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ManageMent SuMMary

This management summary outlines the main conclusions of the project “Medical Tourism”.

1. IntroductIon and Scope

The objective of this report was to produce 1) a price benchmarking of the treatment in the top medical facili-ties in selected countries as well as 2) a map showing the inbound and outbound medical tourist flows. This was achieved by researching, identifying and analysing the aforementioned flows.

The lack of a source that gives a concise overview of the industry was the main concern while working on this proj-ect. For this report, the term medical tourism is defined as: travelling abroad, outside of one’s natural health care jurisdiction, with the intent of undergoing a medical procedure, whether it be necessary or elec-tive. This report focuses on the industry from all main target groups’ view points, i.e. providers and consumers, in order to evaluate the demand and supply impact in the market. Facilitating companies were also considered, al-though not examined in detail.

Issues underlying the validity and reliability of this explorative project are complicating the accuracy of this young industry:

• Duetothefactthatthereisalimitedavailabilityofdatawithinthefieldofmedicaltourism.Organisationswith an interest in the industry tend to keep information to themselves in order to maintain a competitive ad-vantage and some countries tend not to record medical tourism data.

• Patientconfidentialitymakesitdifficulttoobtaininformationonmedicaltouristsduetorestrictionsenforcedto maintain privacy.

• Amissinguniformaccreditationsystem.

• Knowledgegapsamongstdifferentplayersinthemarket:ministriesofhealthandtourism,medicalprofession-als, legal experts and travel suppliers as well as other specific services involved in the medical tourism indus-try. Therefore, the medical aspects are described in general, instead of providing details.

Country SelectionThe main reason why the studied countries were chosen as being major destinations for medical tourism, were the number of medical tourists visiting the country. Moreover, in order to have an overview that is as global as possible, countries were also chosen to be spread over the globe, covering each continent / region famous for medical tourism.

Fouroutboundcountrieshavebeenstudied:theUnitedKingdom,USA,theNetherlandsandRussia.TheUKandUSarethecountriesfromwhichpeoplemostfrequentlyleaveinordertoseekmedicaltreatmentelsewhere.DuetogeographicalproximitytoGermanytheNetherlandsareincluded.Russiawaschosen,asitisanemergingmar-ket with the potential to grow hugely in the field of medical tourism.

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Selection Criteria for Top FacilitiesFive top medical facilities were chosen and described for each inbound country. In some countries less than five facilitieswereavailable,accordingtoourcriteria.Aspecificprocedurewasadoptedinordertoselectatopmedi-cal facility (according to project defined guidelines). The criteria to select a top medical facility, were

1) JCI accreditation: Joint Commission International– the largest international hospital accreditation system.

2) IfacountrylackedJCIaccreditation,otherrecognisedinternationalornationalaccreditationorqualitysys-tems were taken into account.

3) Aninternationalorientation,i.e.internationaldepartmentwithinthehospital.

The inbound country analysis details the consumption phase of the medical tourists’ stay abroad. It covers only the tangible aspects (e.g. services offered and capacity of medical facilities) and not the intangible factors (e.g. thepersonalexperiencesandqualityofservice).Thisisduetoproblemsfindingobjectiveinformationandconfi-dentiality of ex-medical tourists’ data.

TreatmentThe chosen medical treatments represent those most often sought abroad based on our preliminary research. The division between necessary and elective procedures allows all country specialties to be embodied and also en-compasses more expensive treatments as well as cheaper ones.

The report is divided into four chapters covering general background information of the market, analyses of the selected inbound countries, analyses of the selected outbound countries and a general conclusion of the research. The main findings are described below.

Inbound Countries

•Brazil •Dubai •Malaysia •SouthAfrica

•Belgium •Germany •Mexico •SouthKorea

•CostaRica •India •Philippines •Thailand

•Czechrepublic •Jordan •Singapore •Turkey

Outbound Countries

•TheNetherlands

•Russia

•UnitedKingdom

•UnitedStates

Necessary Treatment

•Cardiacbypass •Kneereplacement

•Gastricbypass •Hipresurfacing

•Hipreplacement

Elective Treatment

•Facelift •Rhinoplasty

•Botox •Liposuction

•Lasikeyesurgery •Dentalimplant

•Breastaugmentation

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2. IntroductIon to MedIcal tourISM

“Medical tourism” has been a recognised market since the 1980’s and is now a rapidly developing. The increase in technological and medical research and developments, augmented product consciousness and globalisation are among the most influential trends that affect the industry.

Consumer behaviour can be summarised in four main reasons why patients travel abroad for medical care: a)availabilityoftreatments,b)qualityofhealthcare,c)reducedwaitingtimesandd)costsavings.Allthesefac-tors together could result in even more countries taking initial steps to attract foreign patients as well as a surge in medical tourism products, which will allow the industry to flourish.

Current issues lie in the fact that there is a global deficit of information about medical tourism which could hinder the industry’s potential. This is often due to countries wishing to maintain a competitive advantage or a result of limited information having been collected or recorded. Medical tourism often provokes ethical and legal discus-sionscausingconcernfortheindustry.Nevertheless,measuresarebeingtakentominimisethesefactorswithnewlaws,suchastheproposedEUDirectiveforCross-BorderHealthCare,andthirdpartiesbeingestablished.Eventhough there is currently a large number of accreditation bodies, other issues are rooted in the absence of a uni-forminternationalhospitalaccreditationsystemandthevaryingqualityofmedicalservicesprovided.

To conclude, medical tourism has the capacity to become a highly lucrative market, which can be seen in the in-creasing countries showing interest. This could be especially beneficial for developing countries to boost their econ-omies by generating extra income. Many opportunities can be taken advantage of, and the majority of threats have thepotentialtobeovercome.WiththerevenueofthemedicaltourismmarketpredictedtogrowtoUSD100billion(€67billion)by2010fromUSD60billion(€40billion)in2007*,itisclearthatinterestinthemarketisgrowing.

3. Inbound MedIcal tourISM deStInatIonS

The countries are mentioned in alphabetical order.

BelgiumBelgiumattracts35,000medicaltouristsannuallywhomostlycomeforcosmeticandplasticsurgeryaswellasoncology and cardio treatment despite no governmental promotion as a medical tourism destination and the cur-rent lack of a national accreditation system (alongside no JCI accredited facilities). The reason why many choose togotoBelgiumfortheirtreatmentaremainlytheshortwaitingtimes,thelowcosts,thehighqualityandlan-guageability.VirtuallyallmedicalstaffspeakDutch,FrenchandEnglish.Foreignpatientscanexpecttosave56%(whencomparedtotheUS)or26%(whencomparedtotheUK).However,themajoritycomefromtheNether-lands(60%)andsurroundingEuropeancountries(19%)thankstoacentrallocationwithinEurope.Britishpatientsaccountfor21%asmanyclinicsinBelgiumhaveagreementsandco-operationswithBritishbasedfacilities.Bel-giumhasthecapacitytomeettheneedsof50,000moremedicaltouristseachyear.

* Medical Tourism. Consumers in Search of Value. Deloitte Center for Health Solutions, 2008

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BrazilBrazilattractsmanymedicaltouristseachyear,withUScitizensaccountingfor95%ofthem,eventhoughthecountryisrelativelyunsafeandhasapoorpublichealthcaresystem.Thiscouldbeduetothecostsavingsof60%comparedtotheUS.Manymedicaltouristscombinetheirtreatmentswithaholiday,sinceBrazilasarenownedholiday destination. Moreover, the country’s 20 JCI accredited hospitals are a pulling factor as well as the proxim-itytotheUS.Moreovertherearenovisarequirements.Thosewhocomeformedicalreasonswishtotakeadvan-tageofBrazil’sreputationforcosmeticandplasticsurgery.WiththeMinistryofTourism’spromotioncampaigns,the country aims to maintain its position in medical tourism.

Costa RicaCostaRicaattracts150,000medicaltouristsannually,thankstobeingasafe,establishedholidaydestinationanditsproximitytotheUS.Themajorityofthese(95%)arefromtheUSandcometotakeadvantageofthe25%costsav-ings.Currently,CostaRicaspecialisesindentalandplasticsurgeryyetitisarelativelyunknowndestinationwithintheindustry.Promotionhasrecentlystartedinordertoincreasethenumberofmedicaltouristsby8-9%during2010.

Czech RepublicTheCzechRepublicisapotentialcompetitorwithintheEuropeanmedicaltourismindustryasitoffers17%costsavingtoUKcitizensandisalreadyattractingforeignpatientsfromtheUK,AustriaandGermany.Thecountryisknownforprovidingqualitydentalcareandisapopulartouristdestination,withPraguebeingthemajorattrac-tion.TheCzechRepublicisasafecountrythatoffersadevelopedinfrastructureandisapartoftheEU.Currently,9,000 medical tourists are being attracted annually by its reputation for cosmetic surgery, although recent promo-tion has been implemented to welcome those seeking assisted reproduction which, however, has been met with problems due to national laws.

DubaiDubaiboastsasafe,wealthylocationwhereArabicandEnglisharebothspoken.Itcurrentlyattractsmedicaltour-istsmainlyfromGermany(45%),UK(27.8%)andSingapore(10.3%).ThesemedicaltouristsselectDubaiduetoitslowerwaitingtimesandthehighqualityofmedicalcare.TheworkforceisinternationallytrainedalthoughthisresultsinalackofnationalworkforceandmedicalteachingfacilitiesthatarerecognisedoutsideoftheUAE.Dubai’sspecialisationsfocusoncardiology,orthopaedics,oncology,cosmeticandplasticsurgeryanddermatolo-gy.PromotionofmedicaltourismisincreasingwiththeconstructionoftheDubaiHealthcareCityanditishopedthatthemedicaltourismrevenuewillincreaseUSD1.9billion(€1.27billion)eachyearby2010,withanannualgrowthof15%.Giventhecurrenteconomiccrisis,thismaybetoooptimistic.

GermanyGermanyattracts59,000medicaltouristsfrom163countriesannuallythankstoacentrallocationinEuropeandbeingamemberoftheEU.Despiteminimalcostsavingsandnopromotionwithinthemedicaltourismindustry,GermanyisapopularmedicaltourismdestinationforpatientsfromtheNetherlands(11.4%),France(10%),Aus-tria(8%),Poland(8%)andBelgium(5.7%).Thesemedicaltravellersseekcardiology,oncologyandorthopaedicstreatment. It is hoped that by continuing to offer experimental treatments, such as stem cell therapy, medical tour-isminGermanycanincreaseinthecomingyears.Inaddition,highquality,shorterwaitingtimesandapossibilityto combine a treatment with a holiday are offered.

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IndiaBeingapioneerinthemedicaltourismindustry,Indiaoffersnewtechnology,alternativeandexperimentaltreat-ment alongside an internationally trained workforce who speaks English. Thanks to these reasons, India has a broad spectrum of specialisations including cardiology, cosmetic surgery, dentistry, ophthalmology, orthopaedics, transplantsandassistedreproduction.Nowadays,Indiaremainsaleadingmedicaltourismcountrythatpromoteswidelyatagovernmentalandprivatesectorlevelaswellasofferingmedicalvisas.DuetothesefactorsIndiaat-tractsaround450,000medicaltouristsayear(mostlyfromtheUK,USandSouthKorea)despitebeingacountrythat is often perceived by many to be underdeveloped and unsafe. Cost savings are prominent as one can expect tosave58%whencomparedtotheUSor47%fortheUK.Otherdrivingfactorsarehighqualityofmedicalcare,availabilityoftreatmentsandreducedwaitingtimes.By2012,Indiaaimstoattractonemillionmedicaltourists.

JordanJordanisthelargestmedicaltourismhubintheMiddleEastandattractsaround250,000medicaltourists,mostlyfromthesurroundingcountries(38%Iraqis,30%Palestine,31%Sudan)despitetargetingtheirpromotiontotheUSmarket.Thesemedicaltouristsareattractedthankstotheexcellentlanguageskillsoftheworkforceandthehighqualityofcare.Thecountryspecialisesincardiology,orthopaedics,cosmeticsurgeryanddentistry.Theper-ception among Western patients of the strict religious rules that exist means that Jordan’s reputation is underde-velopedasaglobalmedicaltourismdestination.However,Jordan’spotentialincludescostsavingsof66%whencomparedtotheUSand57%whencomparedtothepricesintheUK.By2012,thecountryisaimingtoreceiverevenueof€668millionfrommedicaltourismcomparedto€4.34millionin2009.

MalaysiaMalaysia has already established itself as a holiday destination but has now expanded facilities to cope with the annual341,288medicaltourists(2007)thatitreceivesfromIndonesia(70%),Singapore(10%),Japan(6%),Eu-rope(5%)andIndia(3%).ThesemedicaltouristsareattractedtoMalaysiathankstoEnglishbeingawidelyspo-kenlanguageandMalaybeingunderstoodbyIndonesiansaswellasthepromotionfromtheMalaysiaHealthTrav-el Council. The main treatments that the country offers are assisted reproduction, orthopaedics, cosmetic surgery andstemcelltherapy.Bydevelopingitspositioninmedicaltourism,andcontinuingpromotion,Malaysiahopestoincreaserevenuesby23%resultingin€394millionby2010.

MexicoMexicoattractsbetween150,000and500,000medicaltouristsannuallybutthisnumbercannotbeexactlyquan-tified,asAmericans(accountingforanestimated95%ofinboundmedicaltourists)donotneedavisatoenterthecountry.AmericansareattractedbyMexico’sproximitytotheUSandcostsavingsofaround63%.Despitepro-motion only from the private sector, Mexico has built a reputation for offering dentistry treatment, cosmetic and plastic surgeries, orthopaedics and cardiology procedures.

PhilippinesThePhilippineshasestablisheditselfasamedicaltourismdestinationandreceives200,000medicaltouristsan-nuallyfromtheUSandCanada(40%),JapanandKorea(20%),Europe(17%),MiddleEast(7%)andMicronesia(6%).Theseforeignpatientsmostlyseekcosmeticsurgery,ophthalmology,cardiologyorcardiovascularsurgeryoroncologytreatment.Ontopofthespecialities,medicaltouristsaredrawninbythegovernmentalpromotion

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alongsidewiththequalityofmedicalstaffthatincorporatetheFilipino’snaturalsenseofhospitalityandlanguageskills.Foreignpatientscanalsoexpectcostsavingsof68%oftheUSand54%oftheUK.Allofthesereasonsto-gethermeanthatthereishopethatthePhilippineswillreceive700,000medicaltouristsinthecomingyears.Thismay be unrealistic due to the weak infrastructure and the current brain drain among medical staff.

SingaporeSingaporereceives600,000medicaltouristsannually,fromtheMiddleEast(50%),Asia(45%)andEurope(5%).ThesemedicaltouristscouldbeattractedbySingapore’sreputationasoneofthewealthiestandcleanestcoun-triesintheworldwithawell-developedinfrastructureasthesefactorsarereflectedinthehighqualityofitshealthcaresystem.Singaporespecialisesincosmeticsurgeries,cardiology,orthopaedicandneurologytreatmentalong-sidestemcelltherapiesandgastroenterologyandoncologyprocedures.Thiswidespecialisation,andgoodqualityof health care counterbalances the minimal cost savings. Thanks to the existing extensive promotion, it is expected that medical tourists will reach the amount of one million in 2012 producing a revenue of € 2 billion.

South AfricaSouthAfricaisalreadyestablishedasaholidaydestinationandisnowstartinginitiativestoattractmedicaltour-iststhankstothewell-developeduniquesellingpointof‘surgerysafari’packages.Despitebeinganunsafe,cor-ruptcountrywithaweakinfrastructureandnoJCIaccreditation,SouthAfricaattractsmedicaltouristsfromlessdevelopedneighbouringcountries(32%Mozambique,28%Lesotho,13%Botswana,12%Swaziland).SouthAf-rica offers specialisations in the areas of ophthalmology, orthopaedic, cardiology, rehabilitation and cosmetic sur-geryalthoughthetwolatterareaimedmoreattheWesternworld.SouthAfricaoffers30%costsavingscomparedtotheUS.Promotioncomesmostlyfromtheprivatesectoralthoughthegovernmenthasrecentlyplannedanini-tiative to increase the number of medical tourists.

South KoreaSouthKoreacurrentlyattracts40,000medicaltouristsmainlyfromJapanandChina,followedbytheUSandCan-ada thanks to the cutting edge technology, which is reflected in specialisations focussing on the areas of oncolo-gy, cardiology, ophthalmology, orthopaedics and dentistry. The introduction of medical visas and construction of a medicaltourismhubonJejuIslandalongsidepromotionbytheCouncilforKoreanMedicineOverseasPromotionarehopedtoincreaseSouthKorea’sreputationasamedicaltourismdestinationforWesternersandincreasein-boundmedicaltouristsupto100,000annually.SouthKoreadoesnotofferanycostsavingsandsoitisunlikelythatthetypicalAmericanmedicaltouristswillbeattracted.

ThailandThailand was one of the pioneering countries who first saw the potential in the medical tourism market and now-adays it remains a leading medical tourism destination. Thanks to a wide variety of specialisations ranging from alternative treatment to bariatric surgery and including areas such as cardiology, neurology and ophthalmology as well as the world famous cosmetic and plastic surgery, Thailand has one of the best reputations in the medi-cal tourism market. This is also due to the confidentiality that Thailand offers and the fact that medical treatment can be combined with holidays. The relatively low level of safety in Thailand does not seem to deter tourists as 1.4millionarestillattractedeachyearfromtheUS(33%),China(29%),Japan(18%),UK(14%)andMiddleEast

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andAustralia(6%).FutureprojectionsforThailandarethatrevenueswillincreasefromUSD2billion(€1.3bil-lion)toUSD3billion(€2billion).

TurkeyTurkeyattracts165,000medicaltouristsayear,mostlyfromEuropeandAsia,whoareattractedbythenaturalthermalbathsandspasaswellasthe35JCIaccreditedmedicalfacilitiesthatTurkeyhastooffer.Costsavingsof58%and40%whencomparedtotheUSandtheUKrespectivelyalsohelp.SpecialisationsinTurkeycoverthefields of cardiology, orthopaedics, assisted reproduction, cosmetic and plastic surgery and oncology. Through thor-oughpromotionofTurkeyasamedicaltourismdestination,itishopedthat36%ofitstotaltourismrevenuewillbe from medical tourism by the end of 2010 despite the fact that the private health sector is relatively small and the public sector is weak.

4. outbound countrIeS

The NetherlandsThemostpopulardestinationsforDutchmedicaltouristsareBelgium,GermanyandTurkey,althoughexactper-centages are not known. The reasons why these people opt for treatment in these countries are cost savings, a possibility to combine a treatment with a holiday, reduced waiting times, proximity of the countries and language skills(mainlyapplicableintheFlemish-speakingpartofBelgium).DespiteallDutchcitizensbeingcoveredbyonecompulsorylevelofbasicinsurance,theaforementionedreasonscausethemtostillseektreatmentabroad.Dueto its growth, the national medical tourism market has an increased number of medical tourism facilitators, as well as specialists performing treatment in countries such as Germany in order to profit from the outbound pa-tientflows.AlthoughDutchpatientsspend€80millionabroadannually,thisstillonlymakesupasmallpercent-age of the global market for outbound medical tourism.

RussiaRussianmedicaltouriststraditionallytraveltoIsraelandGermany,accountingfor45%and20%ofpatientsrespec-tively.Currently,otherdestinations,suchasTurkey,Singapore,Switzerland,FranceandEasternEuropeancountriesareexperiencinganincreaseinpopularity.ThetreatmentmostsoughtafterbyRussiansincludecardiosurgery,or-gantransplantation,eyesurgery,oncologyandotherchronicdiseasesthatrequireadvancedmedicalequipmentandspecialisedaftercare.ThemostimportantreasonswhyRussianpatientsoptfortreatmentabroadarehigherquality,availabilityoftreatmentandlanguageskills,asRussiansoftendonotspeakforeignlanguages.Ingener-al,theydonotseekcostsavingssinceonlythewealthycitizenscanaffordtogoabroad.AsthequalityofhealthcareoutsideofRussiaisregardedashigher,itisprestigiousforpatientstoundergotreatmentabroad.Overall,thecountryrepresentsasmalleroutboundstreamasonlyaround1%ofthepopulationiscurrentlyoptingformedicaltourism but has large potential to become a major player in the outbound medical tourism market.

United KingdomThemostpopulardestinationforBritishmedicaltouristsisIndiaduetotheCommonwealth.Forfertilitytreatment,theCzechRepublicisapopularchoiceandforcombiningtreatmentwithaholidaystay,Turkeyisfrequentlyse-lected.ThemostcommonreasonswhyBritishpeoplegoabroadfortreatmentarereducedwaitingtimes,higher

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quality,costsavingsandavailabilityoftreatment.ThelongwaitingtimesandtheinfectionratesinhospitalsarethelargestproblemsfacingtheUKpopulation.Therefore,manyBritishpatientsarelookingtotravelfortreatment.ThismakestheBritishpopulationthesecondlargestoutboundmedicaltourismflow.ThesignificanceofmedicaltourismhasbeenreflectedintheintroductionofthemedicaltourisminsurancefromPJHayman,andtheincreaseininternationalcooperationbetweenUKbasedcompaniesandforeignmedicalfacilities.

United States of AmericaAmericanmedicaltouriststraveltoLatinAmerica(38%),Thailand(44%)andothercountries,suchasIndia,insmallerproportions(18%).ThemainreasonsforAmericancitizensoptingfortreatmentinaforeigncountryarecostsavings,higherquality,availabilityoftreatmentandreducedwaitingtimes.Costsavingisthemostimpor-tantreasonas,outofthe370millionUSresidents,14%areuninsuredand7%areunderinsured.Inaddition,themothertongueofaround34millioninhabitantsisSpanish.ThesereasonscombinedleadtomanyAmericansseek-ingtreatmentsinLatinAmerica,accountingfor500,000-750,000medicaltravellersannually.Americansarenowthelargestoutboundflowwiththenumberofmedicaltouristsbeingexpectedtodoubleannually.Asaresultofthisgrowingmarket,insuranceplanscoveringmedicaltourismhavebeenintroducedandtheUSbased‘MedicalTourismAssociation’wasestablished.

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5. general concluSIon

5.1 prIce benchMarkIng and MaIn FlowS analySIS

The research has been concluded in a medical tourism flows analysis as well as a price benchmark of the select-edmedicaltreatment,whereallinboundcountrieshavebeencomparedsequentiallytoeachoutboundcountry.The results below visually express the cumulative average price difference for all treatment per country by means of bar charts. The percentages indicate how much cheaper/more expensive the average medical treatment is com-pared to the country indicated.

The United StatesThecheapestcountriesforUSmedicaltouristsareMalaysia,PhilippinesandJordanwhooffer69%,66%and63%costsavingsrespectively.Nevertheless,AmericansdonotnormallyfrequentMalaysiaformedicaltourismandthereisstilllessthan1%ofUScitizensgoingfortreatmenttoJordandespiteitspromotionalefforts.Theydo,ontheotherhand,makeup40%ofmedicaltouristsinthePhilippines,togetherwithCanada.However,ma-jorcostsavingsofferedbyMexicoseemtobeadrivingfactorforUSmedicaltouristsastheyaccountfor95%oftheinboundmedicaltourists.OthercountriesthatAmericansoptforareBrazil(95%)andCostaRica(95%)with60%and25%ofcostsavingscorrespondingly.EventhoughCostaRica’spricedifferenceisconsiderablylow,itssuccessisprobablyduetoitsproximitytotheUS.

The United KingdomBritishmedicaltouristsmostfrequentlyoptforIndia(offering44%costsavings),Turkey(40%),Belgium(26%)andCzechRepublic(17%).EachofthesecountrieshasauniquesellingpointthatcatersforthevaryingdemandsofUKcitizens,suchasshorterwaitingtimes,availabilityoftreatmentandquality.Inparticular,Belgium’scompet-itiveadvantagefortheBritishmedicaltouristsisitsspecialisationincosmeticanddentaltreatmentsatalowercost as well as its proximity, especially thanks to the Eurostar and Thalys trains. In the future, countries that offer significantcostsavings,suchasJordan,MalaysiaandPhilippines(57%,57%and54%respectively)couldserveaspotentialmarketsfortheUK.Atthemoment,however,theybarelyattractanyBritishmedicaltourists.

United Kingdom 20%

Russia 79%

Netherlands 21%

Turkey 58%

Thailand 56%

South Africa 30%

Singapore 27%

Philippines 68%

Mexico 63%

Malaysia 69%

Jordania 66%

India 58%

Germany 56%

Dubai (UAE) 53%

Czech Republic 48%

Costa Rica 25%

Brazil 60%

Belgium 56%

South Korea -1%

US Price Comparision

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USA -57%

Russia 80%

Turkey 40%

Thailand 34%

Philippines 54%

Mexico 44%

Malaysia 57%

Jordania 57%

India 47%

Germany 26%

Dubai (UAE) -67%

Czech Republic 17%

Brazil 49%

Belgium 26%

South Korea -29 %

Singapore 0%

Costa Rica 4%

Netherlands 3%

UK Price Comparision

South Africa 9%

The NetherlandsThemostattractivemedicaltourismdestinationsforDutchcitizensareEuropean,mostlyneighbouringcountries,suchasGermanyandBelgium,butalsoTurkeyduetocostsavingsof29%,29%and34%,respectively.AnotherresearchedEuropeanmedicaltourismhub,theCzechRepublic,offerssavingsofonly10%.Thelargestcostsavingnon-EuropeanmedicaldestinationsfortheDutchcouldbeMalaysia(60%costsavings),thePhilippines(53%),Jordan(50%)andBrazil(47%).

RussiaEventhoughonly1%ofRussiansseekmedicaltreatmentabroadand,thus,donotcontributemuchtothetotalglobal outbound medical tourists, they are considered to be a potential market due to a high spending power. The Russianmedicaltouristsusuallyoptfordestinations,suchasGermanyandIsrael,thankstomanyRussian-speak-ingimmigrantsinthesecountries.However,Germanyistwelvetimes(12,11%)moreexpensivewhencomparedtoRussia.Generally,RussiahasthecheapestmedicalcareoutofallthecountriesstudiedandtheleastexpensivedestinationforRussianscouldbeJordandespitepricesbeingalmosttriple(178%).

United Kingdom -22%

Costa Rica -27%

Russia 69%

USA -53%

Turkey 34%

Thailand 32%

Philippines 53%

Mexico 45%

Malaysia 60%

Jordania 50%

India 31%

Germany 29%

Brazil 47%

Belgium 29%

Dubai (UAE) 29%

South Korea -43%

Singapore -22%

South Africa -1%

Czech Republic 10%

NL Price Comparision

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United Kingdom -1532%

USA -2791%

Netherlands -751%

Turkey -980%

South Korea -1358%

Thailand -1029%

South Africa -1200%

Singapore -1488%

Philippines -921%

Mexico -922%

Malaysia -846%

India -866%

Germany -1211%

Dubai (UAE) -1253%

Czech Republic -1177%

Costa Rica -1314%

Brazil -1085%

Belgium -1211%

Russia Price Comparision

Jordania -178%

5.2 Map concluSIonS

Conclusions from the main flows analysis have been converted into a digital map (see next page) which visually represents the most important inbound and outbound medical tourism flows within the scope of the research. It detailsthemostimportantreasonswhymedicaltouristsoptforcertaindestinationsaswellastheuniquesellingpoints of each selected inbound country and their areas of specialisation.

5.3 general concluSIon

Basedontheconductedresearch,itbecomesclearthattheindustryofmedicaltourismisadevelopingmarketwithvastpotential.However,variousissuesofprejudicesanduncertaintyontheconsumers’partalongsideunclearre-strictions and laws as well as growing ethical concerns have a negative impact on the industry and perception of themedicaltourismmarket.Atthemoment,besidesThailandandIndia,therearerelativelyfewwell-establisheddestinationsthathavealreadyseenthepotentialofthisindustry.Nevertheless,moreandmorecountriessuchas Malaysia are augmenting their promotional efforts and there is an increasing number of newcomers in the in-dustry, especially among European countries, who profit from attracting neighbouring populations. The growing demand for medical treatment for which people travel has resulted in a development of various medical tourism products and the emergence of facilitators.

PotentialoutboundmarketsarealsobeingidentifiedwithcountriessuchasRussiaandtheMiddleEastofferingthe medical tourism industry new target groups to attract. In general, the demand for medical tourism among outbound countries will be maintained as long as major problems with the national health care provision exist.

In conclusion, the prospects of medical tourism are positive and it has been forecast that the industry will grow.

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USA

Belg

ium

USA

USA

USA

Med

ical

To

uri

sm (

inco

min

g):

200

.000

Mai

n S

trea

ms:

US

and

Can

ada

40%

, Jap

an

and

Ko

rea

20%

, Eu

rop

e 17

%, M

idd

le E

ast

7%,

Mic

ron

esia

6%

, Oth

ers

10%

(Ch

ina,

Ind

ia)

Rea

son

s fo

r co

min

g:

Spec

ialis

atio

ns:

USA

Ph

ilip

pin

es

Ph

ilip

pin

es

Ph

ilip

pin

es

USA

Ph

ilip

pin

es

USA

Ph

ilip

pin

es

USA

Ph

ilip

pin

es

USA

USA

USA

Med

ical

To

uri

sm (

inco

min

g):

341

.288

Mai

n S

trea

ms:

Ind

on

esia

70%

, Sin

gap

ore

10%

, Jap

an 6

%, E

uro

pe

5%, I

nd

ia 3

%,

Oth

ers

6% (

Mid

dle

Eas

t)

Rea

son

s fo

r co

min

g:

Spec

ialis

atio

ns:

USA

Mala

ysi

aM

ala

ysi

aM

ala

ysi

aU

SA

Mala

ysi

aU

SA

Mala

ysi

aU

SA

Mala

ysi

aU

SA

USA

USA

Med

ical

To

uri

sm (

inco

min

g):

150

.000

Mai

n S

trea

ms:

US

95%

, Oth

ers

5%

(Can

ada,

Lat

in A

mer

ica)

Rea

son

s fo

r co

min

g:

Spec

ialis

atio

ns:

USA

Mexic

oM

exic

oM

exic

oU

SA

Mexic

oU

SA

Mexic

oU

SA

Mexic

oU

SA

USA

USA

Med

ical

To

uri

sm (

inco

min

g):

59.

000

Mai

n S

trea

ms:

Net

her

lan

ds

11%

, Fra

nce

10

%, A

ust

ria

8%, P

ola

nd

8%

, Oth

ers

63%

(S

wit

zerl

and

, Ru

ssia

, Mid

dle

Eas

t, U

K, U

S)

Rea

son

s fo

r co

min

g:

Spec

ialis

atio

ns:

USA

Germ

an

yG

erm

an

yG

erm

an

yU

SA

Germ

an

yU

SA

Germ

an

yU

SA

Germ

an

yU

SA

USA

USA

Med

ical

To

uri

sm (

inco

min

g):

250

.000

Mai

n S

trea

ms:

Iraq

38%

, Su

dan

31%

, Pa

lest

ine

30%

, Oth

ers

1% (

UK

, US,

Can

ada)

Rea

son

s fo

r co

min

g:

Spec

ialis

atio

ns:

USA

Jord

an

Jord

an

Jord

an

USA

Jord

an

USA

Jord

an

USA

Jord

an

USA

USA

USA

Med

ical

To

uri

sm (

inco

min

g):

1.4

00.0

00

Mai

n S

trea

ms:

US

33%

, Ch

ina

29%

, Jap

an

18%

, UK

14%

, Oth

ers

6% (

Mid

dle

Eas

t,

Au

stra

lia)

Rea

son

s fo

r co

min

g:

Spec

ialis

atio

ns:

USA

Thail

an

dTh

ail

an

dTh

ail

an

dU

SA

Thail

an

dU

SA

Thail

an

dU

SA

Thail

an

dU

SA

USA

USA

Med

ical

To

uri

sm (

inco

min

g):

150

.000

Mai

n S

trea

ms:

US

95%

, Oth

ers

5% (

Lati

n

Am

eric

a, E

uro

pe)

Rea

son

s fo

r co

min

g:

Spec

ialis

atio

ns:

USA

Co

sta R

ica

Co

sta R

ica

Co

sta R

ica

USA

Co

sta R

ica

USA

Co

sta R

ica

USA

Co

sta R

ica

USA

USA

USA

Med

ical

To

uri

sm (

inco

min

g):

N/A

Mai

n S

trea

ms:

US

95%

, Oth

ers

5%

(Lat

in A

mer

ica,

Can

ada)

Rea

son

s fo

r co

min

g:

Spec

ialis

atio

ns:

USA

Bra

zil

Bra

zil

Bra

zil

USA

Bra

zil

USA

Bra

zil

USA

Bra

zil

USA

USA

USA

Med

ical

To

uri

sm (

inco

min

g):

9.0

00

Mai

n S

trea

ms:

Ger

man

y, A

ust

ria,

UK

, Oth

ers

(US

and

nei

gh

bo

uri

ng

co

un

trie

s)

Rea

son

s fo

r co

min

g:

Spec

ialis

atio

ns:

USA

Cze

ch R

ep

ub

lic

Cze

ch R

ep

ub

lic

Cze

ch R

ep

ub

lic

USA

Cze

ch R

ep

ub

lic

USA

Cze

ch R

ep

ub

lic

USA

Cze

ch R

ep

ub

lic

USA

USA

USA

Med

ical

To

uri

sm (

inco

min

g):

165

.000

Mai

n S

trea

ms:

UK

30%

, Mid

dle

Eas

t,G

erm

any,

Oth

ers

(Bal

kan

, US,

Can

ada,

N

eth

erla

nd

s, C

auca

sus)

Rea

son

s fo

r co

min

g:

Spec

ialis

atio

ns:

USA

Turk

ey

Turk

ey

Turk

ey

USA

Turk

ey

USA

Turk

ey

USA

Turk

ey

USA

USA

USA

Med

ical

To

uri

sm (

inco

min

g):

450

.000

Mai

n S

trea

ms:

US

30%

, UK

, So

uth

Ko

rea,

O

ther

s (S

ou

th A

sia,

Mid

dle

Eas

t, A

fric

a,

Du

bai

)

Rea

son

s fo

r co

min

g:

Spec

ialis

atio

ns:

USA

Ind

iaIn

dia

Ind

iaU

SA

Ind

iaU

SA

Ind

iaU

SA

Ind

iaU

SA

USA

USA

Med

ical

To

uri

sm (

inco

min

g):

410

.000

Mai

n S

trea

ms:

Mo

zam

biq

ue

32%

, Les

oth

o

28%

, Bo

tsw

ana

13%

, Sw

azila

nd

12%

, Oth

ers

15%

(U

S an

d n

eig

hb

ou

rin

g c

ou

ntr

ies)

Rea

son

s fo

r co

min

g:

Spec

ialis

atio

ns:

USA

So

uth

Afr

ica

So

uth

Afr

ica

So

uth

Afr

ica

USA

So

uth

Afr

ica

USA

So

uth

Afr

ica

USA

So

uth

Afr

ica

USA

USA

USA

Med

ical

To

uri

sm (

inco

min

g):

40.

000

Mai

n S

trea

ms:

Jap

an, C

hin

a, U

S, C

anad

a,

Euro

pe,

Ru

ssia

Rea

son

s fo

r co

min

g:

Spec

ialis

atio

ns:

USA

So

uth

Ko

rea

So

uth

Ko

rea

So

uth

Ko

rea

USA

So

uth

Ko

rea

USA

So

uth

Ko

rea

USA

So

uth

Ko

rea

USA

USA

USA

Med

ical

To

uri

sm (

inco

min

g):

2.1

56

Mai

n S

trea

ms:

Ger

man

y 45

%, U

K 2

8%,

Sin

gap

ore

10%

, Oth

ers

17%

(Th

aila

nd

, US,

In

dia

)

Rea

son

s fo

r co

min

g:

Spec

ialis

atio

ns:

USA

Du

bai

Du

bai

Du

bai

USA

Du

bai

USA

Du

bai

USA

Du

bai

USA

USA

USA

Med

ical

To

uri

sm (

inco

min

g):

600

.000

Mai

n St

ream

s: In

done

sia,

Mal

aysi

a, P

hilip

pi-

nes,

UA

E, C

hina

, Oth

ers

(Cam

bodi

a, V

ietn

am,

Bang

lade

sh, P

akis

tan,

Pap

au N

ew G

uine

a, U

K)

Rea

son

s fo

r co

min

g:

Spec

ialis

atio

ns:

USA

Sin

gap

ore

Sin

gap

ore

Sin

gap

ore

USA

Sin

gap

ore

USA

Sin

gap

ore

USA

Sin

gap

ore

USA

USA

Bo

xes

for

inco

min

g c

ou

ntr

ies:

Bo

xes

for

ou

tgo

ing

co

un

trie

s:

No

Wai

tin

g T

imes

Ho

liday

Des

tin

atio

n

Pro

xim

ity

Co

nfi

den

tial

ity

Car

dio

log

y

On

colo

gy

Ort

ho

pae

dic

s

Reh

abili

tati

on

Op

hth

alm

olo

gy

Co

smet

ic S

urg

ery

Den

tist

ry

Tran

spla

nts

Plas

tic

Surg

ery

Bar

iatr

ic S

urg

ery

Der

mat

olo

gy

Ass

iste

d R

epro

du

ctio

n

Stem

Cel

l Th

erap

y

Neu

rolo

gy

Alt

ern

ativ

e

Safe

ty

Infr

astr

uct

ure

Ico

n 1

Insu

ran

ce

Ico

ns

for

the r

easo

ns

for

com

ing

/leavin

g:

Ico

ns

for

speci

ali

sati

on

tre

atm

en

ts:

USA

Med

ical

To

uri

sm (

ou

tgo

ing

): 1

5.00

0

Mai

n S

trea

ms:

Isra

el 4

5%, G

erm

any

20%

, O

ther

s 35

%

Rea

son

s fo

r le

avin

g:

USA

Ru

ssia

Ru

ssia

Ru

ssia

USA

Ru

ssia

USA

Ru

ssia

USA

Ru

ssia

USA

USA

USA

Med

ical

To

uri

sm (

ou

tgo

ing

): N

/A

Mai

n S

trea

ms:

Ger

man

y, B

elg

ium

, Tu

rkey

Rea

son

s fo

r le

avin

g:

USA

Neth

erl

an

ds

Neth

erl

an

ds

Neth

erl

an

ds

USA

Neth

erl

an

ds

USA

Neth

erl

an

ds

USA

Neth

erl

an

ds

USA

USA

USA

Med

ical

To

uri

sm (

ou

tgo

ing

): 7

0.00

0

Mai

n S

trea

ms:

Ind

ia, T

urk

ey, B

elg

ium

, Cze

ch

Rep

ub

lic, O

ther

s (I

taly

, Gre

ece,

Th

aila

nd

, M

alay

sia)

Rea

son

s fo

r le

avin

g:

USA

UK

UK

UK

USA

UK

USA

UK

USA

UK

USA

USA

USA

Med

ical

To

uri

sm (

ou

tgo

ing

): 7

50.0

00

Mai

n S

trea

ms:

Th

aila

nd

44%

, Lat

in A

mer

ica

38%

, Oth

ers

18%

(In

dia

)

Rea

son

s fo

r le

avin

g:

USA

US

US

US

USA

US

USA

US

USA

US

USA

USA

24

Ma

nag

eMen

t Su

MM

ary

5.4 outlook For Further developMent and reSearch

Duetotimerestrictionsofthisproject,severalareasrelatedtomedicaltourismhavenotbeenconsidered.Oneofthe suggested topics of further research would be

• Thetransferabilityofhospitalityratingsystemstohospitalssincethereisalackofoneuniforminternationalaccreditation system that is used by every medical facility and trusted by medical tourists.

• Atthelevelofmedicalfacilities,itisinterestingtoproduceabenchmarkingofwaitingtimesinsteadofpric-es as this is an important reason to seek treatment abroad.

• Atthelegallevel,theeffectoftheEuropeanCommission’sproposedDirectiveforCross-BorderHealthCareand the influences this may have on the operations within the industry at a medical tourism facilitator level as well as the governmental implications of this directive.

• Atapatientlevel,theintangibleaspects(suchaspersonalexperiences)ofmedicaltourismshouldbestud-iedalthoughthisispotentiallyadifficultareaduetopatientconfidentiality.Referralpanelsareatrustworthysource to share experiences.

• Theinternetisthemostimportantsourceofinformation.Developmentandefficiencyofsearchmachinessuchas www.hospitalscout.com is of key importance.

Asthismarketisexpectedtogrowexponentially,itispredictedthatmanynewareasandtopicswillberevealedthat will also be of interest and importance.