Sheikh Hamdam, Crown Prince of Dubai summoned the top officials of various government and private sector bodies to a weekend meeting where he emphasised the need for all of them including the Dubai Health Authority (DHA) and Dubai Department of Tourism to work together to promote his latest medical tourism initiative. The prince made it clear that he will no longer tolerate poor promotion, inter-departmental squabbling and the undermining of promotions by the health authority sending citizens overseas for treatment.

Dubai Health Authority’s (DHA) new initiative on medical tourism is aimed at boosting the international status of Dubai as a destination for medical tourism through concerted efforts of all departments and their private sector counterparts. A new task force will be an overall co-ordinating body to promote the city.

Sheikh Hamdan wants the DHA to promote medical treatment, cosmetic treatment, spa and wellness services. The initiative is part of the Dubai Strategic Plan 2015.

The target for health tourism is Dh6.1 billion by the end of 2012. The main market will be other Gulf states. Dubai wants to attract people from nearby countries and stop its citizens going to Saudi Arabia, Jordan and Qatar for high-end medical services. While the official line from Dubai Healthcare City is still that it sees Europe and America as target markets, an increasing number of doctors admit that almost all American and European business is either working expatriates or holidaymakers. Adding air travel costs to high prices means that DHC cannot compete either on price, or unique facilities, for European or American medical tourists.

Dubai Healthcare City says that 15% of 502,000 patients who sought care in 2011 were medical tourists; up from just 5% of 231,000 patients in 2009. So from 2009 to 2011 the number of medical tourists rose from 46,000 to 75,000.
 
While Dubai has been concentrating on the Gulf, USA and Europe, other UAE states have been more progressive, RAK Hospital has been opening small offices in Iraq, Afghanistan, Ethiopia and Nigeria to find out more about the kinds of patients who are travelling abroad for treatment. It has also been putting together its own treatment packages that include airline tickets, visitor visas and negotiated rates at partner hotels near its base in Ras Al Khaimah.The hospital plans to open offices in Russia, Pakistan, Kenya and Uganda to expand this business further.

Dubai healthcare facilities are working to keep local patients from travelling elsewhere for treatment – and boosting the medical-tourism sector of competing countries. Dr Ayesha Abdullah of Dubai Healthcare City explains,” One of the challenges that the UAE faces is stiff competition from popular medical destinations such as India and South East Asia that also provide competitive medical care. Another challenge is many patients still prefer to get medical care outside the UAE.”

Cleveland Clinic Abu Dhabi, which is scheduled to open next year, is encouraging local residents to seek treatment there while it also tries to attract medical tourists from other states including Dubai.

All hospitals in Dubai have been given a deadline to acquire international accreditations in an effort to raise standards in the healthcare sector. The Dubai Health Authority has given all hospitals operating in the emirate until the end of this year to get or begin the process of getting accreditation. The DHA says that 61% of hospitals already have accreditation, while 29p% are in the process of obtaining it, but 10 % of hospitals have not begun the process of accreditation yet. It takes at least 2 years to get JCI accreditation. The DHA is working on a set of guidelines to govern medical tourism. Facilities would be categorised by cost, with minimum standards and customer protection rules in place.

There are two flaws with this latest Dubai initiative. David Hadley of EHL Management Services, which manages The City Hospital and Welcare Hospital thinks, “There are not enough highly specialised services that other countries do not offer.” Dr Ionnis Michael Salivaras of the American Academy of Cosmetic Surgery Hospital in Dubai adds, “Many people travel for treatment due to lower costs. But our costs are not lower so most people who travel here first look for access to quality health care, followed by privacy, and their last concern would be costs.”

Dubai has thrown a lot of money at building new hospitals and DHCC. For this, the most recent of several initiatives, the ruler has taken control; but only time will tell if this high-price state can deliver.

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Medical tourism providers want a more integrated strategy to attract more potential customers from China as they feel that the effect of a new policy allowing independent Chinese travellers to visit the country has been limited due to poor promotion.

Sammy Yen of Lion Travel argues that the travel industry has been trying to develop more comprehensive medical tourism packages through closer cooperation to win over high-end consumers because a business model relying on quantity is not likely to work, “We used to have high hopes for the independent traveller scheme but may have overestimated its benefits.” Yen says that estimates of 3000 more medical tourism visitors from this programme during the second half of 2011 when it became active were wrong as only 1500 went to Taiwan.

The National Immigration Agency (NIA), records 30,000 Chinese independent travellers between June and December 2011. The quota limit of 500 a day was never close to being achieved.

So Taiwan’s medical tourism providers argue that it must offer more than simple check-ups and cannot rely on Chinese medical travellers just turning up. It needs much more promotion and the creation of more high-end services.

Formosa International Hotels and Lion Travel will now provide three-day packages that could cost over S4000 and include health checks, beauty treatment, shopping and golf.

The medical tourism industry is also urging the various government agencies to work together to promote the Taiwan brand and send an integrated message that Taiwan is one of the best travel destinations to heal your body and soul.

Taiwan has no shortage of high-class hospitals able to offer a range of treatment. So there is frustration that the country is just promoting health-checks and cosmetic surgery.

One proposal is to grant medical visas to Chinese citizens, so there would be great potential that would appeal to high-end Chinese tourists who could visit to the island for medical treatment.

In 2011, more than 4 million people travelled to Taiwan, and nearly 1.2 million of them were from Mainland China, thanks to the gradual warming of cross-strait relations.

The Japanese government now grants a six-month visa to foreigners who visit for medical purposes; so the industry argues that Taiwan’s government should also devise policies that give Chinese tourists opportunities to visit Taiwan for medical reasons, rather than force them to enter the island under the pretense of business or tourism.

There is a problem with openly promoting tourism for medical treatment, as this would suggest that the Chinese government, always touchy on such matters, is unable to offer good medical treatment for its citizens. Effectively Taiwan wants to move upmarket from the lower end of health check and simple cosmetic surgery, as there is more potential and more income. But, the political peace between China and Taiwan is always delicate; one false move could close the doors as China argues that the new travel freedoms are only pilots and could be withdrawn if abused.

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A new medical travel insurance product has been launched just for medical tourists to Thailand.
 
Episodes Medical Travel Insurance offers travellers protection against certain risks of surgery along with safeguards against medical emergencies, lost luggage and trip delays. It can be bought online or on arrival in Thailand. There are two parts to the cover, travel insurance and treatment insurance. LMG Insurance and Liberty International Insurance underwrite the cover, and the in-country assistance is by Mondial Assistance (Thailand).

Episodes is two policies, one is travel insurance and the other is cover for complications. Bumrungrad International, Bangkok Hospital, Medical Travel Quality Alliance and Mondial helped with the development. It is not the first global insurance covering the two areas, but is the only one tailored to a specific country destination.

It covers medical tourists for complications of surgery and anaesthesia, cardiopulmonary events or post-operative complications that may occur during an episode of care even after they return home. Medical tourists may buy only complications insurance or complete medical travel coverage.

The Tourism Authority of Thailand (TAT) is projecting that the healthcare sector will earn $11.5bn by 2014, contributing much to the government target of becoming a world-class healthcare destination by 2014.

Since 2008 Thailand has promoted a holistic collection of curative medical treatment plus preventive spa and wellness services. The earning expectations for medical treatment are $8 billion, $2.23 billion for spa and wellness services, and $1.3billion for sales of products and supplies.

Apichai Jearadisak of the Federation of Thai Spa Associations, says Thailand already leads the regional spa market,” With more than 1,200 registered spas, 400 of which are high-end luxury facilities, Thailand has a claim to call itself the spa capital of Asia. Thai spas are working to upgrade the standards of their services and products, as well as the hygienic standards in the spas themselves. Efforts are also being made to improve the quality of their communications and marketing.”

Dr Prapa Wongphaet of the Thailand Medical Tourism Cluster says, “There are more than 30 international accredited hospitals in Bangkok and various tourist destinations such as Pattaya, Phuket, Samui, Hua Hin, Chiang Mai, Chiang Rai and elsewhere .The country can offer a complete combination of advanced medical treatment and other health related services. More than 200 private and public hospitals have received the hospital accreditation certificate issued by the Healthcare Accreditation Institute.”

Since 2010, the Thailand Medical Tourism Cluster concept has involved the collaboration of five government agencies and five leading business associations to support all aspects of medical and health and wellness tourism to Thailand.

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Vietnam is beginning to seriously promote itself as a destination for medical tourism.

The government admits that 30,000 people go to other countries for medical treatment. Other sources say that even a higher figure of 40,000 people seeking medical help outside of Vietnam is probably too low. Many who stay in Vietnam do so because they cannot afford to travel abroad for treatment. Singapore, China and France are among the destinations.

So why is Vietnam now poised to become a regional player in this expanding market? The star destination in the country is Ho Chi Minh City, where few doctors or dentists speak English, but service is often immediate, relaxed and competent. And compared to America and other Asian countries, the prices are incredibly low.

Vietnam is undeniably an attractive destination but foreign tourists come to enjoy the natural beauty of the country rather than to have medical treatment, and most Vietnamese hospitals are overcrowded. The country is currently limited to offering hot springs, Chinese medicine and cosmetic surgery.

The Vietnam National Administration of Tourism (VNAT) has unveiled a plan to triple the number of Russian visitors from 100,000 last year to 300,000 by 2014. VNAT plans to participate in a series of fairs in Russia and organise road shows and publicity campaigns there. How many they can attract for medical tourism is unclear, while Russia and China are key target markets.

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A Chinese town is to create an international medical tourism project for the hot spring resort of Ruzhou. The total investment is ＄400 million. Ruzhou Hot Spring Leisure Resort sits within the hot spring town, 27 kilometres away from Ruzhou city. The hot spring’s water is crystal clear and smooth as silk. It contains over 50 salutary microelements and macro elements and is also a rare high-quality mineral water for medical use. Besides hydrotherapy, the resort will offer acupuncture, massages, and ultrasonic therapy. The key target market is from within China, plus visitors from Taiwan, Hong Kong and Macau.

Despite government efforts to ban unapproved stem cell treatments, companies in China still offer them openly. In January, the Chinese Ministry of Health attempted to regulate the unapproved stem-cell tourism business in China, announcing rules such as required registration for organizations using stem cells in the clinic and a halt to any unapproved stem cell treatments. But not a single clinic has registered, and business is still booming.

The clinics, which operate openly offer expensive and unapproved stem cell treatments for Parkinson’s disease, diabetes, and autism, among other disorders, and attract thousands of medical tourists from around the world. The Chinese health ministry has made several attempts to ban the treatments, including classifying stem-cell treatments as high risk and requiring the approval of a technical audit board, but they are ignored.

The clinics all claim success in treating patients, but none has published data from controlled clinical trials. The stem-cell clinics are aware of the government regulations. The Ministry of Health is trying to regulate the industry, but internal politics means that the clinics think they can safely ignore the law; particularly those with military or other government backing.

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York academics researching aspects of medical tourism are still keen to talk to people who have paid for treatment overseas, people who have travelled to the UK for treatment, and members of the medical tourism industry.

The purpose of the research funded by the National Institute of Healthcare Research is to explore medical tourism to and from the UK.The main research questions focus upon the economic implications of medical tourism for the NHS, the decision making process for individuals contemplating accessing care abroad, and the development of the medical tourism industry.

The studies are a detailed empirical examination of medical tourism, with interviews with medical tourists, members of the medical tourism industry, health care providers and purchasers, and representatives of professional associations. The research involves integrating policy analysis, economic analysis, and industry case studies.

2012 has already been a busy year for the team with the project moving into its final six months. Recruitment of participants has been steady and preliminary analysis has proven extremely interesting.

The team has contributed to various edited books, including two chapters prepared for the ‘Encyclopaedia of Health Economics’, a chapter in a forthcoming book titled ‘Medical tourism and transnational health care’, as well as comment pieces in the Lancet and the British Medical Journal. Dr Hannah King is leading the preparation for a review of the role accreditation plays in the medical tourism industry. Professor Richard Smith has travelled to East Asia and Dr Neil Lunt has visited South Korea.

The team has completed a review of websites aimed at potential consumers of bariatric and dental treatment abroad, the results of which have formed the basis of a book chapter and submission to a journal. The web review was particularly illuminating, with a real variance in the quality of sites reviewed. The purpose was to recreate the search experience of a consumer interested in finding out more about treatment abroad. The team looked at the general quality of the websites and the quality of clinical information.  Crucially, all websites are deficient in some manner.

Dr Jo Hanefeld is making the final edits to a systematic review of the existing academic medical tourism literature. She has already highlighted the often weak evidential base for many of the claims made about the size and scope of the medical tourism industry. This review will be prepared as a stand-alone article, which will be submitted to an appropriate journal.

The project’s key aim is to assist government and the NHS in dealing with and understanding medical tourism, in advance of the new EU rules on cross-border healthcare.

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Business from Europe has fallen, while higher prices and tougher competition mean Middle East and Russian business is at best static; but Singapore is attracting Asian medical tourists seeking quality rather than a low price.

Hospitals are getting more patients from India and China, as well as the traditional sources of Indonesia and Malaysia. Two years ago, Russia and the Middle East were identified as growing markets. Now, patients from less developed nations such as Cambodia and Mongolia are going to Singapore too.

Parkway had a 38% increase in patients from India in 2011 compared with 2010.Treatment for blood disorders, and kidney and liver transplants rank among the top three areas where patients seek help. Dr Lim Suet Wun of Parkway says “Privacy and Singapore’s reputation as a safe country are among the reasons Bollywood stars and wealthy businessmen choose to fly to Singapore for treatment. They can relax and recover in peace, away from public attention.” Parkway has seen strong growth in medical travellers from Vietnam and Burma.

Raffles Hospital also saw a growth in foreign patients in 2011, especially from Cambodia, Burma, Vietnam and Papua New Guinea. The number from each of these countries grew 20 to 50 % in 2011 compared with 2010. Most sought costly treatments for ailments such as cancer and heart disease.

Singapore Medical Group has 19 clinics and reports that patients from China and India are a fast-growing group. Medical tourists are now one in four patients. A substantial number of Indian nationals make use of the group’s obstetrics and gynaecology expertise – some women fly in to give birth.

The Asian Center For Liver Diseases and Transplantation is getting more patients from Vietnam, Laos, Burma, Cambodia and Mongolia. The private liver transplant centre reports that than 90 % of its transplant patients came from abroad. They choose Singapore for the post-operative care and the clean hospital environment.

Taiwan is targeting ethnic Chinese residents of several Southeast Asian countries, but faces stiff competition from regional rivals such as Singapore. The six-month campaign targets ethnic Chinese citizens of Cambodia, Laos and Burma. Because it is quite difficult for ethnic Chinese naturalized in the three countries to obtain visas to enter Taiwan, the campaign allows them easier access if they travel in tour groups with visits to medical facilities on the itinerary. Taiwan is stricter in issuing visas to visitors from the three countries than to applicants from China, for fear they will work illegally in the country. Numbers are small, at three to four tour groups of 15 to 20 visitors each month, but can be expanded if the idea works.

Taiwan face stiff competition from Singapore and Thailand, who have been promoting medical tourism for much longer and are less strict when it comes to issuing visas. People from Burma, Cambodia, and Laos can just visit Thailand and Singapore for medical purposes at will. There is no need to go through the trouble of applying for a visa as they do for Taiwan.

There are other constraints. The pilot requires visitors planning to travel to Taiwan for medical treatment, health checks or cosmetic procedures to make appointments with Taiwanese hospitals two months prior to their journey. Such complications could well make potential visitors choose Thailand and Singapore over Taiwan.

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For many years medical travellers have gone to private Finnish clinics for treatment and now public hospitals want to attract Russian business. Almost all business comes from Russia, with a smattering from other European countries.

Most private clinics with specialist skills that attract foreign customers to Finland are in Helsinki. The number of foreign customers is not known, but many private clinics in the Finnish capital each receive hundreds of patients from abroad each year. People go for cosmetic surgery, surgery, fertility treatment and cancer care.

The Lauttasaari clinic of Suomen Terveystalo, Finland’s biggest private clinic and hospital chain, receives hundreds of foreign clients every year. They go for varicose veins treatments and laser surgery, which is used to remove wrinkles and tattoos: advanced hair transplant techniques.

Some foreigners go to Finland to receive fertility treatments. At Felicitas Clinic, one out of ten clients come from abroad. Some come from Norway where the laws on donor egg treatments are stricter than in Finland.

Publicly funded hospitals in Finland are showing interest in caring for health tourists coming from Russia. Many hospitals are considering different ways of getting Russian citizens to travel across the border for medical care in Finland. Among measures under consideration to make it easier for foreign customers to find medical care in Finland is the establishment of a patient agency to organise travel for both patients and their accompanying family members or friends.
    
Some public hospitals do attract paying private patients from overseas. Coxa, a hospital specialising in joint replacements in Tampere, gets under 100 foreign patients a year; while 30 to 50 Russian women give birth at the Kymenlaakso Central Hospital in Kotka.

At the private cancer centre, the Docrates Hospital in Helsinki, one in five patients are from abroad. Most of the 300 to 400 patients are Russian. In addition to the actual treatments, the customer service includes post-op hotel accommodation. If needed, a nurse can visit the patient to administer medication, until the patient is ready to return home. Some of the clinic’s patients receive treatment a couple of times a month and they will stay in Finland for a few days at a time. The clinic sees its greatest potential for growth abroad. Language skills are given a priority when hiring staff.

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Health tourism could be a viable income-generating option, which, if pursued, could bring substantial numbers of visitors to Jamaica, argues Dr Wykeham McNeill, Minister of Tourism, “Several organisations have shown interest and we are working closely with the Ministry of Health and the Ministry of Investment, Industry and Commerce to ensure that we put in place a health-tourism policy to grow this area. Jamaica has a clear advantage over many other countries, with natural spas but these need serious investment to reach world-class standards. For medical treatment we have a distinct advantage given our proximity to the USA. The fact that we speak English is certainly an advantage.”

This would not be the first time that Jamaica tried to promote health and medical tourism. Last time it failed. MoBay Hope, a private medical centre in Montego Bay, St James, used to offer cosmetic surgery for people from all over the world.
Nichola Francis, of MoBay Hope explains, “”We have not offered that service for the past six years. We still have a very large number of tourist clients, but those are guests at our hotels, who we attend to on an emergency basis.” The clinic seems less than enthusiastic about getting involved in a new national health and medical tourism promotion.

Another possible location in Montego Bay is Doctors’ Surgi-Clinic .Dr Geoffrey Williams of Doctors’ Surgi-Clinic suggests,” Jamaica could emulate the Far East by setting up centres that offer the same range of services. They have put in resources that do not limit them to cosmetic surgery. Taking travel and accommodation into account, the total cost would be between 50 % and 70% of the US cost- although the true medical cost would be 20% of the US price. We already offer cosmetic surgery to visitors from the US, Europe and the Caribbean.”

Jamaica’s public-health sector is ailing and creaking with concerns about the level of resources provided by the government, but the private sector is attracting some people from other Caribbean countries and the USA. Patients go from St Lucia, the Cayman Islands, Miami, Atlanta, Chicago, Washington and New York. To maximise the benefits of health tourism, Jamaica would have to improve the infrastructure and safety of the island.

The Hospiten Group recently opened a clinic in the port of Falmouth .The minister for tourism, Edmund Bartlett said,” The clinic guarantees healthcare services for the numerous visitors to the port of Falmouth and is part of the development of Jamaica as a medical tourism destination”.

The Ministry of Tourism is conducting a study of the economic impact of the tourism sector, which will be completed soon. The Statistical Institute of Jamaica’s (STATIN) Tourism Satellite Account (TSA is a tool to measure the contribution of the sector; and the Jamaica Hotel and Tourist Association’s (JHTA) has a study on travel and tourism as a driver of economic development. These studies may help decide if health and medical tourism is a sector that Jamaica should promote.

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