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/