South Africa is an object lesson of medical travel thriving in difficult conditions


There’s no mystery as to why patients travel to South Africa for treatment. An excellent private healthcare system, competitive pricing, good outcomes in internationally accredited hospitals with top class specialists, English spoken and the ability to work with different cultures and religions add up to a significant international appeal. Throw in a good infrastructure, recognisable and reliable legal framework, including strong patient and human rights and hotels and resorts which can offer every form of recuperation, and it’s no surprise that patients not only from greater Africa but from overseas travel there for treatment.

South Africa’s population of 47 million people divides into roughly seven million insured persons, with the rest either relying on the public healthcare system or self-paying for treatment. Kurt Worrall-Claire, chief executive of the Hospital Association of South Africa (HASA) estimates that the private sector cares for a significantly higher proportion than just insured, however: perhaps as much as 10 million.

“The private sector has 28,000 beds, which is 22 percent of South Africa’s total, and 3.5 million patient days, so we are caring for a considerable proportion of the population, though of course included in these numbers, there are a number of patients treated from outside South Africa’s borders, or expatriates and emergency cases both from within and without,” says Worrall-Claire.

Ironically, it is this success at attracting patients that has led to South Africa not marketing itself internationally as a medical destination. As Worrall-Claire puts it: “We are not campaigning for extra patients. Word of mouth seems to be working for us. There is some spare capacity in the hospitals for international patients, of course, but then one of the attractions of healthcare here is that there are no waiting lists.”

Private healthcare in South Africa is dominated by three large groups: Netcare, Medi-Clinic and Life Healthcare Group. These groups do little to promote themselves overseas. 

“We did do some marketing internationally a few years ago, but didn’t see any real benefit from it,” says Adam Pyle, general manager for marketing, Life Healthcare. “We get far more patients from Africa rather than Europe or the US so we market through agents who work in Nigeria, Ethiopia, Zambia, Zimbabwe and so on, and they do some low level marketing and they have contacts with government people.” Mr Pyle also says that most of the work from abroad comes from word of mouth, and through attendance at conferences in Africa.

Another reason for the large groups not marketing abroad is that there is little opportunity for them to expand at home with government-imposed restraints on them expanding their already large share of the private healthcare market. Ironically, this has meant that instead of marketing themselves abroad to attract patients to South Africa, they have gone abroad to continue their expansion.

To take a few recent examples:  Netcare bought the UK’s General Healthcare (better known to patients for its 49 acute-care hospitals business BMI Healthcare), for US$4.3 billion in 2006, and bought a further nine hospitals from its UK rival Nuffield in 2007 for US$275 million, while Medi-Clinic bought Switzerland’s largest private hospital group, Hirslanden Finanz, for U.S$2.4 billion in 2007.

Despite this overseas expansion, there’s no doubt that visitors are travelling to South Africa for treatment, and frequently they find themselves at a private hospital belonging to one of these companies.

Netcare Milpark Hospital, close to Melville in Johannesburg, has a long history of treating foreign patients, both from other parts of Africa and overseas.

In part, this is because of its excellent accident and emergency department. The hospital is designated a US-Level 1 trauma unit and has recently opened a new burns unit. It has two helicopter landing pads outside the trauma unit entrance, while inside, there is a Lodox Statscan machine, originally devised for the mining industry to check whether workers had swallowed diamonds, but now rather more usefully used to x-ray new admissions to check for injuries which might have been missed by paramedics at the time of the accident.

It takes only ten seconds to come up with an image in contrast to 20 minutes for a conventional machine, and emits 75 percent less radiation.

In addition, the hospital has a cardiology and cardio-thoracic surgery unit which has led this field in South Africa, achieving several medical milestones in the process.

Milpark has a total of 342 beds, 90 of which are ICU and high-care beds. The average stay is around 4.5 days, though for the burns unit cases, this can be as high as 30 days in ICU for severe cases. Milpark is currently accredited with the UK’s Healthcare Accreditation & Quality Unit (HAQU), the organisation which superseded the UK’s HQS

Amelda Swart, marketing officer at Netcare Milpark, says the process has been a positive one.

“It’s been a highly valuable in reassessing what you do, and gets people to think about the processes,” she says, though the decision to become accredited by a foreign organisation was not made with medical tourism in mind. The hospital has some 80 resident physicians, many of whom treat overseas patients, but at present, the process is an informal one.

“We encourage medical travel agents to send patients to the doctors we have here, either directly or through us, and we get queries through our website asking to be referred to a relevant physician,” Swart says.

“We have agreements with local guest houses and hotels to accommodate families, and we have a foreign patient liaison officer, Nyembezi Champion, to help with this process.”

Swart says that most of the foreign patients are travelling from Africa, perhaps African nationals or expatriates with medical insurance who visit South Africa for treatment rather than flying home. 

Since there is little incentive for the large hospital groups to market themselves to an international market, you might expect individual medical practitioners to take up the marketing mantle, but there are very strict rules in South Africa for this sort of advertising.

“Historically, we got work by word of mouth and the rules are stuck on the idea that one practitioner can’t have an unfair advantage over another,” says Dr Peter Galatis, a South African dental surgeon with a private practice in Sandton, Johannesburg. The majority of his patients are insured and residents in South Africa, but some 15 to 20 percent are from outside and of those a small proportion are travelling specifically for treatment (excluding emergency cases). He also receives patients from Surgeon & Safari, although he says that if he takes referrals from overseas patients, “our insurers double the premium and halve the indemnity.”

In addition to rules about how medical practitioners promote themselves within South Africa, even down to rules about the size and colour of signs posted outside a surgery, doctors are not allowed to have a photograph of themselves on any website they establish (most ignore this rule), and in addition, are not allowed to make claims about the quality of their work, only that they undertake it. 

Still, if these rules apply to practitioners, presumably this is where medical travel agents can offer a service. They can represent the doctors, make referrals and act as the practitioner’s agent. Unfortunately not, says Lorraine Melville of Surgeon & Safari.

“The first problem there is that as a commercial body, medical travel agents are not allowed to make referrals to doctors. I have been in a dialogue with the various bodies such as South African Medical Association (SAMA, about this, trying to persuade them that medical travel agents should be regarded not as commercial entities, but instead included as professional associations so that patients can be referred. But no luck so far.” 

Yet, despite the fact that private hospitals are clearly commercial entities, they are allowed to make referrals. Ingrid Lomas is managing director of medical travel agent Surgical Attractions: “This ignoring certain rules is indicative of South Africa as it presently is. There’s nothing definitive in place in any regard. Some may see that as a bad thing, and others as a positive thing it allows you the freedom to perform a service you might not be able to if the rules were being enforced.”

Lomas justifies the process, however. “The clients we deal with value our input. We are sending them to surgeons of note, otherwise they would be confronted with a sea of websites and they wouldn’t know which one to choose, and among the plethora of websites are a few that you wouldn’t recommend.” 

Lomas is also clear that the current business environment is not a positive one for the industry. “When medical tourism took off in this country some years ago, websites popped up with people thinking they could make money without doing any work,” she says.

“Most of them are no longer in business because they have found that there is no support for this industry from the government. In fact, there are just a handful of us who are funding medical tourism in this country. We have been lobbying South African Tourism (SAT) for years, but with no luck, and I feel I wasted a lot of time trying to convince them that this industry is of great benefit to the country as a whole because medical tourists spend so much more than a normal tourist.”

In addition, both Surgeon & Safari and Surgical Attractions amongst others formed an Association of Medical Travel Agents in South Africa to try and lobby the government, but “there wasn’t enough support within the industry for it”, says Lomas.

“One of the aims was to lobby for acknowledgement for our services rather than be looked down on by the South African Medical Association. They agree we perform a service, not least because we don’t deal with surgeons who tout themselves, but nothing came of it.”

As a result, Ingrid Lomas estimates that at present there aren’t more than half a dozen medical travel agents active in South Africa, a fairly damning indictment considering the natural attractions South Africa has.

In part, this is because the medical travel agents tend to make their money from a referral fee, but because surgeons are not allowed to pay brokers for referrals, the normal procedure is for the MTA to take a deposit from the patient, with the balance being paid directly to the surgeon. It’s a convoluted process, and since MTA’s generally don’t organise flights because travel agents offer lower prices (or the internet offers transparency of prices), there are few other opportunities to make money (though they do organise accommodation, and get preferential rates with selected hotels). 

So how can things change?

It’s the same story as in many countries. There needs to be government support of the industry in recognition of the benefits medical travel brings to the country.

There is talk of having a health visa for visitors entering for the express purpose of medical treatment, but it is not imminent. In the meantime, patients will continue to travel to South Africa but in smaller numbers compared with the potential.


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