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Home > Blog > 2011 > The medical tourism numbers game... Part 2

 

The medical tourism numbers game... Part 2

Numbers

Back in May 2008, I blogged on “McKinsey and the medical tourism numbers game..." and commented on their strange way of counting (or not counting) medical tourism numbers.  Given the latest study on medical tourism numbers, “New study numbers US medical tourists in thousands not millions”,  reported in IMTJ, I thought it was time once again to address the thorny issue of....how many medical tourists are there?

Defining the medical tourist

Before you can begin to count medical tourists, you have to be very clear about what it is you are counting. This is one of the greatest areas of confusion in the business sector.

So, what is a medical tourist?

In my view, a medical tourist is someone who travels outside of their own country for surgery or elective treatment of a medical condition. If we apply this narrow definition, we DO NOT include:

  • dental tourists
  • cosmetic surgery tourists
  • spa and wellness travellers
  • "accidental" medical tourists (business travellers and holiday makers who fall ill while abroad and are admitted to hospital)
  • expatriates who access healthcare in a foreign country.

One of the best attempts that I have seen at defining and categorising "health tourism" (as opposed to medical tourism) and its various segments is by Dr Constantine Constantinides - see www.healthtourism8.com.

I will take the liberty of refining and adapting Dr Constantinides approach to develop my own definition and categorisation of health tourism or ...let’s call it “Health and Medical Travel”.

Health and Medical Travel embraces and defines the market as a whole. Within Health and Medical Travel, there are some clearly defined market segments:

  • Medical tourism (or travel) – someone who travels outside of their own country for surgery or elective treatment of a medical condition. This could be broken down further into sub-segments such as:
  • Infertility tourism (or travel)
  • Stem cell tourism (or travel)
  • Transplant tourism (or travel)
  • Dental tourism (or travel)  - someone who travels outside of their own country for dental treatment be it restorative or cosmetic.
  • Cosmetic surgery (or aesthetic) tourism - someone who travels outside of their own country for cosmetic or aesthetic surgery.
  • Spa tourism
  • Wellness tourism

This definition of Health and Medical Travel obviously excludes the accident medical tourist – the holidaymaker of business traveller falling sick while abroad.

It makes sense to segment markets because different market segments contain different types of consumer with different needs and requiring a different approach in terms of service offering, message and promotional activity. It’s at the core of successful marketing. It’s why many medical tourism businesses fail... because they try to be all things to all patients and fail to understand their markets and consumers.

Counting medical tourists

If you thought defining medical tourists was difficult, try counting them.... Because everyone defines medical tourism differently, none of the numbers make any sense at all and we see massive variation in the numbers quoted.

It doesn’t help that some individuals doing the counting or quoting the numbers may have little experience of healthcare or of running hospitals, so when they come up with a number,  they may not realise how ridiculous the number is.  Here’s a couple of medical tourism numbers that you may have heard quoted at conferences and in press releases in 2010 and why they don’t make any sense at all:

  • The Center for Medical Tourism Research was established in 2010 to “increase knowledge in the medical tourism industry”. Last year, it told us that there were 1,120,446 American medical travelers in 2009. These included dental travellers, cosmetic surgery patients but excluded spa and wellness travel.  Let’s assume that just one in five of these 1.1 million American medical travellers actually went for hospital treatment. And let’s assume a five day length of stay in hospital. That’s 1.1 million patient days, enough to fill over 3,000 hospital beds every day for a year, enough to fill more than five Bumrungrad Hospitals to bursting 365 days per year. Does that sound at all likely to you? In terms of destinations, the CMTR research also told us that 7.6% (82,000) of these US medical tourists went to the UK and 0.5% (5,546) of these went to Turkey. 82,000 US medical tourists visited the UK last year........ I am sure that my colleagues in the UK hospital sector would be delighted to welcome this many US patients!
  • In a recent news release for “Patients Beyond Borders Focus On Bumrungrad International Hospital”, I read that “during the past decade, more than 3 million patients from 190 countries have traveled to Bumrungrad”. Now.... there’s no denying that Bumrungrad has an impressive share of the international patient market, and they are undoubtedly a leader and trend setter in the sector... but 300,000 international medical travellers a year for the last ten years? If the patient as stated has travelled to Bumrungrad from another country, we can probably assume that they are not flying in for a chest x ray. So, let’s apply the same average length of stay – 5 days. That’s 1.5 million patient days, a year. Hang on.... Bumrungrad only has 554 beds, but they are filling over 4,000 beds with international patients. An amazing achievement.

So, in the two examples above what’s gone wrong? Are the Center for Medical Tourism Research and Patients Beyond Borders trying to mislead us. No. They just haven’t thought through what these numbers mean and haven’t questioned the source data or the basis of their assumptions.

In the first example, it’s a case of very poor sample selection, sample bias, and making projections for the total population based on what people say they may do rather than analysing what they actually do.

In the Bumrungrad example, it’s also a case of “sample error”.....counting the same patient numerous times over. i.e. an international patient  at Bumrungrad can get “counted” every time they raise  a bill. So, one visit to pharmacy = one visit, one x ray = one visit, one physiotherapy session = one visit. You can easily see how the numbers mount up. (And why the marketing department like them!) There is also the inflation caused by “accidental" medical tourists (business travellers and holiday makers who fall ill while in Thailand and are admitted to Bumrungrad) who get counted as international patients.

So....how many medical tourists actually are there?

Probably a great deal less than you think.  But that doesn’t mean that you shouldn’t be in the health and medical travel market. You just need to be very clear about your own definition of your market segment, and never believe what you hear at a conference or read in the press.

Perhaps in my next blog post, I should tell you how many medical tourists I actually think there are.....

Date published: 13 Jan 2011


Comments

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.

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Shane warn (10/10/2011 07:11:37)

Great information here. However, I wonder how you would classify reconstructive plastic surgery? It is often associated with cosmetic surgery but technically, they're different. Would appreciate some answers. Thanks! :)

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Sha Stevens (08/08/2011 16:58:01)

Great figures and good numbers.
Could anyone help me in getting numbers for tourists travelling for alternative medicine/wellness such as Ayurveda, Yoga etc.?

Ranbir @ Trawellindia (06/04/2011 12:28:26)

Medical tourists need to search <a href="http://www.health-tourism.com/heart-surgery/germany/">Cardiac hospitals in Germany</a> through authentic online databanks that are reliable and full of updated heath tourism informations.

Regards.

Soltz Paztor (12/02/2011 06:38:03)

(last part) Most of the 'businesses' in medical tourism (many non-profits included) are still trying to figure out how to invest in the trend to get an adequate ROI (which is probably the way it should be)- not give money to nerdy researchers to answer questions. The few researchers (thus not a great effort yet!) that are dedicated to this industry are just nipping away at the big questions- so please excuse us if it takes a while to get them answered. So, if you want better numbers please make sure you support (and encourage!) the academics who are still working at this demanding (and rewarding) industry- such as going to Medical Tourism Research conferences (http://www.uiw.edu/medicaltourism/medicaltourismconference2011.html- an unabashed advert!) to see what these researchers (worldwide) are coming up with or giving donations of time, money, or data to medical tourism research centers!
Thank you for your attention,
David
David G. Vequist IV, Ph.D.
Founder/Director
Center for Medical Tourism Research
www.medicaltourismresearch.org
University of the Incarnate Word
San Antonio, Texas, USA
+1-210-805-5825
vequist@uiwtx.edu

David Vequist (18/01/2011 11:29:38)

The analysts reports of the high numbers of medical tourists have certainly made the rounds, now it seems that every country is trying to be a medical tourism destination. In the last month Taiwan and Australia have announced initiatives. I even read that Las Vegas wants to market itself as a medical tourism destination.

Matt Kelleher
<a href=http://smileplanners.com/>Smile Planners Dental Holidays </a>

Matt Kelleher (17/01/2011 15:11:15)

The author makes some good points about inconsistency in medical tourism figures.
Bumrungrad has been very clear that its patient volumes are episodes of care – both outpatient visits and inpatient admits. An outpatient who sees two doctors, gets lab tests, an x-ray and medicine during his day at the hospital counts as one visit. An inpatient who is in the hospital for two days counts as one admit – as does another who is in the hospital for two weeks. Using these definitions, we do indeed have 300,000 visits and admits by non-resident patients in a typical year. We use such figures because they are standard hospital volume metrics, and they reflect the sum of our experience serving international patients.
When stating international patient volumes, hospitals should use accepted measures such as visits, admits, or patient-days. These measures follow the standard convention for companies: Toyota quotes sales in vehicles, Pepsi states market volumes in gallons, and Disneyland Tokyo gives a figure of 17 million annual visitors. Such figures should not be confused with unique headcount.
If a journalist or researcher wants to count only inpatients, exclude dental and cosmetic surgery, or use some other criteria for their purposes, we are happy to cooperate, so long as they are careful to get comparable information from other providers.
Kenneth Mays
Director of Marketing
Bumrungrad International
Thailand

Kenneth Mays (17/01/2011 11:22:16)

(Sorry- my long comment continued!) So, for England we had under 20 people (or 7.43%) that suggested that they received care there (from a sub-sample of 250 that self-reported having travelled for care outside of the U.S.). These people (going to the U.K., for example) could have been over-represented in the sample; some could be "accidental medical tourists" (since 2.7 mil. Americans visited the U.K. in 2009); or it could be a limitation due to the specific population sampled (restricted range). In the academic papers we are writing, the specific limitations are outlined in more detail that is allowed by a 20+ minute overview of the research at a conference. My apologies if I did not clarify in great enough detail at the conference!
To the numbers from Journal of General Internal Medicine- this research is wonderful and most welcomed! The only major drawback of the study was the assumption of the size of the facilitator market in the U.S.; much like the travel agent role in booking travel (which is very infrequent now as internet travel portals rule the day)- our survey of Americans showed that only 19.5% would use facilitators (38.3% would book the procedure through the facility and 40.6% would book on their own [through the internet]). At best, facilitators probably represent 20% of the medical travel market and possibly less if you include health, wellness, dental, eyecare, spa, CAM/alternative medicine and etc.
What I encourage Keith and the many IMTJ readers to continue remembering is that the quest for better numbers is a war of attrition (probably why it is mostly fought in the halls of academia) that takes time, money, and effort. Right now- we (by this I mean researchers worldwide) get very little support from the major stakeholders in medical tourism to collect bigger and better data sets. Most of the 'businesses' in medical tourism (many non-profits included) are still trying to figure out how to invest in the trend to get an adequate ROI (whi

David Vequist (14/01/2011 20:30:24)

I do agree that narrowing the definition of medical tourists would greatly reduce the countable number of clients. For example, many NRI's (non resident Indians) regularly visit India for dental treatment, medical treatment and ayurvedic treatment, do not use the services of health care facilitators and should not be factored into any medical tourism statistic.

Michelle Narula (14/01/2011 17:26:35)

The article gives the industry a concrete ground. We can't base out decisions on illusions fed by interested parties... But further work is needed.

Leonid Voloshenko (14/01/2011 15:19:23)

From a US perspective, I find it laughable that so many people are caught up in actually measuring the size of the existing market. The bottom line is that costs are significantly less and quality is as good as or more likely better than in the US (at certain facilities).

Further, if the market is much smaller as we are lead to believe, US Health plans and insurance companies should be more encouraged to support international medical tourism. Plans can tell their local hospitals that few patients have actually traveled for surgery and the local facilities should not worry about losing patients.

Todd Madden (13/01/2011 20:55:09)

To Keith and the many IMTJ Readers,
Just a note of clarification- our inference of around 1 million U.S. 'medical travelers' in 2009 was based on a large scale study (around 1,800 Americans from across the country) and was not specific to strictly hospital stays in foreign nations (data suggests that a great many could be visiting clinics). Our more inclusive definition, of medical tourism, included dental (our sample suggested 31.25% of the total), health, wellness, spa, cosmetic (13.07%), eyecare (6.84%), medical exams (4.55%), pharmaceuticals/implantable, and CAM/alternative procedures (2.84%). It is very possible that some "accidental" medical tourists also responded to this question ("Have you travelled abroad for medical care") as well. Our suggested numbers are entirely possible and correlate nicely with numbers from the past couple of years at UCLA (just for California) and the Department of Commerce (just for international air travelers) that have 'self reported' numbers of hundreds of thousands (in each study) that travelled for healthcare outside the states. Please realize that perhaps a bulk of this is from the southwest of the U.S. (which makes up over 20% of the population of a country that has over 300 million residents) and into Mexico (our sample showed almost 28%). As a resident of the southern part of the state of Texas I never have a hard time finding someone in San Antonio that has travelled to Mexico for dental, surgery, Lasik, pharmaceuticals, and health/wellness purposes. Arguably, people in the northern states could probably say the same for Canada (although our sample only showed just 5.5%).
As per the additional estimates by country- obviously (as I explained to Keith as we were leaving the stage- last we met in person!) the reliability of the percentages by country past Mexico (1st on our list) drops significantly because of the small number of responses we received that declared a medical visit to each country. So, for England,

David Vequist (13/01/2011 20:20:10)

Good article. All thesemedical tourism numbers thrown at us are really confusing. Consulting firms like Deloitte and others should come up with arguments to tell us how they reached these numbers.
www.TourNCare.com
Online Medical Tourism Community

Dha Kur (13/01/2011 11:50:28)