Medical Tourism- where to go for medical treatment

Where to go for medical tourism?

- by Charles Runckel

Once the decision has been made to go abroad for medical care (see our article, Five Reasons to Go Overseas for Medical Treatment and Three Reasons Not to Travel), the aspiring medical tourist is confronted with many possible destinations. Though many countries boast about their growing medical tourism industries, these are usually either not competitive in price or too weak in quality for American or European tourists. There are effectively three major hubs and three minor hubs that should be considered, while the rest can be safely ignored.

The three major hubs are Singapore, India and Thailand. In 2006, Singapore claimed 374,000 medical tourists while India brought in over six hundred thousand. Thailand is the undisputed heavyweight of the industry, drawing over 1.2 million medical tourists. Many of these tourists will visit Bangkok’s Bumrungrad Hospital, which accounts for a third of Thailand’s medical tourists. To put this in perspective, this single Thai hospital received more medical tourists than all of Singapore’s hospitals put together, and two-thirds as many as all of India. India and Singapore together have fewer foreign medical tourists than Thailand, and these are not just for minor procedures but also major heart and joint replacement surgeries, among many others. These hubs are also growing frantically, with 30% annual increases in foreign tourists as an industry standard and expected to be maintained for the foreseeable future.

The three minor hubs are Central America (exemplified by Costa Rica), Eastern Europe (led by Hungary) and South Africa. The minor hubs established themselves long before the major hubs by focusing on low cost dental and cosmetic surgery. At half the price of the United States, these hubs cannot compete financially with India or Thailand but rely on other benefits to attract tourists. Central America and Eastern Europe are much more convenient to medical tourists in the US and Western Europe, respectively, than the major hubs which all require 18+ hour flights. South Africa offers a more polished package for medical tourists and less culture shock than the major hubs. What makes these hubs minor is not just the numbers of tourists, however, but also their capabilities for major surgery. They do not have the large volume of the major hubs and thus are not equal to their quality or low prices, making them suitable only for dental, cosmetic or other minor surgery.

The Major Hubs

India

India is the cheapest of any of the hubs, major or minor, and is the equal of the other major hubs in terms of quality of staff and equipment. Prices average at a fifth of the United States, with particular deals in dentistry and diagnostic imaging, which approach a tenth the price. India deals with a higher proportion of major surgery tourists than minor surgery and check-up tourists than the other major hubs, which has given rise to specialist hospitals across India. These hospitals are far out of the reach of most Indians and cater specifically to foreign tourists for very specific needs – for example some centers will focus strongly on heart surgery while others will deal with joint replacements. These specialist hospitals are very new with top rate medical teams, high volume and experience in their specialty and the best equipment available. High volume of heart surgeries does not translate into high volumes overall, however, and these hospitals rely heavily on agents, especially on the internet, to recruit prospective patients. These facilities also offer procedures that are rare or unavailable in the United States, such as hip polishing or resurfacing, which is a popular surgery for medical tourists.

Tourism in India can be impressive and at the same time quite uncomfortable. India’s infrastructure is very poor, and though excellent hotels and western restaurants are available, they are extremely expensive. There is also no middle ground, with the alternatives of a luxury hotel or a dump. For those who like Indian food, this is of course plentiful and cheap but do not underestimate how quickly that can become boring on a long trip. India has magnificent sights to see, however, from Hindu shrines to Islamic monuments and palaces and a vibrant modern culture.

While much of the country is poorly developed, a medical tourist can rest assured that their hospital and, for a price, their hotel will be extremely modern and pristine. Venturing beyond these, however, a traveler is virtually guaranteed to suffer from diarrhea and intestinal parasites are common even for cautious eaters. Likewise, the odds of contracting a serious disease are low, however several additional vaccinations are strongly recommended that are not necessary in the other hubs.

Conclusion: India is a good choice for major surgery, but you should make sure you are going to a hospital with a strong track record in your particular condition. Tourism options after treatment are not as comfortable as the other hubs but are among the most interesting.

Singapore

Singapore has a well-deserved reputation as a high-tech, clean and orderly city-state. With medical costs about half those of the US, Singapore is considerably more expensive than India or Thailand and in line with the minor hubs. While the quality of medical facilities is on par with the main medical centers in Thailand and India, Singapore’s major attraction is its status as a developed country and the reassurance this provides to new medical tourists. While Singapore’s hospitals are no more reliable than the medical tourist facilities of their competitors, Singapore’s pristine streets contrast sharply to India’s overcrowded and underdeveloped cities to inspire confidence in the city-state’s medical abilities. For those very nervous about going to a developing country for health care, Singapore’s shining towers are a strong alternative.

The Singaporean government has recently made a significant effort to expand its biotechnology sector, mostly with large financial grants to lure researchers from other countries. While this controversial policy is having mixed results overall, it has been quite successful in supporting stem-cell research when other regions of the world have stalled on the issue. This focus, along with related personal health technologies, have resulted in a number of cutting edge therapies, especially for cancer, that are not available anywhere else.

Singapore’s tourist attractions tend toward high-end shopping rather than white sand beaches (in fact Singapore has to import sand from Indonesia). Hotels and services are very expensive, but many tourists stay only for their medical care and arrange for the vacation portion of their trip to be spent in nearby Malaysia or Indonesia, where Java is a top destination. Most flights to these destinations will have a stopover in Singapore anyway, so it is best to think of it as a vacation to Java with a medical stop in Singapore, not the other way around. Singapore has the best English speaking population of the medical tourist hubs, however, so if the goal is to minimize culture shock staying in Singapore with its diverse and high-end restaurants and luxury services is an option.

Conclusion: Singapore is a good alternative if you’re nervous about going abroad and don’t trust India or Thailand’s medical capabilities, but this is just a matter of confidence and realistically almost all tourists should favor the other two hubs.

Thailand

Thailand is the largest medical tourism hub in total volume and in both high-end and low-end procedures. Long a major tourist destination, Thailand has translated this expertise along with a largely Western-trained medical community into a very convenient package for westerners. Thailand’s two largest medical tourism targets are the Bumrungrad and Bangkok Hospitals, which annually treat 400,000 and 150,000 foreign patients, respectively. Thailand’s prices are about 20% higher than India’s, on average, with the main advantages being a better tourist experience overall and more bundling of services. Whereas most medical tourists going to India should focus of specialty hospitals that are often in different cities, each of these Thai mega-centers is full service. Their massive volume overall translates into high volume in each specialty, which in turn translates into more experienced doctors, better equipment and lower prices.

This packaging of services often earns Thailand regular medical tourists, who find that flying to Thailand annually for a comprehensive physical exam, dental work and any minor procedures along with a week on the beach at Phuket is a cheaper and more enjoyable option than staying at home. Thailand’s tourism options are among the strongest of any medical hub, balancing exotic culture with pristine beaches and supported by a very mature tourism industry. Both Thai and foreign restaurants are plentiful and affordable, while Thai hotels come in all levels of luxury and are much more reasonable than their competition in Singapore or India.

For tourists seeking a number of smaller procedures, Thailand is a sure bet. For first time travelers who want to step outside the more Westernized cultures of South Africa and Singapore, Thailand is also a good choice. Those seeking a specific, major surgery should weigh Thailand and India carefully: the Indian option will likely be cheaper, but not by much and the recovery environment and support are generally better in Thailand.
Conclusion: Thailand is the major player in the medical tourism field for a reason and is both the most balanced of the hubs and overall strongest in several categories.

The Minor Hubs

South Africa

South Africa’s strength lies in the packaging of its tours, rather than the outright price of their medical capabilities. While their hospitals are at first world standards, South African facilities have far less experience with heart or joint surgery and specialist hospitals in India or Thailand are better for these patients. The majority of South African medical tourists are after cosmetic surgery, with breast augmentations as the number one procedure. South African prices hover around 40-60% of those in the US, making them one of the more expensive medical tourism hubs. Tourists to South Africa will find a very polished experience, however, with a mature medical tourist industry.

A cosmetic surgery package in South Africa will consist of a consultation and surgery, personal physical therapist and personal assistant during your recovery in a spa and a safari tour afterwards. Any of these components can be found in other tourism hubs for far less and some travel agents will even bundle them, but the professionalism and polish of the South African package cannot be matched. Combined with widespread use of English and familiarity with western culture, South Africa is a good choice for those who want to travel without tremendous culture shock. Recently, however, crime has become a major problem in South African cities and many hotels will not allow guests out at night except in a hotel car, which further limits exposure to the local culture.

Conclusion: South Africa is a solid candidate for tourists that want to be pampered after their cosmetic surgery and don’t mind paying a premium for it.

Costa Rica

Costa Rica’s main selling point is that it doesn’t require a trans-Pacific flight for US tourists to get there. As with many smaller hubs, the focus is on cosmetic surgery and dental work. Costa Rica boasts gorgeous beaches and rainforests and is no stranger to American tourists, making this a very convenient and appealing option. Prices are approximately 40-50% of the US, however like the other small hubs having major surgery here is not recommended.

Conclusion: Costa Rica is a good choice for those seeking dental work or plastic surgery and don’t want to endure a 20 hour plane ride.

Hungary

Like Costa Rica, Hungary offers cheap but reliable dental and cosmetic surgery. The major draw is that Hungary is convenient to European tourists by air or train. Prices are 40-50% of the US, though almost all patients that go there are Europeans with heavily state-supported health care systems. Usually the benefit is availability of procedures rather than cost (no two year waiting lists). One drawback is that this is one of the only medical tourism hubs that does not possess a tropical beach – there are options for tourism but they are more cultural rather than natural or decadent.

Conclusion: Hungary is convenient for Europeans, though like Costa Rica is not suitable for major surgery and is expensive by medical tourism standards.

Summary

Central America and Eastern Europe should only be considered by those who need very minor procedures or who are so busy they can’t get away for a trans-Pacific flight and are willing to pay twice as much for the convenience. South Africa is similarly expensive, and should appeal only to those who value pampering and a Western atmosphere as absolutely essential. Among the major hubs, Singapore is the most expensive (about twice the price of India or Thailand) and equivalent in quality. Singapore’s major selling point is the confidence it inspires as a developed country as opposed to its developing competitors, even though this advantage is entirely a matter of perception and marketing.

India and Thailand are clearly the strongest choices in terms of price, capability and quality. For those seeking smaller procedures, and especially several smaller procedures, Thailand is certainly the better choice. In addition to packaging these services better, Thailand offers a smoother tourism experience than India, with the tourism aspect often an important factor for those seeking non-critical procedures. For the major surgeries that are the entire purpose of a trip, India and Thailand are in a dead heat. Both will boast state of the art equipment, top-notch foreign-trained surgeons and low prices. India’s slightly lower prices are offset by Thailand superior service and packaging. As a tie is not of much use to prospective tourists, Thailand tends to be a better choice for most medical tourists as it both matches India for major surgery while is in the lead for service, tourism options and other procedures.

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