity, cultural familiarity, and US expat communities. India's 14–18 hour flight, perceived safety, and unfamiliarity create real conversion barriers.

Post-operative complication liability is an existential risk

DVT/PE post-surgery on long-haul return flights, wound infections after return, complications requiring US ER care — all create reputational and potential legal exposure. No centralised US registry exists.

Legal & regulatory complexity is underestimated

HIPAA BAAs, telehealth licensing in 50 states, India's DPDP Act 2023 cross-border compliance, anti-kickback safe harbour, FTC ad substantiation. Budget $15K–$40K for legal setup alone.

03Market Opportunity

A $9–11B host market with the US share at 0.3%.

India MVT is large, growing, and dangerously concentrated on Bangladesh. The collapse of that corridor in late 2024 reset hospital negotiating dynamics in favour of new Western channels.

India inbound medical tourists (000s)

MoT Lok Sabha USQ 4136

Actuals 2022–2024; forward projections from Mordor 12.42% CAGR baseline.

2024 source-country share

MHA / Newslaundry

Bangladesh dropped 43–59% YoY late 2024 → Indian chains are actively hunting Western corridors.

Bangladesh75%
Iraq5%
Somalia1.8%
Oman1.6%
Uzbekistan1.4%
Nigeria / W. Africa2.5%
United States0.3%
UK / Europe1%
All others12.4%

Market sizing — low / base / high

Medium confidence
MetricLowBaseHighSourceConfidence
US medical tourists (all destinations, 2023)1.2M1.8M2.2MPatients Beyond BordersMedium confidence
US patients to India (2024 actual)~1,900~2,500~4,000Newslaundry/MHA — needs RTI verificationLow confidence
India MVT market size (2025)$8.35B$9–11B$11.14BCustom Mkt Insights / Mordor IntelligenceMedium confidence
India MVT market (2030 projection)$14B$16–18B$22BIMARC / Mordor — long rangeLow confidence
US-to-India SAM (5-year buildout)$150M$400M$900MConsultant model — planning onlyLow confidence
New entrant Year-3 revenue potential$1.5M$4M$10MConsultant model — Section 13Low confidence
04US Demand & Personas

Five payable archetypes — built around insurance failure points.

Demand is concentrated where US insurance breaks down: high-deductible musculoskeletal, IVF self-pay, retiree dental, denied bariatric, and diaspora cardiac. Personas drawn from intake patterns and the US payer survey.

Persona 01

Mark, 57 — Houston, TX

High-deductible knee replacement
Insurance
Employer HDHP, $5,500 deductible, $8,000 OOP max
Procedure
Bilateral TKR — India $9–14K all-in vs. $58–72K US
Pain
OOP costs blow through HSA; 6-month wait for OR time
Trigger
Saving $5–7K vs. US cap, plus Facebook peer testimonials
Barrier
“Is it safe?” — surgeon credentials, infection rates, what if something goes wrong back home
Channel
Google search; Medical Tourism USA Facebook groups; Reddit r/medicaladvice
Facilitator revenue$2.2K–$4.0K per case
Persona 02

Priya & David, 34/36 — San Jose, CA

IVF self-pay couple
Insurance
CA AB1960 covers 3 cycles; 2 failed, 3rd denied. US self-pay $18–25K
Procedure
IVF donor-egg cycle — India $5.5–10K all-in
Pain
Out-of-pocket on third cycle is prohibitive
Trigger
$16–19K savings + cultural comfort + family in Chennai
Barrier
IVF lab accreditation, embryo legal status across countries
Channel
NRI physician referrals; Indian-American fertility groups; AAPI events
Facilitator revenue$1.0–$2.0K facilitation; LTV >$4,000 with repeat cycles
Persona 03

Bob, 68 — Sarasota, FL

Dental implant retiree
Insurance
Medicare (no dental); private dental capped at $1,500/yr
Procedure
Full upper arch All-on-4 — India $7.5–14K vs. $28–35K US
Pain
Cannot afford US dental on fixed income
Trigger
India 50% cheaper than Costa Rica option his friends used
Barrier
14-hour flight vs. 3 hours to Costa Rica; lab quality; warranty
Channel
Retirement community newsletters; AARP blog; senior FB groups
Facilitator revenue$1.5–$2.2K per case
Persona 04

Sandra, 42 — Nashville, TN

Self-employed bariatric patient
Insurance
Marketplace plan; bariatric not covered (denied twice). US cash $28–35K
Procedure
Sleeve gastrectomy — India $8.5–11K all-in
Pain
Insurance denied; $30K+ savings is life-changing on freelance income
Trigger
Dr. Lakdawala (Mumbai) reputation; financial necessity
Barrier
Nutritional follow-up; finding US dietitian to work with India-surgery patient
Channel
ObesityHelp.com; r/gastricsleeve; Google ‘gastric sleeve India cost’
Facilitator revenue$1.7–$2.9K per case
Persona 05

Raj, 63 — Queens, NY

Indian-origin cardiac patient
Insurance
Self-employed marketplace plan; $12K OOP max; pre-auth delays 3–4 months
Procedure
CABG — Apollo Delhi $10–14K vs. $160K US quote
Pain
US wait + cost; brother-in-law is Apollo cardiologist
Trigger
Family network, cultural comfort, $140K+ net savings
Barrier
Return-flight medical clearance; US cardiologist follow-up
Channel
Word-of-mouth in Indian-American community; AAPI physician network
Facilitator revenue$4.0–$6.5K per high-value case
05Procedure Matrix

Phase-1 menu = ortho, bariatric, IVF, dental.

Procedures are sequenced by margin, evacuation risk, and US trust. Transplants and complex oncology are explicitly excluded from launch scope.

ProcedureUS cost ($)India hospital ($)India all-in ($)SavingsPhase
Total Knee Replacement30–60K5.5–9K9–14K65–80%Phase 1
Hip Replacement32–60K5.5–8K9–13K67–80%Phase 1
CABG (cardiac bypass)70–150K4.5–10K8.5–16K80–90%Phase 1–2
Sleeve Gastrectomy20–35K4.5–7.5K7.5–12.5K60–79%Phase 1
Roux-en-Y Bypass25–40K5.5–9K8.5–14K62–78%Phase 1–2
IVF (one fresh cycle)15–25K2.5–5K5.5–10K55–76%Phase 1
Dental All-on-4 / Arch25–45K4.5–9K7.5–14K65–80%Phase 1–2
Spinal Disc Replacement50–100K7–14K10.5–19K71–82%Phase 2
Spinal Fusion (TLIF/PLIF)50–120K6–12K9.5–17K72–86%Phase 2
Single Dental Implant3.5–5.5K0.4–0.8K2.9–4.8KVariesPhase 2
Liver Transplant300–500K25–40K31–50K80–90%Avoid
Kidney Transplant150–300K12–20K17–28K83–90%Avoid
Oncology (chemo course)50–200K+8–30K13–38K70–85%Phase 2 specialised

Sources: Apollo / Fortis / Narayana international package pages, FAIR Health Consumer US self-pay benchmarks. Full per-cell sourcing in Annexure B.

06Cost Arbitrage

65–90% savings survive every realistic cost layer.

Even with flights, hotels, and a 15–25% facilitation fee, India all-in remains 50–80% under US self-pay. Arbitrage is structural — driven by labour cost, hospital capex, and PPP — not transient.

US self-pay vs. India all-in (USD)

FAIR Health · Hospitals
$98.5K
Avg saving on CABG
Apollo / Narayana cardiac packages
$12.5K
All-in IVF cycle (India)
Hospital + travel + facilitation
$24K
Dental All-on-4 saving
Even with travel layered on
<$50/night
IRS HSA lodging cap
Pub. 502 — eligible reimbursement
07India Supply Side

Ten partnership-grade chains — Apollo, Fortis, Medanta, Narayana lead.

JCI + NABH accreditation, international-patient infrastructure, and active US/Western corridor strategy define the Priority-1 partner pool. Narayana's HCCI (Cayman) is an explicit US gateway.

Apollo Hospitals

Delhi, Chennai, Hyderabad, Bengaluru, Mumbai
9
fit /10
Strengths
Cardiac, ortho, oncology, neurology, transplant
Accreditation
JCI: 10+ facilities; NABH group-wide
IP traction
Q3FY26 IP rev ₹190 Cr (~$23M), +28% YoY
Priority 1

Fortis Healthcare

Delhi (Escorts), Gurgaon, Mumbai, Bengaluru
8
fit /10
Strengths
Cardiac (Escorts), ortho, oncology
Accreditation
JCI: Escorts, Malar; NABH group
IP traction
Q4FY25 IP rev ₹145 Cr (~$17M), +17% YoY
Priority 1 (cardiac)

Medanta — The Medicity

Gurgaon, Lucknow, Patna
8
fit /10
Strengths
Multi-specialty; Dr. Trehan cardiac; spine
Accreditation
JCI Gurgaon; NABH
IP traction
FY23 IP rev ₹156 Cr (+68% YoY)
Priority 1

Narayana Health (HCCI)

Bengaluru, Kolkata, Cayman Islands
9
fit /10
Strengths
Cardiac, ortho, oncology — HCCI explicit US gateway
Accreditation
JCI Enterprise (HCCI); NABH
IP traction
HCCI: 46K+ patients from 60+ countries
Priority 1 (US gateway)

Manipal Hospitals

Bengaluru, Mangalore, pan-India
7
fit /10
Strengths
Ortho, oncology, neurology, transplant
Accreditation
JCI Yeshwanthpur; NABH group
IP traction
Serves 160+ countries
Priority 2

Kokilaben Dhirubhai Ambani

Mumbai
7
fit /10
Strengths
Oncology, neurology, bariatric, cardiac
Accreditation
JCI, NABH, NABL, CAP
IP traction
Premium Mumbai positioning
Priority 2 (premium)

Aster DM Healthcare

Kochi (Medcity 1,745 beds), Bengaluru, Hyderabad
6
fit /10
Strengths
Multi-specialty quaternary; oncology, cardiac, gastro
Accreditation
JCI Medcity; NABH group
IP traction
India Q3FY25 rev ₹2,780 Cr
Phase 2

Max Healthcare

Delhi NCR (Saket, Shalimar Bagh, Patparganj)
6
fit /10
Strengths
Cardiac, oncology, neurology, bariatric
Accreditation
NABH; JCI Saket (verifying)
IP traction
FY24 rev ₹5,200+ Cr
Phase 2

Kauvery Hospital

Chennai (Alwarpet, Vadapalani)
6
fit /10
Strengths
Cardiac, neurology, emergency
Accreditation
NABH; JCI applying
IP traction
~750 beds; strong South India brand
Phase 2

CARE / KIMS

Hyderabad
6
fit /10
Strengths
Multi-specialty, cardiac, ortho
Accreditation
NABH; JCI CARE Banjara verifying
IP traction
Strong Hyderabad option
Phase 2
08Competitive Landscape

No US-domiciled, India-specialist, employer-grade competitor.

13 active platforms surveyed. None combine HIPAA-grade infrastructure, US-side aftercare, employer B2B muscle, and India specialisation. The 2008 WellPoint–Serigraph benchmark has not been re-built.

Competitor scan

PlayerHQModelIndiaAftercareKey gap
PlacidWayDenver, COMulti-destination marketplace + hospital SaaSMediumNoneNot India-specialist; no aftercare; no employer B2B
Medical Tourism Corp.Austin, TXHospital referral marketplaceMedium-HighNoneGeneralist; limited India depth
MedRetreatMultiplePackage travel + facilitationLowNoneLow online presence; appears semi-active
HealthbaseBoston, MAFull-service concierge; employer pilotsHighPartial — US coordinatorActivity level unclear post-Serigraph
IndUSHealthNorth CarolinaSelf-insured employer B2B (since 2005)India-onlyYes — corporate post-opLimited digital presence; niche B2B only
Vaidam HealthGurgaon, INHospital matchmaking + patient supportIndia-onlyPost-op videoIndia-domiciled; no US legal entity
CureMeAbroadMumbai, INAI-assisted matching + coordinationIndia primaryHIPAA claimedIndia-domiciled; US legal entity unclear
LyfboatIndiaMarketplace + matchmakingHighLimitedIndia-domiciled; thin US-side service
MediGenceIndia / UAEMarketplace + conciergeHighLimitedGeneralist destinations; weak US presence
ClinicSpotsIndiaDirectory + leadsHighNoneLead-gen, not navigation
IndiCureIndiaCosmetic-focused conciergeIndia-onlyLimitedCosmetic niche; not multi-specialty
GoMediiIndiaHospital referral platformIndia-onlyLimitedDomestic-leaning; US-side missing
MedicoExpertsIndiaConcierge + second opinionsHighPartialIndia-domiciled; B2C-only
Whitespace
Geography

No US-domiciled, India-specialist, employer-channel, HIPAA-grade competitor. IndUSHealth closest but minimal digital footprint.

Aftercare

No competitor offers structured US-side 90-day post-return monitoring as a core service. The #1 conversion barrier sits unaddressed.

Employer Channel

No new US self-funded employer pilot since 2008 WellPoint–Serigraph. 17-year structural gap with vastly higher savings ROI today.

Trust Infrastructure

No platform combines surgeon credential vetting, virtual hospital tours, and transparent outcome data to a US-credentialing standard.

Segment Specialisation

Focus on 2–3 procedures (TKR/THR + bariatric + IVF) enables deeper hospital ties and higher conversion vs. generalist directories.

09Business Model

Hybrid transparent fee + premium clinical navigation.

Patient pays a disclosed facilitation fee; hospital pays a separately disclosed services fee under a written MOU. This passes FTC, anti-kickback, and trust tests simultaneously.

ModelRevenue / unitRiskTrustScaleVerdict
Patient-paid flat facilitation fee$1.5–$3.5K/patientLowHighLowAcceptable Year 1
Hospital-paid undisclosed commission$1.5–$6K/patientVery HighVery LowMediumNever recommended
Hybrid: transparent patient fee + disclosed hospital service agreement$2.5–$5K combinedLow–MediumHighMedium-HighRECOMMENDED ★
Self-funded employer / TPA B2B$50K–$500K/yr per employerMedium (ERISA)HighHighPhase 2+ ✅
Subscription concierge$3.6–$6K/yr per patientLowHighLowNiche only
Marketplace / directoryLow — race to bottomLowLowVery HighNot as primary
White-label hospital IP desk$150–$500K/yr per hospitalMediumMediumMediumPhase 3
Premium clinical navigation (advisor)$3–$7K/patient all-inLow if structuredVery HighHigh w/ techRECOMMENDED ★
10Insurance & Payments

The only payable channels: ERISA self-funded, HSA/FSA, self-pay.

Medicare and Medicaid are structurally excluded. The viable channels rely on ERISA preemption, IRS Pub 502 eligibility, and disciplined patient-direct-pay flow.

CoverageOverseas?Detail
Traditional Medicare (A/B)NOOnly narrow Canada/Mexico border emergencies. ~65M enrollees.
CMS.gov Medicare rules
MedicaidNOState-based; no elective overseas. 90M+ enrollees.
CMS.gov Medicaid
Employer fully-insured planGENERALLY NOCarrier controls; no incentive to lose medical revenue. 43M covered.
KFF 2024
Self-funded ERISA employer planYES — IF DESIGNED63% of US covered workers. ERISA preempts state mandates. 17-year gap since last pilot.
KFF 2024 Employer Health Benefits Survey
HSA / FSA / HRAYES (medical only)Foreign hospital fees eligible if medically necessary; $50/night IRS lodging cap.
IRS Publication 502 (2024)
ACA Marketplace planGENERALLY NOCarrier-controlled; emergency-only overseas if any.
HealthCare.gov / KFF
Standalone medical tourism insuranceYES — patient-purchasedCAP Global Protective Solutions; Seven Corners MTI fill complication gap.
Carrier product pages
Patient payment flow
  1. 1Patient inquiry & medical eligibility screen
  2. 2Indian hospital quote (itemised, USD)
  3. 3HSA / FSA / HRA documentation pack assembled
  4. 4Patient pays hospital directly (USD wire)
  5. 5Facilitator fee invoiced separately
  6. 6Treatment in India (JCI hospital)
  7. 7Complication insurance active 90 days
  8. 8US aftercare & PCP handoff

Patient pays hospital direct in USD; facilitator invoices a separate, disclosed fee. Avoids fee-splitting / kickback exposure under FTC, AKS (where applicable), and state laws.

12Operational Roadmap

12 months from incorporation to first 10 patients.

Sequenced, compliance-first build. No patient acquisition until legal + hospital + aftercare stack is live.

Months 1–2

Phase 1 — Legal & Setup

  • US LLC formation; Delaware or Wyoming
  • Healthcare attorney memo on operating states
  • HIPAA policy stack + BAA template
  • Patient Services Agreement & disclosures
  • Hospital MOU template (services-fee structure)
Months 3–4

Phase 2 — Hospital Partnerships

  • Identify 3–5 JCI hospitals (Apollo, Fortis, Medanta, Narayana HCCI)
  • Verify JCI / NABH; confirm last audit
  • Negotiate package rates + 60-day price guarantee
  • Escalation contacts & 24/7 IP coordinator
  • DPDP Act 2023 Data Processing Agreement signed
Months 5–9

Phase 3 — Product & Insurance Integration

  • Patient intake platform (HIPAA-grade CRM)
  • HSA / FSA / HRA documentation packs (IRS Pub 502)
  • Encrypted record transfer (TLS 1.2+, AES-256)
  • US aftercare network (telehealth + nurse navigator) contracted
  • TPA / employer outreach (ERISA self-funded)
  • Complication insurance product embedded (CAP / Seven Corners)
Months 10–12

Phase 4 — Pilot

  • 5–10 pilot patients (TKR/THR + bariatric only)
  • 3–4 supportive states: WI, NC, OH, IN
  • Outcomes & NPS tracking; case studies
  • Compliance review & legal post-mortem
  • Refine model; Series A trigger if 3+ employers signed
13Financial Model

Year-3 base $634K revenue · path to $2M+ in upside case.

Three scenarios on patient volume, average ticket, and CAC. Year-1 EBITDA negative across all cases; Y3 base is near breakeven, upside materially profitable.

Revenue scenarios ($K)

Consultant model
Y1 patients12
Low
6
Base
12
High
20
Rev (base)
$47.5K
EBITDA (base)
$-206.1K
Y2 patients60
Low
30
Base
60
High
120
Rev (base)
$237.6K
EBITDA (base)
$-172.4K
Y3 patients160
Low
80
Base
160
High
320
Rev (base)
$633.6K
EBITDA (base)
$-80.4K

Unit economics by procedure

ProcedureIndia hospital costGross facilitation revCACCoordination costNet / patient
TKR / THR$7–9K$3.06–3.42K$1,400$700$260–620
Bariatric (Sleeve)$5.5–7.5K$2.79–3.15K$1,200$700$190–550
IVF (1 cycle)$3–5K$2.04–2.40K$1,000$600−$260 to $100 (LTV positive)
Dental All-on-4$5.5–9K$2.49–3.12K$900$500$390–1,020
Cardiac (CABG)$9–14K$4.12–5.02K$2,000$900$520–1,420
14Sensitivity

CAC, conversion, and Y3 volume dominate the downside.

Three variables — CAC, lead-to-booking conversion, and Y3 volume — each can independently erase $250K+ of Y3 EBITDA. The rest is manageable.

Hospital commission
Watch
Base
18%
Stress
12%
Impact
−$140K Y3 EBITDA
MitigationMOU rate-lock; 2-yr pricing clause; diversify hospitals
Average ticket size
Watch
Base
$12,000
Stress
$8,000
Impact
−$95K Y3 EBITDA
MitigationTarget cardiac/spine in Y2+; min ticket filter
Customer Acquisition Cost
Critical
Base
$1,400
Stress
$3,000
Impact
−$256K Y3 EBITDA
MitigationSEO from day 1; employer channel near-zero CAC; NRI referral
Conversion rate (lead → booking)
Critical
Base
4%
Stress
2%
Impact
−$316K Y3 EBITDA
MitigationTrust infra: virtual tours, surgeon CVs, outcomes, testimonials
Y3 patient volume
Critical
Base
160
Stress
80
Impact
−$330K Y3 EBITDA
MitigationMaintain self-pay channel; don't depend on employer Y1–2
Flight cost rise
Manageable
Base
Stable
Stress
+30%
Impact
Marginal — patient bears travel
MitigationAll-in quote refresh quarterly
India hospital pricing
Watch
Base
Stable
Stress
+15%
Impact
Savings remain >50%
MitigationLock rates 60–90 days; alternate hospital options
Complication rate
Critical
Base
<2%
Stress
5%+
Impact
Reputational: existential
MitigationStrict exclusion criteria; 90-day nurse navigator
15Risk Register

14 enumerated risks, plotted by probability × impact.

Top-right quadrant (high probability × high impact) demands hard controls before scaling. Clinical and reputational risks are existential — they receive Phase-1 mitigation.

Probability × Impact

DVT/PE on return flight3×5
Clinical
Wound infection post-return3×4
Clinical
Telehealth licensing violation3×4
Legal
High CAC / Google Ads inflation4×3
Financial
Wrong patient selection2×5
Clinical
Hospital JCI lapse2×5
Reputational
Negative US media event2×5
Reputational
Hospital pricing change3×3
Operational
HIPAA data breach2×4
Legal
FTC enforcement2×4
Legal
Hospital partner disintermediates2×4
Competitive
US–India geopolitical change2×4
Geopolitical
Visa denial / delay2×3
Operational
INR/USD currency move3×2
Financial
16Strategic Positioning

Win on trust infrastructure — not on lead volume.

The defensible position is a US-domiciled, India-specialist navigator with auditable trust pillars. Every pillar maps to a US patient objection.

01

Transparent pricing

Itemised quotes in USD. No bundled clinical + travel invoices. Facilitation fee disclosed at intake.

02

Accredited hospitals only

JCI verification per facility, NABH overlay. Annual re-audit check; backup hospital per procedure.

03

Named, vetted surgeons

NMC registration verified; subspecialty training, procedure volume, publications on surgeon profile.

04

US aftercare coordination

90-day post-return nurse navigator; PCP handoff protocol; complication-insurance embedded.

05

Ethical payment model

Hospital service-fee structure (not per-patient kickback). Disclosed in writing per FTC 16 CFR 255.

06

Compliance-first operations

HIPAA BAA per hospital; DPDP Act 2023 DPA; state telehealth review; E&O & cyber liability cover.

07

Evidence-based education

Outcomes data, surgeon CVs, virtual hospital tours. No unsubstantiated savings claims.

17Go / No-Go

Ten conditions for GO. Seven hard stops for NO-GO.

A binary, board-ready checklist. Failure on any single NO-GO trigger should halt launch.

GO conditions
  1. 01Signed MOUs with ≥2 JCI-accredited Indian hospitals (itemised package rates)
  2. 02US healthcare attorney memo: model, entity, PSA, BAA, anti-kickback by state
  3. 03HIPAA infrastructure live: BAA per hospital, encrypted stack, privacy policy published
  4. 04DPDP Act 2025 Data Processing Agreement per Indian hospital partner
  5. 05Named US aftercare partner (telehealth / nurse navigator) under contract
  6. 06Complication insurance product (CAP / Seven Corners) embedded in booking
  7. 07Minimum $75,000 liquid capital (legal $25K + insurance $15K + Y1 marketing $20K + buffer $15K)
  8. 08Written clinical exclusion policy (Medicare/Medicaid; ASA IV+; transplant; cardiac instability)
  9. 09Payment flow validated: patient pays hospital directly; facilitation fee separately invoiced
  10. 10Procedure scope locked to Phase 1 (TKR/THR, bariatric, IVF, dental) for first 12 months
NO-GO triggers
  • Model relies entirely on undisclosed hospital commission
  • No qualified US healthcare attorney has reviewed the structure
  • No US-side aftercare network exists
  • Cardiac surgery as Y1 volume driver for high-risk patients
  • Organ transplant included in launch menu
  • Capital reserve under $50,000
  • Marketing claims that cannot be substantiated with cited primary data
18Annexures

Audit trail — 15 reference artefacts.

Each annexure is a verifiable working document referenced throughout the deck. Full materials accompany the long-form report.

Annex A

Master Source Database

Single index of every primary, government, industry, and competitor source cited. Audit trail for every claim.

Annex B

Procedure Cost Comparison

Verifiable US vs. India cost data per Phase 1 procedure with cite-able source per cell.

Annex C

US Insurance / HSA / FSA Guide

IRS Pub 502 line-by-line guidance and patient HSA/FSA documentation checklist.

Annex D

Medical Visa Checklist (US Citizens)

e-Medical Visa requirements, FRRO extension protocol, paper-MED backup.

Annex E

Hospital Due Diligence Checklist

JCI / NABH / outcomes / IP infrastructure / commission terms — verification template.

Annex F

Patient Intake Form

Clinical screening including ASA risk, comorbidities, exclusion triggers.

Annex G

Patient Consent / Disclosure Checklist

FTC 16 CFR 255 material-connection disclosure; informed consent for cross-border care.

Annex H

Hospital MOU Term Sheet

Recommended positions on commission %, 60-day price guarantee, escalation, IP coordination.

Annex I

Teleconsultation Compliance Checklist

State-by-state telehealth framing — 'informational only', US-licensed navigator presence.

Annex J

Post-Op Follow-up Protocol (90 days)

Nurse navigator cadence, escalation triggers, US PCP handoff documentation.

Annex K

DVT / Travel-Risk Checklist

Procedure-specific minimum-stay, LMWH protocol, MEDIF clearance, contraindications.

Annex L

Competitor Matrix

13-competitor scoring on India focus, model, aftercare, tech, US-side coverage.

Annex M

Financial Assumptions

Every model input with low/base/high range and sourcing notes.

Annex N

Risk Register

14 enumerated risks with probability × impact, early-warning indicators, mitigation owner.

Annex O

Primary Research Plan

RTI filings, patient survey design, hospital primary-source verification roadmap.

19Sources

Every number traces to a primary source.

Government, market, hospital, legal, and competitor sources used in this deck. Confidence ratings indicate methodology strength, not legitimacy.

Government / Regulatory

MoT Lok Sabha USQ 4136 (Aug 2025)

2024 medical FTAs to India: 644,387; country breakdown

High confidencetourism.gov.in/sites/default/files/2025-08/usq.4136%20for%2018.08.2025.pdf
Indian Visa Online — e-Medical Visa

e-MED visa eligibility, duration, process

High confidenceindianvisaonline.gov.in/evisa/tvoa.html
MHA Annex III — Visa Categories

Medical visa types & eligibility

High confidencewww.mha.gov.in/PDF_Other/AnnexIII_01022018.pdf
HHS — HIPAA Business Associates FAQ

Cross-border PHI; BAA requirements

High confidencewww.hhs.gov/hipaa/for-professionals/faq/2083/
IRS Publication 502 (2024)

HSA/FSA eligible expenses; $50/night lodging

High confidencewww.irs.gov/publications/p502
DPDP Rules 2025 — Rule 15

India cross-border data transfer model

High confidencewww.dpdpa.com/dpdparules/rule15.html
CMS.gov — Medicare Coverage Rules

Overseas elective exclusion

High confidencewww.cms.gov