What is the future of medical travel in Europe?

Tourism has been one of the hardest-hit sectors by the pandemic, as governments across the world have imposed severe movement restrictions to slow down the virus. In a two-part feature, Ian Youngman looks at the immediate future of European medical tourism. The second article will explain the latest EU plans for tourism and opening borders.

Recovery research

A recent prediction from global forecaster, Oxford Economics, is of dramatic reductions in tourism numbers in key EU countries, with exact numbers depending on the potential duration of travel bans. Meanwhile, UNWTO expects tourism globally to fall by up to 80% in 2020 compared to 2019.

Although a rapid recovery is expected in 2021, the levels of international travel registered in 2019 are not expected to be restored before 2023, since the prolonged effects on incomes are reflected in tourist numbers.

Medical tourism can only happen after countries remove travel restrictions and predictions for a summer boom in European travel now look increasingly unlikely.

Ban in force until June

The European Commission (EC) has recommended that Schengen Member States and Schengen Associated States extend the temporary restriction imposed on 16 March on non-essential travel to the EU for another 30 days, until 15 June.

All EU Member States (except Ireland) and non-EU Schengen countries (except the UK) have taken national decisions to implement and prolong this travel restriction. The travel restriction does not apply to EU citizens, citizens of non-EU Schengen countries and their family members, and non-EU nationals who are long-term residents in the EU for the purpose of returning home.

While some EU and Schengen Associated States are taking preliminary steps towards easing the measures for fighting the spread of the pandemic, the situation remains fragile both in Europe and worldwide. The EC states this calls for continued measures at the external borders to reduce the risk of the disease spreading through travel to the EU.

The EC says that the lifting of travel restrictions should be phased: as underlined in the Joint European Roadmap on lifting containment measures, internal border controls will need to start being lifted gradually and in a coordinated manner before restrictions at the external borders can be relaxed in a second stage. Restrictions on free movement and internal border controls will need to be lifted gradually before EU countries can remove restrictions at the external borders and guarantee access to the EU for non-EU residents for non-essential travel.

The travel restriction, as well as the invitation to extend it, applies to the ‘EU+ area’, which includes all Schengen Member States (including Bulgaria, Croatia, Cyprus, and Romania) and the four Schengen Associated States (Iceland, Liechtenstein, Norway, and Switzerland), 30 countries in total, but not the UK. The EU calls for a continued coordinated approach as action at the external borders can only be effective if implemented by all EU and Schengen States at all borders, with the same end date and in a uniform manner.

Not medical tourists

For health tourism and medical tourism, except for very rare cases when urgent treatment can only be obtained in another country, the continued ban means a total cessation between most European countries and even within countries. Cancer patients are struggling to get treated in their own countries and those that have been travelling overseas for care, no longer can.

EC package plans

Prospects for 2020 may get a bit clearer for Europeans from 13 May, when the EC is expected to adopt a broad package on tourism, transport and borders in the context of the coronavirus crisis. Details on this will be covered in my second article.

The European Commission is considering:

  • Communication on tourism.
  • Health and safety protocols for main tourism locations, including hotels and other accommodation.
  • Guidance on safe and healthy resumption of passenger transport.
  • Guidance on lifting of internal borders.
  • Communication on the assessment of the application of the temporary restriction on non- essential travel to the EU.

    Elderly travel ban

    Elderly travellers may find themselves banned from travelling abroad, the EU’s medical agency has warned. The European Centre for Disease Prevention and Control (ECDC) says that the movement of vulnerable groups will need to be restricted even when lockdowns are lifted. There are clear risk groups that are more affected and more likely to die so the ECDC suggests that people who have a higher risk should not travel if the virus is still around. The ECDC classifies anyone over 70 and those with health conditions including hypertension, diabetes, heart disease and cancer, as vulnerable.

If the EU adopts the ECDC proposal this would prevent many potential medical tourists traveling to or from most of Europe.

Airports

The EC is expected to recommend social distancing and wearing masks at airports and aboard flights. The measures may go as far as suggesting temperature checks and even blood tests on passengers.

Tests

European protocols could involve people getting tested before they fly out and then carefully monitored once they arrive, either with an antibody or a PCR test. This sounds good in practice but may be impractical in reality.

Inbound EU travel revival prospects

The tourism recovery will involve the participation of public and private sectors, health campaigns to regain the trust of consumers, and national tourism promotion.

One of the main challenges that Europe is facing is that the pandemic has spread to almost all the counties that send tourists there. Most European counties are very wary of opening too early to the UK, USA and even China.

The World Travel and Tourism Council (WTTC) says that it is essential to ensure coordination between the leading countries and refrain from independent practices because these will complicate the tourism recovery process.

WTTC believes that a return to normal will take place in stages, starting with domestic and family leisure trips, then tourism within Europe, and ending with travels abroad.

Europe hopes to make domestic tourism the foundation for recovery amidst worldwide travel restrictions, but the purchasing power of people in a global economy in free-fall is a matter of concern.

Health certifications

Major hotel groups, countries and regions are bringing in a raft of health certifications. These promise that hotels and resorts and food will be clean and safe; something that many have assumed should have been true anyway.

Medical tourism reinvention?

The current situation has opened up a range of possibilities to reinvent many aspects of the tourism industry. Apart from telehealth, how this works for medical tourism is unclear

EU ‘green zones’

A report by two professors from the Spanish business school ESADE, Miquel Oliu and Bary Pradelski (Green-zone travelling: A pan European approach to save tourism) says that many EU countries have launched their exit plans based on regions. As the incidence of the virus decreases, mobility between these regions will normalise.

The professors suggest a ‘green zoning’ to all of Europe. The idea is simple: allowing the mobility of people between green zones of different European countries through a network of regions certified by European institutions, thus mitigating the enormous economic costs that the closure to international tourism could cause for these countries.

Regions with this green label would become part of a certified network of green areas where travel and tourism would be deemed safe and allowed. Given its current levels of spread and control on the pandemic, the Balearic Islands could, for example, receive this green label so that travel between the islands and German regions (also with this label) would be allowed.

Who wants to travel?

Opening up tourism is one thing, but getting people to travel domestically, yet alone globally, may be another problem entirely. With domestic healthcare meaning longer waiting lists, more people may want to look overseas for treatment, but fewer will be able to afford it.

For insurers, the risk of lawsuits if they allow customers to travel overseas and get ill with the virus is a totally new area that may mean they refuse to allow overseas treatment, whatever the policy says.

Who wants medical tourists?

With healthcare systems in most countries under pressure, whether countries have the capacity for medical tourists is also an unknown.

But the problem goes deeper. With elderly, overweight and people with health problems being a core of medical tourism, these are the people who are most at risk from the virus. So, will countries want to encourage visits by people who could be high risk?

Health tourism may be the first to recover, while dental tourism to clinics may be the next revival.

The forgotten niche

Despite reading thousands of news reports and endless pages of official plans, not one has mentioned European medical tourism or even health tourism in their recovery plans.

The absence of a reputable global or European medical tourism organisation means the industry has no voice at the top tables of European tourism. The national medical tourism associations are silent too.

Where next for EU medical tourism?

There is no return to normal for European medical tourism. Telehealth has moved from theory with reluctant use, to an area that governments and insurers have been promoting and introducing as a replacement for physical consultations.

How Europe uses this for medical tourism is a challenge. But it cannot replace an operation, cosmetic surgery or dental work. For 2020, domestic medical tourism is likely to slowly resume but not cross-border European medical tourism. 2021 may see a revival but with changes to how it works, who goes where and for what, and which countries want medical tourists.

IMTJ would love to hear from any national or regional medical tourism organisations on what their plans are to restart medical tourism. Email [email protected]