Huge opportunity for health tourism

30 March 2015

Healthcare authorities have to overcome a lack of trust in the quality of local care and build confidence among patients in the region to unlock the sector’s potential

When one-year-old Mohsen arrived at Dubai Healthcare City (DHCC) in September 2013, he was unable to walk or experience the sense of touch.

At a private hospital back home in Saudi Arabia, he had been undergoing physical therapy three times a week, as well as occupational therapy and a series of diagnostic tests, but his development continued to be delayed. After hearing about the approaches taken to treat such conditions at the Dr Majdi el-Halik Paediatric Physical & Mental Rehabilitation Centre, his parents decided to travel to the UAE for treatment.

Seeing results

Mohsen was diagnosed with developmental delay and an underlying chromosomal medical condition, as well as sensory issues. He was enrolled in an intensive rehabilitation programme, which included physical therapy and hyperbaric oxygen therapy to help his blood carry more oxygen to the organs and tissues in his body. During a year of rehabilitation, the toddler has been able to walk, climb stairs and develop his sensory, motor and mobility skills.

Mohsen is one of 1.2 million patients treated at DHCC during 2014. “Patient numbers have been increasing by 20 per cent on a year-on-year basis; about 15 per cent are medical tourists,” says Fatma al-Sharaf, strategy and partner development manager at DHCC, who also leads its medical tourism strategy. “People are coming to DHCC for infertility, cosmetic treatment, dental, cardiac and orthopaedic treatment.”

Established in 2002, DHCC is a key part of the Dubai Health Authority’s plans for the emirate to treat 500,000 medical tourists by 2020. Key to its ambition is the ability to attract GCC travellers and those from the wider Middle East who would previously have gone outside the region.

Medical tourism

Such health travel is a global market estimated by US-based Patients Beyond Borders (which compiles an annual publication of industry and patient information) to be worth $55bn a year, with 11 million people travelling for treatment annually.

Travellers from mature healthcare markets are flying across the world to benefit from cost savings of anywhere between 30 and 90 per cent. In markets with inadequate healthcare investment, patients are flying in to international centres of excellence, where world-leading experts can treat them.

“People travel for better quality and affordability; they might be looking for access to services that are not available at home, and often to avoid long queues,” says Renee-Marie Stephano, president of the US-based Medical Tourism Association.

In numbers

11 million
Number of people travelling for medical treatment annually

Number of medical tourists Dubai plans to treat by 2020

Sources: Patients Without Borders; Dubai Health Authority

The Middle East has a tradition of sending patients to the US and Europe, but several factors have seen a recent shift in travel patterns.

Healthcare reform

“In the past five years, there has been a decrease in Middle Eastern and GCC patients coming to the US, and a lot of that has to do with healthcare reform in the referring nations, which are looking at ways to cut costs and are very focused on the patient experience,” says Stephano, pointing to a growth in local facilities achieving international accreditation, and increased promotion of health travel within the region. At the same time, markets such as Thailand, Jordan and Turkey are absorbing Middle Eastern medical travellers who previously visited Western markets.

In 2014, Jordan’s Private Hospitals Association (PHA) reported 250,000 medical tourists creating income of $1.4bn. “But that is a conservative estimate as it only accounts for inpatients; the number treated is double this,” says Abdallah Hindawi, CEO of PHA.

The country is seeking to attract more travellers by promoting its highly qualified bilingual professionals and its internationally accredited hospitals. It has 10 recognised by the Joint Commission International (JCI), widely recognised as the world’s leading accreditation organisation. At the same time, Jordan also points to its rich cultural heritage and the wellness benefits of the Dead Sea, located to the west of the country.

Price competition

But perhaps one of Jordan’s biggest selling points on the health tourism front is that it is highly competitive on price, with surgical costs similar to those in South Asia. According to PHA, a hip replacement surgery would cost $11,000 in Jordan. Data from Patients Beyond Borders shows this compares favourably with the rest of the world, with the same operation costing $33,000 in the US, $21,400 in Singapore, $16,500 in Thailand and $8,000 in India.

Turkey too is highly competitive on pricing and, like Jordan, has been investing heavily in its healthcare infrastructure. According to the Turkish Healthcare Travel Council, hip replacement surgery in one of its 46 JCI-accredited hospitals would cost $10,750. Stephano says Turkey is a good example of cross-governmental collaboration to promote its medical tourism sector. “The health, tourism and economy ministries [in Turkey] are all involved in creating a strategic plan for health tourism,” she says.

“Basically, they have a long-term strategy and are very focused on service development, training and education of the professionals that work within the facilities and healthcare and hospitality. I think that is something that is going to raise competition in the Middle East because they can provide the care affordably.”

New infrastructure

Meanwhile, GCC markets such as Qatar and the UAE have been focusing on building new healthcare infrastructure, often supported by international partnerships. DHCC, for example, is about to embark on a second phase. The extension has a development area four times greater than the original site, which currently hosts 120 healthcare facilities.

“Phase two of Dubai Healthcare City will help us shift our focus from medical tourists only to medical and wellness tourists,” says Al-Sharaf. Adding more hospitality and rehabilitation facilities is part of DHCC’s plan to increase medical tourism both in volume and as a proportion of total visitors.

Also seeing growth is Dubai’s first medical tourism facilitator, Salamatak Healthcare Management. “The number of travellers is increasing every year; I believe the quality and the destination itself are proving themselves,” says Ibrahim Abu-Gharbieh, managing director of the company. Based in DHCC, the firm began operations in May 2014.

“Last year, we started bringing in patients interested in coming to Dubai for cosmetic surgeries, reconstructive surgeries, sports medicine, eyes, teeth and orthopaedic surgery,” says Abu-Gharbieh.

Between 70 and 80 per cent of patient treatments will fall under packages offered by Salamatak Healthcare. These bundles include medical costs, accommodation, transfers and translation if required. So far, most visitors are from the GCC and Arabic-speaking countries, but this group has recently expanded to include clients from Russia and Africa.

“What we are doing now is concentrating on bringing in a segment that would like to come to the UAE healthcare system, and in the near future we will start directing the enquiries that come from patients who can’t find what they want in Dubai to countries where it exists, such as India, Thailand, Jordan and Turkey, for example,” he says.

Super-specialised care

The most popular treatments in the UAE are weight-loss surgeries, in vitro fertilisation and cosmetic treatments, which tallies with demand for services in other Middle Eastern markets. “Regionally, we see a lot of people travelling for cosmetic, weight loss, orthopaedic and dental [services],” says Stephano. “We are not seeing a lot of patients staying in the region for super-specialised care. They still want to travel out for higher levels such as oncology and cardiovascular [care].”

One of the strategies being used to try and retain more local patients for higher level services is partnerships with international organisations. Kuwait’s Cancer Control Centre, for example, partnered with Canada’s University Health Network in September 2010 to strengthen cancer service delivery.

“Kuwait is focused on delivering a centre of excellence within that facility and then they train the staff to deliver the service on that model,” says Stephano. “After that they provide regular advisory services over time to ensure it is going to deliver continuously on that model. It is not an easy project.”

Creating centres of excellence is an emerging trend, one Stephano says will make the Middle East more competitive, especially if its models are based on international standards delivered by top physicians focusing on patient experience. Abu Dhabi’s
partnership with the US’ Cleveland Clinic is a good example, with the facility offering a US model and quality of care to local patients in order to reduce the need to travel overseas.

Bahrain too has ambitious plans to attract medical tourists with the $1.6bn Dilmunia Health Island project, which is currently under construction on the country’s northeastern coast.

Wooing patients

Building new facilities is vital, but the region must go much further if it is to retain Middle Eastern health travellers in the future. Promoters of schemes have to overcome a lack of trust in the quality of local care and build confidence among patients in the region.

At the same time, they must invest in long-term training and education programmes, and luring leading healthcare professionals. “To attract those doctors, you have to pay them considerably to get them to come and spend their time in the facility or for them to relocate. That cost, combined with the cost of the equipment, sometimes outweighs the benefits of staying local,” says Stephano.

In today’s competitive market, there are many challenges for both established and emerging medical tourism destinations in the Middle East, but at the same time there is huge opportunity.

Those that can strike the balance between delivering high-quality treatment at internationally accredited service levels and competitive prices while ensuring patient-focused hospitality will be most likely to succeed.

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