What have we learned from the gold rush of medical tourism?

Last year, I blogged about “Medical tourism…lessons from the California gold rush”. It’s taken me a while to write the postscript to this, but I finally got around to it last week when I spoke at the European Medical Travel Conference in Barcelona.

Last year, I blogged about “Medical tourism…lessons from the California gold rush”. It’s taken me a while to
write the postscript to this, but I finally got around to it last week when I spoke at the European Medical Travel Conference in Barcelona. (You can download my presentation “Medical Tourism: After the Goldrush” as a pdf file on the IMTJ web site).

In my gold rush analogy, I describe how in 2005/6, medical tourism became the next big thing.

In Google News for 2006, you’ll see headlines appearing like these:

  •  “One million medical tourists flocking to India”
  • “Bumrungrad attracts more than 400,000 foreign patients each year”
  • “Philippines is set to cash in on the $3-trillion global medical tourism market”
  • “Half a million Britons travel for treatment….”

News stories appeared around the world about a surge in medical tourism. The first prospectors for “medical tourism gold” appeared – medical tourism agents and facilitators, overseas hospitals and clinics were seeking their fortune in the world of medical tourism. The tales of medical tourism gold began to multiply. Estimates of the number of medical tourists were in the hundreds of thousands, the millions, and then the tens of millions. Few medical tourism prospectors questioned the validity of these claims of the discovery of a rich vein of income or whether it was sustainable.

Those involved in the early gold rush exaggerated their successes, claiming massive finds (e.g. “one million medical tourists to….). New entrants pursued the dream without really thinking through their strategy and approach to the market. A community of medical tourism prospectors developed.

As the number of medical tourism prospectors grew, the “saloon keepers” arrived to profit from this growing community, and “store owners” and “tool suppliers” appeared to guide the prospectors in their pursuit of gold. The saloon keepers arrived in the form of the associations and medical tourism conferences that made their money from membership fees and delegate fees. They provided a place where the prospectors could get together, but they also built on the hype, retelling stories of the latest discoveries and attracting more people to the medical tourism gold rush. Entrepreneurs, suppliers and consultants arrived on the scene to provide the tools and advice that the prospectors needed to mine medical tourism gold.

Protectionism appears

In the California gold rush, it didn’t take long before the local prospectors and land owners became fearful of the influx of overseas prospectors (Asian, South American, European) and introduced rules and codes to cut them out of the prospecting business.
In the medical tourism gold rush, we’ve seen the same… the “West’s revenge” where local associations and governments act to protect their business or economy from the threat of overseas healthcare providers. In the UK, we have the British Association of Aesthetic Plastic Surgeons raising concerns about cosmetic surgery tourism (Cosmetic surgery tourists in breast implant risk) ; in Ireland, we have the Irish Dental Association complaining about overseas dental treatment (Dentists warn over foreign treatment), and in the USA President Obama raises concerns about Americans travelling to Mexico and India for treatment (Youtube – Obama targets India again).

Codes of practice, hospital accreditation and medical tourism certification schemes appear to “protect” the patient (or perhaps to make the healthcare provider more attractive?)

So who made money in the medical tourism gold rush?

Well… it’s probably fair to say that quite a few people actually lost money! Entrepreneurs and investors attracted by the hype and the exaggerated claims of market growth found out that the reality was somewhat different. They failed to research and really understand the market. They failed to question the so called “experts”. However…..the best equipped, the best informed and the best organised medical tourism prospectors did well and have survived the gold rush.

The “saloon keepers” (associations, conference organisers and the like) did well while the hype lasted but have found it harder to attract members and delegates in recent times. Several medical tourism conferences have been planned and announced only to be cancelled when it is apparent that delegate numbers won’t hit break even. Other conferences have lost their focus moving away from the emphasis on medical tourism into areas such as spa and wellness, extending their remit into self insurance and healthcare reform to attract a broader (and bigger) audience.

So what happens now…after the gold rush?

The worldwide economic downturn has meant a reduction in discretionary consumer spend – houses, cars, luxury goods – all these markets have suffered. And healthcare has been no different. In the UK, the number of people covered by private medical insurance, declined in 2010 for the first time ever. The number of people opting to pay for cosmetic surgery, or for dental treatment or for elective surgery has fallen. But there are signs of recovery (particularly in the UK market).

Too many prospectors chasing too little medical tourism gold has been made worse by the knock on effect of the economic downturn. But there’s an upside to the downturn for medical tourism. A surge in national debt means that there is now massive pressure on governments and payors to reduce healthcare costs. In the UK, a year ago, a new government came to power saying that the National Health Service would be immune from expenditure cuts. A year later we now see headlines such as “NHS presents spending cuts to government”.

At Treatment Abroad, last week, we received our first ever enquiry from an NHS hospital trust asking about the options for the provision of spinal surgery both in the UK AND in Europe. Perhaps, we will see local and national funding bodies seriously considering the options for treatment of their patients in another country?

What kind of medical tourism world are we facing?

A different one!

A converging medical tourism world: For a great demonstration of how the health and wealth of nations is converging, watch this excellent BBC video “200 countries, 200 years…in 4 minutes” in which Professor Hans Rosling, doctor, academic, and statistician, shows where we have come from and where we are going.
A regional or cross-border medical tourism world: The next time you here someone extolling the virtues of “global healthcare”, ask them to explain exactly what they mean, and when they think that global healthcare will become a reality. We haven’t got close to sorting out the realities and the practicalities of cross border healthcare let alone global healthcare. Read Ian Youngman’s recent article on why the medical tourism world is shrinking, on why it’s good news for the industry.
A regulated medical tourism world: The recent adoption of the European Directive on Patient Mobility will stimulate some thinking (and hopefully some action!) across Europe in terms of making medical travel happen where safety and quality are a given, not an issue. It may also start governments thinking about regulation particularly in the medical travel facilitator/agency sector. Regulation and bonding of (leisure) travel agents exists in many countries already; some would argue that existing regulation should be applied to medical travel agents, and that these should be similarly bonded.
A concentration in the market: Too many small providers and facilitators serving too few customers means that a shake up is probably overdue. If the market does develop significantly, it may become attractive to some of the bigger players in healthcare and in tourism…. but we will need to see a significant expansion.
Joined up healthcare: The best informed, the best equipped and the best organised facilitators and providers will continue to prosper. But the real step forward in medical travel will be taken by those businesses who deliver joined–up healthcare, from diagnosis through treatment to rehabilitation and recovery…..

…which probably gives me the subject of my next blog post.


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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.