Medical tourism has become one of the modern areas of medicine associated with the globalization of the modern world community. The volume of investments invested in this industry is increasing every year. Medical tourism is located at the intersection of the fields of medicine and economics, reflects the process of commercialization of healthcare and is becoming an increasingly promising and profitable area of the tourism business. First of all, travel has become affordable and safe. The visa regime is maximally facilitated and in some countries even canceled for short trips. Air travel has connected states previously separated by months of land travel. Tourism infrastructure has become a profitable business (Ak et al., 2018). Currently, large five-star hotel complexes related to the SPA industry have been created on the sea coasts. Rest in such hotels is a great place for an annual vacation, allowing you to fully restore your health. As a rule, medical procedures are combined with a varied and educational cultural program. Many resorts have gained worldwide fame, for example, the Czech Karlovy Vary.
The structure of medical tourism includes clinics and travel agencies of the host country and the country of residence of tourists. In some cases, prior to travel arrangements, the country of residence may offer prior medical advice or laboratory testing. This, in particular, is due to the fact that the decision on the need to provide medical care is often made by the patient himself (customer of services), and the receiving party, on the one hand, determines the most appropriate type of treatment, and on the other hand, “cuts off” the obviously doomed to failure. treatment in case of contraindications (Ak et al., 2018). As a rule, the tour package includes tickets, transfer, tourist visa, hotel accommodation, services of the host travel company, transfer of medical documentation to the attending physician and a contract for the provision of medical services. As part of globalization, the process of standardizing the provision of medical care, which is identical in many states, continues. First of all, this applies to the standards of emergency medical care. The provision of planned therapeutic care in different countries has its own nuances, which allows foreign tourists to make certain preferences. Patients travel to receive high-quality high-tech medical care. In some cases, the economic factor can also become decisive if the cost of an identical package of services differs significantly, which is typical, for example, for India, Singapore, and Thailand.
What Does TMT Do?
In addition to providing professional support and quality services around the world, TMT has several other main goals. Of interest are the results of an analysis of medical tourist flows of British citizens (50,000 patients per year), which revealed the fact that most of them turned to clinics in France and Germany in order to reduce the time to receive assistance when included in the waiting list for free insurance procedures (Ak et al., 2018, p. 56). The structure of this medical flow was also studied: 20 thousand patients sought general medical care, 14.5 thousand for cosmetic procedures, 9 thousand for ophthalmic care or knee and hip arthroplasty, and 5 thousand had problems related to reproductive medicine (Ak et al., 2018, p. 78). As a rule, clinics belonging to the medical tourism sector are accredited by JCI (Joint Commission International, USA, Chicago) and have an official conclusion of the Joint Commission International. Thus, a report and compilation of an updated database of medical institutions is being carried out. In addition, it also makes it possible to provide vulnerable segments of the population with all the necessary services.
Why Medical Tourism?
Medical tourism is a phrase used to describe all people who travel to other countries for medical treatment. Medical tourists typically travel to access health care at a lower cost than what they would have to pay if they received the same treatment at home (Ak et al., 2018). By looking for medical care options abroad, people can leave their health in the best hands. Medical tourism helps to control the situation and provides an opportunity to access the most talented and qualified doctors in the most modern medical institutions in the world. In addition, such an event provides travel and acquaintance with other countries, which is also a desired goal and even a dream of many people.
75% of the US population prefers to take the opportunity of medical tourism
In the 80s and 90s of the 20th century, Americans began to travel abroad for cosmetic surgeries – face and stomach skin tightening, breast implants. Today, most people go abroad to have heart surgery, knee and hip replacements, liver transplants and, most often, dental treatment. Medical industry experts expect exponential growth in medical tourists. In this regard, many major US insurance companies began to offer pilot programs that cover the cost of treatment in other countries. If it turns out that the patient’s treatment abroad is cheaper, the insurance companies will pay more modest compensation (Rittichainuwat, 2018). The American Physicians Association and the American College of Surgeons recognize that medical tourism is driven by the high cost of medical care in the United States and welcome when patients find the best treatment for them. However, doctors warn that for treatment abroad, patients should choose licensed specialists and medical institutions that have the appropriate accreditation.
63% of the world’s population use the opportunity to receive treatment abroad
The international market for medical services and technologies has shown steady growth over the past two decades. The pandemic caused by a new coronavirus infection has only increased the interest of patients from different countries in cross-border travel in order to receive routine medical care. More than 14 million people travel each year to receive medical services, according to the Medical Tourism Association. Patients choose another country to gain access to new techniques and better drugs. In some cases, the determining criterion for selection is the price. Even with additional travel and accommodation costs in another country, the patient can save between 30% and 80%. For example, a heart valve replacement surgery in the US costs about $150,000, while in India it costs only up to $10,000. In leading medical tourism centers, doctors use new protocols with effective and gentle methods that are not always available to patients at home. Often a person wants to be treated by a particular doctor after reading good reviews about him.
3% of the world’s population has a negative attitude towards medical tourism
Different nations are characterized by a different interpretation of treatment, which affects the mood of skeptics. The fact is that if some people use mud baths, tea or special food for the purpose of treatment, while others use pills, misunderstandings can arise. The human psyche tends to reject everything new and incomprehensible, and this factor extends to the field of medical tourism. There is an opinion, widespread among opponents of such tourism, that treatment with alternative methods may be fraudulent or ineffective (Wilks et al., 2021). However, the percentage of such people is very small and constitutes the predominant generation of older people, whose consciousness and worldview are no longer so flexible and open to the new. It is important to note that gradually the number of skeptics is decreasing, which means that the authority of such treatment programs is recognized.
Medical tourism is not only useful and practical, but also an interesting option that allows you to combine treatment and knowledge of the world
Medical tourism refers to people traveling to another country other than to receive medical treatment. In the past, it usually referred to those who traveled from less developed countries to major medical centers in highly developed countries for treatments not available at home. However, in recent years, it may equally apply to those from developed countries who travel to developing countries for lower medical prices. Motivation may also be for medical services not available or illegal in the country of residence. Medical tourism is a broader term for travel that focuses on treatment and the use of medical services (Rittichainuwat, 2018). It covers a wide range of health-oriented tourism, ranging from preventive and medical treatment to rehabilitative and curative forms of travel. In the past, some discredited or bogus doctors have set up shop outside of the US to promote dubious or dangerous treatments or outright scams. Medical tourism is far from these scammers today, but there is still a need to be vigilant.
The U.S. Market
The United States is well known for having one of the most advanced healthcare systems on the planet. Highly qualified specialists work here and the most advanced models of medical equipment are used. People from different parts of the world come here to undergo therapy using the most effective methods, cosmetic surgery procedures, joint replacement, treatment of cardiovascular diseases, organ transplantation, treatment of eye diseases are especially in demand. According to statistics, between 60,000 and 85,000 medical tourists come to the country every year. Most of these people go for effective treatment. In percentage terms, this is approximately 38% of Latin Americans, 35% of citizens of the Middle East, 16% of Europeans and 7% of Canadians (Rittichainuwat, 2018, p. 39). Approximately 32% of foreign respondents answered that they came to the US to receive medical services, the quality of which would simply be better than in their home country (Rittichainuwat, 2018, p. 66). And 15% of foreign patients come to get quick access to the necessary procedures and not to wait in lines.
Usually, foreign patients who come to be treated in a foreign country are assisted by a local or international medical tourism association. Such organizations are non-profit and perform the functions of non-state control over the quality of medical services. The American Medical Tourism Association exists too, and not even one. Of the relatively recent organizations of this type, IAMT, the International Medical Tourism Association, headquartered in New Jersey, can be distinguished. The main objective of the association is to provide a foreign patient with an opportunity to choose based on objective information about different clinics and doctors.
U.S. Health Insurance System
The United States is the only developed country that does not have compulsory health insurance. A fragmented system of public, private, and non-profit sectors is operated by a third party, insurance companies, which act as an intermediary between patients and health care providers, monitor the appropriateness of prescriptions and pay for treatment. For 2019, these administrative costs alone were estimated at $496 billion, or 13.8% of total costs (Wilks et al., 2021, p. 71). The legislation in this area is arranged in such a way that most medical services are covered by the health insurance system. In other words, it is common practice to partially or even fully pay for treatment abroad from the patient’s insurance. This allows us to conclude that the state not only supports the sphere, but also encourages it in order to provide citizens with everything they need most.
Despite the fact that the sphere of international tourism is in demand and relevant among the population, it needs to develop. In the context of the United States, it should be noted that the state consists of a large number of states that differ from each other both culturally and geographically. In turn, specialists can open and find new healing places on the territory of the state, open hospitals and clinics that will help increase the number of clients. However, services should be provided by specialists, which means that the number of students studying for the necessary specialties should be increased in order to maintain the number of services (Wilks et al., 2021). Finally, people must learn and be informed about all the possibilities, and accordingly, it is necessary to create numerous marketing campaigns to promote the business. In addition, as noted earlier, a large number of people are looking not only for treatment, but also for a pleasant pastime, which should be gradually introduced into the field. For example, in addition to providing medical services, you can organize excursions, relaxation procedures.
In addition, the sphere regularly faces difficulties in implementation or promotion. The first and most significant problem is the constant growth of competition in the field, as more and more places and clinics open every year. In addition, the international quality standard is also improving, and pricing may create difficulties because other countries will be more profitable. It is important to note that the financial factor is an extremely acute issue, which not only reduces competitiveness, but can, in principle, lead to the decline of a business. This is due to the fact that the range of choice among the population is currently extensive, so people always choose the most profitable organizations where they do not have to overpay (Puczkó & Stackpole, 2021). Another problem is the lack of places for people in places where demand is high. The fact is that in any clinic and organization the number of patients is limited, which contributes to either the formation of queues or the loss of potential customers. If the restriction is ignored, the quality of the entire system will be significantly reduced, which will lead to a decrease in prestige.
Despite the fact that the US market in this area is quite developed, medical tourism must continue to develop and maintain its competitiveness
As a result, the following information should be underlined for the US market. Today, the organization of treatment in the United States is deservedly popular, because America leads the industry. Maximum attention is paid to health care: this can be seen in federal support, improving equipment, improving pharmaceuticals, conducting research, and improving the skills of staff. The high level of medical care in America is also based on the excellent technical equipment of medical institutions and the comfort of hospitals. At the same time, the market faces certain difficulties and challenges that cannot be ignored (Wilks et al., 2021). With timely control of all possible problems and the development of the sphere, the state will be able to maintain a leading position in this area.
Worldwide, medical tourism is a multi-billion dollar industry and is expected to grow. Researchers estimate that hundreds of thousands of people from the United States alone travel to another country each year for a medical procedure. Often travelers travel abroad for everything from cosmetic surgery, cardiac surgery and dentistry to fertility treatments, cancer care and orthopedic surgery (Wilks et al., 2021). As a result of the rise in medical tourism today, many employers and insurers have developed relationships with hospitals in other countries in an attempt to control the cost of medical care. Medical tourism as a sphere is developing in absolutely all countries, which, in turn, leads to the globalization of healthcare and international relations in the field of health.
Medical tourism has become one of the areas that have been particularly affected during the pandemic: closed borders, an enormous burden on healthcare systems have led to the fact that the flow of medical tourists has reached its minimum. The global economy is slowly recovering from such a blow, and it is necessary to work to restore the flow of medical tourists, as well as use the forced break to increase the attractiveness and quality of medical services provided to foreign citizens. For the development of medical tourism, it is necessary to pay attention to clinical excellence (Puczkó & Stackpole, 2021). Of course, the cost of services plays an important role, but mostly middle-income and above patients are sent for treatment abroad, who are primarily looking for better and more efficient medical care. An important role is also played by the safety of medical care, which is maximally oriented to the patient and efficiently planned in time. Understanding the cultural, religious, social needs of foreign patients, as well as language support is also very important. The clinic must do everything possible to make the patient feel comfortable in the most familiar environment.
It is necessary to consider in detail the risks and problems associated with international medical tourism. First of all, these are the medical risks associated with climate change. A patient who intends to receive medical services abroad must be warned against a sudden change in climate. It must be remembered that exotic food can have an unpredictable effect on the body, forcing tourists to “leave the race”. It is also necessary to take into account the hypoglycemic properties of exotic plants, the spectrum of which is different in different countries (Puczkó & Stackpole, 2021). Another feature of tourism to exotic countries is the danger of infectious diseases. Not coincidentally, entry into many countries is only allowed after strictly prescribed vaccinations. Another danger associated with medical tourism is the dissemination of infectious agents. The scientific literature describes concurrent infectious outbreaks in various European clinics among patients previously treated in Asian countries. It is important to note that the legal aspects of providing assistance may vary from country to country. As a result, claims filed in different countries may be handled differently and the decision may vary when evaluating similar situations.
Medical Tourism Agencies: Growth or Challenge?
Medical tourism agencies play an ambiguous role for the industry as a whole. The fact is that the tasks of such organizations are to provide a service that provides convenience in finding, paying for and implementing health improvement programs in different countries. This really greatly simplifies the algorithm of the patients’ actions, performing all the bureaucratic work for them and reducing the search time. Nevertheless, such organizations introduce a serious commercial aspect into the sphere, that is, they dictate their prices and complicate competition between organizations (Puczkó & Stackpole, 2021). This is explained by the fact that agencies charge people a commission for their services, which is the main source of income for organizations. Therefore, it is impossible to unambiguously characterize the activities of such corporations, but their presence is a plus for the population.
At the global level, medical tourism is a more multifaceted and complex area that faces more challenges. However, there are many tools to make it easier for people to use services.
Medical tourism is complex and very responsible, because you have to work with human health. The margin of such tours for a travel agent is high: prices are serious, and tourists are interested. The main reason for the development of medical tourism is the technical capabilities, high level of service and highly specialized specialists that can only be gathered in individual clinics. However, it is important to emphasize that this area has its own challenges that need to be dealt with (Wilks et al., 2021). Today it is already a whole industry that has formed a huge market for medical services with its own uniqueness and specificity. Specialists from various fields are involved in the design of such tours: doctors, organizations that provide loans if necessary, travel agencies, lawyers, insurance companies. However, patients should carefully study agencies that are aimed at making a profit.
Major Markets and Specialties
According to the Medical Tourism Index (MTI), as well as reports from research corporations Oxford Economics and Visa, by 2025, the world’s medical tourism turnover will reach more than $3 trillion. Today, the global medical tourism market is valued at $439 billion annually. In the next 10 years, it will grow by at least 25% per year (Wilks et al., 2021, p. 66). The top 10 medical tourism destinations include Canada, the UK, Israel, Singapore, India, Germany, France, South Korea, Italy, and Colombia. A patient who decides to receive medical care abroad faces the problem of choosing a country, a clinic and a particular doctor (Wilks et al., 2021). Organizations are found with the help of Google, interview friends and relatives. As a rule, the case ends with the fact that a person simply chooses the site he likes, where they promise to help quickly and cheaply. However, due to inexperience, you can make a big mistake, which is not only insulting, but also expensive. Typically, such firms operate as ordinary travel agencies and are not very concerned about the quality of medical services provided by partner clinics.
Current Major Markets per Specialty
Turkey opens the MediGlobus ranking “TOP 5 countries for treatment abroad in 2020”. Among medical tourists, this state is one of the most popular. Every year more than 800,000 foreigners come here for diagnosis and treatment. The number of people wishing to visit Turkey for medical purposes is steadily growing. This is due to the fact that the country has an impeccable ratio of price and quality of services provided. For example, the cost of surgical intervention here is at least 2 times cheaper than in Israel or Germany, and the level of service is no different (Wilks et al., 2021). The leading areas of Turkish medicine are: oncology, transplantology, plastic surgery, cardiac surgery, as well as orthopedics and traumatology. Doctors who work in the above areas have international recognition and many years of experience in successful patient management. Among the top doctors in Turkey, there are: Prof. Turnc Oktenolu (a world-famous neurosurgeon specializing in radiosurgery using the CyberKnife), Prof. Bulent Cihantimur (a plastic surgeon who is among the top 50 specialists in the world), Prof. Merdan Fayda (chief radiation oncologist Liv Hospital). There are 46 clinics in the country that have the prestigious JCI accreditation, which testifies to the impeccable quality of service and the safety of patient treatment. At the same time, the following hospitals are especially popular among foreign citizens.
A quarter of a million foreign patients are treated in Germany every year. In terms of healthcare spending as a share of GDP, this country ranks second in the world after Switzerland. Here, colossal funds are directed to equipping clinics, purchasing diagnostic and treatment equipment, and conducting medical research. Diagnosis and treatment are prescribed exclusively according to international standards. The clinics use only high-quality medicines that are produced for the EU countries. Many German clinics use robotic surgeons controlled by doctors (Wilks et al., 2021). They perform safer operations with thin incisions and minimal blood loss. The risk of complications after such interventions is much lower. It uses high-quality devices for laparoscopic surgery, robotic catheters for the treatment of cardiac arrhythmias. In Germany, there are many university clinics that are engaged in research activities. All innovations are quickly introduced into medical practice. For example, to destroy tumors in German cancer centers, linear accelerators are used, which, unlike radiation therapy, practically do not damage healthy tissues. It became possible to clean the ejaculate of HIV-positive men, after which their spermatozoa can be used for IVF.
Israel is called one of the most sought after countries for medical tourism in the world. According to the Israeli Ministry of Health, more than 30,000 patients from Russia, Europe, Cyprus and the United States come annually. According to the International Health Research Center (IHRC), Israel ranks 3rd for the quality of medical care for international patients. For example, the authoritative magazine Newsweek every year includes the medical center. Sourasky (Ichilov) and the Sheba Clinic in the list of the best hospitals in the world. When compiling the rating, the team of specialists takes into account the quality of medical services and services, patient satisfaction (Puczkó & Stackpole, 2021). The Organization for Economic Co-operation and Development (OECD) and a special committee of international experts in the field of medicine gave the highest rating to the healthcare system and clinics in Israel. They noted that the country has one of the best systems for early detection of diseases, which avoids unnecessary hospitalization and reduces the cost of treating the patient in the future.
The high quality of medical services in clinics is confirmed by the accreditation of the International Joint Commission (JCI). To receive it, the medical center must meet 1,600 requirements, including the quality and safety of medical services, staff qualifications, and the level of service. There are more than 10 clinics with such accreditation in the country.
Up-and-Coming Markets in Specialties
Among the promising and developing markets in this area are Spain, India and Egypt. The fact is that countries are characterized by their climate and a huge number of specific aspects, such as food and plants, which contribute to the acceleration of the treatment of complex diseases. However, these states are not leading either due to a lack of specialists or due to the lack of appropriate equipment. However, local governments are increasing the financing of the sphere as efficiently as possible, which allows us to expect an expansion of the services provided (Puczkó & Stackpole, 2021). In addition, at the moment there are a large number of services at a relatively low price compared to the leaders, so the potential of these markets is significantly underestimated.
As a result of the analysis, it can be noted that in order to achieve leadership positions in ratings, market must provide not only services, but also ensure high quality. This is done by having a large amount of a unique knowledge, training professionals and creating credibility and positive statistics (Puczkó & Stackpole, 2021). In order to unleash the potential of the medical tourism market, any state needs to finance and develop each element of the services provided, which, in turn, will create demand. In addition, it is important to follow the price range, which is very scattered in the leading countries, but beneficial for the majority. This is also the most important factor in the success of the sphere in a particular market.
Ak, B., Ozdemir, L. and Shapekova, N. L. (Eds.). (2018). Recent researches in health sciences. Cambridge: Cambridge Scholars Publishing.
Puczkó, L. and Stackpole, I. (2021). Marketing handbook for health tourism. Rhode Island: Stackpole & Asossiates, Incorporated.
Rittichainuwat, B. N. (2018). Special interest tourism. Cambridge: Cambridge Scholars Publishing.
Wilks, J., Pendergast, D., Leggat, P. A. and Morgan, D. (2021). Tourist health, safety and wellbeing in the new normal. Singapore: Springer Singapore.