GOOD INDICATIONS BUT ROOM FOR IMPROVEMENT
Much has been written about the many benefits and opportunities that medical tourism offers. Those wishing to take advantage of those benefits and opportunities, though, should also be aware of the challenges.
PUBLIC HEALTHCARE SACRIFICED – THE PRICE OF CITIZENSHIP?
Many statesmen the world over believe that healthcare is a fundamental right of all citizens. Among them is former director-general of the Malaysian Ministry of Health, Tan Sri Dr Abdul Khalid Sahan who maintains that, “everyone has a right to receive it irrespective of his or her ability to pay,” adding that the Government is accountable for ensuring that healthcare is made accessible to all citizens.
Keeping with that ideal, Malaysia ’s public healthcare services, while not free for everyone, are said to be heavily subsidised by the Government. With an estimated 10.8 million Malaysians or 40 percent of the population medically insured, there are potentially 16.2 million citizens who will have need of the services of public hospitals which account for about 39,000, or 77 percent, of the total hospital beds in the country.
Then there are healthcare costs that rise continually driven by investments in medical research, development and technology. Global medical cost inflation is estimated to average about 10 percent each year and in Malaysia it is estimated to be above that at about 15 percent per year. If costs continue to rise high and fast it won’t be long before private healthcare ceases to be within the reach of some of the people who make use of it at this time.
CONTROLING THE QUALITY OF PUBLIC HEALTHCARE
Should that happen will private patients go back to government hospitals and if they do will they be turned away or will the subsequently increased workload then affect the speed and quality of those services?
Lured by the more lucrative fees that come from private practice, there is now one doctor to attend to every 1.3 beds in the private sector compared to one doctor for every three beds in the public sector. According to Datuk Dr Jacob Thomas, president of the Association of Private Hospitals of Malaysia government hospitals are already overloaded with patients.
Now add to this situation the transformation of Malaysia into a medical tourism hub. There are many people concerned about how Malaysians may suffer while the rest of the world comes here to heal.
Oxford Business Group Editorial Manager Adam Jones put it well when he said, “the Filipino health sector bears resemblance to that of its educational system in that the private sector maintains several very high-level institutions, while the public sector is faced with a severe lack of funding due to a stretched national budget.” There are many countries in Asia like that.
For Malaysia , the concern isn’t only that beds are being taken away. With only half the over 10,000 vacancies for doctors in government hospitals and clinics filled by June this year, the remaining positions had to be filled by foreign doctors.
MEDICAL INSURANCE THAT TRAVELS
The inability of hospitals in medical-travel destinations to enter the networks of the developed markets’ payors in order to work directly with insurance companies and other health care funders remains a major institutional barrier to growth of the industry.
The United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP), says that the main barriers to medical tourism includes the nonportability of health insurance under mode 2, of the World Trade Organisation’s (WTO) General Agreement on Trade in Services (GATS) which refers to consumption abroad (CA) ie. travelling abroad, including via health tours, to seek high-technology treatments or cheaper health services.
In October last year Angelis Insurance launched the first cover for treatment carried out outside the UK, available to any UK domicile travelling abroad for procedures.
One month later, Seven Corners launched the first worldwide medical tourism insurance program that reduces travel-related and medical risks associated with patients electing to have surgical procedures abroad.
In September this year PJ Hayman introduced the first international medical insurance cover that pays policyholders for medical costs and other expenses that arise from their elective treatment abroad. The cover, however, is only available to UK nationals.
So while there is some development in this area, development appears limited in many regards, and there is still a large lacuna. Asian insurance companies, working together with government and health service providers, promoting insurance products in the markets which we wish to attract to this area, can help close this gap and accelerate the growth of the industry in this region.
SAFETY AND QUALITY ASSURANCE
Central to this phenomenon of a person interested in putting himself or herself in the care of experts in a faraway country that he or she has probably never visited, is the issue of quality. Given the wide selection of available medical facilities in many different countries, it can be difficult for the medical tourist to identify qualified, experienced physicans and modern hospitals that provide high-quality care, consistently.
A useful point of reference for patients selecting medical facilities outside their home countries may be provided by accreditation from the Joint Commission International (JCI), which has accredited more than 125 facilities in 24 countries, or the International Organization of Standardisation (ISO).
There are a great many accreditation bodies the world over. Among them are the US-based JCI and the Europe-based ISO. The one you select would have to take into consideration the market you are aiming at. A great deal has been said about the number of US travellers who venture abroad for procedures, and yet many countries in this region are hard put to attract them to our shores. If Americans rely on their home-based JCI accreditation as a means of valuing the quality of medical services, this is unsurprising. Malaysia has only three JCI-accredited facilities.
Accreditation itself, though, is of limited value unless potential medical tourists and travellers are aware of the accreditation bodies, are made to understand the value of the accreditation, and are given the means to easily and quickly find and compare the features of different medical institutions certified by their accreditation body of choice.
IMAGE & REPUTATION
Developing countries are believed to be poor and lacking in quality facilities or physicians which leads to skepticism amongst patients. Some countries have specific problems related to their politics and human rights records.
Chong Yoke Har, director of the International Marketing Division of Tourism Malaysia , for example, says the challenges facing Malaysia ’s tourist trade include negative media reports, adverse travel advisories, misconceptions about Malaysia as a Muslim country linked to terrorism, unprecedented pandemics and global issues such as tsunamis, fuel hikes and the economic slowdown.
Another example is India . The country still faces overpopulation, environmental degradation, poverty and ethnic and religious strife; problems that may dissuade some patients from traveling to India to receive healthcare.
CLEAR, DIFFERENTIATING STRATEGY
Secretary General of the National Chambers of Commerce and Industry Malaysia (NCCIM), Datuk Syed Hussien Al-Habshee said the lack of effective marketing strategy was the reason why Malaysia , despite the fact it is a Muslim country, is behind Thailand and Singapore in attracting medical tourists from the Middle East . While Malaysia appears to have the edge in terms of religion, Muslim hospital staff, halal food and other aspects, Middle East tourists prefer to go to Thailand and Singapore . He is right about one thing. All countries wishing to promote medical tourism need to have a clear strategy. Importantly, and this he does not mention, that strategy needs to be relevant to the markets we wish to attract. Perhaps for Middle Eastern medical tourists, there are things far more important to them than Muslim hospital staff, halal food and those other aspects Syed Hussein mentioned. Thailand is universally known as the Mecca of Medical Tourism driven largely by Bumrungrad’s almost thirty years of activities. India , the second largest destination in terms of medical tourist arrivals, is the clear price leader for the region. Singapore ’s infrastructure which is second to none is a strong draw, provided you are willing to pay for it.
Countries like Malaysia need to carefully consider what their strategy is and focus on that. I suggest they begin with deciding who they wish to attract and find out more about the needs and attitudes of those people. Talking to people from the Middle East who have gone to Thailand and Singapore for their treatment or procedures, for example, would be a good place for Malaysia to start. The strategy a country chooses to adopt would likely consider what the country views as its strengths and advantages. While important, this is, nevertheless inward-looking.
Importantly, countries should consider the market they wish to attract, and what their target is travelling to seek: the world’s most advanced technologies, better care than they can find in their home countries, quicker access to medically necessary procedures delayed by long wait times at home, or lower costs for discretionary procedures.
FOLLOW-UP CARE
Many procedures require follow-up treatment or additional operations, which should optimally be performed by the original surgeon. According to McKinsey, “continuity of care is a major consideration for patients suffering from chronic disease, and it’s not clear how well a multinational approach to the delivery of care could address this issue.”
There are many stories of people treated overseas having no follow-up care and suffering complications.With Medical Tourism patients often face difficulty in getting follow-up treatment in their home country after receiving medical treatment abroad. The patient is usually in hospital for a few days, then goes on the vacation portion of the trip, and returns home. In such instances complications, side-effects and post-operative care would then be left to the medical care system in the patients’ home country.
LEGAL ISSUES
As medical travel specialist Galavantor Middle East’s CEO Rose Ann Shetty puts it, “hospitals are answerable to the law in their country.” Because the patient must abide by the medical tourism destination’s law in the event of bad outcomes or complications after treatment, the quality of law as it relates to legal recourse, becomes an issue. Representative Lee Ae-joo of Korea ’s ruling Grand National Party also said at a National Assembly session in November last year, “We have yet to set up a proper legal system for domestic patients. It will be a disaster when an accident happens to a foreigner.”
According to Associate Professor Puteri Nemie Binti Jahn Kassim, from the Ahmad Ibrahim Kulliyyah of Laws at the Islamic University of Malaysia, while “the increased number of foreign patients has opened up possibilities of Malaysian health care providers being subjected to malpractice claims and triggering a myriad of cross-border legal issues… there is no internationally accepted legal framework to regulate medical tourism and issues of legal redress in relation to unsatisfactory provision of treatment across international boundaries.”
NUMEROUS OTHER ISSUES
The issues and challenges facing medical tourism, or opportunities, depending on how one looks at them, are as numerous as they are varied. Some of these include, depending on country:
• Training standards of doctors in medical destination countries
• Language barriers
• Low pay or coverage (insurance)
• Lack of coordination among the various players in the industry like airline operators, hotels, hospitals and professional services consultants
• Awareness among insurance companies to cover overseas surgeries
• Limitations to advertising and promotional activity due to the ministry of health (or other government agency) restrictions
• Lack of consumer or target market insights to allow for marketing and marketing communication activities that are relevant and engaging
• Lack of transparent worldwide data on the quality of health care
Parting Dose
It is obvious that medical tourism offers a whole host of benefits for the many Asian countries jumping on the bandwagon. This is all the more reason for the many different stakeholders to consider all the issues confronting this fledgling industry and work together, not just key players in a market, but across markets in Asia , to support each other. In doing so we can ensure the proper development of a global healthcare industry.
By Jeff Seow