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The growth of medical tourism industry in Europe

October 26, 2019

 Are you looking for the best European country for medical tourism? Do you know the advantages and disadvantages of medical tourism? Take a look at this article to know more.

There are more people going abroad for medical treatment

In recent years, health tourism is becoming more and more popular all over the world. It is a form of tourism that involves patients travelling to other countries looking for medical treatment abroad. As the market for medical tourism in Europe has been growing, let’s learn more about the EU medical tourism in this article.

What is health and medical tourism?

Health and medical tourism is a form of tourism that consists of patients going abroad for medical treatment or health assistance. It includes all other services associated with tourism such as transportation, accommodation, and hospitality. Health tourism in Europe combines three components, including medical tourism, wellness tourism and spa tourism. 

The definition of wellness tourism is different in each European country, depending on the culture and geography in the EU. For example, wellness tourism focuses on outdoor activities like walking and swimming in Scandinavia, while it is connected to the seaside, the Mediterranean diet and the slower pace of life in southern Europe. Although wellness tourism is diverse across the EU; the importance, growth, and impact of health tourism on the overall tourism industry and economy is undeniable. And the market for health tourism has been growing dramatically in recent years, which has led to new forms of health tourism such as fertility tourism and dental tourism.

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The growth of health tourism in Europe

It is not easy to estimate the total size of the health tourism sector in the EU due to the limited and fragmented data and the overlapping definitions by different sources and countries. There are more people travel from richer countries like Germany, the United Kingdom, Sweden, the Netherlands, and Ireland to other medical tourism countries in Europe, especially in Eastern Europe for affordable healthcare. According to a research from PwC, the market has been growing at 12-15 percent each year.

Where are the top health destinations for European medical tourists?

The best medical tourism countries in Europe were primarily the United Kingdom, France, Germany, Italy, and Spain. However, since all EU citizens can have free access to treatment in the community space, a new public-pay medical tourism market appeared. As a result, other countries that offer lower medical costs such as Hungary, the Czech Republic, Romania, Poland, and Latvia have become popular destinations for Western Europeans. Today health tourism contributes about 5 percent of the tourism industry in the EU, makes up about 0.3 percent of the EU economy. The fact is health tourism has a higher domestic share than traditional tourism does, so increasing the share of health tourism may reduce the seasonality of tourism, which then increase labor quality and sustainability.

Among EU countries, Turkey has become a popular destination for medical tourists who look for treatments that are less complicated. That’s one of the reasons why the Turkish government are implementing policies to enhance the health tourism market in the country. For example, the government offers discounts for patients flying with Turkish Airlines. Also, the government is planning to introduce tax-free healthcare zones for foreign patients. As a consequence, there are more and more governments and companies in Europe are offering cheap flights, open borders and inclusive packages to broaden this segment of the tourism market.

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Some key statistics about medical tourism

As the industry is growing so fast, let’s take a look at some statistics from a survey that was conducted by the Medical Tourism Association in June 2019 to understand why and how to enhance this market:

– There are 64% of patients didn’t have health insurance when they travelled for medical care

– About 83% of patients traveled with a friend or family member

– 33% of patients traveled for cosmetic surgery

– Almost 90% of patients or their companions combined the trip with tourism activities

– Nearly 80% of the demand for medical tourism is driven by lower costs

– Each medical trip costs tourists between €6,083 and €12,885

– 48% of respondents would be interested in medical tourism again in the future

– The decision to travel abroad for treatment depends on the cost of medical treatment and the quality of it

– 36% out of 49 participants that had traveled abroad for medical treatment used a medical tourism facilitator.

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How big is the medical tourism industry?

Eurostat and IPK International has released some Europe medical tourism statistics which give us a general overview as well as value of medical tourism industry:

– In 2014, the total volume of health tourism (wellness, spa, and medical treatments) in the EU is around 56 million domestic arrivals and 5.1 million international arrivals.

– Health tourism contributes 4.3 percent of all EU arrivals

– Germany, France, and Sweden are the top destinations in the medical tourism industry in Europe. 

– Wellness tourism contributes from 66 to 75 percent of EU health tourism.

– The revenue of health tourism is €46.9 billion which represents 4.6 percent of overall tourism revenues and 0.33 percent of GDP

– Five countries: Sweden, France, Poland, Italy, and Germany contribute more than 75 percent of EU health tourism revenues 

– Most medical health tourism clinics serve both local patients and international patients for additional revenue stream.

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Advantages and disadvantages of medical tourism

Why do people travel for healthcare? There should be some positive effects of medical tourism. As a matter of fact, there are various reasons that European tourists are travelling abroad for medical treatments. Firstly, they will have access to certain treatments that are not available in their countries. Secondly, they are travelling to the countries that have lower cost and higher quality of the treatments. Last but not least, they have the opportunity to combine the medical trip with a holiday to rest and recover in the destination country. 

Depending on the procedure, patients may even spend more time in their hotels than they would at a hospital during their trip. They often spend a couple of nights at a hospital after the treatment and spend the rest of the time in a hotel for recovery or doing physical therapy. A survey from European Commission shows that 49 percent of EU citizens is willing to travel for health care. Their decisions can be affected by the EU directive on healthcare. In order to protect the financial sustainability of national healthcare systems, Member States must reimburse their citizens at the value that the care they receive would cost at home. 

Many patients combine their medical trip with a holiday

On the other hand, the patient and their family members are often not sure about the qualification in other countries. In this case, misinformation can lead to inefficient treatment and wastage of resources. Additionally, some hospitals abroad don’t provide pre-operative and post operative care. Also, patients might have problems with legal permits and paperwork. And due to the difference in culture and language barrier, the patients can get nervous and anxious before and during the treatment. 

Moreover, there are other certain disadvantages for patients from poorer countries with healthcare systems that are less developed. For example, healthcare services cost less money in Croatia than in Sweden. So if a Croatian patient seeks medical treatments, they would have to pay out of pocket for the substantial difference. On the other hand, a patient from a wealthier Member State can look for treatments in other destinations with lower costs. In general, that scenario is particularly beneficial for wealthier member states in terms of economic gains.

The impact of the EU Directive

The latest report finds that over the last three years, cross-border patient mobility within the EU shows only a slight upwards trend. The reason could be improvements in the information available to citizens and a better awareness of patient rights as a possible consequence. After five years since the launch of the Directive, cross-border patient flows are stable and mostly driven by geographical or cultural proximity.

#1: There is no major budgetary impact on national health systems

There has been no further European court rulings were required to ensure the rights since there was the EU Directive. However, patient mobility and its financial dimensions within the EU remain relatively low, and the Directive has not made any major budgetary impact on the sustainability of the national health systems.

On the other hand, patients are increasingly aware of their rights under the Directive. The Directive has created a framework to cooperate health systems, including Health Technology Assessment and eHealth. Aside from that, 24 thematic European Reference Networks (ERNs) for rare, complex and rare-prevalence diseases was established, which brings together more than 900 specialised healthcare units in over 300 hospitals across the EU. Also, there are more than 200 virtual panels on patient cases operating under the ERNs.

#2: It has helped remove cross-border patient mobility barriers

As European citizens have more access to information, the number of patients that travel overseas for medical tourism treatments has slightly increased in the last three years. Patients from EU Member States that have no “prior authorisation” system for choosing and reimbursing for healthcare received in another Member State will have the freedom to choose and reduce the administrative burden. 

The adoption of the EU Directive has removed some barriers

Other countries that had authorisation barriers could reduce the number of patients who try to take advantage of the Directive. For example, in some Member States, if a patient wanted to obtain their reimbursement, s/he would be required to provide a certified translation of their medical documents. The translation could represent a disproportionate obstacle to the free movement of services, because the cost of the translation can be higher than the reimbursement in some countries. 

Likewise, other Member State introduced a minimum threshold for reimbursement, at €15. Also, another Member State required a certificate from the foreign NCP, which attests that the healthcare provided within its territory would be compliant with the safety and quality standards. With the adoption of the EU Directive, all three examples above have now been removed.

Experience Gondola Rides#3: Requests for reimbursement remain low

According to Article 20 of the Directive, Member States need to report on an annual basis on their patient mobility. These reports combine all the information, including healthcare provided, requests for information about healthcare, reimbursements made, reasons for which healthcare was or was not reimbursed and healthcare with or without prior authorisation.

Additionally, the report provides an overview of the data received in the past few years. However, some data includes cases of reimbursement under the social security coordination rules. The reason is because not all Member States can maintain a strict separation between reimbursements for healthcare and reimbursements under bilateral cross-border agreements. According to the data on prior authorisations, the number of requests remains generally low. However, it has steadily increased since 2015. 

#4: Requests not subject to prior authorisations

In 2015, 2016 and 2017, requests for reimbursement for treatment not subject to prior authorisation was relatively low but has remained very steady. While the number of requests in 2015 was 180,704 across 19 Member States plus Norway; in 2016, it was 209,568, granted over 22 Member States; and in 2017 the total number of requests was 194,292 across 20 Member States. These data shows that there is no significant growth or reduction regarding EU citizens’ use of the rights granted under the Directive over the three years of the reporting period.

Things to do in ParisThe flows of cross-border patients

After receiving prior authorisation, the greatest flow of patients was from France to Spain. Without the need of authorisation, the greatest flow was from France to Germany. For treatment without prior authorisation, France has the greatest number of travelling patients, and the three most common destinations for healthcare are Spain, Portugal and Belgium. Aside from France, the next most frequent cases of patient mobility were from Denmark to Germany, Poland to Czech Republic and Norway to Spain. Additionally, patients prefer to receive healthcare near their home if possible. And when they travel, they prefer to travel to a neighbouring country.

In conclusion, health tourism is growing at an exponential rate and national policies in certain countries are enhancing the growth of it. This shows that health tourism is an important strategy in Europe.

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