TITLE Factors behind the growth of medical tourism

INTRODUCTION

This Interim Report reviews investigatory progress and presents further findings of the medical tourism.

The aim of my research is to identify and study why the numbers of patients travelling abroad for medical treatments are rapidly growing and to examine whether the practise brings more benefits or risks for both hosting countries and patients.

My main objectives will be:

finding an answer of why is if beneficial for Europeans and Americans to seek medical treatment,
Market Profile Review and to demonstrate clearer picture a current medical tourism industry, it’s birth and the reason behind its remarkable growth during the recent years.-,
promotion strategies for Malaysia and India.

In the current tourism industry medical tourism plays a main role. I came across many people who would like to have more information regarding travelling abroad for medical treatment. Unfortunately there is no much information from a third party’s point of view. You would find lots of commercial websites and magazines but they might not give you a research answer for the doubts. Creating a paper with information helpful for medical tourists will be an asset to the medical tourist industry and people or organisations involved in it. My paper will be a reference for anyone travelling abroad with medical conditions.

The results from this study will then be used to determine whether the event is overall more beneficial or more risky. The justification of this research is to increase awareness of people considering travelling for medical treatments.

The major problem I will be facing in my research is the lack of the accurate information and the difficulty in finding reliable information about the topic.

Although medical tourism is not a new phenomenon and it has been around for decades the media started selecting medical tourism as an industry only for the past few years following the news of growing numbers of uninsured Americans becoming consumers of medical care in record numbers. Another area under investigation is to find a way of gathering information from people or organisations related to this topic. The people who have gone through medical treatments are normally hesitant to talk about it and it is usually very hard to reach them. The organisation like hospital or professionals like doctors are hesitant to disclose facts and supporting statements because disclosure of such information is a breach of the doctor-patient confidentiality policy and can affect the doctor in a negative way.

I will be looking at both academic and majority of commercial data obtained from Indian and Thailand websites. I will be also travelling to India in December hoping to interview an Indian doctor and an employee working in the travel agency over there. The purpose of this investigation is to fill the gaps in information of medical tourism and also to create awareness whether it is safer or more risky to travel aboard for medical treatments.

Literature review

Since I have submitted my project proposal I have found several book, articles and internet websites some of which I agree and some of which I don’t. Interestingly there were few articles where the data did not match with other data.

Following are my findings:

Jeff Schult in his first book about medical tourism called “Beauty from Afar “presents his findings after his journey abroad for a dental treatment.

He describes medical tourism as a phrase that is used to describe the phenomena of people going overseas for healthcare. He said that people think of medical tourism as a form of vacation: medical sounds that the patient is going to the doctor and tourism is like going on the vacation. He says it is not a good way to think anybody is going overseas for medical care or surgery should think of it as a vacation.

The author explains that it is building up this way by companies.

I don’t agree with the author because there is many patients who travel abroad not only for a purpose of medical treatment. If the procedure is serious then the patient won’t be taking the journey as a purpose of vacation. But if the patient is travelling for example for a dental treatment then it is advisable to visit the country and explore the culture.

I completely agree with the phrase that he has used in his book in terms of tourism promotion “come to Argentina learn ...

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The author explains that it is building up this way by companies.

I completely agree with the phrase that he has used in his book in terms of tourism promotion “come to Argentina learn to tango and have a breast lift”. The author does not like a promotion of marketing tourism this way, neither the doctors nor I.

He also describes interesting topic of why is it so cheap to have a treatment done abroad. Author then explains that it is nothing wrong or dangerous in travelling abroad “if a facelift that costs 15 thousand dollars in Beverly Hills cost 2 thousand dollars in Malaysia”. That is appropriate costs for the same quality care in those countries. Furthermore he states that in the major international cities of the world medical care is equal to, comparable to sometimes better that what can we find in United States.

Another article from where I have learned why patients are being faced to pay high prices in United States are the article “Rising popularity of medical tourism reveals deterioration of U.S. healthcare system” (2005).Mike Adams challenges the healthcare saying that the country doesn’t have the best healthcare in the world but the most expensive treatment. He also adds that “in terms of results for dollars spent, I think the United States ranks very near the bottom of the list of all industrialized nations. We get less actual health than anyone else for each dollar that we spend.” I think that perfectly explain why so many Americans are leaving the country to find offshore locations and experience quality medical care and surgical procedures elsewhere. As the result they are saving enormous amount of money.

Author asks many MD’s and they insist that “as much as 80% of all healthcare dollars that go through their office cover nothing but paperwork”. Author thinks it could be a lot simpler, if the will be much less paper system and the same 80% of the price can be saved. Another reason why these surgical procedures are so much more affordable in Asia is because of the liability issue. Author says that in the United States, doctors and hospitals must carry extremely expensive medical malpractice insurance policies.

Adams says that travelling abroad is safe and the service is outstanding with a high-quality. I agree with his statement. The main reason why I agree is that e live in the area of internet and nothing can be hidden. Through this channel bad word will spread very quickly and tourists won't come to visit their hospital.

Overall I think these findings are very valuable and explain why especially so many Americans travel aboard and moreover what is the reason of so expensive medical treatments in United States.

Another author praising medical treatments abroad is Phillip Palmer.In his article called “A Journey through Medical Tourism” he says how nice the hospitals in so called “third world country” actually are. As he has himself travelled for a medical treatment, Palmer states: “They're very nice. You have a full time nurse in your room, 24 hours a day, seven days a week." He also writes about the companies promoting medical tourism. For example Planet Hospital arranges everything from visas and airport pickup to the choice of hospitals.Another interesting issue author touches is the level of the service. I have found out that doctors in “third world countires” are mainly being trained in the U.S. or U.K and have certificates. He summaries his article by saying that travelling abroad for surgeries protects your savings account.

In the article called “People's Democracy” Amit Sen Gupta I have found the main selling points of medical tourism. First of all is the cost effectiveness. The slogan which this author and many other articles uses is called “First World treatment’ at Third World prices” and the difference in cost as follows: “Open-heart surgery could cost up to $70,000 in Britain and up to $150,000 in the US; in India’s best hospitals it could cost between $3,000 and $10,000. Knee surgery (on both knees) costs 350,000 rupees ($7,700) in India. In Britain this costs £10,000 ($16,950), more than twice as much.

I agree that the price really differ, but is it only the pluses, or else are there any minuses? From the information gathered, I found out lots of issues related to the industry. I have reached the articles which talk about the positive sides of a surgery abroad but I have also reached the articles which are concerned with the risks of conducting the surgeries in foreign countries.

Krysten Crawford in her article called “Medical tourism agencies take operations overseas” 2006 states that the medical tourism is a risky business for a companies promoting medical tourism. The author states that this is mainly word of mouth business and if anything goes wrong there is a lot to loose. The companies have to spend time and travel money to meet with hospital officials, to verify the quality of care and negotiate prices. Hotels need to be outfitted for recuperating patients and have an English-speaking staff.

I agree with the author that it is not enough for a company which promotes and makes money out of the patients to pick the patients up from the airport and collect the money. There is nothing worse than a staff who can hardly speak English.

From the website I have found an article called “Medical Tourism' Industry Grows Rapidly” where I have acknowledged potential risks for patients receiving a treatment in a foreign country.

In case of any complications the follow up care might be very expensive in home country as it is impossible to fly abroad again. It might be also hard to asses the quality as well as the language barrier might be problematic.

I have already learned from Mike Adams article about malpractice laws in the United States but on the other hand it might differ again in other countries.

Article touches the United States again, where they may need to become more efficient and affordable to avoid losing business overseas.

The article state that following factors will decide on growth of medical tourism:

- Insurance market if the insurance market will react it will stop the development and formation of the companies specializing in arranging trips for medical tourists.

- Image problem- consumers from UK or United States will have to overcome stereotypes of developing world poverty, lack of education and hygienic problems in order for the industry to thrive

The issue with the insurance companies too slow to react the businees of companies making business out of medical tourism is surprising but on the other hand it will be very downsizing for those companies if those companies will finally start reacting to the market.

I will not agree with the second idea of the article which refers to an image problem stopping further development of medical tourism. Medical tourism industry is increasingly growing trend and it will not stop until something unexpected will occur.

As I think India contributes significantly in the growth of medical tourism the article called “The healthcare tourism conundrum” wrote by Prabhudev Konana might be a helpful tool in finding some more information. Author identifies India along with other poorest nations. I have discovered that Asia is having the greatest shortage of healthcare professionals. India has around 650,000 physicians with a density of 0.60 physicians per 1000 people. In comparison, the U.S. has 2.56 per 1000. More troubling is that India has a large numbers of patients with tuberculosis, malaria, AIDS/HIV, leprosy, and other contagious diseases.

Another sad issue is that India has low public healthcare spending. In India, more than 75 per cent of the healthcare spending is in the private sector (for the U.S. it is 44.6 per cent). The percentage of out-of-pocket spending on private healthcare is a whopping 97 per cent. In the U.S., it is just 24.5 per cent and in most European countries it is even lower.

I started asking myself whether medical tourism is overall more beneficial or risky as there is a massive gap between the demand and the supply. Private cost of healthcare services may rise since healthcare tourism amplifies the gap between the demand and the supply. But what will happen with local people? Ethical question should be asked whether it is in the best interests of the nation? And will it affects people’s lives?

Research Methodology

I have chosen a qualitative method of approach for my research for a methodology to research medical tourism phenomena. That is particularly appropriate method for further research about medical tourism as it involves the systematic collection, organisation, and analysis of materials derived from talk or simply observation. Each of the research methods examines one or more techniques from interviews, observational techniques and an archival research. Written data sources consist of published and unpublished documents, reports and newspaper articles. In general primary sources are the unpublished data and the data gathered from the people or organization directly. The research method I am going to carry out is called ethnographic research. “It comes from the discipline of social and cultural anthropology where an ethnographer is required to spend a significant amount of time in the field”( Lewis1985).

I am travelling to India end of the year where the personal communication with people in India can be made in order to cover additional information. I am hoping to immerse into the significant culture of the medical tourism phenomena and find out why in India as a new entrant medical tourism is significantly growing, how hospitals are promoting their businesses and whether the promotion is ethical with doctor practice.

I know it is going to be hard to obtain this information but it is worth trying as there is almost impossible to find this particular data.

In depth interview will be conducted with an Indian doctor where I will be aiming at answers to the questions like:

1. What sort of marketing strategies are being used in attracting foreign clients?

2. Are the charges for foreign nationalities the same as for natives or do they vary?

3. Are there any barriers in communication between the patients and doctors in the hospital?

4. What are the advantages and disadvantages of treating foreigners?

5. What are the advantages and disadvantages for local people?

6. What happens in case of a failure of medical treatment and how many have you had? (Not expecting an accurate answer for this one).

7. Are there any communications Medias before and after the treatment?

Other in -depth interview will be made with a person working in a travel agency in India. The additional research I would like to cover will be:

1. Why mainly Americans and British are likely to have a treatment abroad.

2. Are there any main year scale, sex, income within the patients conducting the treatments?

3. How large is practise in numbers. I should be getting some information from the data in the computer.

4. How his company promotes India as a destination for a medical tourism.

I have had a great difficulty in finding the people who undergone medical treatments abroad. I have registered with where I am hoping to run a private discussion board with people who have had medical treatment abroad.

TIME PLAN

I have included long-term research time plan, which I will be submitting by the end of May next year. I have included all tasks I will be engage with while doing my research project. At the same time I will be continuously gathering any new information about medical tourism.

1. February 2006- Survey literature and learn to use relevant tools.

2. March 2006- Engagement with a topic and research on information available from different Medias on the chosen topic.

2. April 2006- Gathering information from the electronic database and the Internet about medical patients who flew abroad to have a treatment done. I will then divide successful/ unsuccessful stories to include in the project when writing about risks and hazards of medical tourism.

3. May 2006 –Concentrating on the downsides of medical tourism, investigate whether the patients are well informed about the risks and problems prior the journey.

4. June-November 2006- Further reading, finding and covering any potential gaps in my knowledge

5 December 2006- January 2007- in-depth interview with an Indian doctor and with the travel agency worker. During my research holiday I will be also accessing Indian hospitals in order to find out more about sanitary conditions, which I have found, is questionable.

6. February-March 2007- run the discussion group with the group of people from and possibility to interview a patient by email.

7. April 2007-Final touches to my project and referencing.

Jeff Schult Beauty from Afar: A Medical Tourist's Guide to Affordable and Quality Cosmetic Care Outside the U.S. (Paperback) in case link http://www.uchc.edu/ocomm/features/stories/stories06/feature_medicaltourism.html
Mike Adams Rising popularity of medical tourism reveals deterioration of U.S. healthcare systemhttp://www.newstarget.com/007097.html
3.
http://pd.cpim.org/2004/0509/05092004_snd.htm Amit Sen Gupta.
Krysten Crawford in her article called “Medical tourism agencies take operations overseas” http://money.cnn.com/2006/08/02/magazines/business2/medicaltourism.biz2/index.htm?postversion=2006080306
“Medical Tourism' Industry Grows Rapidly” http://www.forbes.com/business/2006/10/25/health-medical-tourism-biz-cx_1026oxford.html