Americans rate South Africa as quite low on their list of preferred destinations, at number 27 on a list of forty. Canada is the preferred destination for Americans followed by the UK, Israel, Singapore, India, and Germany. Brazil and China are at numbers 22 and 23 respectively and Mexico at 29.
Currently, there seems to be very little interaction between the travel medicine fraternity and medical tourism. It was certainly startling to realise the extent of the burgeoning industry which was put in perspective at the World Medical Tourism and Global Healthcare Congress held in the Chinese resort town of Boao which is situated on the island of Hainan an hour’s flight from Hong Kong.
About 750,000 Americans travel internationally in search of healthcare. The number of medical tourists travelling to Asia alone is expected to have surpassed 10 million last year, with Thailand, India, and Singapore expected to control more than 80% market share. The industry projects annual growth of 15% with a value of 32 billion dollars by 2020. Contrary to popular belief some of the major procedures striven for are not cosmetic and dental care but cardiac, oncological, orthopaedic, and infertility treatment. There seems to be bidirectional movement currently with the major growth areas being the Asia-Pacific region, Eastern and Western Europe, North America and South America.
The high-end market is dominated by American institutions such as the Cleveland Clinic, John Hopkins and Mayo Clinic and they actively market their facilities and expertise which comes at considerable cost. These consumers are more willing to pay for private facilitates and cost is usually not a factor. They are aware of screening facilities and the benefits of preventative interventions and seek the very best of the high technology market. South Africa is experiencing a similar situation, although on a much smaller scale as dollar flush consumers from countries such as Angola and Botswana seek the services of private health care institutions here.
The growing medical tourism market is driven by outbound patients seeking care and procedures in foreign countries as it is either exorbitantly expensive in their home countries, waiting lists for the procedures are extremely long and sometimes run into years, or are not available at all. They seek quality accessible medical care at an affordable price. The range of savings for American medical tourists has been estimated to be about 30% if they travel to Brazil, 50% if the destination is Costa Rica, more than 50% if they travel to Thailand and a staggering 90% for certain interventions performed in India.
A practical example is the full treatment course for Hepatitis C with the drug Sofosbuvir which cost $84,000 in the USA and $900 in India. China is now actively marketing its medical tourism industry and is currently building a fully-fledged medical tourism city close to Boao in Hainan which will have oncological, cardiac, orthopaedic, haematological, and other units available with plans for units that can perform micro and nanosurgery.
The world’s population is also aging. Projections are that by 2050 there will be two billion earthlings aged 60 or older, with 80% living in low or middle-income countries. In fact, by 2020 those over 60 will outnumber children under the age of five for the first time. There is a definite association between longevity and income and in the Western World, as well as in countries with rapidly growing economies such as China, it is projected that the population will live longer. This will fuel the need for medical procedures and hence the projections for the growth of medical tourism.
There is also a concomitant awareness of anti-aging procedures, whether experimental such as stem cell therapy or touted as alternative medicine. Travel medicine practitioners should be aware of current developments as internet ‘research’ is often undertaken by potential medical tourists. The Botox and cosmetic procedures industry is massive in the Asia Pacific region and is projected to grow exponentially.
• Communication may be a problem if different languages are involved and this increases the chances of misunderstandings.
• Some institutions may reuse needles between patients which can transmit diseases such as hepatitis and HIV.
• Some countries are known to be a source of counterfeit or inferior quality medication.
• Antibiotic resistance is increasingly becoming a global problem. Resistant bacteria can spread if hygiene standards are not maintained.
• Some countries obtain their blood supply from paid donors. This may not always be screened and blood-borne diseases may spread in this manner.
• The risk of DVT’s is increased if a patient flies soon after surgery.
The CDC advises those planning to obtain medical services and procedures in foreign countries to be mindful of the abovementioned risks and also recommend a few other considerations:
• Consult a travel medicine practitioner four to six weeks before travel so that an adequate fitness to travel assessment can be done. The risks of the procedures to be performed and its impact on travel can also be discussed.
• The qualifications of the contracted health care providers in the foreign country have to be verified.
• A written agreement has to be in place as to the scope and costs of the procedures.
• The legal recourse if a problem arises pre, during and post-travel has to be ascertained.
• If the language in the foreign country is different to the country of origin, ensure that good translating facilities are in place.
• Copies of all medical records, including allergies, medications used and underlying medical conditions should accompany the patient.
• All medication should have trade, scientific and generic names written down as well as the directions of usage.
• Arrangement for follow-up care upon return with the usual local health care provider should be arranged before departure to the foreign country.
• After the procedures in the foreign country, all required records, notes and follow-up advice post surgery has to be obtained by the patient.
• If the trip involves tourism as well, the patient has to ensure that all planned activities such as swimming are permitted post-surgery.
South Africa is being increasingly marketed as an ideal medical tourism destination. The superb tourist attractions, world-class private medical facilities, highly rated accommodation and recuperative spa facilities and the very favourable exchange rate certain makes for an attractive alternative to the more established countries. Travel medicine practitioners should try to stay abreast of the latest trend and developments.
