Is medical tourism really global, or is it a local industry?

 

Attracted by optimistic projections of the uptake of healthcare travel, and the mother lode of fifty million uninsured and underinsured Americans, every country, service provider and hospital seems to have entered the medical tourism fray.

With the advent of US healthcare reform, the optimism has been renewed by some protagonists. A saner view holds that there will be no immediate impact of the reform and it is only after 2014 that one may begin to determine the impact of the US legislation.

If the healthcare travel industry is to rise to the challenge of serving patient mobility effectively, it must first understand the dynamics of the industry. The industry is not in its nascent stages any longer to be lured by projections based on a wing and a prayer. There is sufficient empirical data to make more accurate predictions that serve the industry rather than telling the commissioners of the research what they would like to hear. There is only so much one can do to ‘push’, let’s also get to grips with the ‘pull’ factor to understand the dynamics completely.

The pattern of patient mobility in medical tourism

Let us examine patient mobility to destinations that have emerged or are staking a claim to being centres of excellence. An unmistakeable pattern emerges;

    a. Malaysia gets 65% of its healthcare visitors from Indonesia.

    b. Thailand attracts 80% of its medical tourists from South East Asia.

    c. Despite its visa policy towards its neighbours, 85% of the international patients in India’s hospitals come from countries like Afghanistan, Bangladesh, Bhutan, Myanmar, Nepal, Pakistan, Sri Lanka and from non-resident Indians.

    d. Jordan plays host to Sudanese and Libyan patients more than from anywhere else.

    e. Turkey has drawn more patients from the nearby Central Asian Republics than the US market that it is pursuing with determination.

    f.  Belgium, the Czech Republic, Hungary and Poland in the European Union have seen more patients come from the United Kingdom, Germany and Italy but predominantly for treatments that fall outside the scope of insurance or NHS cover (in the case of Britain).

    g. Most of the universally sought after under-insured and uninsured in America have found their way to Argentina, Brazil, Costa Rica, Guatemala, Mexico, and other Latin American destinations that are geographically and culturally contiguous. Only a very small number of patients get as far as the Far East, South Asia or West Asia.

In the case of Malaysia, Thailand, India, Jordan and Turkey patients travel from countries where facilities for healthcare are inadequate and it is convenient to seek treatment close by to contain travel costs. It also means that there is minimal cultural, linguistic and dietary dislocation.  

Britons travel to European countries for cosmetic surgery or dental treatment rather than for elective procedures. Europe is culturally similar, most European destinations are between 1-2 hours away and, alive to the growing tourism needs, most people that these healthcare travellers come in contact with in these countries speak English. The experience makes for convenience and comfort that some other competing destinations not too far away – like Turkey or Jordan –find it hard to rival.   

The oft repeated mantra about Britons resorting to healthcare travel because of long waiting times in an underperforming NHS does not ring true any longer. Yes, there are Britons who spend up to six months a year in Goa or Kerala, but they will not account for the windfall of patients that some projections have been based upon. Whatever its shortcomings, the NHS provides for the needs of the 56 million people dependent on it with little reason for anyone to look elsewhere for timely access to healthcare.  In addition, there is the EU Directive on Cross Border Healthcare, which seeks to offer extended choice and absorb the flow of elective treatment between countries. It is unlikely that European tourist will venture beyond the Continent in search of healthcare in any great numbers.  

No sooner does one land at New York’s JFK airport than the English-Spanish multilingual signs catch one’s eye. There is a natural affinity for Americans to head South to countries which abound in healthcare choices. The number of Americans who go to destinations in Latin America because it is within their ‘comfort zone’ makes these destinations a natural choice. These destinations are barely 3-5 hours away, offer ease of communication in Spanish or English languages and are culturally not too daunting a prospect for the American healthcare traveller.

Improve your understanding of your catchment area

Centres of excellence in healthcare need to define their objectives through a better understanding of the catchment areas where their target audiences reside. Only then will they be able to reorient their strategy to reach out and secure a meaningful market share. The universal quest for the elusive underinsured and uninsured American must give way to a real analysis of the pull factor that will render these hospitals sustainable and commercially viable.  

The members of ASEAN (Association of South East Asian Nations) are a grouping with healthcare destinations in Thailand, Malaysia, and Singapore as well as further afield in South Korea. Other member nations have a barely adequate healthcare infrastructure and an audience that is ready to converge on to these centres of excellence in large numbers. In 2009, 49.6% of all tourists in the ASEAN region were from member nations. Japan and Australia had some 5% each and the European Union as many as 11%. These tourism streams are the funnels to target in order to maximise the opportunity in healthcare travel.  

India has a middle class (per capita income of over US$ 25,000) that equals the population of the United States at around 250 million. This affluent native audience should be the target market for intra bound healthcare travel to Indian Hospitals. There should be a focus on introducing private medical insurance to fill the void in public healthcare and deliver these clients to Indian hospitals. India would also do well to begin catering to the needs of the hundreds of millions in the SAARC (South Asian Association for Regional Cooperation) countries that it borders by putting in place a mechanism that facilitates and welcomes these regional patients beyond the small stream that presently feeds its hospitals. As for the Western medical traveller, let these be a bonus.

Countries in the GCC (Gulf Cooperation Council) have a total population of under 47 million. Together with neighbouring Jordan (4.6 million) Syria (21.9 million) and Egypt (77.4 million), they constitute a region that has just enough numbers to make a healthcare system self-sustainable.  Linguistic and cultural affinity and the fact that there are streams of patient traffic from Sudan (42.7 million) and Libya (6.4 million) make for a viable regional model for tertiary care across borders.  There are vast tracts of land and a communications infrastructure that limits choices. If there is one place where healthcare cluster formation would help serve a sizeable population, it is here in West Asia and parts of Africa. The term “healthcare cluster” is used here as referring to a number of countries as stake holders of a single healthcare system.

Turkey is at the cross roads of the Europe and West Asia on the one hand and between Africa and Central Asia on the other. It has been a tourism destination for a variety of reasons. A developed country, with a steady flow of over 30 million tourists from various regions, Turkey must capitalise on this market share for cross fertilisation of the healthcare opportunity to an existing clientele. A deliberate effort has seen Turkey build state of the art hospitals across the country with the intention of catering to an audience beyond its 72.5 million people. The Central Asian States are a further catchment area for the developed healthcare infrastructure in Turkey in view of the location, a common cultural continuum and accessibility. Turkey must also keep itself abreast of developments in Cross Border Healthcare in the European Union as it aligns itself to seek entry into the EU. In the meantime, it must attempt to secure the client base among the European tourists that frequent its shores.  

With its Directive on Cross Border Healthcare, the European Union has come a long way since Yvonne Watts’ name become synonymous with the opening up of avenues of healthcare provisioning within the EU. However, there may yet be a tortuous path to implementation of the EU Directive. Meanwhile, healthcare travel for treatments not covered by insurance is thriving in the EU. Led by service providers, clinics and surgeons, dental treatment, cosmetic surgery and bariatric surgery are available at significant savings in countries that are new entrants to the EU and account for a considerable flow of intra-EU patient traffic. Of the 70,000 UK healthcare travellers in 2006 and 50,000 in 2008, 70% went overseas for dental and cosmetic treatments and a majority of them to destinations within the EU. This private sector initiative may evolve to be the guiding light in helping the EU Directive find its feet or remain the sole manifestation of it! Destinations further afield may be excluded by provisions in policy, as in the case of the UK, for instance, where patients proceeding to a distance greater than three hours flying time may disqualify themselves from reimbursement.

Latin America has been home to the North American healthcare traveller with purpose built facilities to cater for the American healthcare traveller. Geographic contiguity, an enhanced comfort zone and an insurance mechanism that excludes a fifth of the American population means that they travel to the next best place. That, more often than not, is the short flight away in a Latin American destination. Let us not forget that the US has a litigious culture which has contributed to the high costs of healthcare. If service providers now look towards insurers and employers to come aboard, their considerations must stand the test of overcoming negligence in packaging private medical insurance for treatment in a third country. Quality and cost may add up, but can distances be overcome and continuity of care provided? The answer is yes, if the distances are manageable; this points once again to American healthcare needs being met closer to home rather than in far flung destinations across the world. Let us not forget, one compensation award for treatment gone wrong will throw the entire proposition out off the window.

It is time for the latitudes and longitudes in global healthcare to be defined. The sooner the regional context of globalisation is taken cognisance of, the better served will be patient mobility around the world; with greater patient focus, outreach and a genuine continuum of care. Will the service providers and other stake holders help themselves correct the perspective? Only time will tell.

FURTHER CONTENT PUBLISHED BY THIS AUTHOR

Lessons from a decade in medical tourism

Resources, 25 April, 2017

Zahid Hamid, Euromedical Tours, IMTJ Medical Travel Summit 2017

The onus of care

Articles, 10 August, 2012

Healthcare providers can not rely on certification to draw customers

Regulating facilitators

Articles, 27 July, 2012

Why regulation is needed in medical tourism

The quality of care

Articles, 03 August, 2009

We speak to Zahid Hamid on the quality of care in medical tourism

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