International patient data overstates medical tourism reality

Ian Youngman, healthcare and insurance industry specialist, explains what else gets included in international patient numbers and says it’s wrong to assume all international patients are medical tourists.

In newspapers and on televisions, online and in conversations, the subject of migration is a controversial issue. One argument often raised is that there are too many migrants, they seek state benefits, they burden local health care and they take ‘our’ jobs.

In our industry, what never seems to get a mention however is the effect that migration has on medical tourism figures.

International patient data includes more than medical tourists

When counting medical tourists, the simplistic assumption is that a medical tourist is a patient who is not a citizen of the country, but who may be currently living in or visiting that country. Many reports on medical tourism take the number of ‘international’ patients treated to be the number of medical tourists. In reality, this international patient number may greatly exceed the amount of ‘true’ medical tourists, something that one-off report writers often choose to ignore.

As regular IMTJ readers know, international patient numbers are not just medical tourists but include tourists who get ill abroad, and expatriates.

Less regularly reported is that country-specific international patient numbers can also include students, migrants and temporary workers not counted in longer-stay expatriate figures.

Are we massively overstating medical tourism numbers?

Bearing in mind the less than robust state of most international patient figures, some argue that the difference in these numbers are insignificant.

The latest research however suggests that we may all have been overstating medical tourism figures, due to the significant numbers of legal and illegal migrants in countries.

The latest research from the UN says that in 2017 alone, 5 million new permanent migrants arrived in OECD countries. In addition, more than 4 million temporary foreign workers were recorded in total in OECD countries in 2016, the highest since anyone began measuring such flows ten years ago.

Other migration results find:

• There are 11 million illegal immigrants in the USA and millions more in Europe
• There is increasing evidence of widespread illegal hiring of foreign workers
• International student numbers have reached record levels, with more than 3 million enrolled in higher education establishments in OECD countries
• There are now 67 million expatriates working and living around the globe

Using 2017 OECD figures, 258 million people live outside of their country of birth– and half of these live in OECD countries.

The primary concern is that if countries count students, recent migrants, and anyone else not regarded as a permanent citizen as international patients, then any calculations made to amend international patient numbers to get medical tourism figures may be far too low.

As governments, politicians and the media regularly use medical tourists and international patients as interchangeable descriptions, then perhaps we can really only trust the handful of countries that count actual medical tourists. Even then we must watch for those counting number of hospital visits or adding people accompanying patients.

Illegal employees and refugees: could this be distorting Turkey’s data?

The OECD International Migration Outlook 2018 analyses recent developments in migration movements and policies. It includes two special chapters on the contribution of recent refugee flows to the labour force and on the illegal employment of foreign workers. It also includes country notes and a statistical annex.

OECD countries currently host 6.4 million refugees, with more than half in Turkey alone. The top three countries from which they come are Afghanistan, Syria and Iraq.

Overall, 127 million foreign-born people were living in OECD countries in 2017, or 10% of the total population. Migration has contributed to sustaining much needed labour force growth in many OECD countries.

For the first time, the International Migration Outlook presents consolidated data on all categories of temporary labour migration, including seasonal work. In total, OECD countries are home to more than 4.2 million temporary foreign workers (up 11% from 2016), the largest figure ever measured, reflecting the continuing demand for labour at all levels of qualification in many OECD countries.

The issue of the illegal employment of foreign workers weighs on the minds of many in OECD countries. The illegal employment of foreign workers is commonly understood as migrants who work without a legal right to stay in the host country, but this is only part of the picture. It also encompasses foreign workers who are staying legally in the host country, but who work informally.

Turkey is an example where there are various figures on medical tourists and international patients. The 3 million refugees are not citizens, and may require healthcare more often than locals, so if you count those as international patients and the figures become transformed into medical tourists, then the distortion between international patient numbers and medical tourist numbers is increasing year by year.

For medical tourism, the big takeaway is that when you add the many millions of international students, temporary workers, new immigrants, refugees and illegals into the mix on international patients, and if you accidentally or deliberately confuse medical tourists and international patients, then national and global medical tourism figures become overblown.

Stop using international patient numbers!

My message to every country, researcher and promotional organisation for medical tourism is PLEASE STOP using international patient numbers and pretending they are almost identical to medical tourism numbers. Please provide real medical tourism numbers.

Using real numbers will almost certainly change often well-used figures and perceptions of which countries are doing well on medical tourism and which ones are not; and this is why some countries resist the call for proper medical tourism numbers.

If you want to show how many cars your country makes; you do not include motorcycles, buses and trains. So, let’s change the way that we count medical tourists.