The free movement of goods and services under auspices of the World Trade Organisation and its General Agreement on Trade in Services has accelerated the liberalisation of the trade in health services, involving the movement of patients across borders in the pursuit of medical treatment and health care, a phenomenon commonly termed medical tourism (Lunt et al., 2011, p. 6). Large numbers of people are now travelling for medical treatment driven by low-cost treatments and cheaper flights, and access though the Internet of readily available information. But why would people sacrifice their time leaving their home country and flying elsewhere?
The main reasons identified in the literature are presented as follows.
2.6.2.1 Cost savings
One of the common reasons is to save money. As an example, in the US, as mentioned earlier, there is a lack of health insurance coupled with high medical costs making treatment unaffordable for many. In more detail, one of the reasons for medical tourism from the US is that medical treatment can be received at a quarter and sometimes even a tenth of the cost in Asian countries, as can be seen in Table 7.
Table 7 Medical costs in selected countries
Surgery USA UK India Thailand Singapore Malaysia Korea South
Heart Bypass $113,000 $13,921 $10,000 $13,000 $20,000 $9,000 $24,000 Heart Valve Replacement $150,000 $9,500 $11,000 $13,000 $9,000 $36,000 Angioplasty $47,000 $8,000 $11,000 $10,000 $13,000 $11,000 $19,600 Hip Replacement $47,000 $12,000 $9,000 $12,000 $11,000 $10,000 $16,450 Knee Replacement $48,000 $10,162 $8,500 $10,000 $13,000 $8,000 $17,800 Gastric Bypass $35,000 $11,000 $15,000 $20,000 $13,000 Hip Resurfacing $47,000 $8,250 $10,000 $12,000 $12,500 $20,900 Spinal Fusion $43,000 $5,500 $7,000 $9,000 $17,350 Mastectomy $17,000 $7,500 $9,000 $12,400 Rhinoplasty $4,500 $3,500 $2,000 $2,500 $4,375 $2,083 $4,000 Tummy Tuck $6,400 $4,810 $2,900 $3,500 $6,250 $3,903 Breast Reduction $5,200 $5,075 $2,500 $3,750 $8,000 $3,343 Breast Implants $6,000 $4,350 $2,200 $2,600 $8,000 $3,308 $11,000 Crown $385 $330 $180 $243 $400 $250 Tooth Whitening $289 $500 $100 $100 $400 Dental Implants $1,188 $1,600 $1,100 $1,429 $1,500 $2,636 $3,400
Adopted from Lunt et al. (2011) and Medical Tours Korea (2014)
Table 7 shows that the US has the highest medical costs, followed by South Korea. The major medical tourism destinations selected in Asia provide medical treatment at remarkably lower costs than in developed counties such as the US, while costs in South Korea are relatively a little higher.
The UK also has a similar range of prices, while others present even lower costs than South Korea. Considering the medical costs in South Korea, medical tourism does not appear to be competitive compared to other destinations in Asia. This means that the cost is not everything, and there are other factors to consider with regard to medical tourism.
2.6.2.2 Shorter waiting times
Most patients, particularly in the United Kingdom and Canada, are known to lack timely access to elective procedures, and hence they have a strong willingness to travel to other countries for the purpose of medical treatment (Yu et al., 2011). People from both countries are frustrated by long waiting times to seek medical care and tend to go abroad to have quicker access to services. For example, Connell (2006) indicated the long waiting lists for non-essential surgery such as knee reconstructions and fertility
treatments. The waiting lists for knee reconstructions may be as long as 18 months in the UK, while in India the whole procedure can be done in under a week and patients sent home after a further 10 days. On the other hand, fertility treatments may be very long, and undertaken at an important period in couples’ lives, hence many fertility tourists have gone overseas (p. 1097). Some surgery seems to be regarded as non- essential or low priority in some countries such as the UK or Canada, and people who cannot wait for long within the healthcare system of the home country may find it worthwhile to travel to other countries.
2.6.2.3 Better quality
In this rapidly growing consumer-oriented health industry, quality has become an integral part. Without providing quality services no business can survive. People from rich countries are travelling to less developed countries because of less expensive but high-quality medical care (Bookman and Bookman, 2007). As CEO of Patients Beyond Borders, Josef Woodman (2008) points out that governments of countries such as India and Thailand have poured billions of dollars into improving their healthcare systems to cater for the international health traveller, providing VIP waiting lounges, deluxe hospital suites and staffed recuperation resorts along with free transportation to and from airports, low-cost meal plans for companions and discounted hotels affiliated with the hospital. These basic factors of quality and cost for consumers could stimulate more engagements with medical tourism.
In particular, evidence of high-quality medical services can best be found in an international certification system, of which the Joint Commission International (JCI) of America is one. JCI certifies medical service institutions that meet international standards as outlined in Table 8 (JCI, 2015). The numbers of JCI accredited hospitals have been counted from listing on the website (World Hospital Search, 2015).
Table 8 The Numbers of JCI Accredited Organisations Countries The Number of JCI-accredited
Organisations India 25 Malaysia 13 Singapore 21 Thailand 46 South Korea 22
Adopted from JCI (2015)
(Major Tourism Destinations in Asia by count dated on 15th December 2015)
Even though South Korean medical tourism launched in 2007 following a late start compared to other major Asian countries, many South Korean hospitals have already established the required standards of international medical services as referred to above, and are competitive in the market. This could attract future medical tourists to South Korea as a favourable and reliable destination.
2.6.2.4 Accessibility or availability
People sometimes travel for the specific medical treatments which they cannot obtain in their native countries. The issue of access to a particular treatment may also force patients to outsource medical treatment abroad. Lack of access, either because the technology is not available or is prohibited in the home country, can lead to medical tourism. For example, American patients travel to foreign locations due to lack access to unproven medical therapies such as stem cell or cytoplasmic transfer therapy, accepting a degree of risk in clinics situated in such countries as China, India and Ukraine (Sarwar et al., 2012; Turner, 2011). Other patients travel for procedures that are illegal in their home country. Some patients suffering from renal failure arrange commercial organ transplants in countries where it is possible to buy and sell kidneys (Turner, 2011). Within issues such as these, medical tourists are also willing to travel to obtain unique treatments or treatments unavailable in their home countries. These overall main factors – cost savings, shorter waiting times, better quality, accessibility or availability – seem to encourage people who are not satisfied with their home nation’s healthcare system, and the decision to travel abroad will be up to them.