Sun, sea and surgery

Medical tourism is a fast-growing niche market that has largely been untapped by the Middle East travel trade. Agents are advised to steal a march on their competitors by catering to this lucrative sector, says Joanne Bladd

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By  Joanne Bladd Published  October 2, 2006

|~|Med-1-large.gif|~|Bumrungrad Hospital, Bangkok treats many Arab nationals.|~|If the travel industry has traditionally been divided into leisure and corporate tourism, the last decade has seen a new player grabbing for a piece of the market. Medical tourism, whereby patients travel overseas for urgent or elective medical procedures, is on course to become a multi-billion dollar industry within the next 10 years and Middle Eastern travellers are leading the pack. While health tourism is a comparatively new trend in the West, tourists from this region have long sought a combination of sun, sea and surgery. At any one time, between 150 and 200 UAE nationals are receiving medical care overseas and in 2001, the number of Saudi Arabian nationals travelling to the US for treatment topped the 56,000 mark. To a degree, this trend has been driven by necessity. Until recently, high-end healthcare was not readily available in the region and the perception that for world-class healthcare, you must travel, has lingered. This view, together with the readiness of GCC governments to fund overseas treatment for nationals, has seen the medical tourist become a year-round target for eager health-orientated destinations. Traditionally, the UK and the US have been the favourites of travellers seeking state-of-the-art care alongside cultural appeal. But since 9/11, the difficulty in securing visas to these destinations has seen Arab patients look elsewhere for treatment. Now, thanks to a formula of relatively cheap treatment prices and quality care, Asian countries such as Thailand and India are fast consolidating their positions as healthcare hotspots, creating a fresh market that offers ripe pickings to the region’s travel agent community, which is becoming increasingly disillusioned with the zero commission environment. But to date, tour operators have been slow to cash-in on the trend. Unlike Europe and the US, where medical tourism has spawned a host of private operators offering all-inclusive packages, the Middle East trade is yet to embrace the sector’s potential. Big name players, including Emirates Holidays and Etihad Holidays, concede to having no dedicated resources for health tourism. “We’re not focused on medical tourism at this particular time, but that’s not to say we won’t be considering it in the future. It’s certainly a market that is going to develop, particularly from this part of the world,” says Julia Denny, planning and purchasing manager, Etihad Holidays. “But a move into medical tourism would need a lot of consideration, certainly from an insurance viewpoint.” The issue of liability crops up regularly among wary operators as justification for giving health tourism a wide berth. Internationally, the industry is unregulated and popular healthcare destinations are often countries where malpractice laws are loose or non-existent. Insurance companies are yet to offer medical tourism policies, raising the question that should something go wrong during the operation or even once the patient has returned home, who is legally responsible? Agents should advise clients to discuss these issues fully with their healthcare provider before committing to treatment. Established UK and US agencies have tried to avoid the problem by ensuring patients agree contracts directly with the treating hospital. Dr Jagdish Jethwa, co-founder of the UK-based Taj Medical Group, describes his company as an intermediary between the hospital and patient, organising flights, transfers, accommodation and treatment quotes, but not care. “We’re just the broker and we don’t give medical advice. The patient’s contract is with the hospital, so it is the patient’s risk. We’re only putting them in touch, though these are reputable hospitals,” Jethwa says. “Taking into account the flight and the recuperation time in a hotel, prices [in Asian destinations] are generally one-third of the cost of surgery in the UK.” And, according to industry analysts, these financial savings are being ploughed back into the tourism sector. A survey by Abacus International revealed medical tourists spend an average of US $362 a day year-round, compared with the average traveller spend of $144. Established agents can secure a steady income by making hotel and flight bookings and by pocketing the 20% treatment discount that many hospitals grant in exchange for referrals. Aside from the promise of filling beds outside peak months, these high-end figures are another indication of the serious money to be made from this sector. Countries that actively court medical tourism include Thailand, India, Germany and Singapore. Recent additions to the market include South Africa’s ‘surgery and safari’ deals and Eastern Europe is fast developing a booming cosmetic surgery sector. But for regional clients, Asia remains top of the list of healthcare destinations. Concerted promotional campaigns fronted by hospitals and government bodies have seen the country soak up the overspill from the US. These drives have boosted Thailand visitor figures by 30%, from 500,000 in 2005 to 650,000 in 2006, India’s by 30%, from 400,000 to 520,000 over the same period, and Singapore’s by 20% (from 374,000 to 448,800). ||**||A cut above|~|Med-2.gif|~||~|Hoping to boost its share of the market, the Thailand tourism board is one organisation that has taken a proactive role in attracting regional visitors. According to Shaikh Rahmatullah, the Tourism Authority of Thailand’s (TAT) Middle East representative, the last six months have seen the country stage a series of government-backed events to woo potential agents and patients. “A delegation of five hospitals, led by Dr Surapong, president of the advisory board of private hospitals, provided free medical consultations to visitors during the Arabian Travel Market,” he says. “The team also exhibited at shopping malls in Abu Dhabi and Muscat and visited (both) Ministries of Health.” By reaching out to Middle East-based tour operators, Rahmatullah says hospitals hope to promote Thailand as an integrated health and vacation resort. The UAE Ministry of Health already has full-time representatives in the country to help marshal the swelling number of government-funded nationals, and Rahmatullah is hoping the commercial potential of the trend will catch on. It’s undeniable that Thailand does strong business as one of the UAE’s most popular holiday destinations. Emirates Dubai-Bangkok flights are almost 100% full during the summer, and Etihad’s Abu Dhabi-Bangkok route is now running twice daily to meet demands. “It’s our top-selling UAE destination,” Etihad’s Denny confirms. The region attracts two camps of health tourists; those who are on holiday, but add on a check-up or minor surgical procedure, such as Lasik eye surgery; and those for whom the hospital and medical treatment is the main reason for their trip, with the vacation a secondary factor. But the country’s two most popular hospitals have been quick to capitalise on the soaring visitor numbers, winning over clients with competitive rates and traditional Thai hospitality. Bangkok Hospital, based in the heart of Bangkok, is part of the largest hospital group in Southeast Asia and houses an international wing specifically tailored to the Arab market. According to Sukanya Burington, manager of the hospital’s International Medical Centre, the hospital has taken on many of the traditional roles of a tour operator. “We take care of all the inconveniences of having to leave home for treatment,” she says. “We help patients book flights, pick them up from the airport, help them with accommodation and we negotiate a corporate rate with local hotels.” Burington reveals the hospital hopes to form a strategic alliance with Etihad Airways to offer a complete package service to patients. “We’re very open to forming partnerships with bigger companies to better cater to our customers,” she says. And once clients arrive, the hospital’s facilities are designed to help them feel at home. “Aside from Arabic-speaking staff, we offer halal meals, Arabic-language newspapers and a concierge service to handle sightseeing arrangements,” Burington says. “We allow one family member to accompany the patient in the room, free-of-charge, and we have in-house visa services for patients who overstay their time. These charges are borne by the hospital.” Similar services are on offer at the Bumrungrad Hospital (often referred to as the American Hospital) situated in the Sukhumvit Soi 3 district. Claiming to treat more than 350,000 foreign patients a year, Bumrungrad Hospital boasts accredited status by the US Joint Commission for the Accreditation of Healthcare. Dubbed “American in content; just 10,000 miles away”, the hospital is the first in Asia to be endorsed by the organisation, confirming it meets international healthcare standards. World-class care is mixed with luxury appeal; Bumrungrad patients can expect to find plush amenities including massage treatments, high threadcount sheets and an on-call Arabic-speaking concierge. The area around the hospital is also home to Little Arabia and so, Denny explains, is independently popular with GCC nationals. Families commonly visit for a longer holiday and combine medical treatment with down time. “A lot of our hotels are within walking distance of the hospital so families will book packages to be with relatives who are having treatment,” she says. “But the area’s real USP is that the hotels are Arabic-speaking, their signage is in Arabic, they are 100% halal and they have Mecca signs in all the guest rooms. Muslim visitors therefore feel extremely comfortable.”||**||Passage to India|~||~||~|While Thailand’s market appeal mixes high-end hospitality with healthcare, its biggest rival, India, has instead positioned itself as a specialist medical venue. Promotional campaigns point to the number of medical conferences and breakthroughs India has overseen, working from the viewpoint that it’s not just cost but competency that counts. While this is partly a response to the challenges of competing with its more luxurious neighbours (five-star tourism is in short supply in India), the strategy is working. According to research analysts McKinsey & Company, India’s medical tourism market is forecast to be worth $22 billion within six years. Major players from this region, including Air Arabia, have already marked the industry as one to watch. Earlier this year, the carrier launched a daily flight from Sharjah to Mumbai, in a bid to capitalise on the medical trade. “We are considering tie-ups with medical institutions and hotels to position ourselves as a one-stop shop for patients and their families travelling to India for medical care,” says Rohit Ramachandran, Air Arabia’s country manager for India. The Indian government has also played its part in promoting the country to patients by introducing a 12-month medical visa to minimise red tape for health tourists. It has also sponsored key campaigns, including this year’s Indian Medical Tourism Expo that took place in London. Rather than luring patients with post-operation vacations, India’s popularity stems from the quality of its healthcare and its competitive pricing structure, particularly for more complex operations. This reputation has led to the country winning the tagline: ‘First-class healthcare at third-world prices’. The cost of having a pacemaker fitted for instance is less than $7500. In the US, the same operation could cost in excess of $20,000. A large percentage of Indian doctors are trained in the UK or US, and several medical groups, including Indian’s largest, Apollo Hospital Enterprises, are internationally accredited, ensuring clients feel safe. India’s close proximity to the GCC is also an attraction, particularly for those seeking complex surgeries, as a short flying time means less chance of developing post-operative complications such as Deep Vein Thrombosis. Dr Karam Thakur, director of communications and public affairs for the Apollo Group, India’s largest medical corporation, says: “We offer GCC nationals predominately high-end, specialist care and the entire treatment is equal to the cost of a couple of consultations in the Middle East. “Our main pitch is that the time lag between new techniques and equipment here is minimal. For example, the new 64-slide CAT scan was on the front cover of TIME magazine in July, and we had it in-house by October.” But this is not to say GCC guests miss out on home comforts. Standard in-house attractions include halal meals, accommodation for patients and their families, resident translators and, as expected, flights, transfers and accommodation are included in treatment packages. For clients flying into Hyderabad airport, the Apollo Group also has a resident helpdesk in the domestic terminal offering on-hand arrival help.||**||Singapore supremecy|~||~||~|Further East, Singapore is open for business, notching up more than 374,000 health tourists in 2005 with plans to increase this by 20% in 2006. It’s a robust industry, impressively managing to secure a 9% increase in medical tourist arrivals at the height of the 2003 SARS crisis. According to Elaine Lim, assistant director of healthcare services for Singapore Tourism Board, hospitals are noticing an increased number of Middle Eastern clients boosting their traditional customer base, which hails from neighbouring countries. “They are comfortable coming here, because we are a multicultural country and can cater to their needs,” she says. “We offer halal food, we have mosques, our crime rate is very low and most importantly, we have high healthcare standards.” One of Singapore’s biggest healthcare providers, The Parkway Group, has been quick to spot this trend, setting up a medical referral centre (MRC) in Abu Dhabi. The office provides end-to-end care to GCC clients, including limousine airport transfers, and has booking privileges at more than 55 hotels and self-catering apartments in Singapore. Clients are treated at one of the Group’s three private hospitals. The Gleneagle Hospital, for instance, is situated in the central business district overlooking the botanical gardens. An ideal holiday spot, it is less than 1km from the Shangri-La Hotel, and a short distance from the main shopping and entertainment areas in Orchard Road. Another highlight is Arab Street, home to Singapore’s Muslim community and the impressive Sultan Mosque. A short taxi journey away, family-friendly attractions include The Night Safari, the world’s first nocturnal zoo, and Snow City. Despite the steady increase in GCC business, Singapore hospitals are still keen to establish links with regional tour agents, Lim explains. They are a regular presence at local travel and healthcare shows and several hospitals have teamed up with tours aimed at raising the profile of medical tourism. “While our hospitals are doing a very good job at marketing themselves to GCC patients, we would welcome partnerships with Middle Eastern agents,” Lim says. “We have received lots of requests from UK and US agents who see the potential in the market, but we’d like to see this interest from GCC operators.” It’s fast becoming clear that the increasing number of agents jostling for position in the leisure and corporate sector mean companies must identify other ways to boost income. Health tourism, particularly in the GCC, has the potential for huge long-term growth. The combined efforts of foreign tourism boards and private hospitals have given the industry enough exposure to mean it is now wide open for exploitation. And, the region’s obesity and diabetes epidemic means surging numbers of residents will need high-end healthcare in the future, and will want it at competitive prices. What is now a comparatively niche area, in 10 years time will be a mass-market force, so agents should seize the moment||**||THE SALES PITCH|~||~||~|MEDICAL HOTSPOTS: Destination: Thailand Medical speciality: cardiology, cosmetic surgery, ophthalmology (eye surgery) Prices: a heart bypass is priced at approximately US $8500. In the US, a similar operation could cost more than $56,000. Getting there: Emirates: from Dubai, 19 flights weekly; Etihad: from Abu Dhabi, twice daily; Qatar Airways: from Doha, twice daily; Mahan Air: from Tehran, daily; Thai Airways: from Dubai, seven direct flights weekly and four indirect, via Chennai; from Kuwait, three flights weekly via Dubai; from Muscat, three flights weekly via Karachi. Currency: 100 Thai Baht (divided into 100 Satang) = US $2.6. Selling tips: book families into the Little Arabia area to combine close proximity to the Bumrungrad Hospital and easy access to tourist attractions. Many of the hotels in this area offer guests free transport to the hospital each day. Destination: India Medical speciality: hip and knee replacements and angioplasty (repairing blocked arteries in the heart). Prices: a total knee replacement commonly costs more than $20,000 in the US. In India, leading hospitals offer the same operation for less than $8000. Getting there: for UAE clients with limited cash, which can be better spent on treatments, book them on Air Arabia, which flies to four destinations in India; Jaipur, Nagpur, Mumbai and Kochi. Currency: 100 Indian Rupees = US $2.16. Selling tips: advise patients to upgrade to business or first class on return flights to avoid post-operative discomfort and DVT. Destination: Singapore Medical speciality: Health screenings, gynaecology, orthopaedic surgery Prices: a comprehensive check-up, including organ screening, blood tests, cholesterol profile and x-rays costs $291. In the US, patients could expect to pay more than $5000 for a similar check-up. Getting there: Emirates: from Dubai, 17 weekly; Qatar Airways: from Doha, five weekly; Singapore Airlines: from Dubai, 10 weekly; from Abu Dhabi, three weekly; from Jeddah, three weekly. Currency: 1 Singapore dollar = US $0.63. Selling tips: both the Gleneagle and Mount Elizabeth hospitals are within walking distance of five-star hotels, including the JW Marriott Singapore and the Shangri-La Singapore. Take advantage of up-selling opportunities and book accommodation and excursions. QUESTIONS EVERY CLIENT SHOULD ASK: Although a patient’s treatment contract should be exclusively with the receiving healthcare provider, it’s worth advising clients to get replies to these questions in writing from the hospital before going ahead with medical treatment. Who will be operating? What medical qualifications and experience do they have? How many of these operations have needed follow-up treatments? What internationally agreed standards does the hospital meet/comply with and are there inspection reports available? What nursing support is available before and after treatment? What exactly will the treatment package include; e.g. recovery accommodation, access to specialist care if needed? Will there be extra costs for a travel companion? What happens if treatment is unsuccessful? Who will pay if a follow-up visit is required? What liability will the hospital assume in the case of accidents or negligence?||**||

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