Health and Medical Tourism:

Health Management and

Marketing Research challenges
Editorial

Paulo Moreira

Correspondence to:

Editor-in-Chief

editorijhm@gmail.com

The international patient movement is possibly the

most important emerging trend in international
healthcare management. Five healthcare management challenges can, at this point, be identified to
sustain the debate and the process of producing
knowledge.
First, there will be the Comparison challenge.
Health systems will be under growing comparative
scrutiny. Patients and payers will demand access
to credible independent comparative information
on key strategic issues including key quality indicators such as levels of organizational certification
and accreditation, levels of healthcare associated
infections, technical and scientific standards of
professionals as well as technological capacity,
especially concerning eHealth solutions to support
pre and post-acute services associated with the
international patient needs.
Empirical data from non-scientific reports
suggests that top destinations in the World for
International patients include Brazil, Costa Rica,
India, Malaysia, Mexico, Singapore, South Korea,
Taiwan, Thailand, Turkey and United States. These
being destinations for US based patients and
health travelers, we can admit Germany and Israel
as other key destinations for demand from other
regions of the World. This, however, is a most exciting contemporary puzzle game for international
healthcare marketing as concrete and independent
international healthcare market information
remains scarce and scientific healthcare management evidence is also a growing visible gap.
Second, there will be the Adaptation challenge.
Healthcare organizations will be under pressure to
adapt their offer to different segments of patients
as influenced by idiosyncratic cultural and linguistic
needs in a pro-active approach rather the traditional
reactive posture. Additionally, organizations will
need to balance their push-pull strategies as in
some cases attracting international patients may
need to be balanced with offering complementary

W. S. Maney & Son Ltd 2014

DOI: 10.1179/2047970014Z.000000000115

services abroad to support pre and post-acute episodes. For instance, diagnosis services offered in
the foreign market, directly or in partnership, may
be of strategic relevance to direct patients to services
at home already integrated in a supportive program
for the episode, as well as to establish an initial
relationship through all the traditional relationship
marketing dynamics. In short, adapting traditional
healthcare offer to new demands and expectations
as well as new channels will become a key international healthcare management issue.
The making of a world-class healthcare destination, being a strategic objective to be achieved by a
number of national health systems, is complex influenced by a variety of factors, including a number of
health policy and management issues such as
Government and private sector investment in
healthcare infrastructure, commitment to international accreditation, quality assurance, and transparency of outcomes and potential for cost savings
on medical procedures in balance with clinical outcomes. Additionally, international patients need
excellent tourism infrastructures in conjunction
with a mixed and sustained reputation for clinical
excellence as well as published evidence on successful adoption of best practices and state-of-the-art
healthcare technology. Hence, there will be higher
expectation on the availability of internationallytrained, experienced healthcare staff and capacity
of skills development.
Third, the international professional Regulatory
challenge. Healthcare is amongst the few sectors of
contemporary economies which profoundly
depends on professional skills and scientific innovation to guarantee its credibility and legitimacy
amongst peers and decision makers. Clinical procedures and shared clinical protocols become key
components for the smooth development of this
international process.
Professional monitoring and related activities to
assess international quality of practice, will become

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a key topic for research and health systems development, especially considering that identified needs
amongst international patients include the main
areas of health services used by international
patients and health travelers, which are cosmetic
surgery, Dentistry (general, restorative, cosmetic),
Cardiovascular (angioplasty, CABG, transplants),
Orthopedics ( joint and spine; sports medicine),
Cancer (often high-acuity or last resort),
Reproductive (fertility, womens health), Weight
loss (LAP-BAND, gastric bypass), scans, tests,
health screenings and second opinions. Further
analysis of international demand and related professional and regulatory monitoring may include
eye surgery, dentistry and Organ, cell and tissue
transplantation (organ transplantation; stem cell)
as other areas of relevance showing an increasing
market demand.
Fourth, the international financing challenge. One
key element to sustain the growth of this trend is
Price transparency. Using US costs across a variety
of specialties and procedures as a benchmark,
empirical evidence available in 2014, claims
average range of savings for the most-traveled destinations between a potential saving of 65% to a
minimum of 20% (i.e.: Turkey, Thailand, Taiwan,
South Korea, Singapore, Mexico, India, Malaysia,
Costa Rica or Brazil). Structures of commissioning
and contracting may be required at different levels
of national health systems, including the need for
national, regional, local or organizational management skills to be in place assuming this process as
a strategic healthcare management function for providers and payers. Having said this, how big is the
market of international patient flow? A definite
answer to this question is challenging, as estimates
and forecasts vary widely and reflect current inconsistencies in defining medical and health travel, lack

of credible data at country level and also difficulties

in sharing international comparative data. Having
said that, the so far unchallenged possibility that
this market may be annually worth USD 3855
billion, based on over eleven million cross-border
patients worldwide spending an average of USD
3,500-5,000 per visit, including all costs (clinical,
travel and accommodation).
Additionally, stemming from international
healthcare financing processes, we will need to
support the diversity of payers, including distinctive
approaches to payments by individual patients,
insurance payers and governments. Thus, diverse
models of financing will stem from one end, with
regulated contracts, to the opposite end of free
flow of patients. These models of financing access
are likely to also reflect the diverse reality of
patient needs and specificity of healthcare procedures and clinical protocols which are related to
the final cost identified.
Fifth, the media and its ideological strands in
different countries worldwide will demand for strategic communication analysis as well as healthcare
market audience studies including assessing and
generating updated knowledge concerning destination branding, healthcare corporate communication
channels development and all other dimensions of
marketing communications.
The International Journal of Healthcare
Management is already a key outlet for these
issues and we look forward to contributing further
to this international development within our role
of being a leading scientific Journal in this field of
international research and knowledge generating.
Key words: Medical Tourism, health tourism,
eHealth, destination branding, international
healthcare financing, international professional
regulation

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