The explosive growth in medical tourism

9^th June 2014

Dr Michelle Tempest on the effects medical tourism will have on the NHS

Medical tourism, when people travel to another country to obtain medical treatment, is not a new concept. The first record of medical tourism dates back thousands of years to when pilgrims travelled to the Saronic Gulf in Greece. Today, medical tourism is a multibillion pound market predicted to grow a further 20% in 2014 and the UK is yet to capitalise on the global customer.

Globalisation has made medical travelling increasingly popular as family, friends and carers are scattered all over the globe. In 2012 over 11 million medical tourists were recorded. Examples of what medical tourists seek include:

• higher quality care
• more advanced technologies
• internationally-trained and experienced medical teams
• top reputations (spreading via the internet or word of mouth)
• Reduced cost of care
• and shorter waiting times.

International accreditation along with global brand status has also become increasingly important. The most well-known accreditation group is the American based Joint Commission International (JCI). Accreditation is seen as a recognition of top quality care with over 650 hospitals accredited in over 50 countries (figure 1). Currently the UK has zero hospitals accredited. London trades on the basis that it is already a major international city with high medical standards, although it is expected that the JCI will accredit a London hospital very soon – so watch this space.

The European Union medical tourist market is also set to change. Irrespective of how votes were cast in 2014 May elections, the ‘European Directive on Healthcare’ was passed in 2011, and is set to be implemented this year. The Directive is based on the landmark case of Mrs Yvonne Watts, aged 75, who paid £3,900 for a private hip operation in France after she was put on a long NHS waiting list. Her lengthy court battle played out in both the UK and European courts. The resulting Directive means that people will be allowed to choose any EU country to have their state paid healthcare delivered. Assuming the procedure is medically necessary, their home country will be obliged to pay for it (up to the home country price/tariff). Patients must incur their own travel costs and living expenses.
So what will this mean for the NHS? We have already seen above how the private healthcare market has seen rapid expansion in medical tourism. Will this now be translated to the public-pay market? In April 2014 patient choice stepped over yet another Rubicon when mental health rightly got parity with physical health, allowing patients to choose their provider. Currently to be chosen, providers must be registered as ‘qualified’ (Any Qualified Provider, AQP). However, it does not seem like too much of a leap of faith to expect European hospitals to apply for AQP status. After all, Germany already has four JCI accredited hospitals and Belgium three, targeting the private travelling patient.
So, it seems the EU healthcare Directive will bring both risks and an opportunities for NHS, private and third sector providers. Risks include that the best providers may see a mass of European patients requesting treatment and impacting waiting lists. Other providers may see a drop in demand if UK patients choose to be treated abroad. Opportunities include the NHS brand excelling and becoming the destination of choice; with patient volumes and European money increasing. Plus, the NHS may be able to transparently recoup over £1.5billion currently spent but not charged to overseas patients accessing care. Finally, there is an opportunity for AQP accredited providers, to actively market across pan-European borders to fill their units. Only time will tell how health tourism will impact our health economy, but as the old proverb goes ‘Forewarned is forearmed’.