How can we measure a destination’s attractiveness?

In country after country, in clinic after clinic, I hear the same mantra repeated as the rationale for why people should visit for medical tourism. “High quality, latest technology,  low cost” is the repetitive chant of those who seek their fortune in medical tourism.

The “significant seven” are:

  • Geographical proximity
  • Cultural proximity
  • Destination image
  • Destination infrastructure
  • Destination environment
  • Risk and reward
  • Price

Note that I have not included quality or technology in these high level determinants.
See the graphic for an overview of the seven determinants.

Geographical proximity

In simple terms, geographical proximity , can be summed up as “how easy is it for patients to get to you?”. The reason why cross border healthcare (meaning patients crossing just the one national border) accounts for the biggest proportion of medical tourism is easy to identify. It’s a short trip in a car, on a train or a plane. It’s hassle free.
Geographical proximity in medical tourism embraces the following factors:

  • Travel time

    A destination that targets source countries more than three hours flight time away is unlikely to succeed (in most cases…. but there are exceptions to the rule). Medical travel is regional not international. Yet in Europe and Asia, there are many destinations that spent their money and their efforts in the pursuit of the American dream, the millions of US patients who are supposed to be desperate for low-cost healthcare and are willing to fly to the ends of the earth to find it. The dream is far from reality. It may remain a dream.

  • Travel convenience: Ease of airport access

    Travel is not just about flight time. People prefer direct flights from airports close to their home to airports close to their ultimate destination. The first place that a destination should start in selecting its target markets is to identify which airports provide regular flights to the desired destination. And by regular I mean daily, direct, low cost flights. Healthcare is not always predictable. So patients and providers must factor in some flexibility in travel arrangements. Once a source airport is selected, the destination can then target its marketing efforts to the catchment area of that airport, not waste its promotional spend on a wider national target audience who may rule them out because the departure airport is three or four hours drive away.

  • Travel convenience: Barriers to entry

    Another aspect of travel convenience are the barriers to entry that may exist in terms of visa requirements. A complex and lengthy application process for visas for the patient and his or her companion/family may block any consideration of the destination for treatment. Some countries have attempted to overcome this by introducing a fast track system for medical visas.

    Cultural proximity

Countries that are geographically close may not be culturally close. A more distant destination with closer cultural ties may be more attractive and this may outweigh concerns about ease of access. There’s a large proportion of the medical tourism market which is driven by family and cultural ties. For example, Latin-American US residents who travel to Latin American countries, second and third generation Anglo-Indians who travel to India.
The key factors include:

  • Language:Good communication is key to a positive patient experience. (See: Treatment Abroad Medical Tourism Survey 2012). It’s vital that the hospital and clinic staff and patients have a common language. Placing an interpreter between doctor and patient may be a solution but it’s far from ideal. Far better that the medical staff and patient can communicate directly. But the medical travel experience extends outside the hospital or clinic; a country that has a “language match” or where a common language (usually English) is widely used by the resident population will score highly. It’s what makes Tunisia attractive to the French cosmetic surgery tourist.
  • Religion:For some patients, their religious beliefs are an integral part of their culture. There is little to be gained by a destination seeking patients where religion may be a factor. Take Poland for example. Despite the undoubted expertise of Krakow’s hospitals and clinics would it make sense for the city to pursue Moslem patients when for historical reasons the city has xxx churches but not a single mosque?
  • Customs and practices:It’s often simple things that reflect cultural proximity. Cyprus is an attractive destination for UK patients. It’s an ex-colony, people drive on the left… the plug sockets are the same as in the UK!
  • Food:We shouldn’t underestimate the importance of familiarity with the local cusine. When Arab patients travel to the UK or Germany for treatment, they often bring the extended family. They may opt for apartment rather than hotel accommodation because the family wishes to cook their own meals.

    Destination image

Destination image is rarely considered in medical tourism. But it’s a factor that plays a big part in desination marketing in the travel industry in general. “Place myths” determine how a patient views a destination. When someone chooses to go for surgery abroad, they will draw on their perceptions of that destination, be they real or imagined.
For example:

  • If you go to India, you’re bound to suffer “Delhi belly” at some stage.
  • If you go to Germany, you can be sure that you’ll be treated with relentless efficiency, but it may be lacking in the personal touch.
  • If you go to Spain, things may be a little more relaxed; the “manyana, manyana” approach may also apply to your medical care.
  • If you go the USA, you’ll find the latest technology (but pay highly for it!)

Destination image is not easy (nor cheap!) to change. You are what you are…. or what people believe you to be. Destinations must accept what they are and focus on the strengths within their brand “personality”.

Destination infrastructure

Destination infrastructure relates to the underlying services and facilities which are available at the destination. This can be on a country or clinic/hospital level. It may embrace the concierge services that support the treatment service, the range and quality of accommodation available for the medical tourist and the ease of getting around at the destination.
The role of the medical travel facilitator may be important in overcoming concerns in terms of infrastructure.

Destination environment

Within destination environment, I include those factors that may enhance attractiveness for some patients:

  • Climate: For some patients this may be a factor. But the “sun, sea and surgery” offer may be misguided when for most patients the focus is on the treatment not the tourism element.
  • Tourism attractions: For patients travelling with family or companions, the opportunities for local sightseeing may appear to be a big plus from the destination’s point of view. But id it really front of mind when once again the patient’s focus is on the treatment.
    Facilities: Within facilities, I include the facilities within which the treatment takes place, and the technology that is used to deliver the treatment. These are rarely a differentiator….. although every hospital and clinic will tell you that their technology is “state of the art”. They wouldn’t tell you anything else, would they? Consider the analogy of air travel. The consumer assumes that the plane they will fly in is “state of the art”, safe and will get them from A to B. They don’t make decisions about which airline to fly based on the plane or the technology that will deliver them to their destination.

    Risk and reward

Risk and reward is one of the most difficult areas when consumers want to compare destinations, hospitals, clinics, health providers and health professionals. The medical tourist is trying to balance a successful outcome to their treatment against the potential risk of something going wrong. Factors that may affect how a destination (meaning a country of a specific healthcare provider) is rated may include:

  • Outcome: How confident can the patient be that the chosen provider will deliver a satisfactory outcome? What proof is provided in terms of either clinical outcome data or patient recorded outcome measures? And if it is provided, how does a non-medic make an informed choice?
  • Safety: Every prospective medical tourist asks him/herself the questions… “Will I be safe?” “What could go wrong?” Comparison of post operative complication rates, hospital infection rates and so on are difficult enough for patients within their domestic healthcare market. Making a comparison across borders is nigh on impossible and will remain so.
  • Track record:At the most basic level, the argument that a destination or a provider that does lots of a particular type of surgery carry some weight in destination attractiveness. (But it’s rarely highlighted by destinations). Take cosmetic surgery for example. According to the International Society of Aesthetic Plastic Surgery, surgeons in which country do five times more rhinoplasties (nose jobs) than surgeons in Thailand? Answer: Brazil….. which suggests that Brazil might be the place to find rhinoplasty expertise.
  • Guarantee:In measuring risk and reward, the existence of some form of treatment guarantee from the provider may provide a point of differentiation, but it’s often difficult to understand what the “guarantee” from the provider actually covers.


When it comes to medical tourism, many destinations believe that it is low treatment costs that will attract patients. But it isn’t. Low cost or “cheap” treatment implies low quality. Read “Medical tourism….it’s not about price!” And treatment cost is not the only price factor in medical tourism. Price is affected by:

  • The cost of treatment.
  • The cost of travel to the destination.
  • The cost of the stay (incorporating accommodation and living costs for the patient and companion/s)
  • The cost of insurance – specialist medical travel insurance and medical complications insurance

The low price offered by a distant destination may be offset by the high cost of airline travel.
For the prospective medical tourist making price comparisons is not straightforward. If they rely on the comparisons provided online by agencies and facilitators, they may be a little confused. A quick search of medical tourism web sites comes up with this range of prices for hip replacement in the USA:

  • $19,500 to $57,000

And for hip replacement in the UK, here’s what you will find quoted:

  • £8,000 to £34,000

No wonder the patient finds it difficult to make a comparison! The reality for the UK is that the range of prices for private hip replacement is £7,500- £13,450 (as quoted by the major hospital groups). So, the oft quoted domestic prices for countries such as the USA and the UK may not actually represent reality. Within the domestic market prices may vary by as much as 100%, making travel within the home country as attractive as overseas medical travel for some patients.


Medical tourists don’t make decisions about competing destinations by comparing the levels of technology, quality and cost. It’s a far more complex decision process. Nevertheless, in an immature and unsophisticated medical tourism marketplace, most destinations put this at the forefront of their marketing. The destination (or healthcare provider) that gets behind this façade and spends time on developing its understanding of the concept of “destination attractiveness” is the one that will prove successful in the long term.




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Keith Pollard
As Editor in Chief of International Medical Travel Journal (IMTJ) and a Healthcare Consultant for LaingBuisson, Keith Pollard is one of Europe’s leading experts on private healthcare, medical tourism and cross border healthcare, providing consultancy and research services, and attending and contributing to major conferences across the world on the subject. He has been involved in private healthcare, medical travel and cross border healthcare since the 1990s. His career has embraced the management of private hospitals in the UK, research and feasibility studies for healthcare ventures, the marketing and business development aspects of healthcare and medical travel and publishing, research and consultancy on cross border healthcare.