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Medical Tourism~ Profit from Global Healthcare


The health care industry faces huge challenges and changes. Medical Tourism is just one of those changes happening in this field. People have traveled with the purpose of undergoing medical treatment since ancient times. However, it has only been since the 1980’s that traveling for medical reasons has been recognized as a developing global healthcare market.

The increase in technological developments, medical research and augmented product consciousness are among the most influential trends that affect the medical tourism industry. National health care systems, health insurance companies and hospitals urgently need to understand medical travel and its effect on national health care plans, insurance reimbursement schemes and legal positions in case of malpractice or otherwise.

The current situation is dominated by the fact that there is a global deficit of information about medical tourism which hinders the industry’s real potential for all target groups involved: hospitals, potential patients and medical travel facilitators. This lack of information and communication is due to countries wishing to maintain a competitive advantage, or as a result of limited information having been collected or recorded.

Medical tourism still raises questions on ethical and legal issues causing concern for the industry. Nevertheless, measures are being taken to minimize these factors with new laws, such as the proposed EU Directive for Cross-Border Health Care , and third parties being established. Even though a large number of accreditation bodies exist, a uniform international hospital accreditation system is lacking, which makes it difficult to judge the quality of medical services provided.

Our goal is to analyze where certain treatments are performed, which clinics are experts, to provide price benchmarks and best practices in general. The desire to provide our target group with a structured overview of medical tourism as it stands today resulted in the study “Medical Tourism: Profit from the Global Health Care.”


National statistics give numbers referring to medical tourists, however those are not concise.  The lack of a reliable source giving a concise overview of the industry was the main concern to start this project. It is unclear so far who is registered as a medical tourist. The mentioned research defines a medical tourist as follows:

  • A Medical tourist  is: a person traveling abroad, outside of one’s natural health care jurisdiction, with the intent of undergoing a medical procedure, whether it be necessary or elective.

The chosen medical treatments represent those most often sought abroad based on our own preliminary research. The division between necessary and elective procedures is shown below.

Source: Medical Tourism Survey – Project Group 17, Maastricht Hotel Management School
The entire report gives answers on Medical Tourism from all main target groups’ view points, i.e. providers and consumers; evaluates the demand and supply as well as facilitating companies.

Consumer Behavior

The health care market is becoming increasingly consumer-focused with people making health-related decisions based on their judgement rather than relying on the advice of others. On top of our extensive field research, many surveys have been studied and are listed in our report which highlights consumer behavior.

Consumer behavior can be summarized in four main categories.  Why patients travel abroad for medical care is listed in sequence of importance below:

1.    Availability of treatments is the most crucial factor. Certain medical procedures (e.g. stem cell treatment, assisted reproduction) are not performed in some countries due to legal, ethical and cultural concerns or lack of technology and expertise.

2.    Quality of treatment and reputation of the specialist are vital, as people are not willing to risk malpractice and its consequences.

3.    Reduced waiting times for treatments. Those vary significantly between countries.

4.    Cost savings is the least important for the EU population, which might be due to the national health care systems and quality. US citizens, however, travel abroad mainly for cost saving reasons due to being uninsured or underinsured. Even with traveling and accommodation costs, the total expenditure is often still lower than the treatment cost at home.

Currently only 3-4% of people travel abroad for medical care leaving a huge potential for the market to increase. Nevertheless, there is a clear difference between Europe and the US, as the majority of Europeans (53%) would be willing to travel abroad for medical reasons, while this percentage is much lower for the US (27%). Reasons why Europeans are more willing to travel are geographical proximity and established international co-operations within the EU. Factors such as age, level of education, living environment and previous experiences influence individuals’ openness towards medical tourism. Intrabound medical travel has not been taken into account within the context of our study.


The following reasons, according to our consumer behavior research, discourage medical travel:

  • Convenience is the reason why medical tourism is often concentrated in border regions. Teleconsult prior to and after treatment is a way to solve concerns on long distance travel and after care.
  • Satisfaction with the national health care system discourages medical travel abroad. As long as the national health care system is well organized and people feel taken care of, this is the show stopper for medical travel.
  • Lack of information both in quantity and quality. This is the area where medical tourism facilitators add value to both medical tourists as well as to the medical sector.
  • Lack of language skills varies per region. This is most prevalent in Eastern Europe and the UK. In Eastern Europe, fewer people speak an auxiliary language, whereas British citizens might be concerned that the local population will not speak English. In border regions people are often familiar with the neighboring language.
  • Cost concerns are strongest in the new EU Member States, who often have a lower GDP per capita and is due to expected high traveling costs and the perception of treatment abroad being an expensive offer.

Consumption Phases

Limited data is available on consumer behaviour in the pre-consumption, consumption and post-consumption phases due to confidentiality issues. Visually, the consumption phases can be pictured as follows:

The conclusions described below are based on the outcome of the US and German surveys. ,

Pre-Consumptions Phase

To reach the medical tourist, his decision pattern prior to traveling needs to be understood. Research on medical tourism offers and facilities is mainly done using the internet. The importance of accreditation of medical facilities abroad is high in the decision making process as 81%  indicated that it played a role when selecting a facility. There is a strong preference for using a facilitating company to ensure a medical tourist is not left on his own.

Consumption Phase

The experience of US medical tourists is positive during their stay abroad. The selected hospitals were rated as high and also the facilitating company was judged to be helpful. Although some minor problems occurred concerning language barriers, this did not significantly influence people’s experience. A small percentage of German medical tourists received inpatient care; most cross-border health care entails spa, outpatient treatments and purchase of medication.

Post-Consumption Phase

Overall, both US and German medical tourists had a positive experience abroad when traveling globally. 95% of Germans questioned were satisfied with their treatment abroad. Moreover, 63% of US medical tourists indicated they had a better experience than they would have had in their home country. Almost all of them would recommend medical tourism to others. Facilitators were also well rated, as the majority of US medical tourists would advise others to use one.

Currently, medical tourism is still a small market. Yet there is potential for rapid growth into a big industry, due to the willingness to travel for medical care and the diversity of destinations suiting all needs. In addition, the overall medical tourism experience is positive and many would recommend it to others. Transparency in quality levels and structuring the offering will help the industry to become more accessible for potential medical tourists.

Accreditation and Quality Systems in Health Care

Accreditation is a reliable way to assess the level of quality of health services in medical tourism destinations, providing a standard of credibility which gives a feeling of confidence in the medical services provided. The criteria of accreditation differ from one accrediting institution to another, but normally cover similar aspects. Due to the fact that there is no uniform approach to the accreditation process, some hospitals undergo multiple accreditations to achieve performance credibility.

Joint Commission International (JCI) is the most recognizable international accrediting body. There are also organizations, such as the International Society for Quality in Health Care (ISQua) and the United Kingdom Accreditation Forum (UKAF) that serve as umbrella organizations and support accrediting institutions. Universal quality systems, such as International Organization for Standardisation (ISO), are also used for health facilities. There are other interesting national organizations such as, TÜV Rheinland, from Germany. TÜV Rheinland works with medical facilities in 62 countries.

Moreover, the Medical Tourism Association has recently launched the Medical Tourism Facilitator Certification Program focusing on medical tourism aspects. It does not intend to accredit quality or to replace any accreditation system.

Our report features a full list of accreditation systems, which cannot be mentioned here. When analyzing accreditation systems, it is helpful to know how the various systems are grouped together as:

  • Umbrella organizations
  • Quality Systems
  • International Accreditation Systems, such as Joint Commission International
  • National Hospital Accreditation Systems

The importance of a globally recognized accreditation system, comparable to systems in the hospitality industry (e.g. Leading Hotels of the World or Relais et Châteaux) should be acknowledged. Recognized standards boost the credibility and trustworthiness of locations and therefore increase the chance to be considered as a destination for medical tourists.


Our research shows that facilitators play an important role in the decision process of potential medical tourists. Medical Tourism facilitators or Medical Tourism agencies’ main function is to help Medical Tourists to find the best option, make travel arrangements and secure the individual persons’ needs. Over the last few years, a myriad of these companies emerged, helping this market to grow. One of the main advantages to using facilitators is the one-stop-shopping, including flight tickets, visas and arrangements concerning hospitals.

Lack of regulation in the industry, however, allows the emergence of many facilitators with and without knowledge of the market needs. The lack of structured criteria for facilitators in service quality and trustworthiness makes it difficult for potential medical tourists to select the best product offering. International agreements and a quality assurance system would help the market to separate the wheat from the chaff.

Medical Tourism Swot Analysis

The aforementioned aspects are summarised in a general SWOT analysis:


Medical tourism is a rapidly developing marketplace that has more internal strengths and potential versus factors hindering its growth. Trends and consumer behavior relating to the industry, such as the increase in technological developments and augmented product consciousness, will allow medical tourism to flourish. This, in turn, could result in even more countries taking initial steps to attract foreign patients as well as a surge in medical tourism products.

Major issues for a country, hospital or cluster of health care institutions to position themselves and be successful in this industry segment are language skills by medical and other hospital staff. Trustworthy facilitators and high level support, to position the country or region as an incoming medical tourism destination by the Ministry of Health or Ministry of Tourism, completes the offering. Ethical topics, such as legal regulations, requirements for facilitators and regulation standards in case of malpractice need to be addressed.

Despite the promise of this developing market, current issues lie in the fact that there is a global deficit of information on medical tourism. Sometimes this is due to countries wishing to maintain a competitive advantage, and other times this is a result of limited information. Steps are being taken to minimize this shortage of information with new laws and third parties being established. Other concerns are rooted in the lack of a uniform international accreditation system and varying quality of services provided.

Overall, medical tourism has the capacity to be a highly lucrative marketplace, as many countries are already proving. This could be especially beneficial for developing countries to boost their economies. Many opportunities are taken advantage of, and the majority of threats (complications with regulations and prejudices) have the potential to be overcome. With the revenue of the medical tourism market predicted to grow by US$ 40 billion (€ 27 billion) by 2010, it is clear that interest in the market is growing.

About the Author

Sjannie Hulsman, MBA, is the owner of Reza Consultancy, established in 2003. Reza Consultancy operates in the hospitality and professional service industry and seeks to combine the strengths of hospitality and hospital services. Reza Consultancy considers success to be highly related to tangible and intangible service quality, quality of products, and relationships. Guest, patient or customer experiences are emotional and influenced by the attitude and motivation of staff as well as personal state of mind.

At the same time attitude and motivation of staff are highly influenced by the relationship between management members and connections between management and work force and between work force members. Companies, who are able to bridge those needs, who anchor their vision and mission effectively at all organizational levels achieve above average success.

Reza Consultancy is fascinated by these processes. The process that bridges the gap between strategy, implementation and operational effectiveness, touches on all business and human aspects within a company. With over 20 years experience in the international hospitality industry and the professional service industry, Reza Consultancy knows how to optimize strategic goals to achieve operational excellence and aims to enhance medical tourism know-how and transparency of the sector by bringing together diverse industries and customer experiences. Mrs. Hulsman is part of the innovation council of MTA.

Reza Consultancy ( is reachable via Mohnweg 2, D – 42579 Heiligenhaus. Phone: +49 (0)2054 8755668 / +49 (0)151 55309876, Fax: +49 (0)2054 8755666 or e-mail: is reachable via Dr. Bettina Horster, VIVAI Software AG (

Betenstr. 13-15, 44137 Dortmund, Fon: +49 231 – 914488-75, Fax: +49 231 – 914488-88

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