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How is the rise in medical tourism affecting medical inflation and care quality?

Medical tourism is on the rise. But what’s driving it and what are the effects on governments and individuals?

The global market is expected to grow at a rate of 21.4% between 2017-2023 and is just one of the reasons the international private medical insurance market (iPMI) is burgeoning.

Thousands of patients benefit from access to cheaper treatment, as do the governments of many developing nations who can earn millions by offering cheaper procedures. But even this latter benefit brings a difficult conundrum to the governments of many developing nations: to provide the best health care for nationals by sending them abroad for treatments unavailable at home, or retain that money to invest in national health systems at home? Those that choose the former, are placing increased pressure on their national health services as much-needed investment is going abroad. This is also a driver of medical inflation: flying a patient to another country can mean higher costs than if it were carried out at home. This means there is less to invest in the national system and costs are driven up.

And for those nations making a virtue of selling cheaper treatment, the cost is often reduced levels of care for nationals, as tourists use up national resources and the private sector attracts the best clinicians.

Leading the health tourism charge is the U.S., closely followed by Europe,  where thousands of patients fly abroad to receive treatment, avoiding domestic waiting lists and potentially enjoying reduced treatment costs. Asia Pacific and South and Central America currently dominate the market, where Americans can save up to 60% on treatment.

Driving this global trend are a number of factors, explored below, from aging populations and medical inflation to inadequate domestic care and health care cuts.

This article explores some of the implications of the rising numbers of people travelling for treatment. It also begins to explore how health and wellness systems and institutions – from national health services to health insurance companies — are responding to this trend.

Why?

The root causes of this increase are cuts in national health funding, ageing and affluent populations, staff shortages and a range of lifestyle factors.

Cost and access are the main drivers for travel.

  1. Company executives, the C-suite and those on assignment are travelling to access better treatment in the country of their choice, and not just when they’re unwell or managing a condition, but in pursuit of preventative wellness care as well.

  2. Many people travel to countries that offer lower-cost medical treatment because they can’t afford them at home or don’t have access to the treatment at all. 1.7 million Americans live in households that will declare bankruptcy due to their inability to pay their medical bills; while savings of 65-80% can be saved on medical bills if Americans fly to Malaysia (December 2017). Many around the world are in the same situation. Others are flying for cheap elective surgery and treatments for things such as cosmetic surgery and dentistry.

  3. The third contributing factor is certain nations’ reliance on foreign countries for specialist treatments. Nigeria’s national health service sends many patients abroad for treatment, paying other countries for access. In an effort to “reduce our dependence on foreign medical tourism” Nigeria announced the construction of a N7.5 billion (£14.9m, $20.7m) ultra-modern specialist hospital in Kano Statein (February 2018).

  4. Another reason for travel is national health care system waiting times. The UK’s Telegraph reported in 2017 that many UK citizens are travelling abroad to receive immediate treatment as NHS waiting times can be long — waiting times in Wales have gone up by 400% since 2013.

  5. The aging populations of developed nations are also having an impact — and continues to grow. Aging is a concern for costs to health care systems, with increased care needs over longer lifespans. Also of concern are health care costs for older people. As national health services buckle under the pressure of increased demand from an aging population, waiting lists expand and medical inflation drives up costs. As such, many older people seek alternative, cheaper treatments abroad.

1. The blessing and the curse for governments

While some countries are benefitting from an influx of patients keen to exploit cheaper care, some national health services are feeling the pressure. For example, while Costa Rica earned $338 million from the trade in 2012, the UK’s National Health Service (NHS) said in 2016 that 0.3% of NHS spending went to "deliberate health tourism" and those taking advantage of free NHS services. Another estimate in the same year came from Lord Bates who said the cost of visitors to the NHS in 2012-13 was £2bn — approximately 2% of the NHS budget. Though increased immigration health surcharge has been proposed to tackle this.

This is proving a challenge for many governments who want to provide the best health care for nationals. Sometimes this means using specialist care in other countries, but flying a patient to another country can mean higher costs than necessary — contributing to medical inflation. This in turn means that governments have less to invest in their own national system… and costs go up again.

A quick sweep of recent news shows many countries are getting in on the action, building pay-to-play services and promoting them. For example:

One nation making the most of the opportunity is Cuba. Speaking at the ITIC in Barcelona in November 2017, Humberto Barreto Nardo, Director General of Asistur SA explained how Cuba wanted to build a strong infrastructure which offered basic medical care and the best medical standards for its population and medical tourists. He detailed how, in addition to this, the Cuban Medical Services Market Developer — a corporate entity created to guarantee medical care with best means and human resources

2. The blessing and the curse for individuals

Nations and private enterprise tapping the market isn’t helping patients because it’s contributing to global health care inflation — the cost of health care — and not addressing the prevention and intervention of diseases and conditions.

The results are: health insurance premium increases, higher costs to governments (budget/target shortfalls and/or potential tax increases) and, most importantly, fewer healthier people.

And that’s if it all goes well… Many patients fly for lower cost treatment, only to find there are subsequent complications. But, having not budgeted for it and finding themselves miles away, are unable to deal with them.  

A 2013 report found that: “Researchers examining outbound medical tourism from Oman found that 15% of 45 surveyed medical tourists experienced complications following treatment abroad, while a survey of the British Association of Plastic, Reconstructive and Aesthetic Surgery found that 37% of members had seen patients with complications resulting from medical tourism.”

The role of the expat

Demands on the system from expats traveling back to their countries of origin is also causing waiting lists to lengthen and costs to rise.

For many expats, international Private Medical Insurance (iPMI) is the best way to ensure you have access to good quality care and treatments wherever you are. This has its own effect as increased pressure on private resources can drain national health services of staff and hospitals.

Best practise

It is something of a truism in the West that the best health care is preventative, not curative. For too long, health services focused on reducing pain, exchanging organs and curing diseases. The 21st century has seen the blossoming of what Aetna International calls, value-based care. This approach puts the whole patient at the centre of their health journey (not their condition, not their disease), making it easier for people to get quality care, while keeping medical inflation in check. Many governments are investing in keeping people healthy with nutrition information, quit smoking campaigns and other initiatives. In a pay-to-play system, everyone loses out: nations have less money to spend on keeping their population healthy, medical inflation effects insurers, which then puts premium costs up for individuals.

Our value-based system aims to put the patient at the centre of their plan to keep them healthier and keep premiums low. Recognising that, individuals are increasingly demanding global access to care, it’s important that they can choose the regions in which to access care. Each region offers a carefully maintained network of care providers and the area of cover chosen helps shape the plan and premium. Our in-house Care and Response Excellence (CARE) team of specialised clinicians and multilingual case managers available 24/7/365 to support individuals pre-trip, post-trip, and anytime in between.

The medical tourism trend looks set to continue as more people look to travel for treatment. While this means that the iPMI industry is booming, it’s important for employers and individuals to rely on a health benefits and wellness partner that ensures the right care and outcome, at the right time, in the right place and at the right cost. At Aetna International, our strength lies in our global network of health care providers and our in-depth local knowledge and our ability to provide access to quality care no matter where they are.

If you’re looking to better understand iPMI market trends or for international health and wellness benefit solutions, contact one of our expert sales consultants for more information.

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