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Showing posts with label Medical. Show all posts
Showing posts with label Medical. Show all posts
Tuesday, October 26, 2010
Medical tourism statistics: Comparing apples with apples ....
At Treatment Abroad, we’ve recently completed some research into the medical tourism market for a third party. It’s been an interesting exercise and has really made us question some of the statistics that are quoted (and that often become accepted truth) about the number of medical tourists and the value of the market. What is a medical tourist?
The first challenge in estimating market size is to be very clear about what a medical tourist actually is. He or she isn’t a tourist. It’s someone whose specific reason for travelling to another country is for medical treatment. It’s not someone who happens to fall ill and requires treatment when they are on holiday/vacation.
Yet many tourism organisations, government bodies, hospitals and clinics classify ailing holidaymakers as medical tourists. They are not.
The data from one destination that we examined claimed vast numbers of medical tourists but in the “small print” acknowledged that the vast majority of these happened to fall ill while visiting the country for other reasons, either business travel or holiday travel.
Another inflationary factor is the expatriate resident. Back in the 1990’s I was involved in the marketing of the Portland Hospital for Women and Children in London. We used to track hospital admissions by nationality of patient. Based on that analysis, the hospital was the biggest medical tourism destination in the world for American medical tourists..... or was it? Of course not. As the only private maternity hospital in London, it attracted a large number of American women whose families were based in or working in London. Did a single American woman fly across the Atlantic specifically to give birth or for gynaecological treatment in London? No, but we could have made it look like plane loads were arriving every month!
Comparing apples with apples
Before the dawn of computing, I studied statistics at college. What I learned about statistics is that you have to compare like with like. You compare apples with apples. But in medical tourism people compare apples with grapes, and oranges with lemons...... Let me explain....
Let’s agree that a medical tourist is someone who travels specifically for treatment in another country, And let’s also agree that medical tourism is a specific segment of the health tourism market which does not include travel to medical spas or wellness resorts or for non-invasive therapy. For the sake of clarity, we’ll exclude dental travel from medical tourism in this instance.
So John Smith jumps on a boat or a plane or a train or into a car and crosses a border into another country and has...an operation or an elective procedure. (Should we include patients who don’t stay overnight? There’s another discussion...).
Are we agreed on what a medical tourist is? Good. John Smith is a medical tourist. He’s one medical tourist, isn’t he?
Well..... that depends where he goes.
In Country A (or in Hospital A), he counts as one medical tourist.
But in Country B (or Hospital B), he counts as 20 medical tourists.
20...am I mad? No.
This is how it works in Country B.
John Smith arrives in Country B. He visits the specialist, and the hospital raises an item of service bill for the visit. The hospital records him as one medical tourist treated.The specialist sends him for an X Ray. The hospital raises an item of service bill for the visit. The hospital records him as another medical tourist treated.The specialist sends him for some pre op blood tests. The hospital raises an item of service bill for the visit. The hospital records him as another medical tourist treated.He has the operation. Bingo! Another medical tourist.He collects some medication from the hospital pharmacy. Another medical tourist.He has post op physiotherapy for ten days.... ten medical tourists.And so it goes on.....John Smith is one medical tourist but according to the hospital records he’s twenty or thirty or maybe even more. And this is good news for the marketing guys in the hospital and at the tourism board. They have some pretty impressive medical tourism statistics.
So, we can see that the medical tourism statistics quoted by some destinations are subject to “statistical error” but not the kind of statistical error I learnt about at college. In some cases this is error on a magnitude of ten fold or twenty fold or even more.
Take medical tourism statistics with a pinch (or sack) of salt
When you hear the latest claim of medical tourism numbers from a hospital or a medical tourism destination, take them with a pinch of salt (or perhaps a sack of salt). And do some basic “hospital” mathematics. If they’re claiming let’s say 200,000 medical tourists a year, ask them where they are putting all the patients.
Let’s put this number into perspective. The Royal National Orthopaedic Hospital in London is the largest specialist orthopaedic hospital in the UK. It’s a very busy and successful hospital. Last year, it admitted around 10,000 patients to its 220 beds. That’s around 45 patients per bed per year. So, 200,000 “real” medical tourists might need....4,400 beds....and hospital beds are hard to find in many countries.
So how do we fix the problem?
When the UK NHS publishes statistics on hospital performance (See Hospital Episode Statistics Online), every set of statistics it publishes has a “responsible statistician”. He’s the one who ensures that they’re comparing apples with apples.
Let’s appoint a “responsible statistician” for medical tourism. Any volunteers out there?
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 extractionsMy 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!
The war of words....Is it medical tourism or medical travel?
I just read Constantine Constantinides informative and latest missive on medical tourism. Constantine runs Healthcare Cybernetics and is one of the "wise heads" of medical tourism.
Constantine says:
"I am getting fed up with industry newcomers (the “Johnny-come-latelys”), industry outsiders and the self-important upstarts who take issue with the word Tourism – claiming it is not “grand” enough for them to be associated with.They propose replacing it with the word “Travel”. Some even suggest we dump everything and start talking of Global Health (as if healthcare has not been global for ages).......I do not like the “tourism” word – but neither do I like the several suggested alternatives"
He makes some interesting points:
"The word Tourism is derived from Tour - from Anglo-French tur, tourn turning, circuit – a there and back journey.Travel may not include a “back”.
So, here's my two pennyworth (English idiom!).
Let's start with Google's view. Why? Because Google reflects the way that people use words.
I did a search on Google UK for various terms:
A search for medical tourism generated 19,700,000 results. (Our Treatment Abroad and related web sites secure three of the top ten positions. A pat on the back for our search engine optimisation team!)
A search for medical travel generated 73,300,000 results.
A search for health tourism generated 36,600,000 results.(Treatment Abroad is no 2 for this search. Another pat on the back for SEO.)
A search for health travel generated 250,000,000 results. A search for global health generated 133,000,000 results.But we probably need to be a bit more specific. By putting the phrase in quotes e.g. "medical tourism", Google only returns results for the exact phrase: "medical tourism" generated 5,290,000 results.
"medical travel" generated 443,000 results.
"health tourism" generated 798,000 results.
"health travel" generated 505,000 results.
"global health" generated 3,220,000 results
The previous analysis tells you what words and phrases are most frequently used on web sites indexed by Google. But what terms do people use when searching? Here's another analysis. This time we look at the average monthly search volumes on Google worldwide:
medical tourism - 90,500 searches per month health tourism - 14,800 searches per monthhealth travel - 165,000 searches per monthglobal health - 135,000 searches per monthAnd the winner is?
It's probably medical tourism....Why? Because it's the phrase that's in common usage, whether we like it or not. It's what the media use when they write about the industry. It's what the man on the Clapham omnibus would probably say. Is it the best phrase to use? Probably not.
I prefer medical travel!
Wales....... the latest medical tourism destination for US patients?
A recent news story on CNN attracted my interest when it featured a US patient who travelled to Wales (in the United Kingdom) for sinus surgery to save money. It was headlined “'I can't afford surgery in the U.S.,' says bargain shopper”. It’s an interesting story which shows how the media can sometimes put a slant on a story to create news, but it does highlight some real opportunities for medical tourism providers. The story (view the CNN video) tells us about Godfrey Davies, an American, who needed sinus surgery. It tells how he “set out on a mission to find an affordable surgeon”, and was appalled at the costs that he was going to incur in the USA. The story was picked up by a multitude of other web sites who took it at face value.If you view the video, you get one impression. If you dig a little deeper, you actually get to understand the full story and where this patient fits within the medical tourism marketplace.
As a Brit, I found it a bit odd when I viewed the video. My first impression? Here’s a story about an American guy travelling all the way to Wales for surgery....... Why would he do this? And why Wales? But then I dug deeper. It was in fact a story about someone who started life as a “Welsh bloke”, became an “American guy” and went home for an operation. There’s a clue in his name (Davies...it’s a Welsh surname) and in his slightly odd accent (It’s a Welsh accent). Godfrey comes from Wales. It is where his family lives. He’s a UK and a US passport holder. He married an American and became a US citizen in 2002. He doesn't have health insurance in the US because he believes that the quoted premium of $1,000 per month is too much. He says that "with the deductible and co-pay, I would have had to pay more in over three and a half months than coming home to Wales."
So, what can medical tourism businesses learn from this story?
Firstly, don’t take news stories at face value. There’s sometimes an underlying logic to a news story which the media doesn’t always fully expose. It may make the news less newsworthy. In this case, it’s understandable why a Welshman (as opposed to an American) might choose Wales as a medical tourism destination.
Secondly, it highlights one of the key factors in why people select medical tourism destinations. Godfrey Davies chose Wales because it is an excellent cultural match, there is no language problem for him, and he feels 100% safe there. And it’s cheap!
Godfrey went to the BMI Werndale Hospital in Bancyfelin, Carmarthenshire. It is part of BMI Healthcare, Britain's leading provider of independent healthcare with nearly seventy hospitals and clinics nationwide. To give you another example, I myself had a total knee replacement at one of BMI Healthcare’s hospitals near London, The BMI Clementine Churchill Hospital. How much would it cost for a knee replacement in an American hospital? $50,000. How much did it cost me in the UK? £10,000 all in ($15,000). The UK price is cheaper than Korea ($17,800), and not far off the prices that Americans pay in countries such as Thailand ($12,000) and Singapore ($10,800). Given the cultural and language match, and the lower travel cost, if you were an American which destination would you choose?
Thirdly, it’s a great example of the kind of American medical tourists that some medical tourism businesses should be targeting..... people from their own country. Thus, the biggest and most realistic opportunity in the USA for Korea based medical tourism providers is most likely to be Korean Americans. Target the easy win, if you want to succeed.
Fourthly, it supports the argument that the UK might actually be an attractive medical tourism destination for US patients. Despite the different accent, there’s no language barrier! There’s a public healthcare system that delivers excellent outcomes. And there’s a private hospital system that already provides treatment for patients from all over the world who travel to the UK to access healthcare quality and expertise. And...... as Godfrey Davies has demonstrated, you can save an awful lot of money over UK prices.
How much does private treatment cost in the UK?In addition to Treatment Abroad, we also run various UK health information sites. One of these is Private Healthcare UK. It will tell you all you need to know about private treatment in the UK.
The outlook for medical tourism in 2010
Before looking forward to 2010, let's look back and assess where medical tourism is now. So, was 2009 a good year for medical tourism? In 2009, we heard medical tourism “experts” across the world continue to talk up the potential for medical tourism without any sound basis in reality. It’s in the interests of some within the industry to boost the profile of medical tourism and frankly to exaggerate its potential. But whereas some industry pundits talk in tens or hundreds of thousands of patients, others talk in millions. These over optimistic forecasts have in themselves created a burgeoning medical tourism industry and a flurry of market entrants who may find that the going gets tough in 2010. Much of the current medical tourism sector has been built on hype rather than solid foundations. “In the land of the blind, the one eyed man is King” said Erasmus, and this has certainly been true in medical tourism.
Reality bites.... in the UK
The medical tourism sector is (a) not immune to recession and (b) is not going to thrive in a recession. The argument that people are more likely to look for low cost treatment overseas if money is tight just doesn’t stack up. How has the recession affected self paid treatment in a mixed healthcare economy such as the UK? The number of patients paying cash for elective surgery such as hip and knee replacements and the discretionary spend on cosmetic surgery is down 20% over the last 12 months. And the missing 20% are not going abroad because it’s cheaper. They are hanging on to their money, delaying treatment or deciding to spend their money on more essential outgoings.
Reality bites.... in the USA
For many new entrants to the market, the USA is seen as the “golden goose” of medical tourism. It depends what you read and who you believe. Compare these predictions and numbers:
For 2008
For the future
“23 million Americans could be traveling for medical tourism in 2017.” (Medical Tourism Association – Sep 2009).Recession adjusted forecast: 1.62 million medical tourists in 2012. (Deloitte Medical Tourism Update – Oct 2009)Is either of these future predictions anywhere near the mark? What might be the factors influencing an upward or downward trend:
Obama... the President who may change the way that the USA funds healthcare. And he’s making progress. Universal healthcare coverage in whatever final form it takes pushes medical tourism to the margins.... which is where it is in most developed countries. People do and will travel for treatment but it will always be a small minority wherever they are.Insurers, employers, HMOS’s..... We’re still a very long way from seeing funders of healthcare make a significant move towards using medical travel as a way of reducing healthcare costs. Will it happen? Yes... but slowly and at the margins.The recession isn’t over.... and it isn’t going away anytime soon. In both the US and Europe, unemployment levels hit 10% in December 2009. American workers have been unemployed an average of 29 weeks, the highest ever recorded since the data was tracked from 1948 onwards. Americans are visiting their physicians less, reducing the number of drugs they pay for. They are reducing their level of care. But as with the UK, large numbers are not offsetting this by pursuing lower cost options overseas.According to a report in USA Today this month, medical tourism is number nine in the top ten travel trends for 2010 in the USA. According to USA Today, the three drivers are:
More coverage of overseas medical care by major U.S. insurers.An increase in individual insurance policies that typically carry a high deductible.A marketing push by companies that combine travel and medical services.But will these drivers drive significant growth in the USA or elsewhere in the world?
Some, but only a few, insurers will provide coverage....but will patients actually want to travel?There may well be an increase in deductibles....but will patients be able to afford to “top up” their healthcare anywhere....in their home country or overseas.Companies may well increase their marketing spend and may increase public awareness a little....but what we don’t have in medical tourism is a “big player”, a company that’s prepared to risk hundreds of thousands of dollars/pounds/euros in bring medical tourism to the masses.So... is it medical tourism boom or bust in 2010?
Neither. Medical tourism is not the Holy Grail that will save holiday destinations around the world who are already suffering from the “let’s stay at home” effect of the credit crunch? It’s not the easy win for hospitals and clinics who have been adopting the “if we build it, they will come” approach. The reality is that we will see growth in the long term.....growth where medical tourism makes sense and not at the exponential rates that some have predicted.
The good news (for medical tourism) from the economic downturn is that every Western government is going to be under pressure to cut public expenditure and that usually means cuts in healthcare provision. Let’s take the UK as an example. The UK government knows that it cannot afford to fund the healthcare system as it has in the past. The UK national debt in 2010 is 72% of Gross Domestic Product; ten years ago, it was 33% of GDP. In Ireland, the Irish government unveiled one of the most severe budgets in the Republic's history embracing cuts in public expenditure across the board.
In many countries, the pressure on public funding of healthcare will be greater than ever before. In the long term, an ageing population demanding more healthcare and pressure on healthcare budgets will mean more patients funding their own care and looking at overseas treatment as a serious option. And that means there’s an opportunity for medical tourism.
Regional healthcare not global healthcare
In truth, there has never been a global healthcare market, and it’s unlikely that there will be one in the near future....unless, of course we:
Where does medical travel really work...and happen? Across borders....from one neighbouring country to enough....within rather than between continents. However in need of treatment they are, and however desperate they are to save money, the number of patients who are prepared to board a plane and fly for eight hours plus to a different country with a different language and culture is minimal. It’s medical tourism at the margins. And it’s medical tourism that puts patients at risk through combining surgical procedures with long flights.
Patient flows in medical tourism follow low cost airline routes with short flight times or cross border land routes. Americans flying or driving South for surgery, Brits traveling to Budapest for dental treatment, the Japanese heading West to Korea for cosmetic surgery, the Indonesians travelling to Malaysia and Singapore, Central Africans heading for South Africa and so on.
The competition is going to get hotter
With medical tourism numbers failing to live up to the inflated predictions, we may now be faced with too few patients for too many providers. Those who have come to the market in the last twelve months are going to wonder where all the promised patients are. The simple laws of supply and demand mean increased competition. But that doesn’t necessarily mean that prices will plummet. Only the foolish will drop prices to attract patients. Consumers don’t opt for the cheapest when it comes to making healthcare decisions. Yes, they want to save money, but cheapest implies low, quality, risk...all those things that medical tourists are trying to avoid. Added value, customer service, creating new business from existing or past customers will all become important in differentiating your business, and attracting new patients.
New models for medical tourism?
The credit crunch, increasing competition, the slow growth in patient numbers (if we see any growth at all in the near future) will encourage new approaches to medical tourism. We’ve seen the Hungarian “dental tent” come to the UK, and we hear that cruise ship medical tourism is on the agenda of the European Medical Travel Conference. And perhaps in 2010, we may see the serious adoption and exploitation of telehealth and e-medicine in the medical tourism sector.
In a recession....find a niche
So, what can those pursuing the Holy Grail of medical tourism learn from all this?
One key to success in a recession is to find a niche and ideally one that is a recession proof niche - one that people spend their hard earned cash on when money is tight. Whereas many healthcare providers try to be all things to all patients, those that succeed will select their niche and focus their efforts.
There are some niche areas of healthcare that are relatively recession proof and may prove attractive. Infertility treatment is a good example:
Public funding of infertility treatment is under pressure in many countries.The need is high and people aren’t prepared to delay treatment too long.Money may be tight, but having children is the one thing that they may spend money on rather than anything else.It’s high value.There are others...get your thinking cap on and go out and find them.
In summary
2010 may be the year in which we see some rational thinking and some rationalisation in the medical tourism world. Perhaps the recession will bring some of the “blue sky” thinkers down to earth. New market entrants are going to feel the pinch; the long established players will maintain their reputation, improve their services and continue to thrive.
Long term, the medical tourism sector is here to stay.
Stay with it.... businesses that ride out the recession will come out of it in better shape. It’s still an attractive market sector and the business is there for those who take the long term view.
Comparing the costs of (accidental) medical tourism
Whereas much of the attention in the medical travel sector is focused on medical tourism (i.e. where the primary reason for travel is some form of surgery or treatment), a more established and mature market sector is the provision of healthcare services for the tourist or business traveller who falls ill when abroad. The structure and maturity of this sector means that it is far easier to gather comparative data such as the cost of healthcare and actual treatment in different countries. Cost management is in the hands of the international insurers, the travel insurance companies and the assistance companies who negotiate prices with hospital providers worldwide.A recent analysis of travel insurance claims, published by the UK based travel insurer, Sainsbury’s Travel Insurance, provides an insight into the variation in hospital costs across the world and the rising trend in hospital costs.
According to their analysis:
In 2009, a record number of people needed medical treatment whilst abroad.The most expensive country for inpatient hospital treatment was the United States, with the average hospital visit costing £6,000.The average cost of hospital treatment in a foreign country has climbed to £2,040 over the last 12 months, an increase of 6.25% year-on-year.The most significant increase in treatment costs were seen in Turkey (+10%), the USA (+10%) and Spain (+7.5%).Over the summer months (May to September), the most common reason for hospitalisation was gastroenteritis with the average bill for inpatient treatment amounting to £1,200. The most expensive hospital bills were for those who suffered a heart attack abroad, resulting in medical expenses that averaged £12,500.
It’s interesting that the international assistance companies who deal with these "accidental" medical tourists have shown little or no interest in entering the medical tourism business. They have everything in place to become the world’s number one facilitator and blow everyone else out of the market:
They have a network of “approved” hospitals around the world.They facilitate treatment for thousands of international patients in foreign countries every day.They have call centres to deal with patient enquiries.They have extensive technology and systems to manage the patient process.They have people on the ground in major destinations who can provide local support.They have comparative data on treatment outcomes and comparative costs in hospitals around the world.So, why haven’t companies like Europ Assistance, Mondial Assistance and AXA Assistance entered the medical tourism market and used their expertise to attain a dominant market position?
The answer is probably quite simple. The medical tourism market is just not big enough to be attractive to them, nor worth the hassle. Which is good news for the existing operators...but puts the medical tourism market opportunity in perspective compared to the long established international assistance market.
The slumbering giant of medical travel?
Where do you think the international patients' centre shown above is? Singapore? Thailand? Malaysia? India? Korea? Read on to find out...
This week’s International Medical Travel Journal covers a recent announcement by the UK Department of Health (See: Liberated UK hospitals to attract medical tourists) that it plans to remove the cap on the proportion of income that NHS hospitals can earn from private surgery. NHS hospitals are allowed to treat private patients (both domestic and international patients) in addition to their primary responsibility for serving the needs of the UK public.
Many NHS hospitals have private patient wards or dedicated units which benefit from their location close to the extensive clinical resources and medical technology which are available with an NHS general or teaching hospital. These are well supported by private patients but these NHS units have been restricted in terms of their revenue potential; across the UK, NHS hospitals were not allowed to generate more than 2% of their income from private paying patients. Some individual hospitals were allowed to generate a much greater proportion but were still limited in their revenue earning potential.
At medical tourism conferences around the world, the UK gets barely a mention. Yet it ranks in the top ten destination countries in terms of medical tourist numbers and probably in the top five in terms of revenue generated (Source: Team Tourism Consulting 2010). London continues to attract high value medical travellers seeking expertise and quality rather than the lowest prices. The average treatment cost for these patients is around £20,000, and for individual patients it can be much more. London also benefits significantly from the related expenditure of these medical travellers e.g. accommodation for friends and family during these extended patient stays.
Private patient facilities at leading London teaching hospitals such as Moorfields Eye Hospital, Great Ormond Street Children's Hospital, Royal Brompton & Harefield Hospitals, Kings College Hospital, Royal Marsden Hospital, and Guy’s & St Thomas’ Hospital have always been attractive to international patients and they compete with other international centres of excellence in countries such as the USA and Germany . Indeed, these NHS private patient facilities earn more from international private patients (medical tourists) than they do from UK private patients.
The Harris International Patient Centre at Great Ormond Street (pictured above) is a good example. The Centre has 130 staff, working with over 170 clinicians in Great Ormond Street Children's Hospital. It’s bigger than most international patient departments serving “medical tourists” that you would find anywhere in the world. And it’s very busy. But, until now Great Ormond Street and similar NHS run international patient facilities have been limited by the private patient income cap.
That is about to change... London “the slumbering giant of medical travel” may wake up to some of the newly emerging opportunities presented by the international patient market:
The London hospitals mentioned above have a long and impressive track record in attracting international patients.
They were involved in medical tourism long before the term was invented.
And they are able to provide quality and prices that will be attractive to many emerging source markets for medical travel. For example, if US derived medical tourism does eventually take off, and American patients can make significant savings by travelling to London for major surgery (not far short of those available in Singapore or Thailand), would London be an attractive option? Same language (...almost), same culture (...almost).
This American who travelled to Wales for surgery may be the start of a growing trend....
Patient choice in medical tourism...Let's hear the patient's voice
The recent Medical Tourism Climate Survey conducted by IMTJ for the European Medical Travel Conference 2010 provided an interesting insight into the current state of the industry and how people in the industry are thinking about medical tourism. The survey analysed the views of over 250 people involved in medical tourism from 55 countries. One particular question that drew my attention was one that asked people in the industry about the factors that influence patient choice. The question was this:“What factors do you think are important to medical tourists when they choose a healthcare facility or treatment provider abroad?”
Expertise and qualifications of the doctor/dentist ranked first. Comments and ratings by other patients ranked second.
It’s the high ranking of “patient opinion” that surprised me, given the industry’s apparent reluctance to “buy in” to the concept of patient ratings and reviews. Hospitals worldwide are investing large sums of money in accreditation and quality standards, sometimes as a marketing tool to attract patients and referrers. But very few patients have any idea what JCI accreditation means, or how this can help them to compare quality at different hospitals.
So, how are patients comparing competing destinations and healthcare providers?
As patients evolve into healthcare consumers, they are considering the purchase of healthcare in much the same way that they consider the purchase of any consumer good or service. And medical tourists are no different.
Let’s consider the tourism or travel element of medical tourism and medical travel. When consumers are booking a holiday or a hotel, what do they do and where do they go to gather information that will guide their choice. To determine price and availability they visit travel and holiday portals online. Sites such as Lastminute.com and Expedia attract massive volumes of traffic. And where do these consumers go to gather “opinion” about quality and services at their destination or hotel. Travel consumers want to hear from “people like me” before they buy.... which is why TripAdvisor has become one of the busiest web sites in the travel sector.
So, what are the options for medical tourists who want to hear from “people like me” before they buy? Many patients whether they are travelling patients or “stay at home” patients make extensive use of patient forums before they make a decision on treatment at home or abroad. Infertility treatment abroad is a good example. Take a look at the Fertility Treatment Abroad section of the FertilityZone web site, and some of the discussions that take place around the services provided by various IVF and infertility clinics abroad:
If you were a patient seeking infertility treatment abroad what would influence your decision more....
I’m willing to bet that the views of other patients....“consumer opinion” would be the major influence on your decision. (Obviously, for IVF treatment, patients would also be looking at outcome data/fertilisation rates published by the clinic). This seems to be the conclusion reached by the respondents in the IMTJ Medical Tourism Climate Survey.
So...why hasn’t the medical tourism sector bought into patient ratings and reviews?
At Treatment Abroad, we were the first to enable medical tourists to rate and review overseas hospitals and clinics. At Medical Tourism Ratings and Reviews, patients can score these clinics and post their comments about the service and treatment received. To enable this, we invest heavily in Bazaarvoice, the world leaders in online rating systems to manage our new service. They make sure that only valid reviews make it on to our medical tourism reviews site. The moderators are well educated, trained and tested to ensure only appropriate user-generated content gets posted. Nevertheless, we are disappointed in the adoption of this reviews system by our clients.
When we promote the reviews system direct to patients and people who have enquired about treatment abroad, we get excellent take up. Patients are keen to share their experiences and benefit from other patients’ experiences. Similarly, some of our clients see the benefit of allowing patients to rate and review their services and actively encourage their past patients to visit the site and post a review. The system is free. It doesn’t cost the client a penny extra to participate. But many of our clients are less enthusiastic about patient reviews.
Why is there reluctance to encourage patient reviews for medical tourism?
The most common objection from clients is that they are worried about negative reviews. What happens if a patient actually says something that they don’t like?
Well, as all of the hotels and holiday providers on Trip Adviser know, a negative review may affect their business negatively. Or will it?
On Medical Tourism Ratings and Reviews, we publish negative patient reviews, as long as they are not profane or violate other rules of moderation, such as raising litigation or malpractice issues.
Negative patient reviews are valuable
Negative reviews are of value to the healthcare provider and to healthcare consumers. Negative reviews show credibility – if there are nothing but 5-star reviews for your services, healthcare consumers get suspicious about the authenticity of the content.
Negative reviews also give objective feedback and help healthcare providers uncover blind spots. Perhaps there was a breakdown in a process or poor communication with the patient, or some misinformation in the description of your services on your website. Direct feedback from your patients is the most transparent way to uncover these issues and get them solved quickly.
When we publish a negative review on Medical Tourism Ratings and Reviews, we give the client a chance to respond – to explain what went wrong and to say what they are doing to put things right. Negative reviews which we reject and do not publish (but we do pass to clients) are also incredibly valuable. When patients are upset with your service or their treatment, they sometimes get angry, which can cause them to violate the terms of our review system, use profanity, threaten legal action or go off on a tangent – all things that can lead us to reject a review.
Don't ignore negative patient reviews
It’s important for healthcare providers not to ignore this information, because if you can uncover and solve a legitimate problem, and complete the circle, it makes it less likely that the patient will spread their rancour to blogs, forums, and other places where you are unable to see, control or address their comments.It’s important for healthcare providers to review all negative content, so they can uncover service or system improvements to improve future patient interactions.
The message... it’s time for medical tourism providers to start actively encouraging patients to rate and review their services and to start listening to what patients have to say. Accept that sometimes things do go wrong, that patients will be unhappy and will want to tell the world.
You may learn more from getting something wrong than you do from getting something right.
The US healthcare reforms and medical tourism
Caroline Ratner at IMTJ has just published a summary of US reaction to the Obama healthcare reforms from the medical tourism sector, so I suppose I had better throw my comments into the mix. First, let me stress that I am by no means the world expert on the US healthcare reforms! (Does one exist?) But I have been asked by the UK media recently to comment on the reforms and in particular to comparisons with the UK healthcare system. It’s been interesting to watch from afar how a nation is having to deal with both rising healthcare costs and demands for increased expenditure on healthcare.
It’s acknowledged that the USA is one of the most expensive healthcare systems in the world, spending 15.3% of the nation's GDP on healthcare (WHO statistics). This compares to around 8.2% of GDP for the UK and similar for other European countries. Despite the high expenditure, the USA gets atrocious value for money out of what it spends.
Take a look at these comparisons:
The UK spends less than half the amount per capita compared to the USA, but provides a similar number of doctors, more nurses and more beds per 10,000 citizens. Not bad value for the taxpayer's money.
Despite these facts......in the healthcare reform debate in the US, the UK NHS has been used as an example of “how not to do it” and at one point those campaigning against the reforms launched a series of television adverts using “tragic” stories from Britain's National Health Service to contest Barack Obama's plans. The reality of the UK NHS is rather different... it works pretty well most of the time and it costs the nation half of what the US spends (as a percentage of GDP). If .......you were a US politician and could wave a magic wand which would transform the US healthcare system overnight to an NHS system of universal healthcare, free (in most cases) at the point of delivery, AND it would cost the country half the money....what would you do. It’s a no brainer. But there are no magic wands.
The perception of the NHS overseas is very different to the experience of the NHS within the UK Here’s a couple of recent, typical quotes from US industry commentators on medical tourism and the US healthcare reforms:
“People from UK and Canada is (sic) not looking for treatment outside their countries because of being denied of healthcare insurance or financial constraints, it is because of high cost of care and extensive waiting times for elective surgeries”“ (the reforms) will also potentially create long waiting times for medical procedures which will create situations like in Canada and the UK, where patients travel outside their country because of long queues for important surgeries.Note the references to the long queues and extensive waiting times in the UK. This kind of uninformed and factually incorrect comment does little for the credibility of the medical tourism industry. It’s political dogma.
Here are the hard facts on UK waiting lists:
The average NHS waiting time from referral to treatment is around 8 weeks. It’s often much shorter.Anyone suspected of having cancer has the legal right to wait no more than 2 weeks to see a specialistAnyone referred for elective procedures has the legal right to start treatment within 18 weeksIf there is a significant waiting list in your local area, you have the right to exercise patient choice and go to another hospital anywhere else in the country to avoid the wait. (internal medical tourism). You can also compare outcome data, infection rates and many other data online through NHS ChoicesIf you have a serious and life threatening problem, there’s virtually no waiting list. That’s why I’ve only ever met one British heart surgery patient who has gone abroad for treatment. Despite this, I’m regularly amazed by overseas providers or consultancy companies who call me to discuss their plans for attracting British patients overseas for major surgery such as heart bypass.And here’s some recent “real life” experience.
The Web Communications Manager at my company recently celebrated the birth of his first child. Unfortunately, the birth was at 27 weeks so it has not been easy for him or his wife. The child has been in paediatric intensive care for some weeks in a local hospital, and has recently been transferred to Great Ormond Street Hospital in London for heart surgery. Is he happy with the NHS care?....Yes. Has it cost him a penny?.... No.My wife has a recurrent inflammatory problem at the back of her eye. She has regular assessments at the local NHS eye unit, and recently went for a minor procedure. It was urgent, so she didn’t have to wait. She went to the brand new eye state of the art NHS eye unit at Stoke Mandeville Hospital. How long did she wait?..... a week or so. How much did she pay?..... Nothing?Are British patients flooding overseas for treatment because of “long queues” and “extensive waiting times”? No. The majority of UK medical tourists are not patients requiring elective surgery that they can’t get or will not wait for on the NHS. The reality of healthcare is that patients want affordable (or free) treatment close to home, or within their country. Before they even consider going abroad for treatment, they explore all the avenues for treatment within their own country.The NHS has its faults, of course, but no system is perfect. And would I swap our NHS for the current US model? No, I couldn’t afford it..... either as an individual or as an employer!
So, will the Obama healthcare reforms lead to a massive surge in medical tourism, as some have suggested? No.
Medical tourism will continue to grow as more patients become aware of the possibility of low cost treatment abroad. But we should never forget that what every patient wants is affordable healthcare on their own doorstep.....and travelling for treatment is for many a last resort.
Will Obama end the American medical tourism dream?
As reported in International Medical Travel Journal this week, President Obama has pledged to cure Americans from "the crushing cost of health costs." His proposed reforms include lower prices from hospitals, salary cuts for doctors, and payment to hospitals by government insurance schemes linked to quality of care not quantity of care. He also wants to give Americans the option of a public health insurance plan. His plans follow a social insurance model which is found in some European countries. Simplifying the funding structure within US hospitals could also lead to significant cost savings. At present an individual US healthcare provider may have to administer payments through upwards of 700 different providers.
Past research (1) has shown that while the United States spends significantly more on health care per capita than Europeans nations, Europe actually delivers more real resources per capita. For example, Europe employs a larger health workforce per capita and delivers more physician visits, hospital days, and prescription drugs than the United States. Higher prices and administrative inefficiencies account for most of this differential.
Obama's grand plan could end the American medical tourism dream. Introducing what is in effect a publicly funded healthcare system and forcing down prices could remove a key driver for outbound medical tourism from the USA.
The IMTJ's conclusion:
"If Americans are a target market, you need to keep a very close eye on US healthcare reform as it could quickly impact your business. You may even have to change from marketing on price to marketing on quality alone."
...and I tend to agree.
Recent years have seen a bandwagon effect in the medical tourism sector. And it's been a "get it cheap" bandwagon. But for decades medical tourism has been driven by patients seeking better treatment, specialist expertise, and higher quality. Some new market entrants may need to rethink their strategy.
1 Mark V. Pauly, “US health care costs: The untold true story,” Health Affairs, 1993, pp. 152–9.
NHS Patient Choice - Lessons for medical tourism
In the UK, "patient choice" is one of the driving forces in healthcare. Since April 2008, patient choice has been extended in the UK. Patients can choose which hospital they are treated in....anywhere in the country. Patients can choose the time of their hospital appointment. In some cases, patients can choose the individual consultant they see. The NHS Choices website lists information about all NHS hospitals, such as their MRSA rates, facilities and ratings and reviews by patients which means that patients can make an informed choice.The NHS Choose and Book web site enables people to make their choices.
In reality, the patient choice initiative has been a bit of a disappointment. One problem is that not enough patients are actually aware that they have a choice. The Report of the National Patient Choice Survey, England - December 2008 has analysed uptake of patient choice so far.
The key findings:
The percentage of patients recalling being offered a choice of hospital for their first outpatient appointment was 46% in December 2008, the same as in September but up from 30% in the first survey (May/June 2006)50% of patients were aware before they visited their GP that they had a choice of hospitals for their first appointment, up from 48% in September and 29% in the May/June 2006 survey.
The factors influencing choice
Hospital cleanliness and low infection rates were given most often (by 74% of patients) as an important factor when choosing a hospital.The other five are quality of care (given by 64% of patients), waiting times (63%), the friendliness of staff (57%), the reputation of the hospital (55%) and location or transport considerations (54%).So what can medical tourism businesses learn from this?
If UK patients can compare NHS hospitals on MRSA rates, post operative infection rates and outcomes, why can't they do this for overseas hospitals? Or perhaps, why is it difficult if not impossible to find a hospital treating medical tourists that publishs such data or makes it freely available on their web site?
Many people in the UK have the right under EU law to travel abroad for treatment. The EU Directive sets up a framework around this. but the basic right of free movement already exists. So, why aren't people taking advantage of this?
They don't know they have the right.They don't "trust" overseas hospitals.They would rather wait for treatment on the NHS in their local area.Awareness of overseas treatment options can be generated by the providers themselves. One of the best tools to consider is the use of patient stories to create local press coverage and thus raise awareness. See this story in the Scotsman. Let's see more of them!
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.
A word of warning for medical tourism companies
A woman from Wales who underwent cosmetic surgery in Belgium is bringing a test case against the Belgian clinic in the UK courts.The patient is suing the clinic after undergoing a face-lift and upper and lower eye surgery in 2005. She claims that she has been left with scarring around the eyes and the ears and has experienced numbness of the face. It is a significant case because it could set a precedent for other patients who wish to sue a clinic or medical tourism company after going abroad for treatment. Rather than sue in Belgium, the legal firm involved have decided to sue the clinic in the UK courts where they might expect higher payouts if they win the case. Laurence Vick, the solicitor who is representing the patient, is a medico-legal expert and specialises in clinical negligence claims. (Coincidentally, he and I were undergraduate students at the same college, many years ago!)
The question of who to sue in medical tourism cases is one that faces any patient where surgery abroad doesn't work out as it should. Is surgery abroad any riskier than surgery in the UK? No one knows.... because there is no comparative data. But the answer is probably not. Nevertheless, any surgery carries a risk. Cosmetic surgery is not risk free, so there are going to be cases of alleged clinical negligence where the patient will pursue a legal action. Medical tourism companies need to be aware of this test case, particularly those that have a UK presence. Rather than sue the surgeon or the hospital in the destination country, the patient may opt to sue the medical tourism company in the UK.
The opportunities for Korea in medical tourism
South Korea is a country that has come late to the medical tourism game, but it may in the long term become one of the winners. Perhaps initially attracted by the inflated forecasts that are touted around the medical tourism industry by “industry experts” and commentators, Korea has however taken a more realistic view of where its success may lie.The recent Busan Medical Tourism Convention provided an insight into how Korea is thinking about the opportunities presented by medical tourism. In 2010, Korea is expecting to attract around 60,000 medical tourists and the target is to attract 140,000 in 2015. This is not an unreasonable target and is far more realistic than some of the numbers that we see appearing from government and tourism organisations in other countries. The “highest quality, lowest cost” strategy is not one that Korea wants to pursue or indeed should be pursuing. Korea’s research into existing medical travellers shows that quality, convenience and trust factors far outweigh cost related drivers. In terms of relative costs of healthcare services, Korea is significantly less expensive than the USA (but then every country is) but is not as price competitive as countries such as India, Singapore or Thailand. Indeed, something like a knee or hip replacement would cost a similar amount in Korea to the cost of private treatment in the UK.
So, Korea is not going to win on cost. Nor is it going to attract vast numbers of medical tourists from Europe. Its prices aren’t competitive enough and long flight times will deter potential European patients. The same may apply to patients from the USA if the much hyped US medical tourism boom begins to happen. For a US patient, the perception of quality of care in medical destinations such as Korea, Singapore and Thailand may be very similar. So, if it comes down to the cost factor, Korea will lose out.
So, from where is Korea looking to attract its patients? The drivers of accessibility and cultural match provide the answer:
Although the USA is a twelve hour flight away, cultural connections mean that the Korean community within the USA has to be a prime target. Around 1.2 million Korean Americans, many of whom are on the West coast should provide a source of patients.
Within a one hour flight from Korea is Japan, already a source of many cosmetic surgery tourists, and where healthcare costs are rising fast.
And not much farther away is China which may provide a plentiful supply of medical tourists in the longer term.
The interesting market that Korea and many countries are turning their attention to is Russia. With the movement towards a market economy in Russia, there’s a wealthy upper class that is investing abroad, taking holidays abroad....and seeking healthcare abroad.
How can Korea create a competitive advantage in the overcrowded world of medical tourism? It may not be in Western medicine; Kang Dong Hospital in Busan is a Korean hospital that combines Western medicine with “traditional” oriental medicine and provides a model of healthcare that is attractive to many in the Far East.
Another opportunity is for Korea to build on its existing strengths and the image it has created in world markets. Through the success of companies such as Samsung and LG, Korea has created a hi-tech modern image for itself. Applying its technological knowhow and skills to the medical tourism sector may prove advantageous in creating an edge over the competition. The only technology company that I have encountered at a medical tourism conference so far is Samsung.
It has been said that Korea’s success in technology and in manufacturings industries such automotive lies in its ability to copy what others are doing, learn from their mistakes, do it better and work harder at it. If Korea applies the same philosophy to medical tourism, then some of the more established destinations will be looking over their shoulders.
Medical tourism and a medical city ...a lesson from history
Back in the mid 1990's, before someone, somewhere coined the term medical tourism, I was a UK Marketing Director with an American owned hospital company. We were big in medical tourism.... but in those days, it was known as the international patient business. One day, I got a call from a head-hunter, promising big money for an opportunity that surely I wouldn't want to miss.... This is roughly how the conversation went:
Head-hunter: "We've got these American investors who are planning to spend $500 million on a brand new 260 bed state of the art private hospital in the UK. They plan to attract international patients from all over the world. It's going to be called "Health Care International."
KP: "Sounds interesting. Where are they going to build it?"
Head-hunter: "On Clydebank. It's going to be massive."
KP: "Clydebank..... You mean Clydebank.... in Scotland....near Glasgow."
Head-hunter: "Yes, that's right. It'll be close to the airport so people will be able to fly in from all over the world. Labour costs for hospital workers in Scotland are much lower than they are in America"
KP: "Are you serious?" "Or is this a bad joke?"
Head-hunter: "I'm serious. It's backed by some American guys who are ex-Harvard Medical School and a US medical ventures company. They're going to create a medical city. They know what they're doing. They want someone to run it who knows the business inside out. You come highly recommended. Are you interested?"
I think my response was something along the lines of, "Not in your wildest dreams".
So...what happened?
Health Care International was one of the biggest disasters of all time in terms of a hospital development. They built the Clydebank hospital....... patients didn't come. Surprise, surprise, they failed to fill its 240 beds, 21 operating theatres and neighbouring five-star hotel. By 1995, it was going bust.
Unperturbed by this unmitigated failure, in walked a group of Middle Eastern investors from Abu Dhabi with a plan to "develop the hospital as a centre of international medical excellence". It grew to 540 beds. And in 2002, it went bust again. In walked the National Health Service who picked up a state of the art hospital and all the equipment for around $50 million!
It's still there. It's now part of the NHS National Waiting Times Centre and is known as the Golden Jubilee National Hospital.
And there's not a medical tourist in sight!
History repeats itself...
It was the poet and philosopher, George Santayana, who said, "Those who do not study history are doomed to repeat it."
At the core of the Health Care International debacle was a failure to understand marketing and a failure to understand the market.
Around the medical tourism world today, I see history repeating itself. Investors getting involved who may have little real grasp of the international patient business, being guided by others who may have even less.
So, my suggestion to the investors and medical tourism pundits is "Get your history books out".
Or buy a decent marketing text book. It might save you a few million!
Light at the end of the medical tourism tunnel?
Following my outpourings on the “Outlook for Medical Tourism in 2010”, I am pleased to say that I’ve received some positive feedback (always a good thing.... I’ll keep on blogging!). And some reassurance that I am not alone in my view of the medical tourism world. In particular, one of the long established medical tourism facilitators told me “how it was” in 2009 and how they think it might be in 2010. It’s refreshing to hear someone be open and upfront about their business experiences in medical tourism and the challenges that are facing people in the business.
I’d like to share some of these comments with others in the medical tourism world. Here is what it was really like in 2009 for one medical tourism business, a business that is well established, well run, and isn’t a “one man and his dog” outfit. I’m going to respect their confidentiality and not name the company concerned.
The view from the marketplace
Here’s what our medical tourism facilitator had to say about 2009:
“We have dabbled in the elective surgery market and have come to the same conclusions as you.... that to continue in this sector we would need to consolidate and concentrate on niche or rather more specialist sectors. Otherwise, we are finding ourselves becoming a "Jack of all trades and Master of none".
Last year was a really bad year. We were very busy with enquiries, but our conversion rate was disappointing and for those that did convert, the average spend was down. We have put the conversion problems down to a 50/50 mix of:
Another factor that has not helped is the pound sterling rate against other currencies, especially the Euro; this has meant a 20% increase in costs and prices. This does not only apply to the treatment cost but the patient stay while they are away. (Hotel rates are more expensive, eating out is more expensive etc.) The effect has been significant. Our patient numbers fell by 30% in 2009 and the average spend per patient dropped by 25%.”
So, a difficult time for this medical tourism business. But it is not unique. Some dental clinics in Europe have been relating similar experiences. One major implant centre in Budapest has reported overseas patient numbers down by more than 20% and a similar 25% fall in average spend per patient.
Do these experiences reflect the reality of the medical tourism business in recession?Lies, damned lies and statistics?
The UK is one country where we count stuff. We have an Office for National Statistics and they employ around 4,000 civil servants who count stuff...including medical travellers. At Treatment Abroad, we do our bit to keep the civil servants in jobs by buying the data that they produce – specifically, the International Passenger Survey (IPS), a survey of a random sample of passengers entering and leaving the UK by air, sea or the Channel Tunnel. The IPS attempts to identify the number of people both travelling into the UK and out of the UK where the prime reason for travel is medical treatment (as opposed to business or a holiday).
Now.... you need to take these statistics with a very large pinch of salt. Statistics contain statistical errors and the smaller the sample, the bigger the risk of the error.
Here is a graph of IPS data showing outbound medical travellers from the UK from 2002 to 2009 (projected from 3rd quarter statistics). The sample size in this data is small - the number of actual travellers interviewed in each quarter who stated that their prime reason for travel was medical is around 50 to 100. So, there is room for wide variations in the data!
But, it may well be a reflection of the actual trends in UK medical tourism and for 2009 may indeed reflect the experiences of many in the marketplace who have seen the number of medical tourists in decline over the last 18 months or so, since the credit crunch hit.
Light at the end of the tunnel?
Our medical tourism facilitator quoted above has a more positive outlook for the future:
"We have already seen an increase in booking numbers for dentistry in 2010. January is already 100% up on January 2009 (and nearly the same number as in 2008, so something is starting to change.”
With some good news on the economic horizon in the UK, we may be seeing an increase in consumer confidence. House prices are increasing, and we have seen a return to economic growth, albeit not as good as many would have hoped. We wait to see what the effect may be on unemployment. But, like many industries, medical tourism follows the trends in the economy as a whole. Medical tourism is not immune to recession and certainly is not flourishing in it.
The way forward.. focus and think niche
Back to our medical tourism facilitator, who is planning the strategy for 2010:
“Our progress for 2010 will be to expand the dentistry further and concentrate more on the cosmetic surgery. We had taken a step back on cosmetic surgery in 2009, due to the difficult climate and similar to your (Keith Pollard’s) points about offering too much, we have recognised that rather than be a "Jack of all trades.....", we need to have a separate department. Having the same staff switching between the two products (dentistry and cosmetic surgery) does not really work.”
And our medical tourism facilitator concludes with a message for all in the industry:
“I totally concur with the conclusions of your article, and recognise that this medical tourism industry is not as simple and as great as people have made out. Only the companies that keep adapting and recognise the importance of focusing and having the correct resources to manage a particular sector of this industry will survive or be commercially viable.”
Medical tourism...lessons from the California gold rush
In 1848, gold was discovered in California by John Sutter, a German immigrant. News of the find spread rapidly and thousands arrived in search of their fortune. Prospectors came from across the USA, from Hawaii, Mexico, Chile, Peru and China. The California gold rush had begun. California’s output of gold rose from $5 million in 1848 to $40 million in 1849 and $55 million in 1851. But there wasn’t enough gold to go around....only a minority of gold miners made much money from the Californian Gold Rush...the best equipped, the best informed, the best organised and resourced. Others also made money; the saloon owners (and brothel keepers!) who kept the prospectors entertained made a healthy profit, and so did the entrepreneurs and store owners who provided the supplies and tools that the prospectors needed (often at exorbitant prices).
Are there some parallels and some lessons here for those involved in the medical tourism gold rush?
The discovery of medical tourism gold....
Although the concept of travelling for treatment has been around for centuries, it was probably around 2005 when the medical tourism gold rush really took off; it still continues today and shows little sign of abating. News stories appeared around the world about a surge in medical tourism – patients travelling to save money on treatment costs (as opposed to seeking medical services and healthcare quality that were unavailable in their own country). The first prospectors appeared - medical tourism agents and facilitators, and overseas hospitals and clinics seeking their fortune in the world of medical tourism.
Word spreads, prospectors pursue the dream of medical tourism gold....
The tales of medical tourism gold began to multiply. Estimates of the number of medical tourists were in the hundreds of thousands, the millions, and then the tens of millions. Few medical tourism prospectors questioned the validity of these claims of the discovery of a rich vein of income or whether it was sustainable.
Those involved in the early gold rush exaggerated their successes, claiming massive finds (e.g. “one million medical tourists to....), encouraging others to join the frenzy. Healthcare providers in countries all over the world entered the race - Singapore, Malaysia, Korea, Jordan, the Philippines, Tunisia, Turkey, Eastern Europe, many of them backed by their tourism boards, health departments and government initiatives who saw medical tourism as a rich source of foreign currency.
....without thinking or understanding what’s really involved
New entrants pursued the dream without really thinking through their strategy and approach to the market. Some went into the market ill equipped; some went into the market without realising what it might cost to be successful; some went looking for medical tourism gold in completely the wrong place!
A community of medical tourism prospectors develops
As the number of medical tourism prospectors grew, others (the saloon keepers) arrived quickly to profit from this growing community, and store owners and tool suppliers appeared to guide the prospectors in their pursuit of gold.
The saloon owners arrived in the form of the associations and medical tourism conferences that make their money from membership fees and delegate fees. They provided a place where the prospectors could get together, but they also built on the hype, retelling stories of the latest discoveries and attracting more people to the medical tourism gold rush. Of course, the more people in the gold rush, the more people there are in the saloon, and the more money there is to be made by the saloon owner.
The entrepreneurs and store owners also arrived on the scene to provide the tools that the prospectors needed to mine medical tourism gold. Web sites like our own (Treatment Abroad) that link patients with providers, systems companies like Health Travel Technologies and e-Medsol that provide the systems to manage patients, and consultancies, strategists and advisers like Irving Stackpole and Vivek Shukla who help the prospectors to locate medical tourism gold came into being. Are these entrepreneurs and store owners (including my own Treatment Abroad "store") taking advantage of uninformed prospectors by providing poor quality services and products and overcharging for them. Or are they providing sensibly priced services and much needed tools that will bring long term success to those who use them wisely? Only time will tell.... and it will be the success of the prospectors who determine our success.
The gold runs out...or is harder to find and mine
As in the California gold rush, reality has failed to live up to expectations for many prospectors. Clinics, hospitals and facilitators are finding it harder to acquire patients and there’s a great deal of competition out there. Nevertheless, for many the gold rush mentality continues.
After the gold rush?
So, what’s the likely outcome of all this? What can we expect in the next stage of the medical tourism gold rush? In my next blog post, I’ll give some thought to who will strike gold and how will the industry develop.
Practice makes perfect...a message for medical tourism providers and patients
In the largest ever study of hospital mortality rates published in the UK,"death rates for emergency patients jump 6 per cent when newly qualified doctors start work. The Health Services Journal reports that "the traditional first day for NHS doctors is the first Wednesday in August. Researchers found that patients brought into hospital the week before were more likely to survive.....Researchers could not find a definite reason for the higher mortality rate, but said early August was known as an “unsafe period” in hospitals due to the influx of new doctors"Now, what can we conclude from this?
Might I suggest that doctors with more experience are better than those with less experience? It goes without saying, really.
So, how does this help the medical tourist who is trying to make a decision about which doctor or specialist overseas to choose for their operation? The problem of patient choice in healthcare whether it is a choice of an overseas surgeon or a domestic surgeon is the "how do I know that he's any good?"issue. In the UK, we're probably ahead of the game in enabling patients to make informed choices about treatment. The NHS web site is has been renamed "NHS Choices" and in recent years there's been a drive to expose data on clinical outcomes and surgeon and hospital performance, and make this freely available to patients.
One of the strengths of the UK healthcare system (and one of its shortcomings!) is that the vast proportion of healthcare is delivered by one healthcare provider - the NHS. This means that data on processes, outcomes, performance and patient satisfaction is fairly standardised, thus enabling valid comparisons to be made between one hospital and another, between one specialist and another.
Let's imagine that I need a knee replacement. Under the NHS, I can choose to go to any hospital in the UK, not just my local hospital. But let's assume that I want to stay fairly local. Here's some of the data I can access about my local hospitals through NHS Choices. For each "quality factor", I have highlighted the best result.
Impressed? Which hospital would you choose? Or which hospital would you rule out of consideration? The above table only scratches the surface of the data that is now being made available to patients. I could also compare the quality of the food, levels of service and so on. And I can also begin to make comparisons between individual surgeons.
Where does this leave the medical tourist? The reality is that there are few countries where this kind of comparative information would be made available to the patient. And the reality is that different healthcare systems often measure things in different ways, so that comparing outcome data from a hospital in Thailand with outcome data from a hospital in India might be very difficult.
So, the medical tourist probably needs to ask some very basic questions about the hospital and specialist. One of which is a fundamental measure of "how do I know that he's any good?” It's "how many times have you done this operation before?" "Practice makes perfect" as the recent study demonstrates. Choose a surgeon with experience in exactly what you require. If you're looking for a knee replacement, choose an orthopaedic surgeon who does knee replacements and virtually nothing else. Don't choose a "general" orthopaedic surgeon who does “everything under the sun" - knees, shoulders, feet, hips etc.
And ask the guy "how many have you done this year?"
Orthopedics and Medical Tourism
Aside from elective procedures, such as plastic surgery, orthopedic surgeries are an increasingly popular option in global healthcare because patients may be un-insured, underinsured or somehow denied benefits. Cost savings are significant as the prices of procedures like total knee replacement and hip replacement surgery costs on average $35,000 and $50,000 respectively in the USA. The total costs of the orthopedic procedure are clearly lower in international medical tourism due to arbitrage, exchange rates and relative cost of living. However, even in the domestic medical tourism space there are significant discounts when the costs are calculated on cash versus insurance basis.
It is possible to live pain-free! For a list of providers: http://www.medvoy.com/procedure/orthopedic-knee-surgery
Tags: cost savings, denied benefits, domestic medical tourism, global healthcare, hip replacement surgery, hip surgery, insurance, international medical tourism, knee replacement, medical insurance, medical tourism, orthopedic surgeries, Orthopedics, pain-free, total knee replacement, un-insured, under-insured, underinsured, USA
This entry was posted on Wednesday, October 6th, 2010 at 10:16 am and is filed under Medical Tourism. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
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