---

" Marketing yourself to medical tourists: a practical guide for Commonwealth countries "

---

Also referred to as health travel, medical tourism is a term used to describe the act of travelling across international borders to obtain healthcare. This can be for virtually any type of treatment, but often includes elective procedures, or those requiring complex specialisation not available in one's home country. Currently more than 50 countries identify medical tourism as a national industry.

---

Medical tourism is an industry experiencing rapid growth and development worldwide. According to Deloitte, the major international accounting and consulting firm, throughout 2007 over one million American, British and Canadian patients were treated abroad and this figure is predicted to rise beyond 15 million by 2017. Deloitte also reported that with over 47 million people in the US (2006) being uninsured and not able to receive state-funded domestic medical treatment, an estimated six million of these will travel abroad for treatment and surgery by 2010.

Other key factors driving the increase in treatment abroad are patients simply wanting more affordable private healthcare or seeking to obtain immediate surgery (thus avoiding state healthcare waiting lists), those requiring a medical specialisation only offered in another country, or those who just like the idea of recovering whilst relaxing in a holiday destination. Skyrocketing private medical costs in developed nations plus an increasingly ageing population in the west will also contribute to fuelling cross-border patient travel.

In the US in particular, there are other significant catalysts including the proliferation of US-based medical insurance companies now providing discount policies for those holders who agree beforehand to treatment abroad, plus major US companies choosing to send their employees abroad for quicker and more cost-effective treatment.

In the UK, one of the major promoting factors behind medical tourism is the recent EU Proposal for a Directive on patients’ rights in cross border healthcare which was released in 2008. This will allow patients the freedom to obtain core health services (to which they are entitled to in the UK) in another European Union Member State and the UK National Health Service (NHS) will be requested to reimburse patients for the direct treatment costs. Patients will even be able to undertake treatment without the prior consent of the NHS or the constituent primary healthcare trusts.

Taking all of the above into consideration, it is easy to see why the medical tourism industry is beginning to blossom and governments worldwide are beginning to fund the development and promotion of their healthcare systems and infrastructure to a widening pool of international patients. As an indication of the economic appeal, the market valuation to destination countries of America’s departing patients alone is expected to reach US$21 billion a year, by 2015 (Source: Deloitte).

Traditionally, the key departing medical tourist markets in addition to the US and UK are Canada, Australia, Japan and certain areas of mainland Western Europe. Well-established travel routes exist – medical tourists from the US and Canada often travel to South East Asia, Central and South America, and the Caribbean. UK residents are fond of travelling to Southern and Eastern Europe (and also the US, for treatments unavailable on the NHS) and according to research by McKinsey in 2007, 99 per cent of Australian medical tourists travel to Asia. Medical tourism is also developing in smaller nations: the Middle East state of Jordan for example received an estimated 3,000 US, UK and Canadian patients in 2007 (Source: Deloitte).

In terms of the current impact on Commonwealth nations,major existing medical tourism destinations include South Africa, India, Singapore, Malaysia (where the number of foreign patients tripled from between 2001 to 2006, reaching nearly 300,000 - Source: Deloitte), Malta and New Zealand to name butma few, while numerous Commonwealth nations within the Caribbean, Africa and Asia are also actively advancing their medical offering to external visiting patients.

Key drivers encouraging medical tourism :
• High domestic cost of private healthcare in the US, UK, etc.
• Lack of domestic medical insurance or state medical provision
• Waiting times in the key source destinations
• Improvements in technology, healthcare standards and international accreditation in destination countries
• The increasing ease and affordability of international travel
• The benefit of greater confidentiality when being treated abroad (such as with HIV treatment and cosmetic surgery)
• Various treatments being only available abroad (such as Stem Cell treatments)
• Ability to link operations in-between vacation time at a tropical destination.

“The market valuation to destination countries of America’s departing patients is expected to reach US$21B a year, by 2015…” ( Deloitte )

---

---

Members of the Commonwealth are in an advantageous position when it comes to aligning themselves as medical tourism destinations. Commonwealth nations have existing and wellestablished social, economic and cultural connections with countries that are currently leading source markets for medical tourism such as the UK, Canada and Australia.

Commonwealth nations often have higher levels of spoken and written English; a crucial factor for the vast majority of medical tourists, and medical personnel are also generally trained to similar standards to other more developed Commonwealth nations. Many surgeons, doctors and hospital staff from emerging Commonwealth nations take part in training exchanges within major hospitals in the more developed Commonwealth nations. Both of these factors combine to create an appealing set of circumstances for would-be medical tourists. Lastly, strong family ties between a nation and its Commonwealth counterparts are a major draw for medical tourists and should not be overlooked. For individuals who already have family relations in a particular destination (which is not an uncommon occurrence between Commonwealth nations), travelling for medical purposes is made all the more appealing and many individuals will undertake minor surgical procedures (such as dental treatments) in more affordable clinics, while on vacations to see family and relatives.

---

---

In order to successfully establish a medical tourism industry at both national and regional/local scales (this can even
include supporting a cluster of individual clinics), it is essential for Commonwealth Ministers to consider the following three elements:

1. Accreditation and healthcare standards
Perhaps the primary factor that can deter potential medical tourists from making the decision to be treated abroad is the perceived standard of healthcare and cleanliness in clinics, hospitals and surgeries overseas, especially in what are seen as less-developed nations. In many cases this is a mistaken assumption as some of the world’s finest and most respected medical institutions are now located in destinations such as India, Thailand, Mexico and Costa Rica.

In a 2008 survey of patients by the American-based MedicalTourism Association (MTA), 81 per cent of medical tourists indicated that accreditation played a role in their decision to travel overseas, and this entire group reported that the specific accreditation of the chosen hospital was an important or very important consideration for their decision. Demonstrating your nation’s macro and micro medical accreditations and record of surgical excellence cannot be under-estimated.

On international healthcare accreditation, the main body evaluating individual clinics and hospitals is the American-based Joint Commission International (JCI), commonly perceived as the ‘gold standard’ in international healthcare accreditation. In addition to JCI, there are three other main schemes: the Trent Accreditation Scheme (primarily UK/Hong Kong based); the Australian Council on Healthcare Standards International (ACHSI) and the Canadian Council on Health Services Accreditation (CCHSA). However, international accreditation is by no means wide-reaching – the total number of hospitals and clinics being part of one of these four schemes is in the hundreds, not the thousands. In addition, accreditation is a big financial commitment so it may not be cost-effective for smaller
clinics to apply. National and region-specific qualifications can also offer important indications of quality.

For Commonwealth destinations that currently have no such accreditation bodies (or an affiliation with one of the aforementioned international organisations), this is clearly something worth establishing through relevant governmental health departments. Ensuring your healthcare offering at all levels is of the highest international standard and is thoroughly accredited and regulated, is the first stepping-stone to encouraging increasing patient numbers from abroad.

2. The Internet
How do potential patients in the medical tourism source nations research their medical treatment possibilities? Unsurprisingly, in the same survey, the MTA highlighted that 73 per cent of medical tourism patients researched their international medical treatment options using the Internet.

Consequently, this means a web presence is essential for alldestinations, individual specialists, clinics and hospitals seeking the attention of the medical tourism trade. In almost all cases your website is the first impression potential clients will have of you, which means your website should be a direct reflection of your nation’s (or clinic’s) mission and strategy.

While the old saying is ‘never judge a book by its cover’, this is generally not the case with medical tourism websites. Potential medical tourists will inevitably have some reservations about the perceived quality of services when travelling abroad for treatment and it is highly likely that a vast majority will, even if only subconsciously, link the look and feel of your website to the quality and professionalism of your surgical offering. An error in the loading or navigation of your site could be the quickest way to send a potential patient to a competing destination.

Be sure to have a professional-looking site to help alleviate any concerns of quality. The website should be aesthetically pleasing, clean and easy to use and navigate through. Offering different language versions of your website is also a major advantage.

Lastly, including your website and thus your clinic, hospital or authority’s details on a medical tourism directory website or search engine is an effective way to maximise treatment enquiries and resulting patient numbers. YourSurgeryAbroad.com, for example, contains almost 1,200 clinics and hospitals in 75 destinations, covering 26 treatment areas and is becoming an increasingly popular destination for potential medical tourists to conduct their initial online research.

Best practice example: Malaysiahealthcare.com

A world-class example of a Commonwealth medical tourism provider is Kuala Lumpur based Malaysiahealthcare.com – an excellent online portal for international patients interested in treatment and surgery in Malaysia. Through their website www.malaysiahealthcare.com, they offer patients a one-stop service, acting as medical and holiday consultants and using their established network of national providers. The organisation’s services include:

• Identifying and booking desired medical treatment, hospital and doctor
• Identifying and booking all travel, stay and/or holiday within Malaysia
• Online payment and wire transfers
• Pre-treatment consultations with specialists
• Help in immigration procedures
• Arrangement of a destination manager to handle all groundwork and treatment itinerary in Malaysia
• 24 hours toll-free number for patient assistance

This excellent level of service is a result of a long-term and sustainable approach, and produced by partnering with leading hospitals, tour operators, and finance and insurance companies. The benefits are obvious – by providing incoming patients with a seamless service the prospect of going abroad for treatment becomes far more appealing and hassle free. This industry-leading format should be replicated across other Commonwealth nations and providers.

3. Accessibility
If a potential medical tourist has the confidence that your nation’s medical provision is of a high standard, and they have been able to clearly research an available clinic or hospital, it goes without saying their final decision will probably rest with how easy it is to both travel to the destination and be treated once they are there.

Ensuring air transfers into your key airports are linked (ideally directly) to major national hubs is an obvious priority; however what is often over-looked is the level of service (both in terms of medical, accommodation, transfers, etc.) that patients receive during their stay.

International patient liaisons have proven popular in many well-travelled medical tourism destinations. These liaisons are staff members whose sole purpose is to communicate with international patients prior to, during and after treatment, as well as to provide assistance with any information desired by potential patients such as accommodation, visa assistance, tourism advice and bookings.

Having one central person to contact and assist who is familiar with the anxiety and needs of foreign patients is a comfort to incoming patients. Obviously, having dedicated staff members is more relevant to larger hospitals and clusters of clinics that have the staff and financial capacity. For smaller clinics, simply assigning an existing staff member as the central contact for foreign patients will suffice.

If this is not in a clinic’s capacity, it is worthwhile investigating the use of medical tourism brokers/facilitators who will take the place of an international liaison. A broker provides holistic packages by organising the communication and appointment with clinics, travel, accommodation, etc. For destinations that are currently not serviced by any commercial brokers, this is something that should be established as statistics from the MTA show that just over half (51 per cent) of medical tourists used some form of facilitator to help coordinate their care.

Even if there is no established international patient contact, and the decision is made not to use brokers, destinations should develop relationships with complementary services, such as translators, tour companies, hotels and airport pick-ups. This allows them to offer holistic packages to potential medical tourists and thus eliminates the additional burden associated with worrying about where to stay and how to get there. At the very minimum, the availability of translators and hotel or airport pick-up are a good start.

---

---

In conclusion, the expanding global medical tourism industry provides Commonwealth nations with a world of opportunity to establish and promote their private healthcare provision specifically for international patients.

The benefits of this to Commonwealth nations are not just economic, bringing patient fees and indirect expenditure around accommodation, travel, retail and subsistence. Two other benefits include, firstly, the impact on the state healthcare provision of having international standard facilities within the nation’s borders (and the consequent knowledge and technology exchange between institutions and individual specialists).

Secondly, with the world in the middle of an economic downturn and talk of global recession, medical tourism may be one of the only industries that is truly ‘recession-proof’. During times of economic slump in developed nations, patients are actually more likely to seek more cost-effective and affordable treatment abroad.

It is essential that Commonwealth nations lay solid foundations which include healthcare provision of the highest standards and that they consider future international patient requirements at every stage of the development process. For example, the national and local tourism boards must work in partnership with the nation’s health authorities. Not only must a government health authority ‘sell’ their facilities and expertise, but they must also promote the destination as a whole.