At first blush, Medical tourism seems like a good idea. Travel to Thailand, UAE, or Germany – and while exploring the culture, food, wines and shops, make a stop at a local hospital for a tummy tuck, a kidney transplant or a hip replacement.
- Medical tourists frequently cross international borders for healthcare.
- Treatments can include (but are not limited to) dental, neurological, and cardiovascular medical aide.
- People are willing to travel for health maintenance, enhancement, or restoration away from their home country in order to have work done through much more affordable healthcare facilities elsewhere.
What is Medical Tourism?
Medical tourism (also known as health tourism, medical outsourcing or medical travel) is defined as organized travel across international borders to access medical treatment which may or may not be available in the travelers’ home country. Medical tourists frequently cross international borders for the maintenance, enhancement or restoration of their health through affordable healthcare facilities and treatments and can include (but not limited to) dental, neurological, and cardiovascular treatments.
In 2019 the global medical tourism market was valued between US$44.8 billion and US$104.68 billion and is expected to reach US$273.72 billion by 2027
Before 2019, the market was increasing as additional benefits were being added at host countries including:
1. Improved healthcare
2. Latest technology
3. Innovative medicines
4. Modern devices
6. Personalized care
Propelling the market growth:
1. Inadequate home country (or company sponsored) insurance benefits
2. No (or limited) healthcare insurance in the local market
3. Increasing demands for procedures not covered by insurance (i.e., gender reassignment operations, fertility treatment, dental reconstruction)
A 2021 study conducted by the Center for Disease Control and Prevention found that 0.75 – 1.6 million people from the USA travel out of the country for medical care to avoid high treatment costs. A hip replacement surgery in the USA can cost approximately US$39,299 while the same surgery in India, Costa Rica or other developing countries is priced at between US$7,000 and US$15,000, including logistics ( www.thebusinessresearchcompany.com ).
Cash Flow for Destination Country
Medical tourism generates foreign exchange income and contributes to the overall development of an economy. It also provides employment and business opportunities for residents while promoting growth of allied businesses such as pharmaceuticals, medical devices, and tourism.
Government support to maintain the general reputation and political stability of the host country drives this market. Politicians and bureaucrats are willing to invest in local enterprises to capitalize on the growth of medical tourism and they have been authorizing projects that help in overall development of infrastructure (i.e., public transport systems, and water supply facilities) to attract high-end medical travelers. In cooperation with private sector tour operators and hoteliers, healthcare providers offer comprehensive medical tourism packages that include airline and ground transportation reservations, hotel accommodations, cultural experiences, and medical insurance.
Many cosmetic surgery procedures are considered elective and not covered under most insurance schemes. Because insurance does not cover the relevant procedures, and the costs are paid for by the consumer, lower costs in other countries appeals to the foreign patient. Money is saved by traveling to destinations and scheduling treatments at rates that are lower while experiencing activities at the destination country. The countries focusing on the growth of medical tourism offer luxurious accommodations, comfortable treatment options by hospitals and arrangements for tourism-focused activities post-treatment.
Another benefit to the host country is a slow-down or reversal of the migration of medical professionals to developed countries. The Apollo group in India claims to have attracted more than 123 expatriate medical professionals to return by offering more medical tourism with competitive salaries and the opportunity to live and work in their country of origin while still being able to practice advance healthcare. (However, this represents just 10 percent of the number of Indian-trained physicians entering US medical residencies each year and scarcely makes a dent in the estimated need for 800,000 more physicians in India over the next decade).
Medical tourism has also allowed some developing countries with smaller populations to sustain and subsidize advanced medical care and technology, as well as to maintain critical medical specialties with low domestic demand.
Where to Go?
Popular destinations for medical tourism include: India, Thailand, Costa Rica, Mexico, Malaysia, Singapore, Brazil, Colombia, Turkey, Taiwan, South Korea, Czech Republic, and Spain. Before Covid, India and Thailand were the most popular destinations and Thailand’s status has been enhanced as it is one of the most popular destinations in Asia. The increasing number of private hospitals, improvements in overall healthcare infrastructure and less expensive treatments contribute to the growth of inbound medical tourists in Thailand.
Thailand has been the preferred destination for cosmetic and bariatric surgeries including breast augmentation, laser tattoo removal, liposuction, Botox, hair transplant and CoolSculpting. Currently the country has more than 450 private hospitals and the number is expected to increase exponentially. Thailand has targeted countries for growth including China, Laos, Myanmar, Cambodia and Vietnam as a result of the growing affluence and increasing demands for professional healthcare services in these countries.
India has been the favored destination for knee and hip replacement and gastric bypass while Costa Rica has been selected for dental procedures. Germany is considered a host country for cancer treatment and the disease accounted for a large growth market in 2019 because of an increase in incidences worldwide. Medical services for cancer are expensive and demands prolonged treatment therefore reduced costs in different countries fuels the growth in the market.
France is also a host country for cancer treatment as it has many radiotherapy machines, linear accelerators, fast access to doctors and the highest success rate in Europe ( https://www.medic8.com ).
Fertility treatment (reproductive tourism) shows fast growth at a rate of 9.7 percent over the next few years. Approximately 20,000 to 25,000 couples annually seek assisted reproductive technology services abroad. An estimated 4.0 percent of European Union citizens receive treatment in other countries.
Turkey is a popular destination for IVF services and the cost difference between the USA and Turkey is so significant that that overall cost of obtaining the service from Turkey remains lower even with additional expenses for travel and accommodations. It has been determined that the quality of the Turkish hospital to be better than the corresponding indicators in US hospitals
Taiwan medical tourism started in 2008 and it is the destination for very difficult surgeries such as liver transplants, cord blood transplantations, cancer treatment and plastic surgeries. Many select Taiwan for outpatient and health examination services with most patients arriving from Mainland China, Indonesia, Philippines and Vietnam. The revenue from the Taiwan medical tourism industry is expected to grow to a market estimated to be close to US$743,740,000 by 2025.
Restricting Growth:
Lengthy partial reimbursements by payers and difficulties associated with travel, language barriers, availability of documentation and VISA approval issues impede the growth of medical tourism.
The Covid 19 pandemic and its impact on the global economy has disrupted the industry creating uncertainty in demand for specific products and limited availability of medical and industrial applications.
The countries severely impacted by Covid 19 include India, and China. In addition, travel restrictions and suspension of cross-border transportation has brought international travel to a halt, adversely impacting on the growth of medical tourism.
Know Before You Go:
Patients can save from 30-80 percent of the total treatment costs by leaving the USA. Low costs and easy availability of labor is a primary incentive for the increased interest in medical tourism destinations.
For travelers interested in pursuing medical tourism, a full and complete research effort should include the accreditation and/or certified skill level of the provider and the facilities. Two organizations (on an international level) offering insight into the educational, skill, knowledge and background of facilities and practitioners include the Joint Commission International (considered the gold standard for international credentialing). Their seal is considered to be internationally a sign that a hospital operates with the highest standards. The International Organization for Standardization (ISO) includes approximately 100 countries and ISO90000.2001 is designed as a management tool to achieve control and consistency in all aspects of business, from technical to administrative.
Proceed with Caution:
For people contemplating medical tourism healthcare professionals recommend a visit to a US travel medicine specialist at least one month before departure to ensure that their medical conditions are well controlled, have adequate medication and receive appropriate vaccinations. Medical tourists are also advised to verify the qualifications of the individuals providing their care and the credentials of the facility where they will be treated. It is critical to be aware of the fact that foreign standards for healthcare providers and facilities may be different from those of the United States, and all procedures carry risks.
Host countries frequently have no or lax enforcement of malpractice laws, posing additional risk. Little or no malpractice insurance costs allow developing country practitioners and facilities to maintain low prices but leave medical tourists with few options if malpractice is suspected. In Singapore and Malaysia, courts overseeing malpractices suits defer to the opinions of attending physicians, essentially requiring a doctor to “confess” to malpractice in order for any compensatory damages to be awarded.
It may not matter to many medical tourists; however, the concentration of host countries on foreign medical travelers is, in fact, denying benefits to the poorer citizens in these developing countries and the use of medical services is considered a generic equity issue.
The medical tourist should also be concerned with the reality that government and basic medical insurance may not cover international medical procedures requiring patients to pay in cash. In addition, there may be little postoperative care for potential negative side effects as recovery needs vary on the basis of the nature of the procedure. Some markets offer recovery retreats with a 24-hour trained nursing staff, while others offer recovery time at hotels or lodges several miles away from the physician and patient after surgery, greatly increasing the response time could create post-operative complications.
Before Committing:
When all the features, advantages and benefits have been analyzed along with risks, potential medical tourists should look closely at their current health insurance policies and plans. Most travelers heading to Thailand, Singapore, Malaysia and India have pre-paid for their medical treatment; however, if they experience medical complications or have to cancel the trip, without additional insurance, they may be unable to recover their costs and experience higher than anticipated medical expenses.
For travelers who have pre-paid their medical treatment and want protection against the high costs associated with medical complications additional insurance may be a viable option if there is an interest in protection of the financial investment in case the trip is cancelled. There may also be an advantage to acquiring evacuation coverage in case the patient has to be moved to another medical facility. It may also be useful to acquire insurance for incidents unrelated to medical treatment.
Risk Review
1. Infections: One of the biggest risks is infections. Other countries have different standards of sanitation and medical facilities may present a challenge. Infections can occur anywhere for a wide variety of reasons, including unsanitary practices and facilities and/or the equipment used during surgery may not be sterile. Bacterial and viral infections are a major health risk. HIV and hepatitis from dirty needles and surgical equipment could present a problem. Check out all facilities (domestic and foreign) before they are necessary.
2. Medication dangers. Counterfeit medications are not confined to one country; however, the quality may differ from one hospital to another and from one country to another. Research the doctor and the pharmacy before venturing abroad.
3. Communication barriers can put a glitch in medical treatments. If you do not speak the language of the host country your ability to share your issues with your medical team may send the professionals in the wrong direction, even when an interpreter is available.
4. Blood transfusions may be required during or after treatment so it is imperative that the foreign medical facility has high screening standards for blood donations. The standards vary and medical tourists may be at risk for hepatitis or HIV.
5. Travel may create hiccups in medical plans. Air travel may increase the risk of blood clots. In addition, the combination of surgery and stress or fatigue following long multi-time zones flights can make the risk higher.
6. Post-operative care protocols differ among hospitals and locales and the appropriate follow-up can often be crucial to the success of the procedure. Patients who travel abroad for medical treatment risk returning with complications or infections that require costly treatment. Check and document follow-up procedures (and associated costs) at the host country medical facility.
7. Laws and lawyers. If there are issues with the surgery or treatment what are the legal remedies available? It may be difficult to pursue a legal remedy for your case as you may have no legal rights and unable to receive compensation for a mishandled surgery.
8. Credentialled standards differ widely from hospital to hospital and from locale to locale. Will the professional selected be licensed and what are the specifics? Check the credentials of everyone and everyplace.
9. There may be hidden costs. Medical tourism may appear to be a less expensive alternative – but are you sure? Require a written agreement with the health care facility or the group arranging the trip, defining treatment, supplies, medications, and care… covered (and not covered) by the costs associated with the trip. If additional hospital days are required and / or extra medical care is necessary, what are the costs associated with these situations?
Transplant tourism is part of medical tourism with a focus entirely on transplantation surgery. With a critical shortage of available organs in the US, transplant tourism has become popular. Currently the United Network of Organ Sharing (UNOS) reports there are more than 105,000 American on the transplant candidate waiting list with more than 15,000 patients awaiting a liver transplant. UNOS data shows a decline in donorship with living donor numbers decreasing by 1.7 percent and deceased donors down by 1.2 percent in 2008.
The AASLD and International Liver Transplant Society (ILTS) have positions against the exploitation of donors, the recovery of organs from executed prisoners and condemned the use of paid living donors. Can you verify that the organ you receive has been obtained in an ethical manner? You could potentially be contributing to the exploitation of lower income populations, teenagers, children or prisoners.
Contacts and Records
Before leaving your home for a medical procedure, make contact with your local doctor so he/she knows where you are going and what you are doing – just in case you need follow-up assistance when you return.
Have copies of your medical records that includes the lab and other studies done related to your condition for which you are getting the care and a list of allergies you have. Prepare copies of all prescriptions and a list of all the medicines taken, including the brand names, generic names, manufacturers and dosage. Get copies of all medical procedures and meds administered for your treatment so you can share them with your home-based medical team.
Medical tourism can be dangerous, so it is critical to understand the risks prior to departure.
