New standards for cosmetic surgery in Europe

The Health Tourism Blog has moved to the IMTJ web site. You can now find the Health Tourism Blog here in future.I will continue to post the first few paragraphs of the blog posts here. You can find the full version of this blog post on IMTJ:

Here's an extract of the latest blog post: New standards for cosmetic surgery in Europe


The recent PIP implants controversy has raised more concerns about regulation, operation and standards within the cosmetic surgery industry. In the UK, the Guardian newspaper has recently highlighted private cosmetic clinics that employ surgeons to carry out breast enlargements, nose jobs and tummy tucks who do not hold qualifications as plastic surgeons within the NHS (Private cosmetic clinics employing 'unqualified' surgeons).  There are also concerns about the quality standards and practices of cosmetic surgery clinics both within the UK and across Europe. A new European Standard on Aesthetic Surgery Services represents a significant move to address these shortcomings.

Regulating the cosmetic surgeons

In general, cosmetic and plastic surgeons who carry out cosmetic surgery at one of the private hospitals owned by UK groups such as Nuffield, BMI and Spire hospitals will hold an NHS consultant position, usually in Plastic Surgery or ENT Surgery - NHS consultants who do some private cosmetic surgery work. In contrast, many of the surgeons working for the cosmetic surgery chains such as Transform, Harley Medical Group and the Hospital Group are not NHS consultants.
The British Association of Aesthetic and Plastic Surgeons (BAAPS) has raised concerns about the influx of cosmetic surgeons into the UK from Europe. The BAAPS President told the Guardian, "We very often get applicants from Europe. Although they automatically get on the specialist register, the quality of training they have had is in no way equivalent to a trainee in the UK and they are often not deemed suitable for an NHS post".

According to Transform, "Qualifications obtained in other parts of Europe are at least the equal to those obtained in the UK" and said it was "completely untrue and highly misinformed" to suggest otherwise.
In June 2011, the European Commission published a Green Paper, “Modernising the Professional Qualifications Directive”. This Directive, adopted in 2005, sets the rules for mutual recognition of professional qualifications between Member States.  Consultation on this paper has now closed.

Read more about this in the full version of this blog post on IMTJ: New standards for cosmetic surgery in Europe

Cosmetic surgery tourism and the PIP implant controversy

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:  Cosmetic surgery tourism and the PIP implant controversy

The PIP breast implant controversy continues to grab the headlines across Europe. Concerns have been raised by women who have had their breast implants as “cosmetic surgery tourists”. What do they do if they have received a PIP (or a Rofil M) implant in a cosmetic surgery clinic in another country? Research by Treatment Abroad shows that UK patients may be less at risk than if they had gone for breast augmentation in the UK.

It is estimated that 40,000 women in the UK have received implants manufactured by the French company Poly Implant Prostheses (PIP). PIP implants contain low grade silicone; there are concerns about the risk of rupture of PIP implants and the effect that this silicone will have on the patient.

Reaction has varied across Europe. The French government has offered to pay for implants to be removed. The Czech, Dutch and German health authorities say that the implants should be removed. The UK government has said that there is no evidence that routine removal of PIP implants is necessary. However the NHS has agreed to remove PIP implants for free if the original operation was undertaken by the NHS (usually as part of a breast reconstruction after surgery for breast cancer). It has also said that women who are concerned about their breast implants should be able to have them removed for free by their private cosmetic surgery clinic.

The reaction from the private cosmetic surgery clinics in the UK has been mixed. Many providers such as BMI Healthcare have agreed that women who wish to have their PIP implants removed and replaced will be able to do so, at no cost.

However, the company that has done the largest number of PIP implants in the UK has said that it will not replace them free of charge. The Harley Medical Group has 13,900 clients who received PIP implants between 2001 and 2010 at their 31 clinics in the UK and Ireland. At the weekend, patients marched on the offices of cosmetic surgery clinics in Harley Street demanding that private clinics replace PIP breast implants.

.....Continue reading this health tourism blog post on the IMTJ web site.

Why the medical tourism industry must do better...much better

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: Why the medical tourism industry must do better...much better

Whilst the medical tourism industry continues to sing its own praises and tell itself how great it is.... consumers are telling a different story. The 2011 Medical Tourism Survey being conducted by European Research Specialists on behalf of Treatment Abroad raises some concerns about the quality of treatment and customer service that the industry delivers to patients.

As results of the latest Treatment Abroad Medical Tourism Survey 2011 come in, we’re beginning to get an idea of how patients view the medical tourism experience. So far, we’ve managed to generate 860 responses to the survey from patients who went to more than 60 countries.  Each respondent completes a fairly detailed online survey that takes them around 5-10 minutes. The results are being analysed by an external research market researcher. (Find out more about the Treatment Abroad Medical Tourism Survey 2011). The aim is to generate over 1,000 survey completions to provide valuable insight into the medical tourism experience.

We’ll be releasing the full results and report in 2012, but I have taken a look at the “story so far” provided by the research. The bad news is that since the previous survey was conducted two years ago, the industry hasn’t got any better at what it does. Initial analysis, suggests that it has got worse. Patient satisfaction levels are down. When asked:

• “How satisfied are you OVERALL with your experience of going to another country for treatment?”

...only 65% of the patients say that they are “Very Satisfied”, and 20% say they are “Quite Satisfied”.
These results are disappointing; they are well below what you see when you research satisfaction levels for patients visiting private hospitals and clinics in their own countries.

.....Continue reading this medical tourism blog post on the IMTJ web site.

Medical tourism: Trends for 2012 and beyond

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"!

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!

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

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

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?

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

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?

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

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

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?

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

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

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.