Harvard Professor Glenn Cohen, author of a new book, “Patients with Passports: Medical Tourism, Law, and Ethics.” hit the medical tourism nail on the head this week when he said this in an article entitled “The rise of medical tourism"
Harvard Professor Glenn Cohen, author of a new book, “Patients with Passports: Medical Tourism, Law, and Ethics.” hit the medical tourism nail on the head this week when he said this in an article entitled “The rise of medical tourism”:
“When I go to medical tourism conferences, I am always surprised at how many people are in marketing. It seems like an industry much more dominated by the business and the marketing people rather than the healthcare people.”
He’s right of course. Let’s take the typical medical tourism agency or facilitator. Ask the proprietor for the name and qualifications of the agency’s Medical Director. Ask who develops and who signs off the clinical pathways... who deals with fitness to travel... who is charge of the clinical aspects of case management? In 9 out of 10 cases, you will receive a blank stare. Because the agency’s focus is on sales and marketing... generating leads... turning leads into customers..... After all, it’s the hospital’s job to deal with the healthcare issues, is their thinking.
One of the shortcomings of the medical tourism sector is that around the industry sits a community of advisors, consultants, marketing experts and pundits who lack one vital ingredient... experience and knowledge of the healthcare business. Some are looking for the quick buck - over hyping the medical tourism sector as “the next big thing” without really understanding how healthcare works. They see the industry as about making money. But they don’t really grasp what delivering healthcare services is really about.
Let’s look at a few examples of where the industry’s lack of healthcare understanding and expertise gives rise to problems.
I’ve written about the “medical tourism numbers game” in previous articles. (See “Medical tourism skyrockets”, “The medical tourism numbers game... Part 2”, “McKinsey and the medical tourism numbers game...”). The “$100 billion medical tourism market” sounds like a great place to be. And if you’re selling consultancy or marketing services into the sector, $100 billion sounds like a more impressive figure than $10 billion (which is probably much nearer the mark). The problem arises when you start to convert these inflated claims be they revenue or medical tourist numbers into hospital stays and hospital occupancy.
When someone talks about 50,000 or 100,000 international patients visiting country A or country B or hospital X or hospital Y, the person quoting (or re-quoting) these figures has to understand what 50,000 patients needing inpatient hospital treatment actually means in terms of hospital beds, staffing and resources. Let’s say that the average length of stay for a hospital admission is 5 days. So, 50,000 patients will stay for 250,000 “patient days” (or "bed days") in a hospital. A typical private hospital (in most medical tourism destinations) has around 150 beds (many have less) and is open 365 days a year. So, the total available patient days are 150 beds x 365 days = 54,750 patient days. In reality, hospitals don't operate at 100% occupancy; Most hospitals are staffed to operate at around 75% (if they are doing well!.... and lower than that if they are not.). So, the available number of available patient days is closer to 40,000 patient days.
Compare this with the 250,000 patient days required by our medical tourists... and you’ll see that 6 or more of these 150 bed hospitals will be packed out with medical tourists 365 days per year to service the requirement. Hmmm..........
When a destination or a group of investors is making a decision about a new medical tourism initiative, getting the numbers right is vital for any chance of success. The lack of real numbers and real analysis in the industry is a major barrier to this. Failing to understand these numbers and convert these numbers into real world hospital occupancy leads to bad decisions or the wrong decisions being taken.
If you want advice on finance you go to an accountant... if you want advice on a legal issue, you go to a lawyer. If you want advice on operating and delivering healthcare services you need to go to a healthcare expert.
It’s the doctors, the healthcare professionals, and the healthcare service managers who appear to have missed out on the medical tourism boom. Instead, we have a scenario where “in the land of the blind, the one eyed man is King”. Destinations, hospitals, and clinics which are desperate to get their share of the medical tourism pie get caught up in the hype, and end up being led in the wrong direction by the “one eyed man”. I’m not saying that all industry advisers and consultants are poor... it’s just that there aren't enough good people out here who really understand how healthcare systems and healthcare services work.
A destination must have a very clear idea about its target markets and where the opportunities are for it to attract international patients. If a destination cannot precisely define the niche markets which it wants to exploit, then it will ultimately fail. And to understand where these opportunities exist, you must have an in-depth understanding of the health system, the healthcare needs and patient expectations within the target market. Sadly, this advice is often lacking and leads to another failed medical tourism initiative.
And that’s why Professor Cohen is right. We need to clear away the marketing “fog” and get down to the nitty gritty of what delivering healthcare services across borders is all about. And to do that the the healthcare management specialists, the doctors and the healthcare professionals need to get more involved. In the perfect medical tourism world, patients would be driven by doctor to doctor referral (or doctor to hospital/clinic referral).... based on patient need, not by marketing hype and agency commissions. But it’s not a perfect medical tourism world!
We encourage patients to check out the credentials of the surgeons and clinics; perhaps we should start credentialing industry advisors and business consultants?
As Editor in Chief of International Medical Travel Journal (IMTJ) and a Healthcare Consultant for LaingBuisson, I am one of Europe’s leading experts on private healthcare, medical tourism and cross border healthcare, providing consultancy and research services, and attending and contributing to major conferences across the world on the subject. I am a regular speaker and commentator on medical tourism and the independent healthcare sector.