Medical Tourism Medical Tourism Introduction Medical tourism is the act of traveling to other countries to obtain medical, dental or cosmetic care. Medical tourism is a new term but thousands of years old act. People have been traveling across the continents in search of cures for any imaginable illnesses and making therapeutic trips for health wellness. In ancient Greece, pilgrims and patients came from all over the Mediterranean to the sanctuary of the healing god, Asklepios at Epidaurus, and from the 18th century wealthy Europeans have been traveling to spas from Germany to the Nile. In recent years, medical tourism is becoming more popular with patients seeking treatment for health and well-being purposes abroad.
Medical Tourism is also known as Medical Travel, Health Tourism, Surgical Tourism, Health Travel, Treatment Abroad, Surgeries Abroad, and Medical Outsourcing.
Medical Tourism Concerns
Though many are eager to be the right pieces in the puzzle, many are still struggling to get the right fit. There are a number of concerns and risk factors for patients getting treatment much less seeking them abroad. Some concerns for patients include a consistent quality of care, lack of extensive dialog between the patient and the doctor, lack of post-op follow up, cultural differences and difficulty in obtaining sufficient insurance coverage. In order to mitigate the risk, it’s essential that the patient works with well reputed facilitators.
Medical Tourism Accreditation
The qualifications of the doctors are important but as U.S. board certification requires specialist training to be undertaken in the U.S. and not anywhere else, there would be relatively few doctors in the world having American board certified qualifications compared to the number of overall physicians. Membership and fellowship of the Royal Colleges in the United Kingdom are the main specialist qualifications for much of the Commonwealth countries in the world such as Singapore which is a major medical travel destination. Accreditation with Joint Commission International (the international arm of the Joint Commission) is the usual ‘mark of quality’ for hospitals outside the United States but there are many other accrediting bodies such as Trent Accreditation Scheme in the United Kingdom.

Medical Tourism Savings
The medical savings for unilateral hip replacement are 86.5% and 83.5% in India and Costa Rica, respectively. The calculated savings are actually quite close to the commonly cited number of 90%. But American patients are not particularly interested in medical savings. They really want to know what their total savings will be since this is what truly affects them. For this analysis of hip replacement, the total cost savings are 75% for both India and Costa Rica, as compared to what a patient would really pay in the United States, presuming reasonable efforts to get a discounted price.

Quality & Care of Service
The safety and quality of care available in many offshore settings is no longer an issue. Organizations including the Joint Commission International (JCI) and others such as ISQUA, TRENT, ISO are accrediting these facilities. Receiving safe and quality care is the primary issue for consumers considering outbound medical tourism as a treatment option.
Medical tourism (MT) is also defined as patient movement from highly developed nations to less developed areas of the world for medical care by bypassing services offered in their own communities. Medical tourism differs from the traditional model of international medical travel where patients generally journey from less developed nations to major medical centers in highly developed countries for medical treatment that is unavailable in their own communities. While the general definition of the MT above covers most of the aspects of the phenomenon, it is important to note that there is no international consensus yet on the name of the phenomenon. MT is often related to globalization and neo-liberal healthcare policies which in this case considered undermining the quality and quantity of the services available to middle class in home countries. Services typically sought by travelers include elective procedures as well as complex specialized surgeries such as joint replacement (knee/hip), cardiac surgery, dental surgery, and cosmetic surgeries. Individuals with rare genetic disorders may travel to another country where treatment of these conditions is better understood. However, virtually every type of health care, including psychiatry, alternative treatments, convalescent care and even burial services are available.
Over 50 countries have identified medical tourism as a national industry. However, accreditation and other measures of quality vary widely across the globe, and some destinations may become hazardous or even dangerous for medical tourists.
History
The first recorded instance of medical tourism dates back thousands of years to when Greek pilgrims traveled from all over the Mediterranean to the small territory in the Saronic Gulf called Epidauria. This territory was the sanctuary of the healing god Asklepios. Epidauria became the original travel destination for medical tourism.
Spa towns and sanitariums may be considered an early form of medical tourism. In eighteenth century England, for example, patients visited spas because they were places with supposedly health-giving mineral waters, treating diseases from gout to liver disorders and bronchitis.
Description
Factors that have led to the increasing popularity of medical travel include the high cost of health care, long wait times for certain procedures, the ease and affordability of international travel, and improvements in both technology and standards of care in many countries. The avoidance of waiting times is the leading factor for medical tourism from the UK, whereas in the US, the main reason is cheaper prices abroad. In 2009, there were 60,000 patients going for treatment abroad in the UK.
Many surgery procedures performed in medical tourism destinations cost a fraction of the price they do in the First World. For example a liver transplant that cost $300,000 USD in America cost about $91,000 USD in Taiwan. A large draw to medical travel is convenience and speed. Countries that operate public health-care systems are often so taxed that it can take considerable time to get non-urgent medical care. Using Canada as an example, an estimated 782,936 Canadians spent time on medical waiting lists in 2005, waiting an average of 9.4 weeks. Canada has set waiting-time benchmarks, e. g. 26 weeks for a hip replacement and 16 weeks for cataract surgery, for non-urgent medical procedures.
Medical tourists come from a variety of locations including Europe, the Middle East, Japan, the United States, and Canada. Factors that drive demand for medical services abroad in First World countries include: large populations, comparatively high wealth, the high expense of health care or lack of health care options locally, and increasingly high expectations of their populations with respect to health care.
In First World countries like the United States medical tourism has large growth prospects and potentially destabilizing implications. A forecast by Deloitte Consulting published in August 2008 projected that medical tourism originating in the US could jump by a factor of ten over the next decade. An estimated 750,000 Americans went abroad for health care in 2007, and the report estimated that a million and a half would seek health care outside the US in 2008. The growth in medical tourism has the potential to cost US health care providers billions of dollars in lost revenue.
An authority at the Harvard Business School recently stated that "medical tourism is promoted much more heavily in the United Kingdom than in the United States".
Additionally, some patients in some First World countries are finding that insurance either does not cover orthopedic surgery (such as knee/hip replacement) or limits the choice of the facility, surgeon, or prosthetics to be used. Medical tourism for knee/hip replacements has emerged as one of the more widely accepted procedures because of the lower cost and minimal difficulties associated with the traveling to/from the surgery. Colombia provides a knee replacement for about $5,000 USD, including all associated fees, such as FDA-approved prosthetics and hospital stay-over expenses. However, many clinics quote prices that are not all-inclusive and include only the surgeon fees associated with the procedure.
According to an article by the University of Delaware publication, UDaily: “ | The cost of surgery in India, Thailand or South Africa can be one-tenth of what it is in the United States or Western Europe, and sometimes even less. A heart-valve replacement that would cost $200,000 or more in the US, for example, goes for $10,000 in India--and that includes round-trip airfare and a brief vacation package. Similarly, a metal-free dental bridge worth $5,500 in the US costs $500 in India, a knee replacement in Thailand with six days of physical therapy costs about one-fifth of what it would in the States, and Lasik eye surgery worth $3,700 in the US is available in many other countries for only $730. Cosmetic surgery savings are even greater: A full facelift that would cost $20,000 in the US runs about $1,250 in South Africa. | ” |

Popular medical travel worldwide destinations include: Argentina, Brunei, Cuba, Colombia, Costa Rica, Hong Kong, Hungary, India, Jordan, Lithuania, Malaysia, The Philippines, Singapore, South Africa, Thailand, and recently, Saudi Arabia, UAE, South Korea, Tunisia, Ukraine, and New Zealand.
Popular cosmetic surgery travel destinations include: Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Mexico, Turkey, and Ukraine. In South America, countries such as Argentina, Bolivia, Brazil and Colombia lead on plastic surgery medical skills relying on their experienced plastic surgeons. In Bolivia and Colombia, plastic surgery has also become quite common. According to the "Sociedad Boliviana de Cirugia Plastica y Reconstructiva", more than 70% of middle and upper class women in the country have had some form of plastic surgery. Colombia also provides advanced care in cardiovascular and transplant surgery.
In Europe Belgium, Poland, Slovakia, and Ukraine are also breaking into the business. South Africa is taking the term "medical tourism" very literally by promoting their "medical safaris".
A specialized subset of medical tourism is reproductive tourism and reproductive outsourcing, which is the practice of traveling abroad to undergo in-vitro fertilization, surrogate pregnancy and other assisted reproductive technology treatments including freezing embryos for retro-production.
However, perceptions of medical tourism are not always positive. In places like the US, which has high standards of quality, medical tourism is viewed as risky. In some parts of the world, wider political issues can influence where medical tourists will choose to seek out health care.
Health tourism providers have developed as intermediaries to unite potential medical tourists with provider hospitals and other organizations. Companies are beginning to offer global health care options that will enable North American and European patients to access world health care at a fraction of the cost of domestic care. Companies that focus on medical value travel typically provide nurse case managers to assist patients with pre- and post-travel medical issues. They also help provide resources for follow-up care upon the patient's return.
Process
The typical process is as follows: the person seeking medical treatment abroad contacts a medical tourism provider. The provider usually requires the patient to provide a medical report, including the nature of ailment, local doctor’s opinion, medical history, and diagnosis, and may request additional information. Certified physicians or consultants then advise on the medical treatment. The approximate expenditure, choice of hospitals and tourist destinations, and duration of stay, etc., is discussed. After signing consent bonds and agreements, the patient is given recommendation letters for a medical visa, to be procured from the concerned embassy. The patient travels to the destination country, where the medical tourism provider assigns a case executive, who takes care of the patient's accommodation, treatment and any other form of care. Once the treatment is done, the patient can remain in the tourist destination or return home.
International Healthcare Accreditation
International healthcare accreditation is the process of certifying a level of quality for healthcare providers and programs across multiple countries. International healthcare accreditation organizations certify a wide range of healthcare programs such as hospitals, primary care centers, medical transport, and ambulatory care services.
The oldest international accrediting body is Accreditation Canada, formerly known as the Canadian Council on Health Services Accreditation, which accredited the Bermuda Hospital Board as soon as 1968. Since then, it has accredited hospitals and health service organizations in ten other countries.
In the United States, the accreditation group Joint Commission International (JCI) has been inspecting and accrediting health care facilities and hospitals outside of the United States since 1999. Many international hospitals today see obtaining international accreditation as a way to attract American patients.
Joint Commission International is a relative of the Joint Commission in the United States. Both are US-style independent private sector not-for-profit organizations that develop nationally and internationally recognized procedures and standards to help improve patient care and safety. They work with hospitals to help them meet Joint Commission standards for patient care and then accredit those hospitals meeting the standards.
QHA Trent Accreditation, based in the UK, is an active independent holistic accreditation scheme.
The different international healthcare accreditation schemes vary in quality, size, cost, intent and the skill and intensity of their marketing. They also vary in terms of cost to hospitals and healthcare institutions making use of them. A forecast by Deloitte Consulting regarding medical tourism published in August 2008 noted the value of accreditation in ensuring quality of healthcare and specifically mentioned JCI, ISQUA and Trent.
Increasingly, some hospitals are looking towards dual international accreditation, perhaps having both JCI to cover potential US clientele, QHA Trent for potential British and European clientele, and Accreditation Canada. As a result of competition between clinics for American medical tourists, there have been initiatives to rank hospitals based on patient-reported metrics.
Other organizations providing contributions to quality practices include: * The United Kingdom Accreditation Forum (UKAF) is an established network of accreditation organizations with the intention of sharing experience good practice and new ideas around the methodology for accreditation programs, covering issues such as developing healthcare quality standards, implementation of standards within healthcare organizations, assessment by peer review and exploration of the peer review techniques to include the recruitment, training, monitoring and evaluation of peer reviewers and the mechanisms for awards of accredited status to organizations.
Risks
Medical tourism carries some risks that locally-provided medical care does not. Some countries, such as India, Malaysia, or Thailand have very different infectious disease-related epidemiology to Europe and North America. Exposure to diseases without having built up natural immunity can be a hazard for weakened individuals, specifically with respect to gastrointestinal diseases (e.g. Hepatitis A, amoebic dysentery, paratyphoid) which could weaken progress and expose the patient to mosquito-transmitted diseases, influenza, and tuberculosis. However, because in poor tropical nations diseases run the gamut, doctors seem to be more open to the possibility of considering any infectious disease, including HIV, TB, and typhoid, while there are cases in the West where patients were consistently misdiagnosed for years because such diseases are perceived to be "rare" in the West.
The quality of post-operative care can also vary dramatically, depending on the hospital and country, and may be different from US or European standards. However, JCI and Trent fulfill the role of accreditation by assessing the standards in the healthcare in the countries like India, China and Thailand. Also, traveling long distances soon after surgery can increase the risk of complications. Long flights and decreased mobility associated with window seats can predispose one towards developing deep vein thrombosis and potentially a pulmonary embolism. Other vacation activities can be problematic as well — for example, scars may become darker and more noticeable if they sunburn while healing. To minimize these problems, medical tourism patients often combine their medical trips with vacation time set aside for rest and recovery in the destination country.
Also, health facilities treating medical tourists may lack an adequate complaints policy to deal appropriately and fairly with complaints made by dissatisfied patients.
Differences in healthcare provider standards around the world have been recognized by the World Health Organization, and in 2004 it launched the World Alliance for Patient Safety. This body assists hospitals and government around the world in setting patient safety policy and practices that can become particularly relevant when providing medical tourism services.
Finally, after returning home, a patient will have limited contact with his or her surgeon. This means that it will be difficult to deal with any complications that may arise later such as a delayed infection.

However, balancing potential risks is the fact that in some foreign hospitals most or all nurses are registered nurses, as opposed to the nurse’s aides or other less qualified personnel which are commonly used in American hospitals. Understaffing and the use of overworked and fatigued nursing staff, which is common in American hospitals, may not be as prevalent in some foreign hospitals.
Legal issues
Receiving medical care abroad may subject medical tourists to unfamiliar legal issues. The limited nature of litigation in various countries is one reason for the lower cost of care overseas. While some countries currently presenting themselves as attractive medical tourism destinations provide some form of legal remedies for medical malpractice, these legal avenues may be unappealing to the medical tourist. Should problems arise, patients might not be covered by adequate personal insurance or might be unable to seek compensation via malpractice lawsuits. Hospitals and/or doctors in some countries may be unable to pay the financial damages awarded by a court to a patient who has sued them, owing to the hospital and/or the doctor not possessing appropriate insurance cover and/or medical indemnity.
Ethical issues
There can be major ethical issues around medical tourism. For example, the illegal purchase of organs and tissues for transplantation had been alleged in countries such as India and China prior to 2007. The Declaration of Istanbul distinguishes between ethically problematic "transplant tourism" and "travel for transplantation".
Medical tourism may raise broader ethical issues for the countries in which it is promoted. For example in India, some argue that a "policy of 'medical tourism for the classes and health missions for the masses' will lead to a deepening of the inequities" already embedded in the health care system. In Thailand, in 2008 it was stated that, "Doctors in Thailand have become so busy with foreigners that Thai patients are having trouble getting care". Medical tourism centered on new technologies, such as stem cell treatments, is often criticized on grounds of fraud, blatant lack of scientific rationale and patient safety. However, when pioneering advanced technologies, such as providing 'unproven' therapies to patients outside of regular clinical trials, it is often challenging to differentiate between acceptable medical innovation and unacceptable patient exploitation.
Employer-sponsored health care in the US
Some US employers have begun exploring medical travel programs as a way to cut employee health care costs. Such proposals have raised stormy debates between employers and trade unions representing workers, with one union stating that it deplored the "shocking new approach" of offering employees overseas treatment in return for a share of the company's savings. The unions also raise the issues of legal liability should something go wrong, and potential job losses in the US health care industry if treatment is outsourced.

Employers may offer incentives such as paying for air travel and waiving out-of-pocket expenses for care outside of the US. For example, in January 2008, Hannaford Bros., a supermarket chain based in Maine, began paying the entire medical bill for employees to travel to Singapore for hip and knee replacements, including travel for the patient and companion. Medical travel packages can integrate with all types of health insurance, including limited benefit plans, preferred provider organizations and high deductible health plans.
In 2000 Blue Shield of California began the United States' first cross border health plan. Patients in California could travel to one of the three certified hospitals in Mexico for treatment under California Blue Shield. In 2007, a subsidiary of BlueCross BlueShield of South Carolina, Companion Global Healthcare, teamed up with hospitals in Thailand, Singapore, Turkey, Ireland, Costa Rica and India. A 2008 article in Fast Company discusses the globalization of healthcare and describes how various players in the US healthcare market have begun to explore it.
Destinations
Africa and the Middle East
Israel
Israel is emerging as a popular destination for medical tourists. In 2006, 15,000 foreigners travelled to the country for medical procedures, bringing in $40 million of revenue.
Medical tourists choose Israel for several reasons. Some come from European nations such as Romania where certain procedures are not available.
Other medical tourists come to Israel to visit the Dead Sea, a world-famous therapeutic resort. The Israel Ministry of Tourism and several professional medical services providers have set out to generate awareness of Israel's medical capabilities.
Iran
Iran is also among the 12 countries with biological medicines technology and can serve as a health tourism center. 30,000 people come to Iran each year to receive medical treatment (2012).
Jordan
Jordan is an emerging medical tourism destination, with related revenues exceeding one billion dollars in 2007. More than 250,000 patients from other countries sought treatment in Jordan that year. This included an estimated 45,000 Iraqis and approximately 25,000 patients each from Palestine and Sudan. An estimated 1,800 US citizens, 1,200 UK citizens, and 400 Canadians also sought treatment in Jordan that year. Treatment costs can be as low as 25 percent of costs in the US. The kingdom was rated as number one in the region and fifth in the world as a medical tourism hub in a study by the World Bank.
United Arab Emirates
Hospitals in Dubai and other emirates have expressed intent to develop in medical tourism. Some have American-sourced international healthcare accreditation, while others are looking towards the UK, Australia and Canada for accreditation services. For example, QHA Trent has now accredited several hospitals in the UAE.
South Africa
South Africa is the first country in Africa to emerge as a medical tourism destination. It offers medical and dental care.
The Americas
Countries in the Americas that are treating foreign patients include Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Dominican Republic, Guatemala, Mexico, Panama, Peru and Uruguay.
Brazil
Brazil has long been known as a destination for cosmetic surgery. For non-cosmetic procedures, Brazil is only now entering the global market. However, Albert Einstein Jewish Hospital in São Paulo was the first JCI-accredited facility outside of the US, and more than a dozen Brazilian medical facilities have since been similarly accredited. Brazil requires visas for US citizens based on a reciprocal arrangement since Brazilians are required to obtain a visa to visit the US. Unlike in the U.S and other countries where medical procedures are simply done in an office, Plastic surgery in Brazil is done only in specialized clinics or hospitals.
Canada
Canada has entered the medical tourism field. In comparison to US health costs, medical tourism patients can save 30 to 60 percent on health costs in Canada.
Colombia
Colombia is most likely the most underestimated destination for Global Healthcare in the Americas. Struggling with security and drug-related issues more than 15 years ago, Colombia is today one of the most thriving economies in South America and safe for tourists. Colombia's major cities like Bogota, Medellin, Cali and Cartagena are already receiving more than 1.45 million tourists each year and the numbers are increasing. Global Healthcare has been identified as one of the main drivers for economic growth in the medical sector. Patients from the Caribbean already know Colombia as a first class destination for medical procedures and cosmetic treatments. Now hospitals and facilitators are beginning to successfully convince also US-Americans of the quality of medical services provided in the country. An independent platform to compare the quality and prices of medical and cosmetic services is being supported by the government's export agency and regional initiatives. Colombia is overcoming its stigma and becoming a major player in Global Healthcare, serving needs of patients all over the Americas.
Costa Rica
Costa Rica's popularity in the medical tourism industry has been growing steadily over the years. Currently there are 3 Joint Commission International accredited (JCI) Hospitals all of which are in San Jose, Costa Rica. Recently announced by JCI accredited Clinica Biblica, is a $40 million dollar hospital in Guanacaste designed to target the influx of medical tourism arriving in the Liberia International airport every year. This will make for a total of over six major private hospitals and 22 public hospitals. When the World Health Organization (WHO) ranked the world’s health systems in the year 2000, Costa Rica was ranked as no. 36, which was higher than the U.S., and together with Dominica it dominated the list amongst the Central American countries.
Costa Rica offers these levels of care ranging from Intermediate Life Saving capabilities, Complex Life Saving Treatment Capabilities, Advanced Life Savings Treatment Capabilities, and Life Style Treatment Services (Full range of dental work and cosmetic surgery).
Costa Rica's proximity to the U.S. helps attract over 20,000 U.S. patients a year. The Deloitte Center for Health Solutions, in their 2009 report "Medical Tourism Consumers in Search of Value" reported cost savings average of between 30-70% of US prices.
Cuba
Cuba has been a popular medical tourism destination for more than 40 years. Thousands of patients travel to Cuba, particularly from Latin America and Europe, attracted by the "fine reputation of Cuban doctors, the low prices and nearby beaches on which to recuperate."[66] In 2006, Cuba attracted nearly 20,000 medical tourists.
Medical treatments included joint replacement, cancer treatment, eye surgery, cosmetic surgery and addictions rehabilitation. Costs are about 60 to 80 percent less than US costs.
Cuba has hospitals for Cuban residents and others that focus on serving foreigners and diplomats. In the 2007 American documentary film, Sicko, which criticizes the US healthcare system, producer Michael Moore leads a group of uninsured American patients to Cuba to obtain more affordable medical treatment. Sicko has greatly increased foreigners' interest in Cuban healthcare. A recent Miami Herald story focused on the high quality of health care that Canadian and American medical tourism patients receive in Cuba.
The Cuban government has developed Cuban medical tourism to generate income for the country. Residents of Canada, the UK and most other countries can travel to Cuba without any difficulty, although a tourist visa is generally required. For Americans, however, because of the US trade policy towards Cuba, travelers must either obtain US government approval, or, more frequently, travel to Cuba from Canada, Mexico, the Bahamas, Jamaica or the Dominican Republic. Cuban immigration authorities do not stamp the passports of US visitors so that Americans can keep their travels a private matter.
To date no Cuban facility has achieved JCI Accreditation.
Mexico
Americans, particularly those living near the Mexican border, now routinely cross to Mexico for medical care. Popular specialties include dentistry and plastic surgery. Mexican dentists often charge one-fifth to one-fourth of US prices, while other procedures typically cost a third what they would in the US.
In Texas, legislators explored the possibility of allowing health maintenance organizations to operate on both sides of the border. However, physicians in south Texas lobbied against the changes, arguing that local doctors could not compete with the lower costs in Mexico". US doctors point out that the Mexican legal system makes it almost impossible to sue Mexican doctors for malpractice.
However, many who travel to Mexico for care report that they are satisfied. According to a report commissioned by Families U.S.A., a Washington advocacy group for health-care issues, "About 90 percent [feel] the care they had received in Mexico had been good or excellent. About 80 percent rated the care they had received in the United States as good or excellent".
Indeed "some U.S. dentists ... have conceded to the competition and begun a 'reverse migration' opening offices in Mexico to take advantage of lower costs". More American insurers are providing coverage for travelers, as the out-of-pocket costs to them are much lower. "With healthcare costs in the United States continuing to rise, many employers in Southern California are turning to insurance plans that send their workers to Mexico for routine care, plans that are growing by nearly 3,000 people a year."
Tijuana has proven to be a convenient center for 'medical tourism'. Due to its strategic geographic location, patients from California and much of the west coast have turned to Tijuana for elective procedures as well as for others such as chemotherapy, among others. According to the San Diego Union Tribune, about 1 million Californians go to Mexico for healthcare, and most of these patients go to Tijuana. Many of these patients seek weight loss, and plastic surgery, in addition to alternative cancer treatments. According to the Secretary of Tourism of Baja California, in 2009, close to 8 million people went to Tijuana for some type of healthcare.
In addition to dental and plastic surgery, Mexican hospitals are popular for bariatric surgery for weight loss, considered an elective procedure that is not covered by some US insurers. A popular bariatric procedure, lap band surgery, which was approved by the FDA in the US in 2001, has been performed for longer by Mexican surgeons.
Some clinics may also offer alternative medicine therapies that have been proven ineffective and are banned in the United States. The Mexican government has shut down some of these in recent times, in response to controversial cases like that of Coretta Scott King.
Panama
In Panama, health and medical tourism is growing rapidly. Factors drawing medical tourists include Panama's tourist appeal, position as a hub for international travel, and use of the American dollar as the official currency. Many of Panama’s doctors are bilingual, board certified, and accustomed to working with the same medical equipment and technology used in the United States and Europe. On most procedures, Panama offers savings of more than 50% compared to the US and Europe. No Panamanian hospitals currently have international healthcare accreditation, whether through US, British, Australian or Canadian sources.
United States
A McKinsey and Co. report from 2008 found that between 60,000 to 85,000 medical tourists were traveling to the United States for the purpose of receiving in-patient medical care. The same McKinsey study estimated that 750,000 American medical tourists traveled from the United States to other countries in 2007 (up from 500,000 in 2006). The availability of advanced medical technology and sophisticated training of physicians are cited as driving motivators for growth in foreigners traveling to the U.S. for medical care, whereas the low costs for hospital stays and major/complex procedures at Western-accredited medical facilities abroad are cited as major motivators for American travelers. Also, it has been noted that the decline in value of the U.S. dollar is offering additional incentive for foreign travel to the U.S., although cost differences between the US and many locations in Asia far outweigh any currency fluctuations.

Several major medical centers and teaching hospitals offer international patient centers that cater to patients from foreign countries who seek medical treatment in the U.S. Many of these organizations offer service coordinators to assist international patients with arrangements for medical care, accommodations, finances and transportation including air ambulance services.
Many locations in the US that offer medical care comparable in price to foreign medical facilities are not Joint Commission Accredited.
Uruguay
Uruguay recently entered the medical tourism market. A private medical tourism initiative, Uruhealth, has been created with support from the Ministries of Tourism and Public Health. The initiative involves the infrastructure, human resources and experience of two healthcare companies: MP Personalized Medicine (Montevideo) and SEMM-Mautone Hospital (Punta del Este).
Asia/Pacific
In 2007, Asia held almost 13 percent of the global medical tourism market, receiving 34 billion USD.
China
China is fast emerging as a desirable destination for individuals seeking medical care in a wide range of medical specialties, including cardiology, neurology, orthopedics and others. A number of private and government hospitals in major cities have established international departments. Many leading hospitals provide treatments integrating Traditional Chinese Medicine with Western medical technology and techniques. China is home to leading stem cell research and treatment hospitals that offer Westerners who want to take advantage of stem cell treatments that are still considered experimental or have yet to be approved in their home country.
Hong Kong
As of 2006, Hong Kong had 12 private hospitals and 39 public hospitals, providing 3,124 and 27,755 beds respectively. A wide range of health care services are offered. All 12 of Hong Kong's private hospitals have been surveyed and accredited by the UK's Trent Accreditation Scheme since early 2001. This has been a major factor in the ascent of standards in Hong Kong's private hospitals. The Trent scheme works closely with the hospitals it assesses to generate standards appropriate to the locality (with respect to culture, geography, public health, primary care interfaces etc.), and always uses combinations of UK-sourced and Hong Kong-sourced surveyors. Some of Hong Kong's private hospitals have now gone on to obtain dual international accreditation, with both Trent and JCI (and have therefore attained a standard surpassing some of the best hospitals in Thailand and Singapore). Others are looking towards dual international accreditation with Trent and the Australian group. Hong Kong public hospitals have yet to commit to external accreditation.
India
India’s medical tourism sector is expected to experience an annual growth rate of 30%. The Indian government is taking steps to address infrastructure issues that hinder the country's growth in medical tourism.
South Korea
Listed on CNN.com as one of the “hot destinations” for medical tourism, South Korea is quickly establishing itself in the field of medical tourism.
However, The Korea Times reported in a series of articles that Korean hospitals have adopted a discriminatory pricing policy, charging foreigners two to three times more than the full-fee for locals. The paper revealed that the price disparity in medical fees for foreign patients is extremely high, considering that the difference between the lowest and highest fees for the most-sought-after procedures exceeds more than 10 times on average.
It claims the government is overlooking soaring medical fees on foreign patients, who are unprotected from malpractice, discriminatory charging, overpricing and patient privacy rights under the Korean Medical Law.
In 2008, Korea had 27,480 foreign-based patients and the Korean health ministry expects that number to increase to 140,000 by 2015. Due to legislation passed in May 2009, state-licensed clinics and hospitals are now allowed to directly seek out foreign patients through various promotional activities. In 2009, South Korea had a total number of 60,000 medical tourists. In 2010, the number had risen to 80,000. The South Korean Ministry of Health has set the target for 2015 to up to 300,000 medical tourists. Areas such as Seomyeon medical street have catered to the tourism by building tourist information centers and providing guides.
Korean hospitals and clinics provide a variety of medical services for medical tourists including comprehensive health screening, cancer treatment, organ transplantation, joint/rheumatism care, spinal treatment, ophthalmology, dental care, infertility treatment, otorhinolaryngology, and Korean traditional medicine. Currently, the most popular treatments for medical tourists are cosmetic procedures such as eyelid surgery, nose jobs, facelifts, and skin lightening.
Over 30 South Korean hospitals and clinics are member providers under the Council for Korea Medicine Overseas Promotion (CKMOP). Among these facilities are the “Big Four” – Seoul National University Hospital, Samsung Medical Center, Asan Medical Center, andYonsei Severance Hospital.
Malaysia
Malaysia is well on its way to develop itself as a medical tourism hub and is the most visited medical tourism destination by UK patients, attracting 8.5% of all UK medical tourists. The country has excellent hospitals, English is widely spoken, and many staff has been trained to a high level in the UK or in the US. There is a highly active Association for Private Hospitals of Malaysia working to develop medical tourism. However, while Malaysia has a national accreditation healthcare scheme (MSQH), many of Malaysia's hospitals are currently firmly on the way to achieving international healthcare accreditation.
Malaysian hospitals such Gleneagles Hospital Kuala Lumpur [10], International Specialist Eye Centre, Penang Adventist Hospital are JCI accredited. The Ministry of Health has launched a medical tourism page.

New Zealand
New Zealand is a relatively new destination to medical travel. It has all the hallmarks of a very successful destination especially for North American based patients. This includes being a first world, developed economy with a sophisticated and comprehensive medical system. It is first and foremost English speaking with a rich heritage of producing world class doctors and medical research.
Many of its private hospitals are internationally accredited, state of the art and offer an integrated package of care.
The cost of the surgical care in New Zealand is significantly cheaper. On average it is considered that New Zealand’s surgical costs are around 15 to 20% the cost of the same surgical procedure in the USA. One patient who had his prosthetic hip replaced in New Zealand said the total cost including travel, lodging and the surgery at a private hospital was $20,000, as opposed to the $80,000 - $140,000 he was told the operation would have cost at home.
Added to this the personalized level of medical care, the world renown natural beauty and tranquility, the fact that New Zealand is one of the safest[106] places in the world and only 12 hours direct flight from the west coast of North America, then New Zealand as a medical travel destination looks set to develop.
Pakistan
Pakistan has mentioned its keenness on working towards medical tourism and has considered it as a key element in its recent tourism policy. Despite facing security and infrastructure-related challenges, medical tourism in Pakistan has been arranging potential trips for many medical health and care procedures. Pakistan has been said to have a "huge potential" in becoming a regional medical tourism hub, comparable to many other countries in its neighborhood. A number of modern hospital facilities exist in major cities such as Islamabad, Karachi and Lahore which are fully equipped and facilitated. Many doctors and surgeons in Pakistani hospitals tend to be foreign qualified. A number of patients from neighboring countries have traveled to Pakistan for treatment. Other patients, mainly of Pakistani origin, especially from the Middle East, United Kingdom and United States, also travel to Pakistan to seek a range of treatments which they cannot otherwise get in their resident countries either due to expensiveness or lack of insurance cover there; common treatments that these patients seek include cardiac surgery, infertility treatments and cosmetic surgery. In the past, a sizable number of global patients traveled to Pakistan for kidney transplants although these cases have dropped ever since legislation came into place that sought to regulate the illegal trade of selling kidneys. According to Pakistani medical experts, medical tourism is still an untapped market that can be turned into a huge opportunity if the government "focuses on key issues".
Philippines
The Philippines has been growing as a destination for medical tourism. The US Medical Tourism Association magazine reported that this services sub-sector grew 8.0% in 2007. The number can be expected to grow as American health-care costs rise, or if pending legislation results in an increase in patient wait times for surgical procedures (as has been seen in other countries where care has been nationalized), due to the traditional political, economic and cultural connections between the United States and the Philippines. International accreditation of hospitals has increased, and QHA Trent has now accredited hospitals in the Philippines.
The Philippines is one of a few countries that sends qualified nurses, physicians and dentists to the US, the thousands serving in American medical facilities being a testament to its quality of medical education. Many also work in the UK. According to year 2000 WHO rankings of the world's health systems, the Philippines takes its position on no.60.
Singapore
Singapore has a dozen hospitals and health centers with JCI accreditation. In 1997 (published 2000), the World Health Organization ranked Singapore's health care system sixth best in the world and the highest ranked system in Asia. In 2000, Singapore received 410,000 medical tourists. By 2012, the Singaporean government aims to attract one million international patients annually.
Patients come from neighboring countries, such as Indonesia and Malaysia, and patient numbers from Indochina, South Asia, the Middle East and Greater China are growing. Patients from developed countries such as the United States and the UK are also beginning to choose Singapore as their medical travel destination for relatively affordable health care services in a clean cosmopolitan city.
Singapore recently launched the region’s first cardiology clinic catering especially for the needs of women. This is in recognition of the fact that cardiovascular disease (heart disease and stroke) is the top killer among women in Singapore and in many other countries in the Asia Pacific. The Women’s Heart Health Clinic is located in the National University Hospital. Its emphasis is on prevention as well as treatment. Women are treated by an all-women team comprising a cardiologist, dietician (heart-healthy diet), occupational therapists (lifestyle management) and physiotherapist (exercise prescription).
Taiwan
The Taiwanese government has declared its determination for the country to become a medical tourism center. In 2007, the Department of Health launched a campaign to promote inbound medical tourism, focusing on integrating the resources of the government and academia to build Taiwan's brand as a medical tourism destination. Costs for procedures remain comparatively low. Taiwan is known for liver transplants, joint replacement surgery, bone marrow transplants, and reconstructive and plastic surgery.
Thailand
Medical tourism has been a growing segment of Thailand's tourism and health-care sectors. In 2005, one Bangkok hospital took in 150,000 treatment seekers from abroad. In 2006, medical tourism was projected to earn the country 36.4 billion baht.
Treatments for medical tourists in Thailand range from cosmetic, organ transplants, cardiac, and orthopedic treatments to dental and cardiac surgeries. Treatments also include spa, physical and mental therapies, as well as procedures that are considered more along the lines of fringe medical practices. One patient who had coronary artery bypass surgery at Bumrungrad International hospital in Bangkok said the operation cost him US$12,000 (8,200 euro), as opposed to the $100,000 (68,000 euro’s) he estimated the operation would have cost him at home. Bumrungrad treated approximately 55,000 American patients in 2005 alone, a 30% increase from the previous year.
Hospitals in Thailand are a popular destination for other Asians. Bangkok Hospital, which caters to medical tourists, has a Japanese wing, and Phyathai Hospitals Group has interpreters for over 22 languages, besides the English-speaking medical staff. When NepalPrime Minister Girija Prasad Koirala needed medical care in 2006, he went to Bangkok.
Many Thai physicians hold US or UK professional certification. Bumrungrad International hospital states that many of its doctors and staff are trained in the UK, Europe and the US. Bumrungrad International was accredited most recently in 2005 by the Joint Commission. Some of the country’s major hospitals have also achieved certification by the International Organization for Standardization’s ISO 9001:2000. However, ISO 2000 is not an accreditation scheme.
The World Health Organization's 2000 ranking put the Thai healthcare system at number 47, below the USA's ranking at 37 and the United Kingdom's ranking at 18.
Japan
To promote medical tourism, the Japanese government issues six-month entry visas to travelers entering Japan to receive medical care, double the duration of regular tourist visas. An estimated two percent of foreign visitors to Japan came for medical care. Japan's medical system is reportedly strong in the area of cancer treatment.
Europe
Countries in Europe that have active medical tourism sectors include Turkey, Romania, Cyprus, Germany, Hungary, Estonia, Lithuania,Malta, Poland, Portugal, Czech Republic, Slovakia, Spain, Bulgaria and Ukraine.
In 2006 it was ruled that under the conditions of the E112 European health scheme, UK health authorities had to pay the bill if one of their patients could establish urgent medical reasons for seeking quicker treatment in another European union country.
Bulgaria
Bulgaria is a member of European Union since 2007, which helps medical tourists from Europe reduce their travel costs. Bulgarian standard of living is lower in comparison with other developing European countries. However, this fact is significant for its lower prices for providing health care services. On the other hand, Bulgarian physicians are highly qualified and have specialized in renowned Bulgarian and international universities. There are a number of modernly equipped hospitals, clinics and medical centers, therefore, health services in Bulgaria offer excellent combination of high value and state of the art medical care offered at competitive pricing.
The biggest private hospital in Bulgaria Tokuda Hospital Sofia, which is a member of Tokushukai Medical Corporation and Cambridge University Hospitals affiliated, have served over 8,000 international patients from USA, Canada, EU, Russia and the former republics, and the Middle East for the past five years.

The unique combination of highly qualified medical care at competitive price and the numerous places of interest in Bulgaria give the opportunity to combine travel for health reason with recreational, balneological, historical, religious, pilgrim, adventurous tourism and many others. Spa tourism in Bulgaria is very well developed, thanks to the great number of mineral and thermal springs and the modern facility infrastructure of Bulgarian tourism. Full information about the medical treatment options in Bulgaria is provided by the Association of Bulgarian Medical Tourism.
There are also a number of assistance companies, which offer medical information about travel, accommodation and logistic services.
Czech Republic
Czech Republic has built its medical tourism on spas and medical care equaling the world standards (for example Ostrava University Hospital). The Czech Republic is well known for its affordable and high quality medical treatment. The most of Czech doctors studied at Charles University in Prague which was founded in 1348. Back in the 14th century it was the first university in Central Europe region and currently it is one of the oldest universities in Europe. The study demands enormous attention to practical training in combination with a broad theoretical knowledge. As a result the medical education in Prague is honored abroad as one of the top in the world.
Cyprus
Cyprus is actively developing its medical tourism industry. Currently very few hospitals have independent accreditation.
Estonia
Estonia is particularly popular among Scandinavians for medical tourism. The medical tourism industry achieves world standards and has to comply with EU regulation since it joined the EU in 2004. Estonia is known for its good medical care and scored particularly high in the Health Consumer Powerhouse report, produced on behalf of the European Union.
France
British NHS patients have been offered treatment in France to reduce waiting lists for hip, knee and cataract surgery since 2002. France is a popular tourist destination but also ranked the world's leading health care system. This ranking reflects the expertise offered by doctors and surgeons to patients cared for in France. The French National Authority for Health (HAS) issues high-level quality requirements for French health care, with which clinics and hospitals must comply in order to be accredited.
Germany
Germany is a destination for patients seeking advanced medical technology, high standards, safety, and quick treatment. All German citizens have health coverage, resulting in a high hospital density, with twice as many hospitals per capita as the United States. The high hospital density results in shorter waitlists for treatment. Costs for medical treatment compete well with other developed European countries and are commonly 50% of those in the USA.

Germany is an attractive destination for patients from the Middle East since traveling to the USA has become more difficult for them since the September 11 attacks. US citizens sometimes travel to Germany to seek treatments such as artificial cervical disc replacements that are not US Food and Drug Administration (FDA) approved.
Hungary
Because of an advantageous geographical location thermal water can be found with good quality and in great quantities on over 80% of Hungary's territory. Approximately 1,500 thermal springs can be found in Hungary. There are approximately 450 public baths in Hungary.
The Romans heralded the first age of spa in Hungary, the remains of their bath complexes are still to be seen in Óbuda, to this day. The spa culture was revived during the Ottoman Invasion of Hungary who used the thermal springs of Buda for the construction of a number of bathhouses, some of which are still functioning (Király Baths, Rudas Baths).
In the 19th century the advancement in deep drilling and medical science provided the springboard for a further leap in bathing culture. Grand spas such as Gellért Baths, Lukács Baths, Margaret Island, and Széchenyi Medicinal Bath are a reflection of this resurgence in popularity.
Lithuania
Lithuania is one of several countries actively promoting medical tourism. Treatments involve cosmetic surgery, eye surgery, and other services.
Poland
Since 2004, when Poland joined the European Union, it has become another locale for people seeking cheaper medical treatments. The quality of care in Poland must comply with EU standards. The best hospitals and clinics in Poland are concentrated in various organizations such as medical-tourism-poland.com.
Romania
Romania is a member state of the European Union. Medical tourism services in Romania varied but cover a large scope. The quality of services is implemented by both national and EU bodies of accreditation. Medical tourism in Romania is quality driven as outlined in the Medical Tourism Magazine, issue 18.
The private healthcare system in Romania is amongst the most dynamic in the country in terms of investments and growth. Market reports state that growth can still be expected in the private system in the years to come.
There are facilitators in Romania helping traveling patients access services, both medical and touristic services.
Turkey
Turkey attracts medical tourists from Europe and the Balkans, the United States, Eurasia and the Middle East, hosting about 200,000 patients annually.
Over 34 hospitals and medical institutions have achieved Joint Commission International accreditation.
In Turkey, all medical tourism activities will be distributed to all the activities to which the Ministry of Health participate overseas and within the country, to the culture and tourism directorates in provinces and to the offices in the country by Culture and Tourism Ministry, to all the activities held abroad and in the country the Medical Tourism Association and OHSAD (Private Hospitals and Medical Institutions Association ) take part to, to the representatives of TUMSIAD in the United Kingdom, Germany, France, Belgium, Holland, Denmark, Austria, Iran, Jordan, Syria, Kosovo, Macedonia and Bosnia, with a view to promote the Turkish health services.
United Kingdom
The United Kingdom is one of the most active of medical tourism destinations, especially London. Nevertheless, as at the present time very few UK private hospitals have gone through independent international accreditation (they only have the mandatory registration with the UK's watchdog, the Care Quality Commission), so they have not as yet measured themselves against the best clinics and hospitals elsewhere in the world.

Two Local Studies A. Philippine Medical Tourism
The Philippines: The logical choice in medical tourism
Medical Tourism is a term that was initially coined by travel agencies and the media to describe the phenomenon of travelling in order to receive health care. It also means that doctors and nurses can also go and work in foreign countries and spend some time in these countries, thus earning money while enjoying their stay.
The Philippines is an archipelago consisting of 7107 islands and is situated in South East Asia. The Philippines, or officially, the Republic of the Philippines, with its capital city Manila in particular, has become a haven for tourists looking to obtain quality health care at an affordable price.
The Philippines was discovered in 1521 by Ferdinand Magellan and then subsequently became an interest of Spain. The archipelago was named “Las Islas Filipinas” in 1543 in honor of Philip II of Spain, by Ruy Lopez de Villalobos. The Philippines were to remain in Spanish hands as a colony for a further 300 years.
Medical professionals in the Philippines are regarded as some of the best in the world, having graduated from the best Universities in the Philippines and also in the United States, they tend to be very professional and focused on the health of their patients. There are numerous Hospitals to choose from, but a choice can be narrowed down to Private or Public health care and there is no major difference between the private and government hospitals as all are run by experienced health care professionals. The facilities are really the only difference between private and public health care. The quality of the doctors and nurses is not a factor as both types of institutions are run by true professionals. The other factor is price, as is the trend world-over, the private facilities are more expensive than the government, but that is all.
So if you are planning on having a holiday and having your health looked after, be sure to head to the Philippines. You will be attended to by brilliant health care professionals and when you need to recover, you can spend time at any one of the thousands of resorts, where you can relax and recover while enjoying the beauty of the islands. B. Medical Tourism Philippines (MTP) welcomes tourists from all over the World to visit the Philippines for their medical and leisure needs. The most common procedures are cosmetic and plastic surgery, dermatology, Weight loss surgery, ophthalmology, and dentistry. The Philippines has been growing as a tourist destination of choice for health and vacation because of our world class physicians, modern technology, and our uniquely Filipino brand of caring and compassion at great values for money at a fraction of the cost in developed countries. We are home to some of the best hospitals and stand alone Specialty clinics in the world, offering world-class expertise, state-of-the-art facilities, and the distinct warmth of the Filipino hospitality. We also have some of the world's best spa retreat resorts and tour destinations in this part of the earth.Below are the three compelling reasons why you should have your medical procedure in the Philippines. |

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Two Foreign Studies A. Medical Tourism: Globalization of the Healthcare Marketplace
Michael D. Horowitz, MD, MBA, FACS, Research Associate, Jeffrey A. Rosensweig, PhD, Associate Professor of International Business and Finance and Director, and Christopher A. Jones, DPhil, MSc, FRSM, Research Associate
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Abstract
The citizens of many countries have long traveled to the United States and to the developed countries of Europe to seek the expertise and advanced technology available in leading medical centers. In the recent past, a trend known as medical tourism has emerged wherein citizens of highly developed countries choose to bypass care offered in their own communities and travel to less developed areas of the world to receive a wide variety of medical services. Medical tourism is becoming increasingly popular, and it is projected that as many as 750,000 Americans will seek offshore medical care in 2007. This phenomenon is driven by marketplace forces and occurs outside of the view and control of the organized healthcare system. Medical tourism presents important concerns and challenges as well as potential opportunities. This trend will have increasing impact on the healthcare landscape in industrialized and developing countries around the world.
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Introduction
Medical tourism has captured the interest of the media. Articles, guidebooks, and broadcasts on medical tourism are being published and produced with increasing frequency.[1–12] A Google Internet search using the term “medical tourism” performed on July 29, 2007, returned 1,100,000 results – an increase of 300,000 in the preceding 62 days. Individual practitioners and medical organizations must be able to provide accurate information about this rapidly evolving trend. There is a compelling need for all parties involved in healthcare to become familiar with medical tourism and to understand the economic, social, political, and medical forces that are driving and shaping this phenomenon.
In medical tourism, citizens of highly developed nations bypass services offered in their own communities and travel to less developed areas of the world for medical care. Medical tourism is fundamentally different from the traditional model of international medical travel where patients generally journey from less developed nations to major medical centers in highly developed countries for medical treatment that is unavailable in their own communities. The term medical tourism does not accurately reflect the reality of the patient's situation or the advanced medical care provided in these destinations.
Nevertheless, this phrase has come into general usage and it provides an unambiguous way of differentiating the recent phenomenon of medical tourism from the traditional model of international medical travel.
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The Increasing Popularity of Medical Tourism
Although there are no verifiable statistics regarding the magnitude of medical tourism, the available information suggests that a substantial number of patients travel to developing nations for healthcare. In 2004, 1.2 million patients traveled to India for healthcare and 1.1 million medical tourists traveled to Thailand.[13,14] One source projects that 750,000 Americans will go offshore for medical services in 2007, with this number increasing to 6 million in 2010.[15] It is estimated that medical tourism to Asia could generate as much as $4.4 billion by 2012, with approximately half of this revenue going to India.[1,3] It has been estimated that the global medical tourism industry currently generates annual revenues up to $60 billion, with 20% annual growth.[4,16,17] However, another valuation suggests that the industry is somewhat smaller, with growth to $40 billion projected by 2010.[5]
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Medical Tourism Destinations
The medical tourism marketplace consists of a growing number of countries competing for patients by offering a wide variety of medical, surgical, and dental services (Table 1). Many of these destinations boast modern facilities with advanced technology and appealing accommodations. A substantial number of the physicians in medical tourism destinations received postgraduate training in industrialized nations, have board certification (or equivalent), and may have practiced in the country where they completed their training. Medical tourists are presently traveling to faraway countries for cosmetic surgery, dental procedures, bariatric surgery, assisted reproductive technology, ophthalmologic care, orthopedic surgery, cardiac surgery, organ and cellular transplantation, gender reassignment procedures, and even executive health evaluations (Table 2). A number of countries in Central and South America have developed strong reputations for cosmetic and plastic surgery, bariatric procedures, and dental care.[8–10] India, Malaysia, Singapore, and Thailand are well-established medical tourism destinations that have become popular for patients seeking cardiac surgery and orthopedic surgery.[1–3,11,17] Medical services in India are particularly affordable, with prices as low as 10% of those in the United States.[2] Several highly developed nations including Belgium, Canada, Germany, Israel, and Italy are attracting foreign patients under the banner of medical tourism, offering sophisticated modern care with careful attention to patient preference, service, and satisfaction.
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The Global Healthcare Marketplace
The international healthcare marketplace emerged in the late 19th century when patients from less developed parts of the world with the necessary resources to do so began to travel to major medical centers in Europe and the United States to have diagnostic evaluation and treatment that was unavailable in their own countries. The situation is very different in the medical tourism model, where patients from highly developed nations travel to less developed countries, bypassing medical care that is offered in their own community but is inaccessible or undesirable to them. Medical tourists would prefer to have major surgery in their hometown hospital or regional referral center if they felt that was a feasible or reasonable option. However, these patients feel pressed to balance their health needs against other considerations, and medical concerns may be subordinated to other issues. Modern technology enables potential medical tourists to investigate and arrange healthcare anywhere in the world from their home computer directly or with the advice and assistance of a medical tourism agency.
For patients from highly industrialized nations, the primary reason to have medical services in less developed countries is attractively low cost. Such cost-conscious patients choose to accept the inconvenience and uncertainties of offshore healthcare to obtain service at prices they can more comfortably afford.The opportunity to conserve limited financial resources and protect the equity in their home mollifies their uncertainties. A patient from the United States is likely to be a middle class adult requiring elective surgical care who has no health insurance or who has inadequate coverage. Milstein and Smith describe these patients as “middle-income Americans evading impoverishment by expensive, medically necessary operations….” The other group pursuing medical tourism are people seeking cosmetic surgery, dental reconstruction, fertility treatment, gender reassignment procedures, and other treatments not covered by health insurance. The common feature in both groups is that their resources are adequate to purchase healthcare in low-cost medical tourism destinations but insufficient for them to comfortably have the same services in their local market.
For patients from countries where a governmental healthcare system controls access to services, the major reason to choose offshore medical care is to circumvent delays associated with long waiting lists. National health programs do not typically pay for cosmetic surgery and similar type services; therefore, patients from Canada and the United Kingdom desiring these procedures pursue medical tourism for the same economic reasons as those from the United States.
Patients also travel to offshore medical destinations to have procedures that are not widely available in their own countries. For example, stem cell therapy for any one of a number of problems may be unavailable or restricted in industrialized countries but may be much more available in the medical tourism marketplace. Some patients, particularly those undergoing plastic surgery, sex change procedures, and drug rehabilitation, choose to go to medical tourism destinations because they are more confident that their privacy and confidentiality will be protected in a faraway setting. Finally, some patients have medical care abroad for the opportunity to travel to exotic locations and vacation in affordable luxurious surroundings. Although medical tourism agents and travel professionals may promote the “tourism” aspect of offshore care, the recreational value of travel has decreasing importance to patients with complex, serious medical problems.
The primary reason that medical centers in developing countries are able to provide healthcare services inexpensively is directly related to the nation's economic status. Indeed, the prices charged for medical care in a destination country generally correlate with that nation's per capita gross domestic product, which is a proxy for income levels. Accordingly, the charges for healthcare services are appropriate for the level of economic development in which the services are provided. Low administrative and medico legal expenses for overseas practitioners also contribute to the affordability of offshore medical care. For example, the professional liability insurance premium for a surgeon in India is 4% of that for a surgeon in New York.
An important consideration in medical tourism is the potential impact on the residents of destination countries. Mattoo and Rathindran suggest that revenue generated by developing countries providing medical services to foreign patients creates opportunities to improve the access and quality of care available to the citizens of these countries. Bookman and Bookman emphasize that the government of destination countries must implement and enforce appropriate macroeconomic redistributive policies to ensure that the local residents of these nations actually realize the potential benefits of the medical tourism industry. Chinai and Goswami have expressed concerns that medical tourism may seriously undermine the care of local residents by adversely impacting workforce distribution.
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Quality and Safety in Medical Tourism
Faced with the choice of many medical institutions in diverse countries, medical tourists may find it very difficult to identify well-trained physicians and modern hospitals that consistently provide high-quality care. Some medical tourism agents, particularly those with backgrounds in healthcare, may be a helpful resource for patients in making appropriate choices. Accreditation by the Joint Commission International, which has accredited more than 125 facilities in 24 countries, and/or the International Organization of Standardization may provide a useful point of reference for patients selecting offshore medical facilities.
Concerns have been voiced regarding the risk of complications resulting from travel and vacation activities in the postoperative period. The management of postoperative complications that occur after a patient returns from an offshore medical facility, and the consequent costs of this care, are difficult issues that remain unresolved.
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The Response to Medical Tourism
The medical community in developed countries has started to recognize medical tourism as a real phenomenon that involves the profession, practitioners, and patients. Peer-reviewed medical and health journals began publishing papers on this topic in 2006. Medical organizations have addressed medical tourism in articles and other documents posted on their Web sites. The United States Senate Special Committee on Aging held hearings on the issue of medical tourism in June 2006 and called for a task force of experts to explore the impact and safety of lower-cost healthcare abroad.
The insurance industry has become an active participant in medical tourism. In several states, Blue Cross Blue Shield sells insurance policies that enable or encourage patients to have expensive surgical procedures at low-cost offshore medical facilities. In an effort to reduce the financial burden of employee healthcare, several fortune 500 corporations are evaluating the feasibility of outsourcing expensive medical procedures to offshore healthcare destinations. Insurance provider networks are currently being expanded to include physicians around the globe, and it is anticipated that within a decade a majority of large employers' health plans will include offshore medical centers.
Insurance companies are able to use a portion of their substantial savings to offer incentives to beneficiaries willing to have care in medical tourism destinations, including waiving deductible and out-of-pocket health expenses and paying for travel for the patient and even a family member. A particularly interesting response to the migration of patients to offshore healthcare destinations is that some US medical facilities are now accepting referrals from medical tourism agencies and providing highly discounted services to American patients.
In nations that have long waiting lists for certain procedures, medical tourism provides a mechanism to clear backlogs by sending patients to foreign countries without expanding local capacity. Currently, the British National Health System is sending patients to nearby countries for this purpose, and more distant medical tourism destinations may be used in the future. Although this idea has not been explored, there may be novel opportunities to use low-cost offshore medical destinations to provide care for unfunded low-income patients while simultaneously relieving the burden on domestic healthcare facilities and philanthropic organizations.
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The Continuing Evolution of Medical Tourism
The medical tourism industry is fueled and driven by patients who feel disenfranchised by the healthcare system in their home country. These informed patients shop outside the organized medical system to find services that are affordable, timely, or simply available. Millstein and Smith emphasize that the flight of American patients to foreign destinations for lifesaving operations is a symptom of an affordability problem that is symbolically important and must be addressed by physician leaders. These leaders must recognize that patients, like all consumers, will search for providers who offer them maximal value, and medical tourism is an explicit declaration about what patients value most. Physicians and hospitals in medical tourism destinations recognize that they must provide high-quality care to develop a sustainable competitive advantage in the international marketplace. In an article on medical tourism in Time, Princeton University healthcare economist Uwe Reinhardt stated: “This has the potential of doing to the US health-care system what the Japanese auto industry did to American carmakers.” It is increasingly apparent that medical tourism is changing the healthcare landscape in industrialized and developing countries around the world, and there is every reason to believe that this trend will continue to evolve.

B. New study numbers US medical tourists in thousands not millions
A new study “Medical Tourism Services Available to Residents of the United States” published in the Journal of General Internal Medicine casts doubts on many of the claims made about the size of the medical tourism market and concludes that “the number of Americans travelling overseas for medical care with assistance from medical tourism companies is relatively small”.
Published in December’s issue of the Journal of General Internal Medicine, “Medical Tourism Services Available to Residents of the United States” is a report on the businesses and business practices of companies promoting and facilitating medical tourism to US patients and the types and costs of procedures being offered. In late 2008, the researchers conducted a telephone and email survey of businesses engaged in facilitating overseas medical travel for US residents. They collected information from each company including: the number of employees; number of patients referred overseas; medical records security processes; destinations to which patients were referred; treatments offered; treatment costs; and whether patient outcomes were collected. 63 medical tourism companies were selected for inclusion and 45 (71%) completed the survey.
13,500 US medical tourists from 45 businesses since start up
The 45 companies involved had referred an average of 285 patients overseas since start up (not in the previous twelve months). The survey recorded a total of approximately 13,500 US medical tourists in total for all 45 businesses since they started in business. The most common overseas countries that companies reported referring patients to were India, Costa Rica, and Thailand though many other countries were mentioned less frequently including Malta, Israel, Spain and Germany. The most common medical services utilized by overseas medical travelers were orthopedic procedures, cardiac procedures, infertility treatment, and cosmetic surgery. (The study specifically excluded companies that focused exclusively on dental care).
The authors highlight the significant difference between their grand total of 13,500 US medical tourists travelling via 45 medical travel facilitators and the “number of articles, studies, and reports (that) have suggested that between 500,000 and 2,000,000 Americans travel overseas each year for medical care.” They believe that their study mirrors and supports the kind of numbers quoted by McKinsey & Co (Mapping the Market for Medical Travel) who estimated “the current market at 60,000 to 85,000 inpatient medical travelers a year—numbers far smaller than others have reported.”
The study authors propose that the discrepancy in the estimates of the size of the overseas medical market is related to the following factors:
1. Estimates of a much larger US medical tourism market were proposed by parties with personal and/or financial interests in the overseas medical travel market.
2. Their study did not attempt to measure the number of Americans travelling for dental care. This is believed to be quite a high proportion of the US outbound market, particularly cross border to Mexico and to South America. According to Sandra Miller at Health Travel Technologies, “We process more than 600 inquiries per months, and send more than 100 patients a month abroad........We send 20 dental patients per month to top notch dental clinics in Mexico, Costa Rica, the Dominican Republic and El Salvador.”
3. Their study did not attempt to measure the number of Americans who may have traveled overseas without using the services of a medical tourism facilitator. Estimates of how many medical tourists use a facilitator vary widely. Some US estimates put this as low as one in five patients who use the services of a facilitator. (Research on UK medical tourists put this figure as around one in three – Treatment Abroad Medical Tourism Survey 2008).
The authors point out that even when items 2 and 3 above are factored in, “the market may be somewhat smaller than prior studies have estimated”. They also point out that two years after conducting the interviews, they found that 15.6% (7 of 45) of companies that completed the initial interviews no longer had functioning websites and thus were presumed to no longer be in business.
It’s also worth pointing out that the survey was restricted to medical tourism facilitators who had a US phone number. 97 facilitators were excluded from the research for this reason. This in effect excludes many Mexican, South American and Asia based facilitators who handle US patients.
Cost savings for medical travel less than claimed
The study’s findings related to the cost of overseas medical travel also warrant mention. The authors report that “overseas medical costs for several procedures were generally similar to combined hospital and physician payments made by Medicare for the same procedures.” For example, according to the study, a heart bypass surgery costs an average of $18,600 outside the USA. Within the USA, Medicare pays around $21,000 for the procedure. They conclude that “the take-away message is that the expected savings from overseas medical care is dependent on what, typically uninsured, patients might be expected to pay if they instead purchased this care in the US” and “the fact that overseas charges are reasonably close to Medicare rates suggests that there may be significant opportunity for US providers to compete with offshore facilities, in some situations, by offering highly discounted prices to uninsured American patients.”
IMTJ comment
We welcome this attempt to put some validity on the size of the US outbound market. The study is one of the first to approach the thorny issue of US medical tourism statistics by asking medical tourism businesses how many patients they actually handle rather than by creating “guesstimates” based on what people say they might do. It also puts some of the oft quoted predictions of “6 million US medical tourists in 2010, 10 million by 2012” etc etc in a different light.
A similar approach was adopted in 2007 in a study by Treatment Abroad in which facilitators, hospitals and clinics were asked to provide numbers of UK patients treated. This study put the number of outbound UK medical tourists at around 50,000 (similar to numbers recorded in the UK’s International Passenger Survey data.)
However, the new study does have its flaws – sampling bias, exclusion of dental care, exclusion of self arranged medical travel – which undoubtedly impacts the overall number of medical tourists that it counts. Nevertheless, even if we allow for these flaws and factor in the “missing” patients, the study suggests that the annual outbound medical tourism patient numbers for the USA are perhaps in the region of 100,000 to 200,000 at best, rather than the millions that have been mooted elsewhere.
The study highlights the areas of healthcare that are driving US medical travel – cosmetic (and obesity) surgery, stem cell treatment, IVF treatment, cosmetic dentistry and other non-insured areas which will not be covered by “Obamacare”. It does not analyse the clear ethnic trend in medical travel in the USA and elsewhere - people who are travelling from the country of residence to their own, their father's or their grandfather’s nation of birth. This is a significant driver of US medical travel: Mexicans to Mexico, Hispanics to Latin and South America, Asians to Asian countries, Koreans to Korea etc.
Although, they are now in effect two years out of date, the findings of “Medical Tourism Services Available to Residents of the United States” reflect what many people within the industry believe is closer to the truth in terms of medical tourism patient numbers. i.e. thousands not millions. Many countries, their governments and hospital providers have come to believe that the US market represents a rich source of patients but have been disappointed by their lack of success. They may need to revise their expectations and rethink their strategy.
Two Foreign Literatures A. Building a successful medical tourism business
Caroline Ratner from IMTJ spoke to Dr. Michael Horowitz, a former cardiothoracic surgeon, who runs Medical Insights International a consulting firm with clients throughout the world advising medical tourism providers and facilitators on business strategies.
Michael explains why a move into medical tourism may actually be the wrong decision for some healthcare businesses, and why it’s important to have a clearly defined strategy for a medical tourism business. What does Medical Insights International do?
“Medical Insights International provides business to business consulting and we advise clients in the medical tourism industry.
Our particular area of expertise is providing clients with an overall business strategy and structure for entry into the medical tourism business and subsequent success. We have extensive and up-to-date knowledge of the industry and are constantly researching and analyzing the market. As a result we have an awareness of marketplace dynamics, macroeconomic forces, quality of care and patient safety. This enables us to give clients valuable advice about the market, helping them plan and strategize for the short and long term development of their businesses.” Why did you set up Medical Insights set up?
“I practiced medicine – cardiothoracic surgery – until 2004. I subsequently enrolled in an MBA program to better understand the business side of health care. While in business school, I had the opportunity to do an extensive research project on international medical tourism. After graduation, I continued my research and produced a number of key papers that were published in medical journals and also in the budding medical tourism literature. As a result, I soon gained a reputation as an expert in the field. And as my knowledge and interest in the area grew, I began spending increasing amounts of time informally advising people on how to manage a medical tourism business. By 2007 I realized that the logical step was to formalize what I was doing and set up my consulting firm – Medical Insights International.“ Who are your clients?
Clients come from all aspects of the medical tourism industry. I am very interested in serving individuals and businesses interested in entering the market. They are healthcare providers, government entities, insurance companies and medical travel facilitators with the greatest number of enquiries comes from providers based in India and Asia, with some coming from Latin America and Europe.
Our clients could be any company that wants to have assistance in enhancing its business position in the industry. More recently there has been an increase in assistance from US based businesses and individuals wanted to establish facilitation businesses”. How does the consultancy process work?
“One of the first questions I ask clients is why do you want to do this and what their expectations are.
Many people have no clear reason why they are interested in having a medical tourism business. For some, entry into this industry will not likely be right for them or help their overall business position. It is extremely important for those wanting to enter the business to explore the questions of why they really want to do this.
Another critical thing I do is help clients understand the realities of the MT marketplace as it exists today. Further, I help them recognize the potential changes may come in the years ahead. Together we decide what kind of actions is most appropriate, whether for the short term, for a one-off project or for the long term.
I emphasize to clients that it is vital to really understand the business, to explore all of their options, and then work out how their company should be positioned to have the optimal competitive advantage in the marketplace. We work together to incorporate their existing business model alongside their evolving medical tourism endeavor so that they can be merged them into a viable business strategy.” Is the medical tourism market inappropriate for some businesses?
“Building a medical tourism business model is sometimes unsuitable for some companies, which is why I believe it is so important to really look at a client’s reasons for entering the market.
The goal of my consultancy is to assist the client to have a successful business endeavor – one that will most benefit their patients, their facility and organization and the community as a whole. I really feel that among the most valuable contributions I’ve made for certain clients is helping them identify and recognize that serving international patients was not what they really should be doing because of the nature of their existing business.
Even though some people are at first absolutely sure that this is what they want to it is essential that they fully explore their options and potential outcomes. This process is a vital step in strategizing and planning and saves much misery further down the line.” Why shouldn’t a businesses or individual enter the market?
“There is no point in me advising a client to enter the market and grow a business when it is clear that the industry is simply not appropriate for them. Some of the reasons for this include an unsuitable location, inadequate capital, poor facilities, insufficient staff, and an inappropriate service line to attract and serve foreign patients.
Interestingly, among the most valuable contributions I’ve made for certain clients is helping them recognize that serving international patients was not what they really should be doing because of the nature of their existing business. I have advised several clients not to pursue their medical tourism aspirations – and they have thanked me profusely for this advice. “ Can you give some examples of the type of advice you have given clients in the past?
“For example, I have advised hospitals that they would enhance their overall success by focusing their service offerings on one or two highly qualified specialties rather than spreading their efforts on across the board treatments which are already readily available elsewhere.
I also advise clients to take into consideration the impact that treating foreign patients will have on their local existing patients and to carefully balance serving foreign and local patients. Medical tourism can be potentially beneficial to the local population but could also be detrimental. It all depends on what healthcare providers offer and how they choose to serve both local and visiting patients.
For healthcare providers in developing countries, treating foreign patients generates much-needed revenue that may lead to improved services through reinvestment in facilities and equipment, and by enabling the recruitment and retention of top quality medical staff. The downside of an influx of foreign patients is that it could potentially crowd out local patients – both paying customers and those dependent on charitable care. The overall success of these complex endeavors depends on how healthcare providers choose to serve their different constituencies.” What do you think are the biggest opportunities and threats to the medical tourism industry?
“As in any business, potential opportunities and threats frequently present together. A key example of this in the medical tourism is the evolving healthcare reform in the US. I try and help my clients understand that reform in the US will definitely impact on medical tourism in one way or another. For example, reform will likely alter the drivers of international medical travel for American patients. This will necessarily change the patient and case mix seen by facilitators and providers. As a result the reforms might see an increase in business in certain specialities and decrease in others.
At the moment we can’t be certain exactly what plan will get through Congress and work its way through to Obama’s desk. Furthermore, as yet, it is unknown what the actual outcome will be.
There are reasons to believe that there may be some decrease in US citizens travelling for cardiac surgery, orthopedic operations and similar procedures. At the same time, US healthcare reform will have little, if any, impact on cosmetic surgery or dental care.
Another change that appears to be coming is that some of the smaller providers will likely be squeezed out the market as increasing number of large healthcare companies enter the marketplace.”

B. MEDICAL TOURISM
November 1, 2007
Wealthy patients from developing countries have long traveled to developed countries for high quality medical care. Now, a growing number of less-affluent patients from developed countries are traveling to regions once characterized as "third world," seeking high quality medical care at affordable prices, says Devon Herrick, a senior fellow with the National Center for Policy Analysis.
For example: * Reports on the number of patients traveling abroad for health care are scattered, but it is estimated that 500,000 Americans traveled abroad for treatment in 2005. * A majority traveled to Mexico and other Latin American countries; but Americans were also among the estimated 250,000 foreign patients who sought care in Singapore, 500,000 in India and as many as 1 million in Thailand.
The cost savings for these patients can be significant, says Herrick: * Apollo Hospital in New Delhi, India, charges $4,000 for cardiac surgery, compared to about $30,000 in the United States. * Hospitals in Singapore charge $18,000 and hospitals in India charge only $12,000 for a knee replacement that runs $30,000 in the United States. * A rhinoplasty (nose reconstruction) procedure that costs only $850 in India would cost $4,500 in the United States.
But if American health care consumers are to benefit to the fullest extent from global health care competition, there are legal reforms policymakers should consider, including: * Recognizing licenses and board certifications from other states and countries and modifying the federal Stark laws limiting relationships between physicians and hospitals. * This would enable health care providers to offer integrated medical services, including follow-up care for patients returning from treatment abroad.
In addition, the federal and state governments should lead by example by allowing Medicare and Medicaid programs to send willing patients abroad, says Herrick. Medicare in particular would benefit from cost savings due to its large volume of orthopedic and cardiac procedures.

Two Local Literatures A. Medical tourism earnings reach $1.3B
Philippine Global Healthcare Forum Friday
November 10, 2011, 2:29am
MANILA, Philippines — The Philippines earned a total of US$1.3 billion from healthcare and wellness services from overseas foreign tourists and balikbayans who visited the country from the five-year period 2006 to 2010.
This was revealed by healthcare business intelligence firm Healthcare based on its comprehensive research in its recent briefing to the media.
It reported that the global medical and wellness tourism market has become one of the fastest growing sectors in the world economy, with revenues standing at approximately US$40 billion to as much as US$3 trillion according to various sources.
This vital information on this emerging industry is contained in the Healthcare Industry Report “The Philippine Medical Tourism Compendium.” The report contains far-reaching analysis of the key competitive strengths of the country in terms of its hospital and healthcare infrastructure, cost structure advantages, market segmentation, value propositioning and quality systems in relation to the global market.
“The Philippines has the potential to grab a bigger share of as much as US$1 billion to US$3 billion in annual revenues in the global medical tourism market by 2018 if it puts in place attractive investment environment that will enable the country to expand its healthcare infrastructure, more open and liberal travel arrangements for medical tourists and better and more extensive international marketing promotions programs,” Healthcare Executive Director & Chief Strategist Joyce Alumno declared.
Alumno bared during the media briefing that the 1st Global Healthcare Forum will be held on November 11, 2011 to present the findings of the report and to present various issues and developments that will impact on the Philippine medical tourism industry.
During the forum, senior officials from the Departments of Health and Tourism, and other concerned government agencies and from the medical and healthcare industry will converge to discuss the policy areas that need to be addressed if the country is to maximize its chances of becoming a hub for medical tourism in Asia. There is growing consensus that the medical tourism sector is the next sunrise industry for the Philippines, after the much-heralded BPO sphere.
International research firm Deloitte, the study added, has identified the Philippines as one of the emerging players in the multi-billion dollar industry, which currently is dominated in Asia by Singapore, Malaysia and Thailand.
Expensive medical treatment costs as well as limited healthcare coverage especially in countries such as the US, Australia and the UK, along with capacity constraints in these countries’ healthcare facilities, have driven their aging population to seek more affordable, yet comparable medical and wellness services overseas.
The Philippines, Alumno explained, boasts of world-class medical infrastructure and facilities and well-trained and proficient doctors, nurses and medical personnel. The top three tertiary hospitals located in Metro Manila have put up hotel-quality facilities that will cater to not just the high-end Filipino patients, but also the foreign medical patients who have opted to come to the Philippines for their healthcare needs.
She added that “the country possesses the added competitive advantage of having English-speaking and compassionate and caring medical personnel.” Most Americans, she noted, are familiar with the friendliness and caring attitude of Filipino nurses in the US.
Alumno recommended the medical and tourism sectors and other industry stakeholders to get their act together and to craft the Philippine Medical Tourism Roadmap to develop broad-ranging strategies and facilitate the implementation of programs in the area of healthcare infrastructure, quality management and international accreditation, liberalization of visa restrictions for the medical traveler and international marketing and promotions.
She concluded that medical tourism has the potential to contribute significantly to the country’s economy, much like the Business Process Outsourcing industry, while retaining its medical talents in the country and reducing the brain drain and its social and economic costs. B. French Doctor Sets Sight on Philippine Medical Tourism? The pursuit of niche markets is a major component of the Department of Tourism’s strategy to position the Philippines as Asia’s Next Tourism Capital. While attracting mass market is not seen as a difficulty in reaching its annual visitor’s target, it is felt that equal emphasis should be placed on targeting high-level niche markets, comprising of quality visitors who stay longer and spend more. Among some of these key markets include the spa & wellness trade, long-staying retirees, golfers, international film makers and medical tourism.
(PRWeb) April 18, 2005 -- The spa and health business is perhaps the fastest growing niche market. Nearly every major hotel has some kind of spa facility. While many are first-rate and world-class, others are not. Hence, in 2004, the Philippines’ first spa association was set up primarily to uphold industry standards and ensure that clients are aware of those places that are genuinely committed to providing high-quality service. At its inception, the S.P.A Association of the Philippines had members from hotels and resorts, day spas, destination spas, medical spas, spa consultants, training schools and suppliers of equipment and products.

Medical tourism, on the other hand, is a term that has risen from the rapid growth of the industry where people from all around the world are traveling to Asian countries such as Thailand and India to obtain medical, dental, and surgical care while at the same time touring, vacationing, and fully experiencing the attractions of the countries that they are visiting. A combination of many factors has lead to the recent increase in popularity of medical tourism - exorbitant costs of healthcare in industrialized nations, ease and affordability of international travel, favorable currency exchange rates in the global economy, rapidly improving technology and standards of care in many countries of the world, and most importantly proven safety of healthcare in select foreign nations have all led to the rise of medical tourism. More and more people are traveling abroad as an affordable, enjoyable, and safe alternative to having expensive medical, dental, and surgical procedures done in their home countries. Medical tourists are generally residents of the industrialized nations of the world and primarily come from The United States, Canada, Great Britain, Western Europe, Australia, and The Middle East. But more and more, people from many other countries of the world are seeking out places where they can combine vacationing and obtaining their medical care at an affordable cost.

“A study by the Confederation of Asian Industry and a private consultancy firm has estimated "medical tourism" could be worth at least U$ 2 Billion by 2012,” says Dr. Pierre Clero, Medical Director of Clinique Internationale D’ Esthetique based in Paris, France. “Last year, some 1.5 million foreigners visited India alone for treatment, with the number rising by 15 per cent every year. The increasing number is forging new definitions for medical tourism in a country, where medical tourists, until now, consisted only of those from third-world countries (in Africa and Southeast Asia) or those visiting the city for traditional Ayurvedic medicine.” Dr. Clero is currently in Manila as a Consultant for Euro-Clinics Inc., a Filipino-owned medical consortium that explores the potential growth of health tourism in the Philippines by offering a vast array of elective medical procedures to both foreign and local patients.

Adds Dr. Clero: “Currently medical tourists are traveling in large numbers to India, Thailand, the East Indies and South America - places where the quality of healthcare is equal to anywhere else in the world and yet the cost is significantly lower. These regions also offer numerous options for touring, sight-seeing, shopping, exploring, and yes, even lounging on sun drenched beaches.”
“Although these places are currently the most popular choices for medical tourists, the industry is growing so rapidly that more and more countries and medical centers around the world are beginning to tailor services aimed specifically at medical tourists, and the expectation is that the options for where medical tourists can choose to travel will continue to increase at a rapid pace.”

With a large pool of highly trained doctors and low treatment prices, the Philippine healthcare sector aims at replicating Thailand and India’s success. “So far, patients who were forced to cancel their scheduled medical visits due to the recent tsunami tragedy are now looking at the Philippines’ shores. Plus, the long awaited opening of the new airport in the last quarter, and under the promising leadership of the Arroyo Administration, we can expect the bettering of health tourism prospects," Dr. Clero predicts.

A myriad of options exist for medical tourists in the Philippines - from purely elective procedures such as liposuction, breast augmentation, micro-follicular hair grafting, to more serious and life-saving procedures such as joint replacements, bone marrow transplants, and cardiac bypass surgery – foreign nationals and balikbayans can now obtain essentially any type of medical or surgical procedure locally in a safe and effective manner for a fraction of the cost that they would face in their home countries.

Clero calls it global connectivity. "There used to be a time gap in terms of medical technology reaching the shores of Manila, but not anymore. Also, with every third medical practitioner in UK or the US known to be of Filipino descent, first-world patients attach a reasonable amount of confidence and comfort in being treated in the Philippines."

Clero also peg his medical team’s outlook on health tourism to a series of first: innovative facilities offered by Euro-Clinic such as airport-to-hospital limousine service, concierge facility, internet access, in-house interpreter services, sight-seeing packages, spa & wellness etc. Press materials distributed overseas and internet promotion also indicate that patients from the developed world have been impressed by post-operative nursing care and good public relations offered by the group.

What are the cost savings for medical tourists?
Dr. Clero says the cost savings are enormous. “For example, for the same price as a week long vacation for two in Hawaii, a couple can fly to Manila and include airfare, 5-star hotel accommodations, personal tour guide/concierge, and detoxification & spa treatment for the wife while the husband undergoes a hair grafting technique. For other cases, the average cost of tumescent liposuction in the United States is U$25,000. That same operation with comparable rates of success costs less than U$5,000 conducted in the finest and most state-of-the-art outpatient clinic here. Large price disparities such as these exist across the board for numerous medical and surgical procedures. And because of favorable currency exchange rates for medical tourists, the costs associated with accommodations, food, shopping, and sight-seeing are similarly very favorable.”

"Plus, considering India’s questionable sanitary conditions, there is no comparison when it comes to our Philippine clinic set-up" says Dr. Clero, who first came to Manila three years ago and has already invested more than U$1 Million to help boost the Philippines’ health tourism sector.

Emilio Aguinaldo College
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Cavite

School of Business Administration
Accountancy Department

Thesis about Medical Tourism
BUSINESS FINANCE

Submitted by:
Leilyn Kay C. Toyong
Submitted to:
Dr. William Baltazar