International Journal of Tourism Sciences, Volume 7, Number 1, pp. 129-140, 2007 ©Tourism Sciences Society of Korea.

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Medical Tourism: A New Global Niche

William Cannon Hunter∗ Cheju National University

Abstract: Medical tourism is a new global niche market. This market has a significant economic scope, but little research exists regarding the actual effects that medical tourism has on a destination. This paper provides a survey of the history, economic scope and traveler motivations associated with medical tourism. In addition, a discursive analysis explores the implications for the larger medical industry and tourism industry of a destination. A grounded theory is provided that can serve as a foundation for future research, and directions for this research, in collaboration with managers and policy makers are suggested.

Keywords: Destination, Discursive Analysis, Health Tourism, Medical Tourism, Motivations, Niche Market, Representations

Cheju National University, Department of Tourism Management, 66 Jejudaehakn o, Jeju City, Jeju Special Self-Governing Province, Korea 690-756, Email: primala or, Telephone: 010-4699-4199 or 064-754-3 148 Fax: 064-725-2074

as . Although there are no comprehensive descriptions or figures at the global level. In India. Ayurvedic treatments have long existed. Europeans have visited spas as far as the Nile. this journey took people to bathe at the Shrine of Bath in what is Britain today. In addition. Sacred sites in India. This new global niche is currently under-researched and it is the purpose of this paper to first describe the general contours of medical tourism in terms of economic scope. For at least 200 years.130 William Cannon Hunter INTRODUCTION Medical tourism is a new global niche market that is of growing interest to researchers and policy makers in both the medical industry and the tourism industry. offering a mixture of therapeutic and spiritual solutions not available elsewhere until the last century. even before Hippocrates (460-370 BC). Medical tourism also involves recuperation and the enjoyment of certain activities available at the destination. specialization has transformed health tourism (the pursuit of general well being available at certain destinations) into an emerging niche market. Medical tourism has its roots in health tourism. Medical tourism is a form of tourism that involves medical interventions that are substantial and have long-term effects (Connell. A discursive analysis presents the potential effects of medical tourism on destinations in terms of the medical industry and the tourism industry. the father of medicine declared the important therapeutic values of certain environments. This information is sufficient enough to demonstrate the economic and social significance of medical tourism. However. and the question regarding its real impacts on a destination and its resources are in question. HISTORY: ROOTS IN HEALTH TOURISM Medical tourism is a contemporary form of an ancient practice. Along with everything else today. little research has been performed regarding the effects of medical tourism. People for thousands of years have traveled for the sake of health. 2006). 2000 years ago during the ancient days of the Roman Empire. an ancient social practice where people travel to seek cures or certain health benefits available only at certain places. health tourism. Greece and Persia have existed for millennia. medical services and traveler motivations. the effects of medical tourism at the national level are available from a variety of sources. The main point of this lecture is to examine medical tourism’s potential for sustainability. The importance of spas in Europe as a motive for travel is apparent even today. the wider scope of influence is examined through a discursive analysis. Considered a sacred pilgrimage for many. or to seek cures available only in certain locations.

2006). Health tourism has always been around. or medical tourist. and the outcomes are expected to be substantial and long term” (Connell. This type of travel. benefiting both themselves and a growing number of destinations. remote colonies such as the French Pacific territory of New Caledonia was widely recognized as a health tourism destination. principally in developing countries” (Connell. THE MEDICAL TOURISM INDUSTRY: A HIDDEN GIANT Medical tourism is emerging as a unique and readily identifiable form of tourism that is “deliberately linked to direct medical intervention. 2006. The Philippines has historically been a destination for faith healing (Adams. to include specific medical interventions. made especially notorious in the 1970’s with Andy Kaufman’s famous journey to escape death by lung cancer after all other treatments had failed. Medical tourism can be further clarified as a balanced mixture of a particular destination’s natural and cultural environment with the medical treatments available there. mainly in developed countries. once inclusive of any pursuit associated with overall well being (including leisure sports and mountaineering) has become more specialized. and in other ‘exotic’ tropical locales. exercise and diets. bathing. hill stations appeared – therapeutic centers offering certain curative properties and procedures (Smyth. 2004). and a general retreat from daily life. “satisfying the needs of a growing number of people. culture and leisure sports. and there is . Destinations The contours of medical tourism as a niche have not been clearly defined. 2005). 2005). People are generally aware of it. Gupta. In other words. during the peak of the European colonial movement.Medical Tourism: A New Global Niche 131 many still remain in use. all unique to a particular destination. There. Still referred to by some as health tourism. it involves the procedures for a particular medical treatment along with recuperation and the concurrent enjoyment of certain activities associated with nature. It can also be identified as a unique tourism niche. medical tourism incorporates central features of the medical industry and the tourism industry at a destination. For the patient. Health tourism features various therapeutic. or health tourism services (Garcia-Altes. offering certain types of massage. although it is easily recognized. 2005). it is a niche that is identified as medical tourism when travel involves specific medical treatments (CBC. 2004). including fasting. By the 1800’s. healing and curative effects specific to a particular destination and its natural and cultural resources.

medical tourism is a new opportunity for destinations previously under visited. 2004). Hungary declared 2003 as the Year of Health Tourism (Connell. 1995). In Europe.cubanhealth. Of course.132 William Cannon Hunter evidence of its economic and social significance. Cuba offers plastic surgery (specializing in skin diseases) and dentistry for American and emphasizes the quality of its professionals (www. They each cater to distinct markets and they each offer very different products. Perhaps they hope to lure the market away from Singapore. Situated on the Red Sea. Notable destinations for medical tourism are scattered all across the globe. It has a special wing exclusively for Japanese patients (CBC. Eye surgery. Dubai – a fast-growing world-class travel destination – will complete the Dubai Healthcare City by 2010. In the Americas.arabmedicare. Other areas in the Caribbean find it more difficult to enter the medical tourism race. & Lalta. Websites like ArabMedicare. and will include a branch of the Harvard Medical School. Tourism researchers and policy makers can only gain a partial view of the impacts of medical tourism and since comprehensive descriptions and figures have not yet been developed. this will be the largest international medical center from Europe to Southeast Asia. Cushman. currently the largest provider (along with India) of medical services for travelers from Middle Eastern nations. Imrie. as prices are not competitive with Latin America (Huff-Rousselle. one of the top 10 procedures for patients visiting (http://www. offering cosmetic surgery and safari packages. Shepherd. the Bangkok Phuket Hospital is the world leader for sex-change surgery. with Costa Rica a close competitor for the same market. 2006). the only recourse is to examine specific cases – selected destinations and their features. Bangkok’s International Medical Center offers services in 26 languages and recognizes cultural and religious dietary restrictions. India is promoted in Germany and Air Mauritius’ in-flight magazines feature “one of the five most advanced clinics in the world” ( 2006). Thailand caters to American travelers and foreign nationals residing in Asia who are generally professionals who work for international companies and enjoy flexible. Vigorous promotion specifically for medical tourism destinations exists. In the Middle South Africa has grown in prominence. kidney dialysis and organ transplantation are among the most common procedures sought by medical vacationers in Thailand.htm) offer direct access to information on the top 25 hospitals in the Arab world as . Latvia and Lithuania are gaining recognition as destinations offering dental care and plastic surgery. worldwide insurance plans. Figure 1 (Map source: Altis Website) indicates some key locations.

mostly from Middle East and South Asian countries (Gupta. 2006). health tourism. The American Baby Boom generation. There are two types of medical tourists. implemented in 1998 by the government has become the second largest income earner for the national economy (Chaynee. as it exists in industrialized countries. There are already a number of corporations in place there. The other type of medical tourists are people who travel from less developed places to industrialized nations for the purpose of obtaining advanced care unavailable at home. knowing they will get free treatment.000 medical tourists visited India last year. The rise of this medical paradigm. and 35. These include pregnant women arriving in the UK on a holiday visa. dentistry.000 patients between 2001 and 2004. treatment and a post-operative vacation.238 Japanese. Economic Scope The economic scope of the medical tourism industry should not be underestimated. For Malaysia. 2005). pediatric heart surgery. are increasingly seeking health care outside their nation’s borders. 2004). 2006). dominated by the United States has brought with the problems of high costs and differential access to treatment (Borman. 50. or “business travelers bringing their partners or children with them and then . Nigerians spend about US$1 billion dollars per year abroad (Gupta.092 Australians sought medical care (Connell. In Thailand during 2004. 2006).2 billion dollar per year industry (DeMicco & Cetron. 2005). This group treated an estimated 60. 2004). In India. Others say more than 500. 118. about 220 million people. 95. India offers open-heart surgery. transfers. The ones described in this paper are residents of industrialized nations who travel to less developed destinations to receive treatment for certain conditions that may be too expensive or inaccessible at home. Surgeon and Safari for South Africa and Antigua Smiles lure tourists while Gorgeous Getaways in Australia send clients to Thailand and Malaysia for cosmetic surgery (Connell. bone marrow transplants and cancer therapy along with the technological sophistication and infrastructure to maintain its market (DeMicco & Cetron. Some say 150. 247. Medical Tourist Motivations: Push Factors One key reason that medical tourism exists today is because of problems endemic to the global medical paradigm. hotel accommodations.Medical Tourism: A New Global Niche 133 well as medical tourism topics and news – geared directly to the medical tourist.701 Americans.000 medical tourists will visit next year to receive some kind of treatment. such as Apollo Hospital Enterprises (CBC. 2004). usually in the form of package deals that include flights.000 people from the UK traveled for medical reasons in 2003 (Connell.941 British. 2003). medical tourism will become a US1$ billion dollar industry by 2012 (CBC. 2004) or it could become as much as a $2. 2004).

and the health care industry is very complex and the same medical treatments can be received in other countries for a fourth to a tenth of the cost.000. This paper concerns the first type of medical tourist. Australia and New Zealand seek medical treatment outside the boundaries of their own countries (Ross. Travel agencies are specializing in medical tourism for individuals and companies are arranging medical tours for their employees. tours and activities as well as accommodations. the United States “ranks very near the bottom of the list of all industrialized nations” (Adams. 2005). 2001). And this is becoming easier to do. The other type is largely excluded in current research and reports concerning medical tourism as it carries a totally different set of implications. most Americans get less of it per dollars spent.000 in Great . The bottom line is that while the US might have the “best” health care in the world. both knees is about $17.000 at one of India’s best hospitals. medical care is prohibitively expensive.134 William Cannon Hunter ‘suddenly discovering’ there is something wrong with them” (BBC. 2005) and another big part of the expense is liability – in terms of malpractice litigation. 2003). In Canada and Britain. those from industrialized countries. 2005).000 people have no dental coverage. By 2015 the American Baby Boom Generation’s health demands will rise as 220 million people in North America. 1997). including the scheduling of surgeries and the booking of flights. In the United States. such as medical care.000 to $10. as international travel becomes cheaper and more convenient while currency exchange rates remain favorable.000 in the United States. Open-heart surgery might cost $70. 43. The major push factor for medical tourism is that rising health needs of an ageing population is generating demand for medical care outside the borders of industrialized nations. but only $3. at any destination (Handszuh & Waters.000 in Britain and up to $150. Some claim that up to 80% of American health costs are associated with the paperwork necessary to support the complex bureaucracies of Medicare and Medicaid (Adams. Knee surgery. Motivations: Pull Factors The major pull factors for medical tourism are cost-effectiveness and availability of services on demand in combination with the unique features offered at a destination. In addition to the high cost of medical care. The wildly escalating costs of medical care and exclusionary medical care systems in the United States and other industrialized nations are pushing people to travel elsewhere to seek treatment. Waiting lists for certain treatments are also getting longer and longer.000. in combination with a vacation. the waiting list for a hip replacement can be a year or more. Rapidly improving technology and standards of care are the results of the globalization that has produced a consumerist culture and the ability to buy any service. For dollars spent.000 people do not have medical insurance and 120. it is estimated that in the United States. Europe. but available immediately on demand in Bangkok (DeMicco & Cetron.

the privacy available at a remote location is valued.000 including accommodation. the medical industry in industrialized countries is costly.250 in South Africa (http://en. Therefore. But even with an .000 in the US is available in many countries for about $730.700 in India (Gupta. medical tourism is not an autonomous industry – it is a niche market. eye and cosmetic surgeries are about one-fourth the cost in India compared with the West. Eye surgery that costs about $20. 2004). quality of care and infrastructure find their way to developing medical destinations. The following discursive analysis is a first step to developing a grounded theory for medical tourism.wikipedia. Personalized care. medical tourists enjoy high quality care. In this sense. the industry itself is being exported. along with its patients. outlining major critical issues. is concerned with the effects of tourism on destinations’ medical industries. For others. favorable environments for recuperation and cultural sensitivity have made destinations like Thailand very popular for Japanese patients (CBC. recovering after cosmetic surgery or other medical interventions. Knee replacement with 6 days physical therapy runs one-fifth the cost of a similar treatment in the United States. complex and does not offer universal health care. However. improving the general consciousness of what quality medical care is all about (Tan. The Medical Industry Most of the limited existing research on medical tourism. They also point out medical tourism travel motivations. including levels of hygiene.500 dental bridge in the US is about $500 in India. the standards of accreditation and professionalism. its position in terms of the medical industry and the tourism industry should be carefully evaluated. A full face lift costs $20. Existing research and reports related to medical tourism detail specific destinations and markets. and focus on medical interventions available as well as cost comparisons. A $5. And as As previously described.Medical Tourism: A New Global Niche 135 Britain but only about $7. DISCURSIVE ANALYSIS The current understanding of medical tourism has been summarized in section three. Medical tourism’s wider scope of influence in terms of the destination is provided. Destinations offering medical tourism services take measures to stress the quality of its professionals and facilities. This research also focuses on the conditions of the global medical industry in general. to provide a foundation for future empirical studies. 2004). In addition to low cost.000 in the US but is available for about $1. Breast augmentation in Thailand costs about $2. Dental. 2004).

previous research describes the economic scope of this niche market. On the surface this appears to be good news for local economies. tours and other sectors of the local tourism industry. The social problems of public hygiene. In terms of spending and numbers of medical tourists. It requires a complex infrastructure of facilities and an educated staff to handle medical tourism. The Tourism Industry Less attention has been paid to the effects of medical tourism on the tourism industry. However. These catering to the medical tourist hospitals should be responsible for treating a certain proportion of patients from the local population free of cost in return for receiving certain government subsidies. or even the language barrier. insurance coverage. 2004). In addition to the problem of public health care provision is the problem of the distribution of earnings from medical tourism to the local economy. 2005). attractions. 2004). local and national comprehensive healthcare policies and the interests of local residents and citizens can be compromised (CBC. as it exists in certain destinations. travelers worry about malpractice. Medical tourism is the exclusive domain of large specialist hospitals run by corporate entities. Not all facilities are equipped to deal with the unique cultural expectations of patients. of every hospital trying to get access to the medical tourism market (Adams. communicable diseases and the general health and life expectancy of the population are national concerns. nor cater exclusively to the medical tourist. South . With business going to the provider who offers competitive prices with quality care. There is also little evidence of medical tourism having an effect on tourists’ existing destination image perception. And a portion of earnings from medical tourism should be contributed to the local economy by means of taxes or contributions. However. It is also unclear exactly how much money is spent on accommodation.136 William Cannon Hunter improved medical industry. and access to follow-up care. ‘open your new eyes on the beach at Juha” (Connell. there are some potentially negative effects for the industry. some efforts are being made to market medical services in connection with local attractions: “One Bombay hospital has considered the slogan. A local medical industry cannot adopt a strictly commercial approach to health care. A rapidly improving medical industry combined with competitive prices draws ever-larger numbers of travelers to destinations. and profits earned seldom filter back down to the local level. Medical tourism reinforces a medicalised view of health care (Gupta. Medical tourism can potentially have negative effects on the public health care system by drawing attention away from local concerns. but the actual effects of medical tourism on the tourism industry is overlooked. It is unclear whether medical tourism has a direct effect on annual visitation numbers or average length of stay. 2006). Some also worry about the bandwagon effect.

what to buy and what to eat. restoration. landmarks. It has also provided employment for local residents. to represent “the permanent performance of a living and eternal Filipino folklore” (Dumont 1988: 265). with Antigua Smiles and Gorgeous Getaways. and the race of Other” (Hollinshead 1998: 149). overuse and misrepresentations largely associated with rampant commodification. or ‘world’ cultures along with the increasingly packaged eco-tourism and leisure sports experiences available at destinations have brought with them various positive and negative effects. A large concern regarding medical tourism should be its potential effect on destination image. but are also closely tied to raised awareness among policy makers regarding the value of their country’s or destination’s cultural and natural resources. Further horizontal integration between ‘hotels and hospitals’ should be the key focus of future destination policy. In tourism. providing money for conservation. Places and spaces are heterosexualized and racialized (Pritchard & Morgan 2001: 168) and even the landscape becomes “a form of representation and not an empirical object” (Rose 1993: 89). In the worst of cases. with implications for the larger issues related to the two industries between which it is positioned. The major challenge for future research is to maintain a balanced perspective of medical tourism as a niche market. income from tourism and other sources has filtered back to the resource. guidebooks and postcards as well as travel narratives and descriptions that inform the tourist on how to enjoy a destination – what to see. making the medical tourist into a vain and self-indulgent ‘type’. Positive effects are mainly related to economic gains. Connell (2006) offers several examples of how hotels and hospitals have become horizontally integrated. Classic examples exist. commodifying destinations. the ethnicity. by science and by politics. destinations and landscapes” as spaces where a particular form of socio-cultural dynamics is negotiated (Pritchard & Morgan. These representations convey “the arrestive presentation of the culture. The current resurgence of popularity concerning aboriginal. made into a sign by the media. 2000:167). representations are used extensively in the form of brochures. attractions. They reveal “sites. preservation and even education. it has led to conflict. medical . And it seems that medical tourism has already contributed some new representations.Medical Tourism: A New Global Niche 137 Africa has also maintained a seamless packaging of cosmetic surgery and safaris. This discursive analysis introduces the major implications of medical tourism for a destination in terms of its medical industry and its tourism industry. At the same time they combine together to form an impenetrable discourse that “directs expectations. influences perceptions and thereby provides a preconceived landscape for the tourist to ‘discover’” (Weightman 1987: 230). It is yet to be seen if the medical tourism market niche will be able to contribute to the sustainability of a destination’s cultural and environmental resources. In terms of the medical industry. such as The Kodak Hula Show (Buck 1993: 1) that positioned Hawaii as “an exotic spectacle” and how the Tasaday were created. In the best of cases.

Medical tourism appears to be an economically significant niche market but at this point in time it is unclear just how much it will contribute to a destination. Without proper intelligence. However. the social and economic effects of medical tourism are less clear. Medical tourism can contribute to longer stays. However. In terms of the tourism industry. CONCLUSION Medical tourism is a rapidly emerging global niche market. and suggests directions for future empirical research. and its potential benefits and drawbacks identified. the exact effects of medical tourism are largely unknown. In terms of sustainability.138 William Cannon Hunter tourism exports the industry. there is the concern that earnings from medical tourism are not benefiting the local economy. researchers and policymakers can move forward with more focused and destination-based investigations. supplemental packages can lessen the load on valuable cultural resources while potentially generating more income for development and preservation purposes. But with this comes the concern that hospitals will neglect the healthcare needs of local residents in favor of the medical tourist. more spending and more constructive interactions between hosts and guests (Hunter. medical tourism can potentially be an important niche for any destination that is competitive in terms of price and services. General figures are not yet available concerning visitation. quality of care and infrastructure. economic scope and traveler motivations. length of stay or spending directly related to medical tourism. Supervised. Also of great interest should be the effects of medical tourism on a destination’s tourist image. That limitation is addressed by a discursive analysis that defines the conceptual parameters of the research on medical tourism’s effects. both in terms of its medical industry as well as its tourism industry. Medical tourism can also contribute to loosening the stiff definitions of a destination by breaking down stereotypes and other representations. Implications for management and policy makers include the need for closer attention regarding the actual effects of medical tourism on the resources of a destination. Medical tourism contributes to an improved medical industry in developing countries. medical tourism can lead to an even . 2000). In addition. This paper’s major limitation is a lack of grounded theory regarding medical tourism. There is evidence that it has significant social economic effects and is both reinforcing and changing the medical and tourism industries at various destinations. including standards of accreditation and professionalism. With the scope of the medical tourism niche market described in terms of its history. evidence from the discursive analysis (section four) suggests that there are a number of detrimental effects that medical tourism may produce for a destination.

M. will travel. (2004). (1993). Indepth: Health Care 18 (2003). Where healthcare. 30 December. tying natural and cultural resources together with medical services. The most important finding suggested in this paper is that there is a need for collaboration between managers and policymakers.html Chaynee. It can also contribute to maintaining cultural stereotypes and rigid representations through improper promotion and packaging. Tourism . Medical tourism: Need surgery. especially in terms of economic distribution of benefits as well as potential contributions to social and environmental resources and the general sustainability of tourism. CBC. (2005). (2003). sand and… surgery. Medical tourism can also negatively affect the public healthcare system by re-channeling medical resources to the Duala Lumpur: Malaysian Institute of Economic Connell. Research should be performed with the vision of a comprehensive information system to examine the effects of medical tourism on destinations’ cultural. ‘Health tourism rules unveiled’. Philadelphia. BBC News.html BBC. healthcare system. (2004). exacerbating economic disparity and uneven distribution of wealth among those who reside at a destination. ethics. Destinations can implement action plans that detail systematic and comprehensive steps to implement policy that can develop its attractions in new ways.newstarget. Paradise Remade: The Politics of Culture and History in Hawai’i.cbc. Medical tourism: Sea. Buck. E.S.stm Borman. natural and economic resources. PA: Temple University (2006). W. researchers need to implement studies that evaluate the effects of medical tourism on a destination. E. Tourism: A New Global Niche 139 more serious dehumanization between hosts and guests. CBC News Online. and tourism researchers. http://www. 328. and the state collide. Implications for research suggest that medical tourism should not be regarded as a distinct market independent of other interests. REFERENCES Adams. Health tourism. Rising popularity of medical tourism reveals deterioration of U. British Medical Journal. Methods for horizontal integration between the medical industry and the tourism industry need to be developed that can ensure that the maximum benefits for destinations and travelers alike are realized through medical tourism. Health tourism to drive earnings. 60-61. Rather. http://www. http://news.

edu/PR/UDaily/2005/mar/ & Waters. Prospects for health tourism exports for the English-speaking 27. & Lalta.html Dumont. (2004). H. (1993). Trust between culture: The tourist. 167-179. N.) The tourist experience: A new introduction ( 2006 Accepted May 27th. (Eds. Progress in Human Geography. F. identity and tourism representation: Marketing Cymru or Wales? Tourism Management. ‘Submitted March 7th. (2004).).udel. http://news.J. A. Messenger. 20-26). (1995).S. S. Cushman. In H. and Morgan. In C. Steffen. (2005). Pritchard. F. Shepherd. 4(1). M (2005).inq7. 42-67. Annals of Tourism Research 14. Third World Tour Landscapes. (2001). 32(1). Washington. spaces and networks. 22. K. Annals of Tourism Research. Smyth.13(4). 29. M. (2005). London: Cassell. Imrie. Gupta. D. J. HSMAI Marketing Review. 15 October.. Current Issues in Tourism. Dupont and R. 1093-1100.htm Huff-Rouselle. The development of health tourism services. Garcia-Altes. 170-193).cpim. Medical tourism growing worldwide. 28(19).arabmedicare. 227-239. Tan. Hamilton: BC Decker. (2001). M. S. (1997).php?index=2&story_id=14917&col=81 Weightman. Cambridge: Polity Ross.140 William Cannon Hunter Management. Health tourism: An overview. The Tasaday. Rose. C. Medical tourism and public health. M. B. Travel and tourism patterns. K. http://pd.htm Handszuh.J. Culture. A. 3(3): 261-275. (1998). 2007 Referred anonymously . DeMicco. People’s Democracy. http://www. Hollinshead. J. Which and Whose ? Toward the Political Economy of an Ethnographic Sign. (1987). Hunter (2001). DC: World Bank. Medical geography: Therapeutic places.html http://www. 262-266. Textbook of travel medicine and health (pp. (1988). Ryan (Ed. & Cetron. http://altis. 488-495. Heritage tourism under post-modernity: Truth and the past. Medical tourism? Philippine Daily Inquirer. 9 May. Feminism and geography: The limits of geographical knowledge. Cultural Anthropology. R.