The COVID-19 pandemic had a monumentally negative impact on medical tourism. With borders in many countries around the world closed for traveller entry for about 18 months, many consumers dependent on cross-border medical care experienced restricted access. There is now huge pent-up demand for many types of treatments. Many patients delayed necessary elective procedures and a significant number of patients have seen their chronic illnesses become exacerbated due to non-treatment. With the delays in diagnosis of diseases such as cancer, patients are coming forward at a later stage of disease progression. This requires they take longer to treat and are more expensive. There are many other factors significantly affecting medical value travel in post-COVID 2023.
According to the Centers For Disease Control (CDC), USA, ‘medical tourism’ is defined as, “The travel to another country for medical care.”. To the liking of this author, this trend is now generally referred to as ‘medical value travel’ or MVT. A tourist, of course, visits a country different than their own and expects most customs to be very similar….. The tourist can become easily exasperated when they find few similarities. Conversely, a traveller visits a different country and expects most things to be different and is thrilled with the differences.
Prior to the COVID-19-plagued 2020, the countries with the highest volume of international medical travellers were Thailand, India, Turkey, Singapore, South Korea, Malaysia, Costa Rica, and the Cayman Islands. Significantly fewer patients sought care in North America — primarily Mexico and the USA.
The surgical procedures which generally lend themselves to international MVT are ones that patients can safely fly to/from, have low complication rates, relatively short lengths-of-stay (including rehabilitation), and few post-treatment follow-up protocols back home. Generally, these include orthopaedic, cardiac, general surgery, gastric bypass, cosmetic surgery, oncology, and dental procedures.
The pandemic obviously had a significant and negative impact on medical value travel. As many of us painfully recall, borders in many countries around the world were closed for traveller entry from mid-2020 through mid-2021. For people dependent on cross-border medical care, these travel prohibitions made a significant impact on their availability of care.
The results of closed borders brought significant changes to MVT in our post-pandemic world. Not surprisingly, there is now huge pent-up demand for many types of treatments. Many patients delayed necessary elective procedures and a significant number of patients have seen their chronic illnesses become exacerbated due to non-treatment (NY Times). With the delays in diagnosis of diseases such as cancer, patients are coming forward at a later stage of disease progression. This requires they take longer to treat and are more expensive. The United Kingdom’s National Health Services (NHS) waiting list could rise to as many as 10.7 million by Spring 2024 (IMTJ). An analysis analysis of cataract surgery volumes estimated that the United States may face a backlog of over 1.6 million cataract procedures by 2023 (NIH). And according to the Canadian Broadcasting Corporation, Ontario, Canada has a pandemic backlog of one million surgeries.
There are many other factors significantly affecting medical value travel in post-pande mic 2023. For instance, several countries are improving their in-country medical services making it more attractive and less costly for families to care locally for their own. Kuwait, the United Arab Emirates (UAE), Oman, and the Kingdom of Saudi Arabia (KSA) are good examples. Hyperinflation in 2020 in several countries quickly ratcheted up the price of medical care; Turkey is a good example, where inflation topped 85 per cent in October, 2022.
There is good news for medical travellers and for countries and hospitals which seek to attract them. In January, 2023 global air travel exceeded 2019 levels for the first time since the COVID-19 pandemic. According to Price Waterhouse Cooper (PWC), two of the top travel trends to watch this year are “Pent Up Travel Demand” and “Health”. Further, industry watchers now anticipate over 27 million medical tourists by 2023, increasing its market value from US$105 billion in 2019 to US$120 billion in 2023 (HMA).
Increasingly though, a trend of ‘medication tourism’ is blooming because patients find that necessary, often life-saving, FDA-approved medications are either prohibitively expensive or simply not available in their home countries. The medicinal cures for Hepatitis C and Spinal Muscular Atrophy (SMA) are excellent examples. For the former, drugs such as Harvoni and Sovaldi retail for prices over US$70,000 for a one-month course of treatment in America, but can be procured and consumed in many countries for under US$4,000.
This author has believed for many years that increasingly consumers will seek cross-border care for three (3) main reasons in this order: Safety, Service, and Savings. These become the Three Ss of Medical Value Travel.
Many consumers travel for wellness and medical care because their perception is that local care is unsafe and of low quality. In an era of increased data transparency by hospitals in countries like the United States, Great Britain, South Korea, and Malaysia (to name a few), consumers can rather quickly determine outcome measures, nosocomial infection and post-surgical infection rates, etc. through the internet. Also, internationally known brands like the Joint Commission International (JCI) and Newsweek magazine offer easy access to ‘Top Hospitals” around the world.
The second S, that of Service, continues to improve at many hospitals and medically directed wellness / anti-aging centres around the globe. Today we live in an “instaculture”…… that is, as consumers most of us expect most goods and services to be produced or delivered on-demand. Think about it: We click on a computer button and we are able to watch movies, sporting events, etc. In real time, we can participate remotely in family gatherings, business meetings, and self-help groups. We can order a latte from our favourite coffee shop and have bicycle or motorcycle driver bring it so us on a park bench — all in under 10 minutes. Today’s healthcare consumer expects the same impassioned commitment to timeliness and sense of urgency. Primary care telemedicine visits need to be in near-time and on-demand. Specialist visits are expected within 24 hours. If a patient has been given a 10 AM appointment, they reasonably expect to be in the exam room by 10 AM – baring provider emergencies with other patients. Because we, the provider community, establish the expectation in urgent care centres, patients expect door-to-door (D2D) throughput times in under 60 minutes. The consumer expectation for non-emergent patient admissions parallels that which they receive in hotels. The same expectation holds true for inpatient discharge times; once the physician tells the patient they are ready for discharge after some post-discharge nursing education, the expectation standard has been established. This is a difficult bogie to hit when there are international insurance companies involved; it can often take four hours or more to obtain final insurer approval and payment guarantee. This lag mandates that international hospitals work closely with major insurers with which they participate.
Another factor increasing patients seeking international medical travel is patient wait times. Patient wait times for major orthopaedic surgery procedures in the United States can be as long as 6-8 months for patients who have Medicare and Medicaid. Queues for patients in Canada and the UK are routinely much longer than this. Since there is nothing even remotely close to “on-demand” with these elongated wait times, international medical travel in a world with pent-up post-COVID demand is even more enticing.
Savings is the third “S” of the three. Medical travelers, whether domestic or international can easily save 50-85 per cent of the prices in their local areas.
So clearly, you can see that the current ‘value’ proposition in Medical Value Travel can be enormous. A consumer can go on-line to a hospital’s website, review quality indicators, select a physician, book an exam and, in most cases, be on a plane within a week and easily be home within a month. And an increased number of them are doing just that!
