Helping patients make the right choice of medical tourism service

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...

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

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?

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

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

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

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?

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

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

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

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

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

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?

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

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?

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?

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?

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

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."

© Adfero Ltd

Health and medical tourism - a growth business.

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.