(also called medical
, health tourism
healthcare) is a term initially coined by travel agencies
and the mass media
to describe the rapidly-growing
practice of traveling across international borders to obtain
. It also refers pejoratively
to the practice of healthcare providers traveling internationally
to deliver healthcare.
Services typically sought by travelers include elective procedures
as well as complex specialized surgeries
such as joint replacement
, dental surgery
virtually every type of health care, including psychiatry,
alternative treatments, convalescent care and even burial services
are available. As a practical matter, providers and customers
commonly use informal channels of
communication-connection-contract, and in such cases this tends to
mean less regulatory or legal oversight to assure quality and less
formal recourse to reimbursement or redress, if needed .
Over 50 countries have identified medical tourism as a national
industry. However, accreditation
other measures of quality vary widely across the globe, and there
are risks and ethical issues that make this method of accessing
medical care controversial . Also, some destinations may become
hazardous or even dangerous for medical tourists to
In the context of global health, "medical tourism" is a pejorative
because during such trips health care providers often practice
outside of their areas of expertise or hold different (i.e., lower)
standards of care. Greater numbers than ever before of student
volunteers, health professions trainees, and researchers from
resource-rich countries are working temporarily and anticipating
future work in resource-starved areas. This emphasizes the
importance of understanding this other definition.
The concept of medical tourism is not a new one. The first recorded
instance of medical tourism dates back thousands of years to when
Greek pilgrims traveled from all over the
Mediterranean to the small territory in the Saronic Gulf called Epidauria.
This territory was the sanctuary of the healing god Asklepios
. Epidauria became the original travel
destination for medical tourism.
may be considered an early form of
medical tourism. In eighteenth century England, for example,
patients visited spa
because they were
places with supposedly health-giving mineral waters
, treating diseases from
Factors that have led to the increasing popularity of medical
travel include the high cost of health care, long wait times for
certain procedures, the ease and affordability of international
travel, and improvements in both technology and standards of care
in many countries.
Medical tourists can come from anywhere in the First World,
including Europe, the Middle East, Japan, the United States, and
Canada. This is because of their large populations, comparatively
high wealth, the high expense of health care or lack of health care
options locally, and increasingly high expectations of their
populations with respect to health care. An authority at the
Harvard Business School recently stated that "medical tourism is
promoted much more heavily in the United Kingdom than in the United
A forecast by Deloitte
published in August 2008 projected that medical
tourism originating in the US could jump by a factor of ten over
the next decade. An estimated 750,000 Americans went abroad for
health care in 2007, and the report estimated that a million and a
half would seek health care outside the US in 2008. The growth in
medical tourism has the potential to cost US health care providers
billions of dollars in lost revenue.
A large draw to medical travel is convenience and speed. Countries
that operate public health-care systems are often so taxed that it
can take considerable time to get non-urgent medical care. Using
Canada as an example, an estimated 782,936 Canadians spent time on
medical waiting lists in 2005, waiting an average of 9.4 weeks.
Canada has set waiting-time benchmarks, e. g. 26 weeks for a
hip replacement and 16 weeks for cataract surgery, for non-urgent
Additionally, patients are finding that insurance either does not
cover orthopedic surgery (such as knee/hip replacement) or imposes
unreasonable restrictions on the choice of the facility, surgeon,
or prosthetics to be used. Medical tourism for knee/hip
replacements has emerged as one of the more widely accepted
procedures because of the lower cost and minimal difficulties
associated with the traveling to/from the surgery. Colombia
provides a knee replacement for about $5,000 USD, including all
associated fees, such as FDA
and hospital stay-over expenses. However, many clinics quote prices
that are not all inclusive and include only the surgeon fees
associated with the procedure.
According to an article by the University of Delaware publication,
medical travel worldwide destinations include: Argentina, Brunei, Cuba, Colombia, Costa Rica, Hong
Kong, Hungary, India, Jordan, Lithuania, Malaysia, The
Philippines, Singapore, South Africa, Thailand, and recently, Saudi Arabia, UAE, South
Korea, Tunisia and New Zealand.
cosmetic surgery travel destinations include:
Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Mexico and Turkey.
South America, countries such as Argentina, Bolivia, Brazil and
Colombia lead on plastic surgery medical skills relying on their
experienced plastic surgeons. In Bolivia and Colombia, plastic
surgery has also become quite common. According to the "Sociedad
Boliviana de Cirugia Plastica y Reconstructiva", more than 70% of
middle and upper class women in the country have had some form of
plastic surgery. Colombia also provides advanced care in
cardiovascular and transplant surgery.
Belgium, Poland and Slovakia are also breaking into the business.South Africa
is taking the term "medical
tourism" very literally by promoting their "medical safaris".
A specialized subset of medical tourism is reproductive
and reproductive outsourcing
which is the practice of traveling abroad to undergo in-vitro fertilization
, surrogate pregnancy
and other assisted reproductive
treatments including freezing embryos for
However, perceptions of medical tourism are not always positive. In
places like the US, which has high standards of quality, medical
tourism is viewed as risky. In some parts of the world, wider
political issues can influence where medical tourists will choose
to seek out health care.
Health tourism providers
have developed as intermediaries to unite potential medical
tourists with provider hospitals and other organisations. Companies
are beginning to offer global health care options that will enable
North American and European patients to access world health care at
a fraction of the cost of domestic care. Companies that focus on
medical value travel typically provide nurse case managers to
assist patients with pre- and post-travel medical issues. They also
help provide resources for follow-up care upon the patient's
The typical process is as follows: the person seeking medical
treatment abroad contacts a medical tourism provider
provider usually requires the patient to provide a medical report,
including the nature of ailment, local doctor’s opinion, medical
history, and diagnosis, and may request additional information.
Certified medical doctors or consultants then advise on the medical
treatment. The approximate expenditure, choice of hospitals and
tourist destinations, and duration of stay, etc., is discussed.
After signing consent bonds and agreements, the patient is given
recommendation letters for a medical visa, to be procured from the
concerned embassy. The patient travels to the destination country,
where the medical tourism provider assigns a case executive, who
takes care of the patient's accommodation, treatment and any other
form of care. Once the treatment is done, the patient can remain in
the tourist destination or return home.
International healthcare accreditation
Because standards are important when it comes to health care, there
are parallel issues around medical tourism, international healthcare
, evidence-based medicine
and quality assurance
In the United States, the best known accreditation group is the
(JCI). They have been inspecting and accrediting
health care facilities and hospitals outside of the United States
since 1999. Many international hospitals today see obtaining JCI
accreditation as a way to attract American patients.
Joint Commission International is a relative of the Joint
Commission in the United States. Both are independent private
sector not-for-profit organizations that develop nationally and
internationally recognized procedures and standards to help improve
patient care and safety. They work with hospitals to help them meet
Joint Commission standards for patient care and then accredit those
hospitals meeting the standards.
In the UK and Hong Kong, the Trent International Accreditation
is a key player. The different international healthcare
accreditation schemes vary in quality, size, cost, intent and the
skill and intensity of their marketing. They also vary in terms of
cost to hospitals and healthcare institutions making use of them. A
forecast by Deloitte Consulting
regarding medical tourism published in August 2008 noted the value
of accreditation in ensuring quality of healthcare and specifically
mentioned JCI, ISQUA and Trent.
Increasingly, some hospitals are looking towards dual international
accreditation, perhaps having both JCI to cover potential US
clientele and Trent for potential British and European clientele.
As a result of competition between clinics for American medical
tourists, there have been initiatives to rank hospitals based on
Other organizations providing contributions to quality practices
- The Society for International Healthcare Accreditation
(SOFIHA), a free-to-join group providing a forum for discussion and
for the sharing of ideas and good practice by providers of
international healthcare accreditation and users of the same. The
primary role of this organisation is to promote a safe hospital
environment for patients.
- HealthCare Tourism International, the first US-based non-profit
to accredit the non-clinical aspects of health tourism, such as
language issues, business practices, and false or misleading
advertising prevention. The group provides accreditation for all
major groups involved in the health tourism industry including
hotels, recovery facilities, and medical tourism booking
- The United
Kingdom Accreditation Forum (UKAF) is an established network of
accreditation organisations with the intention of sharing
experience good practice and new ideas around the methodology for
accreditation programmes, covering issues such as developing
healthcare quality standards, implementation of standards within
healthcare organisations, assessment by peer review and exploration
of the peer review techniques to include the recruitment, training,
monitoring and evaluation of peer reviewers and the mechanisms for
awards of accredited status to organisations.
- The International Medical Travel Association, (IMTA, based in
Singapore), is a nonprofit association formed to help address
quality standards, liability issues, continuity of care, and other
Medical tourism carries some risks that locally-provided medical
care does not. Some countries, such as India, Malaysia, or Thailand
have very different infectious disease-related epidemiology to
Europe and North America. Exposure to diseases without having built
up natural immunity can be a hazard for weakened individuals,
specifically with respect to gastrointestinal diseases (e.g.
Hepatitis A, amoebic dysentery, paratyphoid) which could weaken
progress, mosquito-transmitted diseases, influenza, and
tuberculosis. However, because in poor tropical nations diseases
run the gamut, doctors seem to be more open to the possibility of
considering any infectious disease, including HIV, TB, and typhoid,
while there are cases in the West where patients were consistently
misdiagnosed for years because such diseases are perceived to be
"rare" in the West.
The quality of post-operative care can also vary dramatically,
depending on the hospital and country, and may be different from US
or European standards. However, JCI and Trent fulfill the role of
accreditation by assessing the standards in the healthcare in the
countries like India, China and Thailand. Also, traveling long
distances soon after surgery can increase the risk of
complications. Long flights and decreased mobility in a cramped
airline cabin are a known risk factor for developing blood clots in
the legs such as venous thrombosis or pulmonary embolus economy class syndrome
vacation activities can be problematic as well — for example, scars
may become darker and more noticeable if they sunburn while
healing. To minimise these problems, medical tourism patients often
combine their medical trips with vacation time set aside for rest
and recovery in the destination country.
Also, health facilities treating medical tourists may lack an
adequate complaints policy to deal appropriately and fairly with
complaints made by dissatisfied patients.
Differences in healthcare provider standards around the world have
been recognised by the World
, and in 2004 it launched the World Alliance for Patient
. This body assists hospitals and government around the
world in setting patient safety policy and practices that can
become particularly relevant when providing medical tourism
Receiving medical care abroad may subject medical tourists to
unfamiliar legal issues. The limited nature of litigation
in various countries is one reason for
the lower cost of care overseas. While some countries currently
presenting themselves as attractive medical tourism destinations
provide some form of legal remedies for medical malpractice, these
legal avenues may be unappealing to the medical tourist. Should
problems arise, patients might not be covered by adequate personal
insurance or might be unable to seek compensation via malpractice
lawsuits. Hospitals and/or doctors
in some countries may be unable to pay the financial damages
awarded by a court to a patient who has sued them, owing to the
hospital and/or the doctor not possessing appropriate insurance
cover and/or medical indemnity.
There can be major ethical issues around medical tourism. For
example, the illegal purchase of organs and tissues for
transplantation has been alleged in countries such as India and
China prior to 2007.
Medical tourism may raise broader ethical issues for the countries
in which it is promoted. For example in India, some argue that a
"policy of 'medical tourism for the classes and health missions for
the masses' will lead to a deepening of the inequities" already
embedded in the health care system. In Thailand, in 2008 it was
stated that, "Doctors in Thailand have become so busy with
foreigners that Thai patients are having trouble getting care".
Medical tourism centred on new technologies, such as stem cell
treatments, is often criticized on grounds of fraud, blatant lack
of scientific rationale and patient safety. However, when
pioneering advanced technologies, such as providing 'unproven'
therapies to patients outside of regular clinical trials, it is
often challenging to differentiate between acceptable medical
innovation and unacceptable patient exploitation.
Employer-sponsored health care in the US
Some US employers have begun exploring medical travel programs as a
way to cut employee health care costs. Such proposals have raised
stormy debates between employers and trade
representing workers, with one union stating that it
deplored the "shocking new approach" of offering employees overseas
treatment in return for a share of the company's savings. The
unions also raise the issues of legal
should something go wrong, and potential job losses
in the US health care industry if treatment is outsourced
Employers may offer incentives such as paying for air travel and
waiving out-of-pocket expenses for care outside of the US. For
example, in January 2008, Hannaford Bros., a supermarket chain
based in Maine, began paying the entire medical bill for employees
to travel to Singapore for hip and knee replacements, including
travel for the patient and companion. Medical travel packages can
integrate with all types of health
, including limited benefit plans, preferred provider
deductible health plan
In 2000 Blue Shield of California began the United States' first
cross border health plan. Patients in California could travel to
one of the three certified hospitals in Mexico for treatment under
California Blue Shield. Perry, Laura. "New Releases." Blue Shield
of California. N.p., 7 June 2000. Web. 15 Nov. 2009.
In 2008, a subsidy of Blue Shield of California teamed up with
hospitals in Thailand, Singapore, Turkey, Ireland, Costa Rica and
India. A 2008 article in Fast Company
globalization of healthcare and describes how various players in
the US healthcare market have begun to explore it.
involves individuals seeking dental care
outside of their local healthcare
is the practice of traveling to another
country for fertility treatments. The main reasons for fertility
tourism are legal regulation of the sought procedure in the home
country, or lower price. In-vitro
Africa and Middle East
in this region involved in medical tourism include Saudi Arabia, South Africa, and
See also: Medical tourism
Israel is emerging
as a popular destination for medical tourists.
15,000 foreigners travelled to the country for medical procedures,
bringing in $40 million of revenue.
Medical tourists choose Israel for several reasons. Some come from
European nations such as Romania where
certain procedures are not available.
Others come to Israel,
perhaps most commonly from the US, because they can receive quality
health care at a fraction of the cost it would be at home, for both
surgeries and in-vitro fertilization
medical tourists come to Israel to visit the Dead Sea, a world-famous therapeutic resort.
Israel Ministry of Tourism and several professional medical
services providers have set out to generate awareness of Israel's
Jordan is an
emerging medical tourism destination, with related revenues
exceeding one billion dollars in 2007.
More than 250,000
patients from other countries sought treatment in Jordan that year.
This included an estimated 45,000 Iraqis and approximately 25,000
patients each from Palestine and Sudan. An estimated 1,800 US
citizens, 1,200 UK citizens, and 400 Canadians also sought
treatment in Jordan that year. Treatment costs can be as low as 25
percent of costs in the US. The kingdom was rated as number one in
the region and fifth in the world as a medical tourism hub in a
study by the World Bank.
Hospitals in Dubai and other emirates have expressed an intent to
develop in medical tourism. Some have American-sourced
international healthcare accreditation, while others are looking
towards the UK, Australia and Canada for accreditation
in the Americas that are treating foreign patients include Argentina, Bolivia, Brazil, Colombia, Costa
Rica, Cuba, Dominican
Republic, Guatemala, Mexico, Panama, Peru and
Brazil has long
been known as a destination for cosmetic surgery.
non-cosmetic procedures, Brazil is only now entering the global
market. However, Albert Einstein Jewish Hospital in São Paulo was
the first JCI-accredited facility outside of the US, and more than
a dozen Brazilian medical facilities have since been similarly
accredited. Brazil requires visas for US citizens based on a
reciprocal arrangement since Brazilians are required to obtain a
visa to visit the US.
Canada has entered
the medical tourism field.
In comparison to US health costs,
medical tourism patients can save 30 to 60 percent on health costs
in Canada. Canada's quality of healthcare is cited by the World
Health Organization as equal to if not better than that of the US
in most categories .
Cuba has been a popular medical tourism destination for more than
40 years. Thousands of patients travel to Cuba, particularly from
Latin America and Europe, attracted by the "fine reputation of
Cuban doctors, the low prices and nearby beaches on which to
recuperate." In 2006, Cuba attracted nearly 20,000 health
Medical treatments included joint replacement, cancer treatment,
eye surgery, cosmetic surgery and addictions rehabilitation. Costs
are about 60 to 80 percent less than US costs.
Cuba has hospitals for Cuban residents and others that focus on
serving foreigners and diplomats. In the 2007 American documentary
, which criticizes the US
healthcare system, producer Michael
leads a group of uninsured American patients to Cuba to
obtain more affordable medical treatment. Sicko
greatly increased foreigners' interest in Cuban healthcare. A
recent Miami Herald
story focused on
the high quality of health care that Canadian and American medical
tourism patients receive in Cuba.
The Cuban government has developed Cuban medical tourism to
generate income for the country. Residents of Canada, the UK and
most other countries can travel to Cuba without any difficulty a
tourist visa is generally required. For Americans, however, because
of the US trade policy towards Cuba, travelers must either obtain
US government approval, or, more frequently, travel to Cuba from
Canada, Mexico, the Bahamas, Jamaica or the Dominican Republic.
Cuban immigration authorities do not stamp the passports of US
visitors so that Americans can keep their travels a private
To date no Cuban facility has achieved JCI Accreditation.
Americans, particularly those living near the Mexican border, now
routinely cross to Mexico for medical care. Popular specialties
include dentistry and plastic surgery. Mexican dentists often
charge one-fifth to one-fourth of US prices, while other procedures
typically cost a third what they would in the US.
This trend has alarmed American healthcare providers who, fearing a
loss of business, warn patients away from Mexico. "The phenomenon
has unsettled US-based dentists who tell horror stories of rampant
infections, undetected cases of oral cancer and shoddy work south
of the border", claims hotly disputed by Mexican dentists. "In
Texas, legislators explored the possibility of allowing health
maintenance organizations to operate on both sides of the border.
However, physicians in south Texas lobbied against the changes,
arguing that local doctors could not compete with the lower costs
in Mexico". US doctors point out that the Mexican legal system
makes it almost impossible to sue Mexican doctors for
However, many who travel to Mexico for care report that they are
satisfied. According to a report commissioned by Families U.S.A., a
Washington advocacy group for health-care issues, "About 90 percent
[feel] the care they had received in Mexico had been good or
excellent. About 80 percent rated the care they had received in the
United States as good or excellent".
Indeed "some U.S. dentists ... have conceded to the competition and
begun a 'reverse migration' opening offices in Mexico to take
advantage of lower costs". More American insurers are providing
coverage for travelers, as the out-of-pocket costs to them are much
lower. "With healthcare costs in the United States continuing to
rise, many employers in Southern California are turning to
insurance plans that send their workers to Mexico for routine care,
plans that are growing by nearly 3,000 people a year."
In addition to dental and plastic surgery, Mexican hospitals are
popular for bariatric surgery for weight loss, considered an
elective procedure that is not covered by some US insurers. A
popular bariatric procedure, lap band surgery, which was approved
by the FDA in the US in 2001, has been performed for longer by
Panama, health and
medical tourism is growing rapidly.
Factors drawing medical
tourists include Panama's tourist appeal, position as a hub for
international travel, and use of the American dollar as the
official currency. Many of Panama’s doctors are bilingual, board
certified, and accustomed to working with the same medical
equipment and technology used in the United States and Europe. On
most procedures, Panama offers savings of more than 50% compared to
the US and Europe. No Panamanian hospitals currently have
international healthcare accreditation, whether through US,
British, Australian or Canadian sources.
Although much attention has been given to the growing trend of
uninsured Americans traveling to foreign countries, a report from
2008 found that a plurality of an estimated 60,000 to 85,000
medical tourists were traveling to the United States for the
purpose of receiving in-patient medical care. The availability of
advanced medical technology and sophisticated training of
physicians are cited as driving motivators for growth in foreigners
traveling to the U.S. for medical care. Also, it has been noted
that the decline in value of the U.S. dollar
offering additional incentive for foreign travel to the U.S.
However, costs differences between the US and many locations in
Asia far outweigh any currency fluctuations.
Several major medical centers and teaching hospitals offer
international patient centers that cater to patients from foreign
countries who seek medical treatment in the U.S. Many of these
organizations offer service coordinators to assist international
patients with arrangements for medical care, accommodations,
finances and transportation including air
It should be noted that many locations in the US that offer medical
care comparable in price to foreign medical facilities are not
Joint Commission Accredited.
Uruguay recently entered the medical tourism market.
A private medical tourism initiative, Uruhealth, has been created
with support from the Ministries of Tourism and Public Health. The
initiative involves the infrastructure, human resources and
experience of two healthcare companies: MP Personalized Medicine
(Montevideo) and SEMM-Mautone Hospital (Punta del Este).
Many Asian Pacific countries are medical tourism
China is fast emerging as a desirable destination for individuals
seeking medical care in a wide range of medical specialties,
including cardiology, neurology, orthopedics and others. A number
of private and government hospitals in major cities have
established international departments. Many leading hospitals
provide treatments integrating Traditional Chinese Medicine with
Western medical technology and techniques. China is home to leading
stem cell research and treatment hospitals that offer Westerners
who want to take advantage of stem cell treatments that are still
considered experimental or have yet to be approved in their home
Kong had 12 private hospitals and 39 public hospitals,
providing 3,124 and 27,755 beds respectively.
A wide range
of health care services are offered. All 12 of Hong Kong's private
hospitals have been surveyed and accredited by the UK's Trent
Accreditation Scheme since early 2001. This has been a major factor
in the ascent of standards in Hong Kong's private hospitals. The
Trent scheme works closely with the hospitals it assesses to
generate standards appropriate to the locality (with respect to
culture, geography, public health, primary care interfaces etc.),
and always uses combinations of UK-sourced and Hong Kong-sourced
surveyors. Some of Hong Kong's private hospitals have now gone on
to obtain dual international accreditation, with both Trent and JCI
(and have therefore attained a standard surpassing some of the best
hospitals in Thailand and Singapore). Others are looking towards
dual international accreditation with Trent and the Australian
group. Hong Kong public hospitals have yet to commit to external
India’s medical tourism sector is expected to experience an annual
growth rate of 30%, making it a Rs. 9,500-crore industry by 2015.
Estimates of the value of medical tourism to India go as high as $2
billion a year by 2012. Advantages for medical tourists include
reduced costs, the availability of latest medical technologies and
a growing compliance on international quality standards, as well as
the fact that foreigners are less likely to face a language barrier
in India. The Indian government is taking steps to address
infrastructure issues that hinder the country's growth in medical
Most estimates claim treatment costs in India start at around a
tenth of the price of comparable treatment in America or Britain.
The most popular treatments sought in India by medical tourists are
alternative medicine, bone-marrow transplant, cardiac bypass
surgery, eye surgery and orthopedic surgery. India is known in
particular for heart surgery, hip
and other areas of advanced medicine.
Ministry of Tourism India(MoT) is planning to extend its Market
Development Assistance (MDA) scheme to cover Joint Commission
International (JCI) and National Accreditation Board of Hospitals
(NABH) certified hospitals. A policy announcement of this effect is
Indian city of Chennai has been declared India's Health Capital, as it
nets in 45% of health tourists from abroad and 30-40% of domestic
Other major cities where medical tourists
are catered to include New Delhi,Mangalore and Mumbai.
Korea, Republic of
Listed on CNN.com as one of the “hot destinations” for medical
tourism, Korea is quickly establishing itself in the field of
medical tourism. Korea is especially popular with Japanese cosmetic
surgery patients due to the cheap costs and high standards of care
practiced by Korean medical facilities.
In 2008, Korea had 27,480 foreign-based patients and the Korean
health ministry expects that number to increase to 140,000 by 2015.
Due to legislation passed in May 2009, state-licensed clinics and
hospitals are now allowed to directly seek out foreign patients
through various promotional activities.
Korean hospitals and clinics provide a variety of medical services
for medical tourists including comprehensive health screening,
cancer treatment, organ transplantation, joint/rheumatism care,
spinal treatment, ophthalmology, dental care, infertility
treatment, otorhinolaryngology, and Korean traditional medicine.
Currently, the most popular treatments for medical tourists are
cosmetic procedures such as eyelid surgery, nose jobs, facelifts,
and skin lightening.
Over 30 Korean hospitals and clinics are member providers under the
Council for Korea Medicine Overseas Promotion (CKMOP). Among these
facilities are the “Big Four” – Seoul National University Hospital,
Samsung Medical Center, Asan Medical Center, and Yonsei Severance
Malaysia is well on its way to develop itself as a medical tourism
hub. The country has excellent hospitals, English is widely spoken,
and many staff have been trained to a high level in the UK or in
the US. There is a highly active Association for Private Hospitals
of Malaysia working to develop medical tourism. However, while
Malaysia has a national accreditation healthcare scheme (MSQH) and
many Malaysia's hospitals are currently firmly on the way to
achieve international healthcare accreditation.
Malaysian hospitals International Specialist Eye Centre, Penang
Adventist Hospital and many others such as Gleneagles Hospital
have or are going to be JCI accredited. The
Ministry of Health has launched a medical tourism page with medical
tourism portals such as Wellness Visit.
New Zealand is a relatively new destination to medical travel. It
has all the hallmarks of a very successful destination especially
for North American based patients. This includes being a first
world, developed economy with a sophisticated and comprehensive
medical system. It is first and foremost English speaking with a
rich heritage of producing world class doctors and medical
Many of its private hospitals are internationally accredited, state
of the art and offer an integrated package of care. The surgeons in
New Zealand are trained both in New Zealand and abroad, usually
spending years of their training in either North America or Western
While New Zealand is aligned medically and culturally to North
America, the cost of the surgical care is significantly cheaper. On
average it is considered that New Zealand’s surgical costs are
around 15 to 20% the cost of the same surgical procedure in the
USA. One patient who had his prosthetic
hip replaced in New Zealand said the total cost including travel,
lodging and the surgery at a private hospital was $
20,000, as opposed to the $
80,000 - $140,000 he was told the operation
would have cost at home.
Added to this the personalized level of medical care, the world
renown natural beauty and tranquility, the fact that New Zealand is
one of the safest places in the world and only 12 hours direct
flight from the west coast of North America, then New Zealand as a
medical travel destination looks set to develop.
Philippines has been growing as a destination for medical
The US Medical Tourism Association magazine
reported that this services sub-sector grew 8.0% in 2007. The
Philippines is one of a few countries that sends qualified
physicians and dentists to the US, a testament to its quality of
medical education. Procedures can be performed at a fraction of the
amount that a patient would spend on the same procedure in the US
or Europe. Some medical centers are accredited by the American
accreditation group Joint Commission International (JCI).
Singapore has a dozen hospitals and health centers with JCI
accreditation. In 1997 (published 2000), the World Health
Organization ranked Singapore's health care system sixth best in
the world and the highest ranked system in Asia.
"SingaporeMedicine" is a multi-agency government-industry
partnership committed to strengthening Singapore's position as a
medical hub and promoting Singapore as a destination for advanced
patient care. Patients come from neighboring countries, such as
Indonesia and Malaysia, and patient numbers from Indochina, South
Asia, the Middle East and Greater China are growing. Patients from
developed countries such as the United States and the UK are also
beginning to choose Singapore as their medical travel destination
for relatively affordable health care services in a clean
The Taiwanese government has declared its determination for the
country to become a medical tourism center. It is estimated that
the government will contribute NT$44.4 million to construct a
platform for the collaboration of the government and the medical
sector in promoting medical tourism. Costs for procedures remain
comparatively low. Taiwan is known
for liver transplants, joint replacement surgery, bone marrow
transplants, and reconstructive and plastic surgery.
tourism has been a growing segment of Thailand's tourism and health-care sectors.
one Bangkok hospital took in 150,000 treatment seekers from abroad.
In 2006, medical tourism was projected to earn the country 36.4
Treatments for medical tourists in Thailand range from cosmetic,
organ transplants, cardiac, and orthopaedic treatments to dental
and cardiac surgeries. Treatments also include spa
, physical and mental therapies.
patient who had coronary
artery bypass surgery at Bumrungrad International hospital in Bangkok said the operation cost him
US$12,000 (8,200 euros), as
opposed to the $100,000 (68,000 euros) he estimated the operation
would have cost him at home.
approximately 55,000 American patients in 2005 alone, a 30%
increase from the previous year.
Hospitals in Thailand are a popular destination for other Asians.
Bangkok Hospital, which caters to medical tourists, has a Japanese
wing, and Phyathai Hospitals
has interpreters for over 22 languages, besides the
English-speaking medical staff. When Nepal Prime
Minister Girija Prasad Koirala
needed medical care in 2006, he went to Bangkok.
Many Thai physicians hold US or UK professional certification.
Bumrungrad International hospital states that many of its doctors
and staff are trained in the UK, Europe and the US. Bumrungrad
International was accredited most recently in 2005 by the Joint Commission
.Some of the country’s
major hospitals have also achieved certification by the International
Organization for Standardization
’s ISO 9001:2000. However, ISO
2000 is not an accreditation scheme.The US consular information
sheet gives the Thai health care system high marks for quality,
particularly facilities in Bangkok. . The World Health
Organization's 2000 ranking put the Thai healthcare system at
number 47, below the USA's ranking at 37 and the United Kingdom's
ranking at 18. The UK's Foreign and Commonwealth Office web site
states "There are excellent international hospitals in Bangkok but
they can be expensive".
Serious political problems during late 2008, including mass
demonstrations and the complete closure of major airports, have
made travel to Thailand less appealing than in the past, and the US
State Department has issued a travel alert for the country.
in Europe that have active medical tourism sectors include Cyprus, Germany, Hungary, Lithuania, Malta, Poland, Portugal, Czech
Republic, Slovakia, Spain, and
Republic has built
its medical tourism on spas and medical care equalling the world
standards (for example Ostrava University Hospital).
Germany is a destination for patients seeking advanced
medical technology, high standards, safety, and quick
All German citizens have health coverage,
resulting in a high hospital density, with twice as many hospitals
per capita as the United States. The high hospital density results
in shorter waitlists for treatment.Costs for medical treatment
compete well with other developed European countries and are
commonly 50% of those in in the USA.
Germany is an attractive destination for patients from the Middle
East since traveling to the USA has become more difficult for them
since the September 11 attacks
US citizens sometimes travel to Germany to seek treatments such as
artificial cervical disc replacement that are not US Food and Drug Administration
2004, when Poland joined the
European Union, it has become another
locale for people seeking cheaper medical treatments.
quality of care in Poland must comply with EU standards.
Turkey has since
many years attracted medical tourists from Europe, the United
States and the Middle East as the country combines quality
healthcare, the newest medical technologies (Cyberknife) and low-cost.
come to Turkey for medical or cosmetic surgery but the country is
also seeking to build on its geothermal resources for an expansion
of therapeutic spas.The German Hospital in Istanbul operates the
country's first ISO-certified IVF center, while Memorial Hospital
was the first private hospital to receive American JCI
accreditation. Since then, over 34 hospitals and medical
institutions have achieved Joint Commission International
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