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15 January 2019
By Josef Woodman, Founder and CEO of Patients Beyond Borders
Nearly 100 million patients have crossed international borders for medical care since the beginning of this century, and even greater numbers have travelled within their own country for unavailable treatments closer to home. In 2019, more than 20 million patients will continue this practice. These international patients pursue medical care ranging from basic health or dental check-ups to complex, life-saving procedures. While the fundamental drivers—access to quality care and affordability—will remain in place this year, six key trends point to sustained growth in clinical quality and patient experience.
1. Raising the clinical trust bar: A critical mass of international accreditation helps bring universal standards to clinical process and patient safety, offering improved choice to cross-border patients and building increased trust throughout the global healthcare community. The U.S.-based Joint Commission International (JCI) has now accredited more than 1,000 hospitals, up from 87 just 10 years ago, an eye-popping 500 per cent growth. More than one-third are in the Middle East, with UAE topping the list at 188 accredited facilities. China, where rapid healthcare infrastructure development is finally beginning to resolve decades of insufficient patient access, now boasts more than 100 JCI-accredited facilities, and health officials expect that number to double by 2025.
Other international accreditors report brisk business as well, including Temos (Germany), which has awarded nearly 70 hospitals and clinics to date. MTQUA (Thailand), specialising in medical travel certifications, has awarded some 60 facilities since its inception in 2014. Expect to see new and established accreditors—such as AAAHC and AAAASF—ride the quality train.
2. The rise of the OMA: The success of online travel agencies (OTA’s), such as Expedia, Booking.com, TripAdvisor, and Ctrip has paved the way for the parallel healthcare vertical, online medical agencies (OMA’s). These third parties facilitate unassisted bookings, enhance the international patient experience with concierge services, and follow a commission-based revenue model.
Leading the field is Bangkok-based Medical Departures and its sister company Dental Departures, having logged more than 100,000 bookings and over 42,000 verified patient reviews. CEO Paul McTaggart reports that unassisted bookings have risen by +125 per cent over the past five years, even for complex treatments, an indication of growing patient comfort with the model. Other online healthcare players on the radar: Quonomedical (Germany), GetDoc (Malaysia), and Practo (India). To date, large U.S.-based OMA’s such as ZocDoc (U.S.), HealthGrades (U.S.), and RealSelf (U.S.) have not yet spread their wings into the global healthcare arena. Expect their entry soon.
3. Health insurers not coming to the rescue: I am surprised by the number of healthcare leaders who continue to believe that the insurance industry will eventually embrace medical tourism. In truth, all the large U.S.-based carriers—Cigna, Aetna, Generale, and Allianz—have long since abandoned this perfectly reasonable, workable model, where a high-deductible policy offers travel coverage and other incentives to create a win-win for both patients and health plans. The reason why this is hiding in plain sight: member hospitals and clinics are relentlessly squeezed for greater discounts on negotiated rates, and have no appetite for the further humiliation of seeing their patients (and margins) exported to far-flung lands.
Even without the participation of big health plans, the marriage of consumers to carriers is inevitable. In the U.S., third-parties such as IndusHealth have made real progress targeting mid-sized self-insured employers. Outside the U.S., Berlin-based Medigo is giving third-party administration a try, focusing initially on the EU market.
4. But hark! Medical tourism is seeing healthy growth: Despite a lack of institutional and corporate support, international healthcare travel is set to grow at 15-20 per cent in 2019. Fuelled by greater access to quality care (see “accreditation” above), consumers in overpriced healthcare economies (such as the U.S., Canada the UK and most of the EU) are aggressively seeking affordable options, while those in rising economies (such as China and Vietnam), are travelling for the best available care without regard to price. International hospitals and clinics, hungry for attractive margins and heightened prestige, are competing aggressively for global patients.
Expect to see even greater growth in regional patient flows, including North America to Mexico and Costa Rica; Australia and New Zealand to Southeast Asia; and EU countries to Eastern Europe.
5. More growth from China: As China struggles to improve healthcare access and resolve issues of extreme air, water and food toxicity, affluent Chinese are seeking cross-border care in record numbers. Medical centres in the U.S., Singapore, Malaysia, and Thailand are seeing a significant rise in the volume of Chinese patients seeking treatment for complex conditions, especially cancer and respiratory diseases. Middle Eastern destinations such as the UAE are also vying for Chinese patients. In September 2018, Dubai Healthcare City announced a tie-up with a third-party agent to promote its services in Macao.
Ed McCarthy, VP for the Center for International Medicine at the U.S.-based City of Hope National Medical Center, reports growing numbers of adult and paediatric Chinese patients seeking treatment for lung and blood cancers (lymphoma, leukemia) as well as cancers of the gastrointestinal tract, breast, prostate, and brain. Southeast Asia’s leading international hospital, Bumrungrad International reports a similar increase in Chinese patients seeking treatment for high-acuity orthopaedic, brain and spine, cancer, liver, and kidney procedures.
In addition to the demand for disease-specific medical care, some 40 million Chinese women are struggling to conceive a child since China’s one-child policy was lifted in 2016. While fertility clinics are opening throughout China at a rapid rate, the perception of poor clinical quality and patient services will keep concerned couples travelling for at least the next decade in search of the best outcome and a happy, healthy newborn.
6. It’s either mental or dental: It’s unavoidable—our bodies generally outlive our teeth. Most of us will eventually require major restorative dentistry, particularly as affluent populations live well into their 80’s and beyond. Even as dental health is increasingly and inextricably linked to general health and well-being, complex dental procedures remain overwhelmingly elective (and expensive) for most patients. This lack of coverage ensures market growth, with dental tourism expected to increase at a 30 per cent clip, the highest rate within the medical tourism sector.
7. Millennials on the march: Unlike their moms and dads, young women and men in affluent economies have developed a distrust of doctors, insurers, hospitals, and big pharma. Who can blame them? In parallel, millennials are more open-minded about travel and way more savvy in using technology to research medical options. Expect to see a larger slice of the medical tourism pie composed of ageing millennials seeking better and less expensive alternatives to the status quo.
Value-oriented millennials are fuelling a rise in “incidental” medical travel, integrating non-invasive procedures into existing travel plans saving hundreds, sometimes thousands on anything from a dental filling to a CT scan or dermal fillers. Popular destinations such as Thailand, Indonesia, Costa Rica, and Mexico will see more spent on health and wellness activities and less on the stereotypical Margaritaville holiday.
8. Telemedicine: Good news and bad for medical travel: From second opinions to patient monitoring, telehealth’s ongoing contributions are well-documented. Less discussed are the benefits to medical travel providers and patients, where remote physician-to-physician consultation enables in-country diagnosis and treatment planning. This remote partnership builds in-country medical capacity and helps patients that do need to travel for a procedure better prepare for treatment and access greater support upon their return home.
In Coimbatore, India, Sri Ramakrishna Hospital (SRH) has recently implemented a tele-diagnostics and tele-radiology programme, using technology from Tata’s new Gloheal division. Patients and doctors from participating providers in various countries can request diagnoses and second opinions online reducing the costs of travel and logistics. Healthcare professionals are trained on-site or remotely through a partnership with GE Healthcare Asia.
Other regional start-ups in this arena include AlemHealth (Singapore), Cura Healthcare (Saudi Arabia), and eTobb (Lebanon).