Ian
Youngman from IMTJ looks at some of the factors that may return outbound
medical tourism to growth. Reductions in
funding and failure to implement reforms within the NHS may lead to a
resurgence in waiting times. Demand for dentistry, cosmetic surgery, bariatric
surgery and infertility treatment abroad could benefit.
Medical tourism across the world has been through
difficult times in the last couple of years, and has not been immune to the global
economic downturn. The UK outbound medical tourism market has suffered;
spending on “discretionary” healthcare has fallen, fewer patients have
travelled for treatment, and those that have gone abroad have spent less on
treatment.
But there are indications that the tide may be
turning.
Outbound medical tourism from Britain at last
shows signs of recovery and growth. Various push factors may help to stimulate
a recovery in medical tourism:
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Poor
NHS delivery
-
Expectations
of increases in waiting times
-
Problems
with NHS dentistry
-
Objections
and delays relating to NHS reforms
-
The
need to tackle obesity, and the resulting demand for bariatric surgery.
Although not perfect, what figures we have
suggest an increase in 2010 and 2011 in outbound medical tourism. Even if you
doubt that there is economic recovery, there are signs that people are fed up
with politicians and media pushing doom and gloom down their throats, that they
are just getting on with their lives, and that includes travelling abroad and
paying for treatment overseas. The ‘my life goes on’ attitude means that if
people want cosmetic dentistry or weight loss surgery, they will pay for but
with perhaps paying more attention to the relative costs at home and abroad.
Pressure on the UK National Health Service
If the recent years of increased expenditure did
little to improve the NHS, then the next few years with cuts and increased
waiting times are likely to drive more British to consider medical tourism.
“The Health System in Transition‘ report by Sean Boyle at the London School of
Economics and Political Science (LSE)) reveals that while public expenditure on
health care in England more than doubled between 1997 and 2010, the impact on
health system performance has been variable. It is the most comprehensive
independent overview of the health and social care system in England produced
this century. It provides a wealth of detail about all aspects of the health
care system, as well as developments in the health of the population.
Drawing on a detailed analysis of the changes to
health care introduced by a series of Labour governments between 1997 and 2010,
the report's author gives his assessment of the impact that these changes have
had in terms of access, equity, efficiency, quality and health outcomes.
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Between
1997 and 2008 health expenditure in cash terms more than doubled from
£55.1 billion to £125.4 billion.
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Expenditure
on health care per capita increased from £231 in 1980 to £1,168 in 2000,
and by 2008 it was £1,852.This spending was accompanied by a continuous
programme of transformation of the NHS in England.
-
Chief
among the changes introduced since 1997 are: the introduction of payment
by results, an activity-based payments system; the expanded use of
private-sector provision; the introduction of more autonomous management
of NHS hospitals through foundation trusts; the introduction of patient
choice of hospital for elective care; new GP, hospital consultant and
dental services contracts; the establishment of the National Institute for
Health and Clinical Excellence (NICE) and the expansion of its remit to
include the development of comprehensive guidelines for all services; and
the establishment of the Care Quality Commission to regulate providers and
monitor quality of services.
More investment, but no increase in productivity
Expansion of the NHS workforce has been a key
focus of government policy since 2000. Thus, there are over 50,000 more
doctors, including 10,000 more GPs, and almost 100,000 more nurses and
midwives. But despite all this money and all these changes, NHS productivity
did not increase over this period. The most recent measure, which includes an
element for quality improvements, shows NHS output increased rapidly between
1997 and 2008, at over 4.5% per annum, but the increase in inputs was even
greater at almost 4.75% per annum.
The good news is that the NHS made substantial
progress in some areas, particularly improving access to elective care, and, to
a lesser degree, outcomes. Waiting lists have halved and people wait less time
for treatment. The 1.3 million people on NHS waiting lists in 1998 fell to
under 600,000 in 2008. Median average waiting times for elective treatment
(e.g. hip replacements, heart surgery) fell from 12.7 weeks in 2002 to 4.3
weeks in 2010.
Sean Boyle says, “ Perhaps the single most
significant factor between 1997 and 2010 was the large increase in public
expenditure on health care. However, much of this increase was taken up by more
staff, pay rises, increased capital costs and increases in costs associated
with improvements in care. The coalition government is already making
significant changes to the structure of the NHS and it is clear that the
financial framework that the NHS faces in the next five years will be very
different from that of the last ten years. The key question is whether an NHS
that found improvements in productivity so difficult to deliver at a time of
record increases in expenditure will find it any easier as spending begins to
fall back. The new government's instinct to introduce yet more structural
change to the NHS at a time of financial stringency may prove the undoing of
both.”
Waiting times creeping up
The latest NHS data on English waiting times
suggests that people have to wait longer for treatment. During March 2011
338,620 admitted patients and 952,293 non-admitted patients, had median waiting
times of 7.9 weeks for admitted patients and 3.7 weeks for non-admitted
patients. For patients still waiting for treatment at the end of March 2011,
the median waiting time was 5.5 weeks. One key change made by the coalition is
to remove the waiting times rules, but we will not see much change in the
figures until NHS reform is clearer.
Delays in NHS reforms
On NHS reform, all was going well until the
government asked for and got reaction from doctors, hospitals and patients on
the detailed and quite revolutionary plans. This led to the amazing scenario of
the government taking a 2 month timeout to rethink plans. Health secretary
Andrew Lansley has admitted that some proposals are unworkable and that the
government's Health Bill may need to go back to the House of Commons for
further review on NHS reforms.
NHS dentistry under pressure
An undercover investigation for television
programme, Dispatches, claims that some patients are paying far too much for
NHS dental treatment. According to NHS guidelines and NHS dental leaflets,
patients should pay a maximum fee for dental treatment and fees are banded
according to the complexity of the treatment. The maximum fee charged for
dental treatments that are available on the NHS should be £204. An undercover
report found that some patients are paying up to £500 more than the maximum fee
for NHS treatment. The report also showed that many dentists are not offering
scale and polish treatment as well as dental examinations and are charging
additional fees if patients ask for a cleaning treatment.
The coalition government have already said the
current payment by results system does not work and that they will change the
system and new pilot programmes are due to be introduced this summer- but the
public have seen three or four such reforms in the last decade and after each
have found they end up paying more for treatment that is harder to find. So
they are pushed into the private sector at which point they compare UK and
overseas costs.
International Passenger Survey (IPS) data suggests growth
The latest International Passenger Survey (IPS)
data from the UK's Office for National Statistics suggests that outbound
medical travel from the UK may be seeing a recovery. IPS is a survey of a
random sample of passengers entering and leaving the UK.Over a quarter of
million face-to-face interviews are carried out each year with passengers
entering and leaving the UK through the main airports, seaports and the Channel
Tunnel. It asks them about the main purpose for their travel e.g. holiday,
business, medical travel. Medical travel represents a very small proportion of
travel in general and the sample size in the IPS data is very small. But the
IPS data for outbound medical travel from the UK rose to a peak of 77,000 in
2006 and fell in 2007 to 72,000; economic recession resulted in a fall to 50,000
in 2008 and 52,000 in 2009. 2010 saw a recovery to 61000.
Latest 2011 trade estimates for outbound UK
medical tourism are 65,000 including 40,000 dental and 15,000 cosmetic surgery.
Add in the effect of increased waiting times and problems with NHS dentistry,
plus the first stirrings of economic recovery, and a recent £6 million award
against a UK cosmetic surgeon and it is probable that numbers will rise during
2011 and even more in 2012.
Travel market recovering
New research released at the World Travel Market
says UK outbound travel receipts will return to pre-global downturn levels in
2014, although the number of travellers will still be more than 10% lower than
in 2008. Caroline Bremner of report authors Euromonitor International told
delegates that there is a change in mindset with a higher spend per outbound
trip, as UK consumers look for value for money instead of the lowest price. The
research – The Travel Industry Global Overview – reveals UK outbound departures
are likely to plateau at around 60 million in 2015. Predictions for 2011 are
for 56.2 million Brits to head overseas, slightly up on 2010’s 56 million. 2012
will see 58.3 million departures; 2013 will increase slightly to 58.7 million
with a jump in 2014 to 59.6 million.
Destinations such as Turkey will remain popular
due to its value for money proposition. Turkey has benefited from the shift
away from North Africa following the political unrest in the Middle East, with
Greece and Spain also taking up the demand. Outbound operators are trying new
sales techniques to boost business with online travel agents and airlines using
instant short –term flash sales and promoting deals.
Demand for bariatric surgery
I have regularly pointed out the potential for
medical tourism from those who need to lose weight. More evidence that the NHS
fails to understand how serious the obesity crisis is, despite recently buying
new ambulances for people too large for normal ones, comes from a surgeon who
demands the NHS wakes up to the potential for bariatric surgery to save lives
and resources. Bariatric surgeon David Kerrigan wants more obesity surgery to
be funded by the NHS,” Like it or loathe it, bariatric surgery is slowly
emerging from the shadows into mainstream clinical practice. More and more
evidence highlights its effectiveness as a treatment for not just obesity, but
also associated metabolic complications such as type 2 diabetes, hypertension
and sleep apnoea. We all know that prevention is better than a cure, but
prevention isn't going to help the one million people in the UK who already
meet the NICE criteria for bariatric surgery. Sadly, ingrained ignorance and
prejudice still dominate the debate around NHS-funded provision of obesity
surgery." A quarter of the UK population is now officially obese.
Growth markets
With all these factors taken into account, it is
likely that more British people will go overseas for dental care, cosmetic
surgery, obesity and fertility treatment but not major surgery. I expect most
to go to Europe due to distance and culture; there may be a few travelling to
Asia but many of these countries will suffer as the British consumer tends to
suspect very low prices mean poor quality. There is no evidence that British
consumers care a jot about international accreditation when choosing
destinations. What they do care about is value for money and knowing exactly
what the price quoted covers, with no hidden extras.
