Caroline Ratner spoke to David Vequist of the Center for Medical Tourism
Research, which is based at the University of the Incarnate Word in Texas
about the work of the center, which was set up over two years ago.
What are the goals of
Our goal is to conduct research into medical tourism and
also to centralise some of the research into all aspects of medical tourism
that’s going on around the world. We aim to be an advocate for researchers and hope
to help fund research and be a voice for sanity and clarity. We try to collect
quantitative information and rigorously evaluate research. At the moment we are
looking at research from India, Germany, Mexico and other countries.
We soon hope to have enough data to make policy
recommendations to various governments and organisations throughout the world.
We’re a bit away from policy recommendations at the moment because things like
numbers and type are still not as valid as they should be.
You have your second
annual conference at Washington in February, what is the conference about and
who is attending?
The main theme of the conference
is about “Knowledge in the Medical Tourism Industry- and the growing Importance of Research”. We are bringing a wide circle of
researchers from all over the world including professors and researchersfrom Philippines,
Tunisia, Germany, United States, Austria, there will be about twenty presentations
in total. The entire schedule is available on the website http://www.medicaltourismresearch.org.
keynote speaker is Glen Cohen, a Harvard Law Professor who is going to talk
about legal precedents in medical tourism from a legal and philosophical
perspective that he suggests government implements. He will also talk about the potential for
taxation vis a vis medical tourism and also the implications on US citizens and
fraud legislation in relation to medical tourism and the legal implications of
travelling abroad for assisted suicide.
We are strategically holding the conference in Washington
because we want to get the attention of NGOs and US and foreign government
entities. We are expecting to have representation for the US Department of
State as well as several Congressional staffers and also representatives from
various embassies because we want to get government bodies involved in the
research and want to raise awareness among the US government of medical travel
and the work we are doing.
also hope to have enough data to report to the conference on our newest study
entitled “Are you willing to leave the country and retire someone because of
cost and healthcare”. It is currently too expensive for many US citizens to
retire in US major cities and many are going to have to rethink their
retirement plans. Mercer recently did
research into the top 25% of wealthiest Americans and it revealed that they don’t
have enough money to retire on if they want to stay in major urban areas. This
factor will change health care everywhere.
Do you think the US Government
and US medical insurance companies are taking a serious and active interest into
research into the potential of medical travel?
Not at the moment. The US Government entities are not yet
interested into research into US health travel because they are only interested
in healthcare reform at the moment. The European Union has been much better in
terms of funding research into cross border healthcare. Most insurance companies are only thinking
about domestic healthcare at the moment, it’s not a priority although some are
looking at it but I believe that they are more concerned about their core
business and currently have little interest in the future of international
healthcare travel. We currently have no support from insurance companies or
governmental entities. The Governments that are prepared to pay for research
are Turkey, India and Korea.
What information does
the CMTR have on US citizens that have had treatment abroad throughout the
The US Department of Commerce has asked people travelling
internationally what was the purpose of their trip and that survey revealed
that nearly 200,000 had travelled abroad for healthcare in 2008/9. Our numbers are quite high and we worked out
that upwards of a million people that travelled internationally for health in
2009 whether purposefully or unintentionally (they became ill or had an
accident while abroad). To come up with this number our question was “have you travelled
internationally for healthcare”. We put no restrictions on what we called
health travel. A person going to Canada
or Mexico for pharmaceuticals counts. Dental treatment is the largest reason for US
medical travel. With 20% of the US
population living in the south west (largest segments being Hispanics and
retirees) many American dentists have
set up practices in Mexico where they can charge considerably less than they
would just over the border.
From your research and your knowledge of
the international marketplace what do you think are the biggest upcoming issues
in international healthcare?
My theory is that there will never be enough health care
available throughout the world to satisfy consumer demand. I believe that there
are a number of factors that will contribute to this and have an impact on the
provision of healthcare and medical travel. Firstly the population throughout the world is
ageing and older people generally require more healthcare than younger people.
The Western world is in recession but the emerging markets and newly
industrialised countries like India and China are experiencing rapid economic
growth and as a result the consumer class in India and China is growing
rapidly. Business Week recently reported on the growing affluence in these two
countries and estimate that together they have a middle class of 1 billion
people. As they get more money these
people are going to want to buy more healthcare. Our need for quality
healthcare is now insatiable, for example people go for diagnostic tests even
when they don’t need to because they can afford to – the worried well.
Additionally as the population ages they will visit healthcare practitioners
three times more a year than when they were younger. All this will create an overload and a two
tier system, where people will go to public healthcare providers for the basic
stuff and private for more specialised and there will never be enough quality
healthcare to satisfy demand.
What other situations
are emerging that you believe will have an impact on medical travel?
As a result of this healthcare shortage investors from all
over the world are investing in healthcare.
One example is that one of the biggest private equity firms in the world,
The Carlyle Group, of which George W Bush is an investor, recently took a major
investment in Turkish healthcare system called Parkway. Turkey is an attractive
location for people investing in healthcare and retirement housing and the
country is preparing for an influx of Northern European and Russian
retirees. The cost of living is low, it’s
got a temperate climate, it’s in a great location and as a result is currently
getting a lot of direct foreign investments from US and Middle Eastern
investors. It’s being seen as a retirement haven and perhaps up to a million people
will retire to Turkey and they will want high quality healthcare when they get
I also believe that there will never have enough hospitals
in India because they can build the hospitals but there will not be enough
staff to run them and this applies across the world too. There are not going to
be enough doctors and nurses, because the population is top heavy and there
will not be enough medical staff to serve the ageing baby boomers. What will happen is that the rich will end up
with best healthcare and the majority will have to wait longer and pay more.
One thing that will drive medical travel is access to
cheaper medication, especially as increasing numbers of US go to Canada and
Mexico to get drugs. Also people will be
able to get hold of drugs and medical equipment before they have been approved
for use in the US and Europe. Drugs are available in India five years before in
UK, EU or US, so if you want the latest and best pharmaceuticals will have to
go to India if you don’t want to wait for them to be approved in the EU and the
How do you get
Most of our funding came from one study from Korea but we’ve
had other funding and the university gives us money too. We received $40k from
Korea and spent 50% of it on collecting data. Last year we received $5-6,000 in
donations. The University gave us money - $20,000 for past two years.
Are you affiliated to
any medical tourism associations or other commercial entities?
No we are not, we’re an academic based research center and
we’re “not for profit” and are not affiliate with any commercial enterprises or
associations. Renee Stephano of the MTA used
to be on the board, but not any more.
Over the last eighteen months several members of the board had raised
concerns that it was inappropriate for her to be on the board. We conduct
research across different regions and countries and work with different medical
tourism associations. The board felt the MTA is very aggressive in trying to mark
its territory and our board members didn’t want it to be perceived that we could
release confidential information to another board member that might be
prejudicial and give them biased information that another medical tourism
organisations and associations wouldn’t have access to. So at the end of 2010 board members voted on
new bi-laws that which said that the advisory board of the centre should not
have a member that is in charge of a medical tourism association because we want
to have the ability to seamlessly work with different entities and it not be
perceived that our data is going to one source.
We can be affiliated with associations across regions around the world
and do joint research with them no one from a medical tourism association can
be on our board.
What do you think
needs to be researched?
People need to realise that some of the things that are
going on in medical tourism are forerunners of other changes in healthcare
systems in the developed world. I believe we need to do more research to find
out what is going to happen. For example research needs to be done into the
emergence of medical hubs and healthcare clusters and that patients are going
to have travel internally in their own countries for healthcare as these
clusters and hubs develop. As more information is available on medical outcome
data, you’re going to see more and more medical travel to specialist areas. If
you are not near a specialist area you will go have to travel and I believe
this will happen around the world. I suspect we’ll see that healthcare facilities
in many rural areas will be non sustainable in the future.
Date published: 4 February 2011
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