How the industry lost its way and how it can get back on track

 

The popular image of medical tourism is of someone flying to a distant country for low cost surgery. Many agencies, hospitals and countries are basing their business model and marketing strategy on this premise, hoping that thousands of Americans and Europeans are seeking cheap surgery in distant places.

I believe this is a myth. The majority of long-distance medical travel seems to be for cosmetic surgery, dental work, fertility treatment and very rare diseases. Most medical travel (meaning for elective surgery) is short-distance. For elective surgery, long-distance travel is rare.

If medical tourism businesses were in the travel trade, many would be out of business in a few months. We have already seen a high attrition rate in medical tourism intermediaries/agencies with medical tourism businesses starting up and disappearing within their first couple of years in business. When you visit some of the medical travel related forums where people are asking basic questions about how to do business in medical travel, this is perhaps not surprising. Most travel agents and tour operators know that while long-haul travel is one part of the business, short-haul travel is usually a bigger slice. For many hotels the main part of their business is people from within their own country, or even country/state/region.

When we argue whether or not Americans prefer overseas or domestic medical tourism, we can get confused. For a Texan, Mexico is nearer then New York. For Canadians, hopping over the US border may be easier than going to another Canadian province. The distances involved confuse us too. If the USA was 52 countries, or the 27 European Union countries merged into one new country, the “United States of Europe”, it would be easier to understand. The distances across the US are huge, the travel time between most EU countries is very short; we still think of vast countries like China as one simple place, despite there being massive cultural and wealth differences between regions within China.

International...or domestic medical tourism?

We have also become confused about international versus domestic medical tourism. The US is the easiest one to understand, but even in the UK you see people going from Scotland to London, or London to Cornwall. Many people in the medical travel business travel regularly between countries, but you are not typical. The average person spends most of the time in their own village/ town/city. Globally, over 90% of the population has never left their own region, let alone their country.

So where am I going with this?

US employers have often commented on now hard it is to get an employee to travel out of their own city, let alone out of their state, for cost-saving surgery and as for going to a foreign country... it’s “out of the question”. But on the other hand across Europe and the US, we have high numbers who cross their local border for dental or medical treatment. We need to get away from the mindset that medical travel is just country-to-country, as for many ordinary people cross-border means leaving their state or region.

I think we as an industry have got it back to front. We talk about the cost saving, but find that many medical tourists travel to expensive destinations. We talk about high quality, but quality comparisons within countries are as wide as between countries. We talk about holidays and beaches, when for most dental or cosmetic operations you will be too fragile afterwards to enjoy the sights, or sunbathing will ruin what you have had done.

Back to front marketing...

Much medical tourism marketing and advertising makes me cringe. Not just because it is badly written in mangled badly translated prose, but that it is all about how wonderful the country/hospital/doctors are. It is back to front marketing, devise a product, seek to advertise it, and then try to find customers that fit that market.

As any marketing professional knows, you first find out what the customer wants and needs, how much they will pay, what competitors offer, and then design the product /service. So why does medical tourism continue to ignore these basics? Partly because it has been misled by self appointed experts on what the demand is, what customers want, and that cost is the only thing that matters.

Back to my tourism scenario.....Particularly in the current climate, a huge proportion of holidaymakers stay in their own country, with probably less travelling to nearby countries and even fewer on a long-distance trip. But the analogy is not perfect as what holiday makers often want is to experience foreign culture and experiment. Now... this view this may bring criticism, but I feel that the last thing that someone wanting a new hip, new teeth or heart surgery is to “experiment” in a foreign country with a foreign culture.

The inverted pyramid model

Here is a simplified model of medical tourism; for any medical or health treatment there is in effect an inverted pyramid. The vast majority of people want to be treated in their own town or city. Fewer will travel within their own state/region. Fewer still will travel far afield within their own country, or across a nearby border. Even fewer will go to a slightly further away country, and then as distance/travel time increases then the numbers decrease. A complex version of this model would add in culture and cultural differences, such as language, heritage, ethnicity; as well as income and age.

My belief is that many in medical tourism, by concentrating almost exclusively on the point of the pyramid, are totally missing the market. Many hospitals in Asia, despite what they say about wanting Europeans or Americans, do in fact realise that the vast majority of their medical tourism business comes from within their own country, or nearby countries.

For many of those running medical tourism businesses, what they are doing is like running a travel agency but only offering long-haul holidays, or like running a second hand car dealership but only selling Porsches. Many hospitals and clinics too are guilty of only concentrating on far away medical travellers. There is some indication that longer running agencies, and an increasing number of medical establishments, are beginning to understand that their real target market is anybody not living locally.

The real culprits in concentrating so hard on long-haul markets, and often only targeting certain source countries, are the destinations themselves. They do this, partly out of ignorance, or based on poor research or believing what they hear at numerous conferences, without questioning the data or the underlying motives of those who benefit from “bigging up” the industry. Exaggerated forecasts and over optimistic predictions have done little for the image of medical tourism or for those market entrants who have followed this guidance.

Be a radio mast

My advice (which does not come with a massive consultancy fee!) is that all hospitals, clinics and agencies should pretend they are a radio mast. From it, circles of radio waves emanate. The further away a listener (the patient) is the harder it is to hear you, and the less relevant your views and news are to them.  So your business model should be first the local market, then domestic medical tourism, then regional medical tourism and only finally to full long-haul international medical tourism. Think of how the customer really chooses healthcare, and abandon “vanity publishing” to get them to change their needs and wants to what you offer.

Much of medical tourism exists in a bubble. We have had riots in Egypt, Thailand and Tunisia; swine flu in Mexico; terrorism attacks in India, and natural disasters in various countries with officials in major countries recommending that non-essential trips to these countries should be avoided. What has been the reaction of the medical tourism sector? Nothing. I have yet to see a website that makes any reference to these problems. Look at airline or tour operator websites and press statements and they provide detailed information or offer alternatives to customers. Perhaps medical tourism intermediaries and hospitals have privately warned customers, but all I seem to see is total blindness. Even when rioters raged through a hospital, a medical tourism promotion body was effectively saying, “Don’t worry what you see on television, it is safe here.” And where were the national and international associations when members needed advice or the public needed a statement?

Cost, quality and the customer experience

Moving on to cost saving...... The US, Singapore, UK, Germany and Switzerland are typical of major destinations that are not the cheapest in the world, they sell on quality. So with several major destinations selling on quality, why do we equate medical tourism with dramatic cost saving?

Health systems and doctors under pressure find it easy to attack medical tourism with stories of botched surgery and poor care. Undoubtedly, some of the cheapest surgery is not top quality, but look at any country and you can dig up stories of incompetence. Ignoring the negative stories as a mere nuisance misses the point. Medical tourism may focus on lower cost, but the message has to be of lower price for an equivalent or better quality of care than you can get at home.

Retailers everywhere may focus on price competition, but in retail and tourism the brighter minds focus on the overall customer experience. This is where some in medical tourism are getting it right, but many more are getting it very wrong. The average American and Western European customer is now used to getting a good customer care experience. They may pay for cheap food and clothes and expect a lower standard of service than for the more expensive equivalent, but they still expect the product to be fit for purpose. So, for medical tourism, even when the price is lower, the customer still expects excellent care and after-care, and this base level of care may be well above what locals expect and get. People do get scared of very cheap prices. You can sell surgery at 20% or 25% less than at home, but when you offer it at 75-80% lower, the customer simply does not believe they will get safe surgery. It’s not credible. Bottom price implies bottom quality. You can wave all the accreditations in the world at them but it will not remove the fear of something that looks too cheap.  This lack of “credibility” in huge savings is a key reason why US businesses have not bought into medical tourism in a big way; they do not trust massive savings.  So, my argument is – and I expect it will provoke a response – that medical tourism has got its pricing badly wrong.  Setting prices for any product or service is tricky, but there is plenty of marketing science on setting price points;  lowering prices does not itself increase long-term sales. Any business can increase short-term sales by cutting prices below the competition, but if medical tourism wants long-term profitable business,  it cannot exist by putting low cost above everything else. Putting it simply, much of medical tourism has not optimized the price-point at which the customer will buy and the organization can make money

Embrace marketing not sales

Sadly, this brings me back to the bubble. Dealing with crises, getting the price and target markets right, and pushing the right customer buttons are not new. Across the globe, many retail and tourism and insurance businesses have found answers to these problems. Is it because so many people in the business have a medical background rather than a service business one, that they struggle on trying to learn from scratch rather than seek to adapt what retailers, tour operators, hotels and the food industry have learnt over the last century?

If medical tourism businesses want to prosper, rather than scrape a living, they need to benchmark against the best businesses in other service industries. I know it is difficult moving from a background where the obedient patient does what the all-knowing doctor tells them, to one where agencies, doctors, hospitals are really patient focused and base price, product and service on real customer needs. But if this industry is to move forward, it has to rapidly evolve a service orientation that embraces marketing rather than sales.   

FURTHER CONTENT PUBLISHED BY THIS AUTHOR

Global medical trends

Articles, 08 March, 2019

Global medical prices will keep rising in 2019

Which destination has the highest risk?

Articles, 07 February, 2019

New study compares risks of travel to global destinations

Promoting Traditional Chinese Medicine

Articles, 24 January, 2019

Will TCM move centre stage in global health tourism?

Medical Travel and Tourism Global Market Report – 1st Edition

Resources, 09 January, 2019

This new report discusses the dynamics of medical tourism and looks at the supply chain, business models, products and the consumer.

Chinese medical tourism scams

Articles, 11 December, 2018

Arrests in US$145m scam targeting Chinese medical travellers

Stars in the East

Articles, 06 December, 2018

The medical tourism axis is shifting

UK health tourism deception

News, 30 November, 2018

UK government figures on NHS health tourism are debunked

Global wellness tourism boom

Articles, 22 November, 2018

Wellness tourism is worth US$639bn, but what do these figures include?

EU cross-border healthcare

Articles, 09 November, 2018

EU Directive fails to meet expectations for medical tourism

Chinese outbound medical tourists

Articles, 03 October, 2018

How to tap into the Chinese medical travel market

Plea for proper figures

Articles, 19 September, 2018

International patient data overstates medical tourism reality

Anti-Tourism – did you predict THIS trend?

Articles, 30 July, 2018

UK’s Cornwall is discouraging tourists to two of its beaches this summer. Predicting medical travel trends is also dangerous.

Terrorism and political risk

Articles, 06 June, 2018

Growing global political volatility is a major risk for medical travel

“Medical tourists don’t need hotels”

Articles, 03 May, 2018

Why the growth of medical tourism is being limited by a lack of appropriate hotels

UK outbound tourism data

Articles, 16 April, 2018

Health warning on ONS 2017 data about British medical tourist volumes

Medical tourism facts and figures

Articles, 22 March, 2018

The magic of medical tourism numbers

The dangers of dealing with medical tourism financiers

Articles, 14 February, 2018

Beware financiers offering you deals that are too good to be true

Chinese outbound tourism changes

Articles, 01 February, 2018

The changing world of outbound Chinese medical tourism

Agreement on post-Brexit healthcare in EU

Articles, 05 October, 2017

Agreement reached on reciprocal healthcare for British and EU retirees

Ireland, Brexit and Cross Border Healthcare

Articles, 21 September, 2017

UK addresses position on Ireland land border

Medical tourism post-Brexit

Articles, 07 September, 2017

Brexit: Citizens living overseas are pawns for negotiators

UK citizens abroad post Brexit

Articles, 23 August, 2017

UK citizens in EU and EFTA countries

EU citizenship post Brexit

Articles, 08 June, 2017

What happens to EU/EFTA citizens in the UK after Brexit?

Brexit, the NHS and medical tourism

Articles, 02 June, 2017

Brexit bill: the half a billion pound NHS bill

European health insurance

Articles, 25 May, 2017

The European Health Insurance Card (EHIC) - a much misunderstood arrangement

EU Package Travel Directive

Articles, 06 April, 2017

Do you know about the EU Package Travel Directive?

Tele-surgery and medical tourism

Articles, 22 March, 2017

Is tele-surgery a threat to medical tourism?

Travel ban impacts tourism

Articles, 13 March, 2017

New Trump order impacts US inbound tourism

Medical travel insurance

Articles, 01 March, 2017

Clearing up the confusion: insurance and medical tourism

Growth of healing hotels

Articles, 16 February, 2017

Healing Hotels of the World and luxury customers

Trump and medical tourism

Articles, 09 February, 2017

The Trump factor: Protectionism and medical tourism

Will Brexit damage UK medical tourism?

Articles, 16 November, 2016

Refuting the claims of a "medical tourism expert"

Medical tourism in 2016

Articles, 01 November, 2016

The upside down world of medical tourism

Medical tourism cruises?

Articles, 04 October, 2016

All aboard for a healthy trip

Medical tourism associations reducing?

Articles, 01 September, 2016

Where have all the national and regional associations gone?

Medical tourism 2016 overview

Articles, 18 August, 2016

Medical tourism in 2016: What has changed?

Healthcare after Brexit

Articles, 04 August, 2016

The future of cross border healthcare in Europe

The EU debate

Articles, 20 June, 2016

Brexit and medical tourism

International and expatriate healthcare and insurance 2016

Resources, 07 June, 2016

There are more opportunities than ever for insurers and brokers to sell health insurance globally to locals and expatriates.

End of the line for Satori

News, 30 April, 2016

US medical tourism agency Satori collapses

Cuba - restrictions still apply

News, 20 April, 2016

Barriers for US medical tourism to Cuba

Turkey medical tourism

News, 15 April, 2016

The falling star of medical tourism

Clamp down on illegal transplants

News, 15 April, 2016

Kidney transplant ban in Sri Lanka

Early days for Iran

News, 14 April, 2016

Sanctions and travel restrictions still in place

Barriers to domestic medical tourism

News, 12 April, 2016

Out-dated advertising rules affect Malaysia

Incentives for Puerto Rico

News, 11 April, 2016

Puerto Rico gearing up for medical tourism

"Uninsured Americans"... Fact or fiction?

News, 07 April, 2016

New data on US insurance

Bariatric travel... hidden cost?

News, 05 April, 2016

Report on impact of Canadians' obesity surgery abroad

Malaysia stays strong

News, 03 April, 2016

Growth in medical tourism despite economic slowdown

Zika virus repercussions

Articles, 01 April, 2016

Does Zika pose a threat to medical tourism?

Global travel trends

Articles, 01 April, 2016

How will tourism fare in 2016?

Tourism troubles in Turkey

Articles, 14 March, 2016

2016: A lost year for medical tourism in Turkey?

A Gulf of medical tourism?

Articles, 26 February, 2016

How is the falling oil price affecting medical tourism in the Middle East?

National Health Systems Report 2016

Resources, 10 February, 2016

This report provides insight into the National Health Systems of over 180 countries, and what their future plans are on a simple country-by-country basis.

Rising popularity of wellness travel

Articles, 25 January, 2016

Health and wellness and the luxury market

Is Asia getting it wrong?

Articles, 10 December, 2015

Medical tourism is not global: Are asian hospitals targeting the wrong markets?

What's my target market?

Articles, 27 November, 2015

Targeting medical tourists... demographics are dead...adapt or perish!

Your next conference speech

Articles, 15 October, 2015

Insert name here... a template for your medical tourism conference speech

Planning and preparation

Articles, 25 August, 2015

Impact analysis and medical tourism

Lithuania medical tourism

News, 06 August, 2015

Lithuania rues failure of cross border healthcare

Dubai acts to reduce healthcare costs

News, 06 August, 2015

DHA introduces price regulation model for private sector health services

Australia breast augmentation package

News, 06 August, 2015

Insurer changes medical tourism option

Health insurance compulsory

News, 06 August, 2015

Chinese visitors to Taiwan must have health insurance

Trends in global healthcare spend

News, 06 August, 2015

OECD Health Statistics 2015: Reductions in spending

Saudi Arabia... compulsory health insurance

News, 06 August, 2015

Compulsory health insurance to be introduced for most visitors

South Korea medical tourism

News, 06 August, 2015

Recovery of South Korea medical tourism after MERS

Health insurance coverage in India

News, 06 August, 2015

86% of the rural population and 82% of the urban population are not covered by health insurance

Japan medical tourism

News, 06 August, 2015

Japanese plans to promote health tourism get mixed reaction

Dubai health insurance update

News, 06 August, 2015

Dubai links health insurance scheme to visa renewal

Comparing US surgeons

News, 06 August, 2015

Consumers to evaluate and compare surgeons based on complications rates and patient outcomes

Malta health plans under attack

News, 06 August, 2015

Doubt expressed about healthcare funding and medical tourism plans

Nigeria universal health coverage

News, 06 August, 2015

NHIS resolves to decentralize the operation of health insurance in the country

Egypt healthcare struggles

News, 06 August, 2015

Pressure on Egypt's ailing health care system

Regulation of Israel medical tourism

News, 06 August, 2015

Special team to investigate and prepare regulation of Israeli medical tourism

Economy problems

Articles, 31 July, 2015

Greece crisis... the implications for Greek medical tourism

Fact from fiction

Articles, 30 June, 2015

Analysing the latest "internet" facts on medical tourism

What are they up to...

Articles, 28 May, 2015

Competitor analysis in medical tourism

Working with competitors in medical tourism

Articles, 08 May, 2015

Who are your nearest competitors in inbound health and medical tourism?

Fakes, scams and frauds

Articles, 19 March, 2015

How do you know who is telling the truth?

Rallying to the Defence

Articles, 08 January, 2015

Medical tourism under attack and on the back foot

When all fails

Articles, 24 November, 2014

Ian Youngman looking into what happens after the worse happens

The future of medical tourism

Articles, 20 November, 2014

What will 2015 bring for medical tourism?

Central and South America: Health insurance, healthcare and medical tourism 2014

Resources, 14 November, 2014

This regional report provides up to date detail from recent research.

Hot topic: Ebola

Articles, 23 October, 2014

What threat does Ebola pose to medical tourism?

The medical magic

Articles, 06 October, 2014

Why do people travel for health, Ian Youngman discusses why

Medical tourism... good news?

Articles, 29 August, 2014

Does medical tourism benefit countries?

Temporary tourism

Articles, 23 July, 2014

Is medical tourism's growth based on hope or reality?

Do your research

Articles, 09 June, 2014

Knowing your market is key to success

Go compare

Articles, 22 May, 2014

Comparison sites, a threat or opportunity?

Don't believe the hype

Articles, 23 April, 2014

How medical tourism has changed and who not to believe

Tourist or Patient?

Articles, 20 March, 2014

The issues in measuring medical tourism numbers

Dental tourism trends

Articles, 21 February, 2014

Looking at the growth of the dental tourism market

The big questions

Articles, 24 January, 2014

Many problems in the medical tourism industry remain unanswered

The imperfect market

Articles, 19 December, 2013

Is the customer really looking for the cheapest surgery?

Travel insured: part 2

Articles, 04 November, 2013

Why isn't medical travel insured?

Travel insured: part 1

Articles, 21 October, 2013

What travel insurance exists?

Building and hoping

Articles, 06 September, 2013

Building a hospital rarely leads to patients beating a path to your door

Understanding customer choice

Articles, 09 August, 2013

How do medical tourist make decisions about destinations?

Stuck in the past

Articles, 28 June, 2013

Is medical tourism making the most of social media?

Headliners

Articles, 14 June, 2013

How bad news can affect medical tourism in a country

The tourism niche

Articles, 26 April, 2013

Are small industries a bad thing?

The tipping point

Articles, 12 April, 2013

Is medical tourism still a pioneer, or merely a bandwagon?

Disaster planning

Articles, 01 February, 2013

What happens when things go wrong?

Powerhouses of medical tourism

Articles, 04 January, 2013

What economies are booming in the medical tourism industries?

The numbers

Articles, 14 December, 2012

Ian Youngman revisits the figures of medical tourism

Accreditation

Articles, 21 September, 2012

Just what is accreditation in medical tourism and does it help your business?

Healthcare politics

Articles, 23 August, 2012

The impact of healthcare reform on the USA's medical tourism industry

The American tourist

Articles, 13 July, 2012

International Americans have not arrived, but what about domestic travel?

Judging quality

Articles, 15 June, 2012

Are certification and accreditation useful guides for a service's quality?

Medical tourism attacked

Articles, 18 May, 2012

Spain and the UK speak out against medical tourism

Changing world

Articles, 23 March, 2012

Ian Youngman talks on how the world of medical tourism has changed

Build it and they will come

Articles, 27 January, 2012

Is medical tourism a "Field of Dreams"?

Kolkata tragedy

Articles, 19 December, 2011

94 dead in a major fire, what does this mean for India's medical tourism industry?

Top ten tourist destinations

Articles, 14 November, 2011

Ian Youngman tries to pick out the top 2012 medical tourism destinations

Is medical tourism behind the curve?

Articles, 16 September, 2011

Friends, Fans and Followers are becoming a powerful market force

Recovering UK tourism

Articles, 23 June, 2011

Is outbound tourism from the UK recovering?

The shrinking world

Articles, 15 April, 2011

The medical tourism world is shrinking, but is this good news?

Why the Cayman Islands matter

Articles, 25 March, 2011

Ian Youngman talks on the Cayman Islands and their role in medical tourism

Insurance tourism

Articles, 07 March, 2011

How will health insurers adapt to medical tourism?

EU directive: Cross-Border healthcare

Articles, 19 January, 2011

Ian Youngman looks at the challenges of implementation of Cross-Border healthcare

What do we know?

Articles, 10 November, 2010

Ian Youngman comments on an academic review of medical tourism

Implications of online advertising rules

Articles, 27 October, 2010

New rules may affect how medical treatment is advertised online

Changing trends

Articles, 30 September, 2010

How changes in tourism will affect medical travel

An industry out of nowhere

Articles, 03 September, 2010

A new global industry has sprung up, as have many before, what can we learn?

Europe agrees new rules

Articles, 17 June, 2010

Ian Youngman looks at the latest development of Cross-Border healthcare

USA healthcare reform

Articles, 21 April, 2010

Ian Youngman reviews the myths of the US healthcare reforms

Are you complying?

Articles, 12 March, 2010

Ian Youngman examines the new European Union Provision of Services regulation

Top ten hospitals

Articles, 27 January, 2010

Are assessments really fair?

The forgotten destination

Articles, 10 December, 2009

Oft overlooked, London could well be a slumbering giant in medical tourism

Getting social

Articles, 06 November, 2009

Medical tourism industries live and die on their press, but how good is the news ?

Legal, decent, honest and true

Articles, 22 October, 2009

Ian Youngman considers whether the medical tourism industry is both legal and ethical

Looking back at '08

Articles, 25 August, 2009

Ian Youngman looks at the predictions made back in 2008

Conference: Competition hots up

Articles, 16 July, 2009

Ian Youngman looks at the competitive market for medical tourism speakers

Will the boss pick up the bill?

Articles, 26 May, 2009

Can businesses insurers break into the medical tourism market

McKinsey's got it wrong

Articles, 26 May, 2009

A recent report on the industry makes some serious errors

The hottest American destinations

Articles, 15 May, 2009

One country serves travelling American medical care more than any other. America

Where do Americans go abroad?

Articles, 12 May, 2009

Just as we don't know how many Americans travel for care, we have no figures as to where

How many American medical tourists?

Articles, 10 May, 2009

There are wide variations in the American medical tourist estimates. We examine a few

Americans travelling abroad for care

Articles, 10 May, 2009

Do we have any idea how many Americans would travel abroad for treatment?

Delivering destinations

Articles, 28 April, 2009

Not every government is active in attracting medical travellers

Offering a premium service

Articles, 10 September, 2008

IMTJ looks at the new insurance products coming to market

Truth in statistics

Articles, 01 June, 2008

Ian Youngman talks on his work: Medical Tourism 2008: the World-wide Business Guide

South Korea: medical tourism report

Articles, 01 June, 2008

Ian Youngman is producing a new set of country specific reports, first up, South Korea

Insurance and medical travel

Articles, 10 May, 2008

Ian Youngman looks at the new products hitting the insurance market

Advertisement

ADD AN ARTICLE

Do you have an article that you’d like to share with the medical travel industry?

Publish for FREE on IMTJ.

ADD ARTICLE

Related Articles

Caribbean medical travel prospects

20 March, 2019

Are small, specialised private clinics the best bet?

Healthcare quality improvement

20 February, 2019

International accreditation requires CQI: what is it?

Albania - a medical travel opportunity?

07 February, 2019

What can Albania offer the medical tourist

Taiwan medical travel opportunity

08 January, 2019

Can Taiwan broaden its appeal to medical tourists?

Patient-centric payments: part two

07 September, 2018

Creating a patient-centric payment experience