Medical tourism is beneficial to everyone

Patients without borders!
Evgenia Lukyanchuk, "Weekly PHARMACY" www.apteka.uaMedical tourism as a practice of providing medical services outside the country of residence of the patient has received significant development in recent years and continues to represent a promising direction for doing business.

The volume of the global medical tourism market is already estimated at $100 billion per year. More and more companies specialize in providing medical services to foreign tourists – purchasing modern equipment and training personnel abroad. This publication will consider the main players in the medical tourism market – countries that are a source of tourists and provide medical care to citizens of other countries.

The term "medical tourism" was born in the 80s of the last century, and today it has become a market with a huge turnover of funds. The emergence of this phenomenon was primarily facilitated by globalization, as well as an increase in health care costs, which has been noted for several years.

The main reason for the active development of medical tourism was the increase in the cost of treatment, as well as a significant difference in its cost in different countries. Thus, patients who are unable to pay for a certain procedure at home or who do not want to waste time waiting for it can receive the appropriate service abroad, often at a much lower price and without delay. In addition, medical tourism allows the patient not only to combine business with pleasure – to significantly save money and time for receiving medical care, but also to relax at one of the most popular resorts in the world. It should be noted that medical tourism can exist within one country, for example, this phenomenon is widely represented in the USA.

Some organizations in the United States and other countries have developed protocols for providing medical care to patients who want to access these services abroad. However, despite such initiatives, the medical tourism market remains poorly structured and is characterized by little regulatory influence.

Recently, the American Medical Association (AMA) has created a list of principles that market participants should follow. This is intended to stimulate further development of the sector. The AMA (American Medical Association Guidelines for Patients Traveling Overseas for Medical Care) Guidelines for Patients Traveling Overseas for Medical Care state:

• Medical care outside the United States must be voluntary.
• The economic benefits of receiving medical care outside the United States should not be obtained at the expense of the diagnostic or therapeutic needs of the patient.
• You can receive medical services outside the United States only in institutions that are appropriately accredited by international regulatory authorities.
• At the same time, the provision of services by local medical institutions should be coordinated and financed accordingly in order to ensure the continuity of medical care.
• The insurance contract for travel outside the United States in order to receive medical services must include the costs of follow-up care after return.
• Patients should be informed about their rights and legal protection mechanisms before leaving the United States to receive medical services.
• Patients should be able to get acquainted with the permits for the work of doctors and the activities of a medical institution, as well as access to the results of the diagnosis.
• The transfer of the patient's medical documentation should be carried out in accordance with the principles of the Health Insurance Portability and Accountability Act (HIPAA).
• Patients should be made aware of the potential risks associated with a combination of surgical procedures and long flights or outdoor activities.

However, along with patients who travel in search of cheaper services and time savings, there is a certain proportion of tourists traveling to countries with a higher level of medical development in search of modern technologies that allow for adequate diagnosis and effective treatment.

Medical tourism is particularly popular among residents of the United States, due to the high cost of medical care in the country. Patients are looking for hospitals in other countries that provide similar services at lower prices. Often the cost of the same services in different countries may differ by an order of magnitude (table). Basically, patients find operators providing such services via the Internet, but increasingly insurance companies conclude contracts with medical institutions located outside the country. The spread of remote medicine technologies and the broad involvement of leading specialists, combined with the entry of insurance companies into the game in the field of medical tourism, minimizes risks for the patient and provides excellent prospects for the further development of this sector. Thus, the volume of the medical tourism market at the end of 2010, according to the German consulting company VIVAI Software AG, is estimated at 75 billion euros.

Comparison of the cost of some of the most popular procedures among medical tourists in the United States and abroadProcedure

India is one of the leaders in providing medical services to foreigners. According to the data published in the report "Medical tourism: Update and implications" by the American audit and consulting company "Delloite", it is expected that by 2015 the increase in income from medical tourism in India will be at the level of 30% per year. Along with the increase in the number of medical institutions providing services to foreign citizens, the urgency of the issue of quality control of medical services is increasing.

Joint Commission International (JCI) is an official international accreditation institution in the medical services industry, represented in more than 80 countries. The number of accredited medical institutions is constantly increasing. So, in 2005 this indicator was 75 institutions, in 2008 – 200, and in 2011 it reached 477 (Fig. 1). Now such organizations are represented in 50 countries of the world. Interestingly, in many EU countries, as well as in Ukraine, there is not a single JCI-accredited medical institution. Among the CIS countries, only 1 medical institution is accredited in Russia.

Fig. 1. Top-15 countries in the world by the number of accredited medical institutions.
Source: official website of the organization "Joint Commission International" www.jointcommissioninternational.org Next, countries with the most developed medical tourism markets, leading players of outbound tourism and countries actively developing this business area will be considered.

The birthplace of medical touristsUSA

Medical tourists from the USA travel to Latin America (38%), Thailand (44%), etc.

The main reason why Americans go abroad for treatment is to save money and time. An important factor in choosing a country for American citizens is the fact that for about 34 million residents of the country, the native language is Spanish, so Spanish–speaking countries prevail.

Thus, the number of Americans who prefer Latin American countries is estimated at 500-750 thousand per year. Currently, the USA is the largest player in the global outbound medical tourism market. According to the data of the company "Delloite", a further increase in the number of Americans traveling abroad to receive medical care is expected, which will contribute to an increase in the amount of lost income by local medical institutions (Fig. 2).

Fig. 2. The volume of spending by American tourists on medical care abroad
and the resulting losses of local medical institutions.
Source: report "Medical tourism: Update and implications" by DelloiteThe growth of healthcare costs over the next decade is expected to reach 6% per year, which will contribute to the search for new ways to save.

Considering that medical tourism allows you to save up to 70% of the costs of treatment in the patient's country (taking into account the costs of relocation and accommodation), the growth of this sector of the economy, according to the company "Delloite", is expected to reach 35% per year over the next years. Thus, it is expected that in 2012 the number of Americans who went abroad to receive medical services will reach 1.6 million. At the same time, the influx of tourists for the purpose of obtaining medical services in the United States will increase much more slowly and will reach 561 thousand patients by 2017.

Considering that obtaining medical services abroad can be much cheaper, many US residents take into account the possibility of receiving such services when choosing an insurance policy. In this regard, more and more insurance companies offer, among other things, programs that include the provision of certain types of services in medical institutions located outside the country with which the relevant contracts are signed. In addition, in the light of the changes carried out in the United States as part of the healthcare reform, in particular the fact that from 2014 the vast majority of companies will be required to purchase health insurance for their employees, the topic of reducing the cost of a health insurance policy becomes even more relevant. One of the possible approaches to achieve this goal may be the wider introduction of the practice of medical tourism. For example, the American insurance company "Anthem Blue Cross and Blue Shield" has signed an agreement with "Apollo Hospitals" (India) to provide medical services to its customers. About 700 corporate clients use this program of the company.

The prolonged economic downturn in the United States has necessitated a reduction in household spending, for which consumers are using more and more tools. Thus, according to data published in the report "The Downturn Shopper: Buckled in for a Wild and Crazy Ride, 2011" by SymphonyIRI Times & Trends, 36% of Americans reduce the number of visits to doctors and resort to self-medication in order to save money. Along with this, due to the increase in the number of unemployed, the share of uninsured citizens is increasing. In light of this, savings on treatment of up to 70%, which are offered to their clients by operators of the medical tourism market, becomes especially attractive (Fig. 3).

Fig. 3. The cost of providing medical care in some countries of the world compared to the USA.
Source: report "Medical Tourism – Profit from Global Health Care" by VIVAI Software AGGreat Britain

The most popular country for receiving medical services abroad among British patients is India, offering savings of 44% of expenses.

In addition, the Czech Republic and Turkey are leaders in the field of reproductive medicine, the use of medical services in which allows you to save 17 and 40%, respectively. Among the reasons why Britons resort to using medical care abroad, it is possible to note savings in time and money, higher quality of services provided. The need for a long wait while receiving medical procedures stimulates the growth of demand for the services of operators of the medical tourism market from the British. It should be noted that the majority of Britons are forced to wait for a long time for the necessary procedure to be carried out, since in some cases this process is paid for and organized by the state.

Today, the UK occupies the 2nd position in terms of the number of outgoing medical tourists per year. In the future, countries that provide significant savings in treatment costs, such as Jordan (57%), Malaysia (57%) and the Philippines (54%), could potentially become popular among Britons.

RussiaThe majority of medical tourists from Russia traditionally go to Israel and Germany, the share of which is 45 and 20%, respectively, due to the absence of a language barrier due to the presence of a large number of migrants from CIS countries.

Currently, other destinations such as Turkey, Singapore, Switzerland, France and Eastern European countries are experiencing an increase in popularity among the Russian population. The most popular procedures are in such areas as cardiac surgery, transplantology, eye surgery, oncology, as well as the treatment of chronic diseases, which requires the availability of modern equipment.

One of the key factors when choosing medical institutions abroad by Russian citizens is the high quality of medical care, financial accessibility and the absence of a language barrier. At the same time, we are not talking about saving money. Only about 1% of Russians make a choice in favor of medical tourism. It should be noted that according to the information published in the report "Medical Tourism – Profit from Global Health Care", Russia has great potential for development in the field of outbound medical tourism.

Fig. 4. The cost of medical care in some countries of the world compared to Russia.
Source: report "Medical Tourism – Profit from Global Health Care" by VIVAI Software AGFor a visit

Belgium

Belgium annually attracts about 35 thousand medical tourists, the purpose of whose arrival is mainly to carry out cosmetic procedures and plastic surgery, as well as the treatment of oncological pathology and cardiovascular diseases.

It should be noted that the country is popular among medical tourists, despite the lack of support from the government and the presence of only one JCI-accredited medical institution.

The main drivers of the growth of the medical tourism market in Belgium are the possibility of significant time savings, relatively low cost and high quality of medical care, as well as, importantly, the absence of a language barrier, since the lion's share of medical personnel speak English, French and Dutch. According to the data published in the report "Medical Tourism – Profit from Global Health Care", medical tourists from the USA can save 56% in Belgium, and British – 26% of funds. However, the majority of patients come from the Netherlands (60%) and EU member states (19%). The proportion of British patients is about 21%.

BrazilEvery year Brazil is visited by a large number of medical tourists, 95% of whom are US citizens.

The operators of the medical tourism market in Brazil offer their American customers savings of 60% of the cost of services in the United States. In addition, in Brazil, it is possible to combine receiving medical services with holidays at resorts. It should be noted that, despite the fact that the country's healthcare system as a whole is not sufficiently developed, there are 28 JCI-accredited medical institutions in Brazil. Along with this, the development of medical tourism in the country is facilitated by the proximity of Brazil to the United States, the absence of a visa regime with this country and support from the Ministry of Tourism.

Costa Rica150 thousand medical tourists visit Costa Rica every year.

Such popularity is due to the proximity to the USA, the quality of treatment and the opportunity to relax. US citizens who accumulate the lion's share (95%) of the tourist flow have the opportunity to save about 25%. Among the most popular destinations among medical tourists are dentistry and plastic surgery.

UAEThe UAE is a prosperous, rich country in which Arabic and English are the official languages.

The majority of medical tourists come to the UAE from Germany – 45%, the UK – 27.8% and Singapore – 10.3%. At the same time, they are attracted mainly by time savings and a high level of medical care. It should be noted that most of the doctors working in the country were trained in leading foreign educational institutions, which guarantees their high professionalism. The most popular destinations among medical tourists are cardiology, orthopedics, oncology, dermatology, cosmetic procedures and plastic surgery.

GermanyGermany is visited annually by 59 thousand medical tourists from 163 countries of the world.

The country is popular among patients from the Netherlands (11.4%), France (10%), Austria (8%), Poland (8%) and Belgium (5.7%), they are attracted by modern technologies and high quality of medical care mainly in cardiology, oncology and orthopedics. One of the drivers of the development of the medical tourism market in Germany in the coming years may be the introduction of experimental approaches to the treatment of various diseases.

IndiaIndia is one of the leaders in the provision of medical services to non-residents.

The country can offer its clients, along with qualified medical personnel who are fluent in English, new technologies, alternative and experimental approaches to treatment. Operators of the Indian medical tourism market offer their clients a wide range of services in various fields, such as cardiology, plastic surgery, dentistry, ophthalmology, orthopedics, transplantology and reproductive medicine.

This area is actively supported by the Government of India, in particular, in the field of medical visas. About 450 thousand medical tourists visit India annually, mainly from the UK, USA and South Korea. Americans can save 58% of expenses here, and Britons can save 47%. The Government of India is striving to further develop medical tourism. Thus, the Ministry of Tourism of India predicts that in 2012 the volume of the country's medical tourism market will reach $ 2 billion with an annual increase of 25%.

MexicoUp to 500 thousand medical tourists come to Mexico every year, 95% of them are US citizens who can count on savings of 63% of expenses.

One of the drivers of the growth of the medical tourism market in Mexico is the proximity of the United States and the absence of a visa regime with this country. Unfortunately, this area does not have support from the government, however, the provision of medical services in the areas of dentistry, orthopedics, cardiology, cosmetic procedures and plastic surgery are popular among tourists.

PhilippinesThe Philippines has proven itself well in the field of medical tourism, thanks to which 200 thousand non–residents visit this country annually in order to receive medical services, 40% of them are citizens of the USA and Canada, 20% of Japan and Korea, and 17% of the EU.

These patients are mainly interested in receiving services in the field of cosmetic procedures, ophthalmology, cardiology and oncology. The drivers of the growth of the medical tourism market in the Philippines, among other things, are the availability of qualified medical personnel who are fluent in English, and government support.

Savings when using medical services in the Philippines compared to the United States and the United Kingdom may amount to 68 and 54%, respectively. It should be noted that weak infrastructure and "brain drain" can slow down the development of medical tourism in this country.

Singapore600 thousand medical tourists visit Singapore annually, 50% of them from the Middle East, 45% from Asia and 5% from Europe.

Among the factors contributing to the development of medical tourism in the country, one can note modern medicine, the presence of a developed infrastructure, as well as the fact that Singapore is considered one of the most environmentally friendly countries in the world. However, with a high quality of treatment, it is not possible to achieve significant savings. Operators of the medical tourism market offer services in the field of cosmetic procedures, cardiology, orthopedics, neurology. It should be noted that the use of stem cell therapies is allowed in the country.

Turkey165 thousand people come to Turkey annually to receive medical care, the lion's share of them is represented by tourists from Europe and Asia, who are attracted by 46 JCI-accredited medical institutions and a developed tourist infrastructure.

Patients from the USA and the UK can expect savings of 58 and 40% of expenses, respectively. Services in such areas as cardiology, orthopedics, oncology, reproductive medicine, cosmetic procedures and plastic surgery are popular in Turkey.

P.S. Due to the fact that the medical tourism market is in a phase of active development, many countries have the opportunity to become significant players in this field. This can promise both a significant increase in the level of income in the healthcare sector, as well as cost savings and an improvement in the quality of care for patients.

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30.11.2011