Not long ago the term ‘medical tourist’ was used to describe unscrupulous patients entering the UK to obtain free treatment on the NHS. Today, in contrast, it is used to describe the thousands of British citizens who flee the long waiting lists to seek private healthcare abroad. JuniorDr's Michelle Connolly looks at the surge of medical tourists travelling abroad for sun, sea and surgery.

Whether it’s for a hip replacement, valve surgery or a simple rhinoplasty medical tourism is booming. Last year alone some £130m was spent on medical tourism procedures outside the UK. However, Britons are still in the Ryanair league compared to countries like the United States where 150,000 Americans jet off each year for long-haul procedures in countries as far away as India, Thailand, Argentina and Malaysia.

But the UK is catching up, according to research by analyst Mintel. Their survey suggests that 12 per cent of Britons would consider surgery abroad because of the substantial savings - costing up to eighty per cent less in some cases - compared to private treatment in the UK.

Dental surgery is the most common overseas procedure with around 20,000 Brits travelling to favourites such as Hungary and Poland for a better smile at around £2,500 a time.
Cosmetic surgery comes a close second with 14,500 of us shelling out for facelifts, breast augmentation and liposuction at a cost of £50 million each year. Those wishing to skip NHS waiting lists for elective surgery, the most frequent of which are joint replacements and cataract surgery, make up a further 10,000 patients spending £36 million.

Word-of-mouth is one of the main drivers for overseas treatment. International medical facilities are promoting good service and reward schemes to encourage ex-patients to recommend to friends. Jacqueline Wilson, a 48 year old Herefordshire housewife travelled to Gdansk in Poland for tooth veneers after first getting quotes from British dental surgeons.

Thailand’s Bumrungrad hospital is the number one international hospital in the world treating some 450,000 medical tourists annually.

“Poland was nearly three thousand pounds less than the price I was quoted in Harley Street and I combined it with four-day spa holiday too,” she said. “The hospitals were clean, the operation fast and the staff were very pleasant and spoke English. I’d recommend the experience without question.” 
 
Selling surgery

Foreign governments and private firms have begun to realise the potential of medical tourism. Brits are being wooed abroad by development agencies such as the Singaporean government’s Singapore Medicine, which describes the UK’s ageing population as “a great potential to be tapped into”. 

Intermediary brokers are one of the big drivers for overseas treatment in what is a difficult process for potential patients to negotiate themselves. Dipa Jethwa, from the London-based Taj Medical Group, explained how they try to simplify medical treatment abroad for clients:
“We liaise with the patient’s NHS consultant to obtain their clinical records. We then arrange flights, visas and their admission to hospital.”

While the mainstay of treatment is joint replacement operations, Taj Medical is also benefiting from the obesity epidemic. “We are seeing an increase in the number of patients, particularly from the US and Canada requiring gastric banding surgery.”

And it’s not just small brokers that are benefiting from the public’s new acceptance of private treatment overseas. High street tour operators such as Thomas Cook have realising the potential and have established partnerships with agencies like Taj Medical.

Because of these new medical expectations centres in countries targeting medical tourists are no longer typical hospitals - they are ‘resort hospitals’ with enticing names such as Kuala Lumpur’s ‘Palace of the Golden Horses’.  

Thailand’s Bumrungrad hospital is the number one international hospital in the world treating some 450,000 medical tourists annually. To accommodate Westerners it has a specially built Starbucks in the reception and a pizzeria upstairs.
 
Americans driving the market 
 
Americans lead the way in medical tourism partly because of the baby boomer generation and also because of sporadic healthcare cover. With 45 million Americans uninsured overseas treatment is the only way to avoid huge medical debts. Last year, the average healthcare expenditure for a family of four exceeded the total annual earnings of a minimum wage worker for the first time.

Howard Staab, a 56 year-old carpenter from North Carolina has become the industry’s poster boy. His local hospital demanded a $50,000 deposit from him for a mitral valve replacement before warning him that the cost of treatment could rocket to $200,000. He got change from $10,000 for a pig valve in New Delhi - and also a trip to the Taj Mahal.
Differences in doctor’s salary partly explain why such considerable savings can be made. The average salary of a US family doctor is $161,000, compared to just $35,000 in India.

India

With four doctors for every 10,000 people, compared with 27 in the US, India is hardly a healthcare model to be copied. Yet India is now seen to be leading the world as a medical tourism destination - with the finance minister calling for the country to become a ‘global healthcare destination’.

Efforts have been made to improve infrastructure to help smooth the arrival and departure of medical tourists. Import duty on medical equipment has been slashed and the government has introduced a special medical visa which permits tourists to stay in the country twice as long as before. As a result India’s medical tourism industry is set to balloon to $2 billion by 2012, according to a joint report by the consultancy McKinsey and the Confederation of Indian Industry.

Effect on the NHS

Many expected the boom in medical tourism to lead to a reduction in UK private healthcare prices - instead the effect has been largely an efflux of medical tourists. Fiona Harris, head of personal markets at BUPA, the UK’s largest private healthcare provider, denies that their business is threatened by the boom in medical tourism:
“Sometimes BUPA customers will seek treatment abroad where it is not available in the UK; in these cases we meet the equivalent UK costs of the treatment.”

Social costs

Often the last thing a patient planning an operation overseas considers is the affect on the local community but it’s one of the key concerns that objectors raise. Many fear an internal brain drain whereby doctors leave small rural practices to work in better equipped urban centres that cater for medical tourists.

Anil Maini, director of corporate development at the Apollo Hospitals group - India’s largest medical tourism organisation - doesn’t deny this is the case:

“There is an internal brain drain but there are enough doctors available to serve both rural and urban populations,” he says. “Doctors who had gone overseas are now returning to India, even though they earn a fraction, maybe twenty times less, than they earned in the West.”

There are many who believe medical tourism hails the beginning of a much broader overhaul in the world’s healthcare systems - the advent of medical outsourcing. Outsourcing means that it won’t be the patient who decides to travel for treatment, it will be your insurer or government who sends you abroad to save money. Just as manufacturing and call centre operations were relocated to countries such as India healthcare is likely to follow.

Cost comparisons

> The average procedure in India is one-tenth of the cost in the US.
> Singapore is a more expensive destination but the savings are still large - a liver transplant would cost $300,000 in the US and just $150,000 in Singapore.

> Partial hip replacement
India $4,500
US $18,000
> Full hip replacement
India $3000
US $39,000
> Orthopaedic surgery
India $4500
US $18,000
> Knee surgery
India £8000
UK (Private) £20,000
> Gall bladder surgery
India $7500
US $60,000

Figures are epproximate. They do not include travel and accommodation costs.

References
Burkett L (2007). Medical tourism. Concerns, benefits, and the American legal perspective. J. Leg. Med. 28: 223-45.

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