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Home > Blog > 2012 > Medical tourism....it’s not about price!


Medical tourism....it’s not about price!

Happy patient with doctors

One of my favourite quotes about price and value comes from John Ruskin, an English writer and thinker. It’s a philosophy that many who market medical tourism services would do well to heed.

“It's unwise to pay too much, but it's worse to pay too little. When you pay too much, you lose a little money - that's all. When you pay too little, you sometimes lose everything, because the thing you bought was incapable of doing the thing it was bought to do. The common law of business balance prohibits paying a little and getting a lot - it can't be done. If you deal with the lowest bidder, it is well to add something for the risk you run, and if you do that you will have enough to pay for something better.”

Ruskin’s quote sums up the problem faced by the prospective medical tourist when researching the options for treatment in another country. It seems to be all about price. “Come to our clinic, our hospital, our country... and we can save you thousands of dollars, pounds, euros on what it would cost for surgery in your own country.”

The clinic/hospital/destination supplements its claims of lowest cost with the usual highest quality/latest technology /best standards claims. And that’s where the disconnect occurs. Cheap implies low quality/high risk purchase.

As Ruskin says, “....if you deal with the lowest bidder, it is well to add something for the risk you run”..... which is why it is never a sensible choice to be the lowest cost offering in the medical tourism market. This is the thorny problem faced by destinations such as India where price is without doubt a major competitive advantage, but the price differential is so significant that patients will ask themselves: ”Why is it so cheap?”, “How can it be so cheap?”, “If it is that cheap, there must be something wrong with it?” “Am I putting myself at risk, if I choose the cheapest provider?”

Comparing medical tourism prices

The other difficulty that the prospective medical tourist faces is making realistic comparisons of price between their own country and the destinations that they are considering. This problem arises on two sides of the comparison.

Firstly, the patient needs to know what they might pay for the surgery or treatment in their own country. Let’s take a patient needing a hip replacement...how easy is it for him or her to find out what the price options are in their own country?

  • If the patient lives in the UK, he or she might expect to pay around $14,000, but this could vary from $11,000 to $20,000 depending on where the hospital is. Pricing information is not easy to find, even online. (Private hospital price comparisons can be found on sites such as Private Healthcare UK)
  • If the patient lives in the USA, what will they be charged for a hip replacement? Various online sources quote a price of around $50,000. But the reality is this could vary significantly or more depending on where the patient lives and how price competitive a local (or distant) hospital is.

So what are the options for these patients? Which destinations are attractive in terms of price? Let’s take India as an example. Typical online prices quoted for India range from $6,000 to $8,000. So let’s say....a hip replacement costs $50,000 in the USA, $14,000 in the UK and $7,000 in India. But does it? What gets omitted from most online price comparisons is the cost of travel and accommodation for the patient (and in many cases for a companion or relative.... most medical tourists don’t go it alone).

Take a USA patient travelling from Chicago to India. ....$7,000 for the operation, then factor in return economy flights for two people. Let’s say $4,000 (for a 20 plus hour flight with one stop). The price now rises to $11,000. Add in $1,500 for accommodation and costs during the stay. Add in another $250 for the insurances you need to cover the risk (travel and complications insurance).  The price is now up to $12,750.... still a big saving on the possible price that you might pay in the USA (but looking much less attractive to the UK patient, albeit with a reduced flight costs).

If patients can’t compare price, can they compare quality?

In the recent Treatment Abroad Medical Tourism Survey, we looked at the factors that guided patients when selecting a clinic or hospital. Here are the top three factors as rated by 560 UK patients who went abroad for treatment.

Medical tourism survey

Price comes below two “judgements” of quality. Of course, the difficulty here is how these patients have made a judgement about the comparative level of quality of different doctors/dentists and hospitals/clinics. Although patients rate “quality” as the most important factor in selecting a healthcare provider, the reality is that they can only make a comparison in terms of perception of quality not actual quality....because:

a.    

The data and information to compare healthcare quality between different medical tourism providers just isn’t available.

b.   

 And... if it were... would they understand it anyway?

And that’s a much bigger discussion for a later article!


Date published: 4 May 2012

Comments

Comments provided below do not represent the views of IMTJ. Comments will be published 'as is' and will not be edited by IMTJ staff. IMTJ is hosting these comments, and is not undertaking an editorial role. However, it is editorial policy to publish comments that have been submitted anonymously. 

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About me

Keith Pollard

Keith Pollard

I am Managing Director of Intuition Communication Ltd, a web publishing business in the healthcare sector. Our sites include International Medical Travel Journal, Treatment Abroad, the medical tourism portal, DoctorInternet, the Arabic medical tourism portal and Private Healthcare UK, the UK's leading site for private healthcare services. I am a regular speaker and commentator on medical tourism and the independent healthcare sector.

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Came to this article by virtue of your end of year summary of best posts. How patients *understand* quality is the key question, as you say, and I hope that will be one of your articles in early 2013. Would love to hear you expound your thoughts on a blogtalk radio show, if you are interested - David Boucher of Companion Global Healthcare recently talked about this very topic http://www.healthtraveltechnologies.com/nuehealth/blogtalk-companion-global-healthcare/ which you might be interested in.

In my experience even the patients focused on price do not perceive themselves as focused on price first - naturally, quality is the number one concern of any patient, regardless of means. Lacking any other information, the *American* patient tends to assume a correlation exists between price and quality, although this has been firmly and repeatedly debunked, it is a sticky notion that still has traction. Relationships with insurers is another way that the American patient presumes a certain quality standard is being met - another interesting curve call in the discussion of pricing transparency and discounting.

Sandra Miller (02/01/2013 19:43:53)

Like in the “distant past”, Medical Tourism (particularly the "abroad version) will not be primarily for reasons of cost.
Keith Pollard makes this point in his article.
One of my documented predictions has been that the “abroad” version of Medical Tourism will become more “want to” (preference and choice) and less “have to” (cost).
Of course, some "out of time" and "die hards" will continue to tout the "70 - 90% cheaper" mantra.

Constantine Constantinides (31/05/2012 01:26:25)

I strongly agree with the article, but feel you are leaving out two important factors that medical tourists usually consider:
1. Communication: Will I be able to communicate with my physician?
2. How comfortable (culturally familiar) will I feel in that environment?
While English-speakers (US & UK) might not consider the first in seeking care in India, I have written a number of articles that address the problem of "Different Englishes" in patient/physician communication.
In the US Quality care has been defined, in part be care that is culturally and linguistically accessable to the patient.

Suzanne Salimbene, PhD. (14/05/2012 19:55:42)

I had a 75 minute conference call with a U.S. Employer yesterday: 15,000 lives, 28 countries, 800 lives in the USA pre-retirement. On the phone were the Medical Director, CFO and Benefits Manager. The question I posed was "Why medical tourism, why now? What's changed?"

The answer: "Too much variance in quality, employees at work sites in locations that are medically under-served, and we want more value for the price we are willing to pay."

The company is fully self-insured, no reinsurance for excess losses, an epidemiologist and full time medical director, and offering 3 PPOs and pharmacy plan and 7 HMOs across the USA.

I believe their sentiment was in line with this article and what we continue to see in the group health market nationwide and globally. It's not about the price.

Maria Todd MHA PhD (05/05/2012 00:54:45)