PS022 - Medical Tourism: Emerging Poles of Excellence

Reports on the number of patients traveling abroad for health care are scattered, but all tell the same story. The cost savings for patients seeking medical care abroad can be significant. As underlined by M. Balasubramanian, Assistant Professor, Apollo Hospital Group, Hyderabad, India, the Apollo Hospital in New Delhi charges 6,000 dollars for cardiac surgery, compared to about 30,000 dollars in the United States.

Prices for treatment are lower in foreign hospitals for a number of reasons, explained  Mireille Kingma, of the International Council of Nurses: labor costs are lower and often third parties (insurances and governments) are less involved or not at all involved.

Health services delivered to medical travelers offer opportunities and risks for both exporting and importing countries.

For importing countries medical tourism can:

• Generate foreign exchange earnings to increase resources for health;
• Create professional opportunities, retaining health professionals and reducing brain drain;
• Help upgrade health infrastructures, knowledge, standards and quality.

For exporting countries it can:

• Overcome the shortage of physical and human resources, and
• Offer more affordable treatments.

But some negative implications have to be taken into account:

• Patient safety;
• Professional accreditation;
• Legal recourses;
• A weakened labor force;
• The creation of a dual market structure (one for foreign patients and the other for local people);
• The diversion of resources from the public health system.

The aim of this medical traveling should be to take advantage of the opportunities and mitigate any negative effects of this "trade" to increase the access and quality of health services, as well as to lower the costs of health services. But some questions still remain. How can patients ensure the medical treatment they will receive will be of high-quality? Should an international accreditation system (such the Joint Commission International) be established? Can health tourism really improve public health initiatives?

It is still difficult to estimate the magnitude of this social phenomenon, as remarked by Jason Yap, Director of Healthcare Services, Singapore Tourist Board, Singapore. In 2006, the medical tourism industry grossed about 60 billion dollars worldwide. McKinsey & Company estimates this total will rise to 100 billion dollars by 2012. Yet, speaking of "tourism" may distort the picture, and today's conception of medical tourism is shallow and insufficient. "It's more about the provision of healthcare services across international boundaries than about adding a sprinkling of healthcare on vacations", he added. Medical tourism is really a small part of medical travel. "Incidentally, after cosmetic surgery, your surgeon will tell you 'no sun, no sea, no sand'. So, do not believe the brochures!"

Medical travel is a growing business, but not a new one. "Singapore was already receiving some 370,000 healthcare visitors in 1997 and stories of patients (even heads of States) traveling there for medical care go back for decades", continued J. Yap.

Do Asian healthcare destinations threaten the facilities of the West? "The true danger in medical travel is not to the sending medical economies", stressed J. Yap, "but to the receiving medical ecologies. Since doctors are enticed away from public hospitals, prices escalate, foreign patients get preferential treatment and public healthcare systems become strained. Countries must pay attention to the public health implications of the medical travel industry, or risk hurting their own population and eventually their medical visitors...."

As outlined by Nick Drager, from the World Health Organization (WHO), medical tourism is only one aspect of the way globalization is changing the healthcare system. Apart from patient travel, many medical tasks can be outsourced to skilled professionals abroad when the physical presence of a physician is unnecessary. This can include interpretation of diagnostic tests and long-distance international collaboration, particularly in case management and disease management programs, because of the availability of information technology. Telemedicine - the use of information technology to treat or monitor patients remotely by telephone, Web cam or video feed - is becoming common in areas where physicians are scarce. Outsourcing often results in lower costs, higher quality and greater convenience.

In addition to that, because potential medical tourists must first be evaluated remotely, most large healthcare providers and medical intermediaries for patients use electronic medical records (EMRs) to store and access patient files. Patients can then discuss the procedures with potential physicians via a conference call and can also get some idea of the safety and quality of medical providers by searching online for testimonies of patients who have had surgery abroad. These Internet communities facilitate the exchange of information about providers, including facility cleanliness, convenience, price, satisfaction with medical services and the availability of lodging while recuperating. KPT Health Insurance Group has built such a community and a multilateral web-based platform available online since 2004, as explained by the last speaker, Mr. Roland Schaer, member of the Board of Directors of the KPT Group. This platform enables staff, customers, care providers and others to store and exchange data and to process digital transactions in a secured environment. More than 120,000 customers are working with this tool.