Who travels for health
care?
What we know and
don't know
Assoc Prof Andrea Whittaker
School of Social Sciences
Monash University
Growth of medical travel in our
region Changing demographic and
social structures in Asia
Aging populations, long
waiting lists and expensive medical care in developed countries
Capital market liberalisation and privatisation of health care in Asia
Cross-border cost differences and legislative and regulatory differences
US- 47 million uninsured US citizens
Who travels? Distinct groups of travellers
Motivations differ- combinations of Access, Quality and Cost
Push factors- high costs, long wait times, poor quality care, limited access health policies restricting access, ease of travel, cultural familiarity
Even from countries with publicly financed universal health care: Ontario, Canada saw a 450 per cent increase from 2001 to 2008 in the number of patients reimbursed for out-of-country medical treatment.
Table ι: Estimated patients treated and money spent in selected countries Sources: Hopkins et al 20102 citing ESCAP;12 DiscoverMedicalTourism.com;41 Health-Tourism.com.42
Country Patients treated
Major services provided
Estimated earnings (US$)
Thailand 900 000 (2008)
Cosmetic surgery, organ transplants, dental treatment, joint replacements
850 million (2008)
India 450 000(2007) Cardiac surgery, joint replacements, eye surgery
480 million (2005)
Singapore 410 000(2006) Liver transplants, joint replacements, cardiac surgery
560 million (2004)
Malaysia 350 000(2007) Cardiology, cardio-thoracic surgery, cosmetic surgery
43 million (2005)
‘Travellers’ Expatriates/ cosmopolitan workforce
Retirees
Tourists- accidental medical travellers
Circumvention patients
Access patients
Diaspora patients returning „home‟ for care
Cosmetic/aesthetic patients
Outsourced patients
Border hoppers in Europe
What we don’t know
No accurate statistics- private commercial in confidence, difficulties with definitions, lack of monitoring in most countries, mobile populations
Current empirical evidence from patients usually small qual studies
No monitoring of implants/ devices used
Complications, medical mistakes
UK study-Noree et al 2014
Triangulated data from five private hospitals in
Thailand and UK International Passenger survey
104, 830 people travelled for health care in 2010 to these five hospitals-of these UK = 3,935 patients, Australia 3,360 patients, most Nov-March
Most UK patients (60%) has small elective procedures costing less than $US 500 (maj breast and facelifts)
Significant minority of older patients travel for serious orthopedic and cardiothoracic procedures- point to waiting lists within NHS.
32% stay one night -5% stay for more than 30 days
Networks
European survey of 77 medical travellers- Hanefeld et al 2014
Motivations for treatment and travel
• Majority travelled because could not access desired treatment in the UK, donor eggs, bariatric surgery
• Other maj theme was mistrust or dissatisfaction with NHS
• Availability, cost, expertise and cultural/familial
Motivations
Dental – lack of public access
Cosmetic- price sensitive as not covered by NHS, personal improvement/affirmation, lower class
Bariatric& orthopedic- long waiting lists, lack of availability
Fertility- circumvention, lack of donor eggs/ surrogacy, long waiting lists or ineligibility
Networks critical for determining location
Rose (PNG to Malaysia)
Father in hospital for oncology/ palliative care unavailable at home
Australia too expensive
Community fundraising helping pay costs
Leila- breast augmentation
Thailand
She said, “Oh, my surgery was really cheap. It cost me $2000” and I thought that‟s a bit dodgy. But she said, “There‟s some places that I was looking at, they were very expensive, they were people that were top surgeons that you need to see, but I just couldn‟t afford them because I couldn‟t afford them.” They were about I think $4-$5000 and they were the most expensive surgeons in Thailand. She said if you go to some of these, like I think she mentioned this place, but she wanted to go to Phuket because she wanted to have a holiday, but she said there was very, very good world renown hospitals in Bangkok. But she was like to me, “I didn‟t have anything to do there so I just thought I‟d go down to Phuket”.
So that‟s how it all got started. So I did all my research through, and then I started doing my research on the internet and then I went on all the blogs.
Regional flows
Malaysia- Indonesian patients constitute 80% of market –mistrust local health system
Thailand- important destination for Myanmar, Vietnamese, Cambodian patients
Market keeps changing
Ibu Siti, Penang hospital
„we choose to come here...it [medical service] is better here. Many Acehnese people seek medical treatment here, we have heard about people's [bad] experience back in Aceh‟.
Outsourced patients
Countries lacking certain capacities outsource patients to other countries for care.
Eg. GCC members government and B2B contracts have been made with hospitals in Jordon, Germany, Thailand and South Korea
Insurers also may insist on outside care
Eg UAE patients now largest group travelling to Thailand for care (21,568 in 2010)
Samad (Kuwaiti, outsourced
father) The problem in the hospitals in Kuwait is they're
overcrowded. They have full facilities, doctors, everything is free. The problem is overcrowding... Rehabilitation is in a different hospital and also overcrowded because it is a government hospital. Private hospitals in Kuwait, they have good buildings, nice, nice rooms, but because of their financial capabilities they are not geared to manage cases like this..
Australia
Cosmetic surgery believed to take up to 85 % of medical travel market (Connell 2006)
Reproductive travel for surrogacy /ova donation growing
Dental
Orthopedic (In a survey of 142 patients waiting for total joint arthroplasty,
Llewellyn-Thomas and colleagues found that 8 months was the mean length of time patients considered to be the maximal acceptable waiting period. Waiting periods in some public hospitals exceed 8 months)
Bariatric
Conclusions
No „typical‟ medical traveller
Motivations differ
„We have to remember that foremost they are not „consumers‟ they are patients‟ (Dr in Malaysian hospital)
Acknowledgements
Australian Research Council Discovery Project
„Medical travel in Thailand and Malaysia‟
Explores the experiences of patients travelling for medical care for chronic medical conditions to hospitals in
Malaysia and Thailand
Australian Research Council Future Fellowship „Borders, babies and biotechnologies: cross border reproductive travel in Asia and Australia
The study aims to study the trade in commercial surrogacy, egg donation and non-medical sex selection and the cross-cultural, legal and social context surrounding it.
http://artsonline.monash.edu.au/reprotravel/