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Sun, Sand, Surf and ... Stethoscopes?

People have been travelling to faraway places in the quest for better health for millenniums, yet as Dr RAYMOND YEUNG writes, Asia's top tourist destinations are just rediscovering the potential of health tourism

Asia's cultural diversity, picture-postcard perfect beaches and fabulous cuisine mixed with a pinch of Oriental mystic have long drawn tourists from around the world like a magnet. Recently, many of the region's top tourist destinations have added a new ingredient into the mix -- health tourism.

Medical tourism -- or more broadly health tourism -- refers to the increasing tendency among people living where medical services are either very expensive or not available to travel abroad in search of more affordable health options, often packaged with tourist attractions.

The development is being touted as the "next big thing" in the travel industry, but in reality, people have been travelling to far off lands to improve their health for centuries. As far back as 3000 BC, travellers afflicted with eye problems made a pilgrimage to Tell Brak, Syria, where healing deities were said to perform miracles. Ancient Romans spas that were believed to cure endless ailments still offer hope and relief to bathers today.

A niche market?

Health tourism covers the whole spectrum of services that promote physical wellbeing. They range from beautiful holiday packages bundled with everything from spa to cosmetic treatments to cardiovascular surgery, and from diagnostic services to rehabilitative Chinese herbal treatments.

Not all medical services are exportable, however. Time factors can be critical -- you wouldn't wait until your next trip to Phuket to take a Panadol or have heart surgery. In fact, you are advised not to travel if you have a fever or upper respiratory tract symptoms. In countries like Malaysia and Thailand, medical tourism is built from a value proposition that foreign patients are able to enjoy a combination of sunshine and health promotion.

In Hong Kong, any non-ambulatory physician service is exportable, as long as it complies with the rules and regulations set by the Hong Kong Medical Council. Chinese medicine practitioners might also become a health tourism attraction, given the CE's initiative to promote Hong Kong as a centre for traditional Chinese medicine.

But just having advanced technology is no longer a selling point to patients in neighbouring countries. It is essentially a people business. Ask yourself who is your preferred doctor. They gain your custom through effective and considerate consultation, good memory of your medical history, accurate diagnosis, complication-free surgery, etc.

It is also worth pointing out that when dealing with one's health, patients willingly pay a premium for better service.  Because of the continuous contraction in the private healthcare sector, the industry is starting to think about our north. A tiny percentage of rich Mainlanders across the border may be willing to pay and come for quality medical services in Hong Kong.

These advantages, combined with hospitality, seamless and integrated services, access to telecom and Internet services, attractions, etc., provide a mighty tempting package. "Medical tourists" would not only benefit the health sector, but as they would be travelling with a companion -- and most likely have a sizeable disposable income -- their shopping, dining and sightseeing excursions would benefit the whole economy.

What is happening in other countries?

In Asia, medical tourism is starting to be seen as a lucrative business. The reason is simple: tourist destinations are competing head to head to attract leisure and business visitors. Besides tempting them with sights, culture and dining options, why not also bring in some money using hospitals? This is, in fact, what is happening in Thailand. Before 1997, many hospitals were built with cheap and easy financing. The Asian financial crisis forced them to realise their excessive investment and look for ways to recover their interest as well as operating costs.

Medical tourism was viewed as a viable option and, consequently, over the past few years some Thai hospitals have been doing exceptionally well in attracting foreign patients. The Thai Health Minister was quoted in the media saying he expects the trend to continue over the next few years, and despite intense competition from Malaysia, Singapore (Table 1), he has set a target of a five-fold rise in foreign patients by 2012.

In India, apart from attracting Indians from overseas, a private hospital chain claims that it has the capacity to subcontract US$1 billion worth of NHS services from the United Kingdom.

In October last year, Singapore set up SingaporeMedicine, an initiative to facilitate the joint forces of the Economic Development Board, Singapore Tourism Board and International Enterprise. Travel agencies in Mainland China and Indonesia were also invited to visit Singapore to design medical package tours for their target markets.

However, with prices varying considerably from country to country, competition for visitors is increasingly fierce, most notably in Malaysia and Thailand. To promote transparency in pricing, the Association of Private Hospitals Malaysia has published list of recommended fees for common medical procedures. This also allows foreign patients to get a ballpark figure of the costs when planning their trip.

For all these efforts, the quantifiable results have yet to be seen, but it does show that medical tourism is at least being taken seriously among policymakers.

What needs to be done in Hong Kong?

It is still not too late for Hong Kong to explore this potentially huge market. We have the infrastructure. Our healthcare professionals are bilingual. Technically speaking, excellent translators are available for simultaneous interpretation in Putonghua or other languages. The superb communications infrastructure in Hong Kong also supports the practice of telemedicine.

There is also no lack of potential partners in the Mainland, who are always looking for new investment opportunities, to finance such initiatives. Anecdotally, some private hospitals in Hong Kong (among the eleven) were approached by some rich Mainland counterparts looking into the possibility of a joint-venture arrangement. Such an arrangement would be able to take advantage of the operators who provide cross-border ambulance services, as well as the firms that specialise in Mainland patient referrals to Hong Kong.

However, a number of issues have to be addressed if Hong Kong wants to attract medical tourists on a large scale. Whether busy private doctors are willing to spend time looking up terms in their simplified Chinese dictionary remains unclear. Even if they are able to speak Putonghua well (doubtful), they would need to translate fluently some referral letters into their working language. It is also unclear how much they would charge for seeing foreign patients.

Greater billing transparency in the private sector, as in Malaysia, would solve this problem. Although Mainland visitors are now allowed to exercise their RMB credit card on top of what's in their wallet, their health bill in Hong Kong may still exceed their limit. And for tourists who wish to pay through their health insurance, a seamless payment system has yet to be developed.

The way forward

The good news is that these hurdles can be overcome with the relevant authorities filling in the gaps that the industry cannot. Advertising is an obvious example, because individual physicians cannot advertise as a professional rule. Hong Kong medicine, therefore, could be packaged as a single brand. Relevant professional bodies could also strengthen their information provision in terms of available physicians and specialization.

Transparency in fees and charges is vital, because physicians' personal goodwill is no longer sufficient for foreign patients. Reasonable pricing together with perceived overall quality of Hong Kong health care will be the key motivations for overseas patients.   For foreign patients who are unhappy with their domestic system, cost comparison is the first thing they would do when making a choice (Table 3).

The promoters of tourism in Hong Kong could include medical services in their upcoming marketing plan, and the private sector might consider setting up international patient centres to aid foreign patients on immigration and other logistic arrangements. As such, the government should provide support through flexible visa applications and extensions.

With effective promotion of medical tourism in Hong Kong, it should be no surprise when our theatres are overtaken by operating theatres as our top tourist attraction!

Dr Raymond YT Yeung is Research Assistant Professor in Health Economics and Policy with the University of Hong Kong. He has been investigating the international trade of medical services for the past few years. The views expressed in this article do not represent those of his employer, project sponsor nor the Chamber. He can be reached at rytyeung@hkucc.hku.hk