Medical tourism: very profitable operations

Thailand, Romania, South Africa… The ultra-competitive foreign healthcare market is exploding. And the offer is diversifying beyond simple plastic surgery: kidney transplants or anti-cancer treatments are thus proposed, particularly in India.

From beard transplants in Istanbul, with accommodation in a 4-star hotel, to kidney transplants in India, to dental implants in Hungary, medical tourism is booming. And here we go for the long haul. The sector, which already weighed €60 billion in 2016 (for 14 million patients), is expected to continue to grow by 25% per year over the next decade, driven by an ageing population, increasingly accessible transport and a diversification of care options.

“Many countries, especially in Asia, began by offering comfort services before diversifying, with more sophisticated care designed to address more serious medical problems, such as kidney transplants or heart surgery,” explains the lecturer at Lyon-III University Virginie Chasles, a specialist in health geography. While the care offered is increasingly varied, the main reasons for traveling for health are still the same: the reduction of waiting times, and especially the quest for lower prices. It is therefore not surprising that it all began with cosmetic surgery, rarely reimbursed by Social Security, and perfectly suited to the commercialization of care.

Specialized agencies

Since the beginning of this mobility in the 1990s, Asia has been at the heart of flows from developed countries, particularly India and Thailand, where the reception of foreign patients is a business in its own right. In the latter, the leading state for medical tourism, the sector represents nearly 1% of GDP. Thailand has long attracted patients with very attractive prices (about 70% lower than in the United States) and high quality care. For a hip replacement, for example, it costs about 42,000 euros in the United States, compared to less than 10,000 euros in Thailand. In 2002, Bangkok’s Bumrungrad Hospital was the first in Asia to receive the leading international accreditation for quality of care. Today, more than half of its turnover comes from foreign patients.

India has had a medical visa in place since 2005, issued to more than 230,000 people in 2015, who came for orthopaedic surgery and cancer treatment: “These countries have set up a real health care export system to bring in foreign exchange,” says Professor Edhec Loick Menvielle. This system also handles the business of agencies specialising in the planning of medical stays. Most patients use it to choose the country of care, the clinic, and organise their entire journey on site, from reception at the airport to post-operative follow-up, including a prior appointment on Skype with the doctor.

“Scalpels safaris”

The shift from wellness mobility to the treatment of serious diseases makes the “tourism” aspect of travel increasingly anecdotal. The primary motivation for this mobility is to use care that is not so easily available where you live, and the distraction aspect is very secondary, when it is present,” confirms Virginie Chasles. Some countries continue to rely on a combination of the two, such as South Africa, which has been offering “scalpel safaris” since the 1990s, generally combining cosmetic surgery, a stay in a luxury hotel and a modest safari, arranged for convalescents. A luxury orientation designed to de-dramatize care, but far from being representative of the profile of all those who travel for their health.

Many do not come from wealthy states and seek care abroad that is non-existent or inaccessible in their country: 80% of foreigners who travel to India for treatment come from the South. Many of them are Africans, but also patients from Iraq or Afghanistan, where health services have been ravaged by war, “But let’s not kid ourselves, such practices are only accessible to the wealthiest classes,” says Virginie Chasles.

“Profitable acts”

In the United States too, many of them go abroad for medical treatment, facing health insurance problems: “This affects the middle classes, not the poorest, but not the richest either. These are people who go into debt, who mortgage their homes to get treatment abroad because it is cheaper than at home,” explains Loick Menvielle of Edhec.

Nevertheless, “medical tourism remains a socially differentiated mobility, not a cure for the shortcomings of national health systems,” says Virginie Chasles. Rather, it would even tend to increase inequalities and leave aside the poorest local populations, who continue to suffer from poor access to public health. India’s private clinics, where everything is planned for the reception of foreign patients, is also the country that spends only 1.4% of its GDP on health, and where residents pay nearly 70% of their medical expenses out of their own pockets. And there, as elsewhere, the best practitioners often turn to the private sector, aggravating the shortage of staff in public institutions: “This system is harmful, it leads hospitals to focus on profitable acts to the detriment of others,” says Loick Menvielle,”The reception of foreign patients could contribute to a general improvement of health systems, but for that to happen it would have to be regulated by the state and not by the private sector.