Features

Patients Sans Borders

30 Sep 2007 by business traveller

The boom in travel has made it easier for patients to receive good quality healthcare in a number of countries. Tom Otley examines these efforts to push the healthcare industry forward.

As frequent business travellers, comfortable in most places in the world, it might not come as a surprise that people travel across borders for medical treatment. Many of us have received treatment in a foreign country.

There are a number of reasons for this. The first, and most general, is that travelling has never been easier. We often concentrate on the negative aspects of travel, but never have there been so many flights, such a choice of destinations, and with such frequency as there is today. And with increased competition, so have prices fallen. In many ways, we have never had it so good.

Coupled with that, as a result of the World Wide Web, there is a greater transparency of information. Ten years ago, if you were thinking of travelling abroad for a medical procedure, you would have had to rely on word of mouth and telephone calls to find a suitable facility or hospital. Now you can find this information – and more – just by logging online and carrying out a simple search. In a few mouse clicks it is possible to access not only the website of the facility, but also a wealth of medical travel agents, consultants and in some cases, the tourism authority of the country in question.

But apart from the lowering of obstacles to medical travel, it seems there are three further incentives causing people to seek treatment abroad. Firstly, other countries may offer them better medical treatment than they can get at home. Secondly, it is often less expensive to be treated abroad. And finally, treatment may be available immediately, whereas there would be a long wait to have it in their home country.

From the receiving countries’ point of view, there are the economic benefits to be taken into account. Figures indicate that Singapore has been particularly successful in marketing itself as a destination for medical travel, in large part to the efforts of SingaporeMedicine, the multi-agency government initiative, linking international patients to the city’s wide range of healthcare options.

“Out of the nearly 10 million visitors to Singapore in 2006, some 410,000 came specifically for healthcare,” says Dr Jason Yap, director of healthcare services, Singapore Tourism Board. “These patients did not come alone and there were 89,000 accompanying persons assisting them on their visits. Another 56,000 received healthcare incidentally on visits for other purposes. So all in all, some 555,000 international visitors to Singapore in 2006 were involved in some aspect of medical travel.”

The range of countries that these travellers have come from, and the range of treatments they require, is staggering, Dr Yap says. “Patients come to Singapore from India for living-donor liver transplants, from UK to avoid waiting for hip replacements, from Indonesia, Malaysia and Indochina because they simply prefer the higher assurance of quality, and from many countries in the region because to be able to travel to Singapore for healthcare is a mark of affluence.

“For visitors from the US, the biggest motivation is the cost savings for high-quality healthcare, as patients can receive US-standard healthcare from JCI-accredited healthcare facilities and internationally known doctors at a fifth of the price back home or less.”

Although, from these figures it might seem obvious why Singapore is investing in medical tourism, Dr Yap suggests that the answer is not so simple: “While the revenue from international patients is naturally welcome… the national imperative to make and maintain Singapore as an international medical hub arises from the need to look after its own citizens and residents.”

Singapore has invested in its healthcare system to create one of the best in the world, with the World Health Organisation ranking Singapore as the best in Asia in 2000. Doctors are sent overseas to train in the best international centres and these doctors return to upgrade and improve local healthcare services to be on par with where they had trained.

However, with her small population of only 4.5 million residents, Singapore finds it increasingly difficult to sustain the many subspecialties, to maintain the many high-end services and to afford the technology. So the effort to draw international patients is really so that a critical mass of patients is maintained. Ironically, and unlike other countries, Singapore seeks foreign patients in order to serve her local patients.

It’s a similar story in private hospitals in London. London Bridge Hospital welcomes patients from around the world seeking highly specialised procedures. Those patients keep its specialists busy, and allow the hospital to cement its reputation as a result of this high-end work. Of course, the revenue these patients contribute to the hospital is very welcome, but more important is the high-end work they are providing.

For countries seeking to attract medical travel, the motivations are clear. In the Philippines for example, not only are thousands of Filipino nurses working abroad as economic migrants because of poor pay and prestige at home, but thousands more are working in jobs outside healthcare. If more money were injected into the system, so the argument goes, then conditions would improve, these nurses would return to healthcare, and a virtuous circle of investment and improved healthcare for patients – both national and international – would be inaugurated.

This is clear in Singapore, where the quality of healthcare is also seen in published clinical indicators, which both attract patients and help improve the quality of healthcare. For example, the incidence of ventilator-associated pneumonias across the Coronary Care Units in Singapore was 2.53 per 1,000 patient days in 2005, compared with 4.4 for the US National Nosocomial Infection Surveillance System. Beyond mere claims of excellence, many healthcare institutions in Singapore publish their success rates on their corporate websites, and these rates are comparable to, if not exceeding, international standards.

While healthcare facilities originally sought international accreditations in order to benchmark themselves against the world, these accreditations also serve as an independent assessment of the quality of their services.

Nevertheless, economics also plays its part in terms of cost. In the US, medical insurance premiums have risen beyond the reach of many. In such circumstances, the motivation to travel abroad for excellent and affordable healthcare is obvious. Singapore is by no means a cut-price destination, but Dr Yap is clear about value for money. “To take one example, for an angioplasty (where faulty coronary arteries are repaired via a cardiac catherisation), the cost to the US insurer is estimated at US$26 to US$37,000 while it would cost US$57 to US$83,000 ‘retail’ to an uninsured patient.”

In Singapore, it costs only about US$13,000, similar to the costs at other major Asian medical travel destinations. So even after factoring in the travel and accommodation costs of the patient and their accompanying persons, the savings are still considerable.

Of course, for every Singapore, there are several destinations wishing to emulate that success. Thailand believes it has a good claim to having pioneered the promotion of medical travel in the Asia-Pacific. As early as the 1980s, Bumrungrad Hospital in Bangkok was entertaining foreign patients, eventually offering them packages for executive check ups and other procedures. These satisfied customers, in turn, helped spread the word about its professionalism and affordable rates. Currently, treatments in the Thai capital are pegged at 40 percent less than similar treatments in Singapore.

Standards there are also getting higher. There are currently three hospitals recognised by the global standards body JCI International: Bumrungrad Hospital, Samitvej and Bangkok Hospital, and more are on the way.

Whether a destination or a particular facility is right for you is a matter of research and your own private circumstances.    Singapore’s healthcare services have evolved dramatically and have created specialised International Patient Liaison Centres to cater to the overseas patient, from the first telephone enquiry and meet and greet at the airport, to interpreter services and support for accompanying persons, to the final send-off and follow-up case management.

Bangkok’s hospitals have also done much to offer add-on value. This ranges from bedside immigration concierge services to renew and extend visas, to Wi-Fi in many patient rooms and, in the case of Bumrungrad, luxury, serviced apartments with in-room washing machines and even spa and Jacuzzi access.

Philippine medical facilities (particularly the Manila-based ones), may, at this stage, still be building a reputation for service excellence, but they’ve put into place several mechanisms to cater to visiting patients. Asian Hospital, St Luke’s and Medical City, to name a few, have set up a special department to deal only with foreign cases. Capitol Medical recently allocated rooms and certain facilities for its Pacific Island and Middle Eastern clientele, which has been growing steadily in the past two years.

In Malaysia, the government plays a vital role in positioning the country as a potential medical hub. In July, it launched the Northern Corridor Economic Region programme, which includes developing health facilities in Penang and Langkawi.

Finally, it must be pointed out that governmental support for such a mission is normally a good sign. There are several destinations well known for medical travel – South Africa, for instance, which, despite having excellent facilities and a good reputation for all sorts of procedures, nevertheless, is very wary of promoting itself. Ask the South African Tourist Board for help in arranging a trip to South Africa for medical tourism, and you will receive plenty of it for the trip element, but very little at all when it comes to finding the right facility.

It’s a very different scenario in Asia-Pacific where the governments of Thailand, Singapore, the Philippines, Malaysia and India often provide links to reputable medical institutions and healthcare establishments on their official websites. Sometimes, the choices can even prove bewildering.

Concerns about potential litigation have made many governments wary, and of course, there is also the problem of orchestrating the sort of joined up thinking necessary for a medical traveller to be welcomed from the start of a trip to the end. In contrast, SingaporeMedicine is a government-industry partnership working to develop and maintain Singapore as a international patient destination. It is led by the Ministry of Health, and supported by three government agencies: the Economic Development Board which develops industry capabilities, International Enterprise Singapore which fosters regionalisation by Singapore’s local healthcare players and the Singapore Tourism Board which manages international marketing and people-oriented services.

These work with the local and international healthcare and medical travel industries to ensure that patients are well taken care of. Where there are issues affecting other government agencies (eg visas), there is a government-wide consensus and effort to balance the different needs for the best solution. With the SingaporeMedicine initiative, the healthcare visitor does not merely go to trustworthy physicians in excellent healthcare facilities or a great tourist destination, but to an entire country that puts the patient first, and where the patients can find peace of mind when their health really matters.

But apart from the lowering of obstacles to medical travel, it seems there are three further incentives causing people to seek treatment abroad. Firstly, other countries may offer them better medical treatment than they can get at home. Secondly, it is often less expensive to be treated abroad. And finally, treatment may available immediately, whereas there would be a long wait to have it in their home country.

Loading comments...

Search Flight

See a whole year of Reward Seat Availability on one page at SeatSpy.com

Business Traveller March 2024 edition
Business Traveller March 2024 edition
Be up-to-date
Magazine Subscription
To see our latest subscription offers for Business Traveller editions worldwide, click on the Subscribe & Save link below
Polls