Global healthcare is expanding. With more travellers seeking treatment for serious ailments and surgery, making medical tourism one of the largest growth industries in the world

By Bronwyn Davis

Borderless bypass

Experts predict that by 2012, medical tourism will evolve into a $100 billion industry with more than 780 million patients seeking healthcare abroad. The figures, from UK-based Research and Markets, suggest the globalisation of medical specialties is becoming an accepted aspect of 21st century life.

What better way to offset the ever rising cost of healthcare than to combine it with tourism, the world's leading economic enabler? The United States alone contributes US$3.5 trillion to the world's GDP through travel and tourism-related spending. Conversely, America's National Coalition on Health Care reports that in 2007 total healthcare spending in the US hit US$2.3 trillion or $7600 per capita.

Enter the new world citizen, who lives and works between two or more countries and perceives the globe as a coalescence of nations, and fosters the notion of convenient international commutability. This growing number of upwardly mobile professionals, along with an ageing population with the resources to travel, represent a substantial market for the global healthcare industry.

The director of the US-based Medical Tourism Association, Jonathon Edelheit, says: 'Medical tourism is about patients making educated decisions on where they can go to achieve the best possible healthcare outcomes at an affordable price. We have entered a global world where consumers have no problem buying services or goods overseas.'

Medical tourism established itself firmly in the global psyche after the Asian economic crisis in 1997 forced many hospitals and governments to promote the industry through economic necessity.

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Currently positioned as a leading provider of medical tourism services and the first Southeast Asian facility to receive international accreditation, Bangkok's Bumrungrad International Hospital was one such facility that began targeting overseas clients in order to stay afloat.

Director of hospital marketing, Kenneth Mays says the hospital was established by an elite group of doctors and investors in 1980. In the early 1990s they embarked on an expansion program, creating the largest private hospital in Southeast Asia. 'It re-opened in January 1997 and in July that year the Asia financial crisis hit. The Thai economy was shattered and the local market for a premium hospital dried up. Management realised they'd go bankrupt if they didn't diversify, so they started international marketing.'

This story is replicated throughout the Asian region where medical tourism is flourishing, endorsed by private hospitals and enterprise alongside government agencies.

Singapore, with its reputation for world-class facilities and sophisticated technologies, is fast establishing itself as a leader in cardiac surgery. In 2003 a government-industry alliance formed to create SingaporeMedicine, with the goal of attracting one million patients annually by 2012.

Meanwhile, Hong Kong is asserting its dominance in the advancement of oncology, attracting increasing numbers of mainland Chinese visitors, along with patients from around the world, in search of cancer treatment using a combination of leading-edge technology and traditional eastern therapies.

Numerous Asian destinations are receiving recognition for their experimental procedures, including advancements in stem cell technology for the treatment of conditions such as paralysis and eye surgery in South Korea. India is gaining a reputation for its elite private hospitals, equipped with the latest in technology and diagnostics. The number of foreign patients visiting India is growing at the rate of 30 per cent a year and it is projected that the industry there will be worth around US$2 billion by 2012.

Indian surgeons also offer a groundbreaking procedure known as hip resurfacing, an alternative to hip replacement that is more affordable and causes less post-operative stress. India's medical diversity is apparent given that robotic surgeries can be combined with alternative healing practices including ayurvedic treatments. Six hospitals within Thailand carry US accreditation and facilities such as Bumrungrad Hospital offer all aspects of specialist medicine.

'Our doctors represent 55 sub-specialties,' says Mays, 'The most common things people come for are cardiology, orthopaedic procedures, back surgery, gastrointestinal surgery and urology.' Mays says around half of the patients passing through Bumrungrad's doors each year are Thais, with the hospital treating 420,000 non-Thai patients in 2007.

In Malaysia, the government actively promotes facilities such as the Penang Adventist Hospital (PAH). Part of an international network, CFO Michael Wong CPA, says the hospital began marketing medical tourism to overseas clientele in 1998. Since then, the number of international patients to PAH has increased from fewer than 200 a month to approximately 4000. 'To date, we attract about 51,000 medical tourists annually from over 20 countries, with the majority from Indonesia,' he says.

PAH offers the full range of specialties including: cardiology; minimally invasive spinal surgery; microsurgery; knee and hip replacement; oncology with multi-disciplinary approach; neurosurgery; wellness and lifestyle medicine; advanced orthopaedic procedures like stem cell regeneration for knee ligaments; and full paediatric services.

It's not just the Asian markets building a thriving business in international healthcare. Costa Rica offers dental surgery, along with orthopaedic procedures. Increasing numbers of Americans are travelling to Mexico to seek bariatric weight loss procedures, such as lap band surgery. Panama is gaining recognition for assisted reproduction, cardiology, cosmetic dentistry, pulmonology and orthopaedics.

Ever popular with English tourists, Portugal is being promoted as the perfect place to recuperate after undergoing treatment at one of the country's top class facilities, with its health system rated 12th overall out of 191 countries by the World Health Organisation. Common procedures include bariatric weight loss procedures such as lap band surgery, orthopaedic, cardiology and eye surgery.

Hungary, Poland and Slovenia are becoming synonymous with low-cost dental surgery, offering competitive dental tourism packages to German, Austrian, Swiss and British residents in particular, with the added incentive of low-cost air travel.

Already a renowned tourist hub, Dubai officially opens its Healthcare City in 2010. Situated on the Red Sea, the clinic will span 34 hectares and boast a prestigious affiliation with the Harvard Medical School, as well as the title of largest international medical centre between Europe and Southeast Asia.

Australia's medical tourism industry could be described as infantile by comparison. A handful of private groups are promoting certain specialist treatments, however both the State and Federal Governments have been less than enthusiastic when it comes to marketing their medical services abroad.

The managing director of the Australian Tourism Export Council, Matthew Hingerty, believes the development of health tourism in Australia should be modelled on the education tourism sector, which has grown into a $10 billion a year industry. He says medical tourism is worth an estimated $6 billion to Australia's economy. Hingerty says Australia's health and wellness industry is already attracting overseas interest, with tourists travelling to local resorts that offer packages including spa treatments, counselling and weight loss programs.

'There's also executive health checks and more specialised procedures such as IVF, coronary artery bypass surgery, cochlear implants, bariatrics, diabetes and skin cancer related treatments. We can provide excellent service in these areas, plus airfares and holiday packages, for around a third of the cost for the procedure alone in the US,' he adds.

Hingerty says, 'Regrettably there has been a lamentable lack of engagement by the Australian Federal and State Governments, both on the tourism and health side, even though we have explained to them that there is significant existing capacity available in the private health sector and we can build further capacity through foreign investment dollars expediting the development of more bricks and mortar.'

While there is little in the way of statistics to determine the number of Australians seeking healthcare abroad, anecdotal reports suggest the numbers are growing, as elective procedure waiting lists in the public hospital system blow out to 100 days or more in some instances. Tourists from the United States are one of the largest groups to embrace the global healthcare phenomenon.

According to a Deloitte report, Medical tourism: consumers in search of value, an estimated 750,000 Americans travelled abroad for medical care in 2007. This is expected to increase to 6 million by 2010, as more uninsured or underinsured Americans seek affordable healthcare alternatives. In a client survey conducted by a US-based medical tourism agency, 33 per cent of respondents said that the prevalence of cheaper healthcare overseas was the number one incentive for seeking treatment abroad.

'Australian health insurer Medibank Private says open-heart surgery can cost up to $180,000 in Australia; in India's best hospitals it could cost between $3000 and $10,000. Savings for total knee replacement in India are around 55 per cent,' experts say.

A heart-valve replacement costing US$200,000 or more in America can go for US$10,000 in India including return airfares and a holiday package.

The total cost of a standard dental filling in England is around £156.00 compared to £8.00 in Hungary. Expect to pay about A$8300 for a knee replacement at Bumrungrad International Hospital, with no waiting time, whereas the average cost of knee replacements in Australia's private system is A$18,819, or choose to go public with this elective procedure and wait for up to 134 days.

Typically, these cheaper prices include airfares, accommodation and even sightseeing and tour services in some instances.

US company Healthbase managing director Saroja Mohanasundaram says: 'International hospitals catering to foreigners generally have facilities comparable to five-star hotels. They offer luxurious accommodation, private spacious rooms and access to hospitality services 24 / 7. Overseas providers invest heavily in new technology and training of surgeons. It's not uncommon to see surgeons working with expensive robotic machines in state-of-the-art operating theatres.'

More than pleased with the standard of overseas medical care is Steve Slaven from Arizona, an uninsured Healthbase client who could not afford to seek local medical attention for the chest pain and lack of energy he suffered last year. 'I got on the internet looking for information. Luck led me to Healthbase. I called and told them my situation. I was in India in an amazing two weeks,' says Slaven.

'Going half way around the world for heart surgery creates a lot of anxiety and raises a lot of questions. But the care I received while in India was beyond my greatest expectation. Physicians, nurses, the hospital and Healthbase all attended to me like royalty.'

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There is no denying that low-cost, high-end medical alternatives are fostering the globalisation of healthcare.

However, senior lecturer at the University of Melbourne's Asia Institute, Andrea Whittaker cautions: 'The issue in assuming that medical tourism has become this ultimate global consumer, freedom of choice situation is that the consumer tends to become the person who refers themselves to these services. The danger is that it's very easy for them to make cost comparisons, but it's not necessarily that easy for them to judge potential medical risks, compare standards of care, or make decisions about appropriate treatment without a doctor's guidance. The consumer is somewhat vulnerable. A lot of the countries don't yet have appropriate safeguards and accountability to protect patients, particularly with regard to malpractice.'

While the legal system in these countries may still be viewed as less than perfect, one of the most significant transitions that medical tourism instigated is a change in long held western perceptions of 'third world' living, sanitation and healthcare standards, in countries such as India and much of Asia.

Whittaker attributes this largely to smart, well coordinated marketing campaigns. 'Essentially, governments undertook definite policies to encourage this trade and heavily promoted their countries as medical tourism hubs. They've done an excellent job at illustrating to people around the world what their medical systems, services and facilities are really like,' she says.

In many respects, medical tourism is also having a positive financial impact on local healthcare systems and economies within countries actively promoting this industry to overseas consumers.

Wong says medical tourism revenue meets about 25 per cent of Penang Adventist Hospital's bottom line. He says medical tourists 'help greatly in accelerating our ability to acquire and upgrade to newer and better medical equipment and assist doctors and medical teams in their treatment plans. The end result is better outcomes and quality of patient care.'

Profits generated from medical tourism facilitate the continual expansion of Bumrungrad Hospital. 'Medical tourism consumes about six-tenths of 1 per cent of our resources in terms of staff hours, but it brings a disproportionate income into the country.' This fact and the continuing cost escalation of mainstream medicine in the developed nations will only see an increase in cheaper service providers and the patients willing to access them.

Source: In The Black Magazine