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How much has the world of medical tourism changed?

Changing world

Having just completed the mammoth task of updating and adding to his 2010 report to produce ‘Medical Tourism Facts and Figures 2012’ Ian Youngman reflects on how much the world of medical tourism has changed in the last two years.

The global recession had a massive effect in slowing down all forms of tourism and people paying for non-essential treatment such as cosmetic and dental surgery, but the underlying demand remains and will grow as we live longer. 2012 will see world tourism numbers hit one billion a year. By the end of 2012, one seventh of the world’s population will have crossed international borders as tourists in a single year. 72% of EU citizens travelled in 2011, and more than 80% will do so in 2012.

Sadness and happiness

What saddens me is that some people are still hyping the figures and their version of what medical tourism is; Western Europeans and Americans flying across continents for surgery at a tenth of the price, and soon to be supported by major insurers.

What makes me happy is the growing number who realise that:

  • Medical tourism is regional not global.
  • It is about surgery for the poor and the well off who have inadequate facilities at home.
  • It is about non-essential cosmetic, dental and fertility treatment for the better off.
  • It will remain a self-pay industry, as insurers are not really interested.



With the exception of a few small schemes, cross–border cover in Mexico and Europe or US domestic tourism, major health insurers are not prepared to pay for medical tourism. The downsides seem too many and their buying power means they are paying between a third and a half of the retail price for healthcare in the USA and Europe, so they cannot make the huge savings claimed by some. Also, they work with global networks of hospitals, so they do not need the help of small intermediaries.The two big domestic medical tourism deals done in the US were done by an international insurance broker, not medical tourism agents.

The Americans

The 6 million or 27 million Americans going abroad for treatment, as promised by one ‘expert” has not happened and will never happen.

Country after country, when promoting its latest hospital, conference or exhibition, STILL quote ancient Deloitte predictions on medical travel. In February 2012, an article in ‘US News’, quoted Paul Keckley of the Deloitte Center for Health Solutions, “We had estimated that employers would drive the medical tourism market. We thought they would approach the medical insurance companies and tell them that they needed to add medical tourism benefits. But the major employers are not clamouring for medical tourism. Healthcare inflation has been under 4 percent each of the past two years, so employers are under less pressure to trim healthcare expenses. And while such savings are still a major priority, medical tourism doesn't show up as a top-tier issue."

Western Europeans

Nearly every Western European country has state healthcare, or compulsory or voluntary health insurance in some form. This means that they do not need to travel anywhere for major or minor essential surgery, and some countries even include dental care.

Western Europeans will travel, normally within Europe, for cosmetic surgery, fertility treatment; cosmetic dentistry and specialist treatment where they can compare private costs at home with private costs overseas.

Customer care

Most business to African and Asian destinations is poor people from Asia and Africa seeking cut-price surgery. They are not after the extras or great service. But when hospitals and clinics targeting better-off customers still offer this basic service and think price will seal the deal, they are surprised that business does not come in quantity. People paying out of their own pocket for non-essential treatment want to be nurtured, cosseted and treated as if they were in a top hotel.

The new customers

The biggest growth areas are well-off people from China, Russia, and the Gulf. They look for value for money but top of the range care. The problem for destinations is that the competition is cut-throat.

The hungry countries

As some of the so-called leaders struggle, newer hungrier countries with government support, consistent and targeted marketing, and treating medical tourism just as another tourism niche are taking their business and finding new markets. These include South Korea, Turkey, and Taiwan – and eventually will include China.

The strugglers

The alleged market-leader, India, gave itself an almighty kick where it hurts when official research put the number of medical tourists at just over 150,000, not the millions prevously claimed. Singapore is the sixth wealthiest country in the world but price rises mean it is having to fight hard to retain business. Countries in the Middle East/Gulf region may be peaceful, but with more than half a dozen countries at war or with serious political unrest, Europeans and Americans avoid the region unless they are among the millions of expat workers there.

The no-hopers

There are scores of small countries and islands claiming to want to be top medical tourism destinations, with conferences, campaigns and new hospitals. They may pick up a few crumbs, but the chance of investors making money is remote.

The top destinations by numbers

  • The top global destination: Malaysia
  • The top European destination: Hungary


The “old guard”

The USA, Germany, Switzerland, Belgium and the UK are all sitting comfortably in the top 20.

Ones to watch

  • Turkey, Poland, South Korea and Costa Rica.


The top supplier of medical tourists


The target

Although large numbers of poor Africans and Asians are the bulk, low-cost, low service level market, many countries do not want to offer factory production line medical treatment.

For customers buying on excellent service and very high quality, the coming nations are China and Russia and woe betide you if you do not employ people who speak their language.

The future

Medical tourism does have a future. It will be about self-pay, niche markets, different marketing strategies for the various customer sectors and segments, and involve regional/domestic travel.

If you want to fail, market to everyone the same way with every treatment and concentrate on price.

If you want to succeed, select niches and specific markets within individual countries and find what their buying triggers are.

And my final message, is do not be defensive. Admit your mistakes, respond properly to customer reviews, and keep tweaking the service based on honest feedback.

If you do it right,  you will have a business. If you do it wrong, you will join the agencies, clinics, hospitals and countries who found out that medical tourism is a much more complicated and tougher business than they were led to believe.

To borrow Keith Pollard’s gold mining analogy, the gold rush days are over, if they ever existed. Most mine owners around the world made their money from coal, tin, stone, slate and copper, while the gold prospectors ended up broke and those who serviced them moved on to the next easy mark. You can make money in medical tourism by sheer hard graft, but it will not make you rich.


Profile of the author

Ian Youngman

Ian Youngman is a writer and researcher specialising in insurance and health. He writes regularly for a variety of magazines, newsletters, and on-line services. He also publishes a range of insurance reports and undertakes research for companies. An ACII, with an honours degree in Economics from the University of Liverpool, Ian was a co-founder of The General Insurance Market Research Association. He also has widespread experience within the insurance industry at management level, working for brokers, a bank and an insurance company.  

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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 in the content of these comments. However, it is editorial policy not to publish comments which have been submitted anonymously.

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Hi Ian, I do not see Thailand in the round-up, interested in your thoughts, is Thailand trending up or down in your opinion? It has taken a few hits in the last year(s), but seems to bounce back well.

Matt Kelleher

Matt Kelleher (15/04/2012 04:54:56)

Nice article very useful for me being a sale executive of one the medical companies in Malaysia.

aga nuls (10/04/2012 23:47:18)


Really nice piece of research and analysis. It is also a great antidote to the magical thinking that still goes on.

I have a different view on "why", which I believe is caused by confusing strategy and marketing that pollute the diffusion curve. But, your situational assessment of the business environment is clear and convincing. Thank you for the post.

Scott Frankum (24/03/2012 01:43:13)

Congratulations, Mr Youngman! This is as honest a pronouncement as one has heard since the phrase - itself a misnomer - 'medical tourism' was first coined. Thank you!

Let it be said that Healthcare travel is destined to remain a cottage industry, devoid of its erstwhile, self-serving promise, shorn of all regulation and a backyard in the high stakes that drive mainstream healthcare;, which is the largest beneficiary of public spending and the biggest employer.

Healthcare travel will adapt itself to the realities. As for those to watch, that may prosper;
- Turkey will be a hub of excellence to the region, truly emerging as a winner in a two-horse race, with Jordan a distant second.
- Costa Rica, will remain an affordable alternative to the US where the have-nots, just as some haves, will find recourse to health and wellbeing;
- South Korea has to make up for a lot of lost ground and time, but it has a legacy of doing so; watch out Bangkok, here comes Seoul.
- Poland will remain a wistful also-ran to Hungary in the lead.

The recession is the best thing to have happened to healthcare travel. It has cleansed the playing field, led to introspection and rationalised expectation. A pension plan it may be, a spin-off it won't ever! So true, Ian, so true.

Zahid Hamid (23/03/2012 23:19:21)

Hello. My name is Sheri Burke and I am with International Patient Facilitators in Cancun and Tijuana Mexico and we provide cosmetic, bariatric and IVF services for patients from the US and Canada. I follow your newsletter and I truly enjoy reading your ideas and opinions. I do agree with your statement, "admit your mistakes, respond properly to customer reviews, and keep tweaking the service based on honest feedback" . Keep up the good work ;)

Sheri Burke (23/03/2012 21:02:56)

Great article - Interesting read! I have experienced phenomenal growth in 2012 compared to 2011 this is due to Niche marketing and targeting the correct audiences. Treatment Aboard website is a great tool for anyone considering surgery abroad.

Angela Chouaib (23/03/2012 17:56:36)