The issues in measuring medical tourism numbers

Ian Youngman, author of Medical Tourism Facts and Figures 2014, highlights the issue of measuring medical tourism numbers and the problem of differentiating between the international patient and the medical tourist.

An article in a German newspaper on medical tourism once again brings up the biggest problem on claimed medical tourism figures. You cannot blame non-specialist journalists for helping to spread the disease of over claimed numbers that is rife. When a journalist asks a country “How many medical tourists do you get?” he or she may fail to appreciate that the response “We get ‘n’ international patients a year “ is not the answer to the question.

Some countries play fair and specify that these are international patients. Other countries claim ‘n’ as medical tourists when they know perfectly well that ‘n’ includes all sorts of patients, many of whom are not medical tourists.

In some countries the difference between medical tourists and international patients is minimal. But in countries where up to 90% of the working population may be short-contract expatriates, or where there are huge numbers of tourists, it can be very important.

Two separate bank studies over recent years found that as a rule of thumb only one in three international patients was actually a medical tourist. This may seem high but is borne out by my independent analysis of figures of many countries.

Who is an international patient?

Most figures on international patients only refer to people who go to hospitals or clinics for in patient or outpatient treatment. So they do not include health and wellness tourists at spas and spa hotels.

Some countries include people going for a health check without treatment, some do not.

Some countries include everybody in the party, accompanying partners, children and friends.

International patients who are not medical tourists

An international medical tourist is one who goes from where they live to another country solely for the purpose of healthcare or health treatment. Many make the mistake of equating “international patients” with “medical tourists”.

The usual error is to include some or all of the following in the counting of medical tourists:

• Holidaymakers
• Diplomats
• Military personnel
• Business travellers
• Non-nationals who are residents but not citizens of the country
• Temporary expatriates
• Long term expatriates
• Overseas students
• Health/spa tourists
• Refugees

Why the difference can be huge

Many Middle East countries have an adult expatriate population of between 50 and 90% of all working age adults. So if you include expatriates as international patients, then they can outnumber real medical tourists by ten to one.

Some small countries rely on tourism for their economic survival so if they include travelers and cruise ship passengers within international patient numbers this distorts reality.

Hospitals in big EU tourism countries like Spain and Germany often include tourists as international patients. When Germany gets 30 million tourists a year, plus millions more business travelers, if these two categories are included in numbers, the true figures vanish.

Due to civil war in parts of the world, there are millions of refugees and when their numbers are included, they can dwarf the number of local hospital patients and real medical tourists. Even decades after the original conflict refugees may be in another country, but still regarded as international patients.

Health and wellness

To complicate the picture further, is a holidaymaker to a spa hotel, or who goes for a medical check-up as part of a shopping trip, a health and wellness tourist, a medical tourist, or a tourist?

Counting

It would be bad enough if each country had a different way of counting. But the grim reality is that within one country, there can be two or three or more different associations, government departments, quasi official bodies or interest groups all putting out their own figures, and all counting in different ways.

Then there are countries that ask hospitals, hotels, and tour operators for numbers of medical tourists. Each group gives an answer. But instead of thinking that a medical tourist may book via a tour operator, and go to a hospital and stay in a hotel for recuperation (so should only be counted once) all three are added together. The most incredible defence of this dubious tactic for inflating numbers was “we are counting income for the economy and not actual numbers.”

Then of course there are partners and companions of medical tourists which more than one country counts as medical tourists. When a Middle East medical tourist may bring an entire family plus servants, this turns confusion into fantasy.

Translation

When original figures are not in a major international language there is further confusion as what may have started off as “non-citizen patients” gets variously translated as international patients, medical tourists or health tourists.

Some countries have unusual ways of counting. For many years, one Asian country produced figures that were multiples of 100,000 but were translated in European and US medical tourism publications as multiples of a million!

Conclusion

Beware what you read. It may not at all be what is seems to be. And beware the source, some organizations have perfected the art of spinning low real figures into high medical tourism numbers, even at respectable conferences.