A fascinating book was published recently, entitled Patients Beyond Borders (see also http://www.patientsbeyondborders.com/), written by Josef Woodman. Mr. Woodman gives us the benefit of three years’ research into medical facilities available to foreign travelers in a range of countries. He has produced what is described as “Everybody’s Guide to Affordable World-Class Medical Tourism”. Mr. Woodman has spent more than three years researching contemporary medical tourism, interviewing patients, practitioners, administrators, government officials and specialists in the field, while conducting an extensive analysis of safety records, accreditations, success rates and consumer trends. giving potential health travelers the most up-to-date information, pros, cons, considerations, and step-by-step instructions for a successful and cost-effective journey. More than 150,000 Americans travel abroad for healthcare each year to a growing number of highly accredited institutions catering to the American public. Navigating the various countries, hospitals, medical centers, travel agencies and brokers can be a daunting task when facing an important health decision.
Patients Beyond Borders was written to narrow the field to the best possible choices, providing the American consumer with an unbiased and informative guide to a fast growing healthcare phenomenon. It has hundreds of well-researched, safe treatment options for affordable healthcare in 22 destinations worldwide. Though aimed at Americans, the book should be a valuable resource to many other nationalities who wish to search for alternative health care options outside their national borders. This subject featured in a recent article in The Economist (March 10, 2007): “Medical tourism: Sun, sand and scalpels”.
The map of “most-traveled health destinations” is testimony to where the bulk of recent developments in international health travel (or medical tourism) have taken place. Asia is dominant, especially India, Malaysia, Singapore, and Thailand. But he also points to significant developments in the Middle East, Central Europe, South Africa, Central and South America, and the Caribbean. What most of these areas have is realtively well developed economies and infrastructure, significant size and substantial investment in basic healthcare, making them capabale of catering to a wide range of travelers in search of medical treatment.
A lot of attention is centering on medical tourism. Singapore just hosted the Medical Tourism Asia 2007 conference during 26-28 February, setting itself as the center of the new global healthcare village. Mr. Woodman notes that public and private interests in Singapore, Thailand, India and Malaysia have poured the equivalent of billions of US dollars into their healthcare infrastructure, translating to huge gains for those seeking medical treatment. Mr. Woodman chose to launch his book at this conference. Singapore has been an international healthcare destination since the 1980s, and 375,000 international patients visited Singapore’s hospitals and treatment centers in 2005. The country boasts 11 Joint Commission International (JCI)-accredited hospitals—more than any other nation besides the US—and one-third of all JCI-accredited facilities in Asia (see http://www.jointcommissioninternational.com/) . By contrast, no Caribbean institutions are accredited; in fact in the region including Latin America, only Brazil has accredited hospitals (9).
The potential market for such travel is huge. This market is made up at least of 84 million uninsured or underinsured Americans, 120 million Americans who do not have dental plans, or the uncounted millions who want an elective procedure (cosmetic surgery, in vitro fertilization, etc). The estimated potential savings are also very significant, depending on procedures. Here are some startling examples: heart valve replacement costs about US$ 130,000 in the US, but could be obtained for between US$ 9,000-18,500 in several Asian countries; hip replacement costs US$ 43,000 in the US but between US$ 9,000-12,000 in Asia. There are also savings on less complicated surgeries, including dental treatments. Given the general cost of travel from the US, Mr. Woodman cites a “US$ 6,000 rule”: if the total quote for treatment in the US costs more than this, it is likely to be worthwhile to travel abroad to have the treatment done.
When I thought about these developments, my initial view was that here was a potential area for Caribbean countries to exploit in addition to traditional tourism. However, the reality is that the best opportunities for the Caribbean are likely to be in the niche of “wellness”, ie, spas, recovery treatments, herbal or traditional healing, as well as some special facilities such as dialysis and fertility clinic. The two Caribbean countries featured by Mr. Woodman (Antigua and Barbados) give a very limited set of what already exists in the region and the potential for growth. The public facilities in the region are very limited by comparison with places like Asia. This does not ignore some excellent private facilities, especially speciality clinics, which are already attracting significant numbers of visitors.
The General Secretary of the Caribbean Tourism Organization, Mr. Vincent Vanderpool-Wallace, is very well aware of the possibilities for exploiting the “wellness” niche, and encouraged this during a side session during the recent Conference on the Caribbean (see blog). The theme has also been well outlined in recent conferences on wellness and sustainable tourism (see http://www.caribbeanhealthtourism.com). Selling the Caribbean as somewhere to rejuvenate, and re-create after months of tiring work will be part of the next push to widen the region’s tourism market.
Many developments are needed to help this sector develop more generally, as well as for it to help the Caribbean. These include wider accreditation of medical facilities. Although many hospitals outside the US are not JCI accredited, such a “stamp of approval” will greatly help those which hope to attract the huge American market. Another needed development is to have US medical insurance (eg, Medicaid) eligible when seeking treatment outside the US. For the region itself, a useful step would be to start to compile a directory of medical facilities in each of the countries. Such information could be disseminated by Caribbean organizations themselves, but also be added to the information compiled by Mr. Woodman, for a future update.
Like so many ventures in the region, we can compete on quality rather than on scale. That said, we know that to the north, Cuba is already a major provider of international medical facilities. Americans are essentially banned from travelling to Cuba, so that leaves open a regional niche. But Argentina, Brazil, Costa Rica, and Mexico are already significant providers.
There is a significant lack of information about the number, origin, spending, and characteristics of tourists who visit the Caribbean for health and health-related services, which begs for a tracking system to be developed and maintained by CARICOM, with support from other regional agencies, such as Pan American Health Organization, Caribbean Development Bank and Caribbean Tourism Organization. Marketing of heatlh tourism to source countries is needed, as is information about the experience of other countries and regions. This should take appropriate notice of the deveoping competition from non-English speaking countries in the region, with Cuba being notable for having developed a national strategy. The Cuban government’s objective is to convert Cuba into a world medical power, and views health care and tourism as having the greatest growth potential of their export sectors, and providing health services to tourists is part of an overall development strategy. It has SERVIMED, a state run company, which relies on the infrastructure of a network of hospitals and 42 resort centres, and markets health tourism through travel agencies, private clinics and word of mouth.
The English-speaking Caribbean has a huge language advantage over Latin America when it comes to dealing with Americans. However, our size works against us in many ways. So, let’s think about and work on exploiting the “small is beaufiful” angle. We have beautiful locations that are much closer than Asia (imagine 23 hours flying to get to Bangkok), and can truly compete in terms of environment and ambience (our many secluded beaches or hilltop sites). Remember, people used to get sent to the region to help with their health. We need to add some other special local ingredients (such as the wider knowledge of the healing properties of many spice and herbal remedies; see for instance www.nut-med.com) to make the Caribbean “brand” of wellness products unique and truly attractive.