Medical Tourism Climate Survey 2013

M E D I C A L T O U R I S M C L I M A T E S U R V E Y 2 0 1 3 © I N T U I T I O N C O M M U N I C A T I O N L T D 1

Medical Tourism Climate Survey 2013

Conducted for the International Medical Travel Exhibition and Conference

(IMTEC 2013)

Monaco

23 March 2013

www.imtj.com

© Intuition Communication Ltd 2013


C O N T E N T S

1. Introduction ................................................................................................................................................ 3

The Medical Tourism Climate Survey ............................................................................................................. 3

2. Executive summary .................................................................................................................................... 4

Provider views ................................................................................................................................................ 5

3. Methodology .............................................................................................................................................. 7

The results ...................................................................................................................................................... 7

Sample bias..................................................................................................................................................... 7

4. About the respondents and their organisation .......................................................................................... 9

5. The current international patient market ................................................................................................ 11

6. The international patient market in the future ........................................................................................ 14

7. Impact of political changes ....................................................................................................................... 20

8. International research panel .................................................................................................................... 22

9. Other comments by respondents ............................................................................................................ 23

10. Services offered by providers ................................................................................................................ 24

11. The medical tourism business of the providers .................................................................................... 28

12. Marketing to medical tourists ............................................................................................................... 37

13. Appendix: Results in detail .................................................................................................................... 42

About you and your organisation ................................................................................................................. 42

The international patient market today ....................................................................................................... 47

Factors affecting patient choice ................................................................................................................... 49

The future of the international patient market ........................................................................................... 52

Impact of political changes ........................................................................................................................... 67

Other comments .......................................................................................................................................... 73

About your services for international patients ............................................................................................ 78

Your medical tourism business .................................................................................................................... 85

Marketing to medical tourists ...................................................................................................................... 88

14. Appendix: Email invitation .................................................................................................................... 91

Email invitation ............................................................................................................................................. 91

15. About Intuition Communication ............................................................................................................ 92


1. Introduction

One of the greatest challenges faced by those who operate in the medical travel sector is the lack of reliable

and accurate information about the market. Much is said and written about the size of the market, about the

exponential growth and how “global healthcare” is going to transform the world. But there is often little hard

fact, and very few statistics to support what is claimed.

Hence, destinations, tourism boards, hospitals, clinics and healthcare providers are unable to benchmark

their performance, track their progress, measure their success, identify market opportunities and measure

their return on investment.

Within Intuition Communication, our aim is to capture and publish independent, standardised, and verifiable

information and data on the medical tourism market and the global healthcare industry

The Medical Tourism Climate Survey

The International Medical Travel Journal (IMTJ), published by Intuition Communication, provides an online

resource and e-newsletter to keep the industry informed about the latest trends and developments in the

sector. Each year, IMTJ “takes the temperature” of this nascent industry through the Medical Tourism

Climate Survey.

This year’s climate survey incorporates the views of over 400 individuals within the industry. The nature of

the respondents does of course influence the findings of this report. There is sample bias towards English

speaking participants (N.B: the survey was not multi-language) and to the US, European and Indian

markets. However, this does not negate the value of the survey in an industry which is bereft of meaningful

information.

The report highlights widespread optimism about the future of medical tourism despite the economic

downturn, with travel for cosmetic surgery expected to be the biggest growth area. The results suggest that

not only is the market currently growing but that it will continue to do so for the next five years or more.

However, it does highlight the fragmented state of the market in terms of the small size and nature of those

providing services and areas of concern such as the lack of marketing expertise and investment, and lack of

government support for medical tourism.

It is encouraging that many of the respondents acknowledge the lack of independent data and market

information, and that they are prepared to share information for the “greater good”.

As a business, Intuition Communication will continue to direct its efforts to plugging the information “black

hole” in medical tourism.

http://www.imtj.com/


2. Executive summary

This is the third Medical Tourism Climate Survey run by IMTJ. The survey was conducted in

February 2013, and attracted 404 participants, representing organisations in 77 different countries.

The Medical Tourism Climate Survey 2013 examines current activities, market and business

growth, current challenges and opportunities in the medical tourism sector. The research was

funded by International Medical Travel Journal and was conducted online using the SurveyMonkey

system.

The USA, the UK and Turkey provided the most respondents. A wide variety of organisation types

were represented in the survey. Providers of services to medical tourists (hospitals, clinics, spas

and medical tourism agencies) accounted for 69.3% of all respondents (hospitals and clinics -

42.7%, medical tourism agencies or facilitators - 24.1%, and health or medical spas - 2.5%).

Other organisations participating in the survey included those which do not provide services direct

to patients and medical tourists but which have an interest in this sector e.g. consultancies,

academic institutions, medical assistance companies, government organisations, tourism boards.

According to our respondents, the three main destinations for medical tourists, based on patient

numbers, are India, Thailand and the USA. The USA, Thailand and Singapore are considered to be

the leading destinations in terms of quality and range of services.

The respondents believe that the most important factors for medical tourists in choosing a

healthcare facility in a particular country are the expertise and qualifications of the doctor/dentist,

the cost of treatment, comments and ratings by other patients, and the standard of hospital or

clinic accommodation.

Our respondents expect the market for medical tourism to grow over the next five years. A quarter

of respondents expect the market to grow by between 5-10% pa, 22.1% expect it to grow by

between 10-15% pa, and 16.1% expect it to grow by more than 20% pa.

The sectors expected to grow the fastest over the next five years are cosmetic and plastic surgery,

dental treatment, cancer treatment and infertility treatment.

The respondents believe that the leading destinations for medical tourists in terms of patient

numbers in five years’ time will be India, Thailand and Turkey, followed by the USA, Germany and

Singapore.

The three most significant changes anticipated over the next five years are thought to be the

adoption of e-health and electronic patient records in medical tourism, followed by major tourism

and travel companies entering the market, and a greater emphasis on quality rather than price

among medical tourists.

The most significant issues facing the medical tourism industry are considered to be the lack of

reliable information about quality of services in other countries, the lack of follow-up care in the

patient’s home country, and the lack of insurance for medical tourists.


http://www.surveymonkey.com/


Half of the respondents think that Obamacare will make little or no difference to the numbers of

Americans travelling to other countries for treatment. About a third of respondents think that the

effect of Obamacare will be to increase the numbers of American patients travelling abroad, and

one-fifth of respondents think that it will reduce the number of American medical tourists.

Just over a third of respondents think that the European Directive on Cross Border Healthcare will

make little or no difference to numbers of medical tourists, while over half think it will increase

numbers and only 12.6% think it will reduce numbers.

Half of the respondents stated that they would be prepared to participate in an international

research panel to share views and experience of medical tourism.

Provider views

Providers of services to patients and medical tourists (hospitals, clinics, spas and medical tourism agencies)

were asked to complete an additional set of questions, related to specific aspects of their business.

Dental treatment, cosmetic and plastic surgery, general surgery and orthopaedic surgery were the

most common services offered by the provider organisations, participating in the survey.

Extensive support services are provided in the destination country for medical tourists by the

provider organisations. More than four out of five providers arrange accommodation/hotels and

airport pick-up. More than half provide additional services such as 24 hour numbers for

questions/emergencies, interpreter services, arrangement of flights, and online consultations via

video or teleconference. Pre-travel and post-treatment follow up in the country of origin are

provided much less frequently (by just over a third of the providers).

Medical tourists are given a substantial amount of information. Nine out of ten providers state that

they supply information on the risks of treatment always or most of the time. Printed and

personalised treatment plans are provided by 88% of respondents always or most of the time,

while 83% provide detailed profiles of surgeons/doctors always or most of the time. After

treatment has been completed, four out of five respondents ask patients to complete a patient

satisfaction survey always or most of the time.

Interpreter services are provided by the respondents, most commonly for English, then German,

French, Arabic and Russian languages.

There was a very wide range of numbers of international patients treated or handled by the

respondents. The majority of respondents treated less than 100 international patients in the last

12 months.

o 65% of hospitals and clinics treated less than 100 international patients in the last 12

months. 15% of hospitals and clinics treated more than 1,000 international patients in the

last 12 months,

o 56% of medical tourism agencies and facilitators treated less than 100 international patients

in the last 12 months. 11% of medical tourism agencies and facilitators treated more than

1,000 international patients in the last 12 months.


According to the providers, their international patient business is growing. Six out of ten

respondents said that their numbers had increased in the last 12 months. They expect their

business to grow: four out of five providers expect the numbers of international patients in their

business to increase in the next 12 months.

According to the providers, the UK provides the most patients, followed by the USA, Russia,

Germany, Australia and the United Arab Emirates.

The biggest internal factor considered to restrict growth of their international patient business is

the size of the marketing budget followed by financial constraints. e.g. cost of finance, and

availability of marketing expertise.

The biggest external factor considered to affect growth of their international patient business is a

lack of government support for medical tourism, followed by increased competition and the image

of the country/destination.

Three-quarters of providers are happy to provide basic information about their medical tourism

activities to improve the availability of data about the market.

According to the providers, the largest amount of marketing spend goes on developing web site

content, followed by social media, then exhibitions and events, PR and media relations and on-line

activity such as pay per click, directory listings, banner advertising and lead generation services.

The lowest spend by respondents is on sponsorship and direct mail. The perceived efficacy of

different types of marketing activity broadly reflects current spend on these activities.

More than half of the providers said they spend less than $10,000 a year on marketing; however,

over one in ten spend over $50,000. And marketing spend on medical tourism seems to be on the

increase; more respondents increased their spend last year than reduced it.

The web sites and publications named as the most effective in marketing medical tourism services

were Google and Treatment Abroad, followed by What Clinic, and then their own websites,

Facebook and social media.

http://www.treatmentabroad.com/


3. Methodology

Two databases were used to attract participants for the 2013 Medical Tourism Climate Survey:

An in-house IMTJ database containing information on hospitals, clinics, agencies and other

organisations involved in the medical travel sector, maintained by Intuition Communication,

publishers of International Medical Travel Journal.

The email distribution list maintained by Informa which is used to promote the International

Medical Travel Exhibition and Conference (IMTEC 2013).

An email (copy provided in the Appendix) was sent to both lists asking individuals to complete an online

medical tourism climate survey to assess their current views on:

Market and business growth

Current challenges

Future opportunities

To encourage participation, respondents were offered a free copy of the survey report.

The survey was conducted online using the SurveyMonkey survey system from 18 February to 8 March

2013. The research was funded by International Medical Travel Journal.

The results

404 individuals completed the survey representing a broad sample of healthcare businesses and

organisations.

The report is based on responses from the whole sample (404 respondents), except for sections 10, 11 and

12 (services offered to international patients, the medical tourism business, marketing to medical tourists)

which were answered only by service providers - those organisations providing services directly to medical

tourists. (i.e. hospitals and clinics, health spas or medical spas, medical tourist agencies or facilitators). The

service providers accounted for 279 respondents.

Sections 3 to 12 contain a summary and analysis of the survey results.

Full details of the results are provided in the Appendix - Section 13.

Sample bias

It is inevitable that in a survey of this type there is built-in sample bias. The number of respondents is higher

than we have achieved in previous climate surveys, but is this sample truly representative of the medical

travel industry? Here are some of the reasons why sample bias will affect the findings:

Some key players have not submitted a response to the survey.

The survey was distributed in English; those who have English as a first or second language

are more likely to respond.

http://www.surveymonkey.com/



Some recipients may take the view that sharing their information is not good business

practice.

Equal weight of view is given to someone who runs a major hospital group and someone who

runs a small clinic.

Some respondents may be overly optimistic about the current and future state of their

business and the industry. And vice versa.

The respondent profile is skewed towards the USA, Europe and India.

Nevertheless, in an industry which is hampered by a lack of information and data, we believe that the

sample size is sufficient to provide worthwhile insight.


4. About the respondents and their organisation

Location of respondents

The 404 respondents represented organisations in 77 different countries: the USA (12.9%), India (11.0%),

the UK (5.1%) and Turkey (4.3%) had the most respondents, followed by Malaysia and Thailand (with 3.8%

each), and Greece, Hungary and Spain (with 3.5% each).

See Section 13: Appendix for the full list of countries represented in the sample.

M E D I C A L T O U R I S M C L I M A T E S U R V E Y 2 0 1 3 © I N T U I T I O N C O M M U N I C A T I O N L T D 1 0

Main business activity

A wide variety of organisation types were represented in the survey. Providers of services to medical

tourists accounted for 69.3% of all respondents (hospitals and clinics 42.7%, medical tourism agencies or

facilitators 24.1%, and health or medical spas 2.5%). Other organisations participating in the survey

included those which don’t necessarily provide direct services to medical tourists but which have an interest

in this sector e.g. consultancies, academic institutions, medical assistance, government organisations being

the main ones.

See Section 13: Appendix for the full list of business activities.


5. The current international patient market

Leading destination countries by patient numbers

According to the respondents, the three main destinations for medical tourists in terms of patient numbers

are India, Thailand and the USA, followed by Germany, Turkey and the UK. These results do not differ

significantly from the previous survey; however, the USA and Germany have moved up the rankings by a

few places, and Costa Rica and Mexico have moved down the rankings.

(Note: The country scores below have been calculated by weighting the country selections: First choice -

score = 3, Second choice - score = 2, Third choice - score = 1).

A full list of countries is given in Section 13: Appendix.


Leading destination countries by quality and range of services

The leading destinations for medical tourists in terms of quality and range of services are the USA, Thailand

and Singapore, according to the respondents. These are followed by Germany, India and Turkey. The main

change from the previous survey is that the USA has moved from fourth to top place, and India has moved

from first to fifth position.



A full list of other countries scores and rankings is given in Section 13: Appendix.

Most important factors for medical tourists

According to the respondents, the most important factors for a medical tourist in choosing a healthcare

facility in a particular country are the expertise and qualifications of the doctor/dentist (97.5% of

respondents think this is very important or important), followed by comments and ratings by other patients

(93% of respondents think this is very important or important), then the cost of treatment (92.4% of

respondents think this is very important or important), and the standard of hospital or clinic accommodation

(92% of respondents think this is very important or important).


Cost of treatment ranks higher as a factor among respondents who are providers compared to non-

providers, as do comments and ratings of other patients, and distance to travel destination. Non-providers

rank standard of hospital or clinic accommodation, post-operative infection rates, and post treatment in the

patient’s country higher than the providers.

In the additional comments given by respondents to this question, some stressed the importance of the

softer human side of looking after patients when they are abroad; even though they may be going to an

excellent facility for treatment, it is the additional services or being looked after and not left on their own

that can make a real difference to their overall experience.

The chart below shows the rating averages for the various factors; a weighting has been applied to the five

ratings that the respondents could choose from: Not at all important (weighting of 1), not important

(weighting of 2), neutral (weighting of 3), important (weighting of 4),very important (weighting of 5). A

rating average was calculated from all responses to the question.

See Section 13: Appendix for additional comments given by respondents and a split of results between

providers and non-providers.


6. The international patient market in the future

Growth rate forecast

The respondents expect the market for medical tourism to grow in the next five years at quite a healthy

rate. 24% of them expect the market to grow by between 5-10% pa; 22.1% expect it to grow by between

10-15% pa; 16.2% expect it to grow by more than 20%pa. If anything, non-provider respondents are a

little more confident in the scale of market growth than respondents who are providers.

See Section 13: Appendix for the split of opinions between providers and non-providers.


The sectors expected to grow the fastest

The respondents were asked to choose three sectors that they expect to grow the fastest in the next five

years. Top came cosmetic and plastic surgery (56.2% of responses) followed by dental treatment and

cancer treatment (43.4% of responses each) and infertility treatment (40.4% of responses). Also high up

the list were (in order of numbers of responses), cardiac surgery and cardiology, orthopaedic surgery, stem

cell treatment, obesity surgery, and transplants.

There were some differences in opinion between providers and non-providers on which sectors will grow

fastest. Non-provider responders chose cancer treatment more often than respondents who are providers

(52.7% vs 38.5%), whereas providers though dental care would grow more than non-providers (51.7% vs

28.0%). Infertility treatment was mentioned more frequently by providers (46.6%) than non-providers

(29.0%).

See Section 13: Appendix for the split of opinions between providers and non-providers.

Forecast of leading destinations

The respondents believe that the leading destinations for medical tourists in terms of patient numbers in five

years’ time will be India, Thailand and Turkey, followed by the USA, Germany and Singapore. India and

Thailand currently feature as the top two destinations according to the respondents, and are forecast to hold

these first two positions over the next five years. The respondents rank Turkey in fifth position for patient


numbers today, but forecast that it will rise to third position in five years’ time.



A full list of other countries is given in Section 13: Appendix.

Future trends and changes

The most significant change anticipated over the next five years is the adoption of e-health and electronic

patient records in medical tourism. (87.8% of respondents think this is likely or very likely to happen),

followed by major tourism and travel companies entering the market. (80.0% think this is likely or very likely

to happen). The fact that medical tourists will make choices based on quality rather than price is thought

likely or very likely to happen by 77.7% of respondents, 68.7% of respondents believe it is likely or very

likely that national governments will introduce legislation and licensing of medical travel agencies and

facilitators. A significant increase in the number of patients suing healthcare facilities in other countries is

thought likely or very likely to happen by 61.3% of respondents. However, prices are not expected to fall

(57.6% of respondents thought it unlikely or very unlikely that prices would fall).

Another aspect that was mentioned in additional comments related to the need for a portal similar to

TripAdvisor for medical tourists. Also mentioned was the need to address the problem of getting visas and

visa extensions for medical tourists.


The chart below shows the rating averages for the various trends and changes. To calculate the rating

average a weighting has been applied to the four ratings that the respondents could choose from: very

unlikely (weighting of 1), unlikely (weighting of 2), likely (weighting of 3), very likely (weighting of 4) and

the rating average calculated from all responses to that question.

A split of opinions between providers and non-providers and additional comments can be found in Section

13: Appendix

The chart overleaf shows the percentage breakdown of responses for each factor.


Issues facing the medical tourism industry

The most significant issues facing the medical tourism industry are lack of reliable information about quality

of services in other countries (90.7% of respondents think this is significant or very significant), lack of

follow-up care in the patient’s home country (83.6% think this is significant or very significant), lack of

insurance for medical tourists (83.5% think this is significant or very significant), followed by lack of

awareness of medical tourism (80.0% think this is significant or very significant) and lack of international

standards for measuring outcomes (76.0% think this is significant or very significant) and lack of

international standards for patient records (77.5% think this is significant or very significant). Lack of

regulation of facilitators and agents is the next most important issue (74.9% think this is significant or very

significant).

The chart below shows the rating averages for the various issues; a weighting has been applied to the four

ratings that the respondents could choose from: not at all significant (weighting of 1), not significant

(weighting of 2), significant (weighting of 3), very significant (weighting of 4) and the rating average

calculated from all responses to that question.

Full results and a split of opinions between providers and non-providers and additional comments can be

found in Section 13: Appendix


7. Impact of political changes

The respondents were asked their views on how recent political and structural initiatives in the USA

(Obamacare) and Europe (EU Directive) will affect the medical tourism market.

Obamacare

Participants were asked how they felt Obamacare would affect the numbers of Americans travelling to other

countries for treatment. Half of the respondents (49.4%) thought that it would make little or no difference

to the numbers. More respondents thought that the effect of Obamacare would be to increase the numbers

of American patients travelling abroad (31.8%) than reduce the number (18.9%). The non-provider

respondents were slightly less pessimistic on this issue of the effects of Obamacare on medical tourist

numbers than respondents who are providers.

See Section 13: Appendix for a split of responses between providers and non-providers and additional

comments.


European Directive on Cross Border Healthcare

Just over a third of respondents (36.0%) believe that the European Directive on Cross Border Healthcare will

make little or no difference to the numbers of medical tourists, while over half (51.4%) think it will increase

numbers and only 12.6% think it will reduce numbers. As with Obamacare, the non-provider respondents

are less pessimistic about the effect of European Directive on Cross Border Healthcare than respondents who

are providers.

See Section 13: Appendix for a split of responses between providers and non-providers and additional

comments.


8. International research panel

Half the respondents stated that they would be prepared to participate in an international research panel to

share views and experience of medical tourism, and another 41.5% said they might participate in such a

panel.


9. Other comments by respondents

The verbatims provided by respondents are listed in Section 13: Appendix.

Providers’ comments related to issues such as the importance of the quality of medical and nursing staff, the

need for independent sources of advice for patients, the need for government involvement in marketing of

individual countries, and also accreditation, regulations, standards and ethics to ensure the highest levels of

professionalism, and exclude those organisations who can’t provide them.

Non-providers mentioned issues such as development of sets of standards for the medical tourism industry,

and organisation and management of the medical tourism industry, including co-ordinated management of

detailed information about the industry across the world to help patients make better choices.


PROVIDER ONLY QUESTIONS

The following sections are based on responses given only by those organisations providing services direct to

patents and medical tourists i.e. hospitals and clinics, health spas or medical spas, medical tourist agencies

or facilitators (279 respondents).

10. Services offered by providers

Treatment types offered by the organisation

Dental treatment, cosmetic and plastic surgery, general and orthopaedic surgery, are the services most

commonly offered by the provider organisations participating in the survey.

See Section 13: Appendix for other services mentioned.


Provision of support services to patients

Extensive support services are provided in the destination country. More than four out of five providers

arrange accommodation/hotels (86.8%) and airport pick-up (81.0%). More than half provide additional

services such as 24 hour numbers for questions/emergencies (68.6%), interpreter services (63.6%),

arrangement of flights (52.9%), and online consultations via video or teleconference (52.9%).

Pre-travel and post-treatment follow up in the country of origin are provided less frequently (by just over a

third of these respondents) e.g. follow-up in country of origin (39.3%), consultation in the country of origin

(37.6%).

See Section 13: Appendix for other support services mentioned.


Provision of information to patients

Medical tourists are provided with a substantial amount of information. Nine out of ten providers supply

information on the risks of treatment always or most of the time (90.4%). Printed and personalised

treatment plans are provided by 88% of providers always or most of the time, while 83.1% provide detailed

profiles of surgeons/doctors always or most of the time. After treatment has been completed, 79.2% of

providers ask patients to complete a patient satisfaction survey always or most of the time.

See Section 13: Appendix for other information mentioned.


Interpreter services

Interpreter services are extensively available, most commonly for English, then German, French, Arabic and

Russian languages.

A full list of other languages mentioned can be found in Section 13: Appendix.


11. The medical tourism business of the providers

Numbers of international patients

There was a very wide range of numbers of international patients treated or handled by the respondents in

the last 12 months. The charts below show how many of the respondents were reported by the different

types of patients i.e. outpatients, daycase patients and inpatients. Some respondents provided data on all

three types of patients, while others reported on (or only handle) one or two of the three patient types.

Two respondents inputted some extremely large numbers which we believe to have been incorrectly entered

or are spurious. These have been removed from the analysis to prevent skewing of the data.

The majority of respondents treated or handled less than 100 international patients in the last 12 months.

65% of hospitals and clinics treated less than 100 international patients in the last 12 months. 15% of

hospitals and clinics treated more than 1,000 international patients in the last 12 months.

56% of medical tourism agencies and facilitators treated less than 100 international patients in the last 12

months. 11% of medical tourism agencies and facilitators treated more than 1,000 international patients in

the last 12 months.

N.B. Although a definition of “international patient” was provided, there may still be a differing interpretation

of this by individual providers, and hence inconsistency in the numbers provided.

International patient numbers for hospitals and clinics

The average number of international patients p.a. per facility reported by hospitals and clinics was:

299 Inpatients;

195 Day Case Patients

2,258 Outpatients.

The median number of international patients p.a. per facility reported by hospitals and clinics was:

55 Inpatients;


110 Outpatients.

The chart overleaf shows the responses grouped by numbers of international patients treated pa.


International patient numbers for medical tourism agencies and facilitators

The average number of international patients p.a. per business reported by agencies and facilitators was:

116 Inpatients;


55 Outpatients.

The median number of international patients p.a. per business reported by agencies and facilitators was:

94 Inpatients;


60.5 Outpatients.

The chart overleaf shows the responses grouped by numbers of international patients handled per annum.


Changes in international patient numbers

Provider throughput of international patients is reported to be increasing. Over half of the providers and

agencies (60.3%) thought that the numbers had increased in the last 12 months, while only 17% thought

that numbers had decreased. Less than a quarter (22.6%) said that the number of international patients

using their services had remained the same.


Forecast in changes in international patient numbers in their business

The providers and agencies expect their international patient numbers to grow considerably in the next 12

months. Four out of five respondents who are providers or agencies (79.9%) expect their numbers of

international patients to increase in the next 12 months, whilst a quarter of them (26.3%) expect their

numbers to increase by between 10% and 20%. Only 10.3% expect their numbers to remain the same, and

8.7% expect their numbers to decline.


Where do the patients come from?

Providers and agencies were asked which three countries provide the biggest source of patients for their

businesses. According to respondents, the UK provides the most patients, followed by the USA, and then

Russia, Germany, Australia and the United Arab Emirates.




Internal factors restricting growth of their medical tourism business

The biggest internal factor considered by providers and agencies to affect growth of their international

patient numbers is the size of the marketing budget (36.5% major impact and 33.9% some impact),

followed by financial constraints e.g. cost of finance (24.0% major impact and 38.0% some impact).

Availability of marketing expertise was also an important factor (22.6% major impact and 31.1% some

impact). Availability of clinical staff and capacity to provide services are not considered to have as

significant an impact on growth.

Other internal factors can be found in Section 13: Appendix.


External factors restricting growth of their medical tourism business

The biggest external factor considered by providers and agencies to affect the growth of their international

patient numbers is lack of government support for medical tourism (34.6% major impact and 33.0% some

impact) followed by increased competition (24.3% major impact and 45.5% some impact). Over half the

providers and agencies thought that the image of the country/destination had a major or some impact on

restricting growth (27.1% major impact and 29.3% some impact).

See Section 13: Appendix for other external factors mentioned.


Willingness to provide further information on own activities

It is encouraging to see that three-quarters of respondents are happy to provide basic information about

their medical tourism activities to improve the availability of data about the market.

Additional comments are given in Section 13: Appendix.


12. Marketing to medical tourists

Current marketing activities

According to the providers, the largest amount of their marketing spend goes on developing web site

content (40.9% of respondents said they spend significantly in this area, and another 40.9% invest some

spend in this area). Next biggest spend is on social media (14.3% spend significantly and 32.4% invest

some spend) followed by exhibitions and events (12.4% spend significantly and 25.4% invest some spend)

and PR and media relations (10.5% spend significantly and 28.2% invest some spend). The results of the

survey suggest that spend on on-line promotional activity is lower down the list, with pay per click being the

most popular form, followed by directory listings, banner advertising and lead generation services. The

lowest spend by respondents is on sponsorship and direct mail.

The chart below shows the rating averages for the various activities. To calculate the rating average a

weighting has been applied to the four ratings that the respondents could choose from: zero spend

(weighting of 1), little spend (weighting of 2), some spend (weighting of 3), significant spend (weighting of

4) and the rating average calculated from all responses to that question.


The chart below provides a breakdown of responses for each marketing area.


Perceived efficacy of marketing activities

The perceived efficacy of different types of marketing activity broadly reflects current spend on these

activities, with web site content in first place (56.6% of providers think it is very effective and 33.0% think it

is quite effective) followed by social content (29.4% think it is very effective and 40.7% think it is quite

effective), PR and media relations, and market research. Direct mail and sponsorship are considered to be

not effective or not very effective by over 60% of providers.

The chart below shows the rating averages for the various activities. To get the rating average a weighting

has been applied to the four ratings that the respondents could choose from: not effective at all (weighting

of 1), not very effective (weighting of 2), quite effective (weighting of 3), very effective (weighting of 4) and

the rating average calculated from all responses to that question.


Marketing spend

More than half of those responding to the question about annual marketing spend said they spent less than

$10,000; one in ten spend over $50,000.


Changes in marketing spend

Marketing spend on medical tourism seems to be on the increase, with almost half of providers (46.5%)

saying they spent more in the last year and only 11.2% spent less than last year.

Publications and web sites

There were many different answers to the open-ended question ‘which publications and web sites are the

most effective in marketing your medical tourism services?’; top of the list came Google and the Treatment

Abroad web site with eight mentions each, followed by the What Clinic web site, and then the provider’s own

websites, Facebook and social media. See Section 13 for additional mentions.

Answer Options

Response count

Google 8

treatmentabroad.com 8

whatclinic.com 7

Own website 7

Facebook 4

Google Adwords 3

Social media 3

novasans.com 2


13. Appendix: Results in detail

This Appendix contains more detail on the responses given in answer to some of the questions in the survey.

All verbatim responses are given as provided by the respondent. No corrections have been made for

spelling.

About you and your organisation

Q3 - Company / organisation name

Names of organisations given: 21 Century Hospital Julia Travel & Tourism Co

7 TRAVEL LTD Jyoti Hospital & Minimum Invasive Surgery Center

A2Z Medical Torism in India Kameda Medical Center

AB Consultancy Kamineni Hospitals

academic dental clinic Klinika La Perla

ACCESS Global Healthcare LaDiva Center of Excellence for

Laser,HairTransplant,Aesthetic&PlasticSurgery Acibadem Healthcare Group Laser Clinics (France) Ltd.

Adapta Life Care Marketing Sdn Bhd

Adventist HealthCare LMC

aesthetic dentistry LMT Company

Aevitas fertility clinic, VIncent Pallotti LOHGUANLYE SPECIALISTS CENTRE

AG MEDICAL TRAVEL Longevita

Aga Khan University Longfield Management (P) Limited

Aggarwal Dental Clinic Lotus Medical International

AIHO M

AL ABEER MEDICAL GROUP M&A Innovation

Al Hashar Tourism & Travels LLC M.O.H

Al Iman Medical Clinic Madicare4U LTD

Al Zahra Private hospital,Dubai, UAE Malaysia Healthcare Travel Council

Alhtaia Malaysia Healthcare Travel Council

Alpha Specialist Centre Malaysian Society for Quality in Health (MSQH)

American Hospital Tirana MALO CLINIC

AMTRAC Asia Marketinghouse

Anya Skin Clinic Marlin Safe Med Journey\

Apollo Health City- Hyderabad MCI Management Center Innsbruck

Apollo Hospitals International Ltd MDental

Apollonion Private Hospital Medasia

Apollonion Private Hospital Medaway Health Inc.

artDENTAL - center of dental medicine for aesthetic

dentistry and implantology

Medeguide

Asian Institute of Gastroenterology MEDIC LINK CONSULTANTS LTD

Asian Publication Company ltd., Medica Avenue

ASO Savings and Loans Plc. MEDICA SUPERSPECIALTY HOSPITAL

Astro Air International Inc. Medica Travel

Athens Assistance Medical Care Spain

ATUL NURSING HOME Medical tourism Portugal

az-osp. "cardinale G. PANICO" Medical Tourism Training, Inc

B B CLINIC Medical Tourism Training, Inc.

Bahia Aesthetic Surgery Center Medical Tours Company

BALI ROYAL HOSPITAL Medical Travel Commission

Bangkok Hospital Phuket Medical Travel Europe

Bangkok international dental center (BIDC) Medical Travel Today

Bangladesh Tourism Foundation Medicana Ivf Centre

Baptist Health South floorida Medicatur Medical Travel Agency

Baskent University Hospitals Turkiye Meditour

BCM MediTravel Solutions

Beautiful Escapes MediTrip Advisor

Beautiful Holidays mediwin india tours

Belladent Aesthetic Dentistry&Implantology Clinic MEDSPA BG


BESTRA Medical Guide ltd Mercury Health Travel

Beverly Wilshire Medical Centre MEXICAN ASSOCIATION OF MEDICAL TOURISM

BOC Sleep Centre Miguelangelo Clinic

BON VOYAGE TRAVEL SERVICE ministry of health

BRACES ministry of health - kingdom of Bahrain

Bumrungrad International Hospital MINISTRY OF HEALTH AND QUALITY OF LIFE

Bupa International Miró Center for Oculoplastic surgery

Camino Recovery Mission Hospital

CAP MITERA MATERNITY HOSPITAL- IVF UNIT

CarpatiaGroup MOHFW

CBHCC MONDIAL ASSISTANCE TURKEY

Center for dental implantology and cosmetic dentistry Moreno Travel

CFA Mount Alvernia Hospital

Cincinnati Children's Hospital Medical Center MTC

Cira Garcia Central Clinic My Smile Dent

Clinica dental costa blanca National Daily Newspaper

Clinica Génese do Tempo National Healthcare Group

Clinical Research Centre National Heart Institute

CLINIQUE INTERNATIONALE DU PARC MONCEAU

(PARIS)

National Hospital for Neurology & Neurosurgery

Cluster Medicine Estonia New Hospitals

CN medical tourism Newfoundland and Labrador Medical Association

Companion Global Healthcare Nicolaus Copernicus University

Companion Global Healthcare, Inc. NMC Healthcare

Consultant Nordmed Tour

Consulting in Healthcare and Finance Novasans

Cosmetic Dental Clinic Nucci Medical Clinic, LLC

Cosmeticdirect NURSE SUCCESS GROUP

CosmeticVacations Obstetric & Gynaecology Clinic

Costa Rica Health Travel Ocean Dental Cancun

Cryos International Oftalmolgy Advance Instituto

CT Group of Institution Olive Branch health Mgt

CWH ORALKLASS

Cyprus sun med connections ORBICARE

Danubius medical Spa Holtels Orbicare, LLC

Dental Clinique Osteitis Centre Vienna

Dental Holiday Oxygen Medical

Dental World Manila Panacea Publishing Asia Ltd

dentalia Panorama-Medica Group Co. Ltd.

Dentalp dental clinic Paracelsus travel

DentalSea clinic Parker Hannifin

Dentaturism Center Parsmedix Ltd.

Department of Healthcare Administration, I-Shou

University

Patients Beyond Borders

Derm-Al Beauty Perfection Medical Group

Destiny Meditravel persian treatment & travel

DHA PGIMER

Diamond Helix Medical Assistance Ltd Philadelphia International Medicine

Direct Hair Transplantation phm international

Dr Daniel Garcia Paricio Personalized Plastic Surgery

Institut

Phoenix hospital Group

Dr ErfanianIVF Clinic Phyathai 2 International Hospital

dr kulvinder kaur centre for human reproduction Polmed Travel

Dr Pervin Bilginer Dental Practice Pomadent

Dr. Garg's Multispeciality pvt Ltd praxis fuer fertilitaet

Dr. Rothschild's dental clinic Preecha Aesthetic Institute

East and North Herts Trust Premium Care Colombia

EHFCN Priceless Productions

Emergency Assistance Japan Prince Court Medical Centre

erhiere international company limited Prince of Songkla University

EULEX and ORTOMED private praxis

euphoria healthcare Privet practice

Eurodentaire PT. Mediacare International

EUROMEDICA GENERAL HOSPITAL OF RHODES Pzu Mediana Medikal - Mediana Dental

Euromedical Tours Razavi Hospital


f Reangel SC

Fértilis Clinic Renaissance Healthcare Group, LLC

Fildisi Dental Clinic Reprofit International

Filo diretto Insurance Group Ruby Hall Clinic

Find Medical Tourism Rush University

FirstMed Services GmbH Sacred Heart Dental Clinic

Fondazione Opera San Camillo Sagar Hospitals

Főnix-MED plc Saint James Hospital

Foot and Ankle Clinic sakukidentalhospital

Fortis Healthcare Salvesis GmbH

FREE LANCE ADVISER OWN COMPANY sanjeevani hospital

FrontEnders Healthcare services Pvt Ltd SARONIC NEPHROLOGICAL CENTER Ltd

GE Healthcare Satori World Medical

Gehrig Verlagsgesellschaft mbH Sc Medimar imagistic

General Hospital Jesenice Scanlab

General hospital Pula Sebastian Energy`

Generation Bold secretaria de salud

genese do tempo sehgal dental care centre

Geomedical selfemployed

GEORGALLIDES CLINICAL LABS Seven Corners

Global Benefits Group, Inc. Sevgi Dental Clinic

Global Health Advisors, LLC SGOT-SSOT // SGU-SSU // SGPARC-SSCPRE // SSIPM

Global Health Travel SIA "VASU"

Global Health Travel SIA DentaPlan

Global Health Travel Sime Darby Healthcare

Gooch & Associates SIMED Medical Assistance

Gorgeous Getaways Smart Choice Medical Travel

GPM GOVERNMENT COLLEGE, MANJESWARAM, KERALA,

INDIA

Smile Dental Services

Great Ormond Street Hospital smile partner

Guilmaros S.L. Smilistic®

health and holidays Specialty Hospital

Health Care Strategy Int. SPRING Singapore

HEALTH FIRST Srushti Fertility Research Centre

Health Resources, Ltd. Stem Cell treatment Centers Group

Health Vision Asia STEPS Stravel & Tourism / STEPS Helath & Travel

Healthcare Executive magazine Stomatoloska Poliklinika Jukica

Heart Center Varde SUR India

Heilbronn University Surgical Bliss

Hilton Hotels - West London Symmetria

holhos.com Tajen University

HOLIDAY FOR HEALTH TEMOS AEGEAN

Hospital Britanico de Buenos Aires Temos International GmbH

Hospital Británico de Buenos Aires The Clinic Finder

Hospital de Magalhães Lemos The Health Clinic

Hospital de Olhos Dr. Ricardo Guimarães The Medical Tourist Company

hospital helpline The Medical Travel Commission

Hospital Lam Wah Ee TNHCA

HPP ALGARVE, SA. TRACEY BELL

HR-SCAN LTD. TRAMAZON SAC

Hygeia Holistic Care Travel Cafe

iJET International Travelcity LLC

ilan geva & friends Traveling4Health

Imperial College London @ St Mary's, UCL @ NHNN and

Hospital of St J & E

Treatment in Poland

IMTCC Twin Deer Multi Activities Co ltd

Indexmedica UAB Kardiolita

Indexmedica UKF

Indian Medical Tourism / Travel India Company ULA Technologies/MedTrips

IndiCure Unidolor

inspire peoples consultant univercity

INSTITUT GUTTMANN - Neurorehabilitation Hospital university hospital gent

Instituto Condal de Oftalmología University of Debrecen Medical and Health Science Center

INTEGRATIVE MEDICINE-HOMEOPATHY HEALTH CARE University of Sydney


intelliex V&V Medical - MedTravelBelarus

Inter-Face International Vejthani Hospital

International Board of Mediciner and Surgery Vijay Dental Clinic

International Med Retreat Well-Being Travel

International Surgery Group WELLCARE MEDICAL TOURISM

Intuition Communications Ltd Wijnland Fertiliteit/Fertility

ioc clinica dental William E. Braun, LLC

ISMETT World Med Net India

Istishari Hospital World Wide Health Italy

IVF Europe WorldCare

izmir aktip celebi university, faculty of tourism WTW

Jet Rescue Air Ambulance Xellum Ltd/The Tourism Observatory for Health, Wellness

and Spa Jinepol Women's Health and IVF Clinic xgfhk

Yemen Tourism Promotion Board

Q5 - In which country is your organisation located?

Answer Response

Percent

Answer Response

Albania 0.3% Lithuania 1.3%

Algeria 0.5% Macedonia 0.3%

Argentina 0.8% Malaysia 3.8%

Australia 2.4% Malta 0.3%

Austria 1.1% Mauritius 0.3%

Bahrain 0.3% Mexico 2.1%

Bangladesh 0.5% Netherlands 0.3%

Belarus 0.3% New Zealand 0.3%

Belgium 1.3% Nigeria 1.3%

Brazil 1.1% Oman 0.8%

Bulgaria 1.1% Pakistan 0.3%

Cambodia 0.3% Peru 0.3%

Canada 0.8% Philippines 0.5%

Cayman Islands 0.3% Poland 2.4%

Chile 0.3% Portugal 1.9%

China 0.3% Romania 2.4%

Colombia 0.5% Russian Federation 0.3%

Costa Rica 0.3% Saudi Arabia 0.8%

Croatia 0.8% Singapore 1.1%

Cyprus 1.3% Slovakia 0.3%

Czech Republic 0.5% Slovenia 0.3%

Denmark 0.5% South Africa 0.8%

Estonia 0.5% South Korea 0.3%

France 0.5% Spain 3.5%

Georgia 0.3% Sri Lanka 0.3%

Germany 2.4% Sudan 0.5%

Greece 3.5% Switzerland 0.3%

Hong Kong 0.5% Taiwan 0.8%

Hungary 3.5% Thailand 3.8%

India 11.0% Trinidad and Tobago 0.3%

Indonesia 0.8% Turkey 4.3%

Iran 0.5% Ukraine 0.5%

Ireland 0.3% United Arab

Emirates

1.3%

Italy 1.6% United Kingdom 5.1%

Japan 0.5% United States 12.9%

Jordan 0.5% Uzbekistan 0.3%

Kosovo 0.3% Yemen 0.3%

Kuwait 0.3% Yugoslavia 0.3%

Latvia 0.8%

Lithuania 1.3%


Q6 - What is your organisation’s main business activity?

Answer Options Response

Percent Hospital or clinic 42.7%

Medical tourism agency or facilitator 24.1%

Consultancy (e.g. business or marketing consultancy) 5.0%

Academic institution 3.7%

Medical assistance 3.7%

Government organisation 3.2%

Health spa or medical spa 2.5%

Publisher 2.2%

Education and training provider 2.0%

Industry association 1.7%

Quality and accreditation services 1.7%

Travel agency 1.5%

Hospital development 1.2%

Insurance provider 1.2%

TPA, claims management 0.7%

Airline 0.5%

Conferences and event organiser 0.5%

Hospitality and concierge services 0.5%

Software and technology 0.5%

Tourism board 0.5%

Hotels and accommodation 0.2%


The international patient market today

Q1 - Which three countries do you think are the leading medical tourism destinations TODAY, in

terms of PATIENT NUMBERS?

This question was weighted: a country ranked as first preference, scored 3 points, a country ranked as

second preference scored 2 points and a country ranked third scored 1 point.

Answer Options Response

Algeria 6

Australia 6

Azerbaijan 6

Bahrain 6

Belgium 17

Brazil 27

Bulgaria 6

China 6

Costa Rica 38

Cyprus 6

Dominican Republic 6

Egypt 15

Germany 78

Hungary 47

India 345

Indonesia 12

Iraq 12

Israel 6

Italy 6

Malaysia 23

Mexico 32

Nigeria 12

Panama 6

Philippines 6

Poland 21

Russian Federation 12

Singapore 44

South Africa 6

South Korea 12

Spain 11

Sweden 6

Switzerland 9

Taiwan 6

Thailand 260

Turkey 62

Ukraine 5

United Arab Emirates 3

United Kingdom 51

United States 135


Q2 - Which three countries do you think are the leading medical tourism destinations TODAY, in

terms of THE QUALITY AND RANGE OF SERVICES PROVIDED TO INTERNATIONAL PATIENTS?



Answer Options Response Austria 12

Belgium 18

Belize 6

Brazil 6

China 6

Colombia 18

Costa Rica 30

Croatia 6

Cyprus 12

Denmark 6

Egypt 12

France 6

Germany 152

Greece 6

Hungary 35

India 109

Indonesia 6

Israel 12

Italy 6

Jordan 11

Lithuania 6

Macedonia 6

Malaysia 33

Mexico 29

Panama 6

Philippines 9

Poland 17

Portugal 6

Qatar 6

Romania 6

Singapore 179

Slovakia 6

South Korea 6

Spain 21

Sweden 6

Switzerland 39

Taiwan 5

Thailand 199

Turkey 47

Ukraine 3

United Arab Emirates 15

United Kingdom 26

United States 226


Factors affecting patient choice

Q3 - What factors do you think are most important to medical tourists when they choose a healthcare

facility in a foreign country?

The charts below shows the rating averages for the various factors for providers and non-providers; a

weighting has been applied to the five ratings that the respondents could choose from: not at all important

(weighting of 1), not important (weighting of 2), neutral (weighting of 3), important (weighting of 4),very

important (weighting of 5) and rating average was calculated from all the responses to that question.

Providers (hospitals, clinics, spas and medical tourism agencies)

Non providers (all other respondents)


Verbatim responses

Q3 - What factors do you think are most important to medical tourists when they choose a healthcare

facility in a foreign country?

As a quality consultant I am afraid I am cynical about the clinical sophistication of the typical

health traveller. While clinical outcomes data and infection rates SHOULD be very important, the

lack of data and indicator definition consistency and transparency make it very difficult for even

the sophisticated individual to make informed comparisons and decisions.

Granted, what I perceive them sensing or demonstrating as "important" or not is not necessarily

what they actually should be considering important. With that said, I filled this out by what I see

patients actually doing... not what they SHOULD consider important.

#1 and #2. In order for the figures to reflect what's really going on, you must ask the questions

based on where the patients are coming from -- not just on where they are going, Patients on the

European continent make different choices than those on the North American continent.

Visit hospitals to check their performance their services accreditation at the hospital

The patient wants a good and qualitative service, but if the patient can not afford the treatment

then the objective is not being met. So the cost of treatment is the key thing that makes the

patient go for it or not.

To have hospitals and doctors after return to their country would boost the MT industry. Insurance

company participation is very important for the growth.

Over all, its very important to have a confidence and trust and a strong belief when a patient is

traveling to Asian countries for their medical treatments. A good case study and referrals plays an

important role also in popularising the medical tourism destination.

List of genuine medical tourism agents required

Patients are dependent on agencies who arrange destination hospital or clinic and do not have

much involvement in finding about the facts. So whosoever pays the agencies get the business.

Ensure a pleasant experience

Written believe it is necessary to build brand with e-medicine technology and loyalty

Time factor is important

Quantifiable scientific standards for patients to understand are very important because marketing

can be overwhelming and recourse outside of a home nation may be implausible. Having a

"medical liaison" that can help understand a patient's needs, interpret what they will receive, how

they will receive it, and what they can expect as well as assist them once there is necessary to a

good outcome which contributes to overall value.

The "neutral" rated points would be of importance if the patients knew about them or if they could

assess them. But patients a lay persons and cannot evaluate and assess clinical outcome, doctors'

qualification or what is behind an accreditation or certification.


A patient's decision to travel to another country for medical treatment is often made on multiple

factors. Information obtained through internet often proves crucial

Patients don't know what they don't know... that is why many don't know what to expect and they

go for primarily price and quality

Tourist offer, tourist attractions

With my client's value (i.e. pricing) is high with quality a close second.

Questions 1 & 2 depend greatly on variables such as originating country/language of international

patient, travel/budge profile, et al. Very difficult to assess one country over another in general,

without focusing on the needs of a specific patient, region or demographic.

Cost, quality of treatment, basic amenities, language interpreter services are very important. There

should be a proper legislation for medical tourism and provision of aftercare most probably in the

origin country for the convenience.

A contact or representative in patient's country is most important

Why people seek medical treatment out of their own country? It is very simple answer, because

they want to have better service and quality of treatment to save our loved ones.

Patients always need quick service from authenticated hospital with good assurance

Very different answers for cosmetic surgery and for necessary medical procedures - experience

and cost is most important for the former, expertise for the later

Recent personal experiences has shown me that having an international coordinator who is

available from the moment the patient shows up for treatment to the time they leave by cab or

public transportation - who speaks their language - fluently...not someone who claims to know the

language and assumes a translation that sort of sounds like the word but is not fully understood

by the patient, as might happen in Thailand, but not in Malaysia, where the average local has a

good grip on the English language. I'd say I find communication is the #1 concern. Now that

might not be so for Europeans or Asians who have the capacity to "think" in another language,

which makes one braver...

Treatment not available in home country

Although hospitals often ignore the importance of language access and cultural appropriateness of

treatment, a guarantee language access will be of primary importance in choice of country and

cultural appropriateness will greatly influence patient satisfaction with treatment.

While we believe that clinical outcome data is very important, we don't believe that the medical

tourists understand it and can apply it, therefore from the perspective of the question asked here,

we had to rate it lower.


The future of the international patient market

Q1 - Over the next five years, what do you think the annual growth rate will be in the international

patient market?


Non-Providers (all other respondents)


Q2 - OVER THE NEXT FIVE YEARS, which of these areas of healthcare will see the greatest increase

in international patient numbers? Select the THREE areas that you believe will experience the most

growth in patient numbers

All respondents



Non Providers (all other respondents)


Q3 - Which three countries do you think will be the leading medical tourism destinations IN FIVE

YEARS TIME, in terms of INTERNATIONAL PATIENT NUMBERS?



Answer options Response Answer options Response

Afghanistan 1 Jordan 10

American Samoa 3 Libyan Arab Jamahiriya 2

Argentina 9 Malaysia 75

Armenia 2 Mexico 44

Australia 10 Netherlands Antilles 1

Austria 3 New Zealand 2

Bahamas 3 Panama 6

Bahrain 3 Peru 1

Belgium 9 Philippines 16

Brazil 35 Poland 21

Bulgaria 1 Portugal 1

Canada 7 Puerto Rico 1

China 28 Qatar 3

Colombia 8 Romania 5

Congo 2 Saint Helena 1

Costa Rica 15 Saint Kitts and Nevis 2

Cuba 3 Singapore 77

Cyprus 6 Slovakia 3

Czech Republic 2 South Africa 6

Denmark 3 South Korea 23

Egypt 7 Spain 36

Estonia 1 Sri Lanka 2

France 4 Switzerland 3

Germany 84 Taiwan 10

Greece 9 Thailand 197

Hungary 21 Tunisia 3

India 260 Turkey 116

Indonesia 7 Ukraine 3

Israel 6 United Arab Emirates 18

Italy 4 United Kingdom 30

Japan 1 United States 102


Q4 - What is your view on trends and changes in the medical tourism market over the next five

years? How likely are these changes to take place?



Q4 - What is your view on trends and changes in the medical tourism market over the next five

years? How likely are these changes to take place?

Verbatims

Transparency in hospital and provider complication rates and other statistics will become a

requirement to attract patients.

For the e-health initiatives will depend on infrastructure and available skilled workforce by region

Price, waiting time and perceived quality will dominate decision-making. Those patients who can

pay 'any price' will make decisions on perceived quality of services. Early adopters of emerging

technology, e.g., robotics, nanotechnology, genetics, will draw patients from countries where

regulation, bureaucracy and (medical or) other barriers limit the implementation of innovation.

Third Party Payers and bilateral trade agreements due to gradual extinction of the EU State

Providence and to the EU in economic crisis.

Granted, it is the goal of my organization, the IMTCC, but I see a trend in MT coming into its own

in terms of self-regulation. Trickle down (expecting big govt to step in) is not going to work and

hasn't worked thus far...it's up to the individual players (various types of medical tourism service

providers, docs, mtfs, hotels, etc etc) to come together and play by certain rules and setting our

own higher standards.

Teleconferencing will bring more trust in choosing the consultant / hospital etc

level playing field

Other countries will start to implore the advantages of medical tourism.

Govt are slow to act. India has done a good job creating medical visa, India needs a lot of training

at every level. There is no cultural sensitiveness at many places and this can only improve with

quality education and training.

More and more foreign insurance companies would imbibe medical tourism in its scheme of things.

Airlines and its facilities in bringing the medical tourists. As they need more attention and care

during air travelling and at transit locations. So medical insurance will also play an important role.

1.Significant increase in hospitals pursuing the hospital accreditation that is internationally

recognised in tandem with medical tourist making treatment choices based on quality rather than

price in #4 2.Insurance agencies increasing participation with increase in medical tourists

Mutual collaboration among healthcare provider, insurance and travel agents. Pre & post op care

with smooth and seamless services. Many the patient look for visa and most Embassies fall to give

them. Cost and quality.

The EU cross border legislation & public hospital waiting lists

Global spread of nosocomial diseases as patients do not subscribe to recommended protocols.

Airlines will need to accommodate recovering medical tourists and regulate "patient travellers" or

dedicate rows and cabin areas levying ticket rates for orthopaedic accommodation, O2 tanks, etc.


Teleradiology and telemedicine (consultations) will increase exponentially

I think that there will be a bigger role for insurance companies and that much bigger medical

tourism companies with stronger marketing influence will enter the market place.

U.S. insurers including a medical tourism option in their offerings.

Marketing and promotion standards in healthcare marketing, facilitator networks and case

management standards, disappearance of provision based patient referral business models

Five years hence, technology-driven cost and quality transparency (a la TripAdvisor, et al) will

allow patients to search, compare and make healthcare decisions/transactions in a way that's

nearly impossible today for most consumers.

Insurance companies will enter the market

Attrition and consolidation among medical tourism facilitators

National governments will simplify visa process for medical tourists.

hope establish an international ethical healthcare organisation (independent and the real non

profit)

Every country will improve their hospital services to deliver many aspects of patient satisfaction

and competition become higher everyday especially in the neighbouring countries such Singapore

and Malaysia.

More focus on the physician surgeon dentists.....who are they?

Consumer advertising of medical tourism in main stream media. Providing chronic care over long

periods and relocation for better and cheaper medical care by US retirees

Outcome of Obamacare in the U.S. and its support for MT.

Competition will increase due to more experiences, Communication platforms and Social media

The European Union may be an exception in that the legal environment may be more regulated.

Merger and consolidation; emergence of branded global health provider networks

A global set of market entry privileging and facility criteria may arise, a truly representative global

roundtable will emerge and replace the medical tourism association's intimidating grip on the

market.


Q5 - What are the most significant issues facing the medical tourism industry?

All respondents

Answer Options Not at all significant

Not significant

Significant Very

significant

Lack of reliable information for medical tourists regarding quality of services in other countries

0.4% 8.9% 61.9% 28.8%

Lack of an international standard for patient records

1.2% 21.4% 55.3% 22.2%

Lack of patient /consumer demand 6.6% 36.7% 46.1% 10.5%

Lack of controls on advertising and promotion of medical tourism

4.3% 31.4% 48.8% 15.5%

Lack of insurance products for medical tourists 0.8% 15.7% 52.9% 30.6%

Lack of international standards for measuring outcomes

1.6% 22.4% 51.6% 24.4%

Lack of awareness of medical tourism in the source countries

1.6% 18.4% 57.6% 22.4%

Poor image of medical tourism in the media 1.6% 28.1% 47.8% 22.5%

Lack of follow up care in the patient’s home country

0.4% 16.0% 52.0% 31.6%

Lack of regulation of facilitators and agents 0.4% 24.8% 51.6% 23.3%

Poor advertising and promotional practices 0.8% 26.2% 53.9% 19.1%




Not significant

Significant Very

significant


0.6% 10.1% 64.3% 25.0%


1.8% 22.2% 58.1% 18.0%



4.8% 33.3% 48.2% 13.7%

Lack of insurance products for medical tourists 0.6% 17.5% 50.0% 31.9%


1.2% 26.2% 51.8% 20.7%


1.2% 16.3% 59.0% 23.5%

Poor image of medical tourism in the media 1.8% 27.0% 48.5% 22.7%


0.6% 21.1% 52.4% 25.9%

Lack of regulation of facilitators and agents 0.6% 29.2% 55.4% 14.9%

Poor advertising and promotional practices 0.6% 26.5% 54.2% 18.7%


A weighting has been applied to the four ratings that the respondents could choose from: not at all

significant (weighting of 1), not significant (weighting of 2), significant (weighting of 3), very significant

(weighting of 4) and the rating average calculated from all responses to that question.



Not significant

Significant Very

significant


0.0% 6.7% 57.3% 36.0%


0.0% 20.0% 50.0% 30.0%



3.3% 27.8% 50.0% 18.9%

Lack of insurance products for medical tourists

1.1% 12.4% 58.4% 28.1%


2.2% 15.6% 51.1% 31.1%


2.2% 22.5% 55.1% 20.2%

Poor image of medical tourism in the media

1.1% 30.0% 46.7% 22.2%


0.0% 6.7% 51.1% 42.2%

Lack of regulation of facilitators and agents

0.0% 16.7% 44.4% 38.9%

Poor advertising and promotional practices

1.1% 25.6% 53.3% 20.0%


A weighting has been applied to the four ratings that the respondents could choose from: not at all

significant (weighting of 1), not significant (weighting of 2), significant (weighting of 3), very significant

(weighting of 4) and the rating average calculated from all responses to that question.

Q6 - What other issues does the medical tourism industry need to address?


Unbiased robust data bank of Medical tourist undergone for treatment, doctors, hospital

Need reliable marketing and the insurance covering problems should be solved

Bridge relationship between consultants, hospitals of different countries with referral or source

countries sending patients for treatment abroad.

Lack of benchmarking

How an outside country doctor/organization reach patient of other country regularly

Visas and international migration issues

Culture assimilation, accreditation, Insurance collaboration. A real working model in the industry

which will ease the anxiety of the patients looking for treatment.

Absurd claims by stem cell treatments in India must be banned. They show us in poor light in

world media.

Streamline the process and provide more information about the treatments, facilities and service

providers to the patients.


Personalised service, packages and care. Pricing.

Government Apathy in some countries which is quite a retard for the Medical Tourism Industry

especially in countries like India. Registration of Medical tourists coming on Medical Visa to India is

quite a pain especially that the Registration Agencies are not so conducive to overall significance of

such a policy.

No idea

You guys are doing good. This survey is quite sufficient in all aspects.

A meeting of minds

Medical Indemnity arrangements for individual practitioners treating international patients

An international Health Tourism feedback site should be created so pt's can look up reviews of

other clients prior to their making a decision - based on the Trip Advisor concept

Increase of price in their country

More and quick communication with the agencies, as well the patients

Standardization of health care, transparency and developing SOPs for measuring outcome in

surgical cases

Accreditation - only one to be used in each country, minimum requirements to be laid out for

facilitators

Slow patient queries processing and account settling with patients - by hospitals.

Search for the doctors/ hospital who can surely give care at International levels

My answers are only applicable for donor semen: More information/translation, more guidance,

more consultancy, more service/help to create contact between patients and sperm banks and to

help/support all the way till the goal, which is purchase of semen, shipping, insemination (home or

at clinic) or travel to the clinic abroad and all practical issues related.

Regularization of prices and getting all the medical tourism destination and the hospitals unset one

umbrella.


Lack of a responsive/responsible Association for members of the medical tourism and medical

travel industries.

Most new greenfield hospital in ASEAN are investing in JCI accreditation but this alone does not

change the cultural issues on how risk and adverse events are managed and are transparent

Medical mediation services, Consumer protection tools, Transparency in user-generated posted

reviews of providers

Informed choice to the "consumers". Medical tourists need to be advised on the legal

establishment in the country of therapy, (regarding their area of interest)


Lack of creating accurate awareness to patients before coming for treatment. Lack of detail

information on mode of treatment and cost of treatment beforehand.

Reality and Trusty worthy issues. It can’t be commercial. If it is going too much on commercial

practises then it might affect the quality and right choices.. It need to have ethical principles and

there need to be an international authority or body to control the regularities and issues.. Not a

regulator which certifies the infrastructure, rather a regulator body which looks into the services

part.

1. Participation of insurers that have international coverage and additional items besides medical

costs. These include logistics, accommodation, etc. 2. Uniformity in analysis of outcome data by

the medical tourism association e.g. successful rates by types of hospitals and state/country. This

performance outcome will be the country's benchmark in the future. Insufficient hospitals in the

medical tourism country catering for foreign medical tourist. It is important that the country adopts

a certain acceptable percentage addressing the needs of local patients before deciding to promote

foreign medical patients into the country.

#1 is the inability of patients to get follow up care in the US after returning to the US due to

legitimate liability concerns. US doctors don't like to follow up with other US doctor patients if

there is a perceived or even potential problem. Americans are litigious by nature. Adding a foreign

country to the mix, makes physicians uncomfortable.

If local doctors could communicate better with doctors in other countries (telemedicine consult

would be ideal), perhaps this could improve.

US doctors are suspicious of the quality of care and quality of medical training in our countries.

Sometimes this is founded; most often, it is not. If local, US doctors could develop a relationship

with a particular hospital or set of doctors in a foreign country, even visit the facility, this could

help."

they should try to be getting visa for patients so that inflow will be for them to travel

Entire co-ordination of care and medical-legal aspects of other issues, such as disability issues for a

poor outcome if a patient suffers a catastrophic event during a procedure performed in another

country, repatriation coverage in the event there is some unforeseen event, security issues, How

do you address United States HIPAA constraints on an international level?

The medical tourism "industry" is too small to effectively address the larger issues cited above. It's

up to the market, and the ever-elusive "tipping point" to drive patients to cross borders in pursuit

of quality, affordable care.

The integration between hospital facilities and tourism supports such as easy transportation from

the airport to hospital destination in each country.

Tour operators should not yet accepted medical tourism with top priority. On the other hand,

service providers (like hospital etc.) are not at all serious about promoting and make a tie with

other promoters and operators.


Incidence of medical complications, emergencies and post operative infections; Focus on regional

niche markets; Negotiated cost benefits/advantages in niche markets

Communication with ease and less expense by phone and Skype to friends and family to stay

connected with people at home; Message points with a clear understanding of benefits; Cross

national or international insurance coverage for a global population of boomers and older adults

that do not see boundaries, as did the past generations, and will travel for medical care, but need

to feel that the medical procedure is fully integrated through records an communication wherever

they live or travel, Failure to promote medical care to ordinary tourists so they are familiar with it

when they actually need care-in other words a disconnection between medical tourism and leisure

tourism. Yet, the veteran leisure tourist is the same market as the medical tourist.

Follow up care in home country is most on patients minds. If you are sick or have medical

condition that needs addressing, why shouldn't any doctor see that patient? I have heard from

doctors in the U.S. or the UK won't see a patient because that patient has seen a doctor in another

country. I hear a big outcry from M.D.'s in both countries saying that they will not see patients

who they know were treated outside of their region. This is ludicrous. What ever happened to the

Hippocratic oath? Whatever happened to the rights of the patient? I see that here in the U.S.,

there is more talk about ""Domestic Tourism"" where the patient makes a deal with a hospital or

doctor in another state - therefore bring his family to Florida, for example for surgery, and be with

his family in America, rather than a foreign country...

As someone who was a pioneer in cultural and linguistic competence in healthcare in the US, I see

the same failure to recognize the importance of clear patient/physician communication and

understanding the patient's culturally bound needs and expectations as there was in the early days

of cultural & linguistic competence in the US & in other diverse countries. Thus far, medical

tourism has concentrated in the marketing and business aspects and ignoring language & services.

Most hospitals in places pursuing medical tourism are similar in their technical and physician

training aspects, what will make the difference in the future of medical tourism will be making the

patient feel confident and comfortable--this requires attention to communication and cultural

issues. While, at the moment they are seen as non-essential "extras" by both facilitators and

hospitals, they ARE BUSINESS ISSUES! Patients will be attracted to countries and hospitals that

market to their values and in language that is culturally appropriate and correct. They will be

satisfied and thus promote hospitals which provide the kind of care that they are culturally

programed to need.

Combining holiday, getting healthy and stay healthy on high standard

Provider and industry collaboration and globally integrated continuity of care, inefficiencies and

leveraging economies of scale through geographically clustered market entrants that still maintain

a competitive and comparative advantage but simultaneously raise the tide for all players.


Impact of political changes

Q1 - What do you think will be the impact of "ObamaCare" on the number of Americans travelling to

other countries for treatment, EACH YEAR? Obamacare will..




Q1 - What do you think will be the impact of "ObamaCare" on the number of Americans travelling to

other countries for treatment, EACH YEAR? Obamacare will..

Verbatims

I HAVE NO IDEA ABOUT THAT ACTUALLY....

I am not in America so cannot comment

There will be longer waits for procedures and coverage deductibles will increase. Some procedures

may no longer be covered.

No comment

1. ObamaCare has already resulted in the loss of the ""personal doctor"" valued by Americans. For

example, I've lost my primary physician (he quit) due to ObamaCare, and therefore I am now

reduced to being seen by the ""doctor-of-the-day"" for 15 min appointments with a doctor who

knows only my medical chart and has no personal relationship with me. 2. When people start to

experience the ""free tests"" that aren't free with the exchanges, they will more readily shop

across borders for procedures at prices they can budget. For example: 1) Now a colonoscopy is

free only if the test results are not positive. If the test results are positive the patient will incur the

entire cost of the operation. 2) If a patient is seen in a doctor's office for a free exam but is

asked if ""something hurts"", the visit will be recoded and the patient will bear the expense of

what they were told was a free exam.

Especially for those that opt out or want procedures or therapies that are not paid by Obamacare...

alternative treatments included!

Unsure what ObamaCare refers to

In as far as the Insurance policy is not changed, and equal right are giving in terms of treatment

standard. In addition to providing cheap and conducive medical care. People will continue to travel

for medical checkup elsewhere.

I don't know

Depending only on USA patients may not be the best path forward for providers.

Purely depends upon the medical treatments and waiting time at home countries. Health and life is

more important. It may be an important issue for all citizens, but when it comes to life, it is a

decision on individual based and urgency.

If Obama Care aim is to reduce the health care, every citizen should decide where to go to have

medical attention.

No idea

Access will go down (how will the system absorb 40M more patients with same [or fewer] number

of physicians. Costs will continue to go up. Types of treatments patients want are NOT AVAILABLE

in the US, such as stem cell, total body hyperthermia, aphoresis, and a long list of cancer

techniques.


I have no comments on the American medicare

Don't know what's Obamacare

Increased wait times and hidden costs within health caused by the reduction of services that will

be seen through the Affordable Care Act will make people view "combining reduced fee healthcare

and vacations" as a viable alternative to their high deductible healthcare plans.

I expect we won't see significant effects of ACA on medical tourism until well into 2016 and

beyond. Wheels of change, entrenched attitudes, et al, turn quite slowly in US and int'l

healthcare.

More uninsured Americans will be covered, but already-high costs will continue to rise, and service

levels and waiting times will decline.

Good for American citizen since it will give more protection for their own health insurance in their

own country

Pluralistic approach to attaining health care dependent on financial orientation, ethnicity, need and

timing

Obama care will be a disaster as we will lose the best of the medical profession.

No idea

Overcrowding and long wait. I did do workshop on this issue, if you need a copy email me

[email protected]

Don’t really know about the Obamacare.


Q2 - What impact do you think the European Directive on Cross Border Healthcare will have on

patient mobility within Europe, EACH YEAR? The EU Directive will...




Q2 - What impact do you think the European Directive on Cross Border Healthcare will have on

patient mobility within Europe, EACH YEAR? The EU Directive will...

Verbatims

For member states that have a social welfare system this will be an issue of cost recovery as most

of the systems do not incorporate robust billing systems

Americans will continue to travel outside the U.S. for services for which their new or existing

insurance will not pay or law/regulation prevents treatment.

I am not familiar with the European Directive on Cross Border Healthcare

Not familiar enough with it to judge

It all boils down to the cost of treatment and quality of service being provided. In as far the two

mentioned are not put in check, patients will continue their basic trips elsewhere to get treated.

The real growth is in south Asian, middle east and African countries. Caribbean countries and USA

will have better and efficient providers with whom Asian providers can not compete.

We think this is on the constant increase as pricing in eastern Europe is less and quality is good. It

provides competition to us here in SA , as we are far away

As stated above

List of genuine and leading medical tourism agents who get dental patients to India required -

please

No idea

I'm not familiar with the specifics of this Directive.

Don't know about this directive

Having the EU Health card enabling them to travel (with permission) to another nation which they

view as higher quality in the service or specialty with which they need to receive care will increase

patient traffic to many areas. There are some countries with a plethora of sub-specialists and a

concerted lack of general practitioners. Although this may facilitate many areas and stimulate

some of the EU economy through "trickle down" in patients stopping to purchase goods or

ancillary services, it may harm overall healthcare in the long run by creating pockets of specialties

and voids or vacuums in areas.

Because insurance companies don´t support this direction. The patients don´t have any

information about

Maximum 2 %

I'm not in a good position to comment intelligently on this query

Depending on implementation and support

Don't know


I think it’s a positive initiative so that people will have a freedom to find our own better healthcare

When I addressed a delegation at a medical tourism conference the Cross Border was just starting

- makes sense and will work well.


Other comments

Q1 – Any last comments?


Don't reduplicate US model of health care delivery system to other countries specially to

developing one. Don't overestimate importance of international accreditation of hospitals/doctors.

Put emphasis on quality of doctors & other health professionals :- A decent hospital fully equipped

with modern equipments is enough to maximize outcome of procedures/treatments. Strengthen

doctors - patients relationship which will have tremendous +ve impacts on psyche of patients even

for the cases which have gone wrong, thus yielding in higher satisfaction rating from patients. No

more emphasis on comfort, fringe services, pleasure & sight-seeing. Reduce procedures,

formalities & role of middle men to bare minimum. Target , educate regular tourists to specific

country & motivate them to avail the health services

My country and my city must be marketed....this is the biggest problem for our business at the

moment....

No

I hope to attend this events to increase my knowledge

A lot of awareness is needed on what and where patient can avail treatment which is cost effective

best treatment results and patient care.

Kindly guide me how to get international patient in my city agra, india. Lots of foreigners come

here to see taj mahal and other monuments, so how we get patients out of that.please reply.

Please share the results

Thank you for your time and interest

Integrative Medicine involving evidence-based Complementary Medicine ,especially Homeopathic

Medicine is the most promising dynamic for Sponsors.

No

MT focus is needed to improve accreditation and education and training. Develop functional and

efficient models to improve service and efficiency.Bring in the partners (Insurance and hospitals)

to make it a global Industry than a patch work of providers.

Well done for doing this survey. We need some standards and opinions from all in the industry , so

we can all benefit

Thank You

Medical Tourism is an industry per se and not a Fly by Night operation. It involves significant work

and roles and is a work of professionals who understand healthcare markets. Stringent regulations

should be imposed so that entry to this profession is limited and only those who understand

healthcare and patient care would only think of entering.


Our organization is not big, but we want to grow up and every time we´ll be participating more

and more.

I need the list of genuine medical tourism agents who get dental patients to Bombay (India).

No for now

Good luck

I will play a definite lead role in steering MT in Gujarat

Thank you.

At the moment, my impression that nearly all the international patients we see depend on personal

contacts with embassies and other government agencies. There seems to be little availability of

independent quality-based advice for individual patients.

Thank you for asking and sharing!

Do I get a copy of all the answers I gave?

We are Sri Lankan dental care providers giving high standards dental care help us to promote our

hospital internationally. www.sakukidentalhospital.com

My country Kosovo is making initial steps towards Medical Tourism and I would be glad to give my

contribution towards this goal. By the way, Kosovo is a beautiful country with acceptable level of

security, taking into the consideration that some areas are considered less secure.

Be honest in sharing final outcome our survey at various places. i.e. it should not be commercially

industrial driven for individual benefits but trying to help globally & honestly

I would like to attend and participate in your team if you need someone from Turkey. Thank.

Keith, thank you for this work!

Good luck

Please do send us a copy of the result of the survey. Update us in all possible ways so that we may

partner to make the medical tourism industry well regulated, with ethical guidelines incorporated

and make the Medical tourism industry grow. Try and focus with all the countries across the globe

and not just US centric. Make it a Global forum

Thanks for doing this on behalf of the industry. One suggestion: allow a "don't know" or "not

applicable" response to many of these questions, rather than forcing an answer.

No

Thank you IMTJ for your work and care about med.tourism!

The all facilities or facilitator related in medical tourism should look at the patient from outside

ethically, not just to make money. This is a kind of business but first we couldn't forget to be think

of the people to get healthcare services best in true price tariff.


Making Medical Tourism Industry up to standardize with measurable result will be most significant

factor.

It is too early for us to answer some of the questions of the survey. We are at the very beginning

and trying to learn with others that have a longer experience. Congratulations for the initiative, it is

very interesting!

Please understand that sperm banking is a little different than other border crossing activities as

the sperm is the "traveller" more than the patients. However, both is a kind of traveller. The

phenomenon is more wide spread in Europe, as there are many different legislations and only very

few sperm banks that can find out to manage more than one country. The EU directive have

"killed" a lot of small sperm banks. The national legislation in different countries have made it

almost everywhere impossible to run a sperm bank.

All the best and hope my feedback is a value addition.

Thanks for your work to get some reliable data for this industry!


I have been involved in this field (international medical care) as a participant and observer since

the late 1990's as a member of the first class of Joint Commission International surveyors and

subsequently establishing my own consultancy comprised of former Joint Commission surveyors.

The same technological forces that allowed me to successfully market to international clients now

allows patients and providers from different parts of the world to successfully reach each other. As

with any emerging market there will be huge success stories and stories of terrible abuses. Over

time the extremes will moderate toward the center. There will always be uncertainty in medical

decision-making irrespective of evidence-based medicine as the human (patient and provider) are

not standard. Both are flawed. Overall, the emergence of "medical tourism" (or health travellers)

is a boon to both the patients in the source countries and the providers (healthcare personal and

facilities) in the destination countries. Both will benefit in the aggregate. I am pleased that my

colleagues and I have played a small part in this process.

Someone should start the discussion of a UNWTO corresponding Organization for MT, with one set

of standards for Medical Tourism and governmental policy coordination between source and

destination countries or at a macro regional level.

Africa is one of the largest sources of medical tourist, and Nigeria being my country has been a

major contributor to this. It is important that medical tourism is giving more consideration in

African nations either by encouraging it or making it a hub by building good medical facilities to

attract outsiders and providing good professionals to handle health sector in the continent. Thank

you. Engr. Bilyaminu Ibrahim Gusau. Facilitator of NOVA Speciality Surgery India.

Please keep me informed about any conferences related to this subject. Thank you.


Great Job. Keep on bringing the newer innovations on medical tourism through media and

journals. Keep promoting the Medical travel events in the medical booming destinations. This way

it can be pre market survey and preparedness for Medical Travel Customers. Bring more

awareness on medical travel promoters or agencies, Certify these agencies and issue renewing

licensing certification programs by looking at the number of successful patients history.

I totally agree that medical tourists mean where a patient travels specifically for the purpose of

treatment in another country. They are not expatriate resident or business or holiday traveller

who fall ill in a country.

Some healthcare provider or some country quoted a big number of medical tourists that include

accident or non-elective treatment from all holiday traveller, expatriate and resident into their

records."

I work for a Fortune 250 company with 60,000 employees in 40 countries. We are looking for local

care for our employees, particularly integrative/holistic medical care. I am responsible for building

a network of integrative oncology locations worldwide. I would like to be more involved with

Medical Tourism. I spoke at your meeting several years ago and was very warmly accepted.

The fact is that medical tourism is a help worldwide due to specialisation.

Am available for more than once to participate on international platform

As a big player in this industry I sincerely feel there are great growth potentials in the industry.

It is very important to make available adequate information and details about medical tourism

across the world. This helps in the decision making of tourist and in fact a deciding factor on which

country to go.

Medical tourism have a future, and countries having natural resources (climate, thermal water...)

and qualified personnel (physicians etc.) with an efficient organization seem to benefit from this

sector.

Good luck

Although we deal mostly with business travellers, we try to prepare all of our clients in a holistic

sense. Preparing their trips requiring an entire awareness of all risks from culture to security and

health. Concerns over current epidemics, security alerts, worker strikes, or environment need to be

relayed and medical tourists also should be prepared in a similar sense. It concerns me that many

may be swayed by nice photos of clinics unaware that the electric grid in the area may not

function half the time or that the water supply is not filtered to the facility.....The physicians may

have degress, but how about the nurses? Respiratory? Food service HACCP? These issues matter

for complete recovery.

No , thx

No

We know medical tourism is not in organised of so I request to all industry experts they should

think about organisation and management of medical tourism


I am research scholar in medical tourism on the topic "development of sustainable indicators for

medical tourism development" in Kerala, India with special reference to modern medicine. Please

help me in this work by providing data.

The most important for hospital is to create a loyalty patient and the only one way is - the patient's

personal experience.

Many countries, like Bangladesh can enter into the medical tourism industry with their existing

resources. So, it is very important to develop an equal opportunity pattern to develop the market

more big, participatory and win-win.

I believe that the US baby boomer is a prime market for medical tourism and will also be more so

as we age. My expertise is in marketing to and researching that cohort, and I see it coming as less

high quality medicine will be practiced in the US, and we see that other countries as innovative. I

personally have had several of my doctors build or be part of off shore medical facilities. Medical

tourism will also be fuelled by boomers acceptance of and familiarity with alternative medicine

(Chinese, Aruvedic, etc) that has been practiced in other countries far longer than in the US.

Thanks for asking!

My belief is that medical Tourism Travel does exist due to two matters: 1. Lack of service and

quality in home medical care System. Brings People traveling to Advanced countries because of

Image and experiences of Friends, Families etc. 2. Price: People decide to consume standard

health care services because it is cheaper than in home country (e. g. Dentist).

[email protected]. Tenured Professor of International Health.

mailto:[email protected]


About your services for international patients

Q1 - What healthcare and medical services does your hospital, clinic, agency or organisation provide

for international patients and medical tourists?

Additional answers given by respondents

Oral surgery; implantology

Neurorehabilitation (spinal cord injury, brain injury and other major disabilities of a neurological

origin)

Laboratory, radiology, er, mammography, ward, icu/iccu, maternity unit, operating theatre,

nicu/picu, intermediate room, internist, plastic surgery, minimal invasive surgery

Interventional cardiology and radiology, vascular surgery

Rehabilitation in balneology medical centers

Integrative medicine-homeopathy for chronic diseases

Physio therapy

Bmt, liver transplant, pet ct, spect gamma camera,

Otolaryngology, alergology diagnosis, treatment

Pediatric, internal medicine, psychology, hemodialysis, rehabilitation

Clinical laboratory

Naturopathy & ayurveda

And physical rehabilitation

Rehabilitation inclusive of audiology, dietetic, physiotherapy, speech-language therapy, auditory

verbal therapy, psychology, neurofeedback therapy, occupational therapy

Acupunture

Medical services while in the country

Knee implant

Ayurveda and alternative medicines.

Anti-ageing and hormone-balancing

Anxiety, depression and trauma

Ccsvi liberation for the treatment of ms & hair transplants

Care for people with special mental needs, rehabilitation, long-term nursing, sleep-treatment,

medical on-call service helpline solution


Psychiatric care. Not in a regular basis

Our center provides services as screening the operation 's level of kidneys; hemodialysis and on-

line hemodiafiltration

Hemodyalisis, thoracic surgery, neurology, stroke unit. Chest pain unit, bone marrow

transplantation, rheumatology, endocrinilogy and diabetes, internal medicine, physical medicine

and rehabilitation, endoscopy suite, icu (adults and pediatric)

All surgeries and medical treatments

Gynaecological laparoscopy & hysteroscopy training

Onco

Information

Plastic surgery, aesthetic medicine, spa

Facilitation

Sex reassignment surgery

Many others, e.g., pediatrics, endocrinology/diabetes, physical therapy, etc.

Interventional radiology

Medical rehabilitation

All medical services suggested by our partner-hospital

Preventive health promotion

Pet ct, gamma knife

Ayurvedic

Oculoplastic surgery and general ophthalmology

Foot and ankle and sports medicine

Rehabilitation, traditional balneo therapies for mobility disorders

Donor semen

Behavioural health

Pulmonology, dialysis, high risk pregnancies, pediatrics

Medical assistance and advise

Stem cells treatment

All of the above and more.


Q2 - What support services does your hospital, clinic, agency or organisation provide for

international patients and medical tourists?


Arrangement for their hotel accommodations and tours

Cost estimates, appointment scheduling, info on local resources

We send them abroad but we do all the arrangements from a-z

Arrangement of accommodation. Parking place

24 hours alarm center services; home visit/home care services; evacuation/repatriation

arrangements; insurance coverage process; medical check up (including travelling package in Bali)

Daily visits by allocated customer service. Nurse visit after discharge, transportation to and from

hospital for pre and post surgery. Massage

Pastoral services

Travel and complication insurance, discount plans for consultation in the United States for US

residents, discount card for medications and diagnostics in the us.

Personal manager. Helping with arrival documents and organizational issues for foreign (non EU)

patients. Meeting and accompanying patients on arrival in Lithuania. Transport services - car and

driver. In special cases, providing air or ground ambulance for pick-up, accompanied by the

resuscitation team. Searching and booking a rehabilitation clinic after treatment. Organising and

booking various tourist tours for our patients

Tourism service packages

Sightseeing and excursions

Skype consultation

Transportation, tourism

Tour guide

Arranging of foreign exchange, visa extension, visa invitation letters,

Support throughout the process ad tailor made package that includes medical treatment, nursing ,

accommodation, hospitality and transfers.

Arrangement of extension visa, email consultation, concierge services

Clinical laboratory testing

Emergency evacuation services

Touristic activities (guided city tours etc.)

Forex assistance,


Pre-arrival consultation appointments; special arrival services (fast-track); transportation

English speaking only

Golf (playing with pros, green fees, classes and clinics ) European nursing services, most

languages.

Pt visited in her hotel room post discharge by hospital nurse

Due to the language skill of the doctors, interpreter services are usually not necessary

Selection of clinic

UK coordination, medical monitoring and support

Other custom services such as shopping, a night out, dinner at selected restaurants etc

They have an English speaking medical host who meets them for all of their appointments while

they are here and access to a nursing team.

Drop to airport

Publication

Tourism plans - packages

Health guidance, medical consultation

Free welcome pack, free consultation & examination, arranging of sightseeing tours

Patient recovery resort medical travel insurance

Accompanying patient in trip, arrangement of post-care of patient, opd / cme / conferences

conducting, etc.

Emergency health insurance

In house nurse available 24hrs during their stay in apartments. Case manager to answer all

questions before they leave and after they return. Doctor evaluation (based on photos) before

they leave their country. Doctor liaison. Doctor profiles supplied. Detailed hospital information

Contact to embassy. Visa extension for long term treatment. Vegetarian food & hala food church.

Arrange local tours

Skype and viber conferences

Airport transfer

Pre check up in the country of origin

We ship donor semen world wide. We have no clinical treatment.

Concierge services


Interpreter services are not needed as we take English speaking patients and have English

speaking staff in attendance

Case Management Services

Other services upon request

Q3 - What information do you provide to international patients and medical tourists:

Answer Options Never Sometimes Most of the

time Always

A printed and personalised treatment plan. 4.1% 7.9% 15.8% 72.2%

A detailed profile of the surgeon or doctor. 3.4% 13.5% 19.8% 63.3%

Information on the risks of the treatment 2.1% 7.5% 15.9% 74.5%

Information on hospital or clinic infection

rates. 16.3% 21.6% 19.4% 42.7%

Information on clinical outcomes for the

hospital or clinic. 10.9% 17.0% 26.2% 45.9%

Information on clinical outcomes for the

specific surgeon or doctor. 16.5% 20.5% 20.1% 42.9%

A patient satisfaction survey at the end of

their treatment. 6.0% 14.9% 14.9% 64.3%


Travel arrangements

Daily medical report; temporary billing; insurance progress; estimation costs; hospital facilities;

hospital services

The 'never' questions information is on the website

All the information related to logistics and travelling

All information required is included at the website of my practice

Package with all the details - includes & excludes, care to be taken on reaching their home

country, follow up tests to be done & send the results for review by the specialist,

Approximate stay in and out of the hospital

Personalised service for tour travel, hotel accommodation

Success rates

Electronic personal medical data (e-mail, cd, flash drive)

We offer live video during surgery to patient's relative during gynaecological laparoscopy &

hysteroscopy surgery


Any information that patient deems important to make an informed decision about his/ her case

Information on the surgery and recovery

Cost estimates before treatment

24 hour nurse post-operative care

We don’t do any official survey on patient satisfaction although see to it that patients are satisfied

with personalized touch and efficient care considering patients leave problems into account etc.

Several options with hospitals in personalized treatment plan

Alternative healthcare facilities reports before treatment

Treatment plan - yes, printed - no (emailed)

Outcomes data on website

If asked for most of the questions

Q4 - For which languages do your provide interpreters?


Interpreters are available in all languages

Russian, Moldovan, Romanian, Albanian, Macedonian

Catalan

Our teams speak fluent English. Most location also have staff that speaks other languages.

Interpreters for other languages can be available on request,

Norwegian, Danish

Malaysian

Amharic

Lithuanian

Norwegian. The rest can be organized for extra surcharge.

Consultations are held for English-speaking patients or persons accompanying them

Swahili

Latvian

Bhutanese, Cambodian, Myanmar

Hungarian

All languages on request of patients preferred language


Indonesian language

Gujrati

Interpreters are available for any language.

We have a comprehensive "all language" interpreting service on telephone but face to face

interpreters must be booked separately

Norwegian

Norwegian

Malay, Indonesian

Albanian, Serbian, Bosnian, Croatian

with an advanced notice we can outsource qualified interpreters

Urdu

Norwegian

Swahali

Norwegian, French

Burmese, Cambodian, Vietnamese, Mongolian, Amharic (Ethiopia)

Romanian, Albanian, Bulgarian, Serbian,

Uzbek, Kazakh, Ukrainian.

Myanmar. Cambodia. Laos

Ukranian, Romanian

As requested

Almost any language

Bulgarian

Hungarian


Your medical tourism business

Q5 - To what extent do these INTERNAL factors restrict your ability to grow your international patient

business?


Political situation of Iran

Government regulations

Obtaining visa

Not yet a well targeted contact with sponsors and decision makers

Government regulations for medical advertising in Malaysia

Hospitals now have their own wings to facilitate international patients has surely affected our

business.

We just began to work steam cells and after tramits and studies.

We are mostly dealing with local patients and sending them abroad.

As little knowledge of Internet marketing and restricted budget

Difficulty in finding good local staff.

Had been running a centre in partnership earlier and have restarted from scratch after over

15years of partnership & ownership without getting any financial return from my original venture.

Internal limitations (mostly ethical) on the number of foreign patients we could possibly admit due

the current situation of the waiting lists for transplantation.

The donor countries are cutting their budgets and going to the third world

High cost of medical care in US

Q6 - To what extent do these EXTERNAL factors restrict your ability to grow your international

patient business?


A trusted third party (Press Ganey, JCI, etc) to display international v American hospital quality

statistics side-by-side in the public domain

Visa procedure is not easy for Belgium

I do private patients its increasing everyday

MHTC are over coming this

South Africa is a Long Haul destination. Expensive flight and long flights to get here.

Hungary so far focused only on dentistry and thermal water, very small governmental effort to

promote other fields of medical tourism.


No support at all from Local or National Government

Lack of a good medical travel insurance cover and protection if complications when patient arrives

home

Recent laws on surrogacy and nationality issues have cropped up for babies born in our country

not getting citizenship in some countries.

Slow query examination in some hospitals, long period for medical visa processing in embassies.

Cost of care, language, distance, drug lag, device lag.

Lack of preparedness for 'outreach' to target markets by the service providers

The government supports only big health factories!!

If tourism is not marketed for our state it will be a major impact as patients will know very less

about our city.

Q7 -Would you be happy to provide basic information about your medical tourism activities (patient

numbers, types of treatment given etc.) to improve the information about medical tourism in your

country and worldwide?

Verbatims

We would want to be able to get comparable benchmarking data, ie related to other pediatric

providers

due to currently unclear country government policy towards medical tourism

Thanks.

Any information that may help all involved in medical tourism I am involved in this business for last

37 years sending patients around the world.

Willing to do and appreciate it if able to provide feedback results in return for contribution

Will consider in exchange for some advertising on IMJT

No yet is the precise answer

We don't have updated information in Brazil...

MT needs to organised and needs to be working with hospitals in US for post op care and partner

with insurance companies for future growth. Regulation, certification and seamless process to

future in MT is a must.

Let us know how we can associate with IMTJ to improve and support this problem.

We dedicate ourselves to promote a professional secure environment, looking forward and

embracing challenges while maintaining sustainable growth according to 'Global Best Practices.


We are under stringent NDA's with Hospitals and Service providers which restricts divulgence of

any information.

Only General Information, not details on Patients or processes on them.

Unsure

We have had patients from more than 20 countries and all have been 100% satisfied for many

good reasons like latest treatment procedures, no price fluctuation for foreigners and ethical

practice.

They might be willing in the future but at the moment there are many developing factors and

uncertainties

Data is sensitive part, we all know the average flow of international patient to particular country /

city to diagnose or assist to grow further.

Willing to join International Network of Medical Tourism Market

As long as any information given is confidential and will not be passed to third parties.

Since I have just restarted my centre the data is very limited and have faced umpteen problems

living in a country where bribe prospers so just started growing up so data is very inadequate.

Basic information will be provided according decision our Legal Department

We are currently starting the business in Portugal. We do not have information to share yet. We

will be happy to provide it next year!

Having the information is one thing, making it verifiable will make numbers credible

No

There is a cooperative effort in the US undertaken by the US International Cooperative in Chicago.

I am sure they would share their data.


Marketing to medical tourists

Q5 - Which publications and web sites are the most effective in marketing your medical tourism

services?


allexperts.com

Antalya Health

Arab countries newspapers

athens.angloinfo.com

BKPA Review (BKPA)

chat areas about health solutions

clinic finder

Deik

dental departures

dentalworld.com.ph

direct comments from patients

directories

e-newspapers and magazines

euromedicaltours.com

fertility.treatmentabroad.com

flyer and brochure

Forums

globaldialysis.com

google organic

healthinTurkey

hospitalmedicmar.com

imer.at

IMTJ

International publications and web sites

intmedtourism.com


isaps.org

ivfeurope.eu

just dial services

Kidney Life (NKF)

listing directories

local mostly

magazines

masqsalud.com

med. directories

medbeaver.co.uk

MEDEGUIDE

media such as newspaper and TV news

medical magazines

Medical Tourism Association

medical tourism conferences

Medical Tourism Facilitators Websites

medical tourism magazine

medical tourism websites

medicaltourismdatabase.com

medvoyage.info

mls-dentalcosmetics.com

News paper ads n flyers conference and events

newspapers

online magazines

online marketing and multimedia PR activities

online media

osteomyelitis.at

placidway.com


plasticsurgeryforum.com.au

plasticsurgeryindia.net

Popular sites in India and some of the travel magazines

private healthcare

rightchoiceuk.com

the dedicated ones

Twitter

web

web sites of local hospitals

website

yourdentistryguide.com

Any that is authentic and has international reach and is also at the same time very cost effective.

I need information about how to contact the right medical tourism agencies who would get us

international patients for dental treatment

It is country specific. Local publications and websites of the target country are more effective.

Still searching for effective sites

UK doesn’t work like this. Patients are sponsored so push is to Governments not individuals

We operate directly with brokers


14. Appendix: Email invitation

Email invitation

The following email invitation was sent to the participants:

Subject: The Medical Tourism Climate Survey 2013

Funded and operated by International Medical Travel Journal (www.imtj.com), the annual Medical Tourism

Climate Survey provides insight into the current state of the medical tourism market and the issues and

challenges for the future of the industry.

We want you to provide your input. Whether you run a hospital, a clinic or a medical tourism agency, or

whether you provide services into the medical tourism sector, your views are important. As a reward for

your participation, you will receive a PDF copy of the final report.

The survey must be completed online by Friday 8th March 2013. It will only take 5-10 minutes of your time.

• Complete the medical tourism climate survey:

https://www.surveymonkey.com/s.aspx?sm=lbC6uvqHnbb6GWhdShWhGw_3d_3d

The results of this year’s survey will be published on 22nd March at the International Medical Travel

Exhibition and Congress in Monaco.

FILL THE VOID!

The survey will help to fill the vacuum of information in the marketplace and will provide some real data on

which hospitals, clinics and businesses can make decisions about the future. The more people who

participate, the more valuable will be the results.



CONFIDENTIALITY

Your answers will be kept confidential, and the compiled report will not identify the answers given by

individuals or organisations. The data will be collated by an independent external market researcher on

behalf of International Medical Travel Journal.



If you want to know more about the Medical Tourism Climate Survey 2013, contact IMTJ -

[email protected]







15. About Intuition Communication

INTUITION COMMUNICATION is a specialist publisher of consumer and business-to-business information

on private healthcare and medical tourism. It has three areas of activity within medical tourism:

INTUITION INTELLIGENCE provides independent research and data on the private healthcare

and medical tourism markets. We publish surveys and reports, and undertake bespoke research

projects. Our services include original research into patient needs and behaviour; benchmarking of

competitors; market forecasting and trends; and best practice guides. Our reports include: The

Medical Tourism Climate Survey, The Treatment Abroad Medical Tourism Survey, The Medical

Tourism Facts and Figures Report.

INTUITION MEDIA operates consumer-facing health and medical tourism online portals

providing information for patients about treatments, destinations and healthcare providers. Around

500,000 patients visit our sites each month seeking information to support their healthcare

choices. Our medical tourism sites include Treatment Abroad, Fertility Treatment Abroad, Medical

Tourism Reviews, and DoctorInternet, an Arabic medical tourism portal. We also operate inbound

medical tourism portals such as: HealthCzech, Treatment in Turkey, Treatment in Spain,

Treatment in Hungary, and Treatment in Cyprus. And in the B2B sector, we publish International

Medical Travel Journal.

INTUITION SOLUTIONS is our customer publishing and content marketing service for

healthcare providers and destinations. We provide tailored content and publishing solutions –

online, in print, and face to face. This ranges from website and mobile app builds and branding, to

destination guides, magazines, video and digital content creation, and live events.

Who to contact

For further information about Intuition Communication, International Medical Travel Journal, and the Medical

Tourism Climate Survey:

Call: Keith Pollard

on +44 (0)1442 817817

or mobile 07710 229102

Web: www.imtj.com

Email [email protected]

Write: Intuition Communication Ltd

3 Churchgates

Wilderness

Berkhamsted

Herts HP4 2UB

Fax: 01442 817818

http://www.treatmentabroad.com/

http://www.fertilitytreatmentabroad.com/

http://reviews.treatmentabroad.com/

http://reviews.treatmentabroad.com/

http://www.doctorinternet.ae/

http://www.healthczech.com/

http://www.treatmentinturkey.info/

http://www.treatmentinspain.com/

http://www.treatmentinhungary.net/

http://www.treatmentincyprus.com/





Medical Tourism Climate Survey 2013

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