Best Destination for medical tourism

Best Destination for medical tourismSingapore

Singapore’s status as one of the world’s freest economies and a highly developed nation has made it a medical tourism hub for both Asians and westerners for years. Cancer treatment is a top speciality there. The World Health Organization ranks Singapore the best health care system in Asia, and sixth in the world. Personal responsibility is a key driver that keeps health care costs in here reasonably low.

You will pay more in Singapore than in places like Thailand, but the quality of life in Singapore is second to none. One US-based grocery chain had a policy of paying the entire hospital bill, with travel costs for two, for employees who got hip and knee replacements in Singapore. Life expectancy in Singapore is several years longer than that of the UK. By many standards, the city-state has the world’s slowest infant mortality rate. If you’re looking for the most developed country for less expensive surgery, Singapore might be for you. However, there are stories of excessive costs, which together with rising health care standards in other countries, are causing medical tourism to shift to other parts of Asia.

While Mexico is the best known country in the Americas for foreigners seeking care, Brazil stands out one of the most advanced in the region. Looking good and feeling sexy is important in Brazil – almost to extremes, so it’s no wonder the country is home to more cosmetic surgeons than anywhere else on earth. Plastic surgery is done in a hospital, not in an office, in Brazil, and doctors are highly trained in such procedures. Up until recently, medical tourism in Brazil was largely relegated to elective procedures. However, the country has the first JCI-accredited hospital in the world outside of the United States – and now has more than 40 JCI-accredited hospitals.

Brazil has the least efficient medical system on this list, although it is nearly tied with the United States in terms of medical efficiency. Costs for plastic surgery can be as much as 60% less than in western countries, and surgeons can handle just about any procedure you can dream up. There are even veterinarians offering cosmetic surgeries on pets. Brazil is home to perhaps the world’s most renowned plastic surgeon. However, Brazil’s beauty consciousness surely can’t hurt anyone looking to save money on a nip and tuck.

Yes, really; India has become a top health tourism destination for high-end surgeries at inexpensive prices. Two of the top ten medical tourism hospitals are in India. Stories of westerners traveling to India and saving 75% over home country costs for large procedures – travel costs included – are not uncommon. India is anticipated to have a $2 billion industry serving overseas patients by 2015, thanks to well over 100,000 patients who visit each year. The Indian government is easing restrictions on citizens of many countries, making it easier for them to travel to India visa-free and with fewer restrictions (US citizens do need a visa to enter India, which costs $67 plus any agency service fees).

India is widely known for its advanced medicine services and advanced equipment. Doctors tend to be highly trained due to large medical tourism cities like Chennai and Noida having foreign patients fill half their hospital beds. Also, the language barrier is lower for English speakers, and Indian hospitals are bringing in translators for non-English speaking foreigners. Health care costs in India can run as low as ten cents on the dollar compared to the US or the UK. Popular treatments include bone-marrow transplants, eye surgery and hip grafting and replacement. India is also a top destination for cardiac bypass surgery at facilities. The procedure can cost less than $10,000 as compared to more than $100,000 in the west.

Thailand is world-renowned for its medical tourism and expat health care services. So much so that medical tourism is growing by 16% a year. There is no denying that their medical system is prized for offering a wide range of surgeries and other procedures at cheap prices. Many doctors in Thailand have been trained in western countries or Singapore and speak excellent English; nurses tend to speak English relatively well, also.

Ever since the crash of the baht in the nineties, Thailand used its currency crisis to attract medical tourists from around Asia, mainly for cosmetic surgeries. Today, Thailand is a haven for inexpensive plastic surgery, but also non-elective procedures. A facelift that might cost $15,000 in The Land of the Free would cost $2,500-3,000 in Thailand. Meanwhile, bypass surgery could cost around $25,000, an 80% discount over US prices. Experts recommend sticking to Bangkok rather than the coastal resort towns for access to the best doctors and care.


Malaysia sees well over half a million medical tourists – most from around Asia – each year due to the country’s developed infrastructure and low costs. The general consensus is that, as Singapore gets more expensive, Kuala Lumpur is picking up the slack with facilities that are just as good. English is more widely spoken in Malaysia than in Thailand, and infrastructure is better than countries like India.

Like other countries in Asia, Malaysia saw medical tourism as a way to diversify its economy during the Asian financial crisis. Malaysian hospitals offer services such as in vitro fertilization at around one-fifth the price of western facilities, as well as offering sophisticated treatment for burn victims. Malaysian hospitals also offer total physicals that would cost several thousand dollars in the US, with blood work, for a few hundred dollars.

Other countries are joining in to grab their share of foreign patients, as well. Jordan has seen millions of patients cross into its borders, and has received a top five ranking for medical tourism from the World Bank, while Colombia is fast rising as a medical tourism hub.

Mexico: High-grade Medical Care with Minimal Cost and Wait

Magnificent Mexico is home to a rich and dazzling array of sights and sensations, breathtaking beauty and remarkable scenery. From ancient Mayan ruins, decadent beaches, sparkling coastlines, tantalizing cuisine and low travel and living costs make Mexico a smart choice for the budding leisure traveler or medical tourist.

Relish in the sparkling blue waters of Puerto Vallarta, the gorgeous peaks of the Baja California Peninsula, the hum and rumble of Mexico City, its enchanting entertainment and rich, lavish culture. Just a hop and skip across the southern border of the USA, and a small jump away from the multitudinous nations of South America, Mexico’s ease of accessibility close to major ports of entry make it an appealing choice for travelers from the USA, Canada and developed countries across the world. With its tropical, salubrious weather and inviting pace and lifestyle, traveling through greater Mexico is a tourist’s delight. Additionally, Mexico affords an opportunity for high-grade medical care and procedures for just a fraction of the cost you’d find in the US and other developed nations.

One of the world’s major health destinations, Mexico’s health system is ranked as a high-grade World Health Organization medical provider, supplying a variety of cutting edge hospitals and medical facilities, services and accredited, board-certified surgeons, general practitioners and specialist health professionals. Mexico offers a range of specialist procedures, including cosmetic surgery, dentistry, hip and knee replacement, orthopedic surgery, cardiac and eye surgery.

Medical Tourism – The Role of the Destination Brand

An exciting market for medical services is taking shape as more consumers are willing to travel for health and medical care. This market is complex, and little is known about the motivations of those who decide to travel for care. Clinics and hospitals, as well as cities, regions, and countries are investing resources in the hope of realizing some of the anticipated benefits. Most medical tourism investments have not, however, achieved positive Return on Investment (ROI). Empty or only partially used clinics and hospitals which were built to serve medical travelers are a drain on private and public resources and are extraordinarily difficult to support and staff. These very public marketing mistakes also create resistance to further investment. What are needed are tools to better understand why some consumers travel for care, while others will not, and predict market behavior to prevent or reduce investment errors.

The modern healthcare services market continues to grow as seen by the increase in expenditure in both public and private sectors, and rising insurance penetration and premiums. Further evidence of this is price inflation in the sector. Average real growth in spending on healthcare in OECD countries has been 4.0% per year since 1970, with the highest rate 8.2 %. This growth has attracted the interest of investors and governments.

Historically, healthcare services have been produced and consumed locally. The medical travel sector remains an early stage market, but is growing and has captured international attention because of its economic development potential.

Who travels for care?

Until recently, economically advantaged consumers mostly from developed countries have traveled to other developed locations, perhaps outside of their home countries, to consume healthcare and medical services. What is distinct in this more recent medical travel market is the phenomenon of consumers from developed countries traveling to developing countries.

This new medical travel market is motivated by several factors including, the availability of procedures which may not be available where the consumer lives, prompt access, access to procedures which may not be legal or acceptable where the consumer lives, perceived expertise or superiority of a provider in a distant destination, as well as lower healthcare costs in a particular destination. These travelers now represent a sizable market, estimated to be US $30 – 60 billion annually with growth rates of 20 – 30%.

Nations recognize the medical sector and the international medical travel market in particular as an opportunity, and investing in the medical industry as a way to increase gross domestic product (GDP), improve services, generate foreign exchange, create a more favorable balance of trade, and boost tourism. Countries are launching advertising and public relations campaigns to bolster their own international medical appeal, to increase the relative attractiveness of themselves vis-à-vis others and thereby create preference among consumers.

Competitive position is not an accident

The best brands in the world cannot assume that global markets will beat a path to their door. The organizations and individuals behind Apple, McDonald’s, Amazon and Nike understand the critical need to market their products effectively, and have invested heavily to both establish and sustain their brands’ competitive positions. The obvious value of these brands is apparently not so obvious to many business leaders and policymakers in the world that would like to establish themselves as medical travel destinations. Too many attempts are made to establish a hospital, city, a region or even a country as a medical travel destination without considering and / or marketing the brand of the destination. This oversight ignores decades of well-established business principles and research.

What is a “brand”?

A brand is the dominant opinion, or pervasive perception of anything. The perception of a location among the would-be foreign consumers of dental or medical services, i. e. the “destination brand”, plays a critical role in their decision to travel to that location for healthcare. Considering the obstacles and risks associated with the decision to travel for healthcare, it is easy to understand that the perception of the destination, its brand, would weigh heavily in the consumer’s choice. One of the problems in medical tourism and international medical travel is that the role of destination brand in consumers’ choices to travel for care is not yet well understood. We know that it is important, but there have not been objective, reliable measures of destination brand in the context of medical travel.

Destination brand & medical traveler choice

The choice of a medical provider by a consumer is complex. The circumstances may be urgent, such as an emergency, emerging (progressive pain), psychological (self-image) or lifestyle (child bearing) motivations. The range of motivations is broad, from urgent to deliberate. Consideration of a distant destination assumes that consumers deliberate the decision to travel for care, although even in urgent circumstances if local services are not available, sick or injured consumers will seek services wherever they believe these are available or of higher quality. Within this emerging, highly differentiated market of consumers choosing to travel for care, what is not well understood is the role of destination perception – “destination brand” in consumer choice.

The Medical Travel Index

A model to rate and rank destinations based on the measures which medical tourists use to make decisions is needed. Such a model will enable providers and policymakers to successfully plan, position and market a destination to a target audience. Rather than guessing whether consumers will be attracted to a particular hospital or a location, this model creates a way to estimate attraction – or resistance – as a factor in consumer choice. By analyzing, weighting and harmonizing secondary sources such as destination rankings and relevant published indexes, a comparative metric, the Medical Travel Index (Robertson, Stackpole, Geenty, 2015) can be applied to this marketing challenge. The Medical Travel Index scores and ranks countries based on their comparative attractiveness as medical travel destinations, and is indifferent to the country’s marketing messages.

Components of the Medical Travel Index

The Medical Travel index uses five prominent factors to create a nation’s ranking. These factors include a measure of travel and tourism attractiveness, economic freedom, corruption, supply of medical resources and the states’ burden of cost. Each of these is from respected, reliable published sources, then weighted (as shown) and standardized to allow comparison.

The Travel and Tourism Competitive Index quantifies a nation’s ability to attract tourists. This measure is a crucial factor because it approximates the attractiveness of a country’s travel and tourism sector is and is heavily weighted. Also included is the measure by Bloom Consulting, which publishes the annual Country Brand Ranking, based upon data collected by the World Tourism Organization (UNWTO), and is widely respected. These scores were merged to form the “Travel” portion.

The Economic Freedom measure is based upon the The Index of Economic Freedom produced by The Heritage Foundation. This provides an established perspective of a nation’s ability to provide citizens the resources to “…act with autonomy while in pursuit of their economic livelihood and greater prosperity” (Heritage Foundation, 2014).

The Corruption measure was based upon a ranking of Corruption Perception provided by Transparency International, which isderived from global surveys of perceived corruption. This offers insight into how those pursuing medical travel may view different nations (Transparency International, 2013).

The Supply measure is based upon hospital and physician density for each studied nation. The statistics were provided by the CIA World Factbook as well as by the World Health Organization (WHO). Consumers evaluate the relative availability of care by medical practitioners and Supply is a measure of capacity in a destination nation.

The final measure, State Burden, is based on healthcare spending and poverty statistics. Health Expenditures as a proportion of the Gross Domestic Product was provided by The World Bank Group. The poverty data is taken from the CIA World Factbook and measures the population below the poverty line. Consumers may use these to gauge the wealth of a nation’s population and how much of its resources are devoted to healthcare.

Countries & Rankings

Countries included in this initial application of the Medical Travel Index were derived from publications and other documents where the country promoted itself as a medical travel destination (through a cabinet level ministry or a reputable agency) or which were identified in the literature by other authors. Excluded from this analysis were countries which have, based on the best available information, negligible volumes of medical travelers, or have not encouraged medical travelers. Forty-four (44) countries were included in the initial group.

In this analysis, countries such as Germany, France, South Korea and the United States emerge among the most highly rated international medical travel destination brands.

This methodology also produced some paradoxes. Japan and Canada rank very highly, but it is unclear that Japan has been effective attracting many medical travelers. Canada is in the midst of a public debate about whether foreign consumers are inappropriately “jumping the line” on Canadians, and whether this form of medical export should be discouraged.

Other countries, such as Mexico and India, which have aggressively promoted themselves as medical tourism destinations, did not rank as highly as many others; Mexico ranked 29 th and India 43 rd. Economic Freedom, Corruption and State Burden weighed heavily in this comparative ranking. The component scores of the Medical Travel Index can serve as a guide to policymakers as to what needs to be addressed in order to measurably improve their country’s comparative ranking.

This resulting paradox of comparative / competitive ranking can be seen in the Middle East. Israel (20 th ) has done little to promote itself as a medical travel destination, while the United Arab Emirates (23 rd ) is aggressively pursuing various segments of this market.

It should be noted that one of the strengths, and certainly one of the weaknesses of this methodology is that it is based on published data. From the consumer’s point of view, perceived corruption or poverty may not prevent a decision to travel to a particular destination if the situation is desperate enough, or the economics are compelling. In a relatively non-pressurized decision, these factors certainly have greater influence.

What about money and distance?

The Medical Travel Index models and ranks the comparative attractiveness of countries as medical travel destinations, without attempting to adjust for relative economics (e. g. Purchase Power Parity), or distance (travel time). Much more research and analysis is needed for adjustments and refinements to the model to account for these factors.

Globally, the modern healthcare services market continues to grow. Across the developed world, healthcare spending is rising and will continue to do so driven in part by consumer demand. The growing market for international medical care and medical tourism is attractive to developing nations. The need to better understand consumer choice in this complex, medical travel market dynamic led to the development of the Medical Travel Index (Robertson, Stackpole, Geenty, 2015), an objective way of rating and ranking the brands of destinations attempting to attract international medical consumers. This measure is independent of anything the destination says about itself. Further work is necessary to refine the model so that it is more predictive. As the medical tourism and international healthcare markets continue to grow and evolve, additional measures will be developed to more effectively evaluate the impact of destination brand on consumer choice.


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