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The Asia-Pacific region is known as a favorite destination for global medical travelers due to its medical expertise, innovative technology, safety, attractive tourism destination and cost advantage in the recent decade. This study contributes to propose an approach which effectively assesses performance of medical tourism industry based on considering the economic impact factors as well as provides a conceptual framework for the industry analysis. Grey system theory is utilized as a major analyzing approach. According to that, factors impact on the sustainable development of medical tourism in Asia-Pacific region could be identified. The performance of each destination in this region was simultaneously revealed. The results presented an overall perspective of the medical tourism industry in the scope of the Asia-Pacific region, and in Taiwan particularly. Data was collected on six major destinations including Singapore, Thailand, India, South Korea, Malaysia and Taiwan. The results proved that tourism sources and healthcare medical infrastructures play a crucial role in promoting the healthcare travel industry, while cost advantage and marketing effectiveness were less considered. In addition, performance analyse indicated that Thailand has a good performance and stands in the top ranking, followed by Malaysia, India, Singapore, South Korea and Taiwan, respectively. The revenue of Taiwan has increased slowly in the last six years, with a market worth approximately NT$20.5 billion, and the number of medical travelers is expected to increase to 777,523 by 2025. The findings of this study are expected to provide useful information for the medical tourism industry and related key players in strategic planning., Competing Interests: The authors declare no conflicts of interest.

In the global economy, tourism is one of the most noticeable and growing sectors. Thissector plays an important role in boosting a nation's economy. An increase in tourism flow canbring positive economic outcomes to the nations, especially in gross domestic product (GDP) andemployment opportunities. In South Asian countries, the tourism industry is an engine ofeconomic development and GDP growth. This study investigates the impact of tourism onPakistan's economic growth and employment. The period under study was from 1990 to 2015. Tocheck whether the variables under study were stationary, augmented Dickey-Fuller andPhillips-Perron unit root tests were applied. A regression technique and Johansen cointegrationapproach were employed for the analysis of data. The key finding of this study shows that there isa positive and significant impact of tourism on Pakistan's economic growth as well as employmentsector and there is also a long-run relationship among the variables under study. This studysuggests that legislators should focus on the policies with special emphasis on the promotion oftourism due to its great potential throughout the country. Policy implications of this recent studyand future research suggestions are also mentioned.

Economic loss due to traffic accidents is noticeable in India; however, the country lacks research works to estimate the magnitude. This study is an attempt through a Stated Preference (SP) survey to know how users value safety and how much they are willing to pay (WTP) for a safer road facility to reduce the risk of their involvement in road traffic accidents. The survey was conducted for two-wheeler riders of selected roads in Calicut City. Attributes selected for SP experimental design includes travel time, travel cost and traffic accidents per year and Binary Logit model was used to determine the WTP values. It was observed that travel cost, accident rate of the route selected, age, occupation, personal income and number of household members have significant impact on the decision-making process. WTP value of a road accident for a two-wheeler user was found to be Rs 0.53/person/trip.

Background: Tuberculosis (TB) patients often incur large costs related to illness, as well as for seeking and receiving health care. Despite TB treatment being free under RNCTP, out of pocket expenditure incurred (OOP) by patients for TB diagnosis and treatment impoverishes the households. This expenditure may turn catastrophic (more than 20% of their family income) impacting adherence and leading to poor treatment outcomes., Objective: To estimate the proportion of households experiencing catastrophic expenditure due to TB and also to find out the various costs contributing to catastrophic expenditure., Methods: In this cohort study, 450 TB patients (including 96 children) registered under Revised National Tuberculosis Control Programme (RNTCP) in Delhi were interviewed at three different time points (in the beginning of treatment, end of intensive phase, end of treatment). Interview schedule was used to collect information on direct medical and non-medical, and indirect costs. The TB-specific indicator of "catastrophic total costs" incorporates both, direct medical and non-medical payments for treatment such as transportation, lodging charges and indirect costs such as wage loss., Results: A total of 450 patients were enrolled in this study, out of which 425 were followed up to the end of treatment. It was observed that 7% of TB patients registered under RNTCP in Delhi experienced catastrophic expenditure due to TB. The total mean cost to patients with TB was Rs. 12165 (Rs. 1406 during diagnosis and Rs. 10759 during treatment). The indirect cost was higher compared to direct cost i.e.Rs. 7564 and Rs. 4601 respectively)., Conclusion: This information will be useful for policy makers to design an intervention to provide financial protection to TB patients. In addition, findings of this study will aid in providing baseline evidence to periodically measure the OOP which is the one of the End TB strategy target., (Copyright © 2018 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Background: Private healthcare is choice of point of care for 70% of Indians. Multidrug resistant tuberculosis (MDR-TB) treatment is costly and involves duration as long as 2 years., Aim: To estimate costs to patients undergoing treatment for MDR-TB., Methods: A health-economics questionnaire was administered to 50 consecutive patients who successfully completed ambulatory private treatment for MDR-TB. Direct costs included drug costs, investigations, consultation fees, travel costs, hospitalisation and invasive procedures and cost prior to presentation to us. Indirect costs included loss of income., Results: Of our cohort of 50 patients, 36 had pulmonary TB while 14 had extra-pulmonary TB (EPTB). 40 had MDR-TB and 10 had XDR-TB. There were 15 males and 35 females. Mean age was 30 years (range 16-61 years). Treatment cost for pulmonary MDR-TB averaged $5723 while it averaged $8401 for pulmonary XDR-TB and $5609 for EPTB. The major expense was due to drug costs (37%) while consultation fees were only 5%. Annual individual income for the cohort ranged from $0 to $63,000 (mean $11,430). On average, the cost of treatment ranged from 2.56% to 180.34% of the annual family income. 34/50 (68%) had total costs greater than 20% of annual family income and 39/50 (78%) had total costs greater than 10% of annual family income. The number of patients with total costs >40% of total family income was 22., Conclusion: MDR-TB in the private sector results in "catastrophic health costs". Financial and social support is essential for patients undergoing treatment for MDR-TB., (Copyright © 2018 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Community based study on health expenditure is a rarity in India. A Rural Community based longitudinal study was undertaken in Jaulgaon village of Maharashtra, with objectives of finding out the health expenditure contributed by direct treatment, related travel and relevant loss of wages with certain pertinent associated factors. 50% of the village population was studied (N = 256) by pre-designed, pre-tested schedule following WHO guidelines. A monthly house to house interview was conducted over 12 months. During study period, 78% study subjects suffered some illness with mean illness episode 1.74/person and 6.37/family without any sex difference. The annual health expenditure of the community was Rs 1,576/family, 4,31/person and 2,42/episode, which was about 4.3% of their income. The major part of the expenditure (82%) was for direct treatment cost, followed by loss of wages (12%) and travel related cost (6%). Expenditure was seen to be significantly associated with family income (P = 0.000) and education (P = 0.006).

This article engages ethnographically with the neoliberalization of nature in the spheres of tourism, conservation and agriculture. Drawing on a case study of Wayanad district, Kerala, the article explores a number of themes. First, it shows how a boom in domestic nature tourism is currently transforming Wayanad into a landscape for tourist consumption. Second, it examines how tourism in Wayanad articulates with projects of neoliberalizing forest and wildlife conservation and with their contestations by subaltern groups. Third, it argues that the contemporary commodification of nature in tourism and conservation is intimately related to earlier processes of commodifying nature in agrarian capitalism. Since independence, forest land has been violently appropriated for intensive cash-cropping. Capitalist agrarian change has transformed land into a (fictitious) commodity and produced a fragile and contested frontier of agriculture and wildlife. When agrarian capitalism reached its ecological limits and entered a crisis of accumulation, farming became increasingly speculative, exploring new modes of accumulation in out-of-state ginger cultivation. In this scenario nature and wildlife tourism emerges as a new prospect for accumulation in a post-agrarian economy. The neoliberalization of nature in Wayanad, the authors argue, is a process driven less by new modes of regulation than by the agrarian crisis and new modes of speculative farming.