Features

Patients without borders

11 Oct 2007 by Mark Caswell

As frequent business travellers, comfortable in most places in the world, it might not come as a surprise that people look abroad for medical treatment. Global travelling has never been easier – never have there been so many flights to such a choice of destinations as there are today, and with increased competition, prices to those destinations have fallen.

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. Now, you can find this information by going 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 better medical treatment than they could 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 in their home country.

From the receiving countries’ point of view, there are economic benefits to be taken into account. Singapore is a good example, since it has been particularly successful in marketing itself as a destination for medical travel. This is due, in large part, to the efforts of SingaporeMedicine, a multi-agency government initiative which links 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 for the 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, 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, says Dr Yap.

“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 prefer the higher assurance of quality; and from many countries in the region because being able to travel to Singapore for healthcare is a mark of affluence.

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

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 it as the best in Asia in 2000. Doctors are sent overseas to train in the best international centres and then return to upgrade and improve local healthcare services.

However, with a population of only 4.5 million residents, Singapore finds it increasingly difficult to sustain the many sub-specialities, to maintain 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 local patients.

It’s a similar story in London’s private hospitals. London Bridge Hospital welcomes patients from around the world seeking highly specialised procedures – they keep its specialists busy and allow the hospital to cement its reputation as a result of all this high-end work.

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 because of poor pay and prestige at home, but thousands more are working outside healthcare. If more money were injected into the system, so the argument goes, conditions would improve, nurses would return to healthcare and a virtuous circle of investment and improved healthcare would be inaugurated.

This is visible 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. Many healthcare institutions publish their success rates on their corporate websites and these are comparable to, if not exceeding, international standards. While healthcare facilities originally sought international accreditations in order to benchmark themselves against the world, these 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.

To take one example, for an angioplasty (where faulty coronary arteries are repaired via a cardiac catheterisation), the cost to the US insurer is estimated at US$26,000 to US$37,000, while it would cost US$57,000 to US$83,000 to an uninsured patient. In Singapore, it costs about US$13,000, similar to the costs at other major Asian medical travel destinations. So, even after factoring in travel and accommodation costs, the savings are still considerable.

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 region. 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 per cent less than similar treatments in Singapore.

Standards there are also getting higher. There are currently three hospitals recognised by the global standards body JCI: Bumrungrad Hospital, Samitivej 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 telephone enquiries and meet-and-greet at the airport, to interpreter services and support for accompanying persons, to follow-up case management.

Bangkok’s hospitals have also done much to offer add-on value. This ranges from bedside immigration concierge services to wifi in many patient rooms
and, in the case of Bumrungrad, luxury serviced apartments with in-room
washing machines and spa 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 special departments to deal only with foreign cases.

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, are very wary of promoting themselves. Ask the South African Tourist Board for help in arranging a trip for medical tourism and you will receive plenty of help 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 be 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 (for example, 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 which puts the patient first, and where the patients can find peace of mind when their health really matters.

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