Sun, sea, sand and surgery

Global medical tourism spending grew from $2.4bn to $11bn between 2000 and 2017, marking growth of 358%, according to the World Travel & Tourism Council. The sub-sector accounted for 1.2% of all international tourist spending in 2017, doubling the 0.6% seen in 2000.

As the world’s biggest spender in outbound medical tourism, US citizens paid $2.3bn on medical tourism services abroad in 2017. The country, which is also the largest destination market, attracted $4bn spending from global medical tourists in the same year, accounting for nearly 36% of global medical tourism spending. 

Middle Eastern countries such as Kuwait spent more than $1.5bn on global medical tourism in 2017, thanks largely to the government’s financial support for medical procedures abroad. European countries dominate the top 10 largest markets for both outbound and inbound spending on medical tourism. 

Rising temperature

Against this backdrop, foreign investment in the healthcare sector saw its best year ever recently, with 146 investment projects announced globally in 2019, a 111.6% rise on the previous year, according to greenfield investment monitor fDi Markets. 

Jonathan Edelheit, CEO of the Medical Tourism Association, says in recent decades patients have become increasingly willing to travel in order to obtain high-quality healthcare, thanks to faster transportation and more affordable airline costs. 

“[Moreover], with all the big global insurance companies rolling out health insurance policies allowing people to travel for care now, it presents a unique opportunity for hospitals to really attract new markets,” he adds. 

For many people, buying pharmaceuticals abroad can also be much cheaper. For example, Harvoni – a medicine used to treat chronic hepatitis C – costs $1125 per pill in the US, but just $34 per pill in Brazil, so a US patient could save $90,000 on a 12-week treatment course bought in Brazil. “There are a lot of these very expensive speciality drugs that keep coming out 50% cheaper than US healthcare,” says Mr Edelheit. “We’re starting to see more employers pay for employees’ airfares and hotels abroad to get their medications.” 

The growth of medical tourism also ties into the general boom in global tourism. After record highs in 2018, international tourism visitor numbers grew by 4% in the first six months of 2019, compared with the same period the previous year, according to the World Tourism Organisation.

Additionally, the tourism sector saw a 10-year high of greenfield foreign investment in 2018, in terms of capital and number of projects – a performance that could repeat itself according to the latest data for 2019, according to fDi Markets. 

More beds

Before 2000, the top destinations for medical tourism were Europe and the US. Since then things have diversified, as lower and middle-income countries have become more attractive, especially for less wealthy consumers. For example, the United Arab Emirates and China are welcoming large numbers of foreign investment healthcare tourists, not least because US visa policy has become stricter towards Arab and Chinese patients.

“Some of [president Donald] Trump’s visa policies have inadvertently spurred healthcare investment in other parts of the world. Customers need top hospitals beyond the US and closer to their home countries. So medical tourism is becoming more regional, [for convenience’s sake too],” says Mr Edelheit. 

In 2015, Mubadala Investment Company opened Cleveland Clinic Abu Dhabi, as part of the US Cleveland Clinic Foundation. “[The clinic targets] wealthy Gulf patients expecting high-quality healthcare but who used to go to the US, Germany and Switzerland. Why not get American healthcare right there in the Middle East?” says Mr Edelheit. 

New markets

Abu Dhabi has prioritised healthcare over the past decade. The UAE government’s Vision 2021 plan aims to accredit all hospitals, clinics and healthcare organisations with world-class international standards. 

China’s healthcare market is increasingly attractive for foreign investors due to the country’s ageing population and growing middle class. Given that the country is estimated to have nearly one-quarter of its population over the age of 60 by 2030, Singapore-based hospital Raffles Medical Group is bullish about the hospital industry. With an investment of $119m, Raffles opened a hospital in the south-western city of Chongqing in 2019. The company already has clinics elsewhere in China and expects to expand a second in Shanghai in 2020, according to the South China Morning Post. 

Recently, sub-sectors of both the pharmaceutical and healthcare industries were added to China’s 2019 Foreign Investment National Encouraged Catalogue in a strong vote of confidence and strategy.

Developing a specialism for medical tourism is another strategy for countries. For example, Israel is popular for bone marrow transplants, Costa Rica for dentistry and Thailand for plastic surgery. 

Possible complications

Setting up medical facilities abroad is not easy, however. “Companies are investing in huge hospitals and then neglecting the marketing. They are just burning a ton of cash,” says Mr Edelheit. When a hospital becomes a brand, it brings in wealthy international patients and attracts the top surgeons, he adds. 

Moreover, if one wants patients flying in from around the world, diplomatic relationships, airline contracts and visa policies are crucial to patient flow.

Mr Edelheit warns that there is also widespread use of disinformation towards prospective investors in medical tourism. “We see a lot of [bogus] feasibility studies. Some governments trying to attract hospital projects give data to investors that make it look like the best investment ever,” he adds.

Moreover, while most experts generally agree that medical tourism has grown over the past decade, official data on numbers and flows of medical tourists between countries is difficult to obtain, and there are many vested interests in portraying a vibrant and growing industry, according to Adebusuyi Adeyemi, assistant fellowship director of Chatham House’s global health programme. 

Hi-tech solutions

Medical tourism’s cutting edge relies on tech-driven services, such as ‘Caremondo’, the Booking.com of medical travel. Customers can pick, compare and book doctors, hospitals and treatments across two dozen countries, get fast access to visa-processing facilities, and book flights and hotels. 

Moreover, the growing digitisation of healthcare records improves the understanding and processing of patient data, streamlines data exchange and enhances patient service and safety (in some parts of the world, medical tourists are still emailing or faxing their medical records to overseas hospitals). 

Another area is telemedicine. India’s Apollo Hospitals, for example, uses global telemedicine centres to oversee remote patient monitoring and conduct virtual rounds, according to Arcana. India, whose many hospitals are limited by a small domestic customer base, provides high-quality care at very low cost, according to Mr Adeyemi.

With e-commerce booming on mobile phones, and medical tourism apps growing fast, it seems that the medical tourism industry is likely to thrive.