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to maximize profits and expand their coverage. However, the constraint lies in the fact that
these services can be afforded by a relatively small size of population in developing
countries. Low insurance penetration, lack of standardization of services, poor information
base, ineffective monitoring leading to low quality, high levels of fraud and corruption,
misallocation of investments and low efficiency of existing hospitals have impeded effective
performance leading to a stagnation of the healthcare sector. In this scenario, corporate
interests in the medical care sector are looking for opportunities beyond the national
boundaries. This is the genesis of “Medical Tourism” industry. The term medical tourism
refers to the increasing tendency among people from the UK, the US and many other third
world countries, where medical services are either very expensive or not available, to leave
their countries in search for more affordable health options, often packaged with tourist
attractions. So it should be named” medical value travel”. In recent years, India is being seen
as an important player in the globally growing “Medical Tourism”, which is projected as a
new segment in travel and healthcare business. The former Indian finance minister Jaswant
Singh envisaged to make India a “Global health destination” and the budget tabled by him
included government policy for collaboration between the available medical expertise in the
country and tourism industry.
PREVIOUS REVIEWS ON MEDICAL TOURISM
1. Martinez-Alvarez, M. Rupa Chanda, and R. Smith in their study on “Medical tourism: a
review of the literature and analysis of a role for bi-lateral trade” published in year 2011
concludes that there is a dearth of data and discussion on such bi-lateral trade. This limited
evidence offers some suggestions. Exporting countries may benefit from medical tourism by
generating foreign exchange and reversing the brain drain, but run the risk of creating a dual
system, where the local population is crowded out. Importing countries can benefit from
alleviating waiting lists & lowering healthcare costs, but may risk quality of care and legal
liability. However, evidence from a bi-lateral perspective suggests that the positive aspects
can be capitalized, and the negative ones reduced.1
2. Dr. Suman Kumar Dawn; Swatia Pal, Both Asst. Professor, Centre for Management
Studies, JIS College of Engineering (Under West Bengal University of Technology), Block
―A’, Kalyani , Nadia -741235 , West Bengal in their study on “Medical Tourism in India:
Issues, Opportunities and Designing Strategies for Growth and Development” published in
year 2011 concludes that the strengths of India’s medical tourism service providers and
points at a number of problems that may reduce the growth opportunity of this industry. This
paper focuses on the key issues and opportunities possessed by Indian medical tourism sector
that enable it to overcome domestic and international barriers on upgrading its medical
services. Finally, this paper analyses and concludes the main reasons why the developing
country like India attracts foreign tourists for the medical treatment.2
3. Dr. Anjana Sharma, Dr. Anupama Sharma, Mr. Saurabh Tiwari in their study on “Medical
Tourism: Building the India Brand Abroad (An Analytical Study of Potential of Medical
Tourism in Gurgaon)” published in year 2012 concludes that India is in an advantageous
position to tap the global opportunities in the medical tourism sector. The government’s role
is crucial to the development of medical tourism. The government should take steps in the
role of a regulator and also as a facilitator of private investment in healthcare. Mechanisms
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need to be evolved to enable quicker visa grants to foreign tourists for medical purposes
where patients can contact the Immigration Department at any point of entry for quick
clearance.3
4. Ferdosi Masoud, Jabbari Alireza, Keyvanara Mahmoud, and Agharahimi Zahra in their
study on “Medical tourism for any study area is complex” published online in year 2013
examine systematically published articles about medical tourism in the interval 2000-2011
and concludes that Among the 28 articles reviewed, 11 cases were a kind of research articles,
three cases were case studies in Mexico, India, Hungary, Germany, and Iran, and 14 were
case studies, review documents and data were passed. The main topics of study included the
definition of medical tourism, medical tourists’ motivation and development of medical
tourism, ethical issues in medical tourism, and impact on health and medical tourism
marketing. The findings indicate the definition of medical tourism in various articles, and
medical tourists are motivated. However, most studies indicate the benefits of medical
tourism in developing countries and more developed countries reflect the consequences of
medical tourism.4
5. Mane Vivekanand A., Dr. Hundekar S. G. in their study on “Indian medical tourism:
Growth, challenges and opportunities” published in year 2013 concludes that India offers
world class medical facilities, comparable with any of the western countries. India has stateof-the-art hospitals and best-qualified doctors. With the best infrastructure, the best possible
medical facilities, accompanied with the most competitive prices, one can get the treatment
done in India at the lowest charges. Medical Tourism in India is currently generating around
US$ 2 billion in revenues and expected to generate around US$ 3 billion by 2013, with the
number of medical tourists to grow at a CAGR of over 19 per cent during 2011–2013 to
reach 1.3 million by 2013. India's share in the global medical tourism industry is predicted to
be around 3 per cent by the end of 2013 -according to a report by research firm RNCOS,
released in December 2010. This paper focuses on the structure, growth, challenges and
opportunities possessed by Indian medical tourism sector that enable it to overcome domestic
and international barriers on upgrading its medical services. Finally, this paper analyses and
concludes with suggestions for attracting more foreign tourists for the medical treatment in
India.5
6. Pankaj Mochi, Niyat Shetty and Dilip Vahoniya in their study on “Medical Tourism Destination India” published in year 2013 concludes that In present scenario tourism industry
is gaining enormous economic benefits. It is not confined itself only to hotels, restaurants and
viewing historical sight scenes, but has touched rural areas, health sector as well. The
globalization of the health care sector and the massive demand for low cost-high quality
treatment for health in recent times has caught the attention of many developing countries
like India that have the adequate resources and potential to meet these demands. The
developing concept of Medical tourism in India has gained tremendous popularity and is
attracting people from all over the world for their medical and relaxation needs. Now a day
people from other countries prefer India for their medical treatment like heart surgery, knee
transplant, cosmetic surgery, hip replacement and dental surgery. This study explains why
India has emerged as destination for medical tourism. It also explores challenges and
competitive advantages and future outlook of medical tourism in India.6
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7. Rajesh Garg, Department of Community Medicine, VCSGGMS and RI, Srinagar-Garhwal
(Uttrakhand), India in their study on “All is not well" with medical tourism published in year
2013 concludes that India is moving not only to western countries but also to the African
world for attracting medical tourists. The Indian government is vigorously promoting medical
tourism by providing tax concessions. The government is putting red carpets for the
foreigners lured by their dollars. Medical tourism is the mockery of that nation (India) that is
still having one of the worst health indicators in the world, maximum number of
malnourished children and maximum privatized health care delivery system in the world.7
8. Sumanth Gopala Reddy in their study on “Medical Tourism in India: An Exploratory
Study” A DISSERTATION submitted in partial fulfillment of the requirements for the degree
DOCTOR OF PHILOSOPHY, Department of Geography, College of Arts and Sciences,
KANSAS STATE UNIVERSITY, Manhattan, Kansas, 2013 states and conclude that the
objective of this research was to answer the questions: 1) how do the attitudes and behaviors
of patients towards the concept of medical tourism influence their decision to become a
medical tourist; 2) why do medical tourists seek treatment in India; and 3) what are the issues
and challenges they face before coming to India as well as while in India. Interviews of
thirty-four foreign patients were conducted in six sites spread across the South-Indian cities
of Bangalore, Hyderabad, and Chennai which revealed useful information in addressing the
research objectives. The three most important reasons that these medical tourists chose India
for their treatments were: 1) the high quality of the doctors and medical facilities in India, 2)
the affordable cost of treatments, and 3) the availability of specific treatments that might not
have been available in their home countries. Patients also researched the topic thoroughly
before they came to India. Knowledge was gained primarily from the Internet, print media,
television shows and friends. Overall, the patients had very positive attitudes towards medical
tourism. Most of them felt that they could get treatment because of their positive opinion on
medical tourism, their ability to get treatment if they desired, and support from their families
and loved ones.8
OBJECTIVES OF THE STUDY
To study the foreign patients awareness about the medical tourism in Fortis Hospital.
To study the foreign patients needs and wants under medical tourism services.
To study satisfaction level of the foreign patient in the Fortis Hospital.
Finally to find out the gap under study of medical services and quality in the Fortis
Hospital.
NEED AND SCOPE OF THE STUDY
The purpose of this master thesis is to academically contribute to the understanding of
the growing phenomenon of medical tourism, which impacts the tourism industry by forming
a new type of niche tourism. Medical tourism refers to a practice of participants of mostly
higher income countries engaging in medical treatments in developing countries with lower
prices. The particular focus is set on exploring the generators of trust, respectively distrust,
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that influence the patient satisfaction towards undertaking a medical treatment in India. In
this paper, we identify the importance of these aspects in the decision-making process of
medical travelers. This qualitative study is carried out by conducting qualitative structured
interviews with patients and their attendants, whose first-hand experiences and perspectives
enrich and complete the theoretical knowledge which is carried out by filling of
questionnaire.
RESEARCH METHODOLOGY
Research methodology is the procedure for conducting the research. A lot of attention
has to be devoted to the procedure and step of the research of the researcher wishes to have
any claims on objectivity or if he wishes to establish a truth and gain wide acceptability.
Research Methodology guiding the present research work has been explained under
the following sub head.
•
RESEARCH DESIGN
The present study is analytical and descriptive as it involves findings about “Medical
Tourism, Global Competition In Healthcare And Satisfaction Level Among Foreign Patients”
at Fortis Hospital, Shalimar Bagh, New Delhi. since the purpose of the study is to select
variable which would likely to be influential in determining ‘Medical Tourism, global
competition in healthcare and satisfaction level among foreign patients” at Fortis Hospital,
Shalimar Bagh, New Delhi..So, the research has a ‘Casual Design’ also.
•
SAMPLE DESIGN
The researcher has taken 50 samples of respondents which include Foreign Patients or
their Attendants which is selected at randomly from Fortis Hospital, Shalimar Bagh, New
Delhi.
•
DATA COLLECTION METHOD
For present study, primary data are collected by personal interviews, observation and
a set of questionnaire which are filled up by Patients or Attendants. A number of questions
pertaining to the different aspects of Medical Tourism and Satisfaction level among foreign
patients are framed and these questions are in proper sequence. Most of the questions are of
rating scale and close ended type and filled by using survey method.
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January February
DATA ANALYSIS & INTERPRETATION
PRETATION
TABLE 1: SHOWS PATIENT/ATTENDANT RESPONSE LEVEL REGARDING
ADMISSION INFORMATI0N, FORTIS HOSPITAL, SHALIMAR BAGH, NEW DELHI
Sr.
No.
Statement
1
The amount of
information
you received
about
the
hospital before
your visit
Helpfulness of
people at the
enquiry
and
registration
Department
Time taken for
registration and
preparing the
admission card
Waiting time:
not having to
wait too long
when you have
arrived before
being attended
Transportation
facility
provided
by
the hospital
2
3
4
5
Overall Response
Excellent
Very
Good
Good
Fair
Poor
Average
Standard
Deviation
Coefficient
of variation
19
25
5
1
0
4.2
0.7
17%
22
22
1
3
2
4.2
1
24%
21
22
3
3
1
4.2
0.9
23%
18
24
3
4
1
4.1
1
24%
29
11
6
3
1
4.3
1
24%
109
(43.6%)
104
(41.6%)
18
(7.2%)
14
(5.6%)
5
(2%)
4.2
0.9
22%
RESPONSE LEVEL REGARDING ADMISSION
INFORMATION
60.00%
43.60% 41.60%
40.00%
20.00%
0.00%
7.20%
FIGURE 1
14
5.60%
2%
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Mean satisfaction of patients/attendants towards the admission information was
4.2+0.9 with coefficient of variation 22% which shows that there is variation in response of
patients regarding helpfulness of people at the enquiry and Registration Department, Time
taken for registration and preparing the admission card, Waiting time and Transportation
facility. Hence there is scope for improvement on the subject of admission procedure in a
hospital.
The present study reveals that 43.6% of the respondent/patients rated admission
information to be excellent and 41.6% of the respondent/patients rated admission information
to be very good and approximately 15 % of the respondent patients answered that there is
possibility of improvement in the admission system of hospital.
TABLE 2: SHOWS PATIENT/ATTENDANT INFORMATION LEVEL REGARDING
INFRASTRUCTURE AND FACILITIES, FORTIS HOSPITAL, SHALIMAR BAGH, NEW
DELHI
Sr.
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
Statement
Accessibility to the
hospital
Outer ambience of the
hospital
Availability of proper
signpost to guide you
through the hospital
Waiting room comforts:
Comfortable Chairs and
pleasant surroundings
Cleanliness
toilets.
Availability of adequate
toilets for Males and
females
Overall cleanliness of
hospital
Quality
of
the
pharmacy, explanation
of Medicines
Prayer room available
Location, cleanliness,
quality and Variety of
food
available
at
Cafeteria
Internet, STD, ISD,
Bookshop
facility
available
Guesthouse facility for
patient’s relatives
Language
Translator
available
Reservation,
foreign
exchange and other
facilities
Overall Response
Excellent
Very
Good
Good
Fair
Poor
Average
Standard
Deviation
18
21
8
2
1
4.1
0.9
Coefficient
of
variation
23%
22
25
1
2
0
4.3
0.7
17%
17
31
2
0
0
4.3
0.5
13%
16
23
6
5
0
4
0.9
23%
23
22
3
2
0
4.3
0.8
18%
23
22
4
1
0
4.3
0.7
17%
27
16
4
3
0
4.3
0.9
20%
22
22
20
21
6
7
2
0
0
0
4.2
4.3
0.8
0.7
19%
16%
25
20
2
2
1
4.3.
0.9
21%
27
18
2
3
0
4.4
0.8
19%
14
27
5
2
2
4
1
24%
29
16
2
3
0
4.4
0.8
19%
285
43.8%
282
43.3
%
52
8%
27
4.1%
4
0.6
%
4.3
0.8
19%
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January February
INFORMATION LEVEL REGARDING INFRASTRUCTURE AND
FACILITIES
43.84% 43.33%
50.00%
8%
4.15%
0.00%
Exellent
Very
Good
Good
Fair
0.60%
Poor
FIGURE 2
The information regarding the infrastructure and facilities of the hospital – like
accessibility, parking facility, ambience, overall cleanliness of hospital, cafeteria, language
translator, quality of pharmacy, availability of prayer room, internet and other
facilities. 43.84% respondents rated the facilities excellent, 43.33% rated the facilities as very
good, 8% good and 4.15% rated it as fair and only 2% gave the feedback poor.
Mean satisfaction of patients/attendants towards the infrastructure and facilities of the
action
hospital was 4.3+0.8 with coefficient of variation 19% which shows that there is variation in
0.8
19
response of patients regarding Accessibility to the hospital, Waiting room comforts, Quality
of the pharmacy, explanation of Medicines, Internet, STD, ISD, Bookshop facility available,
Language Translator availability. Hence there is scope for improvement on the subject of
y.
infrastructure and facilities in a hospital.
TABLE 3: SHOWS PATIENT/ATTENDANT INFORMATION LEVEL REGARDING
TREATMENT, FORTIS HOSPITAL, SHALIMAR BAGH, NEW DELHI
Sr.
No.
Statement
Excellent
Very
Good
Good
Fair
Poor
Average
Standard
Deviation
Coefficient of
variation
1
Courtesy of the
doctor
The way doctor
examined you
Was the doctor
patient
while
hearing about your
complain
The way the doctor
explained
your
treatment to you
Privacy maintained
about
your
diagnosis
How
well
the
purpose
of
the
medicine
was
explained to you
How well possible
side effect of the
medicine
was
explained to you
22
23
4
1
0
4.3
0.7
16%
27
17
3
2
1
4.3
0.9
21%
26
16
4
4
0
4.3
0.9
22%
18
25
2
5
0
4.1
0.9
22%
31
10
6
2
1
4.4
1
23%
19
28
0
1
2
4.2
0.9
21%
17
31
0
0
2
4.2
0.8
19%
2
3
4
5
6
7
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January February
Sr.
No.
8
9
10
11
12
13
14
15
16
17
Statement
Excellent
How well is the
effectiveness
of
treatment
Your confidence in
the doctor
Overall
interpersonal skills
of the doctor
Overall
clinical
skills of the doctor
Courtesy of the
nurse
Responsiveness of
the nurses to your
needs
Length of time
nursing staff took to
respond to your
needs
Helpfulness of the
hospital staff in
General
Opportunity to ask
questions
about
your treatment
Were you satisfied
with the assistant
doctors
Overall
Response
Good
Fair
Poor
Average
21
Very
Good
19
4.1
Standard
Deviation
1
Coefficient of
variation
23%
5
5
0
26
19
3
2
0
4.4
0.8
18%
25
29
2
3
0
4.3
0.8
19%
27
15
5
3
0
4.3
0.9
21%
16
27
5
3
0
4.1
0.8
18%
15
25
7
3
0
4
0.8
21%
15
27
5
3
0
4.1
0.8
20%
14
24
7
3
2
3.9
1
26%
13
23
11
1
2
3.9
1
25%
18
26
4
2
0
4.2
0.8
18%
350
(41.11%)
375
73
42
10
4.2
0.9
21%
(44.1%)
(8.5%)
(4.9%)
(1.1%)
INFORMATION REGARDING TREATMENT
50.00%
41.11%44.11%
8.58%
0.00%
Exellent Very
Good
Good
4.94%
Fair
1.17%
Poor
FIGURE 3
During the course of treatment: (a) Doctor – the courtesy, patience while hearing and
privacy maintained during examination and diagnosis, clinical skills, explanation of the
treatment, medicines etc. and (b) Nurse – courtesy, responsiveness, helpfulness, and
compassion should create great sense on the foreign patients and their attendants.
sense
Mean satisfaction of patients/attendants towards the course of treatment was 4.2
4.2+0.9 with
coefficient of variation 21% which shows that there is variation in response of patients
regarding helpfulness of patients by the (a) doctor about patients complain, explanation about
treatment what to do, privacy maintained about the diagnosis and the effectiveness of
treatment, (b) nurse & hospital staff about helpfulness of the hospital staff in general and
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January February
opportunity to ask questions about your treatment. Hence there is scope for improvement on
unity
the subject of course of treatment in a hospital.
The present study reveals that 41.11% of the respondent/patients rated treatment facilities to
be excellent and 44.11% of the respondent/patients rated to be very good and approximately
15 % of the respondent patients answered that there is possibility of improvement in the
treatment coordination of hospital.
TABLE 4: SHOWS PATIENT/ATTENDANT INFORMATION LEVEL REGARDING
HOSPITAL RESPONDED TO PATIENTS NEED, FORTIS HOSPITAL, SHALIMAR
ITAL
NEED,
BAGH, NEW DELHI
Sr.
No.
1
2
3
4
Statement
Yes
No
Did the hospital staff
encourage
Your feedback?
Were aware that you could
Formal complaint in the
hospital?
Did you have a reason to
make a complaint during
your
Treatment period?
If yes, were you satisfied
with the way your complaint
was handled?
48
Overall Response
2
Average
Mean
0.1
Standard
Deviation
0.2
Coefficient
of variation
21%
47
3
0.9
0.2
26%
49
1
1
0.1
14%
41
9
0.8
0.4
47%
185
(92.5%)
15
(7.5%)
0.9
0.3
29%
HOSPITAL RESPONDED TO YOUR
NEEDS
92.50
%
100.00%
7.50%
0.00%
YES
NO
FIGURE 4
Patients/Attendants needs are the fundamental function of a high-quality hospital.
high quality
Mean satisfaction of patients/attendants towards their needs during the treatment was
0.9+0.3 with coefficient of variation 29% which shows that there is variation in response of
29
patient’s helpfulness regarding satisfaction with the way their complaint was handled. Hence
there is scope for improvement on the subject of patients/attendants needs in a hospital.
hos
The present study reveals that 92.5% of the respondent/patients are beyond doubt
satisfied and 7.5% of the respondent/patients stated to be unsatisfied, so there is possibility of
enhancement in the way hospital responded to patient’s needs of hospi
hospital.
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January February
TABLE 5: SHOWS PATIENT/ATTENDANT RESPONSE LEVEL REGARDING
OVERALL HOSPITAL EXPERIENCE, FORTIS HOSPITAL, SHALIMAR BAGH, NEW
EXPERIENCE,
DELHI
Sr.
No.
Statement
Great
Quite
Bit
Little
Not At
All
Not
Sure
Average
Mean
Standard
Deviation
Coefficient
of
variation
1
Thinking about all
aspects
how
satisfied are you?
How much do you
were
actually
helped by treatment
in the hospital?
24
19
7
0
0
4.3
0.7
17%
232
19
7
1
0
4.3
0.8
18%
22
20
7
0
1
4.2
0.8
20%
18
25
4
2
1
4.3
0.8
21%
87
(43.5%)
83
(41.5%)
25
(12.5%)
3
(1.5%)
2
(1%)
4.3
0.8
19%
2
3
4
If need arises what
are the chances you
would go back to
the hospital:
What
are
the
chances you will
recommended the
hospital to family
and friends
Overall Response
ABOUT OVERALL HOSPITAL EXPERIENCE
60.00%
43.50% 41.50%
40.00%
12.50%
20.00%
1.50%
0.00%
Great Quite
Bit
Little
1%
Not At
All
Not
Sure
FIGURE 5
Overall hospital experience: larger group of the patients 85% was very satisfied with
all the facilities and 15% of the respondent/patients answered that there is possibility of
improvement in the overall facilities of hospital.
Mean satisfaction of patients/attendants towards their overall experience towards
towards
hospital was 4.3+0.8 with coefficient of variation 19% which shows that there is variation in
0.8
19
response of patient’s helpfulness regarding the chances you would come back to the hospital
in future, the chances you will recommended the hospital to family and friends.
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CONCLUSIONS
1. The Admission information desk is at par with the world's best centers having
qualified & experienced staff members with a facility of interpretation for
conversation. Approximately all the respondents are personally satisfied with the
registration department and a bit of them signify to improve services much then
better.
2. Infrastructure & facilities of the hospital has overall scope for up gradation as nothing
is perfect in this world. Hospital has to be updated according to patients need time by
time.
3. Treatment is the main course in the hospital menu card as it serves to the each &
every patient. This study shows that behavior and services rendered by both doctors
and nurses was overall satisfactory with having little bit issues about the explanation
of the treatment by them to patients which can never be completely overcome.
4. Agencies specializing in international medical travel (known as health travel planners
or medical concierge agencies) are a growing part of the medical travel industry and
work with hospitals, clinics, physicians, surgeons, airlines, hotels and recovery
retreats abroad to offer patients the best quality at the most affordable rates.
5. Medical tourism focuses on treatment of acute illness, elective surgeries such as
cardiology, DSA and lasiks, among others.
6. Word-of-mouth is the most common method to be aware of the best hospitals,
surgeons and treatments across the country. Now internet is also pacing up its spread
as more and more people are becoming comfortable using computers.
SUGGESTIONS
1. The information regarding admission procedure makes the first impression on patients
and their attendants about services to be provided, so admission information should be
clear, precise and accommodating. Up gradation and renovation is always a part of
every procedure so it is very compulsory to update the hospital according to needs.
2. The information regarding infrastructure and facilities makes the physical
environment of a hospital which directly effects on patients and their attendants mind
about services to be provided, so it should be always up grade and renovated on time
to time according to needs.
3. The information regarding treatment is the key to success for any hospital in the
market. As better and on time medical services are the primary task of any hospital.
Comprehensively explanation of treatment level should be improved by both doctors
and nurses.
4. The information level regarding hospital responded to patients needs convey the
patient satisfaction graph of any hospital. As there is little bit unsatisfied patient and it
should be improved by doctors, nurses and other staff members.
5. The response level regarding overall hospital experience is not so poor, hence there is
little bit scope for improvement on the subject of patients/attendants overall hospital
experience.
20
13. International Journal of Marketing and Human Resource Management (IJMHRM), ISSN 0976
– 6421 (Print), ISSN 0976 – 643X (Online), Volume 5, Issue 1, January-February (2013)
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