The second in a series of articles on the US medical tourism market.
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Just as we have no idea how many Americans go overseas for medical, dental or cosmetic treatment we have no figures on where they go. There are hundreds of articles and speeches about where they go, but most of this is recycled information, often from those who have a vested interest in suggesting their country is the ideal destination for Americans. Some places and countries have a dubious reputation for accuracy on how many Americans they attract.
This article is written by Ian Youngman, a specialist researcher and publisher of detailed research reports on insurance and medical tourism.
There may be as many as 100 countries seeing $ signs as they target the US medical tourist. Nearly every country claims to offer the lowest price for treatment, the best doctors and nurses, and the latest equipment and technology. If 100 countries are claiming the lowest world price for a dental implant, only one can be telling the truth. There is also price variation due to currency exchange, airfares, agent fees, hotel, travel and food costs. But this means that Joe American can get very confused. The truth is that people tend to go where they feel more comfortable. Medical tourism destinations focus on price, but when you plan a holiday you rarely see tourism boards promoting their beaches and hotels, as “we are the cheapest in the world”. This concentration on price can confuse the American medical traveller. They have little truly comparative data on price in various countries, and are often guided by examples on websites. In the US, medical tourists can now access websites that enable them to compare prices and facilities at a range of hospitals in the US, and although some specialist websites have or plan to extend to other countries, initially Canada and Mexico, their services do not extend further afield. Low price, JCI hospitals, speaking English, easy air travel; scores of countries can now tick all boxes.
How do they choose a destination?
What little research has been carried out on how Americans choose the country they go to for treatment, suggests it is a very ad hoc process. They get ideas from the press, friends, or from websites. Few consumers do extensive research of lots of websites; they pick several providers and go with the one they fancy. But on what selection criteria? This ad hoc selection process means that there could be as many as 100 countries where Americans actually go for treatment. Adding a complication into the mix is that America is a hotchpotch of nationalities and culture, so some decide to go to where they or their ancestors were born.
What is left is anecdotal evidence from hospitals, tourist boards, doctors, travel agents and medical tourism agencies. Fewer Americans are taking long-haul flights to Asia or Europe, and a growing environmental awareness is turning people away from long flights. Only a tiny number are going overseas when their employer or insurer pays for the surgery. This leaves more local trips. A few go North to Canada where private treatment is getting easier to find, or East to Cuba where it is still illegal for most Americans to go for medical treatment, or to the Caribbean where medical facilities are scarce. The vast majority head for Central and South America, but numbers of medical tourists are very vague.
Mexico as a medical tourism destination
The proximity and vast number of hospitals and clinics targeting Americans means that Mexico is the favourite country. How and for how long, recent events will affect numbers going there is a total unknown. Panama is popular, as are Costa Rica and Puerto Rico. If you add very rough medical tourism figures for these four countries, the total is below 100,000. Not every medical tourist is an American or a national living in the US returning home for treatment. The problem with all figures is that few hospitals differentiate between medical tourists and all other international patients. One country recently estimated that it would get 100,000 American visitors over the next five years, but some in the medical tourism sector convrted that to 100,000 a year. No country on the American continent has real medical tourism statistics. Figures are estimated by politicians or tourist bodies, agencies, or someone speaking at a conference. Hospitals and agencies may claim they attract many Americans, but almost nobody is prepared to give real figures.
Perception affects choice
World events have an impact on where Americans go. Some may be well informed on the reality of life in overseas countries, but others rely on their prejudices and television news stories. So, some equate particular countries with events; India and terrorism, Thailand and political violence, Mexico and flu. There is a huge number of Americans who have never had a passport. Add into this mix, Asian countries being promoted on the basis of ‘save up to 90%’. America is a consumer society and promoting very low prices may actually scare off American consumers who equate huge price savings with poor quality.
The proximity and vast number of hospitals and clinics targeting Americans means that Mexico is the favourite country. Panama is popular, as are Costa Rica, and Puerto Rico. Americans also go to Argentina, Brazil, Chile and Colombia for cosmetic surgery and dentistry. Venezuala, El Salvador, Honduras, The Dominican Republic, Ecuador, Guatemala, Peru and Uruguay all see small numbers of American medical tourists.
Newly released research from UCLA says that in 2001, almost a million Americans went to Mexico for treatment, half of them being Mexicans going home. Since 2001, a cross-border medical tourism business has been established and more Mexicans settled in the US. So the annual figures now would exceed a million. If correct, the research suggests that the vast majority leaving the US for medical treatment go to Mexico; a substantial minority goes elsewhere in America, leaving Asia and Europe with the crumbs.
There are no accurate figures from the US on where Americans go. There are no accurate figures from destination countries either. Finding which countries are most popular, as against who makes the most noise or whose politicians make the wildest claims, all links back to the wider problem that we do not know how many Americans go overseas for treatment.
Ian Youngman is a writer and researcher specialising in insurance and health. He writes regularly for a variety of magazines, newsletters, and on-line services. He also publishes a range of insurance reports and undertakes research for companies. An ACII, with an honours degree in Economics from the University of Liverpool, Ian was a co-founder of The General Insurance Market Research Association. He also has widespread experience within the insurance industry at management level, working for brokers, a bank and an insurance company.
