Discovering Medical Tourism

Medical tourism is often depicted as an outsourcing process: you go elsewhere to get cheaper prices, as a shoe manufacturer can transfer its manufacturing activities from Italy to Bangladesh.

Still, this outsourcing process is extremely different as, conversely to a classical industry, you don t keep the same machine, namely the doctor. And beyond the differences there can be in terms of qualifications, there is a whole difference in terms of culture, of medical philosophy. Even though many of those doctors who perform in top tier hospital have been trained in the US, in Australia or in the UK, many Asian doctors are taking into accounts the many peculiarities of the Asian medical philosophy to better their practice. 

What are the main difference between the occidental and the oriental system: 

The goal VS the way to the goal: 

Occidental medicine aims at curing the patient while the asian medicine focuses on the healing process itself, on a day by day bettering of the health condition. This explains the type of therapies associated with traditional Chinese Medecine or Ayurveda that will last a few days or weeks, each day consisting of different healing techniques (mixing dietetics, massage, cleansing…) 

The microscope VS the “macroscope”: 

Occidental medicine focuses on analyzing details, isolating specific parts of the body and assessing it to a series of tests. Oriental medicine is more generalist and is keen on interpreting a series of simple clues easily noticeable to make a statement on the health condition of an individual: e.g. the tongue analysis in Ayurveda, the urine and fecal smell and colors… Hence there is a strong opposition as oriental medicine is empirical and asks for extremely trained and seasoned doctors while occidental medicine is experimental, therefore results can be easily confronted. Asian medicine is very subjective as it considers all individuals as unique (the doshas system for Ayurveda, the 5 elements system for TCM), while occidental medicine is  objective depicting all individuals as similar machines sharing the same patterns (organs, nerves, bones…). The experimental approach is herefore validated as results on a significant amount of individuals are enough to extend it to any potential patient. 

The passive patient VS the active patient: 

A doctor in Europe is often seen as a protector, a kind of father that will pay heed on your health and be there whenever there is a problem. The relation with him is instable (as it is with a father): sometimes customers are putting the blame on him, bare a grudge for a bad prescription, or see him as a superhero. All in all, the patient is always passive, receiving care as a kid gets his food, clothes and toys. The oriental system places the doctor not as a father but as a partner, an advisor. A doctor is here to guide the patient, to give him his own opinion on how he could improve his health but at the end of the day, the patient has the last say when it comes to opting for the best solution for him. In this way, Asian medicine asks for the patient to be aware of his options and to make himself the choice he feels is best for him. Hence, the patient can only blame himself as he was the one to decide on which option to take. 

The straight line VS the circle: 

As previously discussed, the Oriental medical tradition considers that any trauma or organ dysfunction can generate a series of dysfunction in the whole body: this is the five elements system whereby one imbalance of an element will create a series of reaction in the other elements. This is why the healing process is important as it aims at reinvigorating all the elements and not the one affected at first. The occidental system is more based on Search and Destroy: curing as fast as possible what poses a blatant problem, even if this can arouse numerous side effects. It s a go getter approach! The body is seen as a machine; when something is broken you fix it, while Oriental medicine views the body as a vitalistic and dynamic system: when something is broken it can create a chain reaction, therefore many other things to fix.

Recently I visited a string of interesting spa in South East Asia:

• Tria integrative Wellness,
• Amezcua Wellness Centre, 
• San Carlos.

These spa are classified under the medical spa category. The concept of a medical spa consists in linking pampering to health benefits: you go to a medical spa to feel better under a precise Medical protocol. If you figure that a medical spa is a massage table with an electrocardiograph you re not very far. A medical spa will go beyond the word wellness and investigate your health conditions on the short term (medical analysis) and on the long term (preventive care), connecting a spa treatment to diet counselling and stress management.

In fact according to the preventive care theory, nutrition influences the health of your body and keeping tabs with it is a good way to avoid diseases in the long term (this theory still lacks precise documentation but is based on the belied that the synthetisation of amino acids brought by daily food intake affects the creation of neuro transmitters hence the perception of pain and mood).

Let’s take a look at the spa menus proposed by these different medical spa to better understand what it’s all about!

 First, when I arrived at TRIA (Bangkok) I was surprised because the taxi drove me to the Piyavate hospital. Then instead of turning right we took a small road alongside the massive hospital to discover a brand new faciity behind with golf cars and mercedes in the parking lot. Then inside it’s a real treat: wooden atmosphere, with top notch design. The medispa is organised in threee levels (four to come): the first one is hosting a small spa for men and for women, on the second floor you’ll find treatment rooms that are full of medical equipement and at the center a spa cuisine restaurant where you will be served vegetarian food accroding to your diet assesment. Then the second floor is composed by a pool and 4 isolated treatment pavillon

Getting an idea of TRIA: the spa Pavillon (3rd floor) + the food corner (2nd floor)

I really love their approach as it mainly focus on understanding how an alternative medicine can benefit to someone: they use reiki for fatigue, anxiety, hydrotherapy for arthritis, yoga for balance and market that under simple names such as sitting confortably for yoga, go the distance for fitness assesment. A really complete preventive care program in a spa envirronment. Hence a stay at Piyavate can be immediately followed by an experienmce at TRIA, a decisive competitive advantage that is increasingly considered by Asian hospital groups. TRIA did their soft opening last October, I m really impatient to see their operation up and running!

 Amezcua (Manilla, Philippines) has put  up a team of specialists to operate on three distinct fields: alternative medicine (acupuncture, healing touch…), recovery after surgery and aesthetics surgery. The program has an interesting twist as it converts alternative medicine treatments in preventive care screenings (for instance Meridian Stress Assessment (MSA) derived from traditional Chinese medicine that consists in measuring electrical energy throughout acupoints and meridians to estimate one’s level of Qi or the Korean Bu-Hang (where cups are placed in one’s back to see if an organ is reacting abnormally)). They also use innovative alternative medicine processes recently developped such as ozonotherapy (inhalation of pure oxygen to reinvigorate the tissues). As for TRIA it is a rather new concept, and there are eyeing to develop a facility in Koh Samui in the months to come.

 San Carlos, founded in 1993, is well known for its expertise in the field of weight control, insomnia treatment and stress management. Techniques used at St Carlos are mixing traditional Thai medicine and recent western technology. St Carlos both provides general medical care and check-ups, and wellness programs (slimming, rejuvenating, body cleansing), as well as cosmetic surgery.

Spa packages mix laser acupuncture, Ayurveda and herbal medicine… The St. Carlos Weight Loss treatment consists of a mixture of Asian herbs and pharmaceutical components combined to effectively cleanse the body and burn off unwanted fat. First, patients loose weight, then there is a time for weight stabilization

After their treatment, patients are provided with a complete individual health plan. Considering the background of the client’s health problems, spa doctors educate the clients on individual health management, including healthy dietary intake and exercise programs. St Carlos Medical centre also offers a wide range of facial care products, as well as hair treatment and food supplements, under their own brand name, St Carlos.

All in all three different approach:

• TRIA is the future of spa integration to hospital
• Amezcua is all about preventive care through alternative medicine
• San Carlos i s  a medical leader in alternative medicine

Hence if you ask me who is Medhi Spa I ll answer: “he’s the new kid on the block“

In my previous two articles, I have been talking about the possibility for Indian Hospital  to utilize Ayurveda in their healing and medical offers to gain a differentiating asset. Yet there are two hollistic medical system in Asia: ayurveda and traditional Chinese medicine that I ll call TCM to save some time.

Traditional Medicine is an ancient method of health care that combines the use of medicinal herbs, acupuncture, food therapy, massage and therapeutic exercise… Even though the concept yin yang is becoming a cliche of the occidental popular culture, TCM is really based upon this system: the interrelationship between organs is exactly depicting the yin yang theory.

This system, called the Five Phase theory, is based on the  premise that each organ either nourishes or inhibits the proper functionning of another organ (the yin against the yang). TCM aims at stabilizing the whole system for it to operate. Let’s illustrate this idea with the actual five phases

So let’s understand the whole system: for instance, deficiency in EARTH (stomach) leads to deficiency in both METAL organs (large intestine and lungs). Defficiency in METAL generates an imbalance in WATER (kidney and bladder) and in turn affects WOOD that will then affect FIRE. Any imbalance breaks down the whole chain…

Diagnosis in TCM is all about understanding if there is an imbalance of one of these five elements. Hence no x rays, no blood tests, no endoscopy… TCM diagnosis consists of four non invasive methods:

• Inspection of the general demeanor, body. language and tongue

• Question the patient about medical history, diet, lifestyle

• Listen to the tone and strenght of the voice

• Smell any body excretion, the breath or the body odor

• Palpation of the pulse of radial arteries, the abdomen and the meridian

This is actually not a far cry from ayurvedic techniques (even for the gore part), yet, the main difference resides in the meridian analysis and the will to get rid of all symptoms, even the hidden ones (as all elements are affected by the imbalance of one of them). TCM techniques are pretty obscur as they are practiced among the Chinese community in low profile places (in Singapore it is often practiced in a tiny room inside an appartement of a 16 storey building bar…)

I definitely need some guidance to find my way in this TCM shop!!

Many medical spa has taken into account the TCM approach to appeal to international custmers, but some Asian hospitals are trying to fill up the void. The Raffles Hospital hospital has just opened Raffles Chinese Medicine a clinic that emphasize TCM as a complementary medicine for a series of condition most notably stroke recovery and hypertension. Yet, the mysticism of the discipline plus the proven efficiency of TCM should entice Asian Hospitals with an important Chinese Community as their potential customers to develop such services:

• To find best practices to deliver TCM

• To propose an end to end medical follow up (post op recovery through TCM)

• To be DIFFERENT 

As stated in the previous article, Indian medicine has a great asset: its past. In fact, Ayurveda, the hollistic medicine principle derived from centuries of medical tradition, is an original medicine with a certain efficiency that can be built into a decisive competitive factor by Indian hospitals!

Previously, we talked about preventive care and diagnosis according to ayurvedic medicine. What about Disease management? there are four main methods by which and Ayurvedic physician manages disease:

• Cleansing and detoxifying (shodan)
• Palliation (shaman)
• Rejuvenation (rasayana)
• Mental Hygiene and Spiritual Healing (Satvajaya)

Cleansing and detoxifying (shodan)

This is the gore part of Ayurvedic medicine unfortunately and this can really scare off any person willing to discover ayurvedic medicine: pancha karma is all about vomiting, bowel purging, nasal douching to remove toxins from the body. The good part is that in preparation for cleansing an herbal oil massage may be performed (oil is well absorb by the skin and helps to eliminate toxins while passing through the body). herbs can also be introduced in certain parts of the body (especially the noze) to increase resistance to enzyme reaction. After the cleansing, the patient is given ghee (clarified butter) and yogurth to restore the intestinal flora.

Hi! Let me take care of your bowels

Palliation (shaman)

Shaman focuses more on the spiritual part of the healing and uses a combination of herbs, fasting, yoga streches, breathing exercices, meditation and lying under the sun (ah! that’s better than cleansing the body). in fact, the sun is not only a source of heat and light but according to ayurveda a way to better absorb vitamin D, to improve circulation and to strenghten the bones (the time of exposure required depends on your dosha type). Actually Shaman is often used as an alternative to pancha karma (see above ) for those who are mentally weak to undergo this kind of treatment (like me!). Shaman is really sweeter: one of the herbal therapies prescribed consists in consuming honey with certain herbs such as pippili (long pepper), ginger, cinnamon and black pepper…

Meditation as an alternative to cleansing

 Rejuvenation (rasayana)

Rasayana is a program of tonification which is similar to a physiologic tune up.  It is used to restore virility and vitality to the reproductive system, countering strterilirty and infertility, bringing forth healthier  progeny and improving sexual performance. Ayurvedic medicine uses three methods for rayasana: special herbs prepared as powder, pills, jellies and tablets; mineral preparations specific to a person’s condition and exercices (again yoga exercices).

Mental Hygiene and Spiritual Healing (Satvajaya)

Satvajaya is a method aiming at releasing psychological stress, emotional distress and unconscious negative beliefs. This is one of the precursors of stress management and operates in a very original and “modern” way. The categories of satvajaya include mantra or sound therapy to change vibraotry patterns of the mind, yantra or concentrating on geometric figures to take the mind out of ordinary modes of thinking and gems, metals and crystals for their vibratory healing powers.

Yantra: one type of the geometric figures to alleviate stress 

CONCLUSION 

All in all, Ayurvedic medicine is extremly original and should be put forward by Indian hospitals as an innovavtion in treatment. When people hear about Ayurveda they can barely figure out hwat it’s all about. My gut feeling is that some Indian HospitalGroups are being too conservative and too “un Indian” in their product offer for international patients. Again if the market is price driven today, I really think that it will all result to quality on a few years: ”MADE IN KOREA” used to be a problem but then Hyundai and Samsung surfaced with their different and new products to propell the cognitive perception  of Korea very high in people’s mind. To  me, the same can occur with the label ”OPERATED IN INDA“: nobody will feel confortable with it up until quality and differentiation  will be knitted to Indian medical providers

Let’s visit Bumrungrad through this video. You will then understand why I want to dig into the medical tourism business (sorry the video is a little bit dim)

The last days were extremely interesting for me. I was really wandering in the medical tourism jungle, checking which definitions people had in mind. I remember writing the ‘About this website’ page a week ago and I was so unsatisfied by this page that I decided to shelve it and rewrite it later. 

Every time I have a debate about medical tourism, people portray this industry as an unethical way of making money using the despair of people who can’t afford surgery in their country, plus a dangerous production system with all the infamous stories of botched mammoplasty or rhinoplasty.

Yesterday during a dinner, I tried to argue with a cardiologist that medical tourism is not boiling down to low cost procedures but is a wider access to unknown techniques perfectly mastered in Asia. These techniques range from ayurveda to tsubo chiatsu to Lasik surgery etc etc. I acknowledge the cost differential (we were talking about angioplasty) but for me, he was focusing on a non sustainable medical tourism. 

I am using the words ‘non sustainable’ because I feel that the existing business models of medical tourism are all one shot models:

+ heavy medical procedures motivated by a low cost effect or long waiting lists

+ no follow up stemming from the procedure + no customer relationship management approach. 

It is a run and gun approach that certainly has people smearing about the association of words ‘medical tourism’. But again there is hardly any tourism implied by this method> I have pinned this idea as medical travel. Let’s call it INDUSTRIAL medical tourism (as an input -output chained process)

 Yet, this is definitely not the vision I have about medical tourism. NOT AT ALL !

To me, medical tourism in Asia is an open window leading to the best healthcare procedures in the world, innovative techniques to solve rare condition techniques, the best preventive care solutions, unheard of manipulative therapies plus an opportunity to enjoy a tourism experience and so forth. Perhaps my definition is wrong but this is what medical tourism sounds to me. One could argue that I am speaking about health tourism…

Medical and Health Tourism as we define it as a longer life expectancy and a higher volume than the classical model

When considering biological methods such as herbalism or manipulative techniques such as psychotherapeutic postural integration or ayurveda are we only talking about health? These techniques are a genuine front end to medical procedures so how can they be restrained to mere health procedures… Medical tourism must be a sustainable experience and therefore must entice repeated visits: diversifying methods, proposing long term follow up (using tools such as the PRM we have previously reviewed) 

Here is my real first tentative definition of Medical Tourism, that we will call from now on Medical and Health Tourism: 

 ‘ an experience of medical and healthcare techniques culturally connected to a specific place or technically knitted to an hospital for preventive, aesthetic or curative needs ’ 

Experimenting these techniques boils to an exploratory approach that is tied up with traditional tourism (going from one place to another to try out a technique etc etc) but with the particularity of positively affecting our body  Talking about how angioplasty could cost only 10000 USD is definitely not the goal of this blog.   

Discovering medical tourism is going to take a major u turn. In order to carry out a clearer perspective on what we consider medical and health tourism is we will from now on stress upon THIS definition of medical tourism by digging into health and medical procedures specific to Asia and all the techniques that can make medical tourism a sustainable tourism.  

Finally the medical tourism map is working! It is still in its infancy so keep an eye on it

The newest features is a list of hospitals and spas in Asia. It will be gradually completed by articles specially dedicated to the latter during my future trips in Asia. I think I am going to fly to Singapore in mid June… You can access this page thanks to the toolbar in the header…

Tomorrow we’ll talk about online medical resources. but now it is the first of May and as you know, people just want to go out on this particular day…

According to a nationwide survey of 1000 adults conducted by Opinion Research Corp, Americans spend twice as much time researching car and computer purchases than they do in selecting a doctor, and 6 in 10 say they probably wouldn’t change their ways even if price and quality information on healthcare providers was readily available. It looks that the convenience factor is predominant yet one can wonder if this convenience is not correlated with the implicit message sent by the word doctor.

I am a huge fan of some consumer behaviour theories one of these being the famous ELM model (Elaboration Likelihood model) by Richard E. Petty and John T. Cacioppo:

A simple chart done by one of my friends at HEC to explain the ELM model

According to the ELM model one can take two routes when facing a decision problem: the central one which is rationale and the peripheral one which is affective. The  most important underlying concpet is the involvement of an individual when making his decision.

The model defines the elaboration likelihood (EL) of the communication situation as the probability of message- or issue-relevant thought occuring in the consumer’s head. From the consumer’s point of view, it is about engaging or not in extensive issue-relevant thinking to evaluate an issue. According to the ELM model, the involvement or elaboration likelihood (EL) conditions choice in the following way:

+ When the EL is high, the central route should be particularly effective.

+ When the EL is low, the peripheral route should be better.

Medical tourism to gain credibility and striking power should be able to take the central route hence rationalize the decision process by identifying (or creating) key factors to be evaluated by someone opting for the appropriate surgery practice. The involvement is in fact low when talking about surgery knowing that the final decision is normally handled by a professional and there is little need (besides cost) to jump from one specialist to another. The medical service is indeed a long term involvement on which there is only one element that pressures us to decide: trust. And trust is on the peripheral route… Plus the peripheral route is a bumpy one as changing doctor is a stress factor that is added to the primary and ultimate anxiogene factor: the surgery itself.

 Opting for another route thanks to medical tourism communicating through the tourism angle

Medical tourism revamp the central route by introducing new factors to be rationnaly evaluated such as: medical follow up through the trip, intrinsic quality of tourism services… Decision making will not only take into account the trust we have on a system but the rationale evaluation of the various benefits brought by medical tourism. Hospital accreditations, incentive programs proposed by companies or monospecialisation (best hospital for appendicetomy for instance…) can only help to opt for the central route… 

Tourism Quality has been a well documented matter for the last several years. However, before getting started we should ponder over the notion of quality. Tourism Quality has three components that must be sustained through:

(1) internal customer satisfaction

(2) external customer satisfaction

(3) the efficiency of processes

Satisfaction implies that we must translate subjectivity to objectivity. Expectations vary widely from one customer to another. Controlling these various factors should help extending the life time value of a customer that is calculated as follows (Christopher, 1998):

Life time value = average transaction value x yearly frequency of purchase x customer life expectancy

Hence, we should make sure that the purchasing act is repeated and that the level of satisfaction is sufficient and the level of disturbance low enough to arouse a long life expectancy per customer.This LTV should be factored in the Consumer Value Equation (CVE): 

Value = (Results produced for the customer + Process quality)/(Price to the customer + Costs of acquiring the services)

Quality ‘inn’ Medical Tourism: How to reach the stars?

Looking at medical tourism, how can this niche maximize value?

The results produced for the consumer are very important: it is a mix of preventive care that will trim down their risk of catching a decease for instance plus the opportunity to visit new and exotic places highly valued by tourism specialists and by collective imagination. The cachet of Thailand or of Bali by itself deems a psychological high price tag.

The process must flow: the value perceived of this flow will be conditioned by the quality of the incoming services provided by the medical tourism agency.

On the other side, medical tourism achieves an interesting benefit automatically: cost cutting! As we have seen it several times already, the expenses linked to the medical procedure are slashed, and easily covers additional costs generated by tourism activities.

All in all, getting a hedge on medical tourism Value will consist in providing the best incoming services possible.  We also have to take notice on the sustainability of these services and understand that the customer is part of the process and therefore that any improvement in the delivery service must be accepted by him.

As i was flopping around to find some interesting devices to add to this website I finally came to the point that we needed a map. Indeed, medical tourism besides being a blur complex is also a series of places to be known that can be:

+ Hospitals

+ Spa and wellness centers

+ Well known Medical sites (such as in France the city of Lourdes)

As you can see this feature has been included in the column on the right side and we gradually be filled up. In this column I will locate some key spots briefly describe them and eventually write some articles about the latter on this very website that I will connect to the icon. I think it is a good way to get a better grasp on the whole industry.

Following our tour of medicasts now let’s take a look on the evolution of tourism videocasts and podcasts. I have surfed on the net in order to find some of the new podcast players indulging in the tourism business and came out with three of them:

Podibus (http://www.podibus.com/). This website offers to download videos of reputed tourist places in France, for instance a free video of the chateau de Versailles (40 minutes!) or a video tour of the Versailles’ garden (2 euros). The website is planning to launch on the 26 oppof april a guided visit of the Chateau de Chenonceau in 11 languages (45 minutes for 3 euros). A quite interesting manner to buy a postcard or prepare ourselves for the trip at the Chateau!

Pocket Vox (www.pocketvox.com) is way more international as it podcasts tours of cities spreading from  Marrakesh to St Petersbourg. These visits last for one hour and a half and price at 5 euros.

Cityspeak (http://www.cityspeak.com/) is focusing on three cities Paris, London and Rome with a real in depth approach. However, the prices are way above the former services as an audio podcast (let’s call it tourcast!) costs above 17,80 euros. We can wonder if this service is profitable…

 All in all we have a service that is marketable and for which people are ready to pay for! So what about combining medicatss and podcasts and see whether or not people are ready to pay. Indeed the implicit value for a user is not the same:

+ for a medicast: get rational information about medical practices. Objective: get to be more acquainted with some practices

+ for a tourcast: visit a place, prepare a holiday. Objective: be enticing enough to spur imagination

+ for a meditourcast: prepare ourselves to a surgery or light intervention. Objectives: get informed about the hospital where te surgery will be performed

… We hence took out pleasure from the equation by mixing both approaches. Is a meditourcast a potential source of revenue from this point of view? Yes, if people are ready to pay a premium to be reassured. Yet, it is conflicting with the duty of a medcial tourism agency whose purpose is to male a travel easier from a practical and psychological point of view

Serge Fabre is an expert of the tourism Industry. In fact he was during his career Commercial Director of Carlson Wagonlit, then Managing Director of Go Voyages (Number 4 in France actually), Co founder of Cofinoga (a fidelity program called Smiles now) Vice President of operations of Liberty TV (a TV channel dedicated to tourism) and co founder of Vivacances an internet tourism agency that has been sold in 2005 to Opodo. In a word he is an extremly seasonned person that has gone from the early day of the brick and mortar agencies to the internet pure players. He has succesfully experienced various changes and is willing to further investigate other fields.

When 57 I would like to have such a resume…

In fact, we met several times in Singapore in order to discuss this strange wording:”medical tourism”. I was still dubious about this association of tourism with medical services as I had the impression that the operation described by my friend from Sacramento boiled down to what we could call medical travel. Medical travel will consist in making all the appointements to an hospital and take the appropriate plane to fly to this hospital. Serge also investigated the sector by analysing some tourism agencies specialised in medical travel and came out with the following elements:

+ incoming services factor heavily in medical tourism: what is really important is the customer focus orientation of the offers. Medical patients want to have a one stop shopping solution that cannot come from a pure medical travel approach. For instance, people are willing to have a limousine service when they get down of the plane (they fear the barrier of language) hence several features to be booked and coordinated by professional.

+ Even though Tourism is an indirect effect of medical intervention there is a strong tie between the latter and pre or post operation phases: people really enjoy to have the opportunity to relax before a stressful operation or to get fit in a nice resort. The booking of these resort stays and the operation is nevertheless conditional most notably for post operation rehabbing, where a stay depends on the health status of a patient after an operation. However, Serge questionned whether or not the tourism part was not the underlying pull factor behind the medical tourism concept.

In fact, all the agencies we have observed (we will analyse some of them in the upcoming days) are mainly focusing on the medical aspect of the business. Their business models mainly consists in tying up with hospitals with a good accreditation and US or UK educated doctors, set up pre consultation and incoming services without really taking care of the tourism part. There is a kind of discontinuity between the “medical” and the “tourism” part of these businesses: they have built a very strong medical offer on complicated operations at a low cost and consider tourism as a marginal source of revenues (or non appealing factor). In our eyes, this has led people to think that medical tourism only concerns heavy surgery such as the heart valve replacement of my friend from Sacramento.

However, when taking a look at what the ”medical” word implies we can consider:

a. Heavy Surgery (orthopedic, facial surgery…)

b. Elective procedures (botox, laser…) 

c. Health care (specific body therapies…)

d. Preventive care (stress, weight management…)

When looking at these factors, we had the impression together with Serge that medical tourism agencies are loosing an important part of the market (most notably b., c. and d.). In fact, when we think of a health care center through body treatments, “spa” and “health resorts” quickly come to our mind. But spa and resorts are part of the tourism part. Are health care and preventive care out of the medical tourism picture? Why should it be so? Serge and me are now really willing to make an effort to understand what is the real meaning of medical tourism and to be able to make a real distinction between medical travel and medical tourism…

I  just have described a mere shock of civilization. This is nothing compared to the revolution that happened while investigating the cultural gap on medical matters between Asia and our western conception.

This revolution happened in a casual way. I had a luncheon after a seminar in Malaysia where I talked with an overweighted American that has a diabetic condition hence many health troubles. He was in Malaysia for pure business purposes as he is currently living in the U.S., in Sacramento. We were talking about several topics from the evolution of the stock market in Singapore to the development of the agribusiness in Vietnam. however, he happened to tell me that he will have a specific surgery in two days and that he was really delighted of doing it in Asia.

Delighted to face a surgery in Asia? How come? In my eyes, the U.S. were far better in terms of medical practices, after surgery care and so many other parameters. I didn’t understand why the hell this man would come to Malaysia for a surgery, and more importantly an important one (valve replacement). He ran down with me the list of reasons that led him to this strange decision:

Waiting lists: the waiting list for him in the U.S. was extremly long and he would have to go through increasing pain for nothing. He was willing to pay for an opportunity to trim this time

The price itself: while such an operation could cost up to 150000 USD for an uninsured American in the U.S., it would only cost up to 15000 USD in Malaysia (and according to him a paltry 8000 USD in India at Maxhealthcare hospitals). The cost differnetial is indeed very important

The rate of success: in the U.S., the rate of success is lower for such an operation than in Malaysia: 96% against 99% according to him. It was less risky therefore to perform overseas than in the U.S. but what about care after surgery?

Post operation rehabilitation: he was staying in Malaysia after the surgery in what looked like a great tropical resort, the kind of sceneries we can admire in postcards. He could have stayed home in Sacramento for his rehab but considering the fact that the cost of transportation is already beared by the operation and the low cost per day of this resort, he was feeling more at ease by staying in Malaysia. He was even planning to later go to Borneo before finally going back home.

These women will attend my new found friend and not American nurses…

I couldn’t phrase it at that time but I had in front of me the first case of medical toursim:

Best medical practices - Low cost solutions - Wide variety of exotic tourism activities

I was really amazed, it was a perfect matrix. but I was quite unsatisfied by the implied meaning contained in the wording medical toursim: how come we could qualify medical tourism “toursim” as it mainly stems from medical activities. I was feeling quite odd therefore I decided to discuss this matter with Serge Fabre, a relative but also an expert in the tourism industry as he was involved as a leading manager in several companies…