Healthcare Reform - Legal & Policy

Medical Tourism and Cross-Border Health Care: The Dutch Connection

Healthcare Reform - Legal & Policy

NHTV Breda University of Applied Sciences is a modern institution where different applied areas of expertise are taught and where different applied centres of research exist, situated in Breda, The Netherlands.  

These different areas go from International Tourism Management Studies and Hotel and Facility Management to a Media and Entertainment Master, even a Game Academy does exist.  Within the International Tourism Department a focus on cross-cultural management is prevalent.  How can you manage international tourism destinations if you aren’t sensitive for the cultural specificity of every context.

This experience in the cross-cultural led to the inauguration of the Centre for Cross-Cultural Understanding (CCCU) which bridges the academic context with its applied fields.  The centre wants to design instruments which capture these cultural contexts.  How can managers and customers cope with the cross-cultural reality present in an everyday globalising world.  

It is possible to make them aware of these contexts, and to enable them to make conscious and well-taught decisions to arrive at the most functional outcome.  In this venture the local perspective versus the global perspective form a dialectical dynamic which is sometimes counterintuitive.  

The centre wants to settle itself in the different academic arenas such as cultural studies, anthropology, sociology and management studies.  Academic publications, Completed PhD’s and PhD’s in progress, organized conferences and Masterclasses are showing this urge to excel.

As one of the expertise-based fields of attention within the CCCU the research line Medical Tourism and international Health was installed (Tomas Mainil, MA, MsC, PhD in progress) which combines concepts and tools designated to overcome barriers between cross-cultural studies, Medical Sociology, Health Management and Tourism studies.  

The sector of medical tourism contains the idea that different service clusters need to be involved in the construction of a professional and high-end business sector.  It is not only the provision of medical healthcare, but also how to cope with cross-cultures as a patient or medical manager or MD. It is a complex cluster of different services which need to connected to each-other if the patient wants and deserves a quality standard.  F

urthermore it is to understand that medical tourism should also be acquainted with concepts of sustainability as developing countries should benefit from this field of economic boost. Therefore the research line wants to examine ethical and sustainable solutions, which would be beneficial to sustain and to control inputs towards governmental bodies.  Inherent to this approach is the  local perspective, the study of local populations and their relation with globalizing health issues.

Medical tourism, as attracting foreigners to a destination country to receive specialized medical care and adjacent services, already exists in Europe in the form of cross-border health care, where countries such as Belgium, Germany and Italy are receiving patients out of neighbouring countries.  To receive patients out of more distant countries is not yet a large market in Europe.  One sees a shift in the fact that European citizens are also going to.

Hungary (dental care) or Turkey (eye care) to receive minor health care services (read not invasive), but more complex services still need to be further developed.  Germany is leading in this perspective, but also the Belgian Government ordered a study to research the gravity of receiving foreign patients for elective procedures whereas Maastricht University hospital in The Netherlands is aiming at becoming a centre of excellence in cardiac surgery.  

Other examples clearly exist in the rest of Europe, where European and foreign health consumers are becoming, together with their home country MD’s, a joint decision maker of their own health.

NHTV Breda University of Applied Sciences will function as a full partner in the pan-european MBA network for medical tourism and cross-border health management.  NHTV will focus on its own capacities and expertise:  combinations of cross-cultural management, international tourism destination management and sustainability analysis with ethical reflections.  A Dutch approach which doesn’t just want to include only marketing and figures.

In the Netherlands NHTV has identified possible partners to take care of the international health care dimension. Beside others, the European dimensions of public health as well as opportunities and challenges of EU policies (e.g. the four freedoms of the single market, the EU health strategy etc.) and their consequences for patient mobility, patient rights and medical tourism as well as cross-border health services have to be taken into account.

The Department of International Health of Maastricht University with prof. dr. Helmut Brand will guard that public and private international health and adjacent services within the Dutch MBA program will fit in a sustainable European framework, where stakeholders at the European level, EU Member States and their citizens are central partners. In January 2010 NHTV organizes a Four-day Cross-DisciplinaryMasterclass in International Health Services.

It is a first initiative towards a Dutch MBA Program, as part of the European MBA network.  It will cover 4 main expertises and fields which are combined into a coherent toolbox for health managers and professionals who need to deal with the sector of international health care provision.

International Health Management, International Tourism Destination Management, Cross-cultural Management and International Tourism Issues are lectured by international experts and university professors.  Expertise development and network building are recognized as a tool for professionalizing the sector.

As an international hospital with a focus on international patients and their mobility patterns, you need to adopt quality management perspectives if you want to develop your skills, personnel and facilities.  Managing an international patient department requires dealing with different issues.  Hamburg Eppendorf University Hospital and its international counterparts can be seen as good practices.

Just think of the following examples: The need for an international strategic approach and organisational structure of the department – Interpreters, attendants, patient services,  in- or outsourcing? –  Accounting for international patients, commission or not? The process of medical treatment of foreign patients: International Clinical Pathways?! International Health Management takes another road than just copying main management routine.  

With regards to Cross-cultural issues and medical tourism, the process-based delivery of services, which is typical of the health care sector, calls for a cross-cultural approach. Various stakeholders from various networks are involved in these health care services. It involves global and local health care, different professional groups such as medical specialists, but also hotel owners, tour operators, local residents, and – of course – international patients.

International patients find themselves entering a world, a context which is not their own. This may result in cross-cultural conflicts with other stakeholders, sometimes even in malpractice situations.   International Tourism issues could instigate a learning process for health management professionals The sector and reality of tourism is a global phenomenon which may be considered as complex and full of possible conflicts and frictions.

This international field of knowledge may contribute to the development of an awareness of the medical profession based on a counter-discourse perspective. In this process, the notion of health services must be put into this perspective. Sustainable solutions, which have already been implemented in tourism, could make the medical sector depart from its utilitarian use of means and resources.

Managing destinations is all about the geopolitical spaces, which are designated as tourism destinations at varying scales, from entire nations to small local communities or purpose-built resorts. Common to all destinations is the creation of a destination management organisation or DMO. The functions of a DMO are likely to include; destination image making, the coordination of private, public and voluntary stakeholder activities, and the building of community capacity for tourism.

The entry of a tourism destination into the international health market significantly adds to an already complex set of business relationships. Last but not least one should consider the ethical issues, surrounding medical tourism and cross-border health care: They raise numerous ethical problems and questions related to the basic premises commonly accepted in the evaluation of health care such as the special status of health care as a service.

The fundamental principles involved are justice, safety (not harmful), autonomy (informed consent) and efficiency in the creation of well-being. More specific issues are about professional and patient responsibility, insurance portability and fee splitting.

What the future of medical tourism will tend to be, is still uncertain.  However many indications are pointing at a sector which is maturing slowly.  The need for professionalization and expertise building is there without a doubt. This means that the academic and educational sector should support and guard this maturity movement.  Medical tourism as a multi-cluster of services, actors and patients should take its role as an economic sustainable driving force, a need for gatekeepers is a proven necessity.

Tomas Mainil is currently working at the Centre for Cross-Cultural Understanding@NHTV as coordinator of the Masterclass IHS (, is responsible for the research line Medical tourism and International Health within the Centre.  He has a MA in Sociology and a MsC in applied statistics. He is in the progress of a PhD in Medical Sociology on Medical Tourism, cross-bordering Cultural studies, Medical Sociology, Health Management studies and Tourism studies. He is co-founder of the MBA network initiative.

Dr. Vincent Platenkamp is responsible for and leads the Centre for Cross-Cultural Understanding@NHTV.  He has an MA in Sociology and Philosophy, and a PhD in Sociology.  He has a long term working experience in the international cross-cultural Tourism Field and the Centre has several international partner universities and knowledge institutions.

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