Are there opportunities for the Crimean sanatoria?

Stella Tsartsara, Team Leader in Ukraine for the Crimean Tourism Diversification and Support Project in 2012, looks at the origins of Crimea as a medical tourism destination and the potential of its private sanatoria to meet the needs of the growing market for medical rehabilitation.

Are there opportunities for the Crimean sanatoria in the medical tourism market? The immediate response may seem to be “No”, due to the factors that medical tourism professionals will already be familiar with – lack of political will, an uncoordinated policy in the industry sector, Soviet-style marketing of the product, an obsolete banking system, lack of investment and PPP laws, etc. But if we look in more depth, the answer can be “Yes”.

In a recent article by Ian Youngman, “The potential of potential powerhouse economies in medical tourism” the author states: “Russia and the CIS countries offer the biggest long-term market for medical tourism, but while they want a reasonable price, they also demand top quality care and service”.

As the Team Leader in Ukraine in 2012 for the Crimean Tourism Diversification and Support Project, funded by the EU, I undertook a “fam tour”, accompanied by Professor Poberska and Professor Yezhov. We visited 53 Sanatoria and one University Clinic in Crimea, Ukraine, to investigate the value of their medical tourism product.

Crimea is only a small area of the vast and transcontinental territory of Russian and the CIS which stretches from Japan to Germany. It is an area where people from the USSR traditionally had access to the warm sea and the moderate microclimate of Yalta, like no other on the Black Sea. The curative mud and brine treatments from the Lakes of Crimea are claimed to be effective in medical rehabilitation.

A history of curative treatment

Crimea was discovered by the Romanov dynasty. It was the Russian Czars who built the first train line to a “no man’s land” to benefit from the curative treatments cure and to holiday there and who built the Crimea brand as a healing destination. It was subsequently discovered by the Russian intelligentsia who also received treatments while on holiday in Crimea. Over two centuries, Crimea was transformed by the building of Royal palaces that today host the sanatoria – in the country side within magnificent architectural buildings. Anton Chekhov built a sanatorium in Yalta where he treated patients. He was a doctor first and then the writer of the Cherry Orchard.

Subsequently, Vladimir Ilitch Lenin declared Evpatoria as the Soviet Union City for Child Rehabilitation and Treatment, and it is here where the shape of the Crimea was formed as we know it today. In an area the size of Sicily, 600 sanatoria were built to serve the needs of the entire Soviet Union.

Imagine the entire USA population wanting to go for treatment in Sicily. Treatment was paid for by the social security system. Almost all workers in the Soviet Union held a social security card that entitled them to treatment and holidays with their family. Today this system still partly finances the sanatoria in Crimea.

However, it is clear that one day this source of selling medical tourism – the voucher system – will be over.

Potential in the medical tourism market?

So, what does a sanatorium in Crimea offer today? What is its potential in the medical tourism market, both state-funded and private?

The medical tourism offering in a sanatorium in Crimea should be considered in the light of two factors. What diseases can be treated there, and what kind of patients have accounted for 98% of visitors to the Crimean sanatoria?

The range of disease and conditions that Crimean sanatoria treat very successfully today include orthopaedics, spinal cord injuries, musculoskeletal disorders, palsy, cardio-vascular and respiratory disorders and chronic diseases including post-cancer treatment and pain relief.

The segment that the Crimean medical tourism product will address, for the next ten to fifteen years at least, is first of all, 98% Russian speaking. Secondly, it is not the Samsung Galaxy S one generation. It is the Low and Middle Income Countries (LMIC) segment of Europe and the hundreds of millions of Russian and CIS people who cannot afford alternative destinations to Crimea for medical purposes.

We will not consider the potential of the public sanatoria in this article; certain pre-conditions are necessary from the Ukrainian government to support the attractiveness of these facilities as a medical tourism destination.

Let’s focus on the successful private sanatoria in Crimea. What do they offer?

The Crimean sanatoria occupy huge areas of 4 to 18 hectares each, within natural parks with endemic flora. They incorporate five to ten six-storey buildings – hotels and medical facilities, shops, restaurants and cafes, cinemas and libraries, creating what we can call today “Integrated Medical Resorts” providing all-inclusive medical and leisure services.

The medical tourism product of Crimea today is medical rehabilitation – for chronic diseases and conditions, recovery from injury and post-operative recovery, provided in an all-inclusive package of four to eight medical treatments per day with three meals and accommodation for 60 US Dollars per person per day. This is where it starts to get interesting.

The medical tourism product of Crimea is not balneology for general spa and health recovery. I endorse Susie Ellis’ approach in separating spa and medical tourism. Clearly the main product offering in Crimea is medical rehabilitation. As they say “here we cure people; we do not just improve health”.

I have personally visited sanatoria in many countries; nowhere is the medical rehabilitation product as good in medical terms as in Crimea.

An Acropolis that has never been exposed to the public

The map shows countries (in green) surrounding Ukraine where the term medical tourism has been adopted within a government policy or strategy. But this is not so in Ukraine.

This asset is unexploited. It is as if the Greeks had decided not to expose the Acropolis to the public. Only a few private and even fewer public sanatoria have realized the opportunity.

We visited sanatoria with diagnostic facilities, non–invasive surgery facilities and services for the rehabilitation of orthopaedic patients in the cities of Kerch, Evpatoria, Saky and Yalta. We visited sanatoria specialising in the diagnosis, treatment and rehabilitation of patients with palsy that in the summer were crowded out with families with children suffering from palsy, a disease for which only rehabilitation can deliver long lasting effects.

So we pose the question, if someone can access a triad of diagnosis, non-invasive treatment and rehabilitation including three meals per day and accommodation at a cost of 75 euros per day within a park with alpine vegetation and a Mediterranean climate, with movies, shops, cafes, and excursions at a low cost, how attractive would this be for a low to middle income employee? The answer is certainly “Yes”.

In an OECD scoping review on Medical Tourism: Treatments, Markets and Health System implications 1, the authors conclude in an interesting statement: “Clearly, however, source-country payers may benefit from outflows of patients – including employers and employees contributing to health plans, and the public insurance system itself. There may be some opportunities for financial benefit if medical tourism is an option”, through bilateral medical tourism trade deals.

Crimea is not a “sophisticated” destination and this is true also for medical tourism but it possesses assets that each of the competing countries, shown on the map, do not have: climate, resources, hotels close to the Clinics, suitable for medical rehabilitation and at a low price inclusive of all supporting services.

In addition, Crimea is in geographic proximity to the main markets that are of interest ; there is cultural proximity with these markets (except for Russia), given the European and also Muslim population profile. (The second biggest segment of the population are Muslim Tatars.); Crimea’s destination image is appealing to lower and middle income consumers who would prefer destinations “off the beaten track”; the environment is unspoiled and beautiful; and at a price of 75 euros for diagnosis, treatment, and accommodation, then maybe some shortcomings in infrastructure may be forgiven.

Not one sanatorium that we visited believed that it could move forward into the modern medical tourism era alone. They believe that working with medical tourism professionals is needed to modernize their business model. Some of them are eager to do that and taking their first step by attending various medical tourism events.

Move the Acropolis to the North Pole and it is no longer the Acropolis. It is the same with the Crimean sanatoria: the Crimean medical rehabilitation product is a brand in itself, built on a tradition that defines not only the identity of Crimea as a medical tourism destination identity, but is also at the root of the Crimean civilization.

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