Medical tourism is the practice of patients travelling to another country for diagnostic, non-surgical or complex medical treatments. Medical tourism involves two key economic sectors: Health — hospitals, and pharmaceutical, ambulatory and nursing care and tourism — air and local transport, hotel accommodations, food, shopping and sightseeing.
Medical tourism is a multi-billion dollar international industry. The market was valued at US$ 77 billion in 2010, and forecast to be US$ 114 billion by 2013 (RNCOS, 2010). Medical tourism has economic impacts on developing countries.
Nearly 750,000 Americans travelled abroad in 2007 and projection claim nearly 6 million will have travelled to developing countries by 2010 for medical procedures (Bookman and Bookman, 2007). Medical tourism is “driven by a number of forces outside typical medical referral systems.
These medical tourists seek modern healthcare at affordable prices in countries at variable levels of development. Medical tourism is different from the traditional form of international medical care where patients typically journey from less-developed nations to major centres in highly developed countries for advanced medical treatment (Horowitz and Rosensweig, p. 24, 2007).”
According to Deloitte (2008), medical tourism can be broken down to include inbound, outbound and intrabound options. For example, Australian outbound medical tourists travel to another country, such as Thailand and Singapore, for medical treatment; whereas, inbound medical tourists travel from another country, such as New Zealand or Fiji, to Australia for medical treatment.
Domestic medical tourism is also known as intrabound or intranational travel (Wilks and Grenfell, 2006; Hudson and Li, 2012); first proposed as an integrated domestic medical tourism model based on a United States study. Domestic medical tourism is increasing in the United States due to high health costs and insurance premiums.
Many insurance companies and employers provide incentives for their customers and employees to consider travelling within the country for cost-effective and quality healthcare rather than go overseas for medical treatment (Deloitte, 2008; Business Insurance, 2009; Hudson and Li, 2012).
…Australian outbound medical tourists travel to another country, such as Thailand and Singapore, for medical treatment.
For example, Lowe’s Company, with stores in the United States, Canada, Mexico and Australia, has negotiated lower insurance premiums with leading medical hospitals, such as the Cleveland Clinic, and are sending their employees interstate for domestic medical tourism for complicated elective surgeries, such as joint replacements and cardiac procedures because of lower prices and high-quality healthcare (MTM, 2013; Glatter, 2012).
Domestic Medical Tourism in Australia
Domestic medical tourism has been in Australia for at least the past century, when patients travelled from very remote and regional areas to capital cities across the continent. Domestic tourists are interested in medical treatment or complex surgeries, such as diagnostic tests, orthopaedic and cardiac care, radiotherapy, spinal surgery, reproductive or cancer treatment, neurosurgery, among others, to improve their health and quality of life.
Inequities to access and shortages of medical facilities, specialized doctors and surgeons in remote and regional parts of Australia have spurred low- and middle income patients to travel to capital cities for care.
Australia is a big country. More than 69 percent of the population live in a major capital city along the eastern and the southern coast rather than in remote and regional areas, where the population density is lowest.
According to Australian Bureau of Statistics (2010) census data, nearly 15.1 million people lived in capital cities, 4.3 million in inner regional areas, 2.1 million in outer regional areas, 324,000 in remote areas and only 174,000 in extreme outlying places where the indigenous population is largest. In these capital cities, patients have access to the best infrastructure and medical facilities in a timely manner.
Domestic medical tourism has been in Australia for at least the past century, when patients travelled from very remote and regional areas to capital cities across the continent.
The inner, outer regional areas and the remote and more remote areas of Australia do not have the same advantages including access to the latest medical facilities and technology, specialized diagnostic centers, surgeons and hospitals. This has led to inequalities in access to state-of-the-art healthcare facilities, advanced medical technology, and doctors and specialists; thereby, leading to longer waiting periods for surgery and poor health conditions.
Thus, many Australian patients from regional and remote areas must travel to another region, capital city or state within the country, where medical treatment/surgery is available in a timely manner. This is an example of domestic medical tourism. These excursions improve the overall physical health and well being of a patient and may be planned in combination with a short vacation.
For example, Australians from the mining towns of Blackwater or Mount Isa or the regional city of Rockhampton — the Beef capital of Australia — often travel to Brisbane, the capital of Queensland, for cancer treatment, radiotherapy, neurosurgery, orthopaedic care, heart and specialized procedures, eye surgery and in vitro fertilization.
Key Drivers for Domestic Medical Tourism in Australia
Many Australian nationals from the remote and regional areas travel to another city within the state or to state capitals, such as Darwin, Brisbane, Sydney, Melbourne, Adelaide, Perth and Hobart, for a specialist surgeon, second opinion, diagnostic tests, and elective or complex medical surgery, either alone or with a companion.
There is no easily obtainable data to indicate how many Australians are actually travelling from remote and regional areas, or interstate and intrastate, to major state capital cities for medical treatment. The key driving factors for domestic medical tourism in Australia are:
- lack of medical facilities, diagnostic centers and specialty surgeons
- treatment and surgery is unavailable in the very remote and regional areas
- long waiting periods in public hospitals
- advanced medical facilities and the quality of medical care within cities
- shorter distances compared to travel overseas, such as Thailand or India
- removed language, food and cultural barriers
- lack of family or friend support within the city
- no medical visa requirements
- hospitals are covered for insurance in terms of surgical errors or malpractice
- treatments are not available because of state regulations and other legal and ethical issues.
This inequality in access to healthcare between the remote/ regional areas and capital cities imposes stress and burdens on patients and adds costs for travel to access the best medical facilities, surgeons and treatments.
An empirical qualitative study (Hegney, 2005) concluded that cancer patients from remote and regional Queensland had to travel to Brisbane — the capital of Queensland — for radiotherapy.
Travelling interstate for radiotherapy imposed additional restrictions related to accommodations, physical and emotional support, existing health concerns and burdens placed on patient families and friends who also make the trip.
There are many patients living in remote and regional districts in Australia from low socio-economic backgrounds who are not insured and cannot travel overseas for medical treatment. Instead, they either have to wait in the queue or travel intrastate or interstate for medical treatment.
By these means, they incur additional travel, accommodation, food and other incidental costs for both themselves and those accompanying them.
For domestic medical tourism to be most efficient and cost-effective while providing the highest quality care, the government needs to enter into agreements with leading hospitals that offer complex surgeries and are willing to partner with hotels that provide accommodations and local transport facilities (Medhekar, 2012) for patients from remote and regional Australia.
The major private hospitals are not promoting intrabound/domestic medical tourism enough as an option for Australian patients from these sites. A priority should be given to publicizing cost-effectiveness, accreditation, world-class quality, limited waiting periods and the availability of highly specialized treatments at home to patients who may otherwise travel abroad for medical care.
Neighbouring countries in Asia including Thailand, Singapore and India are providing lower costs, little or no waiting periods, world-class quality healthcare, JCI-accredited medical facilities and expertise, state-of-the-art medical technology, attractive nurse-to-patient ratios and a chance to take a mini vacation at an attractive destination (Medhekar, 2012).
Australian health insurance companies and specialty hospitals can offer many of these same features and competitive options to intrabound domestic medical patients. When packaged together, additional revenue will be generated for private Australian hospitals and, at the same time, create more jobs in both medical tourism and in the hospitality sector.
International or outbound medical travel may not be for everyone, especially for senior citizens and middle- and low income groups. Reasons include travel distance, financial issues, safety and security, limited food and cultural affinity, ethical situations and serious health conditions.
If competitive alternative choices are available, private Australian hospitals can attract those domestic patients who otherwise choose to travel abroad for medical treatment and surgery.
It is of utmost importance for patients in remote and regional locations to have easy access to modern medical facilities and technology, and specialized surgeons to close the gaps in secondary and tertiary medical treatment for patients of all incomes.
Therefore, it is essential for the Australian government to build highly specialized hospitals and increase their capacity to provide beds, facilities and infrastructure, and specialized surgeons and nurses that can offer fast, cost-effective, quality healthcare to intrabound domestic medical tourists in capital and regional cities. When achieved, Australia can develop a niche market for specialized surgeries and attract medical tourists from foreign countries.
About the Author
Anita Medhekar is a senior lecturer in economics at Central Queensland University, Rockhampton, Australia. She has been teaching and researching in macroand micro-economics, public finance, public policy, privatization and deregulation, Asia- Pacific economics, economics of e-commerce, development economics, international trade, health and tourism economics, spiritual tourism, and medical tourism. She has several publications in these fields.