HealthAbroad.net: Point of View

According to The Times, Britons- the butt of jokes across the world for their bad teeth, are flying to Hungary to avail of cheaper cosmetic surgery.

Some important cost comparisons given in the article are:

• A single veneer at Goolnik’s City clinic costs £850, while the same costs £150 in Budapest.
• Teeth implants cost between £1500-2000 in the UK while an implant in Turkey costs £566 with free consultation.
• In the UK, the cost of 12 crows or units of bridgework at £450 a unit totals £5400. At Kreativ Dental in Budapest, the cost would be £2,400 plus 10 percent to cover any extras (total £2640), a saving of more than £2,700- more than enough to cover cost of budget flights (SkyEurope flies from Stansted to Budapest for £17 each way) and accomodation (recommended hotel in Budapest costs £28 a night).

Most popular dental work is for crowns, implants and bridge work as the financial savings are quite substantial.

Most popular destinations are France, Spain, taly, Croatia, Cyprus, Hungary, Turkey with Poland and India soon to join the list.

Using a research published by Bath University in 2004, the article states that on an average the NHS has fewer that 4 dentists for every 10,000 people. In Austria, Italy and Poland there are 5 per 10,000, and 6 per 10,000 in the US. Sopron, a small town in Hungary; the self styled dental capital of the world has one dental practioner per 80 inhabitants.

Some medical travellers and obviously the British Dental Association remain sceptical about treatment and hygiene standards of dental clinics in Eastern Europe. However, professionally run clinics matching international standards of treatment and post-operative care but at a fraction of the price, are slowly but surely winning over new converts.

TIME magazine has a very comprehensive write-up on the growing medical tourism industry. If it’s made it to TIME, it’s got to be big right?

Aside from mentioning the by now quite familiar cost comparisons of surgical procedures, the article flags a growing trend of uninsured and underinsured Americans boarding planes not for the typical face-lift or tummy tuck but for discount hip replacement and sophisticated heart surgeries to Thailand, Malaysia and India. Though the numbers are yet to reach worrying proportions, doctors and industry watchers are watching them closely. Elective surgeries are key moneymakers for hospitals and even a small drop off can have a deep impact on their profits.

This trend for the moment shows few signs of abating as some pioneering American corporations swamped by rising healthcare costs are seriously considering offering employees outsourcing as a health-care option. The rationale is quite straightforward, as the article points out,

“The calculus behind this interest isn’t complicated. Many major employers in the U.S. are self-insured, which means they pick up the tab for much of their employees’ medical care. That’s why three major corporations which cover 240,000 lives asked Dr. Arnold Milstein, national healthcare “thought leader” at the consultancy Mercer Health & Benefits, to assess the best places to outsource electice surgeries. Procedures in Thailand and Malaysia, he found, cost only 20% to 25% as much as comparable ones in the U.S.’ top notch Indian hospitals sell such services at an even steeper discount.

The bottom line: If more private payers sent the patients abroad for uncomplicated elective surgeries, the savings could be enormous. “This has the potential of doing to the U.S. health-care system what the Japanese auto industry did to the American carmakers,” says Princeton University healthcare economist Uwe Reinhardt.”

But faced with intense competition, will the American health-care system fare as poorly as the Detroit carmakers? Will the tragedy of having 48 million uninsured adults aged 19 to 64 in the US bring windfall gains to Thailand, Malaysia and India?

A few things are quite clear. Outsourcing health-care is far from being the norm at the moment as US insurers though aware of medical outsourcing are scared off by the regulatory and legal uncertainities. However, the real impetus for medical outsourcing is coming from companies which faced with a need to cut costs wherever possible, are showing a willingness to promote outsourcing healthcare to their employees. While beyond the West, top of the line hospitals most likely to get their business are pulling all stops to stay buffed, while emerging hospitals are dipping into their cash pools to create gleaming oasis of excellence. If you thought medical tourism was the passing fad, think again. It made it to TIME afterall.

According to a recent study done by Kasikorn Research Centre (KResearch) on medical tourism in Thailand, critics are starting to raise concerns over the negative impact of medical tourism induced brain drain on the country’s health-care system.

It is estimated that 1.4 million foreign patients will make Thailand their port of call this year bringing with them revenue of approximtely 36.4 billion Baht. Critics and consumer groups fear that this lucrative industry is weaning away skilled doctors to upscale private hospitals catering to foreign patients, thereby leaving state owned or low-end private hospitals understaffed and the medi-care system in peril.

According to Saree Ongsomwand, President of The Consumer Foundation, the “go-for-foreigners” trend will undeniably have a debilitating effect on the quality of medical services available to the Thai people since as it is Thailand has a poor doctor to population ratio.

Doctors and industry watchers such as Dr. Prapha Wongphate, President of the Thai Private Hospitals Association have a different perspective on the matter. To quote,

“The type of service that we provide for foreign patients and tourists is not exactly the same type of service for the majority of Thais because the former is more costly. So they are different groups of patients.” Making a point that too much is being made of too little, she says that “only 33 of 218 private hospitals grouped under our association target foreigners. The rest are serving Thais as usual.”

Dr. Wongphate makes an important and oft-overlooked point about medical tourism still being in its nascent stage and being a small time contributory to the medicare industry. However, medical tourism has grown in Thailand at an average rate of 14 percent over the last few years as foreign tourists attracted by low prices, high quality service and world famous Thai hospitality have flocked to the country. Nothing points to the reversal of this trend, which also means that health workers and physicians lured by better prospects will continue their flight to high-end private hospitals. It might not be a cascading swell now, but the conditions are quite ripe for a steady draining of skilled physicians and health workers.

The forces of the free market have dictated that private hospitals are targeting Thais and foreigners who are willing to pay more for better service. Although most Thais, 47.5 million, are covered by the pioneering Baht 30-per-visit universal healthcare programme, the prospect of a yet developing shortage of skilled physicians should cause some worry in Thailand.

This headline isn’t mine. It’s from The Independent, a UK newspaper. To quote,

“A 75-year-old woman has won a landmark European Court ruling that patients must be reimbursed for treatment abroad if they face “undue delay” for surgery on the NHS at home.” (emphasis added)

This story/ruling is more important than you might think at first. In fact, it is hugely significant. What the European Court has said is that if there is an undue delay in your surgery at the NHS, even if the specified time (in this case 4 months) is within the target timeframe set up by the NHS for treating patients, patients have the right to a reimbursement of the cost of surgery abroad. The court has stopped just short of awarding the reimbursement (in this case £4,000 for a hip replacement operation in France) saying that its up to the British courts to decide what constitutes an ‘undue delay’.

Since the current NHS policy of not providing reimbursement for surgery done abroad is one of the largest (maybe even the largest) stumbling blocks hindering the growth of medical tourism, this ruling will potentially encourage many more British patients to go abroad for surgery.

But it’s not so rosy after all. To quote,

“”This is a landmark judgment, but its effect on the NHS won’t be big,” Dr Morgan added. “If NHS waiting lists were 18 months there would be an issue but as they decline towards 18 weeks [the Government target by 2008] it becomes less of an issue.”

18 weeks is 4 and a half months. Whether that is or is not a very long period is the million dollar question!

This is data from December 2004 so this number could well have increased by now.

South Koreans, according to an article in The International Hearld Tribune, are now going under the knife to influence their fortune. The traditional Korean fascination for fortune telling is fueling the growth in the cosmetic surgery industry as one in ten cosmetic surgery patients undergoes procedures because he or she believes the changed appearence will attract good fortune. 

“Men and women of all ages are increasingly undergoing plastic surgery so that a new nose with a straight bridge and distinct nodules, a slightly wide and protruding forehead, or sufficient cheekbones will bring wealth and the drive to take charge of their lives”.

As the article reveals, in South Korea, cosmetic surgery based in physiognomy only contributes “a small fraction of the $500 million cosmetic surgery industry”. What really caught my eye, (admittedly amid a few chuckles) was that as Koreans line up to get “bigger eyes and cherry lips”, surgeons are already looking for a far bigger market: China, where a lot of people share a similar faith in fortune-telling and equally if not more importantly, find cosmetic surgery within their financial reach.

It’s time you went to your palmist, face reader, gemologist, astrologer and then fixed THAT appointment.  

The Hindu, an Indian newspaper, reported on 10 May that three branches of the Apollo Hospitals group in Chennai, Delhi and Hyderabad have been rated and accorded accreditation by an international hospital rating organisation, the Joint Commission International (JCI), based in Illinois, Chicago.

“A team of three professionals attached to the JCI evaluated 1,033 measurable quality standards at the respective sites….The team studied the JCI’s focus areas like patient care, hospital administration and management, organisational leadership and staff qualifications.”

JCI accreditation has become something of a holy grail for hospitals that are keen on attracting medical tourists. I read a news story a couple of days ago (can’t find the source now, unfortunately!) where the JCI reported a rising number of inquiries for accreditation from hospitals abroad from a base of practically zero a few years ago. Why? Since hospitals in the US strive to meet JCI accreditation, it has also become a stamp of quality for hospitals abroad.

“Healthcare organisations around the world want to create environments that focus on quality, safety and continuous improvement,” Karen Timmons, Chief Executive Officer, JCI, said in a press release.

“Accreditation meets this demand by stimulating continuous and systematic improvements in an organisation’s performance and outcome of patient care.” (emphasis added)

In layman’s terms, JCI accreditation means that a hospital’s pretty damn good.

Abacus’ recently published report on the growth of medical tourism in Asia is still reverbrating. Some more fascinating data has just come out of this report, via another publication…

• By 2012, up to 3 million medical tourists could come to Asia seeking treatments,
• Singapore currently pulls in more than 370,000 foreign patients per year,
• Of the 160 million international journeys to Asia, only 1.3 million are for medical tourism. That’s less than 1% of the total,
• Abacus estimates that  up to a million foreign patients could visit Singapore annually by 2012, making it a US$1.6 billion market. That’s 1/3rd of the total estimate for all of Asia — seems to be on the high side!

Here’s the full text of the article:

Hospitals in Singapore are poised to tap into a US$4 billion medical tourism market.

Industry experts believe that, by 2012, up to 3 million medical tourists could flock into Asia seeking treatments.

70-year-old lawyer Vimalarajah Velayutham is a self-described workaholic.

He’s determined not to let a painful back problem slow him down.

On the recommendation of his doctor, he’s travelled from Sri Lanka to seek treatment in Singapore at Raffles Hospital.

He’s just one of the more than 370,000 foreign patients who’ve been coming to Singapore.

Vietnam has been identified as a star market with its rising economy.

A third of patients at Raffles come from markets like Indonesia, Malaysia, the Middle East, Russia, and Bangladesh.

Dr Prem Kumar Nair, General Manager, Business Development, Raffles Medical Group, said: “Bangladesh is a country of 130 million people. If you are to take 10 percent, it’s 13 million and that is already three times Singapore’s population, people who can afford private health care overseas.”

Although medical tourism has been around for quite a few years, industry experts believe it’s just the beginning of the beginning.

In Asia alone it’s estimated there are 1.3 million medical tourists a year compared to 160 million international journeys.

This means medical tourism make up less than 1 percent of the Asian travel market.

Don Birch, CEO, Abacus International, said: “From what we’re seeing is we think the growth potential is somewhere in the 30 to, sorry, 20 to 30 percent growth over the next few years, naturally no market can go on doing that indefinitely but certainly it’s a strong area of growth.”

This forecast estimates up to a million foreign patients could visit Singapore annually, making it a US$1.6 billion market here.

Hospitals are doing all they can to attract patients.

Dr Prem Kumar Nair, said: “We have got our studio apartments, which makes it very convenient for family members of patients particularly those family members who’s relatives are very ill they are in intensive care unit or they are undergoing major surgery. They want to be as close as possible to the patients so they can stay in our studio apartments. Raffles has 20 of them.”

Mr Vimalarajah Velayutham said: “The treatment in the hospital was very good, everybody I spoke to was very kind, they go out of their way to help. I’m highly pleased in the way the nurses, helpers, everybody was extremely good. These are the people ideally suited in the field of health.”

And after a treatment, patients could also choose to stay on to recuperate.

It’s estimated that medical tourists spend an average of US$362 a day during their overseas visit, that’s more than double an average tourist’s spending of US$144.

With patients travelling with families, looks like the economic spin offs for the overall tourism industry is set to grow as well. - CNA/ch

MarketWatch, an American web publication, has a great story on the growing medical tourism market. Aside from the now usual story about the growth of medical tourism, the article also has an interesting take whether insurance providers will cover overseas treatments or not…

“Eventually, health insurers also may benefit by sending people overseas for cheaper care if the quality is comparable. But even today, it’s unclear whether a plan will pay for treatment of complications received from a noncovered procedure that was performed abroad if it’s not an emergency (emphasis added), said Mohit Ghose, spokesman for America’s Health Insurance Plans, a trade group of health insurers representing 200 million Americans.”

The medical tourism space is starting to heat up. After the launch of a Malaysian portal on medical tourism, we’ve just heard of the India Medical Tourism EXPO ‘06 to be held in London from 2-4 June.

India is making a really strong push to attract medical tourists. A lot of people have concerns about sanitation, post-operative infections and the general level of medical care in India, but the top Indian hospitals are second-to-none. In fact, it is these “islands of excellence” that are pushing for medical tourists.

The Press Release of the exhibition says that “this year the exhibition will also showcase holistic treatments on offer, including; Ayurveda, Homeopathy, Siddha, Unani, Yoga and Meditation.”

This exhibition was also held in 2005. The profile of visitors to the exhibition was:

• Planning to visit India for treatment 25%
• Looking for partnerships with Indian hospitals 23%
• Interested in knowing more 39%
• No response 13%

25% of all the visitors to the 2005 exhibition were planning to visit India for treatment and 39% were interested in knowing more! Those are really high percentages for an exhibition that seems geared towards the B2B space. If these numbers are accurate, it does indicate that there’s a very high level of interest in medical tourism in India.