Medical tourism

from Wikipedia, the free encyclopedia

Medical tourism is a slang term for the cross-border use of medical treatments . Depending on the type of medical intervention, the stay can last a few days or several months. Reasons for this form of tourism are the lack of treatment options in the patient's country of origin, avoidance of waiting times in the home country or cost savings. Medical tourism is a global trend and is one of the consequences of advancing globalization . Every year a little more than 20 million patients travel abroad worldwide. Medical tourism has an annual volume of around 80 billion euros (as of 2019). Around 40 countries are actively seeking patients from abroad, including the USA , Germany, Switzerland, Israel, India, Thailand and Singapore.

Two thirds of all medical trips take place within Asia. Hundreds of thousands of foreign patients are treated annually in India, Thailand, Singapore, Malaysia, South Korea and the Philippines. These, mostly outpatients, come from neighboring countries as well as the USA, Europe or the Arab Gulf States, with an upward trend of around 15 percent per year. Germany is also a preferred destination for medical tourists, especially from the EU , the Commonwealth of Independent States and the Arab countries. Another interesting target group are US citizens who do not have health insurance and who travel abroad for necessary operations. In 2007, 750,000 Americans traveled abroad for medical treatment; In 2017 there were around 1.7 million.

There are now a large number of tourism companies and patient recruiters around the world who have specialized in medical tourism . Recently, Turkey has been soliciting patients from abroad very strongly, partly with the help of the Ministry of Tourism. In 2013, 360,000 people traveled to the country for a medical procedure.

Classification and demarcation

The term medical tourism is not clearly defined in science and is sometimes controversial among experts. Depending on the approach, point of view and the nature of the topic, numerous synonyms (e.g. clinical tourism, patient tourism, cross-border healthcare, etc.) have emerged in the literature. As the wording suggests, however, the term is made up of two components: medicine and tourism.

The systematisation of the medical trip is most often found in the segments of the tourism industry and in connection with the generic term “health”. The World Health Organization (WHO) defines this term as follows:

" Health is the state of complete physical, mental and social well-being and not just the absence of illness or ailment."

Furthermore, the World Tourism Organization describes the " tourist " as a person who travels to places outside their usual environment and stays there for leisure or business reasons for no more than a year.

In summary, so-called medical tourism describes a trend in the sense of health and medically motivated travel for reasons of cost savings and avoidance of waiting times, which bundles both tourist and medical properties into one offer. Medical tourism can be understood as a form of health tourism - alongside classic health tourism and wellness tourism . At the same time, it functions as a generic term for other sub-areas (Fig. 1: “Systematic classification of medical tourism in the various tourism segments”). The divisions “Prevention Tourism”, “Surgery Tourism” and “Rehabilitation Tourism” form a subdivision of the medical trip.

In contrast to the other two forms of health tourism - spa and wellness tourism - the degree and intensity of the medical applications sought in medical tourism are very high. According to this, the chronically or acutely ill tourist travels as a patient to a country outside of his place of residence in order to undergo targeted medical treatment. The impetus for a medical trip is based on a previous diagnosis or a clinically manifest illness of the patient in his home country, for which he hopes for a qualitatively better, faster or cheaper therapy abroad for various reasons. The medically indicated health trip usually includes an inpatient or outpatient stay in a medical facility. In the case of acutely ill (emergency) patients, a medical trip is often associated with a higher treatment risk and possible complications as part of the therapy.

The terms “foreign patients”, “international patients” or “medical tourists” are used synonymously in the literature for those tourists who specifically go on a medical trip. Experts do not include people who do not travel abroad with the primary aim of medical treatment, but who become patients there involuntarily (e.g. through an accident). Patients from abroad are understood to mean both individual patients and patient groups.

According to Directive 2011/24 / EU (Patient Mobility Directive) , the costs for planned EU treatment abroad in Germany are reimbursed by health insurances in the home country up to the amount that would have been incurred for the corresponding treatment in Germany. Public vaccination programs, organ transplants or long-term care are completely excluded. In advance, it is necessary to clarify with the health insurer which services will be fully or partially covered. As a rule, patients have to pay in advance and can submit the bills to their health insurance company after treatment.

Types of medical tourism

From the point of view of the origin or the flow of patients of the medical tourists, a distinction must essentially be made between two forms: so-called outgoing and incoming medical tourism . In Germany, both forms have achieved high economic relevance in recent years.

Under Outgoing medical tourism in patients currents are to be understood from the domestic market, seek medical tourism destinations abroad and seek treatment there medically. The term incoming medical tourism, on the other hand, describes travelers from abroad who come with the primary aim of undergoing medical treatment in this country.

Typology of medical tourists

Medical tourists have a wide range of motives for treatment abroad. Depending on the patient's origin, a distinction can be made between the following types of medical tourism :

  • Patients looking for the best treatment option worldwide
  • Patients looking for a better treatment option compared to their home country
  • Patients who have to wait for treatment in their home country
  • Patients whose treatment abroad is cheaper
  • Medical emergencies
  • Patients who have emigrated in old age and who use medical services in their home country
  • Patients in border regions
  • Patients who, due to legal restrictions or moral reasons, can only have certain treatments carried out in clinics abroad
  • Check-up patients
  • Medical wellness tourists
  • Patients who need a health-promoting natural infrastructure (climatic health resorts)

The literature also uses three further criteria for typology of medical tourists:

origin 
* Inländischer Patient, aber wohnortfern
* Ausländischer Patient, aber grenznah
* Ausländischer Patient, wohnortfern
Personal motives 
* bessere Qualität der Medizin als im Heimatland
* Disponibilität bestimmter medizinischer Leistungen
* bessere medizinisch-technologische Ausstattung (State-of-the-Art-Technologie/High-End Medizintechnik)
* geringere Wartezeit für bestimmte Behandlungen
* besseres Preis-Leistungs-Verhältnis als in der Heimat
Payers 
* EU-Bürger mit Europäischer Krankenversicherungskarte (EHIC) oder S2-Formular (ehem. E112)
* Ausländische Privatpatienten (Selbstzahler)
* Patienten, deren Kosten die jeweilige Botschaft, ein gemeinnütziger Träger, eine Versicherung oder ein Unternehmen übernimmt

The main motive of the medical tourists is in principle to ensure, to improve or to check the general state of health. The personal motivation for such a trip can be due to two overriding reasons: On the one hand by a doctor's instruction (e.g. an urgent operation for a cancer patient) and on the other hand from self-motivation (e.g. a non-medically necessary cosmetic cosmetic correction) of the patient.

The target states promote this form of "tourism" due to lucrative foreign exchange income and an increase in gross domestic product. At the same time, the target countries can present themselves as medically high-performance, which is also a factor for “normal” tourism.

Medical tourism to Germany

In 2017, according to the Bonn-Rhein-Sieg University of Applied Sciences, around 247,500 inpatients and outpatients from abroad were treated in German hospitals. That is 2 percent less than last year. Their share in the total number of all hospital patients is 0.5 percent and thus far below the figure of around two percent assumed by the European Commission. The estimated sales volume of international patients is around 1.2 billion euros annually. Russia, the most important non-EU country of origin for medical tourists to date, recorded a significant plus of 7.6 percent for the first time; More patients came from Ukraine (+18.9 percent) and Kazakhstan (+36.7 percent). There was a massive slump in medical treatment trips from some Gulf states: Saudi Arabia (minus 36 percent), Kuwait (minus 62 percent) and Oman (minus 28 percent). The number of patients from the Arab world has been falling noticeably since the end of 2016. The triggers are a significant reduction in the financial resources for treatment abroad in many Gulf states and the associated more detailed examination of accounts, structural changes in the embassies and consulates as well as scandals around the international department of the Stuttgart Clinic and the Kuwaiti Health Office in Frankfurt am Main.

Countries of origin
The medical tourists who came to Germany in 2017 came from 177 different countries around the world. Around 65 percent of all inpatients come from the EU, most of them from Poland. Important countries of origin are also the members of the Commonwealth of Independent States (proportion of total inpatients abroad 9.5%) and the Arab Gulf states (proportion 6.9%). Only a small proportion of the medical tourists come from the USA or China. According to official figures, 350 patients and 864 accompanying persons came to Germany in 2005 from Dubai alone, and around 2500 patients per year from the United Arab Emirates .
Fig. 2: Origin of foreign patients in Germany

criticism

The practice of medical tourism has been criticized from several quarters. “The boom in medical tourism in a country like India (...) is associated with a whole range of risks and side effects. This includes, for example, the problem of environmentally friendly disposal of hospital waste or the illegal trade in organs. While the medical care of the Indian population is at a comparatively low level, private clinics for the rich are subsidized with scarce tax revenues. "

Furthermore, various medical and economic criticisms are regularly cited. This includes, for example, the preferential treatment of international patients, while domestic patients have to accept waiting times; the spread of multi-resistant germs by medical tourists, payment defaults in clinics or non-transparent billing due to inadequate legal regulations.

Organ trafficking and the preferred treatment of transplant patients from abroad are not only considered a problem in emerging countries such as China or Colombia, but also occur regularly in German clinics.

Medical tourism by country

literature

  • Frank-Michael Kirsch, Jens Juszczak (Ed.): Medical tourism. Experience with a global growth industry. Paderborn 2017, ISBN 978-3-942409-63-6 .
  • J. Juszczak: International Markets - Potential for German Hospitals. In: JF Debatin et al. (Ed.): Hospital management: strategies, concepts, methods. Berlin 2017, ISBN 978-3-95466-302-6 , pp. 175-182.
  • J. Juszczak, I. Kern: Ethics in medical tourism. In: A. Gadatsch, H. Ihne, J. Monhemius, D. Schreiber (Eds.): Sustainable Management in the Digital Age, Innovation - Control - Compliance. Wiesbaden 2018, ISBN 978-3-658-20173-9 .
  • Devon M. Herrick: Medical Tourism: Global Competition in Health Care. NCPA Policy Report No. 304, Dallas 2007, ISBN 978-1-56808-178-6 .
  • Günther E. Braun (Ed.): Attracting foreign patients to German hospitals. Neuwied 2004, ISBN 3-472-05259-7 .
  • Kirsten Hermes: Medical Wellness as an example of the adaptation of wellness concepts from the USA in Germany. Grin Verlag, Munich 2008, ISBN 978-3-640-18863-5 .
  • Jens Juszczak: International Patients in German Clinics: Approaches to Marketing Health Services Abroad. (= Series of publications by the Economics Faculty of the University of Applied Sciences Bonn-Rhein-Sieg. Volume 8). Sankt Augustin, 2007, ISBN 978-3-938169-10-0 .
  • Jens Juszczak, Bernd Ebel: Services for international patients, proceedings for the conference on medical tourism. (= Series of publications by the Economics Faculty of the University of Applied Sciences Bonn-Rhein-Sieg. Volume 21). Sankt Augustin, 2008, ISBN 978-3-938169-14-8 .
  • Jens Juszczak, Bernd Ebel: Acquisition and care for international patients, proceedings for the 2nd conference on medical tourism. (= Series of publications by the Department of Economics at the University of Bonn-Rhein-Sieg. Volume 28). Sankt Augustin, 2009, ISBN 978-3-938169-22-3 .
  • Kai-T. Illing (Ed.): Patient import and health tourism, international marketing for clinics, health resorts and health regions. Berlin 2000, ISBN 3-9807005-1-8 .
  • Josef Woodman: Patients Beyond Borders. Chapel Hill NC, 2007, ISBN 978-0-9791079-0-0 .
  • Milica Z. Bookman, Karla R. Bookman: Medical Tourism in Developing Countries. New York 2007, ISBN 978-0-230-60005-8 .
  • Jeff Schult: Beauty from Afar. New York 2006, ISBN 1-58479-486-0 .
  • Marvin J. Cetron, Fredrick J. DeMicco, Owen Davies: Hospitality 2010. The Future of Hospitality and Travel. Prentice Hall, 2005, ISBN 0-13-147579-7 .
  • M. Sonnenschein: Medical Wellness & Co: Preventive Health Tourism in Germany - Changing Supply and Demand. Johannes Gutenberg University Mainz, Univ., Diss., Pro Business Verlag, 2009, ISBN 978-3-86805-968-7 .
  • EM-L. Quast: The health business. Diplomica Verlag, Hamburg, 2009, ISBN 978-3-8366-7544-4 .

Web links

Individual evidence

  1. ^ J. Juszczak: Medical tourism destination Germany. Series of studies by the Department of Economics on the medical tourism market at the Bonn-Rhein-Sieg University of Applied Sciences, Sankt Augustin, 2012, p. 3.
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  4. ↑ a b Globalization of Medical Services. In: Deutsches Ärzteblatt. 2007.
  5. ↑ J. Juszczak: Development of the international patient business in the clinic. Seminar documents. Sankt Augustin, 2012.
  6. ↑ James E. Dalen, Joseph S. Alpert: Medical Tourists: Incoming and Outgoing . In: The American Journal of Medicine . tape 132 , no. 1 . Excerpta Medica , January 2019, p. 9 f ., doi : 10.1016 / j.amjmed.2018.06.022 .
  7. ↑ Hair transplantation - medical tourism in Turkey is booming. In: spiegel.de. January 25, 2015, accessed July 25, 2020 .
  8. ↑ Reno Barth, Werner, Christian: The wellness factor: modern quality management in health tourism. Relax-Verlag, Vienna, 2005, p. 45ff.
  9. ↑ Monika Rulle, Wolfgang Hoffmann, Karin Kraft: Success strategies in health tourism: Analysis of the expectations and satisfaction of guests. Erich Schmidt, Berlin 2010, p. 6.
  10. ↑ World Health Organization (WHO)
  11. ↑ United Nations World Tourism Organization (UNWTO)
  12. ↑ EM-L. Quast: The health business. Diplomica Verlag, Hamburg 2009, p. 4.
  13. ↑ Kerstin Böhm: Service Quality in Health Tourism: Success Factor for German Spas. VDM Verlag, Saarbrücken 2007, Annex 1, p. 4.
  14. ↑ Reno Barth, Christian Werner: The wellness factor: modern quality management in health tourism. Relax-Verlag, Vienna 2005, pp. 55–57.
  15. ^ K. Janowski: Medical tourism in Switzerland: patient import and export in Swiss clinics. 2007, p. 9. Hochschule Bonn-Rhein-Sieg
  16. ^ I. Beyer: Health Check-Ups in Germany. 2011, p. 35 University of Applied Sciences Bonn-Rhein-Sieg
  17. ↑ Monika Rulle: European health tourism in the context of changed framework conditions . In: Spektrum Freizeit . No. 1/2005 . Janus-Presse, 2005, ISSN  1430-6360 , p. 130–142 ( duepublico.uni-duisburg-essen.de [accessed September 18, 2019]).
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  19. ↑ J. Juszczak: Medical Tourism Destination Germany, series of studies by the Department of Economics on the medical tourism market. Bonn-Rhein-Sieg University of Applied Sciences, Sankt Augustin 2012, p. 3.
  20. ↑ J. Markus: Business potential from "medical tourism": patients from the CIS countries in German clinics. Berlin University of Technology and Economics, 2009, p. 1.
  21. ↑ M. Sonnenschein: Medical Wellness & Co: Health care tourism in Germany - supply and demand in transition. Dissertation. Johannes Gutenberg University Mainz, 2009, p. 36 ff.
  22. ↑ Noni Edwards: Medical tourism is flourishing in Dubai. July 11, 2019, accessed January 22, 2020 .
  23. ↑ Malaysia's west relies on medical tourism. Retrieved January 22, 2020 .
  24. ↑ Jens Juszczak: The decline in demand from the Gulf States causes a decline in medical tourism. Press release. In: h-brs.de. Bonn-Rhein-Sieg University of Applied Sciences, January 30, 2019, accessed on March 13, 2019 .
  25. ^ Jörg Nauke: Mismanagement in the Stuttgart Clinic: Scandal paralyzes medical tourism. In: stuttgarter-zeitung.de. February 25, 2017, accessed April 1, 2018 .
  26. ↑ كتب الخبر, محيي عامر: الحربش لـ «المحاسبة»: المبالغ المتهم بتبديدها في عهدي تفلمكيابا حوّل لل. Retrieved March 13, 2019 (Arabic).
  27. ↑ M. Onyshchenko-Dubow, E. Shklyar, J. Juszczak: Entry into the CIS patient market, special seminar as part of the medical tourism qualification campaign by Berlin Partner for Business and Technology. Seminar documents. Berlin 2017.
  28. ↑ J. Juszczak: Presentation: International Patients from the CIS States - An introduction to the workshop: Recruiting patients from the CIS States. Department of Economics, Bonn-Rhein-Sieg University of Applied Sciences, Sankt Augustin, May 12, 2011, pp. 8–10.
  29. ↑ Competition for patients in Dubai. (No longer available online.) In: bfai.de. May 24, 2007, archived from the original on September 28, 2007 ; accessed on May 2, 2019 .
  30. ↑ Tourism Watch: Medical tourism in India
  31. ↑ J. Juszczak, L. Boscher: Structure of the business area International patients in the clinic. Seminar documents. Sankt Augustin 2012.
  32. ↑ T. Jelinek: Medical tourists spread multi-resistant germs. In: Doctors newspaper. No. 193, October 25, 2010, p. 14.
  33. ↑ A. Neubacher: Oriental customs. In: Der Spiegel. No. 44, October 26, 2009, pp. 84-87.
  34. ^ J. Juszczak: Medical tourism: The necessary professionalization of a niche. In: Peter Strahlendorf (Ed.): Yearbook Healthcare Marketing 2010. Hamburg 2010, pp. 76–80.
  35. ^ WDR: Medical tourists turn their backs on Bonn Bad Godesberg. February 18, 2019, accessed March 13, 2019 .
  36. ^ J. Juszczak: Medical Tourism - A Global Business. In: Medical Wellness. No. 1, 2008, p. 25.
  37. ↑ Investigations against transplant doctor. In: aerztezeitung.de . July 11, 2012, accessed December 7, 2019 .
  38. ↑ ARD magazine fact of August 14, 2012 and ARD magazine Monitor of August 23, 2007.