Health Tourism

Medical tourism: Trends for 2012 and beyond

2012-01-04T13:48:00.000Z

To keep things simple, this blog has moved to the IMTJ web site. You can find the Health Tourism Blog here in future. Here's an extract of the latest blog post entitled: "Medical tourism: Trends for 2012 and beyond"

Medical tourism: Trends for 2012 and beyond
Christmas is over, the New Year is upon us, so it’s time to dust off the crystal ball and put forward our take on what’s in store for medical tourism in 2012 and beyond. We’ve looked at the future of medical tourism from three perspectives – the market, the patient and the industry

The market

The global economic downturn and medical tourism
Forecasts for the global economy are not encouraging....recession in Europe, anaemic growth in the US and slow growth in the emerging market economies is anticipated for 2012 (Morgan Stanley: 2012 Outlook). If you are in the medical tourism sector, you need to understand some of the fundamental trends that affect businesses and markets in a recession.

In the mature, developed economies (e.g. USA, Europe) continued unemployment and pressure on disposable income will influence demand in 2012. Consumers will minimise or reduce spending on healthcare where they can. This does not mean that hard pressed consumers will be flocking abroad for their operations to save money. Many will delay treatment, or in the case of “optional surgery” such as cosmetic surgery, they may not be able to afford it at all. Domestic prices for surgery will be driven down as hospitals apply marginal costing and prices to fill empty beds. In areas of treatment, where the need for treatment is “income-inelastic”, demand for medical tourism services will remain strong. Patients will continue to dig deep for services such as infertility treatment, stem cell treatment, and for surgery which is essential, life-saving or life changing.
In emerging markets (such as Russia, China), the growth in incomes (and freedom to spend) is outstripping the development of domestic healthcare services and this may drive demand for medical tourism and present new opportunities.

The big question is whether corporate or insurer paid medical travel will get off the ground in 2012. Will employers and insurers see medical travel as a realistic and credible option to reduce healthcare costs. And will their client and subscriber base actually “buy in” to the medical travel option if it is offered to them?

Medical tourism..... global healthcare or regional medicine?
In 2012, there’s a risk that we get distracted by the trumpeting of “global healthcare”. It’s a nice turn of phrase, but in the real world, medical tourism is about regional medicine and cross-border healthcare; this is not going to change in 2012. In fact, the boundaries of medical travel may be drawn in, as travel costs increase. As travel costs climb, the concept of long distance medical tourism becomes less attractive. The imposition of hefty departure taxes in countries such as the UK, Germany and elsewhere will reduce the cost advantages of some destinations.

If you are in the medical tourism business, ALWAYS remember that, for most patients, going abroad for treatment is a decision of last resort. AND that the further a patient has to go... further from their own country....further from their own culture... the greater is the actual and perceived risk. The patient needing major surgery who takes a five hour flight to a country with a different language and a different culture is a comparative rarity.

So is it medical tourism boom.... or bust?
The honest answer to this one.... is probably neither. In recent years, we’ve listened to the hype........

.........to find out more about "Medical tourism: Trends for 2012 and beyond", read the full medical tourism article at IMTJ.

Protecting your medical tourism brand on the internet...beware the "brandjacker"!

2011-10-19T10:31:00.000+01:00

To keep things simple, this blog has moved to the IMTJ web site. You can find the Health Tourism Blog here in future. Here's an extract of the latest blog post entitled: Protecting your brand on the internet...beware the "brandjacker"!"

The internet is a great place to market your medical tourism services but because it is difficult to police, it can be easy for a domain name speculator to hijack your brand. Businesses can find that having spent years developing and investing in a brand, one day along comes a domain name speculator or “brandjacker” who aims to profit from the brand value and customer loyalty that legitimate marketers have built.
“Brandjacking” is difficult to combat; the internet crosses international barriers. When someone hijacks your brand or trademark by registering domain names that are clearly related to your business, it can lead to complex and lengthy legal action to protect your marks. There is a set of guidelines about domain name registrations and dispute resolution published by ICANN (the Internet Corporation for Assigned Names and Numbers) that may be of help. See their Domain-Name Dispute-Resolution Policy .

There’s nothing wrong with registering domain names that you may want to use in your existing or future business activities. I met a group of UK doctors once who had registered over 5,000 domain names related to various types of medical procedure. This was in the early days when you paid over $100 for a domain name! In our web publishing business, we own around 130 domain names... not that many... most of which are in active use for our sites. The problem arises when people start registering multiple domain names:

To obstruct the activities of an existing business by incorporating their brand or trademark into a domain name.

To divert visitors from an established web site (often by registering mis-spellings of domains).

To sell the name back to the brand owner at a premium.

.........to find out more about "brandjacking" in medical touris, read the full article at IMTJ: Go to Protecting your brand on the internet...beware the "brandjacker"!

Believe what your customers do...not what they say!

2011-06-17T10:47:00.002+01:00

To keep things simple, this blog has moved to the IMTJ web site. You can find the Health Tourism Blog here in future. Here's an extract of the latest blog post entitled: "Believe what your customers do...not what they say!"

A recent article in Harvard Business Review, “Four Simple Low Resolution Innovation Tests” highlights the problem faced by anyone who is considering investment in the medical tourism business. How can you know whether people will actually buy your service i.e. whether patients will actually travel abroad to use your services?

Much of the “research” conducted in the medical tourism sector is about what people say they will do.... not about what they actually do. For example, the 2009 Gallup Survey in the USA is frequently used to support the “booming medical tourism market” hypothesis.

The report on this Gallup poll was headed “Americans Consider Crossing Borders for Medical Care”. It found that “up to 29% of Americans would consider traveling abroad for medical procedures”.

Now the key words here are “will consider”. It does not say “will travel” or “have travelled”. And there lies the problem.......

.........Read the full article at IMTJ: Go to "Believe what your customers do...not what they say!"

Medical tourism: After the gold rush

2011-06-17T10:43:00.002+01:00

To keep things simple, this blog has moved to the IMTJ web site. You can find the Health Tourism Blog here in future. Here's an extract of the latest blog post on "Medical tourism: After the gold rush"

Last year, I blogged about “Medical tourism...lessons from the California gold rush”. It’s taken me a while to write the postscript to this, but I finally got around to it last week when I spoke at the European Medical Travel Conference in Barcelona. (You can download my presentation “Medical Tourism: After the Goldrush” as a pdf file on the IMTJ web site).

In my gold rush analogy, I describe how in 2005/6, medical tourism became the next big thing.

In Google News for 2006, you’ll see headlines appearing like these:

“One million medical tourists flocking to India”
“Bumrungrad attracts more than 400,000 foreign patients each year”
“Philippines is set to cash in on the $3-trillion global medical tourism market”
“Half a million Britons travel for treatment....”

News stories appeared around the world about a surge in medical tourism. The first prospectors for “medical tourism gold” appeared - medical tourism agents and facilitators, overseas hospitals and clinics were seeking their fortune in the world of medical tourism. The tales of medical tourism gold began to multiply. Estimates of the number of medical tourists were in the hundreds of thousands, the millions, and then the tens of millions. Few medical tourism prospectors questioned the validity of these claims of the discovery of a rich vein of income or whether it was sustainable.......

.........Read the full article at IMTJ: Go to "Medical tourism: After the gold rush"

Comparing quality in medical tourism

2011-06-17T10:40:00.001+01:00

To keep things simple, this blog has moved to the IMTJ web site. You can find the Health Tourism Blog here in future. Here's an extract of the latest blog post on Comparing quality in medical tourism.

How does a medical tourist make a valid comparison of a doctor, hospital or clinic in one country with a doctor, hospital or clinic in another? The simple answer is that he or she can’t. And the truth is that it may never be the case (well not in my lifetime).

In the hypothetical world, we talk about patients making informed choices about treatment....about how we can provide them with the information that they need to compare healthcare providers and make valid decisions about which one is the “best”, the “safest”, the “highest quality”. But even if someone is only interested in treatment within one country, this may be impossible. In a country such as the UK where there is a national publicly funded health system it becomes more of a possibility. In the UK, there are quality indicators, performance measures, and outcome data that are collected in the same way and analysed in the same way across all healthcare providers (whether they are public or private hospitals). So, patients can make reasonably valid comparisons of healthcare providers.

However, in many countries which are promoting themselves as medical tourism destinations, there may be no strategy or system for collecting data on quality, performance and outcomes on a national basis. So, making an “informed choice” even within that country becomes a virtual impossibility.

.........Read the full article at IMTJ: Go to Comparing quality in medical tourism.

A new dawn for cross-border healthcare in Europe?

2011-03-04T11:57:00.004Z

To keep things simple, this blog has moved to the IMTJ web site. You can find the Health Tourism Blog here in future. Here's an extract of the latest blog post on "A new dawn for cross-border healthcare in Europe?"

A new dawn for cross-border healthcare in Europe?
Will European hospitals see a surge in patient numbers following the approval of the EU Directive on Cross-Border Healthcare by the European Parliament recently?

I would like to say...Yes! But the reality may be a little different. So....let’s take a look at how the EU Directive may (or may not) change the way that healthcare works in Europe and more importantly whether it will give a boost to the medical travel sector.

Consolidation of existing patient rights
The EU Directive does not give patients any rights to cross border healthcare that they don’t have already. It doesn’t introduce any new rights. These rights have already been established by the European Court of Justice. What the Directive aims to do is to establish a framework within which cross border healthcare will operate and to set the rules regarding how patients will access care and what kind of treatment they are entitled to. The new rules should be in place by 2013 (in theory....).

The Directive will end the uncertainty about the kind of treatments that patients are entitled to elsewhere within Europe and it will also allow domestic healthcare systems to maintain control of the patient’s entitlement to cross border healthcare. But the Directive does present opportunities for hospitals and healthcare providers to generate revenue from patients from elsewhere in the EU.

But overall, there will not be an overnight change and we are unlikely to see a surge in the number of cross border patients within the EU.

Within the UK, there are already well established procedures for National Health Service patients who wish to exercise their right to cross border care under existing EU law. Every NHS trust has (in theory) a procedure in place to deal with requests and to manage the process. See “NHS Choices - Planned treatment abroad”. Last year, it is believed that around 500 British patients exercised their right to cross border healthcare and underwent treatment abroad that was funded by the NHS.

.........Read the full article at IMTJ: Go to "A new dawn for cross-border healthcare in Europe?"

The medical tourism numbers game... Part 2

2011-01-13T13:13:00.001Z

To keep things simple, this blog has moved to the IMTJ web site. You can find the Health Tourism Blog here, in future. Here's an extract of the latest blog post on "The medical tourism numbers game... Part 2"

The medical tourism numbers game... Part 2
Back in May 2008, I blogged on “McKinsey and the medical tourism numbers game..." and commented on their strange way of counting (or not counting) medical tourism numbers. Given the latest study on medical tourism numbers, “New study numbers US medical tourists in thousands not millions”, reported in IMTJ, I thought it was time once again to address the thorny issue of....how many medical tourists are there?

Defining the medical tourist
Before you can begin to count medical tourists, you have to be very clear about what it is you are counting. This is one of the greatest areas of confusion in the business sector.

So, what is a medical tourist?

In my view, a medical tourist is someone who travels outside of their own country for surgery or elective treatment of a medical condition. If we apply this narrow definition, we DO NOT include:

dental tourists
cosmetic surgery tourists
spa and wellness travellers
"accidental" medical tourists (business travellers and holiday makers who fall ill while abroad and are admitted to hospital)
expatriates who access healthcare in a foreign country.

Read the full article at IMTJ: Go to "The medical tourism numbers game... Part 2".

Is medical tourism safe?

2011-01-13T13:10:00.002Z

To keep things simple, this blog is moving to the IMTJ web site. You can find the Health Tourism Blog here, in future. Here's an extract of the latest blog post on "Is medical tourism safe?"

A significant proportion of medical tourism and medical travel is driven by people seeking established and proven treatments in countries where the cost of the treatment or operation is much lower than in their home country. Within this segment of the market, the focus of patient safety is upon the hospital, clinic or doctor who is carrying out the treatment. Can the patient be confident that the healthcare provider has the necessary expertise and experience to carry out the procedure? The question... “Does this treatment actually work?” does not arise.

For proven treatments, the hospitals, clinics and doctors (and medical tourism facilitators) can reassure the patient by providing proof of qualifications, accreditations; experience and so on.... and in some cases may be prepared to provide data on clinical outcomes. Unfortunately, this is all too often lacking. Patients are often asked to take on trust the claims of the healthcare provider, particularly in those countries that do not have national standards and systems for the collection of comparative clinical outcome data or independent review and analysis. Even an international accreditation such as JCI is not a guarantee of quality, nor an assessment of how good a hospital actually is at delivering safe and successful treatments.

So, in established areas of medical travel such as cosmetic surgery, dental treatment and elective surgery there is still much work to be done to convince potential medical tourists that treatment abroad is a safe option (or at least as safe as within their home country).

Read the full article at IMTJ: Go to "Is medical tourism safe?"

Predicting future demand for medical tourism: Health tourism blog is moving to IMTJ

2010-11-25T17:15:00.005Z

To keep things simple, this blog is moving to the IMTJ web site. You can find the Health Tourism Blog here, in future.

Here's an extract of the latest blog post on "Predicting future demand for medical tourism".

The latest data on hospital activity within the UK National Health Service provides a useful indicator of where future demand for medical tourism may lie. One of the advantages of the UK public health system is that with one provider....the NHS, and one payor....the NHS it means that an enormous amount of meaningful data can be captured about the state of the nation’s health, about demand for health services and about how the health profile of the population is changing.

Like many developed countries with established health systems, the UK is facing the challenge of meeting the needs of an ageing population at a time when there is massive pressure to reduce or put a hold on public spending, and in effect reduce expenditure on health services. All UK hospitals collect data in the same way (well almost...) and the data is collected centrally by the NHS.

The following data is taken from the recent report “Hospital Episode Statistics: Admitted Patient Care – England 2009/10”, published by the NHS Information Centre.

Take a look at how demand for NHS hospital services has changed over the last ten years. First let’s examine the age profile of patients admitted to UK hospitals:

In 2009/10 there were:

16,806,200 hospital stays, a 38 per cent rise on 1999/2000.
1,939,190 stays for patients aged 0 to 14; a 15 per cent rise on 1999/2000.
7,333,110 stays for patients aged 15 to 59; a 29 per cent rise on 1999/2000.
3,642,940 stays for patients aged 60 to 74; a 48 per cent rise on 1999/2000.
3,837,990 stays for patients aged 75 and over, a 66 per cent rise on 1999/2000.

Read the full article at IMTJ: Go to "Predicting future demand for medical tourism".

Comparing the costs of (accidental) medical tourism

2010-10-06T20:34:00.008+01:00

Whereas much of the attention in the medical travel sector is focused on medical tourism (i.e. where the primary reason for travel is some form of surgery or treatment), a more established and mature market sector is the provision of healthcare services for the tourist or business traveller who falls ill when abroad.

The structure and maturity of this sector means that it is far easier to gather comparative data such as the cost of healthcare and actual treatment in different countries. Cost management is in the hands of the international insurers, the travel insurance companies and the assistance companies who negotiate prices with hospital providers worldwide.A recent analysis of travel insurance claims, published by the UK based travel insurer, Sainsbury’s Travel Insurance, provides an insight into the variation in hospital costs across the world and the rising trend in hospital costs.

According to their analysis:

In 2009, a record number of people needed medical treatment whilst abroad.
The most expensive country for inpatient hospital treatment was the United States, with the average hospital visit costing £6,000.
The average cost of hospital treatment in a foreign country has climbed to £2,040 over the last 12 months, an increase of 6.25% year-on-year.
The most significant increase in treatment costs were seen in Turkey (+10%), the USA (+10%) and Spain (+7.5%).
Over the summer months (May to September), the most common reason for hospitalisation was gastroenteritis with the average bill for inpatient treatment amounting to £1,200.
The most expensive hospital bills were for those who suffered a heart attack abroad, resulting in medical expenses that averaged £12,500.

It’s interesting that the international assistance companies who deal with these "accidental" medical tourists have shown little or no interest in entering the medical tourism business. They have everything in place to become the world’s number one facilitator and blow everyone else out of the market:

They have a network of “approved” hospitals around the world.
They facilitate treatment for thousands of international patients in foreign countries every day.
They have call centres to deal with patient enquiries.
They have extensive technology and systems to manage the patient process.
They have people on the ground in major destinations who can provide local support.
They have comparative data on treatment outcomes and comparative costs in hospitals around the world.

So, why haven’t companies like Europ Assistance, Mondial Assistance and AXA Assistance entered the medical tourism market and used their expertise to attain a dominant market position?

The answer is probably quite simple. The medical tourism market is just not big enough to be attractive to them, nor worth the hassle. Which is good news for the existing operators...but puts the medical tourism market opportunity in perspective compared to the long established international assistance market.

The slumbering giant of medical travel?

2010-08-27T17:41:00.011+01:00

Where do you think the international patients' centre shown above is? Singapore? Thailand? Malaysia? India? Korea?

Read on to find out...

This week’s International Medical Travel Journal covers a recent announcement by the UK Department of Health (See: Liberated UK hospitals to attract medical tourists) that it plans to remove the cap on the proportion of income that NHS hospitals can earn from private surgery. NHS hospitals are allowed to treat private patients (both domestic and international patients) in addition to their primary responsibility for serving the needs of the UK public.

Many NHS hospitals have private patient wards or dedicated units which benefit from their location close to the extensive clinical resources and medical technology which are available with an NHS general or teaching hospital. These are well supported by private patients but these NHS units have been restricted in terms of their revenue potential; across the UK, NHS hospitals were not allowed to generate more than 2% of their income from private paying patients. Some individual hospitals were allowed to generate a much greater proportion but were still limited in their revenue earning potential.

At medical tourism conferences around the world, the UK gets barely a mention. Yet it ranks in the top ten destination countries in terms of medical tourist numbers and probably in the top five in terms of revenue generated (Source: Team Tourism Consulting 2010). London continues to attract high value medical travellers seeking expertise and quality rather than the lowest prices. The average treatment cost for these patients is around £20,000, and for individual patients it can be much more. London also benefits significantly from the related expenditure of these medical travellers e.g. accommodation for friends and family during these extended patient stays.

Private patient facilities at leading London teaching hospitals such as Moorfields Eye Hospital, Great Ormond Street Children's Hospital, Royal Brompton & Harefield Hospitals, Kings College Hospital, Royal Marsden Hospital, and Guy’s & St Thomas’ Hospital have always been attractive to international patients and they compete with other international centres of excellence in countries such as the USA and Germany . Indeed, these NHS private patient facilities earn more from international private patients (medical tourists) than they do from UK private patients.

The Harris International Patient Centre at Great Ormond Street (pictured above) is a good example. The Centre has 130 staff, working with over 170 clinicians in Great Ormond Street Children's Hospital. It’s bigger than most international patient departments serving “medical tourists” that you would find anywhere in the world. And it’s very busy. But, until now Great Ormond Street and similar NHS run international patient facilities have been limited by the private patient income cap.

That is about to change... London “the slumbering giant of medical travel” may wake up to some of the newly emerging opportunities presented by the international patient market:

The London hospitals mentioned above have a long and impressive track record in attracting international patients.

They were involved in medical tourism long before the term was invented.

And they are able to provide quality and prices that will be attractive to many emerging source markets for medical travel. For example, if US derived medical tourism does eventually take off, and American patients can make significant savings by travelling to London for major surgery (not far short of those available in Singapore or Thailand), would London be an attractive option? Same language (...almost), same culture (...almost).

This American who travelled to Wales for surgery may be the start of a growing trend....

Change in UK regulations may reduce infertility tourism

2010-08-24T10:45:00.003+01:00

One factor that can affect any aspect of medical travel and medical tourism is that the market sector can be a victim of its own success. Constantine Constantinides has highlighted this previously in his IMTJ article “Medical Tourism and the West's Revenge”, arguing that in effect the success of medical travel is self limiting.

How can this success be self limiting?

Where overseas treatment becomes an attractive option for patients, domestic providers and governments may react to this trend by becoming more competitive (e.g. by reducing prices for local treatment) or by removing the causes and drivers for medical travel (e.g. by changing local regualtion of a treatment). Thus, the more patients travel abroad for treatment, the greater will be the reaction within the domestic market and a “balance of trade” will be reached.

An excellent example of this phenomenon is this week’s announcement by the Human Fertilisation and Embryology Authority (HFEA) that it intends to conduct a consultation over changes to the rules governing egg and sperm donation in the UK. There has been a significant shortage of egg and sperm donors in the UK due to the restrictions on the payments that can be made to donors. The £250 maximum "compensation" payment for both men and women donors has meant that demand for donor eggs and sperm has far exceeded supply. Waiting lists can be as long as two to three years for those patients eligible for NHS treatment.

The removal of donor anonymity has also been a contributing factor to the reluctance of donors to come forward. According to the most recent HFEA statistics (2008), only 1,184 women donated eggs and there were only 396 new sperm donors in 2008. Around 2,000 babies a year are born in the UK using donated eggs, sperm or embryos. As a result, we have seen an increasing number of UK couples seeking infertility treatment abroad; it has been one of the fastest growing areas of medical tourism. (For the background see “New research paper provides insight into infertility tourism”). The response from the HFEA to the increasing number of infertile couples going abroad is therefore to consider how to reduce this ...... by increasing the payments and incentives to egg and sperm donors, AND thus increasing the supply of eggs and sperm. Payments may increase to £1,000 plus.

It’s unlikely that the changes will have any immediate effect on the market sector. No decisions will be made until the end of the HFEA public consultation next year. The three-month public consultation will not start until January 2011 and the HFEA is expected to be subsumed into the UK’s Care Quality Commission as a result of the UK public expenditure cuts. But there’s a clear warning here for those involved in medical tourism businesses and the medical travel sector. Don’t put all of your eggs in one basket..... Or more seriously, be aware that any segment of the medical tourism market may be limited by its own success when domestic providers and governments seek to reverse the trend.

Medical tourism...lessons from the California gold rush

2010-07-27T15:49:00.008+01:00

In 1848, gold was discovered in California by John Sutter, a German immigrant. News of the find spread rapidly and thousands arrived in search of their fortune. Prospectors came from across the USA, from Hawaii, Mexico, Chile, Peru and China. The California gold rush had begun. California’s output of gold rose from $5 million in 1848 to $40 million in 1849 and $55 million in 1851. But there wasn’t enough gold to go around....only a minority of gold miners made much money from the Californian Gold Rush...the best equipped, the best informed, the best organised and resourced.

Others also made money; the saloon owners (and brothel keepers!) who kept the prospectors entertained made a healthy profit, and so did the entrepreneurs and store owners who provided the supplies and tools that the prospectors needed (often at exorbitant prices).

Are there some parallels and some lessons here for those involved in the medical tourism gold rush?

The discovery of medical tourism gold....
Although the concept of travelling for treatment has been around for centuries, it was probably around 2005 when the medical tourism gold rush really took off; it still continues today and shows little sign of abating. News stories appeared around the world about a surge in medical tourism – patients travelling to save money on treatment costs (as opposed to seeking medical services and healthcare quality that were unavailable in their own country). The first prospectors appeared - medical tourism agents and facilitators, and overseas hospitals and clinics seeking their fortune in the world of medical tourism.

Word spreads, prospectors pursue the dream of medical tourism gold....
The tales of medical tourism gold began to multiply. Estimates of the number of medical tourists were in the hundreds of thousands, the millions, and then the tens of millions. Few medical tourism prospectors questioned the validity of these claims of the discovery of a rich vein of income or whether it was sustainable.

Those involved in the early gold rush exaggerated their successes, claiming massive finds (e.g. “one million medical tourists to....), encouraging others to join the frenzy. Healthcare providers in countries all over the world entered the race - Singapore, Malaysia, Korea, Jordan, the Philippines, Tunisia, Turkey, Eastern Europe, many of them backed by their tourism boards, health departments and government initiatives who saw medical tourism as a rich source of foreign currency.

....without thinking or understanding what’s really involved
New entrants pursued the dream without really thinking through their strategy and approach to the market. Some went into the market ill equipped; some went into the market without realising what it might cost to be successful; some went looking for medical tourism gold in completely the wrong place!

A community of medical tourism prospectors develops
As the number of medical tourism prospectors grew, others (the saloon keepers) arrived quickly to profit from this growing community, and store owners and tool suppliers appeared to guide the prospectors in their pursuit of gold.

The saloon owners arrived in the form of the associations and medical tourism conferences that make their money from membership fees and delegate fees. They provided a place where the prospectors could get together, but they also built on the hype, retelling stories of the latest discoveries and attracting more people to the medical tourism gold rush. Of course, the more people in the gold rush, the more people there are in the saloon, and the more money there is to be made by the saloon owner.

The entrepreneurs and store owners also arrived on the scene to provide the tools that the prospectors needed to mine medical tourism gold. Web sites like our own (Treatment Abroad) that link patients with providers, systems companies like Health Travel Technologies and e-Medsol that provide the systems to manage patients, and consultancies, strategists and advisers like Irving Stackpole and Vivek Shukla who help the prospectors to locate medical tourism gold came into being. Are these entrepreneurs and store owners (including my own Treatment Abroad "store") taking advantage of uninformed prospectors by providing poor quality services and products and overcharging for them. Or are they providing sensibly priced services and much needed tools that will bring long term success to those who use them wisely? Only time will tell.... and it will be the success of the prospectors who determine our success.

The gold runs out...or is harder to find and mine
As in the California gold rush, reality has failed to live up to expectations for many prospectors. Clinics, hospitals and facilitators are finding it harder to acquire patients and there’s a great deal of competition out there. Nevertheless, for many the gold rush mentality continues.

After the gold rush?
So, what’s the likely outcome of all this? What can we expect in the next stage of the medical tourism gold rush? In my next blog post, I’ll give some thought to who will strike gold and how will the industry develop.

New research paper provides insight into infertility tourism

2010-07-01T17:20:00.006+01:00

A recent paper presented at the Annual Meeting of the European Society of Human Reproduction and Embryology in Rome highlights the growth of “infertility tourism” at a time when many medical tourism businesses are feeling the pinch of the recession.

The article, “Cross border reproductive care in six European countries” provides a review of inbound infertility tourism to six European countries receiving patients - Belgium, Czech Republic, Denmark, Slovenia, Spain and Switzerland. Data was collected from 46 centres in these countries. Patients came from 49 different countries, but almost two thirds came form only four countries - Italy (31.8%), Germany (14.4%), The Netherlands (12.1%) and France (8.7%).

Drivers of infertility tourism
Why are these infertile couples crossing borders for infertility treatment? It varies from country to country but the main driver is the law on infertility treatments within the home country. This is the predominant reason for patients coming from Italy, France, Germany, Norway and Sweden. Italian law banned sperm donation in 2004; German law bans egg donation; in France, assisted conception for single women or same sex couples is illegal and there is a ban on advertising for egg donors; regulation regarding donor anonymity affect Scandinavians and British patients; some countries have regulations that limit reimbursement of assisted conception to a maximum age.; some countries have legal limits on the amount that can be paid to donors thus reducing availability of sperm and eggs.

Difficulties in accessing treatment at home were a driver for a third of UK patients, and a wish for “anonymous” donation was expressed by around one in five patients.
There’s also some indication of specific cross border flows: Italians favour Switzerland and Spain, the Germans prefer Czech Republic, the Dutch and French opt for Belgium.
18.3% of patients were looking for semen donation, 22.8% for egg donation and 3.4% for embryo donation.

Market opportunity for medical tourism businesses?
The study estimated that “a minimum estimated number of 11 000–14 000 patients per year” visits the six countries in the study; it may well be much higher than this.

If you’re in the medical tourism business, download the paper; it’s a useful insight into the opportunities in infertility tourism and to the kind of patients that seek it..... which should be a major influence on your marketing. Understanding your market is key to the success of any medical tourism business. For example, the internet was a frequent source of information about infertility treatment abroad in Sweden (73.6%), Germany (65.0%) and the UK (58.5%).

So, it’s good news for my healthcare web publishing business that a Google UK search for “infertility treatment abroad” brings up Treatment Abroad at number 1 and our other sites in positions 2, 3, 4, 6 and 10 in the top ten Google UK results!

Patient choice in medical tourism...Let's hear the patient's voice

2010-05-25T15:14:00.012+01:00

The recent Medical Tourism Climate Survey conducted by IMTJ for the European Medical Travel Conference 2010 provided an interesting insight into the current state of the industry and how people in the industry are thinking about medical tourism. The survey analysed the views of over 250 people involved in medical tourism from 55 countries. One particular question that drew my attention was one that asked people in the industry about the factors that influence patient choice. The question was this:

“What factors do you think are important to medical tourists when they choose a healthcare facility or treatment provider abroad?”

Expertise and qualifications of the doctor/dentist ranked first. Comments and ratings by other patients ranked second.

It’s the high ranking of “patient opinion” that surprised me, given the industry’s apparent reluctance to “buy in” to the concept of patient ratings and reviews. Hospitals worldwide are investing large sums of money in accreditation and quality standards, sometimes as a marketing tool to attract patients and referrers. But very few patients have any idea what JCI accreditation means, or how this can help them to compare quality at different hospitals.

So, how are patients comparing competing destinations and healthcare providers?

As patients evolve into healthcare consumers, they are considering the purchase of healthcare in much the same way that they consider the purchase of any consumer good or service. And medical tourists are no different.

Let’s consider the tourism or travel element of medical tourism and medical travel. When consumers are booking a holiday or a hotel, what do they do and where do they go to gather information that will guide their choice. To determine price and availability they visit travel and holiday portals online. Sites such as Lastminute.com and Expedia attract massive volumes of traffic. And where do these consumers go to gather “opinion” about quality and services at their destination or hotel. Travel consumers want to hear from “people like me” before they buy.... which is why TripAdvisor has become one of the busiest web sites in the travel sector.

So, what are the options for medical tourists who want to hear from “people like me” before they buy? Many patients whether they are travelling patients or “stay at home” patients make extensive use of patient forums before they make a decision on treatment at home or abroad. Infertility treatment abroad is a good example. Take a look at the Fertility Treatment Abroad section of the FertilityZone web site, and some of the discussions that take place around the services provided by various IVF and infertility clinics abroad:

Clinic Fiv Madrid, Spain - 620 comments and 22,219 page views.

IVF in Norway -- 122 comments and 12,431 page views.

If you were a patient seeking infertility treatment abroad what would influence your decision more....

The accreditation status of the clinic?

The qualifications of the doctor?

The views of other patients?

I’m willing to bet that the views of other patients....“consumer opinion” would be the major influence on your decision. (Obviously, for IVF treatment, patients would also be looking at outcome data/fertilisation rates published by the clinic). This seems to be the conclusion reached by the respondents in the IMTJ Medical Tourism Climate Survey.

So...why hasn’t the medical tourism sector bought into patient ratings and reviews?

At Treatment Abroad, we were the first to enable medical tourists to rate and review overseas hospitals and clinics. At Medical Tourism Ratings and Reviews, patients can score these clinics and post their comments about the service and treatment received. To enable this, we invest heavily in Bazaarvoice, the world leaders in online rating systems to manage our new service. They make sure that only valid reviews make it on to our medical tourism reviews site. The moderators are well educated, trained and tested to ensure only appropriate user-generated content gets posted. Nevertheless, we are disappointed in the adoption of this reviews system by our clients.

When we promote the reviews system direct to patients and people who have enquired about treatment abroad, we get excellent take up. Patients are keen to share their experiences and benefit from other patients’ experiences. Similarly, some of our clients see the benefit of allowing patients to rate and review their services and actively encourage their past patients to visit the site and post a review. The system is free. It doesn’t cost the client a penny extra to participate. But many of our clients are less enthusiastic about patient reviews.

Why is there reluctance to encourage patient reviews for medical tourism?

The most common objection from clients is that they are worried about negative reviews. What happens if a patient actually says something that they don’t like?

Well, as all of the hotels and holiday providers on Trip Adviser know, a negative review may affect their business negatively. Or will it?

On Medical Tourism Ratings and Reviews, we publish negative patient reviews, as long as they are not profane or violate other rules of moderation, such as raising litigation or malpractice issues.

Negative patient reviews are valuable

Negative reviews are of value to the healthcare provider and to healthcare consumers. Negative reviews show credibility – if there are nothing but 5-star reviews for your services, healthcare consumers get suspicious about the authenticity of the content.

Negative reviews also give objective feedback and help healthcare providers uncover blind spots. Perhaps there was a breakdown in a process or poor communication with the patient, or some misinformation in the description of your services on your website. Direct feedback from your patients is the most transparent way to uncover these issues and get them solved quickly.

When we publish a negative review on Medical Tourism Ratings and Reviews, we give the client a chance to respond – to explain what went wrong and to say what they are doing to put things right. Negative reviews which we reject and do not publish (but we do pass to clients) are also incredibly valuable. When patients are upset with your service or their treatment, they sometimes get angry, which can cause them to violate the terms of our review system, use profanity, threaten legal action or go off on a tangent – all things that can lead us to reject a review.

Don't ignore negative patient reviews

It’s important for healthcare providers not to ignore this information, because if you can uncover and solve a legitimate problem, and complete the circle, it makes it less likely that the patient will spread their rancour to blogs, forums, and other places where you are unable to see, control or address their comments.It’s important for healthcare providers to review all negative content, so they can uncover service or system improvements to improve future patient interactions.

The message... it’s time for medical tourism providers to start actively encouraging patients to rate and review their services and to start listening to what patients have to say. Accept that sometimes things do go wrong, that patients will be unhappy and will want to tell the world.

You may learn more from getting something wrong than you do from getting something right.

Wales....... the latest medical tourism destination for US patients?

2010-04-29T13:26:00.017+01:00

A recent news story on CNN attracted my interest when it featured a US patient who travelled to Wales (in the United Kingdom) for sinus surgery to save money. It was headlined “'I can't afford surgery in the U.S.,' says bargain shopper”. It’s an interesting story which shows how the media can sometimes put a slant on a story to create news, but it does highlight some real opportunities for medical tourism providers.

The story (view the CNN video) tells us about Godfrey Davies, an American, who needed sinus surgery. It tells how he “set out on a mission to find an affordable surgeon”, and was appalled at the costs that he was going to incur in the USA. The story was picked up by a multitude of other web sites who took it at face value.

If you view the video, you get one impression. If you dig a little deeper, you actually get to understand the full story and where this patient fits within the medical tourism marketplace.

As a Brit, I found it a bit odd when I viewed the video. My first impression? Here’s a story about an American guy travelling all the way to Wales for surgery....... Why would he do this? And why Wales? But then I dug deeper. It was in fact a story about someone who started life as a “Welsh bloke”, became an “American guy” and went home for an operation. There’s a clue in his name (Davies...it’s a Welsh surname) and in his slightly odd accent (It’s a Welsh accent). Godfrey comes from Wales. It is where his family lives. He’s a UK and a US passport holder. He married an American and became a US citizen in 2002. He doesn't have health insurance in the US because he believes that the quoted premium of $1,000 per month is too much. He says that "with the deductible and co-pay, I would have had to pay more in over three and a half months than coming home to Wales."

So, what can medical tourism businesses learn from this story?

Firstly, don’t take news stories at face value. There’s sometimes an underlying logic to a news story which the media doesn’t always fully expose. It may make the news less newsworthy. In this case, it’s understandable why a Welshman (as opposed to an American) might choose Wales as a medical tourism destination.

Secondly, it highlights one of the key factors in why people select medical tourism destinations. Godfrey Davies chose Wales because it is an excellent cultural match, there is no language problem for him, and he feels 100% safe there. And it’s cheap!

Godfrey went to the BMI Werndale Hospital in Bancyfelin, Carmarthenshire. It is part of BMI Healthcare, Britain's leading provider of independent healthcare with nearly seventy hospitals and clinics nationwide. To give you another example, I myself had a total knee replacement at one of BMI Healthcare’s hospitals near London, The BMI Clementine Churchill Hospital. How much would it cost for a knee replacement in an American hospital? $50,000. How much did it cost me in the UK? £10,000 all in ($15,000). The UK price is cheaper than Korea ($17,800), and not far off the prices that Americans pay in countries such as Thailand ($12,000) and Singapore ($10,800). Given the cultural and language match, and the lower travel cost, if you were an American which destination would you choose?

Thirdly, it’s a great example of the kind of American medical tourists that some medical tourism businesses should be targeting..... people from their own country. Thus, the biggest and most realistic opportunity in the USA for Korea based medical tourism providers is most likely to be Korean Americans. Target the easy win, if you want to succeed.

Fourthly, it supports the argument that the UK might actually be an attractive medical tourism destination for US patients. Despite the different accent, there’s no language barrier! There’s a public healthcare system that delivers excellent outcomes. And there’s a private hospital system that already provides treatment for patients from all over the world who travel to the UK to access healthcare quality and expertise. And...... as Godfrey Davies has demonstrated, you can save an awful lot of money over UK prices.

How much does private treatment cost in the UK?

In addition to Treatment Abroad, we also run various UK health information sites. One of these is Private Healthcare UK. It will tell you all you need to know about private treatment in the UK.

If you want to know what UK private treatment costs go to Private hospital treatment - What does it cost? and select an operation.

And if you’re an American (or a Welshman) and you want to follow in Godfrey Davies' footsteps, you can get a quote for UK surgery by completing the enquiry form for UK private hospital treatment.

The US healthcare reforms and medical tourism

2010-04-02T12:46:00.008+01:00

Caroline Ratner at IMTJ has just published a summary of US reaction to the Obama healthcare reforms from the medical tourism sector, so I suppose I had better throw my comments into the mix.

First, let me stress that I am by no means the world expert on the US healthcare reforms! (Does one exist?) But I have been asked by the UK media recently to comment on the reforms and in particular to comparisons with the UK healthcare system. It’s been interesting to watch from afar how a nation is having to deal with both rising healthcare costs and demands for increased expenditure on healthcare.

It’s acknowledged that the USA is one of the most expensive healthcare systems in the world, spending 15.3% of the nation's GDP on healthcare (WHO statistics). This compares to around 8.2% of GDP for the UK and similar for other European countries. Despite the high expenditure, the USA gets atrocious value for money out of what it spends.

Take a look at these comparisons:

The UK spends less than half the amount per capita compared to the USA, but provides a similar number of doctors, more nurses and more beds per 10,000 citizens. Not bad value for the taxpayer's money.

Despite these facts......in the healthcare reform debate in the US, the UK NHS has been used as an example of “how not to do it” and at one point those campaigning against the reforms launched a series of television adverts using “tragic” stories from Britain's National Health Service to contest Barack Obama's plans. The reality of the UK NHS is rather different... it works pretty well most of the time and it costs the nation half of what the US spends (as a percentage of GDP). If .......you were a US politician and could wave a magic wand which would transform the US healthcare system overnight to an NHS system of universal healthcare, free (in most cases) at the point of delivery, AND it would cost the country half the money....what would you do. It’s a no brainer. But there are no magic wands.

The perception of the NHS overseas is very different to the experience of the NHS within the UK Here’s a couple of recent, typical quotes from US industry commentators on medical tourism and the US healthcare reforms:

“People from UK and Canada is (sic) not looking for treatment outside their countries because of being denied of healthcare insurance or financial constraints, it is because of high cost of care and extensive waiting times for elective surgeries”
“ (the reforms) will also potentially create long waiting times for medical procedures which will create situations like in Canada and the UK, where patients travel outside their country because of long queues for important surgeries.

Note the references to the long queues and extensive waiting times in the UK. This kind of uninformed and factually incorrect comment does little for the credibility of the medical tourism industry. It’s political dogma.

Here are the hard facts on UK waiting lists:

The average NHS waiting time from referral to treatment is around 8 weeks. It’s often much shorter.
Anyone suspected of having cancer has the legal right to wait no more than 2 weeks to see a specialist
Anyone referred for elective procedures has the legal right to start treatment within 18 weeks
If there is a significant waiting list in your local area, you have the right to exercise patient choice and go to another hospital anywhere else in the country to avoid the wait. (internal medical tourism). You can also compare outcome data, infection rates and many other data online through NHS Choices
If you have a serious and life threatening problem, there’s virtually no waiting list. That’s why I’ve only ever met one British heart surgery patient who has gone abroad for treatment. Despite this, I’m regularly amazed by overseas providers or consultancy companies who call me to discuss their plans for attracting British patients overseas for major surgery such as heart bypass.

And here’s some recent “real life” experience.

The Web Communications Manager at my company recently celebrated the birth of his first child. Unfortunately, the birth was at 27 weeks so it has not been easy for him or his wife. The child has been in paediatric intensive care for some weeks in a local hospital, and has recently been transferred to Great Ormond Street Hospital in London for heart surgery. Is he happy with the NHS care?....Yes. Has it cost him a penny?.... No.
My wife has a recurrent inflammatory problem at the back of her eye. She has regular assessments at the local NHS eye unit, and recently went for a minor procedure. It was urgent, so she didn’t have to wait. She went to the brand new eye state of the art NHS eye unit at Stoke Mandeville Hospital. How long did she wait?..... a week or so. How much did she pay?..... Nothing?

Are British patients flooding overseas for treatment because of “long queues” and “extensive waiting times”? No. The majority of UK medical tourists are not patients requiring elective surgery that they can’t get or will not wait for on the NHS. The reality of healthcare is that patients want affordable (or free) treatment close to home, or within their country. Before they even consider going abroad for treatment, they explore all the avenues for treatment within their own country.The NHS has its faults, of course, but no system is perfect. And would I swap our NHS for the current US model? No, I couldn’t afford it..... either as an individual or as an employer!

So, will the Obama healthcare reforms lead to a massive surge in medical tourism, as some have suggested? No.

Medical tourism will continue to grow as more patients become aware of the possibility of low cost treatment abroad. But we should never forget that what every patient wants is affordable healthcare on their own doorstep.....and travelling for treatment is for many a last resort.

Medical tourism statistics: Comparing apples with apples ....

2010-03-12T22:28:00.004Z

At Treatment Abroad, we’ve recently completed some research into the medical tourism market for a third party. It’s been an interesting exercise and has really made us question some of the statistics that are quoted (and that often become accepted truth) about the number of medical tourists and the value of the market.

What is a medical tourist?
The first challenge in estimating market size is to be very clear about what a medical tourist actually is. He or she isn’t a tourist. It’s someone whose specific reason for travelling to another country is for medical treatment. It’s not someone who happens to fall ill and requires treatment when they are on holiday/vacation.

Yet many tourism organisations, government bodies, hospitals and clinics classify ailing holidaymakers as medical tourists. They are not.

The data from one destination that we examined claimed vast numbers of medical tourists but in the “small print” acknowledged that the vast majority of these happened to fall ill while visiting the country for other reasons, either business travel or holiday travel.

Another inflationary factor is the expatriate resident. Back in the 1990’s I was involved in the marketing of the Portland Hospital for Women and Children in London. We used to track hospital admissions by nationality of patient. Based on that analysis, the hospital was the biggest medical tourism destination in the world for American medical tourists..... or was it? Of course not. As the only private maternity hospital in London, it attracted a large number of American women whose families were based in or working in London. Did a single American woman fly across the Atlantic specifically to give birth or for gynaecological treatment in London? No, but we could have made it look like plane loads were arriving every month!

Comparing apples with apples
Before the dawn of computing, I studied statistics at college. What I learned about statistics is that you have to compare like with like. You compare apples with apples. But in medical tourism people compare apples with grapes, and oranges with lemons...... Let me explain....

Let’s agree that a medical tourist is someone who travels specifically for treatment in another country, And let’s also agree that medical tourism is a specific segment of the health tourism market which does not include travel to medical spas or wellness resorts or for non-invasive therapy. For the sake of clarity, we’ll exclude dental travel from medical tourism in this instance.

So John Smith jumps on a boat or a plane or a train or into a car and crosses a border into another country and has...an operation or an elective procedure. (Should we include patients who don’t stay overnight? There’s another discussion...).

Are we agreed on what a medical tourist is? Good. John Smith is a medical tourist. He’s one medical tourist, isn’t he?

Well..... that depends where he goes.

In Country A (or in Hospital A), he counts as one medical tourist.

But in Country B (or Hospital B), he counts as 20 medical tourists.

20...am I mad? No.

This is how it works in Country B.

John Smith arrives in Country B. He visits the specialist, and the hospital raises an item of service bill for the visit. The hospital records him as one medical tourist treated.
The specialist sends him for an X Ray. The hospital raises an item of service bill for the visit. The hospital records him as another medical tourist treated.
The specialist sends him for some pre op blood tests. The hospital raises an item of service bill for the visit. The hospital records him as another medical tourist treated.
He has the operation. Bingo! Another medical tourist.
He collects some medication from the hospital pharmacy. Another medical tourist.
He has post op physiotherapy for ten days.... ten medical tourists.
And so it goes on.....

John Smith is one medical tourist but according to the hospital records he’s twenty or thirty or maybe even more. And this is good news for the marketing guys in the hospital and at the tourism board. They have some pretty impressive medical tourism statistics.

So, we can see that the medical tourism statistics quoted by some destinations are subject to “statistical error” but not the kind of statistical error I learnt about at college. In some cases this is error on a magnitude of ten fold or twenty fold or even more.

Take medical tourism statistics with a pinch (or sack) of salt
When you hear the latest claim of medical tourism numbers from a hospital or a medical tourism destination, take them with a pinch of salt (or perhaps a sack of salt). And do some basic “hospital” mathematics. If they’re claiming let’s say 200,000 medical tourists a year, ask them where they are putting all the patients.

Let’s put this number into perspective. The Royal National Orthopaedic Hospital in London is the largest specialist orthopaedic hospital in the UK. It’s a very busy and successful hospital. Last year, it admitted around 10,000 patients to its 220 beds. That’s around 45 patients per bed per year. So, 200,000 “real” medical tourists might need....4,400 beds....and hospital beds are hard to find in many countries.

So how do we fix the problem?

When the UK NHS publishes statistics on hospital performance (See Hospital Episode Statistics Online), every set of statistics it publishes has a “responsible statistician”. He’s the one who ensures that they’re comparing apples with apples.

Let’s appoint a “responsible statistician” for medical tourism. Any volunteers out there?

Light at the end of the medical tourism tunnel?

2010-02-02T14:47:00.011Z

Following my outpourings on the “Outlook for Medical Tourism in 2010”, I am pleased to say that I’ve received some positive feedback (always a good thing.... I’ll keep on blogging!). And some reassurance that I am not alone in my view of the medical tourism world.

In particular, one of the long established medical tourism facilitators told me “how it was” in 2009 and how they think it might be in 2010. It’s refreshing to hear someone be open and upfront about their business experiences in medical tourism and the challenges that are facing people in the business.

I’d like to share some of these comments with others in the medical tourism world. Here is what it was really like in 2009 for one medical tourism business, a business that is well established, well run, and isn’t a “one man and his dog” outfit. I’m going to respect their confidentiality and not name the company concerned.

The view from the marketplace

Here’s what our medical tourism facilitator had to say about 2009:

“We have dabbled in the elective surgery market and have come to the same conclusions as you.... that to continue in this sector we would need to consolidate and concentrate on niche or rather more specialist sectors. Otherwise, we are finding ourselves becoming a "Jack of all trades and Master of none".

Last year was a really bad year. We were very busy with enquiries, but our conversion rate was disappointing and for those that did convert, the average spend was down. We have put the conversion problems down to a 50/50 mix of:

Recession - people not spending, or when they are travelling for treatment, they are spending less.
Competition - it seems in the last 18 months that every person in Europe, with a spare room and who knows a dentist, has jumped on the medical tourism bandwagon.

Another factor that has not helped is the pound sterling rate against other currencies, especially the Euro; this has meant a 20% increase in costs and prices. This does not only apply to the treatment cost but the patient stay while they are away. (Hotel rates are more expensive, eating out is more expensive etc.) The effect has been significant. Our patient numbers fell by 30% in 2009 and the average spend per patient dropped by 25%.”

So, a difficult time for this medical tourism business. But it is not unique. Some dental clinics in Europe have been relating similar experiences. One major implant centre in Budapest has reported overseas patient numbers down by more than 20% and a similar 25% fall in average spend per patient.

Do these experiences reflect the reality of the medical tourism business in recession?

Lies, damned lies and statistics?
The UK is one country where we count stuff. We have an Office for National Statistics and they employ around 4,000 civil servants who count stuff...including medical travellers. At Treatment Abroad, we do our bit to keep the civil servants in jobs by buying the data that they produce – specifically, the International Passenger Survey (IPS), a survey of a random sample of passengers entering and leaving the UK by air, sea or the Channel Tunnel. The IPS attempts to identify the number of people both travelling into the UK and out of the UK where the prime reason for travel is medical treatment (as opposed to business or a holiday).

Now.... you need to take these statistics with a very large pinch of salt. Statistics contain statistical errors and the smaller the sample, the bigger the risk of the error.

Here is a graph of IPS data showing outbound medical travellers from the UK from 2002 to 2009 (projected from 3rd quarter statistics). The sample size in this data is small - the number of actual travellers interviewed in each quarter who stated that their prime reason for travel was medical is around 50 to 100. So, there is room for wide variations in the data!

But, it may well be a reflection of the actual trends in UK medical tourism and for 2009 may indeed reflect the experiences of many in the marketplace who have seen the number of medical tourists in decline over the last 18 months or so, since the credit crunch hit.

Light at the end of the tunnel?
Our medical tourism facilitator quoted above has a more positive outlook for the future:

"We have already seen an increase in booking numbers for dentistry in 2010. January is already 100% up on January 2009 (and nearly the same number as in 2008, so something is starting to change.”

With some good news on the economic horizon in the UK, we may be seeing an increase in consumer confidence. House prices are increasing, and we have seen a return to economic growth, albeit not as good as many would have hoped. We wait to see what the effect may be on unemployment. But, like many industries, medical tourism follows the trends in the economy as a whole. Medical tourism is not immune to recession and certainly is not flourishing in it.

The way forward.. focus and think niche
Back to our medical tourism facilitator, who is planning the strategy for 2010:

“Our progress for 2010 will be to expand the dentistry further and concentrate more on the cosmetic surgery. We had taken a step back on cosmetic surgery in 2009, due to the difficult climate and similar to your (Keith Pollard’s) points about offering too much, we have recognised that rather than be a "Jack of all trades.....", we need to have a separate department. Having the same staff switching between the two products (dentistry and cosmetic surgery) does not really work.”

And our medical tourism facilitator concludes with a message for all in the industry:

“I totally concur with the conclusions of your article, and recognise that this medical tourism industry is not as simple and as great as people have made out. Only the companies that keep adapting and recognise the importance of focusing and having the correct resources to manage a particular sector of this industry will survive or be commercially viable.”

The outlook for medical tourism in 2010

2010-01-14T10:27:00.009Z

Before looking forward to 2010, let's look back and assess where medical tourism is now. So, was 2009 a good year for medical tourism? In 2009, we heard medical tourism “experts” across the world continue to talk up the potential for medical tourism without any sound basis in reality. It’s in the interests of some within the industry to boost the profile of medical tourism and frankly to exaggerate its potential. But whereas some industry pundits talk in tens or hundreds of thousands of patients, others talk in millions.

These over optimistic forecasts have in themselves created a burgeoning medical tourism industry and a flurry of market entrants who may find that the going gets tough in 2010. Much of the current medical tourism sector has been built on hype rather than solid foundations. “In the land of the blind, the one eyed man is King” said Erasmus, and this has certainly been true in medical tourism.

Reality bites.... in the UK
The medical tourism sector is (a) not immune to recession and (b) is not going to thrive in a recession. The argument that people are more likely to look for low cost treatment overseas if money is tight just doesn’t stack up. How has the recession affected self paid treatment in a mixed healthcare economy such as the UK? The number of patients paying cash for elective surgery such as hip and knee replacements and the discretionary spend on cosmetic surgery is down 20% over the last 12 months. And the missing 20% are not going abroad because it’s cheaper. They are hanging on to their money, delaying treatment or deciding to spend their money on more essential outgoings.

Reality bites.... in the USA
For many new entrants to the market, the USA is seen as the “golden goose” of medical tourism. It depends what you read and who you believe. Compare these predictions and numbers:

For 2008

Prediction: “it is expected in 2008 that several million Americans will travel overseas” (Medical Tourism Association).
Reality: - outbound US medical tourist numbers declined to 540,000 in 2008 (Deloitte Medical Tourism Update)

For the future

“23 million Americans could be traveling for medical tourism in 2017.” (Medical Tourism Association – Sep 2009).
Recession adjusted forecast: 1.62 million medical tourists in 2012. (Deloitte Medical Tourism Update – Oct 2009)

Is either of these future predictions anywhere near the mark? What might be the factors influencing an upward or downward trend:

Obama... the President who may change the way that the USA funds healthcare. And he’s making progress. Universal healthcare coverage in whatever final form it takes pushes medical tourism to the margins.... which is where it is in most developed countries. People do and will travel for treatment but it will always be a small minority wherever they are.
Insurers, employers, HMOS’s..... We’re still a very long way from seeing funders of healthcare make a significant move towards using medical travel as a way of reducing healthcare costs. Will it happen? Yes... but slowly and at the margins.
The recession isn’t over.... and it isn’t going away anytime soon. In both the US and Europe, unemployment levels hit 10% in December 2009. American workers have been unemployed an average of 29 weeks, the highest ever recorded since the data was tracked from 1948 onwards. Americans are visiting their physicians less, reducing the number of drugs they pay for. They are reducing their level of care. But as with the UK, large numbers are not offsetting this by pursuing lower cost options overseas.

According to a report in USA Today this month, medical tourism is number nine in the top ten travel trends for 2010 in the USA. According to USA Today, the three drivers are:

More coverage of overseas medical care by major U.S. insurers.
An increase in individual insurance policies that typically carry a high deductible.
A marketing push by companies that combine travel and medical services.

But will these drivers drive significant growth in the USA or elsewhere in the world?

Some, but only a few, insurers will provide coverage....but will patients actually want to travel?
There may well be an increase in deductibles....but will patients be able to afford to “top up” their healthcare anywhere....in their home country or overseas.
Companies may well increase their marketing spend and may increase public awareness a little....but what we don’t have in medical tourism is a “big player”, a company that’s prepared to risk hundreds of thousands of dollars/pounds/euros in bring medical tourism to the masses.

So... is it medical tourism boom or bust in 2010?

Neither. Medical tourism is not the Holy Grail that will save holiday destinations around the world who are already suffering from the “let’s stay at home” effect of the credit crunch? It’s not the easy win for hospitals and clinics who have been adopting the “if we build it, they will come” approach. The reality is that we will see growth in the long term.....growth where medical tourism makes sense and not at the exponential rates that some have predicted.

The good news (for medical tourism) from the economic downturn is that every Western government is going to be under pressure to cut public expenditure and that usually means cuts in healthcare provision. Let’s take the UK as an example. The UK government knows that it cannot afford to fund the healthcare system as it has in the past. The UK national debt in 2010 is 72% of Gross Domestic Product; ten years ago, it was 33% of GDP. In Ireland, the Irish government unveiled one of the most severe budgets in the Republic's history embracing cuts in public expenditure across the board.

In many countries, the pressure on public funding of healthcare will be greater than ever before. In the long term, an ageing population demanding more healthcare and pressure on healthcare budgets will mean more patients funding their own care and looking at overseas treatment as a serious option. And that means there’s an opportunity for medical tourism.

Regional healthcare not global healthcare
In truth, there has never been a global healthcare market, and it’s unlikely that there will be one in the near future....unless, of course we:

Invent an aircraft that can cut flight times by several hundred percent without increasing flight costs and global warming! Unlikely.
Convince disparate healthcare systems worldwide to standardize the way they treat patients. It isn't going to happen.
Get doctors in different countries to work together in providing continuous care for an individual patient (or at least talk to each other!). Some hope here, perhaps....

Where does medical travel really work...and happen? Across borders....from one neighbouring country to enough....within rather than between continents. However in need of treatment they are, and however desperate they are to save money, the number of patients who are prepared to board a plane and fly for eight hours plus to a different country with a different language and culture is minimal. It’s medical tourism at the margins. And it’s medical tourism that puts patients at risk through combining surgical procedures with long flights.

Patient flows in medical tourism follow low cost airline routes with short flight times or cross border land routes. Americans flying or driving South for surgery, Brits traveling to Budapest for dental treatment, the Japanese heading West to Korea for cosmetic surgery, the Indonesians travelling to Malaysia and Singapore, Central Africans heading for South Africa and so on.

The competition is going to get hotter
With medical tourism numbers failing to live up to the inflated predictions, we may now be faced with too few patients for too many providers. Those who have come to the market in the last twelve months are going to wonder where all the promised patients are. The simple laws of supply and demand mean increased competition. But that doesn’t necessarily mean that prices will plummet. Only the foolish will drop prices to attract patients. Consumers don’t opt for the cheapest when it comes to making healthcare decisions. Yes, they want to save money, but cheapest implies low, quality, risk...all those things that medical tourists are trying to avoid. Added value, customer service, creating new business from existing or past customers will all become important in differentiating your business, and attracting new patients.

New models for medical tourism?
The credit crunch, increasing competition, the slow growth in patient numbers (if we see any growth at all in the near future) will encourage new approaches to medical tourism. We’ve seen the Hungarian “dental tent” come to the UK, and we hear that cruise ship medical tourism is on the agenda of the European Medical Travel Conference. And perhaps in 2010, we may see the serious adoption and exploitation of telehealth and e-medicine in the medical tourism sector.

In a recession....find a niche
So, what can those pursuing the Holy Grail of medical tourism learn from all this?

One key to success in a recession is to find a niche and ideally one that is a recession proof niche - one that people spend their hard earned cash on when money is tight. Whereas many healthcare providers try to be all things to all patients, those that succeed will select their niche and focus their efforts.

There are some niche areas of healthcare that are relatively recession proof and may prove attractive. Infertility treatment is a good example:

Public funding of infertility treatment is under pressure in many countries.
The need is high and people aren’t prepared to delay treatment too long.
Money may be tight, but having children is the one thing that they may spend money on rather than anything else.
It’s high value.

There are others...get your thinking cap on and go out and find them.

In summary
2010 may be the year in which we see some rational thinking and some rationalisation in the medical tourism world. Perhaps the recession will bring some of the “blue sky” thinkers down to earth. New market entrants are going to feel the pinch; the long established players will maintain their reputation, improve their services and continue to thrive.

Long term, the medical tourism sector is here to stay.

Stay with it.... businesses that ride out the recession will come out of it in better shape. It’s still an attractive market sector and the business is there for those who take the long term view.

The opportunities for Korea in medical tourism

2009-12-14T14:34:00.008Z

South Korea is a country that has come late to the medical tourism game, but it may in the long term become one of the winners. Perhaps initially attracted by the inflated forecasts that are touted around the medical tourism industry by “industry experts” and commentators, Korea has however taken a more realistic view of where its success may lie.

The recent Busan Medical Tourism Convention provided an insight into how Korea is thinking about the opportunities presented by medical tourism. In 2010, Korea is expecting to attract around 60,000 medical tourists and the target is to attract 140,000 in 2015. This is not an unreasonable target and is far more realistic than some of the numbers that we see appearing from government and tourism organisations in other countries. The “highest quality, lowest cost” strategy is not one that Korea wants to pursue or indeed should be pursuing. Korea’s research into existing medical travellers shows that quality, convenience and trust factors far outweigh cost related drivers. In terms of relative costs of healthcare services, Korea is significantly less expensive than the USA (but then every country is) but is not as price competitive as countries such as India, Singapore or Thailand. Indeed, something like a knee or hip replacement would cost a similar amount in Korea to the cost of private treatment in the UK.

So, Korea is not going to win on cost. Nor is it going to attract vast numbers of medical tourists from Europe. Its prices aren’t competitive enough and long flight times will deter potential European patients. The same may apply to patients from the USA if the much hyped US medical tourism boom begins to happen. For a US patient, the perception of quality of care in medical destinations such as Korea, Singapore and Thailand may be very similar. So, if it comes down to the cost factor, Korea will lose out.

So, from where is Korea looking to attract its patients? The drivers of accessibility and cultural match provide the answer:

Although the USA is a twelve hour flight away, cultural connections mean that the Korean community within the USA has to be a prime target. Around 1.2 million Korean Americans, many of whom are on the West coast should provide a source of patients.

Within a one hour flight from Korea is Japan, already a source of many cosmetic surgery tourists, and where healthcare costs are rising fast.

And not much farther away is China which may provide a plentiful supply of medical tourists in the longer term.

The interesting market that Korea and many countries are turning their attention to is Russia. With the movement towards a market economy in Russia, there’s a wealthy upper class that is investing abroad, taking holidays abroad....and seeking healthcare abroad.

How can Korea create a competitive advantage in the overcrowded world of medical tourism? It may not be in Western medicine; Kang Dong Hospital in Busan is a Korean hospital that combines Western medicine with “traditional” oriental medicine and provides a model of healthcare that is attractive to many in the Far East.

Another opportunity is for Korea to build on its existing strengths and the image it has created in world markets. Through the success of companies such as Samsung and LG, Korea has created a hi-tech modern image for itself. Applying its technological knowhow and skills to the medical tourism sector may prove advantageous in creating an edge over the competition. The only technology company that I have encountered at a medical tourism conference so far is Samsung.

It has been said that Korea’s success in technology and in manufacturings industries such automotive lies in its ability to copy what others are doing, learn from their mistakes, do it better and work harder at it. If Korea applies the same philosophy to medical tourism, then some of the more established destinations will be looking over their shoulders.

Budapest: the “dental capital of Europe”

2009-10-19T17:15:00.006+01:00

A recent visit to Budapest, the “dental capital of Europe” made me consider the perception of medical travel. Many people think that if you’re travelling abroad for treatment because it is far cheaper, then the standard of services can in no way match what you would expect in your home market. Hungary’s dental treatment providers provide a strong contradiction to this perception. I was speaking at the Business Travel Show in Budapest at a dedicated session on dental tourism, organised by the Association of Leading Hungarian Dental Clinics.

Aware of the number of new entrants into the dental tourism market, Hungarian dentists are keen to maintain their position as market leaders. They are also keen that the Hungarian government and tourism board take note of their success and provide support for the dental tourism sector.

Hungary was one of the first countries to exploit the healthcare needs of neighbouring countries and encourage patients to cross borders for treatment. It became common for German and Austrian patients to travel to Hungary for dental treatment in particular, and Hungarian dental clinics prospered in border villages and towns. When we launched Treatment Abroad five years ago, it was to some extent a response to requests from Hungarian dental clinics to increase their profile in the UK healthcare market. Having succeeded in attracting large numbers of German and Austrian patients, Hungarian clinics were spreading their wings and seeking to promote their expertise in other markets. Now, Hungarian dental clinics and services represent the largest segment of services on Treatment Abroad.

The Hungarian dental tourism market is one of the notable successes in the medical tourism market worldwide. In Budapest, the Association of Leading Hungarian Dental Clinics has been formed. The Association represents the interests of seven significant players in the dental tourism business:

VitalCenter

VitalEurope

Bátorfi Dental Implant Clinic

ImplantCenter

Kreativ Dental

Madenta

Solydent

The Association has some clearly defined criteria for joining. For example:

The practice must employ a minimum of ten dentists / oral surgeons.

The practice must be equipped with a minimum of 5 modern dental medical operating units.

The practice must place a minimum of 1,000 dental implants a year.

The practice must provide digital intra-oral and panoramic X-ray.

The practice must ensure that all practitioners work within industry recognized protocols, including clinical governance and undergo regular internal clinical audits and assessments.

See the full list of Association criteria at ALHDC Code of Practice.

The number of patients from overseas that are going through these seven clinics is staggering. Association members carry out around 75,000 treatment sessions per year. Around 60% of these are for dental tourists. The Implant Center alone inserts around 1,800 dental implants each year. Each clinic has multilingual staff and dedicated cars and drivers for transporting international patients.

Although established markets such as the UK, Ireland and Scandinavia provide the bulk of patients, new opportunities are developing in France, Italy and Russia. I visited three of the facilities - ImplantCenter, Kreativ Dental and Vital Europe. Each has a different approach to marketing its services. Whereas Vital Europe focuses on UK patients and provides both consultation and treatment facilities in London and Manchester, Kreativ relies on its overseas agents to convince patients of their quality of service and flies patients straight to Budapest without prior consultation. ImplantCenter has also dental office in Dublin and London.

The expertise and extent of dental services in each individual clinic is quite something. Each clinic has around eight to ten dentists employed by the clinic, some general dentists and some with areas of specialty such as implantology or orthodontics. All three clinics have extensive dental laboratories on site, owned and operated by the clinics themselves.

There are few private dental clinics in the UK that can match the set up of thes dental facilities in Budapest. The challenge for Hungary is how it maintains its lead in dental tourism. New competitors are entering the market, such as Croatia, Czech Republic and Slovakia, some at even lower prices than those in Hungary. The challenge for these new dental tourism competitors is how they match the standards of the "dental capital of the world".

Practice makes perfect...a message for medical tourism providers and patients

2009-09-29T15:33:00.006+01:00

In the largest ever study of hospital mortality rates published in the UK,"death rates for emergency patients jump 6 per cent when newly qualified doctors start work. The Health Services Journal reports that "the traditional first day for NHS doctors is the first Wednesday in August. Researchers found that patients brought into hospital the week before were more likely to survive.....Researchers could not find a definite reason for the higher mortality rate, but said early August was known as an “unsafe period” in hospitals due to the influx of new doctors"

Now, what can we conclude from this?

Might I suggest that doctors with more experience are better than those with less experience? It goes without saying, really.

So, how does this help the medical tourist who is trying to make a decision about which doctor or specialist overseas to choose for their operation? The problem of patient choice in healthcare whether it is a choice of an overseas surgeon or a domestic surgeon is the "how do I know that he's any good?"issue. In the UK, we're probably ahead of the game in enabling patients to make informed choices about treatment. The NHS web site is has been renamed "NHS Choices" and in recent years there's been a drive to expose data on clinical outcomes and surgeon and hospital performance, and make this freely available to patients.

One of the strengths of the UK healthcare system (and one of its shortcomings!) is that the vast proportion of healthcare is delivered by one healthcare provider - the NHS. This means that data on processes, outcomes, performance and patient satisfaction is fairly standardised, thus enabling valid comparisons to be made between one hospital and another, between one specialist and another.

Let's imagine that I need a knee replacement. Under the NHS, I can choose to go to any hospital in the UK, not just my local hospital. But let's assume that I want to stay fairly local. Here's some of the data I can access about my local hospitals through NHS Choices. For each "quality factor", I have highlighted the best result.

Impressed? Which hospital would you choose? Or which hospital would you rule out of consideration? The above table only scratches the surface of the data that is now being made available to patients. I could also compare the quality of the food, levels of service and so on. And I can also begin to make comparisons between individual surgeons.

Where does this leave the medical tourist? The reality is that there are few countries where this kind of comparative information would be made available to the patient. And the reality is that different healthcare systems often measure things in different ways, so that comparing outcome data from a hospital in Thailand with outcome data from a hospital in India might be very difficult.

So, the medical tourist probably needs to ask some very basic questions about the hospital and specialist. One of which is a fundamental measure of "how do I know that he's any good?” It's "how many times have you done this operation before?" "Practice makes perfect" as the recent study demonstrates. Choose a surgeon with experience in exactly what you require. If you're looking for a knee replacement, choose an orthopaedic surgeon who does knee replacements and virtually nothing else. Don't choose a "general" orthopaedic surgeon who does “everything under the sun" - knees, shoulders, feet, hips etc.

And ask the guy "how many have you done this year?"

Transparency and fraud in health tourism

2009-09-22T23:04:00.013+01:00

One of the criticisms of buying services via the web is that you cannot always be sure with whom you are actually dealing. This is especially true in the field of health and medical tourism. When you visit a site about medical tourism:

How do you know who is behind the site?

How can you tell what they actually know about health tourism and healthcare in general?

How do you know if you can trust them?

How do you know where the patient's money is going?

Next month, I'm speaking at the Annual Conference of the European Healthcare Fraud & Corruption Network (EHFCN) in Edinburgh. The Conference theme is "Cross-Border Healthcare in Europe: A Gateway to Fraud and Corruption?".

The European Healthcare Fraud & Corruption Network (EHFCN) is the only European organisation dedicated to combating fraud and corruption in the healthcare sector across Europe. The network represents 23 member associations in 10 countries, which provide healthcare services to millions of people in Europe.

According to EHFCN, "the healthcare sector appears to be particularly vulnerable to corruption. The large amounts of money involved and the complexities of many healthcare systems play a role as well as the fact that there are many processes with high risks of bribery"

And now it is turning its attention to health tourism.

As a web publishing company in the healthcare sector, it's important that Treatment Abroad is transparent, and that when we're publishing health advice on our various web sites, we ensure that the information is written by qualified medical professionals. We make sure that all of our sites go through the Health On the Net Foundation's certification process. (I recommend that all healthcare sites go through this process.) And our company has a Medical Director to oversee what we do - Dr Nick Plowman from St Bartholomew's Hospital in London.

But in the world of medical tourism, is there a problem with lack of transparency and is there significant potential for fraud?

In researching my presentation for the EHFCN conference, I've taken a look at transparency in medical tourism. I did the usual Google searches and I came across Health-tourism.com for the first time: It states that is "a guide for medical tourism, bringing you reliable, objective and useful information that will help you plan your medical travel".

While I was browsing the site, I came across this:

Medical Tourism Transparency Award - "we have created the Medical Tourism Transparency Award. This is a badge awarded to websites of medical tourism providers whose website information meet the criteria below."

Now, let's be clear, the guys at Health-tourism.com may be decent and honest people, with the best interests of medical travelers at heart. But it was their "Medical Tourism Transparency Award" that caught my attention. Health-tourism.com says that "The purpose of this award is to encourage providers to supply necessary information on their web sites - making it easier for you to make an informed decision.

So, I put Health-tourism.com through a "Transparency Test".

I looked all over the site....

It says that it's run by Find Global Care.I can't tell who they are or what their qualifications are.

In the lengthy disclaimer it says "the content on this website has not been reviewed or prepared by medical professionals.

And it says that the "relationship between the visitor/user and FGC shall be governed by the laws of Cyprus". Why Cyprus?

I can't find any names at all.

I can't find out who owns the site or the company.

I can find an address - 1B, Pinetree Boulevard, Old Bridge, New Jersey.

I'm an inquisitive person.....

I did some digging for information on Find Global Care. But all I could find... was another web site - half built at www.findglobalcare.com and an entry on WikiCompany with no information on the company ownership.

So I thought I'd pay a visit to 1 Pine Tree Blvd, Old Bridge, NJ 08857, USA using Google Maps Streetview. (Isn't the web a wonderful thing?). I'm not an expert on US arrchitecture but judging by the Real Estate sigh outside and the building, this looks like an apartment building. But who lives there? And who's behind the business? And what does he or she know about health tourism?

Next, I checked out the domain name. It's registered to Udi Shomer from Illinois. Perhaps he's behind the business? Who is he? I don't know. But it's not a common name, and the web may have some info on him?

There's only ten results for a search for "Udi Shomer" on Google. (Hey, that's close to being a Googlewhack!). Let's take a look at the Udi Shomers on the web:

There's an Udi Shomer who has an entry in the Lonely Planet guide to Thailand.

There's a listing page for Tai Chi in Thailand.

And there's a few references in Israeli job sites (I think).

And that's it.

There's a clear message here for medical tourists who use the web to research healthcare services.

Look (very carefully) before you leap.!

And if anyone knows who runs Health-tourism.com, ask them to get in touch, so that I can fill in the gaps.

Dental tourism...Let's work together

2009-09-17T16:29:00.004+01:00

The Irish Dental Association is the most recent medical professionals body to publish a "survey" raising doubts about medical tourism.
In a recent press release from the Irish Dental Association, they state that "3 out of every 4 Irish dentists are treating patients for problems arising from treatment abroad. Let's take a look at the background to the survey, and examine some of the real concerns that are raised.
The Consumers’ Association of Ireland has published research about the high costs of dental treatment in Ireland. The Irish Dental Association accepts that Irish dentists are not immune from the wider economy and the bottom line is that Ireland is a high-cost economy. As a result, significant numbers of Irish dental patients travel for treatment to minimise treatment costs. Some of these are cross border dental tourists. Many services carried out in Northern Ireland are between 25% and 45% cheaper than the same services in the Republic, according to the study published in the Consumers’ Association of Ireland’s magazine Consumer Choice. And of course, many Irish patients take advantage of low cost treatment in countries such as Hungary and Poland. Several Budapest dental treatment providers have offices or representatives in the Republic of Ireland.
According to the Irish Dental Association survey, 76% of Irish dentists in private practice [more than 3 out of 4] have had to treat patients for problems linked to the dental treatment they received abroad.
First, we need to examine the basis of this claim.

There are approximately 1,700 dentists in private practice in Ireland at present.
440 Irish dentists responded to the survey.
334 said that they are treating problems arising from treatment overseas.
So.... in fact 334 out of 1,700 said that they were seeing problems which is 20%. Obviously, this assumes that those who didn't bother are not seeing problems.

When reviewing such surveys conducted by on or on behalf of professional associations, we have to bear the following in mind:

Inbuilt sample bias: People who see a problem are more likely to respond to a survey on that issue, than those who don't. We've seen similar bias built into surveys conducted by a PR agency in behalf of the British Association of Plastic Surgeons.
Motivation: We always need to remember that professional associations represent the interests of their members. Losing patients to Belfast or Budapest hits the pockets of private dentists.

Nevertheless..... the Irish Dental Association has made some valid points. Are there concerns for dental patients who travel for treatment? Yes. Are the problems as big as the Irish Dental Association suggests. No.

At the end of the day, the Irish Dental Association also has the best interests of Irish dental patients at heart. Dr Donal Blackwell of the Irish Dental Association says that that one of the problems is that when considering travelling abroad for dental treatment, patients tended to focus on short term, aesthetic results rather than the long term quality of the care they receive and suggests that people travelling abroad for dental treatment actually don't know what they need when they enquire about costs. He's certainly right in some cases.

So, what's the solution and what's in the best interests of dentists and patients?

I'd like to see the following:

The Irish Dental Association issuing guidance for dentists and patients when considering dental tourism. See the UK General Dental Council's Dental Tourism Checklist on Treatment Abroad.
Irish dentists providing assessment and follow up of patients who travel abroad for treatment.
Irish dentists visiting some overseas dentists to get an understanding of how they work and their clinical skills and quality.
Irish dentists forming partnerships with overseas dentists, so that patients who need extensive treatment but can't afford Irish treatment have access to the treatment they need under the supervision of their own dentist.
Overseas dentists communicating with the patient's Irish dentist when a patient turns up in Budapest or Krakow - informing the patient's Irish dentist what work is to be undertaken, and providing post treatment reports on the work that has been carried out.

Common sense really. So, let's work together!

Increase in IVF tourism in Europe

2009-07-01T13:39:00.004+01:00

At Treatment Abroad, we've seen increasing interest from IVF clinics abroad that are experiencing significant growth in patient numbers from the UK and other European countries.

The latest report from the European Society for Human Reproduction and Embryology confirms an increase in IVF treatment abroad, The report surveys infertility clinics in Belgium, the Czech Republic, Denmark, Slovenia, Spain and Switzerland and is based on a sample of 1,230 patients visiting these infertlity clinics. See details of the report in the Guardian.

Lack of access to IVF services in the home country for the over 40's and legal restrictions on infertility treatment are the prime drivers. Italy was the biggest source of IVF "medical tourists" accounting for 32% of the patients in the survey. Next was Germany (14%), followed by the Netherlands (12%), France (9%) and the UK (5%). The average age was over 37 but 63.5% of the British patients were over 40.

According to study coordinator, Dr Francoise Shenfield from University College Hospital in London, "Spain and the Czech Republic are popular destinations for oocyte donation; Swedes travel to Denmark for insemination, and the French to Belgium." She also highlighted the significant numbers of Italians who travel abroad to receive treatment that was rendered illegal in their home country under recent legislation or because they believe they will receive better quality care.Extrapolating the data, EHSRE estimates that 20,000 to 25,000 cross-border fertility treatments are carried out each year.IVF related medical tourism is a relatively new but growing trend in the UK, as couples delay having children into their 40's and then discover that they have a problem.

IVF treatment is available within the National Health Service in the UK, but access to treatment can be a problem.

Age and waiting lists can be a barrier to treatment.

Overweight women are excluded from NHS treatment.

Demand for egg donation exceeds supply. ( The right of anononymity for egg donors was removed in 2005)

Obviously, private IVF treatment is available in the UK but this may be expensive and the same legal restrictions will apply.

Whereas some areas of medical tourism may be feeling the effects of the recession and the resulting impact on people’s pockets, IVF treatment abroad is an opportunity worth pursuing for those IVF clinics abroad that can demonstrate impressive results and cater for the needs of the “fertility tourist”.

Medical tourism and a medical city ...a lesson from history

2009-06-11T15:24:00.006+01:00

Back in the mid 1990's, before someone, somewhere coined the term medical tourism, I was a UK Marketing Director with an American owned hospital company. We were big in medical tourism.... but in those days, it was known as the international patient business. One day, I got a call from a head-hunter, promising big money for an opportunity that surely I wouldn't want to miss....

This is roughly how the conversation went:

Head-hunter: "We've got these American investors who are planning to spend $500 million on a brand new 260 bed state of the art private hospital in the UK. They plan to attract international patients from all over the world. It's going to be called "Health Care International."
KP: "Sounds interesting. Where are they going to build it?"
Head-hunter: "On Clydebank. It's going to be massive."
KP: "Clydebank..... You mean Clydebank.... in Scotland....near Glasgow."
Head-hunter: "Yes, that's right. It'll be close to the airport so people will be able to fly in from all over the world. Labour costs for hospital workers in Scotland are much lower than they are in America"
KP: "Are you serious?" "Or is this a bad joke?"
Head-hunter: "I'm serious. It's backed by some American guys who are ex-Harvard Medical School and a US medical ventures company. They're going to create a medical city. They know what they're doing. They want someone to run it who knows the business inside out. You come highly recommended. Are you interested?"

I think my response was something along the lines of, "Not in your wildest dreams".

So...what happened?
Health Care International was one of the biggest disasters of all time in terms of a hospital development. They built the Clydebank hospital....... patients didn't come. Surprise, surprise, they failed to fill its 240 beds, 21 operating theatres and neighbouring five-star hotel. By 1995, it was going bust.

Unperturbed by this unmitigated failure, in walked a group of Middle Eastern investors from Abu Dhabi with a plan to "develop the hospital as a centre of international medical excellence". It grew to 540 beds. And in 2002, it went bust again. In walked the National Health Service who picked up a state of the art hospital and all the equipment for around $50 million!

It's still there. It's now part of the NHS National Waiting Times Centre and is known as the Golden Jubilee National Hospital.

And there's not a medical tourist in sight!

History repeats itself...
It was the poet and philosopher, George Santayana, who said, "Those who do not study history are doomed to repeat it."
At the core of the Health Care International debacle was a failure to understand marketing and a failure to understand the market.

The Americans involved had little real grasp of the international patient business.
The Abu Dhabi investors who bought it out had even less.

But they both had a vision of a booming medical tourism market and it cost them millions and millions of dollars.

Around the medical tourism world today, I see history repeating itself. Investors getting involved who may have little real grasp of the international patient business, being guided by others who may have even less.

So, my suggestion to the investors and medical tourism pundits is "Get your history books out".

Or buy a decent marketing text book. It might save you a few million!

NHS Patient Choice - Lessons for medical tourism

2009-05-28T08:35:00.003+01:00

In the UK, "patient choice" is one of the driving forces in healthcare. Since April 2008, patient choice has been extended in the UK. Patients can choose which hospital they are treated in....anywhere in the country. Patients can choose the time of their hospital appointment. In some cases, patients can choose the individual consultant they see. The NHS Choices website lists information about all NHS hospitals, such as their MRSA rates, facilities and ratings and reviews by patients which means that patients can make an informed choice.
The NHS Choose and Book web site enables people to make their choices.
In reality, the patient choice initiative has been a bit of a disappointment. One problem is that not enough patients are actually aware that they have a choice. The Report of the National Patient Choice Survey, England - December 2008 has analysed uptake of patient choice so far.
The key findings:

The percentage of patients recalling being offered a choice of hospital for their first outpatient appointment was 46% in December 2008, the same as in September but up from 30% in the first survey (May/June 2006)
50% of patients were aware before they visited their GP that they had a choice of hospitals for their first appointment, up from 48% in September and 29% in the May/June 2006 survey.

The factors influencing choice

Hospital cleanliness and low infection rates were given most often (by 74% of patients) as an important factor when choosing a hospital.
The other five are quality of care (given by 64% of patients), waiting times (63%), the friendliness of staff (57%), the reputation of the hospital (55%) and location or transport considerations (54%).

So what can medical tourism businesses learn from this?

If UK patients can compare NHS hospitals on MRSA rates, post operative infection rates and outcomes, why can't they do this for overseas hospitals? Or perhaps, why is it difficult if not impossible to find a hospital treating medical tourists that publishs such data or makes it freely available on their web site?

Many people in the UK have the right under EU law to travel abroad for treatment. The EU Directive sets up a framework around this. but the basic right of free movement already exists. So, why aren't people taking advantage of this?

They don't know they have the right.
They don't "trust" overseas hospitals.
They would rather wait for treatment on the NHS in their local area.

Awareness of overseas treatment options can be generated by the providers themselves. One of the best tools to consider is the use of patient stories to create local press coverage and thus raise awareness. See this story in the Scotsman. Let's see more of them!

A word of warning for medical tourism companies

2009-04-21T16:32:00.004+01:00

A woman from Wales who underwent cosmetic surgery in Belgium is bringing a test case against the Belgian clinic in the UK courts.The patient is suing the clinic after undergoing a face-lift and upper and lower eye surgery in 2005. She claims that she has been left with scarring around the eyes and the ears and has experienced numbness of the face.

It is a significant case because it could set a precedent for other patients who wish to sue a clinic or medical tourism company after going abroad for treatment. Rather than sue in Belgium, the legal firm involved have decided to sue the clinic in the UK courts where they might expect higher payouts if they win the case. Laurence Vick, the solicitor who is representing the patient, is a medico-legal expert and specialises in clinical negligence claims. (Coincidentally, he and I were undergraduate students at the same college, many years ago!)

See the Independent news story: Woman sues in UK over Belgian face-lift

The question of who to sue in medical tourism cases is one that faces any patient where surgery abroad doesn't work out as it should. Is surgery abroad any riskier than surgery in the UK? No one knows.... because there is no comparative data. But the answer is probably not. Nevertheless, any surgery carries a risk. Cosmetic surgery is not risk free, so there are going to be cases of alleged clinical negligence where the patient will pursue a legal action. Medical tourism companies need to be aware of this test case, particularly those that have a UK presence. Rather than sue the surgeon or the hospital in the destination country, the patient may opt to sue the medical tourism company in the UK.

The war of words....Is it medical tourism or medical travel?

2009-04-15T10:27:00.008+01:00

I just read Constantine Constantinides informative and latest missive on medical tourism. Constantine runs Healthcare Cybernetics and is one of the "wise heads" of medical tourism.
Constantine says:

"I am getting fed up with industry newcomers (the “Johnny-come-latelys”), industry outsiders and the self-important upstarts who take issue with the word Tourism – claiming it is not “grand” enough for them to be associated with.They propose replacing it with the word “Travel”. Some even suggest we dump everything and start talking of Global Health (as if healthcare has not been global for ages).......I do not like the “tourism” word – but neither do I like the several suggested alternatives"

He makes some interesting points:

"The word Tourism is derived from Tour - from Anglo-French tur, tourn turning, circuit – a there and back journey.Travel may not include a “back”.

So, here's my two pennyworth (English idiom!).

Let's start with Google's view. Why? Because Google reflects the way that people use words.

I did a search on Google UK for various terms:

A search for medical tourism generated 19,700,000 results. (Our Treatment Abroad and related web sites secure three of the top ten positions. A pat on the back for our search engine optimisation team!)

A search for medical travel generated 73,300,000 results.

A search for health tourism generated 36,600,000 results.(Treatment Abroad is no 2 for this search. Another pat on the back for SEO.)

A search for health travel generated 250,000,000 results. A search for global health generated 133,000,000 results.

But we probably need to be a bit more specific. By putting the phrase in quotes e.g. "medical tourism", Google only returns results for the exact phrase:

"medical tourism" generated 5,290,000 results.

"medical travel" generated 443,000 results.

"health tourism" generated 798,000 results.

"health travel" generated 505,000 results.

"global health" generated 3,220,000 results

The previous analysis tells you what words and phrases are most frequently used on web sites indexed by Google. But what terms do people use when searching? Here's another analysis. This time we look at the average monthly search volumes on Google worldwide:

medical tourism - 90,500 searches per month
health tourism - 14,800 searches per month
health travel - 165,000 searches per month
global health - 135,000 searches per month

And the winner is?

It's probably medical tourism....

Why? Because it's the phrase that's in common usage, whether we like it or not. It's what the media use when they write about the industry. It's what the man on the Clapham omnibus would probably say. Is it the best phrase to use? Probably not.

I prefer medical travel!

The challenge facing the medical tourism industry

2009-04-14T14:12:00.005+01:00

The recent European Congress on Health Tourism in Budapest reflected some of the current issues and challenges facing the medical tourism industry, particularly those presented by a world recession. Budapest is Europe's dental tourism hub, attracting patients from countries such as the UK, Ireland, Germany, Austria, Switzerland and Scandinavia. If the recession is hitting medical tourism, then Budapest is going to feel it more than most.

There were workshops and presentations from various providers and industry players at the Budapest Congress. One of the more down to earth of these presentations was made by Dr Bela Batorfi of The Batorfi Dental Implant Clinic in Budapest. This impressive clinic usually carries out around 1,800 dental implants per year. But with the onset of the global financial crisis they have seen some worrying trends:

The number of patients from abroad has fallen by around 30%. Medical tourists are harder to find!
The average spend per patient has decreased from around £5,000 to £2,600. Medical tourists are spending less per visit.
The average age of patients has increased. Medical tourists are delaying treatment.

The experience of the The Batorfi Dental Implant Clinic is reflected among many of the other dental treatment providers in Budapest. It's not the case that Budapest is losing patients and market share to other destinations. Understandably, many clinics are concerned about the fall off in business and how long it will continue.

Against the backdrop of the financial crisis, Hungary is one of the many countries planning a "medical city" aiming to attract patients from across the world to a centre of medical excellence. According to Balázs Stumpf-Biró, Executive Director of the European Medical Tourism Alliance (EuMTA), Hungary is planning to establish 100 hectares of land near Budapest’s international airport as a health complex, similar to Dubai Healthcare City.

Whether this development suffers the same fate as Dubai Healthcare City remains to be seen. The initial building boom in Dubai has come to a grinding halt. Building anything in the current financial environment is a risky business, and with the medical travel market to Hungary down around 20% to 30%, it's going to be a brave investor who lays the first brick.

Various estimates of medical travel numbers for Hungary put the number of incoming medical tourists at around 300,000 to 350,000 per annum. The vast majority of these are for dental treatment, and many may be "short trip/low cost" cross border visitors from Germany and Austria. But that's still a valuable market.

So what's the long term outlook for medical tourism destinations such as Hungary? Better than most, I would suggest. The medical travel market is here to stay and is here for the long term. Hungary has been at the forefront of medical travel in Europe for the last decade and it can retain that position.

But like most countries being encouraged down the medical tourism route it needs to tread carefully. We hear the usual overblown claims by industry proponents such as the Medical Tourism Association that "the biggest potential market for Hungary is the USA". I can just see hundreds of thousands of Americans getting out their maps of Europe, locating Budapest and booking their long distance flight via New York/London/Amsterdam for their dental implants. It isn't going to happen.

So where should Hungary be focusing its efforts?

Well... :

There's a population of 550 million in the "United States of Europe" who may begin to exploit the opportunities within the EU Directive on patient mobility.
Not so far away from Hungary, there are 140 million Russians who are beginning to spend their money on holidays all over Europe. Medical travel will follow this trend.
And the UK dental problem is here to stay. See this recent article in the Independent: This may hurt a little: Rise in hospital admissions for last-ditch tooth extractions

My advice to Hungary... The same as you would get from business guru, Tom Peters (In Search of Excellence).

Stick to the knitting - stay with the business that you know!

NHS staff numbers reach an all-time high

2009-03-25T10:59:00.005Z

The UK Department of Health today released it's latest update on NHS staff numbers. It reflects the investment that the UK has been putting into the NHS in recent years, and also has an impact on outbound medical tourism from the UK. NHS shortcomings and waiting times are a significant driver of people seeking elective surgery abroad. In the last couple of years NHS waiting times have come down and there is now an 18 week target which most NHS trusts are meeting.

The number of people working for the NHS has reached an all-time high. After a dip in overall numbers in the previous two years, the annual NHS census showed staffing levels recovered to reach a peak of 1,368,200 in September 2008. This is a 2.8 per cent increase on the previous year and a 27.7 per cent increase compared to 1998.

In September 2008, the NHS employed:

408,200 qualified nurses – up 2.1 per cent or 8,600 on 2007 and up 26.2 per cent or 84,700 on 1998.
25,700 midwives – up 2.3 per cent or 570 on 2007 and up 12.4 per cent or 2,800 on 1998.
34,900 consultants – up 3.7 per cent or 1,200 on 2007 and up 56.4 per cent or 12,600 on 1998.
49,200 hospital doctors in training – an increase of 5.1 per cent or 2,400 on 2007 and up 59.4 per cent or 18,300 on 1998.

The number of people in employment in the UK was 31.32 million in December 2008 which means that 4.4% of the UK workforce is employed in the NHS.

The UK unemployment rate has now reached 6.5 per cent. So, the NHS is quite a good place to have a job!

Will Obama end the American medical tourism dream?

2009-03-12T15:07:00.011Z

As reported in International Medical Travel Journal this week, President Obama has pledged to cure Americans from "the crushing cost of health costs." His proposed reforms include lower prices from hospitals, salary cuts for doctors, and payment to hospitals by government insurance schemes linked to quality of care not quantity of care. He also wants to give Americans the option of a public health insurance plan. His plans follow a social insurance model which is found in some European countries.

Simplifying the funding structure within US hospitals could also lead to significant cost savings. At present an individual US healthcare provider may have to administer payments through upwards of 700 different providers.

Past research (1) has shown that while the United States spends significantly more on health care per capita than Europeans nations, Europe actually delivers more real resources per capita. For example, Europe employs a larger health workforce per capita and delivers more physician visits, hospital days, and prescription drugs than the United States. Higher prices and administrative inefficiencies account for most of this differential.

Obama's grand plan could end the American medical tourism dream. Introducing what is in effect a publicly funded healthcare system and forcing down prices could remove a key driver for outbound medical tourism from the USA.

The IMTJ's conclusion:

"If Americans are a target market, you need to keep a very close eye on US healthcare reform as it could quickly impact your business. You may even have to change from marketing on price to marketing on quality alone."

...and I tend to agree.

Recent years have seen a bandwagon effect in the medical tourism sector. And it's been a "get it cheap" bandwagon. But for decades medical tourism has been driven by patients seeking better treatment, specialist expertise, and higher quality. Some new market entrants may need to rethink their strategy.

1 Mark V. Pauly, “US health care costs: The untold true story,” Health Affairs, 1993, pp. 152–9.

EU votes on medical tourism directive

2009-03-10T19:41:00.003Z

Members of the European Union's various committees vote this week on whether to make changes to the EU Directive on cross border healthcare. The Directive aims to provide a framework for patient mobility, whereby patients in one member state will have the right to treatment in another state.

The UK's General Medical Council (GMC), which regulates the country's 230,000 doctors, is running a lobbying campaign to protect Britons seeking healthcare in Europe from what it describes as "dangerous" doctors. the GMC wants the new EU laws to give patients access to the disciplinary history of incompetent clinicians.

Quoted in the Guardian, Paul Philip, the GMC's deputy chief executive says:"The vast majority of doctors do a very good job under very difficult circumstances. However, when UK patients travel to mainland Europe, there is a risk they could be treated by a doctor who is not fit to practise or not fully qualified to give the required treatment."

UK patients have full access to GMC records and are able to check whether a doctor has been disciplined, or is the subject of a disciplinary hearing. The GMC wants doctor organisations in other countries to provide similar patient access to information about their doctors.

In the first 9 months of 2008, the UK NHS paid for over 500 British patients to have treatment elsewhere in Europe. Some patients were also funded by their primary care trusts. It is estimated that another 80,000 Britons funded their own treatment overseas.

European Union medical travel Directive gets the nod from the Lords

2009-02-25T16:50:00.002Z

The EU Directive on Cross Border Healthcare is making it's way through the labyrinth of British government. Slow progress, but it's progress towards a European market in healthcare.

The House of Lords EU Committee have welcomed the proposal from the European Commission for a Directive on patients' rights to cross-border healthcare. The Committee has called for improvements and has warned that, due to the unpredictable impact of the provisions in the Directive, it must be carefully monitored upon implementation.

Download the House of Lords Committe report.

The Committee has agreed with the Commission that, as the right of EU citizens to travel to another Member State to receive healthcare has been confirmed by the European Court of Justice over the last ten years, it is essential to put in place a legal framework to replace the current ad hoc arrangements.

The Committee also considered whether patients seeking healthcare in other European Member States should pay the costs themselves in advance of treatment and then claim reimbursement later. They have raised concerns that this would prevent those without adequate financial means from taking advantage of their right to cross-border healthcare. The Committee's report recommends that a patient's own healthcare provider should pay the fees directly to the provider in the other Member State, and suggests that this could be linked with the process of securing authorisation prior to travel, which the Committee considers necessary both in order to protect the financial resources of health systems and to enable patients to make informed decisions about their treatment.

The report also calls on Member States to ensure that patients are aware of their rights under the Directive and are informed about the quality of care that they can expect, any potential language barriers, and how to make a complaint should that be necessary. Member States should finance information for its own citizens about healthcare abroad and should draw up a description of its own health system to guide other Member States. Acknowledging that it may fall to medical practitioners, such as GPs and dentists, to actually provide the information to patients, the Committee argue that the Directive should avoid the imposition of any administrative burden on healthcare professionals.

The Committee have also called for greater clarity on systems of redress when patients are dissatisfied with, or harmed by, healthcare provided in another Member State.
The Committee welcome the Directive's provision that a Member State would be able to refuse to accept a patient from another Member State if, for example, this would increase waiting times for treatment. Nevertheless, they recommend that this part of the Directive would benefit from some strengthening.

Finally, the Committee emphasise that the impact of the Directive will only be clear once it has been implemented, and so recommend that it be reviewed within three years, rather than five as proposed by the Commission.

The Committee's 57 page report can be downloaded from: http://www.publications.parliament.uk/pa/ld200809/ldselect/ldeucom/30/9780104014356.pdf

The smoke and mirrors of medical tourism

2009-02-18T10:03:00.008Z

When is a medical tourism facilitator a medical travel agent?

According to our Medical Tourism Survey in 2008, around a third of UK medical tourists make their arrangements through a medical tourism facilitator. In some countries, such facilitators account for an even greater share of the market, and their influence is growing. The concern of many is the uncontrolled growth of the sector and the lack of regulation within it.

Let's say that I want to start a medical tourism facilitation business. How easy is it?

What do I need?

I need a name. I'll call my business "Magical Medical Travels".

I need a telephone. I've got one of those.

I need an internet connection. I've got one of those.

I need a web site to generate some patients. I can create something that will do the job, using a cheap package such as 1&1 web hosting.

I need some hospitals and clinics overseas that are prepared to pay me a commission, if I send patients to them. I'm sure that I can find a few of those.

I suppose I need to find someone in the destination country who can look after the patients while they are there.

....and maybe some documents that I can get the patient to sign.

Oh, and it might be a good idea to invent a few patient testimonials...

Do I need to be medically qualified? Well, I'm known as Dr Pollard on several internet forums, and I have some drpollard@ email addresses, so that should be fine.

Cash flow. Well, if I take money up front from patients, and then pay the treatment providers late, that's not a problem. I'll buy some online advertising, and leave it a few months before paying the bill.

I'll pay a few hundred pounds to join one of the medical travel associations; that will give me some credibility.

It's pretty easy really? And that's how some (not all!) medical tourism facilitators have come about. Medical tourism is a very fragmented market and there's a pretty wide range of facilitators in the business.

Which brings me back to the title of this blog: "When is a medical tourism facilitator a medical travel agent?"

In the UK and Europe, that's actually quite an important question. Let's expand the question...

"What's the difference between a medical tourism facilitator who sells a consumer a package of accommodation, travel and treatment and a regular travel agent who sells a consumer a package of accommodation, travel and related holiday activities?".

In the UK, the activities of travel agents are highly regulated. For example, the "Package Travel, Package Holidays and Package Tours Regulations" were introduced to protect consumers from unscrupulous travel agents. A package is defined as the "pre-arranged combination of at least two of the following components - transport, accommodation, other tourist services".

So, is a medical tourism facilitator a travel agent? Some would say...yes!

And if that's the case, the Package Travel Regulations come into force and my new facilitation company, Magical Medical Travels might have some problems. It means my company will be subject to controls over:

What I can say in my brochure or web site.

The nature of any contracts I make.

The information I provide to the consumer.

Changes in price.

Security in the event of insolvency. ie. I will need to be bonded.

With regard to the latter, when someone books a holiday in the UK, many will look to see if the travel company is ABTA (Association of British Travel Agents) bonded. Which means that the company has placed a bond with an authorised institution, based on their turnover. The minimum bond is £20,000.

Even if you pay the bond, you can't join ABTA, unless you comply with their Code of Conduct, and submit to random inspection.

Let's compare this to the medical travel business, a sector that was once described last year by Avery Comarow, as the "The Wild West of Medical Care Abroad".

Anyone can set up as a medical travel agent/facilitator.

There's no regulation.

There's no compulsory code of conduct.

Anyone can join one of the associations such as MTA or IMTA.

There's no bond required.

So what's the industry been doing to fix the problem?

IMTA launched a Patients' Bill of Rights some while back.

Treatment Abroad has encouraged better business practices into the market, by introducing the Treatment Abroad Code of Practice for Medical Tourism. We now have eight providers who have signed up to the Code and have been externally assessed

MTA launched an accreditation programme in July 2008 , then hastily renamed it a certification programme, but still hasn't certified anyone (according to their web site).

The Council on the Global Integration of Healthcare shows promise with its current development of a Medical Travel Facilitator Certification programme and its work on the Medical Tourism Facilitation Standards in the area of oncology.

In the perfect world, we need an ABTA of the medical travel world - properly funded, run by a truly representative Board of Directors, that is answerable to its membership, that publishes an annual report and financial statements, that only accepts members who meet clearly defined criteria, that inspects member premises at random, and that requires all members to place a significant bond for the protection of medical travellers.

Likely?

I doubt it.

What is more likely....

As medical travel grows, especially in a background of government driven initiatives such as the European Directive on Cross Border Healthcare, governments will begin to regulate medical travel facilitators and agents. Bodies such as ABTA in the UK and similar organisations in other countries would probably favour and support this.

"What makes a medical travel agent any different and exempt from regulation?", they would say.

What can medical tourism learn from previous recessions?

2009-01-15T19:53:00.004Z

How will the medical tourism sector fare in a global recession that's affecting everything from house prices to car sales to polar bears and dog ownership!

If unemployment in the Western world climbs to record levels in the coming year, is this good news or bad news for the healthcare sector?

Some good news comes in a recent McKinsey analysis. According to McKinsey, in previous recessions, US consumers changed their their spending priorities rather than cutting all expenditure across the board. In discretionary areas of expenditure such as dining out, personal care products, and charitable donations fell. But expenditure on groceries, books, insurance, education and healthcare actually rose.

See the McKinsey analysis - Industry trends in recessions.

However.... compared to the 1990/91 and 2000/01 downturns what we are facing now could be much much worse. In the UK, there are early indications that discretionary expenditure on private education and, of more relevance, private self paid surgery is being affected.

It remains to be seen whether those with less money in their pockets will be attracted by low cost treatment abroad , and whether the credit crunch stimulates new demand for medical tourism.

How well written are medical tourism web sites?

2009-01-12T10:00:00.005Z

For many medical travellers, the first point of contact with a hospital or clinic is usually a web site (see the Treatment Abroad Medical Tourism Survey 2008). And since many patients are seeking healthcare providers where communication in the English language is important, the web site is an important factor in patient choice. A site written in poor English reflects badly on the service offered and discourages potential patients.

So... how well written are medical travel web sites.

Sadly, many are written in a way that actually discourages patients from using the hospital, clinic or medical tourism service. Most would benefit from being re-written by a native English speaker .

To help solve this problem, Treatment Abroad has launched a low cost “Perfect English” service for healthcare providers who want to improve web sites targeted at US and UK medical tourists, and other English language speakers. The “Perfect English” team provides a review of the English version of a site and gives you a version re-written in “perfect English”. The team has extensive experience of producing “perfect English”; they are based in Brussels, Belgium and support many European Union politicians and officials with translation and improving the English versions of EU materials.

If you want to know more about the Treatment Abroad Perfect English service, you can complete the enquiry form on Treatment Abroad.

Marketing in the medical tourism downturn

2009-01-08T15:49:00.004Z

There are conflicting views on how the global financial crisis is affecting medical tourism. The view expressed by organisations such as the Medical Tourism Association is that the "...with the economy and the credit crisis, more people are waking up and paying attention (to medical tourism)."

The harsh reality may be somewhat different. BusinessWeek reports that "...in some medical tourism hotspots, formerly booming hospitals are seeing empty beds." The MD of Parkway Hospitals in Singapore, "expects the foreign patient numbers to stabilise after dropping 10 per cent".

Whether the credit crunch encourages more people to consider travelling abroad for treatment remains to be seen. People are short of cash, unable to borrow and are delaying expenditure on house purchases, cars and other major expenditures. Healthcare is not immune to this. Although in the last global recession, healthcare was less affected, the likelihood is that people who might have considered medical tourism may decide to postpone their expenditure.

Areas likely to be affected most are those “non-urgent”, discretionary treatments such as cosmetic surgery. In countries where medical tourism is influenced by waiting lists, patients may decide to hold out for free treatment in their own country rather than go for the paid for, immediate treatment available elsewhere. In the USA, the story may be different, as the financial crisis puts pressure on health insurers and employers to find ways to cut rising healthcare costs.

The simple answer is that no one knows yet how the financial crisis will affect medical tourism. But it’s best to be prepared.

So, here are our recommendations for marketing in a medical tourism downturn (....follow these and they will also pay off, if there’s an upturn).

And no apologies for giving the services of Treatment Abroad a plug!

1. Target your activities
There are many hospitals, clinics and medical tourism operators out there who don’t have a clearly defined service strategy. What service am I selling, into what markets and to what demographics? Now is the time to think this through, and identify very clearly your market niche.

2. Maximise your return on marketing investment
Measure your return on investment on all marketing activities. And invest in those that deliver results:

Invest in the web, because it’s the one area of marketing expenditure where you can measure your return and control your budget easily.

Use PR. It’s a low cost and effective way of promoting your services to patients in other countries. (Become a Treatment Abroad client and we’ll give you our free guide to generating PR coverage!)

Take advantage of free web promotion. Send your news articles to Treatment Abroad (it’s a Google approved news feed for medical tourism – your news story will get indexed by Google within the hour, if published).

3. Improve your conversion rate
Turn more web enquiries and leads into paying patients and customers. If someone has bothered to complete an enquiry form for your service, then they have probably done the same for some of your competitors. Respond faster, and respond better with an informative, personalised and high quality response. (Become a Treatment Abroad client and we’ll give you our free guide to enquiry management!)

4. Generate referral business
Past patients are the one of the best sources of future patients. 20% of medical tourists who travel for treatment have been recommended by a friend or relative.

Give a “Recommend a friend” discount voucher that your past patients can give to a friend or relative.

Generate word of mouth recommendations by encouraging patients to contribute to reviews sites such as Medical Tourism Ratings and Reviews.

5. Be brave!
Don’t cut back your marketing budget. In a recession, the strong survive. Use the opportunity to take market share from competitors who are less well equipped, and ill prepared to deal with a downturn.

Don’t cut your prices because you think it will bring you more business. Think about where you can add value to your service offering to give yourself a competitive edge and concentrate on customer service and service quality.

Put the above into practice. Then, whether we see an upturn or a downturn.... you'll be on the winning side!

What can Google tell us about medical tourism?

2008-12-01T16:24:00.013Z

Who knows what's going on in healthcare? Who knows what conditions and disorders are causing people problems? Who knows what's happening in medical tourism?

Google!

Google is a treasure chest of information about how people are behaving and what issues are concerning them. Google logs the online activity and search behaviour of hundreds of millions of users. It knows what you and I do on the web everyday. It knows where we are, most of the time. And from the data that Google collects, it can draw conclusions. And so can you.

A recent example of this in the healthcare sector is Google Flu Trends . Google has realised that certain search terms are good indicators of flu activity. Google Flu Trends uses aggregated Google search data to estimate flu activity in a US state up to two weeks faster than the federal centres for disease control and prevention.

Outside of healthcare, a UK web intelligence company was able to predict the winner of a TV talent show, based on the online activities of people who were watching the show and researching the contestants online.

So what does Google know about medical tourism....? Probably quite a lot more than most people in the business.

Let's take a simple example. Suppose I want to know which are the most popular countries for cosmetic surgery for UK patients who travel for treatment.

I can analyse the search activity of UK internet users by looking at the relative number of searches for cosmetic surgery and plastic surgery which also incorporate location or country names.

I then combine all of this data to create a search volume of country related cosmetic surgery related phrases. For each country, I can then calculate a share of the total volume of searches. And we get the table on the right.

Interesting stuff.... Now, it doesn't tell me which countries people are actually going to (in the same way that Google Flu Trends doesn't actually tell you that people have flu), but I'm willing to bet that it's not a bad indicator. And it's probably a far better indicator than the top of the head data that many "experts" toss around.

So, if your job is about marketing medical tourism, you need to consult the new medical tourism guru - Google Inc.

Medical tourism: Survival of the fittest?

2008-12-01T10:34:00.003Z

No industry is immune from global recession, and that has to be the case for the growing medical tourism industry. In past recessions, businesses in the healthcare sector have perhaps suffered less than others; in a recession, people still get ill, and it's often difficult to delay expenditure on healthcare. But there are some indicators that medical tourism is begining to feel the pinch.

According to a recent article in BusinessWeek, "Medical Tourism: Surviving the Global Recession", the Bumrungrad Hospital in Bangkok, one of the world's leading centres of medical tourism is seeing a fall in overseas patient revenues. Similarly, the Association of Private Hospitals of Malaysia is reducing its forecast of overseas patient revenues, and some Indian medical tourism providers are reporting that "medical tourism is on the wane". The situation is further complicated in India and Thailand by the recent terrorist incidents and political protests.

If we think back to 9/ll and the subsequent Iraq involvement, these events had a major impact on travel related businesses and medical tourism flows from the Arab States to the Western World. Countries such as the UK saw a significant drop in inbound medical tourism, and Arabic patients transferred their loyalty to countries such as Germany.

The counter argument is that in times of economic hardship, people are going to be more inclined to go overseas to avoid high costs in their own country. i.e. they look to buy cheaper, so this is good news for the medical tourism industry.

What's going to happen? Here are my thoughts:

The speed and size of this global recession is such that it must have a negative impact on medical tourism; people are going to hang on to their cash, and delay treatment whether that is treatment within their own country or overseas.
It doesn't necessarily mean that less people are going to travel for treatment.It probably means that the growth in number of medical travellers which has been widely predicted is going to be much less than anticipated.
Many of the "new-born" medical tourism facilitation companies that have appeared in recent months are going to find it tough going.
Those businesses in the sector that have their marketing act together will do best. They'll focus on those marketing activities that deliver results, they'll have a clear idea of what their marketing and service strategy is, and they'll look to generate business and referrals from existing and past patients. See "Five Tips for Marketing in a Recession"

So....it's going to be survival of the fittest in the medical tourism sector. There's plenty of opportunities out there, but there will be fewer to go around. Which means that some businesses are going to find the going tough.

How to run a medical tourism conference...

2008-11-13T17:44:00.013Z

Autumn is conference season, and it seems that medical tourism is becoming the most talked about subject on the conference platform. Three years ago, there was little interest in this area, but in 2008 it seems that every events company and association has jumped on the conference bandwagon.

In recent weeks, I've attended the World Health Tourism Congress in San Francisco, the Health Tourism Development Conference in Vienna, the Health Tourism Show in London, the Global Healthcare Conference in Dubai and spoken on medical tourism to a meeting of UK NHS management, and to a Cerner Healthcare Convention in Kansas. My colleague, Philip Archbold has spoken at the Indian Medical Tourism Congress in Chennai. Coming up...I'm off to address the International Medical Travel Conference in Korea, and speak at a meeting of the Cyprus Health Promotion Board.

So, I've become a bit of a medical tourism conference "groupie.....

But it prompts the question: Do we need all these events, and are they actually worthwhile?

In my previous company, one of the core activities was event planning and management; many of these events were within the healthcare sector. So, I do have some knowledge of what makes a good event and what can go wrong. Being an attendee/speaker/delegate at these medical tourism events has been an eye opener. Frankly, compared to other industries most of them aren't delivering the goods.

Where's it going wrong?

Here are my top ten recommendations for medical tourism event organisers:

1. Set some objectives....

Most of the medical tourism events that I have attended seem to have some kind of vague objective of "let's get a bunch of people together to "address some of the issues", and facilitate some networking (and we'll make a bunch of money while we do it.....).

2. ....and measure your success!

If you don't have SMART objectives, you can't measure your success. Sending out a post event "What did you think of the conference?" survey is the usual cop out in this respect..but what is it actually measuring? Most medical tourism conferences don't even bother with this most basic of measurement tools.

3. Plan the agenda

The current approach appears to be mainly along the lines of "who can we get to speak". Why not plan an agenda, and then identify those people who would be best to cover specific topics? Let's have some speakers from outside of the medical tourism fraternity who can give a different perspective!

4. Buy professional expertise

If events aren't your core expertise, buy some expert help. Get a professional event organiser in to plan, market and run the conference, The Medical Tourism Association did a great job of getting numbers to the San Francisco Congress, but in terms of structure, content and organisation ........

5. Abolish the all day plenary session

Different people have different information needs. The medical tourism industry is a melting pot of providers, purchasers, facilitators, insurers, etc etc. Run specific, smaller workshops or sessions that cover key issues for targeted groups of delegates. Start the day with a lively, thought provoking keynote presentation then break the audience into smaller sessions. The Cerner Healthcare Convention has cracked this one. A stimulating keynote address each day followed by 300 plus targeted workshops for the 5,000 plus attendees.

6. Fire some of the speakers

I've seen good, bad and just plain awful this year. My greatest gripe? Speakers who have been given a clear and very specific brief...and then ignore it completely, often making a "This is what we do in XXXX, aren't we wonderful" presentation. All speakers are guilty of promoting their own interest/business. That's part of why they are there, and it's to be expected. But, it shouldn't make up 100% of their presentation. If you want me to name names, I'll email
them to you....

7. Ban the "destination presentation"

The conference platform is not the place to run a 30 minute "advertisement" ..... "my country/destination/hospital/company has the "highest quality healthcare", "state of the art technology" etc etc

8. Organise

If you're going to attempt to run some structured networking or "buyer meets seller" sessions, plan it properly, match up the right people and run it like clockwork. Take a look at other industries and see how well they do this.

9. Keep to time

If there's one thing a conference must do, especially when it's based on parallel sessions is run to time. If speakers over run, turn off the mike. Dubai could learn a thing or two here.

10. Make it fun!

Liven it up! We're human beings. We're out of our regular job for a few days. We want to enjoy ourselves. Will someone please do something different.....!

Finally, one medical tourism conference not to miss in 2009; the 2nd European Congress on Health Tourism in Budapest. Why? Under the guidance of a medical tourism expert, Dr Uwe Klein, perhaps this one will hit the mark?

Medical tourism: The answer to the global healthcare problem?

2008-11-13T07:43:00.004Z

A recent article from McKinsey International highlights the magnitude of the challenge that leaders of governments in the developed countries are going to have to deal with sooner rather than later. The article looks at the increasing proportion of a country's wealth that is going to be dedicated to the health of its citizens in future years.

In Europe currently around 9% of GDP is spent on healthcare; in the USA, it's higher, nearer 16% of GDP. For the last fifty years, the increase in health care spending in OECD countries has been 2% above the GDP...... which means that healthcare is taking an increasing proportion of the national wealth. But what happens if this continues? McKinsey says that "if current trends persist to 2050, most OECD countries will spend a fifth of GDP on healthcare. By 2080, Switzerland and the United States will devote more than half of GDP to it, and by 2100 most other OECD countries will reach this level of spending."

Those are pretty astonishing statistics! There's a decent analysis in the article, outlining the supply and demand factors that drive this growth, and offering some arguments as to why this trend will not or cannot continue at this rate. However, the harsh reality is that whatever governments do, they and their citizens will be faced by the burden of ever increasing healthcare costs.

And that's the reason why healthcare is becoming global, and medical tourism is being talked about as one of the solutions. More and more, governments will not be able to provide and consumers will not be able to afford the healthcare that they need. The global market in healthcare provision will expand to meet the growing demand from both consumers and governments for low cost treatment overseas. And that's where medical tourism comes in.

Reference: Healthcare costs: A market based view: McKinsey International

Medical tourism ratings and reviews

2008-10-22T17:22:00.007+01:00

It's been a couple of months since we launched medical tourism ratings and reviews. It's met with a variable response from the medical tourism industry, and from the patients themselves.

Medical tourism ratings and reviews at Treatment Abroad enables patients to provide feedback on their experience of travelling for treatment abroad. The Ratings and Reviews system is integral to our business philosophy of “helping patients to make the right choice”. It's run through Bazaarvoice, the US based world leader in reviews systems who operate similar systems for companies such as Dell, Sears, Argos and many others.

When a patient submits a review of a medical tourism agency, a hospital or a clinic, the review is checked by the Reviews Team to ensure that:

The review is valid, honest and fair comment.

It is not a spurious review that has been “invented” by a healthcare provider to promote their facility or to damage a competitor’s reputation.

The review does not contain profanity or inappropriate content.

The review does not raise issues of legal liability.

Healthcare providers and agencies are given the opportunity to respond to any negative reviews.

So...what do the healthcare providers think of ratings and reviews?
It's interesting.... those medical tourism agencies and healthcare providers that are "marketing oriented" have adopted the approach with enthusiasm. They see it as a highly attractive way of generating "word of mouth" recommendation of their services and it doesn't cost them a penny.

Companies such as Gorgeous Getaways in South Africa and Vital Europe in Hungary are actively encouraging their patients to review their services:

Others are less enthusastic....and I'm not sure why! Is it because they are fearful of patients posting negative comments about their experience? Is it because they are just not switched on to the power of "word of mouth" and the way in whiuch consumers are using the web to influence product and service purchase?

Experience from other industries shows that:

63% of consumers are more likely to purchase from a supplier, if it has ratings and reviews.
77% of online shoppers use reviews and ratings when purchasing.
82% of those who read reviews said that their purchasing decisions have been directly influenced by those reviews.

Asking people to record their experience of medical tourism should encourage more patients to travel for treatment abroad. And, Medical Tourism Ratings and Reviews should help healthcare providers to tune into the “patient’s voice”.

So...what do the patients think of it?
They love it! The feedback on their medical tourism experience is overwhelmingly positive, and it's helping to reassure other patients who are considering medical travel. Patients are healthcare consumers; and typical consumer behaviour is beginning to influence the way that they buy healthcare. If they can rate and review their hotel or holiday experience on TripAdvisor.... why not do the same for medical travel?

medicaltourism.com ......going, going gone?

2008-08-28T17:10:00.006+01:00

What's a domain name worth? Especially in the growth business of medical tourism.

The Medical Tourism Association (of which my Company is a member) has recently announced that it is handling the sale of the domain name medicaltourism.com, on a commission basis. A reserve price of around $100,000 has been put on the sale.

Which raises the question of how you value a domain name and what is one actually worth?

The domain medicaltourism.com was originally owned by Sparrow Mahoney, who ventured into medical tourism after experiencing low cost surgery in Croatia after a car accident. Sparrow has now flown the medical tourism roost.The domain has been bought by a third party looking to make a fast buck.

Here’s a few recent domain sale prices in the health sector:

healthstore.com $27,500
healthcaresolutions.com $10,700
healthinsurer.com $4,595
healthglobal.com $2,700

So, would you pay $100,000 for medicaltourism.com?

There is certainly some value in the domain name.The words within a domain name can influence Google rankings, but it's certainly not a major factor. There's value in a domain name if it's associated with a strong brand or an existing web presence.

With regard to medicaltourism.com:

The site has only 24 pages indexed on Google. Do a Google search for site:medicaltourism.com.
It has only six inbound links logged on Google Do a Google search for link:medicaltourism.com.
It has a negligible amount of traffic.

Bidding will take place at the World Medical Tourism and Global Health Congress in San Francisco in September.

Any offers?

EU Directive on cross border healthcare boosts health tourism

2008-07-02T19:00:00.005+01:00

After a six month delay, the EU Proposal for a Directive on patient’s rights in cross border healthcare has finally been released. It provides an added stimulus to the already growing number of medical tourists who seek hospital treatment elsewhere in the European Union. Its aim is to create a formal framework for cross border healthcare and remove the obstacles that patients face if they wish to travel for treatment in other EU countries.

I'll attempt to answer some of the questions that people are asking about this new Directive and its impact.

Why do we need a Directive on cross border healthcare?
The Directive has come about from a desire to create a European market in healthcare, and to some extent as a result of European Court judgements which have upheld the rights of patients to gain reimbursement for treatment in other countries where they have been subject to "undue delay" in their own country.

What does it cover?
The Directive proposes a number of developments in cross border healthcare, including reimbursement of medical tourists, patient safety and quality issues, European cooperation on healthcare, assessment of new medical technology and standards for e-health and transfer of patient information between member states.

How will it affect UK NHS patients?
In April this year, NHS patient choice in the UK was extended, giving patients the right to opt for treatment anywhere in the UK. The Directive, in effect, extends this patient choice to anywhere in the EU, provided that the treatment is available at a cost which is the same or lower than the NHS cost.

Under the Directive, the NHS will be requested to establish a direct payment or reimbursement system. This means that patients will not have to fund the treatment and then claim the cost back from the NHS. They will have to fund their travel and accommodation costs. No prior approval is required from the NHS or the patient's primary care trust.

It doesn't mean that patients in the UK or elsewhere in the EU can opt for treatments overseas that are not covered by the NHS. So, if a new drug or a new procedure is available in another country, the patient cannot obtain payment for this.

How many patients will opt for treatment abroad?
Who knows? Patients may decide to travel abroad because:

Surgeons and hospitals with better results for their treatment may be available elsewhere in Europe.
Hospital infection rates may be lower in other European countries.
Faster treatment may be available elsewhere.

It is worth noting that:

There is no requirement for the patient to be suffering "undue delay" in treatment.
The patient will need a referal from a GP.
Patients cannot jump the waiting list in other countries..... which is one reason why why we will not see large numbers of patients travelling to the UK for treatment. They will join the end of the queue of existing UK patients.
And since the UK is one of the most expensive healthcare providers in Europe, this will also discourage an inflow of patients from lower cost countries.

How will it affect the NHS?
It depends on how many UK patients opt for treatment abroad. If the NHS can prove that the number could be so large that it would affect the planning and funding of healthcare facilities in the UK, then it can make an application to set up a "Prior Approval" system which means that a patient would have to apply for treatment abroad. This is unlikely, I believe. It would be an admission of failure by the Government that the NHS cannot compete in a competitive European marketplace.

Overall the Directive has to be a good thing for both the NHS and UK patients. It could reduce the burden on NHS waiting lists, and offer cost savings where cheaper treatment is available elsewhere in the EU. It would also mean that NHS hospitals would face increased competition and would have to improve their performance relative to other European healthcare providers.

What else is covered by the Directive?
In addition to clarifying the position regarding medical tourism within the EU, the Directive also embraces:

The establishment of common principles in terms of guaranteeing patient safety and ensuring quality and continuity of care.
Stimulating greater European cooperation on healthcare including the establishment of “European Reference Networks” which would create a concentration of expertise, training and resources for specific diseases and health issues.
Establishment of a European network for the assessment of new medical technology.
Establishment of standards for e-health, in particular the transfer of patient information and treatment records between member states.

When will it take effect?
It's a draft directive, so it has to go through the EU mechanisms to be officially adopted as policy. But it's a part of a consultation process that's been going on for three years, so it's likely to become reality.

Good news or bad news for the medical tourism industry?
Undoubtedly, good news! It will add to the credibility of medical tourism, and will mean that people become more familiar with and confident about travelling for treatment. It will also reinforce the need for an improvement in standards and business practices in the industry. (See the Treatment Abroad Code of Practice for Medical Tourism).

Ultimately, it will result in greater patient choice and more people will choose to travel for treatment abroad.

For patients seeking treatment now who can't wait until the Directive comes into force, they can download Treatment Abroad's Guide to Medical Tourism or visit Treatment Abroad.

Helping patients make the right choice of medical tourism service

2008-05-25T14:04:00.005+01:00

More and more people are using online reviews to make decisions about the products and service that they buy. Consumers worldwide want to hear from “people like me” before they make a decision about which product or service to buy. TripAdvisor has become the first place that many people visit when they are planning a holiday or booking a hotel.

So, would medical tourists benefit from hearing about the experiences of other people who have travelled abroad for treatment? Undoubtedly, Yes!.

The web is now the first place that people look to research hospitals and clinics online before they decide where to go. Choosing a doctor, operation, or hospital, is a big decision, and the more opinions a patient can gather, the more secure they feel with their ultimate choice.

The philosophy of our online business is "helping patients to make the right choice". That's why we've just launched Treatment Abroad Ratings and Reviews to provide patients with the “word of mouth” that will help them to make the right choice of medical tourism service, hospital or clinic. We know from other areas of industry that:

63% of consumers are more likely to purchase from a supplier, if it has ratings and reviews.
77% of online shoppers use reviews and ratings when purchasing.
82% of those who read reviews say that their purchasing decisions are directly influenced by those reviews.

But how much trust can people put in reviews of such services? A medical tourism agency, hospital or clinic, doctor or dentist may be tempted to either:

Create a fake review to promote their own service.
Create a fake review to damage a competitor’s reputation.

We have chosen BazaarVoice as the partner for our Ratings and Reviews system because of their ability to identify fake reviews through the algorithms they run on review submissions, the tracking of IP addresses of reviewers, the validation of email addresses, and BazaarVoice’s experience of moderating thousands of reviews for major clients every month.

We have also warned clients and healthcare providers that any attempt to bias our reviews service will result in immediate removal of all review content.

We'll see how Treatment Abroad Ratings and Reviews develops over the coming months. But we're sure it will help potential medical tourists to differentiate between the good and bad in terms of medical tourism service providers.

McKinsey and the medical tourism numbers game...

2008-05-13T16:43:00.005+01:00

According to a new report on medical tourism from McKinsey (login required):

"Between 60,000 and 85,000 people annually travel abroad for inpatient hospital care, a number.....far lower than commonly assumed".

According to the Wall Street Journal:

... the McKinsey report "contrasts sharply" with common assumptions and with figures often used by those who market medical tourism. "There's been an enormous amount of hype" regarding people traveling abroad to receive necessary procedures at a lower cost, Mango (from McKinsey) said.

So what are we to make of this "authoritative" report.....?

One industry insider who has compiled a comprehensive review of medical tourism suggests:

"The McKinsey figures are nonsensical......looking just at figures from Asia for travellers from Asia and the Gulf, they are way way out."

One problem with the McKinsey data is that it relies heavily on government statistics, and few governments record medical travel. Even where figures are collected then they do not include home nationals who work overseas going back for treatment, or US and other residents returning to a country of origin for treatment.

It's also a strange method of counting medical tourists, if you decide to leave out:

people travelling across borders for treatment, which would include UK to France or Belgium, Canada to the US, the US to Mexico, Mexico to the US , China to Taiwan or Hong Kong, central Africa to South Africa , Ireland to the UK, etc etc.
people travelling back to their homeland for treatment.
people travelling to the homeland of their parents/grandparents
expatriates working overseas
people who decide to mix travel and treatment eg UK travellers to Spain, South Africa
people who mix business travel and treatment
people who live in two countries eg UK and Spain
And..all outpatients

Other oddities...

If they reckon the number of medical tourists are 60,000 to 85,000 worldwide, how does this stack up against other reported data:

70,000 - 100,000 UK medical tourists (from our own Treatment Abroad medical tourism research and the UK International Passenger Survey data)
Last year, 92,000 patients from the UAE visited the Philippines.
One dental clinic alone in Budapest that is treating over 4,000 patients from abroad each year.
10,000 visitors to Korea last year for medical treatment, according to the Korean Tourism Organisation.
Singapore Tourism Board says 555,000 tourists received medical treatment in 2006.

And overall... it is a little strange to say that someone travelling overseas for a hip operation is a medical tourist, but someone travelling for a dental extraction or cosmetic surgery is not.

Whatever the real numbers are, McKinsey did conclude:

"Medical travel is a highly relevant market ........ The acceleration of unsustainable health care costs in many developed economies, the advent of advanced technologies in just a few locations, and the increasing concentration of wealth in developing economies are only a few of the factors fueling it. Over the next couple of decades, these trends may largely dispel the idea that health care is a purely local service"

So... good news for the medical travel industry!

A code of practice for medical tourism

2008-03-11T10:29:00.011Z

At Treatment Abroad, we have introduced the first medical tourism code of practice for healthcare providers. The "Code of Practice for Medical Tourism" aims to encourage best practice in medical tourism through a commitment by healthcare providers overseas to a voluntary code of practice.

The standards of business practice and customer service in the medical tourism indutry are variable. But having said that ...they are probably much higher than many critics of the industry suggest. (In our recent survey of 650 medical tourists, 97 per cent of patients said they would be willing to travel abroad for treatment again).

The Code is an opportunity for agencies and healthcare providers to reassure patients considering overseas treatment that they are adopting best practice.

If the medical tourism industry continues to grow, it needs to adopt some common standards and best practices. Hence the Code of Practice for Medical Tourism. Healthcare providers and agencies who sign up to the Code will be identified as adopting a “best practice for medical tourism” and will be recognised on http://www.treatmentabroad.com/.

In addition providers who are approved will be able to display the Treatment Abroad accreditation mark on their website and patients will be able to access accreditation details online.

In order to receive accreditation, organisations are asked to demonstrate best practice in a number of areas covering provision of information, the patient experience and contractual terms, conditions and guarantees. The application will be reviewed by an independent consultant.

We believe that this is a positive step for the industry and offers a chance for providers to demonstrate their commitment to best practice in dealing with patients from overseas.

Further information about the Code of Practice for Medical Tourism is available at:www.treatmentabroad.com/medical-tourism/code-of-practice

Do concerns about MRSA and hospital infection drive patients abroad?

2008-01-31T13:50:00.001Z

Medical tourists who travel abroad for treatment, don't just do it to save money. In our soon to be published "Medical Tourism Survey", 56% of the respondents who went for elective surgery abroad said that worries about the risk of MRSA/hospital infection in NHS hospitals were a "Very Important" or "Quite Important" factor.

According to the Health Protection Agency's latest data, there was an 18 per cent drop in cases of MRSA in England from July to September compared to the previous quarter (April to June). This is a drop of about 230 cases per quarter. however, there were still 1,072 cases reported in England during July to September 2007 .

The latest C. difficile figures show that there were 10,734 cases in patients aged 65 years and over in England, reported in the third quarter of 2007. This is a 21% decrease on the previous quarter. In patients between 2 and 64 years of age, 2,496 C. difficile cases were reported in the third quarter of 2007.

So.... there is some indication that the NHS is having some success in improving its poor reputation for hospital infection. But there's an awfully long way to go. The UK is way behind countries such as Norway, Sweden, the Netherlands, Czech Republic and Spain in controlling MRSA and hospital infection rates. (See MRSA statistics in UK and Europe).

Until the NHS can reduce hospital infection rates to a minimal level, patient concerns will continue to be a factor in why people choose treatment in private hospitals in the UK or treatment abroad.

EU Cross-border Healthcare Directive delayed

2008-01-29T09:36:00.000Z

According to EurActiv, an independent media portal dedicated to EU affairs, the EU Cross-border Healthcare Directive which intends to lift restrictions on patients travelling for treatment in other EU countries could be either redrafted, withdrawn or downgraded.

The EU Cross-border Healthcare Directive has taken a couple of years to develop and was scheduled to go public on December 17th 2007. It became the main UK news story of the day (the EU had leaked early copies of the Directive to the media). But by midday, the EU had decided not to publish the Directive and announced a delay of 4 weeks or so in publication due to "agenda issues".

Methinks...that some governments including the UK were not too happy about the implications of the Directive and how it might place their own health system in a bad light as they became "exporters" of patients.

EurActiv believes that the Commission has been asked to redraft the Directive.

A representative of a medical stakeholders' organisation told EurActiv:

"This is an issue between the rich and poor EU member state. Health care costs vary widely across the EU, so it would be easier for rich countries to reimburse cheaper care abroad than for poor countries to reimburse their nationals seeking expensive care in wealthier countries."

According to a Commission spokeswoman, the proposal is still scheduled for publication at the "beginning of 2008".

High UK dental costs driving patients abroad

2008-01-10T13:34:00.000Z

A new study has been published which compares the cost of providing dental treatment in nine European countries. The UK has the highest costs of dental treatment. (Note: the study compared the cost of providing dental treatment, not the prices that are charged to patients).

According to Siok Swan Tan of Erasmus University Rotterdam, the lead author of the study, differences in dentists' are the most important reason for the variation in costs. "They account for 70 per cent of total costs in England, and range from €0.09 per minute in Hungary to €2.88 a minute in England."

As a result prices for both NHS and private dental treatment in the UK are much higher than in other European countries. It's the main driver for the growth of dental tourism with Hungary the leading destination for UK patients.

The research is part of a wider European Commission study that compares the cost of medical procedure; the study was published in the journal Health Economics.

You can read a full report on the study on the Independent newspaper site. The story made front page news in the UK today.

EU Cross-border Healthcare Directive boosts health tourism

2007-12-19T11:22:00.000Z

The new EU Cross-border Healthcare Directive which is to be announced today intends to lift restrictions on patients travelling for treatment in other EU countries. Patients wishing to travel to other EU countries for medical treatment will be able to reclaim the cost of treatment from the NHS and will only have to pay their travel and accommodation costs, plus any top-up fees if charges in the foreign hospitals are higher than the NHS cost.

The directive could revolutionise the way we experience healthcare in the UK and throughout the rest of Europe. The directive will take the concept of patient choice to a new level. Competition from European hospitals could prompt much needed changes within the NHS. Successive UK governments have made token gestures to introduce market forces within the NHS; ranked 17th out of 29 European countries in the recent Euro Health Consumer Index, the NHS now faces real competition in the European marketplace.

The Directive will provide a framework for cross border healthcare and will deal with issues such as quality of care, patient safety, method of funding and transfer of patient information. There are also plans to introduce "European reference networks" which would bring together medical expertise across Europe and encourage greater collaboaration between centres of excellence.

Dental tourism....without going abroad?

2007-12-14T20:25:00.000Z

This week sees news that two buy-to-let-property development millionaires plan to open a series of drive-in dental centres close to motorway junctions around the UK. Having seen the growth of dental tourism in the UK, they have decided to bring overseas dentists to the British patient, offering prices for dental treatment which will be competitive with those in countries such as Poland and Hungary.

They plan to set up a national chain charging the same or less than NHS clinics. Thie service will be staffed by dentists from Eastern Europe who will receive free housing but will only get salaries in line with what they would earn back in Eastern Europe.

Whether this idea will get off the ground remains to be seen. Will they be able to find overseas dentists who are prepared to work at Eastern Europe salary rates when they are based in the UK? How will they attract the best overseas dentists to work at these rates? And how will they select the dentists?

If it works....perhaps we'll see the UK becoming a dental tourism destination?

British patient wins NHS payment for treatment abroad

2007-12-04T16:57:00.000Z

Another British patient has succeeded in recouping the cost of treatment abroad from the NHS.

Ann Belshaw of Suffolk took the Suffolk Primary Care Trust to court to pay for a scan at a private clinic in Germany. The NHS originally told her that she would have to wait a year for a scan on her back at the Addenbrookes Hospital in Cambridge.

A three-year legal battle then ensued to force her local NHS Health Trust to pay for her private treatment abroad. The Trust has now agreed to pay the £350 cost of the scan and Mrs Belshaw's legal costs , just as the the case was to go before London's High Court. Had it gone to the High Court, there is little doubt that the European Court of Justice ruling on cross border treatment (the Yvonne Watts case) would have applied.

This legal precedent combined with the forthcoming EU proposals on cross-border healthcare could lead to significant growth in medical tourism from the UK.

EU proposals promise boost to medical tourism

2007-11-26T08:58:00.000Z

European Commission proposals to be released next week will increase patient mobility within the EU and give NHS patients access to hospitals across the Continent; patients in other EU countries will will also have access to NHS hospitals.

The proposals will confirm the ruling of the European Court of Justice on overseas treatment for waiting list patients who are suffering "undue delay". Yvonne Watts, a British patient who was on a waiting list for hip replacement paid to go to a French hospital for her hip operation; she then went to the European Court of Justice to claim the costs of the operation from the NHS. The Court confirmed the legal right of patients to seek treatment in another EU state, if they have to suffer "undue delay" in their country of residence.

The new proposals could result in a boom in NHS sponsored health tourism. Patients would pay for travel and accommodation costs, but the NHS would foot the bill for the treatment.

Details of the new proposals are expected to be made available this week.

Cosmetic surgery abroad under fire in the UK press

2007-11-20T08:37:00.000Z

The growth of medical tourism is attracting more and more attention to issues such as quality of treatment, accreditation of surgeons and dentists, hospitals and clinics.

The British Association of Aesthetic Plastic Surgeons this week launched an attack on “botched cosmetic work” carried out by surgeons overseas, based on a “study” of 36 UK plastic surgeons who reported having to correct surgery carried out abroad. The “study” resulted in headlines such as these:

Operations done abroad fail to cut it – Daily Telegraph
Plastic surgeons attack botched holiday surgery – The Guardian
UK surgeons 'fix overseas blunders' - Channel 4 News
More fly off for bargain facelift holidays - then seek repairs back home – The Times

Recently, dental tourism was also criticised, by the British Dental Health Foundation, resulting in headlines such as this:

How my smile was ruined by a dodgy dentist

Now....you have to bear in mind the motives of the British Association of Aesthetic Plastic Surgeons and other professional associations in publicising such issues. They and their PR agencies represent the interests of UK surgeons, dentists and medical professionals. It's bad for business if people start travelling for treatment!

Let's take the "dodgy dentist story". The British Dental Health Foundation reported there has been "a significant increase in calls to its helpline from people who have had bad experiences of dental tourism". In fact, they receive around 40 calls per month about medical tourism out of 3,500 calls in total. Of the 40 calls, 5 are from patients reporting problems or who are unhappy with their treatment. And given the growth of medical tourism, you might expect an increase....

The British Association of Aesthetic Plastic Surgeons story is based on a study of 36 members.

"Half the surgeons who took part in a survey have seen at least “a little more” repair work than last year, while a third have seen “much more” repair work as increasing numbers of Britons opt for cheap surgery abroad"

Given that the number of UK cosmetic surgery procedures rose by 40% last year and medical tourism based cosmetic surgery probably rose by around 100%, you might expect there to be more problems seen?

At Treatment Abroad, we are pursuing several initiatives to counter such criticisms and promote the concept of medical tourism. Our current survey of medical tourist experiences of treatment abroad is one of these initiatives.

Another initiative is the development of a “Code of Practice for Medical Tourism”. You can find out more about what we are trying to achieve on the Code of Practice page on Treatment Abroad.

New health index means good news for medical tourism companies

2007-11-14T14:44:00.000Z

The recently published Euro Health Consumer Index provides some interesting insights into the state of the UK health services and some encouragement for those who see the UK as a developing market for outbound medical tourists. The Index rates the public healthcare systems in 29 European countries on many factors such as clinical outcomes, quality of care, access to health services and patient information.

Austria emerges as the 2007 winner of the Euro Health Consumer Index, followed by the Netherlands, France, Switzerland and Germany.

The UK comes a very disappointing 17th out of the 29 countries; its score is dragged down by waiting lists and uneven quality performance. Medical tourism destinations such as France, Belgium, Estonia, Cyprus, Spain and the Czech Republic all outscore the UK.

As a separate exercise, the Euro Health Consumer Index 2007 included a value for money adjusted score, the "Bang-For-the-Buck adjusted score", which attempts to measure the value for money which the consumer gets from the healthcare system allowing for the spend on public healthcare in the country.

More bad news for the UK National Health Service.....

The UK sinks to 26th out of 29. Only Bulgaria, Poland and Latvia do worse.

Despite the efforts of successive UK governments, the NHS continues to deliver value for money to UK health consumers.

And that's probably good news for medical tourism companies!

UK media gives medical tourism a favourable press

2007-11-11T21:28:00.000Z

The UK press continues to provide plenty of coverage for medical tourism, the vast majority of which is incredibly positive. Whereas the media are usually quick to find the "bad news" story, this has certainly not been the case with medical tourism. The recent exception was this story "How my smile was ruined by a dodgy dentist" in the Daily Mail.

However, the UK media is, in general, giving medical tourism a favourable press:

Record numbers go abroad for health treatment with 70,000 escaping NHS - Daily Mail
70,000 Brits have ops overseas - The Sun
Fears and frustrations driving patients abroad - Sunday Telegraph
Long distance surgery is a snip - The Times

The recent increases in UK patients traveling abroad are becoming somewhat of an enbarrassment for a Labour government which has invested significantly in the NHS in recent years. The Tory party have seen the opportunity:

"Andrew Lansley, the shadow health secretary, said the figures were a "terrible indictment" of government policies that were undermining the efforts of NHS staff to provide quality services."

Waiting times for operations, lack of access to new treatments and fears of MRSA and hospital infections are significant problems in the UK NHS.

And they all factors which will encourage more people to travel abroad for treatment......

Resources
You can see a regularly updated list of medical tourism news stories on Treatment Abroad.

How many medical tourists are there?

2007-04-18T13:14:00.000+01:00

There has always been speculation about the true number of medical tourists travelling from the UK for treatment abroad.

We've just completed the first ever survey of medical tourism providers, and have come up with some interesting data on the medical tourism market. The Treatment Abroad Medical Tourism Survey 2007 (www.treatmentabroad.net), reveals that over 50,000 people travelled abroad for treatment last year, and spent £161 million on medical tourism. The number of medical tourists increased by 25% over the 12 months and will continue to grow over the next 6-12 months.

Dentistry is the most popular service with dental treatments such as crowns, dental implants, bridges and veneers leading the way. Over 20,000 Brits travel abroad for their teeth, spending around £2,500 each, with an estimated market value of over £50 million per annum.

Cosmetic surgery is a close second with around 14,500 patients travelling outside the UK. Breast augmentation, tummy tuck, liposuction and facelift are popular choices; patients spend around £3,500 each, creating an estimated market size of £50 million.

The most common types of elective surgery for patients travelling abroad are hip replacement, knee replacement, laser eye surgery and cataract removal, with some 10,000 patients spending £37 million in 2007.

New association formed for medical tourism

2007-04-18T13:02:00.000+01:00

At the recent World Health Tourism Congress in Cyprus, the launch of the International Medical Travel Association (IMTA) was announced.

The IMTA seeks to represent the interests of medical travellers and the medical travel industry including healthcare providers and medical travel facilitators. The association currently has 26 registered members from across the world. Dr Steven Tucker, Medical Director of the West Clinic Excellence Cancer Centre in Singapor, is the President of the IMTA.

How successful the organisation will be in developing internationally accepted standards and codes of conduct for medical tourism.....who knows?

The medical tourism market is very fragmented consisting of many minor players such as doctors, dentists and individual clinics and various medical tourism "facilitators"and hospital groups. As yet, no one company has attempted to take a really significant share of the market. It's likely that those who take the lead in this fast emerging market will be the standard setters which others will follow.

A boom in cosmetic surgery abroad?

2006-12-01T10:38:00.000Z

Cosmetic surgery is becoming "acceptable" in the UK. The plethora of personal makeover and cosmetic surgery programmes on UK television has helped to fuel a boom in cosmetic surgery. Whereas, five years ago, major UK healthcare providers such as BUPA and BMI Healthcare only dabbled in the cosmetic surgery market, they are now taking the business very seriously and have seen year on year growth of around 25% to 30%.

Sainsbury's Bank estimates that every day, around £1.8 million is spent on cosmetic surgery. It estimates that this year, in the UK, over £5 million will have been taken out in personal loans for cosmetic surgery, and around a fifth of this will be in loans for men. The average size of loan for cosmetic surgery is around £6,500. Mintel estimates a 240% growth during the period 2001 - 2006, and predicts that by 2009 British adults will be making a trip to the cosmetic surgeon at least a million times a year

This is good news for medical tourism providers. The low cost of cosmetic surgery abroad will expand the market by providing a solution for those who could not otherwise afford treatment.

Cosmetic surgery currently represents around 50% of the enquiries that we receive at Treatment Abroad.

Where is the cheapest place to go for treatment abroad?

2006-10-03T11:07:00.000+01:00

We have just published the first independent survey of medical tourism prices - Treatment Abroad PriceWatch 2006.

Comparing prices to the cost of private treatment in the UK, the biggest savings in elective surgery to be made are on prostate removal in Bulgaria with an 82% cost reduction and gall bladder removal, saving 79%. Turkey also offers major package savings in six procedures from cataract removal and eye surgery to coronary angioplasty and partial knee replacement.

In cosmetic surgery, the biggest package savings of between 80 and 85% can be made on cheek implants, liposuction and facelifts. Bulgaria once again offered the greatest savings in 13 cosmetic procedures although Morocco is the cheapest place to go for breast augmentation.

Dental treatment – considered increasingly costly in the UK – is also under threat from other countries such as Latvia, Poland and Croatia. Package savings of up to 61% can be made on dental implants, 52% for wisdom tooth extraction and 44% for full acrylic dentures.

The report on medical tourism prices embraces elective surgery (e.g. hip replacement, knee surgery abroad), cosmetic surgery and dental treatment abroad.

The survey compiled data from 108 clinics, hospitals and healthcare providers in 30 countries, roughly a third of the estimated number of overseas hospitals and clinics promoting their services to the UK market.

A password protected downloadable PDF copy of the Treatment Abroad Price Watch Survey 2006 is available from Treatment Abroad.

Should the NHS extend NHS patient choice to hospitals overseas?

2006-10-02T21:17:00.000+01:00

With the advent of “Choose and Book”, NHS patients are now offered a choice of at least four providers once their GP has decided that a referral is required. These providers can be NHS trusts, foundation trusts, treatment centres, or private hospitals. Will, at some stage, this choice be extended to include hospitals in Europe and further afield?.

The UK health services are suffering from a shortage of qualified nursing and medical staff, and this is constraining NHS effectiveness in reducing waiting lists. One of the solutions has been to import staff from other countries, but will the NHS turn to exporting patients as an alternative solution? A pilot project managed by Guy's and St. Thomas' Hospital has already explored this approach. The project offered mostly elderly patients who had been on the waiting list for more than 6 months, the option of orthopaedic surgery in Belgium. In total, nearly 500 UK patients travelled to the five selected Belgian hospitals for orthopaedic surgery between June 2003 and April 2005. Patients were extremely positive about their experience and the quality of care that they received.

Given the choice of an operation at a UK hospital in three or four months time, or an operation next week in a state of the art hospital in Belgium, India or Poland, how many UK patients might choose the latter?

India: a global destination for medical tourism

2006-10-02T12:02:00.000+01:00

India is the top global destination for medical tourism, according to a new market research report. A study on the Indian Healthcare sector, conducted by RNCOS, has revealed the country's medical tourism market to be worth over $310 million, expected to rise to $2 billion by 2012. Medical infrastructure and technology in India are accepted to be on a par with the UK and the US and the efficient services and affordable hospital expenses make it an attractive choice for patients seeking treatment abroad. Figures show that 120,000 overseas patients travelled to India in 2005 to receive private medical treatment and this is expected to rise by 30 per cent. The most common treatments that visitors seek are heart surgery, knee surgery, cosmetic surgery and dental care, procedures which patients may not be eligible for under the NHS system and which generally have long waiting lists in the UK.

RNCOS concluded: "The healthcare industry overview shows that the medical infrastructure and technology in [India] is in par with those in USA, UK and Europe. "India can vie with some of its best hospitals and treatment centres in the world and therefore make it a favourable destination."

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Health and medical tourism - a growth business.

2006-10-01T21:58:00.000+01:00

Health and medical tourism is a growth business. More and more UK patients are choosing to go as far afield as Brazil, South Africa and Malaysia for cosmetic surgery. But the growth isn’t restricted to the “nip ‘n tuck holiday”. According to Norwich Union Healthcare’s annual survey, the Health of the Nation Index, almost half of patients who travel to another country for treatment are doing so for major operations such as heart surgery and hip replacement.

It is estimated that around 50,000 Britons travel abroad for private surgery each year (International Passenger Surgery 2005) . But what’s the attraction? Why are people willing to put their health in the hands of another country’s surgeons?

The main driver is, of course, cost. By travelling to Belgium for treatment, a patient can save 40% on the cost of going privately in the UK: by choosing South Africa, a 50% saving is possible; and by opting for countries such as Croatia, Poland or India, savings of over 60% can be expected.

For cosmetic surgery, the low cost, the ability to combine recovery with a relaxing holiday and perhaps having surgery unbeknown to friends has meant that popular holiday destinations such as Spain, and Tunisia are attracting UK patients.

For elective surgery, there are other factors playing a part. There is no doubt that the actual or perceived risks of MRSA and hospital acquired infection in the UK, have convinced some patients that they will be “safer” in a hospital overseas. Data published by the European Antimicrobial Resistance Surveillance System2 shows that the proportion of Staphylococcus aureus bacteria which is methicillin resistant is certainly higher in the UK (44.5% in 2002) than in countries such as Belgium (19.2%), Czech Republic (6.2%) and the Netherlands (1.0%). But this does not show the incidence of hospital acquired MRSA infection.

A significant trend is the increasing share of the medical tourism market being taken by the “developing” healthcare providers. Dental tourism is booming in Hungary with people travelling for dental implants at 25% of UK costs. Countries such as Croatia, Poland and the Czech Republic are actively marketing their services to UK patients, and India may become a major provider for medical tourism. A study by the Confederation of Indian Industry and McKinsey estimated medical tourism could be worth £1.21bn by 2012. The Indian government has set up a system to fast-track medical visas, and Indian hospital groups see a huge potential market for their services. Last year 150,000 patients from overseas visited India for treatment, and the number is rising by 15% a year.

The internet has played a key part in widening the treatment options for private patients in the UK. In the same way that Britons shop the internet for consumer products, “treatment seekers” are using the internet to research treatment options and compare costs in the UK and abroad. Dedicated web sites such as Treatment Abroad (http://www.treatmentabroad.net/) have developed in response to patients who want more information about overseas options, and to overseas providers who wish to promote their services to the UK public.