Is outbound tourism from the UK recovering?


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:

  •     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.

  • Between 1997 and 2008 health expenditure in cash terms more than doubled from £55.1 billion to £125.4 billion.
  • 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.


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