Increase in IVF tourism in Europe

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”.

The challenge facing the medical tourism industry

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!

EU votes on medical tourism directive

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.

How to run a medical tourism conference...

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?

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

EU Directive on cross border healthcare boosts health tourism

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.

High UK dental costs driving patients abroad

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.