A new international study published in the Lancet this week highlights the challenge that is faced by healthcare systems worldwide and points to opportunities for medical travel destinations to provide healthcare for the “third age”._x000D_
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The Global Burden of Disease study (download available) analysed more than 300 conditions affecting people living in 188 countries between 1990 and 2013. The study was put together by the Institute of Health Metrics and Evaluation (IHME) at the University of Washington, USA, and the Department of Healthcare at Northumbria University in the UK._x000D_
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A key message of the research is that ” progress in health does not mean fewer demands on health systems”_x000D_
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If you’ve worked in healthcare, you’ll know about the concept of QALYs. QUALYs are a measure of the state of health of an individual in which the benefits, in terms of length of life, are adjusted to reflect the quality of life. One QALY is equal to 1 year of life in perfect health. In this study, the researchers used DALYs, or disability-adjusted life years, to compare the health of different populations and to measure ‘health loss’. ( One DALY equals one lost year of healthy life)._x000D_
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In developed countries, they found that although life expectancy is increasing, this was not necessarily spent in good health. In their analysis of the UK between1990 and 2013, they found that the main causes of health loss were ischemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, lung cancer, Alzheimer’s disease, depressive disorders, falls, lower back and neck pain, skin diseases and sense organ diseases. The fastest‐growing leading causes of health loss for British men were diabetes, Alzheimer’s disease and diseases of the sense organs, such as vision and hearing loss._x000D_
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So, people are living longer…. but they are being affected by chronic disease. According to the report authors: “The increase in healthy life expectancy has not been as dramatic as the growth of total life expectancy, and as a result, people are living more years with illness and disability.”_x000D_
Different countries, different health problems, different needs
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The report also highlights the way in which different countries are impacted by different diseases and conditions. When medical tourism destinations start to promote themselves it’s often on an “all things to all patients” basis. i.e. “Come to Country A because we’re great at healthcare” (…. any kind of healthcare)._x000D_
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The report contains a detailed analysis of the “Ten most common GBD (Global Burden of Disease) level 3 causes of DALYs for 188 countries in 2013”. In simple terms, what are the things that result in chronic disability in these countries? It demonstrates the way in which the drivers of medical travel may vary for each country. Here are some data from the table showing the top three contributors to disability for ten selected countries._x000D_
| Country | Primary cause | Secondary cause | Tertiary cause |
| China | Stroke | Back and neck pain | Heart disease |
| Columbia | Violence(!) | Heart disease | Depression |
| Germany | Back and neck pain | Heart disease | Stroke |
| Netherlands | Back and neck pain | Heart disease | Lung Cancer |
| Nigeria | Malaria | Lower Respiratory Infection | HIV/AIDS |
| Russia | Heart disease | Stroke | Back and neck pain |
| Saudi Arabia | Road accidents | Diabetes | Back and neck pain |
| Turkey | Heart disease | Back and neck pain | Chronic Obstructive Pulmonary Disease |
| UK | Back and neck pain | Heart disease | Stroke |
| USA | Heart disease | Back and neck pain | Chronic Obstructive Pulmonary Disease |
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Note how different countries have different health problems… and therefore different needs. If you’re based in Asia and you’re targeting Chinese and Russian outbound medical tourists, what opportunities might be presented and what areas might you target?_x000D_
Health and wellness tourism for the third age
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Much of the effort and activity around the medical tourism sector is directed at those with acute problems – people who need a hip replacement, a cataract operation, extensive dental treatment and so on. Less attention is paid to the management of chronic conditions and to the support of those individuals who are in the “third age” – those with an extended life expectancy but who may be suffering from chronic complaints. The third age has been defined as “the period in life of active retirement, following middle age.” In developed countries such as the UK, much of the focus in healthcare is how the system can deliver care to those who are in relatively good health… but are impaired by a chronic condition. Some countries, such as Germany, have been criticised for “exporting the problem”. Growing numbers of elderly and sick Germans are being sent to care homes and rehabilitation centres in eastern Europe and Asia because of rising costs and falling standards in Germany. The austerity move has been dismissed as ‘inhumane deportation’._x000D_
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Nevertheless, the opportunity is there for destinations and providers to develop the health and wellness tourism sector and meet the chronic rather than acute healthcare needs of an ageing population._x000D_
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The discussions taking place at the International Health and Wealth Conference 2015 (IHW) in the Algarve, Portugal in October will provide insight into the opportunities in this sector._x000D_
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