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Home > Blog > 2010 > Medical tourism statistics: Comparing apples with apples ....

Medical tourism statistics: Comparing apples with apples ....

Oct 22 2008

At Treatment Abroad, we’ve recently completed some research into the medical tourism market for a third party. It’s been an interesting exercise and has really made us question some of the statistics that are quoted (and that often become accepted truth) about the number of medical tourists and the value of the market.

What is a medical tourist?
The first challenge in estimating market size is to be very clear about what a medical tourist actually is. He or she isn’t a tourist. It’s someone whose specific reason for travelling to another country is for medical treatment. It’s not someone who happens to fall ill and requires treatment when they are on holiday/vacation.

Yet many tourism organisations, government bodies, hospitals and clinics classify ailing holidaymakers as medical tourists. They are not.

The data from one destination that we examined claimed vast numbers of medical tourists but in the “small print” acknowledged that the vast majority of these happened to fall ill while visiting the country for other reasons, either business travel or holiday travel.

Another inflationary factor is the expatriate resident. Back in the 1990’s I was involved in the marketing of the Portland Hospital for Women and Children in London. We used to track hospital admissions by nationality of patient. Based on that analysis, the hospital was the biggest medical tourism destination in the world for American medical tourists..... or was it? Of course not. As the only private maternity hospital in London, it attracted a large number of American women whose families were based in or working in London. Did a single American woman fly across the Atlantic specifically to give birth or for gynaecological treatment in London? No, but we could have made it look like plane loads were arriving every month!

Comparing apples with apples
Before the dawn of computing, I studied statistics at college. What I learned about statistics is that you have to compare like with like. You compare apples with apples. But in medical tourism people compare apples with grapes, and oranges with lemons...... Let me explain....

Let’s agree that a medical tourist is someone who travels specifically for treatment in another country, And let’s also agree that medical tourism is a specific segment of the health tourism market which does not include travel to medical spas or wellness resorts or for non-invasive therapy. For the sake of clarity, we’ll exclude dental travel from medical tourism in this instance.

So John Smith jumps on a boat or a plane or a train or into a car and crosses a border into another country and has...an operation or an elective procedure. (Should we include patients who don’t stay overnight? There’s another discussion...).

Are we agreed on what a medical tourist is? Good. John Smith is a medical tourist. He’s one medical tourist, isn’t he?

Well..... that depends where he goes.

In Country A (or in Hospital A), he counts as one medical tourist.

But in Country B (or Hospital B), he counts as 20 medical tourists.

20...am I mad? No.

This is how it works in Country B.

  • John Smith arrives in Country B. He visits the specialist, and the hospital raises an item of service bill for the visit. The hospital records him as one medical tourist treated.
  • The specialist sends him for an X Ray. The hospital raises an item of service bill for the visit. The hospital records him as another medical tourist treated.
  • The specialist sends him for some pre op blood tests. The hospital raises an item of service bill for the visit. The hospital records him as another medical tourist treated.
  • He has the operation. Bingo! Another medical tourist.
  • He collects some medication from the hospital pharmacy. Another medical tourist.
  • He has post op physiotherapy for ten days.... ten medical tourists.
  • And so it goes on.....

 

John Smith is one medical tourist but according to the hospital records he’s twenty or thirty or maybe even more. And this is good news for the marketing guys in the hospital and at the tourism board. They have some pretty impressive medical tourism statistics.

So, we can see that the medical tourism statistics quoted by some destinations are subject to “statistical error” but not the kind of statistical error I learnt about at college. In some cases this is error on a magnitude of ten fold or twenty fold or even more.

 

Take medical tourism statistics with a pinch (or sack) of salt
When you hear the latest claim of medical tourism numbers from a hospital or a medical tourism destination, take them with a pinch of salt (or perhaps a sack of salt). And do some basic “hospital” mathematics. If they’re claiming let’s say 200,000 medical tourists a year, ask them where they are putting all the patients.

 

Let’s put this number into perspective. The Royal National Orthopaedic Hospital in London is the largest specialist orthopaedic hospital in the UK. It’s a very busy and successful hospital. Last year, it admitted around 10,000 patients to its 220 beds. That’s around 45 patients per bed per year. So, 200,000 “real” medical tourists might need....4,400 beds....and hospital beds are hard to find in many countries.

So how do we fix the problem?

When the UK NHS publishes statistics on hospital performance (See Hospital Episode Statistics Online), every set of statistics it publishes has a “responsible statistician”. He’s the one who ensures that they’re comparing apples with apples.

 

Let’s appoint a “responsible statistician” for medical tourism. Any volunteers out there?

Date published: 12 Mar 2010


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Comments provided below do not represent the views of IMTJ. Comments will be published 'as is' and will not be edited by IMTJ staff. IMTJ is hosting these comments, and is not undertaking an editorial role. However, it is editorial policy to publish comments that have been submitted anonymously. 

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About me

Keith Pollard

Keith Pollard

I am CEO of Intuition Communication Ltd, a web publishing business in the healthcare sector. Our sites include International Medical Travel Journal, Treatment Abroad, the medical tourism portal, DoctorInternet, the Arabic medical tourism portal and Private Healthcare UK, the UK's leading site for private healthcare services. I am a regular speaker and commentator on medical tourism and the independent healthcare sector.

Use the comment submission form below
Very nice post Keith.
Dental health Tourism:
www.soinsdentairesturquie.com

DentalTreatmentAbroad (06/11/2010 12:36:09)

Thank you for your very valuable information
---------------------------
www.dentalcareantalya.com

DentalTreatmentAbroad (06/11/2010 12:34:42)

Dear Keith,
Good study however when we talk about medical tourism, we should accept that this has become an industry as more than hospitals or medical tourism companies, patient require it because of obvious reasons. The only hitch was or still it is that going to third world countries, however as the time goes this phase would also go. For any class of patient saving of 60 to 70 percent means a lot and that too same quality treatment.
One more thing in Indian set up your example of john smith doesn't hold good because patient gets all sort of required treatment in the same hospital and this is an advantage.
Deepak
http://india-for-medicaltourism.blogspot.com
http://medicaltourism-costcomparison.blogspot.com/
www.mediprimeindia.com

Medical Tourism (06/11/2010 12:33:00)

Comparing apples to apples is currently not easy across borders, as pointed out in this article. While getting cost data is readily available, it is typically not possible to get a set of quality mesures/outcomes to compare quality and safety across borders and across hospitals. It remains a 'black box' as to how data are collected, what definitions are used, and if it is possible to stratify whatever data there are to look across procedures and diagnoses. If this 'industry' is to compete and if there are to be Centers of Excellence, data will be required. I have been trying to find a way to centralize this effort, using evidence based definition and measures that are not complicated and easily compared. Keith, you make some very important points!

skleefield (06/11/2010 12:31:10)

Mr. Keith, you have presented great points here. Medical tourism is indeed booming nowadays. Would love to read your other articles. :)

anti aging lifestyle (06/11/2010 12:29:46)

Great post! Have you checked out the research studies last January 2010? They all have the same point as yours. Best of luck on health tourism.

back pain products (06/11/2010 12:28:05)

thank you for explaining this. Your title is very catchy. Gret job here, Keith. If I was a responsible statistician, I would volunteer. I hope we can fix this problem.

Grand Junction Chiropractor (06/11/2010 12:24:29)

Dear Keith,

Do you feel that quality of health care in another country can be controlled or measured? Are there any efforts been made or can there be efforts made to control and measure quality in other countries? I have heard of some organizations starting "Quality of Care" programs to help people have a better idea of health care costs and quality abroad. But how effective do you think such programs are?

Also, what are your views on patients in the U.S.A traveling abroad to receive health care? I have heard that high costs in U.S. is the highest factor, but are there any other stronger or equally strong factors? Do you have any statistics to support your answer?

I look forward to your comments on the above.

Thank you.
Student

Anonymous (06/11/2010 12:21:52)

I must say that medical tourism industry has bright outlook if it is developed sensibly. Industry leaders should come together to develop such strategies.

Rockon (06/11/2010 12:20:46)

It should be noted that some countries, especialy in Asia, have added "Medical Tourism" as a reason for visiting their country. I would assume that that would be one of the best indiactors of true figures. But I believe many would not want goverments people to know that, so it is not always ticked.
Robert Graham, Meditour, Australia.

Robert Graham (06/11/2010 12:18:58)

Dear Keith,

Appreciate your blog. I couldn't agree anymore, we need honest and accurate data to claim the size of the industry.

It is said that “Statistics are often used as drunkard uses a lamp-post… not to light his way but to support his instability. Isn't this true in many cases? sometime, statistics are no substitute for judgment. Most of us can recall the story about the statistician who, going by the average depth of a river, drowned mid-way.

On one hand, we need honest statician on other hand we need organizations and government bodies to develop structure for recording and evaluating such figures.

Many innocent naive business people are falling in the trap of medical tourism, they consider it as lucrative business opportunity because figures are escalated unreasonably. I get many such consultation inquiries, which I refuse gently.

However, I must say that medical tourism industry has bright outlook if it is developed sensibly. Industry leaders should come together to develop such strategies.

Thanks for addressing important point.

Dr Prem (06/11/2010 12:17:40)

Appreciate your blog, kieth. I couldn't agree anymore, we need honest and accurate data to claim the size of the industry.

It is said that “Statistics are often used as drunkard uses a lamp-post… not to light his way but to support his instability. Isn't this true in many cases? Statistics are no substitute for judgment. Most of us can recall the story about the statistician who, going by the average depth of a river, drowned mid-way.

On one hand, we need honest statician on other hand we need organizations and government bodies to develop structure for recording and evaluating such figures.

Many innocent naive business people are falling in the trap of medical tourism, they consider it as lucrative business opportunity because figures are escalated unreasonably by many organizations. I get many such consultation inquiries, which I refuse gently.

However, I must say that medical tourism industry has bright outlook if it is developed sensibly. Industry leaders should come together to develop such strategies.

Thanks for addressing important point.

Dr Prem Jagyasi
www.DrPrem.com

Dr Prem (06/11/2010 12:15:11)

Very well said- the good news is that there is more academic research being performed (we just had a research conference in January 2010 with some amazing studies presented from researchers all over the world [an academic journal is coming as well!]- and will have another research conference next February 2011) in this area (for example- our center has just finished a large scale study of American medical tourists and is preparing to collect another sample of Europeans). This will ultimately be the best repository and judge of these statistics, going forward, as we have a proven infrastructure (peer-review journals, etc.) to determine the validity of data and limited bias (or possibly incentives) regarding the 'truth' found in the data. I am very confident now that in the future the situation will be more transparent!

David
Founder/Director
Center for Medical Tourism Research (CMTR)

David G . Vequist IV, Ph.D (06/11/2010 12:12:55)

I too, have been researching myriad (and contradictory) medical travel statistics from varied resources over the past year, and I think the old sayings hold true: Consider the source and trust your instinct.

From my years of experience in Guatemala, I have personally spoken to dozens of global travelers who are thrilled by the quality medical services and low prices here. What they find absolutely astounding however, (especially the Americans) is that they are treated with compassion, respect and genuine caring. This is beyond accurately recording statistics, it's the right way to treat people. Maybe in the future the numbers will catch up.

Lori (06/11/2010 12:10:11)

Comparing apples with apples is one thing, but comparing doctors, clinics, and dentists is another :-)
However your company treatmentabroad does it well and we are, as I expect most clinics are, thankful that you are continually gaining respect for the "medical tourism" sector, especially in the UK.
Far-fetched statistics featuring "success rates" by individual clinics and doctors is something you could perhaps tackle next :-)
All the best,

Daniel Shaw
dental holiday

Daniel Shaw (06/11/2010 12:08:39)

Very nice post Keith. I have started reading your Blog. I also have a Blog on Medical Tourism:
http://emedtravel.wordpress.com

All the best,

Amin Etemad, MBA

Amin Etemad, MBA (06/11/2010 12:06:36)

Dr. Klein:
The same game with numbers was also presented last year at TEMOS conference, where a presentation aroused the impression, that 70.000 medical tourists ar in Germany. Of that 70.000 only a minor proportion are elective medical tourists. A high proportion of those have been treated in Garmisch for ski accidents. although this is known among experts, this statistical figure is used to impress hospital decision makers and to bring them near to invest in medical tourism -
for how many patients you say?

Dr. Uwe Klein (06/11/2010 12:03:37)

Dear Keith,

How nice is to see that someone else gets to the same point.MAPE Turismo y Salud has been also analysing some data, and in
certain countries, according total number of medical tourist per year, the ratio would become 6000 patients in hospital per day, so either they do have around 30 hospitals in the country only working with medical tourists, or something is very very wrong.

Medical tourism has been focused exclusively on the cost savings for a medical treatment, and it needs to have also other benefits.

May be some prices of reference in the medical tourism origin countries are not reflecting the real picture of the market. This situation especially has repercussions on the surgical cases as the non-hospital expenses increase considerably, as more days of stay are quoted at the country of destination and usually people go with someone else as accompanying person.

Medical Tourism is a reality. Its motivation does not need to be only for cost savings, but also needs to guarantee the mobility of people by offering medical care beyond the hospital. Creation of netwoks and management is a must.


We can extend and would be very glad to share this information and cooperate with you on trying to get this figures out of the 'dark side'. We count with experience on this sense, for statistical studies.

Margarida Colet/Pedro Gonzalez (06/11/2010 12:01:47)

While all the marketing media coming to the unlimited world of internet marketing. So, Why not Dental marketing? To be updated with latest technical marketing, It must be dental internet marketing.

DrKeithCurrie (06/11/2010 11:59:38)