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Medical tourism: a HOPE report

There is a growing popularity for medical tourism. There is, however, no general agreement on a standard definition of this business, which is characterised by speculation-based data collection

Pascal Garel
Chief Executive,
HOPE, the European Hospital 
and Healthcare Federation
A growing popularity has recently been gained by medical tourism. There is, however, no general agreement on a standard definition of this business, which is characterised by speculation-based insight and significant gaps of evidence-based comparable data collection and industry regulation. Inconsistent literature about medical tourism and health tourism adds to the confusion. HOPE has been working for the last two years on trying to get a clearer picture. The report ‘Medical Tourism’, published in September 2015, is the result of this work.
The medical tourism industry faces unreliable data when defining and measuring the market by the number of patients. The estimate proposed by McKinsey (2008) is 60,000 inpatient medical tourists (outpatients like dental tourists excluded), and that by Deloitte Center for Health Solutions (2007) is 75,0000 Americans only travelling abroad for treatment; this shows an improbable scope from thousands to millions of medical tourists.  Medical industry events for stakeholders could be potentially key for industry ranking and knowledge. However, the usefulness of these events is limited by lack of reliable data at the basis of performance appraisal and presentation too.
Drivers influencing patients’ decision in having medical treatment abroad are is not universally classified by scholars or by practitioners. Research is needed on medical travellers’ profiles and decision-making processes. Various professionals interact with industrial intermediaries that provide either more patient or more provider-oriented packages, often in a dysfunctional referral system. While brokers and agents only contact foreign facilities for treatment lacking medical knowledge, as no regulation exists, medical tourism facilitators follow the entire patients’ journey, as they are professionals usually working with internationally accredited healthcare providers. Furthermore, despite the high risks, medical travel insurance providers showed little interest in offering such insurance since coverage and risk calculation lack standardised data and regulation. 
Powerful tools for influencing medical travellers’ decision, appealing websites and social media do not solve risk-facing problems even when they are very informative ones. The role of Member States in medical tourism varies. Policy-making, decision-making and even investment-making have been identified to encourage the industry to grow and to promote themselves as medical tourism destinations. 
Although this is about health and life, no common regulatory framework, no standard procedure and no transparent practices are in force. Questions are raised about providing locals and tourists an equal or a different treatment and what regulations are needed to cope with entities and physicians who undergo local regulatory framework of the destination country. Desire for more patients’ trust, self-regulation and standardisation within the industry is bringing international accreditation and certification. However, accrediting and certifying bodies do not usually investigate the quality of consequently not comparable or guaranteed medical services and outcomes. Standards vary across accrediting bodies that grant permissive but expensive certificates.
Far from being approached through reliable, comparable and authoritative data, medical tourism relies then heavily on speculation-based information perpetuating references and idea-based reporting as a must in business. Hence medical tourism is not what people think it is. Some myths, that is, false-to-be statements, are circulating including opinions that medical tourism is a global phenomenon; patients primarily value price; principal medical procedures are performed; the medical tourism market is skyrocketing and new.
To go further HOPE is now working specifically on the European Union experience in medical tourism. European healthcare systems usually provide a universal health insurance but they have different health baskets. There are then a lot of patients that receive medical treatment by travelling within European Union’s borders, either in emergency or in elective care. This mobility is facilitated by mechanisms in place, in particular the regulation on the application of social security schemes (1708/71), the directive on patients’ rights in cross-border healthcare (2011/24/EU) but also the cooperation in border regions.
A free pdf copy of the report is available on the HOPE website: