Measures to Develop and Promote “Down-Under Medical Tourism Hub”

Anita Medhekar

Presented at Medical Tourism Summit Melbourne 20-21st November 2014

1. Introduction

2. Medical Tourism

3. Case of Australia

4. Down-Under Medical Tourism Hub

5. Recommendations

6. Conclusions

Measures to Develop and Promote “Down-Under Medical Tourism Hub”

What initiatives Australian government, medical and

the tourism industry should take to promote itself as

a competing “Down-Under Medical Tourism Hub” &

increase its share in export of healthcare services

abroad? • http://qfg.com.au/videos/ivf-fertility-specialist/ivf-clinic-qfg-cairns • http://www.apollohospdelhi.com/apollo-hospitals-the-global-destination • https://www.youtube.com/watch?v=CC4qxxb0-Os • https://www.youtube.com/watch?v=Znsle0iFYno&list=PL524EEEE970FCE365

Introduction

Introduction

• Sun

• Sea

• Sand

• Sex

• Safari

• Spirituality

• Surgery

There are three types of medical travel: inbound, outbound and intra-bound. • educated decisions • cost effective/affordable price

• with low/no waiting period

• JCI accreditation

• state-of-the-art medical facilities & technology

• experienced medical surgeons

• quality of nursing care

• privacy & confidentiality

• improve…quality of health and well-being

Introduction

WTO‟s 4 modes of trade in services (GATS) 1. Consumption abroad 2. Commercial presence 3. Presence of natural persons 4. Cross-border supply

Cross-border/ bilateral trade in healthcare services can be measured by:

• number of foreign medical tourists • foreign exchange revenue • market share and size • success of specialist treatment • demand for allied healthcare services

Introduction

• medical travel, medical outsourcing, healthcare tourism,

wellness tourism, medical refugee & biotech pilgrims.

• niche segment of the global health & tourism industry.

• Is an economic activity that involves international trade

in healthcare services, for the sustainability of the two

distinct sectors of the economy: medicine and tourism.

• The economic impact of medical tourism globally and

in the developing economics is significant.

• It was worth US$ 100 billion by the end of 2012.

• Forecast… 130 billion by 2015 ( 20-30% annually).

Medical Tourism

• Medical tourism is defined as “the organised travel outside one’s natural healthcare jurisdiction for the enhancement or restoration of the individual’s health through medical intervention” Carrera & Bridges (2006, p.449).

• “Medical tourism is a phenomenon where a patient travels with or without a companion outside his /her country of residence, to another country for medical treatment. This could be risky, invasive, and involves complex surgical procedures with the use of highly specialised medical equipment, technology and experienced surgeons, for the improvement of overall physical health and quality of life, combined with a vacation at an exotic destination” (Medhekar, 2010, p.6).

Medical Tourism

Fugure-1 Health Tourism Typology

Source: Medhekar (2010)

Health Tourism

Typology

Medical Tourism Wellness Tourism

1. Non-Surgical

2. Diagnostic

3. Surgical

1. Spa

2. Yoga

3. Ayurveda

4. Homeopathy

5. Naturopathy

Examples: Types of Treatment Diagnostic

Blood screening Bone density CT-Scans Diabetes Electrocardiograms Heart stress test Lipid analysis MRI

Medical Bariatric surgery • Gastric bypass • Laparoscopic gastric banding • Body contouring Cancer treatment Cosmetic surgery • Breast augmentation/reduction • Facelift • Liposuction Cardiology and Cardiac Surgery • Coronary artery bypass • Cardiac valve • Replacement/reconstruction Dental work • Cosmetic dentistry • Dental reconstruction Eye surgery Orthopaedic • Joint replacements/reconstruction Organ and tissue transplantation • Solid organ transplantation • Bone marrow transplantation • Stem-cell therapy Reproductive system • In-vitro fertilization • Hysterectomy • Prostatectomy • Gender reassignment procedures

Wellness

Ayurveda Acupuncture Herbal treatments Hot-water natural springs Spas Yoga Spiritual retreats (Ashrams)

Source: Medhekar (2010)

1. Medical & Wellness Tourist- 1: purpose of travel is MT & may engage in wellness tourism.

2. Medical Tourist- 2: main purpose of travel MT and a short vacation.

3. Non-Resident: specially travelling to country of birth for Medical or wellness treatment/ or falls sick overseas.

4. Foreign Workers: expatriate & diplomatic workers/staff fall sick while working and living in a foreign country.

5. International Students: falls sick while studying in a foreign country.

6. Business Traveller-1: falls sick in a foreign country while on business and needs medical treatment.

7. Business Traveller-2: during business trip may engage in various types of wellness tourism activities.

8. Tourist-1: falls sick on a holiday, in a foreign country.

9. Tourist-2: along with tourism, may also engage in various types of wellness activities- spa, yoga & herbal medicine.

Source: Medhekar (2013, p. 9)

Who are the medical tourists (MT)?

• infrastructure development

• medical research and technology

• accreditation-quality

• highly experienced medical staff

• information distribution

• marketing and promotion

• regulation

• ethical issues

• English language/interpreters

• economic & political stability

• public and private partnerships

Development, Growth & Competition

• rising healthcare cost

• high health insurance cost

• long waiting period for surgery

• non availability of certain surgical procedures

• restrictions put on insurance benefit claims

• globalisation, digitisation & trade

• informed decisions/ education/advertising

• high levels of disposable income

• ease of travel & holiday

• longer hospital recuperation period with 24 hour skilled nursing care and assistance

Why patients travel abroad for treatment?

Information search model of medical treatment

abroad Information Search Model of Medical Treatment Abroad

Source: Medhekar and Newby (2012:66)

Transaction

costs

Waiting time

Treatment

costs

Travel costs

Insurance

Risk costs

Service quality

Technical -

treatment

Functional –

medical

facility

Conditions

Income

Affordability

Treatment

accessibility

Country

conditions

Internal Information

Search

Previous

experience

External

Information

Search

Family

Friends

Medical expert

Hospital

website

Online blogs

U-tube

Medical tour

operator

Print media

• Island continent & a popular tourist destination. • Medical destinations are similar to tourist destinations. • world’s best medical facilities and professionals. • From Jan-Sep 2013- 10,739 people visited Australia for MT-

double the number in 2006, spent about $26 million in 2013, up from $12.7 million in 2006 (Tourism Research Australia 2013).

• Global market share in 2010 = 0.001%, 0.6%; by visitors, and 3.3% by visitor expenditure.

• Challenges- distance to travel, cost of travel, high surgery-price, lack of marketing, promotion and investment support from the government in medical tourism related human resources and infrastructure facilities.

• 2006-2010, inbound medical tourists came from New Caledonia, NZ, Fiji, Vanuatu, Indonesia and PNG.

Case of Australia

• Australian Tourism and Export Council: Health and Medical Tourism in Australia in 2010, 12,800 (0.23%) people visited for medical reasons, from a total of 5.5 million.

• 2008-09…market report ATEC, 2009-1st health and wellness conference in Cairns, 2009-fertility centre , Melbourne- 2014, 1st MT summit.

• In 2012, a total of 5,691,791 tourists visited Australia holiday (44%), visiting friends and relatives (25%), business (16%), education (6%), employment (4%) and other (4%) (TRA, 2013).

Case of Australia

Cost Comparison's ($US) 2008 prices

Countries Heart

byPass

Hip

Replace

-ment

Knee

Replac

-ement

Hyste-

rectomy

Australia $33,340 $16,470 $13,905 $4,922

USA $130,000 $43,000 $40,000 $20,000

UK $24,544 $14,000 $16, 625 $10,000

India $9,300 $7,100 $8,500 $3,000

Thailand $11,000 $12,000 $10,000 $4,500

Singapore $16,500 $9,200 $11,100 $6,000

S. Korea $34,150 $11,400 $24,100 $12,700

N. Zealand $30,500 $15,000 $14,000 $6,000

Costa Rica $24,000 $12,000 $11,000 $4,000

Source: Compiled from Deloitte 2008; Voigt & Laing 2010; RNCOS 2010; Deloitte 2011; American Medical Association (2008) (Note: Comparisons are in year 2008 prices in $US. Since 2008, Aus$ nominal exchange rate has appreciated in terms of US, also slightly affecting the relative prices in other countries).

Waiting Time

• (i) The waiting time between specialist assessment and the time the patient is admitted for surgery (inpatient‟ waiting time) and (ii) Waiting time at the time of admission for treatment (Hurst and Siciliani,2003).

• GSA (2012)…it is the time the doctor refers a patient to a specialist, who then refers the patient on an elective surgery waiting list… depending on the patients health condition.

• Crawford et al. (2002) study calculated waiting time from the dates of GP appointment and referral letter to… clinical appointments, investigations and operation.

Median waiting time: state/territory

Source: Australian Government Institute of health and welfare (2012)

Waiting Time

• Health Minister of Queensland Mr. Springboard …it is “waiting list for the waiting list…a wait to get on the surgery waiting list” Herald Sun (2012a).

• Nationally in 2011-12, total knee replacement had the longest medium waiting time of 184 days and coronary artery bypass graft had the shortest median waiting time of (16 days).

• By specialist surgeon, longest waiting time is for ophthalmology (74 days) for 50% of the patients and it took nearly 335 days to treat 90% of the patients followed by ENT with a medium waiting time of 66 days.

Median waiting time to - elective surgery, by specialty of surgeon, 2010-11

Source: Australian Government Institute of health and welfare (2012)

Median waiting times for elective surgery, by indicator procedure, 2010-11

Source: Australian Government Institute of health and welfare (2012)

Asia & China West & South Asia Middle East &

Africa

Latin America &

The Caribbean

Europe

32-China 1-Bangladesh 3-Egypt 1-Barbados 6-Austria

17-Indonesia 21-India 1-Ethiopia 1-Bahamas 3-Belgium

10-Japan 1-Pakistan 18-Israel 46-Brazil 4-Czech Republic

30-South Korea 1-Srilanka 11-Jordon 2-Chile 9-Denmark

13-Malaysia 5-kazakhstan 3-Lebanon 3-Colombia 4-Germany

6-Philippines 12-Qatar 2-Costa Rica 1-Greece

21-Singapore 65-Saudi Arabia 9-Mexico 26-Ireland

37-Thailand 47-UAE 3-Peru 24-Italy

13-Taiwan 3-Kuwait 2- Panama 15-Portugal

1-Vietnam 1-Yemen 46-Brazil 1-Russia

2-Brunei 2-Oman 3-Peru 23-Spain

9-Mexico 1-Switzerland

3-Peru 48-Turkey

Total- 83 to 182 19 to 29 108 to 217 46 to 73 134 to 174

Source: Compiled from Joint Commission International (22-8-2014)

http://www.jointcommissioninternational.org/JCI-Accredited-Organizations/

JCI accredited medical hospitals

https://www.bumrungrad.com/virtual-tour https://www.youtube.com/watch?v=iofMSZ0WGSc http://www.apollohospdelhi.com/apollo-hospitals-the-global-destination https://www.youtube.com/watch?v=0MIbdC-fPJY http://www.kokilabenhospital.com/

1. demand and need of the medical tourist

2. customised healthcare service marketing

3. oriented towards patient, trade, niche super-specialities and competitors can guide niche product development and innovation

4. effective marketing of wellness and medical tourism destinations, JCI accreditation, super-speciality hospitals, niche treatment, research and medical expertise to the world.

Medical Tourism- Promotion

1. Product (tangible & intangible wellness and

medical goods and services)

2. Price of medical treatment, travel and tourism

3. Place of medical treatment

4. Promotion of health tourism services

5. Patient & Personnel

6. Physical Proof of world class medical facilities

7. Process or Procedure

14P’s Patient-Marketing-Mix (PMM)

8. Personalisation of patient healthcare

9. Publications of health and medical information or physical evidence

10. Patient Packaging

11. Patient Education

12. Patient Privacy

13. Patient health, medical and cultural sensitivities

14. Public-Private Partnerships for providing, and promoting world quality of global healthcare Source: Medhekar, Wong & Hall (2014), Table-1, pp.58-60

Healthcare Service- 14P’s PMM

1. cost of medical treatment/surgery

2. availability of medical treatment/surgery

3. how to reduce waiting time?

4. exchange rate fluctuations

5. reputation as a safe/free from super bugs

6. far from Asia… proximity to pacific islands

7. high quality of nationally accredited/JCI?

8. rules on quarantine/migration…superbugs

9. MT…domestic patients place in the queue

10. anonymity, privacy, English language

Challenges & Drivers

Recommendations & Policy Implications Diversify the economy (export sector)

Corporate identity & International accreditation

Promote Australia as a MT destination

Implement 14Ps of patient-marketing-mix

M-visa/ M-escort visa for long term stay

FDI medical infrastructure

Employment opportunities (health & tourism)

Equity & efficiency aim… benefit local indigenous population

Recommendations & Policy Implications National & Global-PPP

Integrated policy- trade, tourism, health and social services

Reinvest tax revenue/ profits in the public health system

Perth, Melbourne, Gold Coast, Cairns and Darwin

Corporate identity & international accreditation

Global transferability (health insurance, expertise, legal, ethical, issues)

Conclusion Medical tourists are making informed personal

healthcare decisions to get the best outcome at an affordable price, quality, no waiting & privacy based on internal and external sources of information search.

Medical tourism specialised treatment, hospital and destinations to be positioned, branded & marketed as a niche for medical treatment in Australia.

Government policy initiatives (PPP) for the sustainable development, promotion, marketing, packaging of „Down-Under Medical Tourism-Hub‟ in Australia.

World MT congress, Global health and spa summit and trade fairs to raise awareness of Down-Under Medical Tourism Hub.

Australian Hospitals • IVF Monash - latest technology- pre-implantation genetic diagnosis

• Epworth Group - Melbourne, 600 patients, Asia-Pacific, robotic, IVF, weight loss, orthopaedic & cancer care.

• Parkville Precinct - which includes the new $1 billion Comprehensive, state-of-the-art Cancer Centre, (opening in 2015).

• The Royal Children's Hospital- Global

• Queensland Cairns Fertility Clinic http://monashivf.com/why-monash/tour-our-facilities/

• http://www.placidway.com/profile/2021/PlacidAustralia

Thank you Questions? Experience-Down-Under Medical Tourism Hub