Crossing domestic or international borders for medical treatment, also known as medical tourism, has become increasingly common—in 2010, more than 5 million patients traveled for health care. The growth of medical tourism is driven by excessive health care costs in developed nations, rising affluence in developing nations,(1) and the aging global population.(2) The industry’s market value in 2012 is predicted to reach us$40 billion, and travel for health care is expected to increase over the next two decades by as much as 30 percent worldwide.
Who Are the Medical Tourists?
Although widely used by the media and commercial interests, the term medical tourism is misleading. In truth, patients combining surgery with a sunny vacation are rare. The great majority of medical travelers fall into three categories:
- Value patients travel from developed nations such as the United States, where health care is expensive and health insurance coverage is limited. Eighty-five percent of patients in this group are over 50 and have conditions that require expensive medical care. These patients are often uninsured or underinsured, or need procedures that are not dependably covered by insurance, such as weight loss surgery and dentistry. The pervasive emphasis on youth and appearance in many developing countries adds to the demand for affordable plastic surgery and cosmetic dermatology.
- Access patients are from places where the availability and quality of health care services are limited. Many of these patients originate from countries with less developed health care systems that are unable to meet the rapidly rising demands of their newly affluent populations. Some patients from areas with overburdened public health systems, such as the United Kingdom and Canada, are seeking more immediate health care than they can obtain at home.
- Quality patients are traveling to find exceptional specialty care—the latest therapy or innovative treatment protocol, the most respected physicians, the best outcomes, the plushest experience. Quality patients are frequently seeking critical care and are not as limited by cost considerations as other medical travelers.
Domestic Travel for Health care
Increasingly, medical tourism is involving domestic as well as international travel, by patients seeking higher quality or more affordable health care. Procedure costs vary widely across some countries, including the United States, influenced by the variable cost of living and regional availability of services. Cost disparities have motivated some employers and insurers to offer domestic medical travel as an option. Lowes, America’s second largest home improvement retailer, now sends employees in need of heart surgery to Cleveland Clinic from all parts of the United States. By sending its personnel to the most highly ranked cardiac program(3) in the country, Lowes is saving money, as well as employee lives.
Residents of countries with large land areas, such as Mexico, China, and India, often travel from rural to urban areas seeking higher quality health care. Magnet hospitals in large cities attract a significant percentage of their patients from within their national borders but outside of their local treatment areas.
The Global Health Care Marketplace
Medical travel has influenced how top health care providers view potential clients, because competition for patients is no longer based only on proximity but also on services, measurable outcomes, and costs. While the majority of any facility’s patients are still local, attracting international patients can make the difference between profitability and stagnation.
Innovative treatments and advanced technologies draw patients to internationally recognized medical centers that can afford expensive equipment and highly paid specialists. Proton beam therapy, for example, offers patients more aggressive and accurate treatment of tumors, with reduced radiation exposure and fewer side effects. Due to the equipment’s US$100 million-plus price tag, however, there are fewer than 40 proton therapy centers around the world. Costly investments are also required for research, development, and government approval of niche treatment protocols such as chronic cerebrospinal venous insufficiency CCSVI for multiple sclerosis, regenerative stem cell therapies, or nonsurgical alternative treatments for back pain. And because few facilities offer them, few physicians have extensive practice in these new therapies.
Globalization of health care has resulted in a dramatic rise in international quality standards, which offers reassurance to medical travelers. Ten years ago, the Joint Commission International (JCI, the US-based arm of the Joint Commission) had accredited only a handful of international providers. In March 2011, JCI accredited its 400th hospital.(4) Regulation and oversight at the national level are also rising in many countries.
Greater access to information through the Internet allows patients to look beyond the traditional referral network, independently evaluate treatment options, and connect with previously inaccessible providers. To compete for these increasingly informed international patients, hospitals must provide more transparent access to data on procedure volumes, success rates, accreditation, physician certifications, and comparative costs. Bumrungrad International in Bangkok, which treats around 400,000 international patients annually, was among the first hospitals to make “real-time” cost information available to the public. Recently developed information distribution technologies enable sharing of medical records and communication between specialists. Online second opinions are now readily available as well.
The Social and Political Impacts of Medical Tourism
International hospitals in developing countries are sometimes viewed as elitist, and seen as plundering medical expertise and funding from public institutions that primarily treat local patients. However, these same international hospitals are largely responsible for raising the benchmarks of health care quality within their regions. In India, Apollo Indraprastha Hospital was the first to offer Western-style care and attracted international travelers, as well as, affluent local patients. Its clinical standards have now been emulated and adopted by providers throughout India, offering affordable, high-quality treatment in more remote cities and helping to close the health care gap between have and have-not patients.
Developed nations grappling with critical challenges to their overburdened health care infrastructures can learn much from their global counterparts. For example, Medicare administrators in the United States might explore opportunities for cross-border coverage for qualified patients who are willing to travel. Such a program is successfully under way in Singapore: Citizens there are allowed to utilize their MediSave accounts in nearby Malaysia, where reliable medical treatment can be had at significant savings to both patients and plan sponsors.
With the rise of clinical specialization and expensive instrumentation, the general hospital model adopted by the United States, Canada, and European nations in the mid-twentieth century has grown administratively bloated and inefficient. Conversely, health care infrastructures organized around specialties and subspecialties increase efficiency, reduce costs, improve patient experiences, and attract international patients. Medical travelers account for up to 30 percent of revenue for international hospitals that focus on specialties, such as Anadolu in Istanbul, Fortis/Wockhardt in Bangalore, and Bumrungrad in Bangkok. And Singapore recently reorganized its entire public health care infrastructure around specialties, establishing facilities such as the National Heart Center, National Cancer Center, and National Eye Center. Nations seeking solutions to health care infrastructure woes would do well to examine this highly efficient and competitive model.
As globalization of health care continues to level the international playing field, the notion of patients traveling long distances for treatment may become outdated. In an ideal world, only the quality patient, driven by choice, would need to engage in medical tourism. For the foreseeable future, however, medical travel—domestic and international—offers significant health care options to the growing millions of consumers seeking safe, affordable medical treatment.
1 Ching Li, ed., China’s Emerging Middle Class: Beyond Economic Transformation (Washington, DC: Brookings Institution Press, 2010), chapter two.
2 United Nations Department of Economic and Social Affairs, Population Division, World Population Ageing: 1950–2050 (2001), www.un.org/esa/population/publications/worldageing19502050/.
3 “Best Hospitals 2011–12,” US News & World Report, July 2011.
4 Joint Commission International, Accredited Organizations, www.jointcommissioninternational.org/JCI-Accredited-Organizations/
Josef Woodman is Chief Executive Officer and Founder of Patients Beyond Borders. He is a consumer advocate for affordable, quality health care options and has chaired and keynoted conferences on medical tourism and global health care in 14 countries. Patients Beyond Borders is a consumer guide for international health care travelers. For more information, visit www.patientsbeyondborders.com