Introduction
Initial Situation
Recently, the industry of medical tourism gained significant traction, which led to the opening of numerous clinics focused on providing care for foreign customers in many countries worldwide. The trend is particularly evident in Asia, which has become one of the main destinations for people seeking treatment.
Problem
The global pandemic caused by the spread of the COVID-19 virus and the international borders’ closures which ensued had a direct impact on the sphere. The purpose of this research is to assess the implications of these events for medical tourism in Asia, determine their nature, and analyze the possible ways for hospitals to benefit from them. Thus, the paper poses the following questions: Has the pandemic negatively affected medical tourism in Asia? How can medical tourism providers take advantage of the pandemic in improving their products?
Relevance of the Current Research
The research on this topic is limited, and the current study aims at discovering evidence which will provide insight into the problem. The findings established during the research can serve as a foundation for future educated decisions on the part of governments and medical tourism providers.
Methodical Approach
The methodology utilized in this study implies conducting a search on the Internet to discover relevant sources, both academic such as peer-reviewed journals and popular ones including newspapers.
Definitions of Health Tourism and Medical Tourism
Defining Health Tourism
Before assessing the impact of the COVID-19 pandemic, a distinction must be made between health, and medical types of tourism, as well as appropriate definitions for both phenomena, have to be presented. Over the years, researchers proposed a large number of possible definitions for health tourism, all of which cover various important aspects of this type of travel. For example, according to the World Tourism Organization (2018), health tourism constitutes “Forms of tourism which have as a primary motivation the contribution to physical, mental and spiritual health through medical and wellness-based activities.” Moreover, Mainil et al. (2017) stated that health tourism involves three key categories such as medical tourism, wellness tourism, and spa tourism. Thus, in this paper, medical tourism will be defined as a type of travel with an intention to participate in medical, wellness, and spa activities in order to improve one’s health.
Defining Medical Tourism
As it was mentioned before, medical tourism is usually viewed as one of the categories of health tourism, which constitutes a more general term. Nevertheless, it is important to identify all the characteristics of medical tourism to continue exploring the topic of the effect of the pandemic. According to De la Hoz-Correa et al. (2018), medical tourism is “Travel across international borders with the intention of receiving medical care… motivated by an interest in cost savings and/or avoiding waiting times” (p. 200). This activity involves undergoing a variety of medical procedures, including cosmetic and dental surgeries, cell and tissue transplantation, check-ups, and diagnostics. Béland and Zarzeczny (2018) wrote that individual motivations for medical tourism might vary and include a desire to improve quality or access treatments which are not legal or available in the patient’s home country. Thus, in this paper, medical tourism will be defined as a type of health tourism which implies traveling abroad to obtain medical services.
Advantages of Medical Tourism from the Perspective of the Destination and the Customer
Benefits for the Destination
Medical tourism destinations are numerous and can be found on different continents and parts of the world, including countries in Asia such as China, South Korea, and Singapore. Medical tourism significantly contributes to these nations’ economies and grants them a chance to earn considerable amounts of money. A study conducted by Beladi et al. (2017) demonstrated that medical tourism had a positive effect on a country’s economic growth. Similar findings were reported by Ile and Tigu (2017), who wrote that medical tourism could contribute to a developing country’s growth if it was used as a part of its national strategy. Such evidence shows that medical tourism can be an important factor for the economic success of the destination.
Despite the fact that the primary goal of individuals traveling abroad to improve their health is to receive medical care, on their trips, they also use other services. For example, medical tourists rent apartments or live in hotels, as well as dine at restaurants, which benefit from the influx of foreigners caused by medical tourism. Additionally, this type of tourism provides local medical facilities with financial resources necessary for paying high salaries to the personnel, buying costly equipment, and training the staff, which further attracts more customers from abroad.
Benefits for the Customer
People who choose to receive medical services abroad tend to do it due to different factors and circumstances. One of the most popular motivations of such individuals is a desire to save money and obtain medical care for a smaller price compared to the rates in their home country. Developing nations usually have a skilled labor force capable of conducting advanced health-related procedures but low wages and salaries in contrast to the developed nations. This allows local hospitals to provide services to foreigners at prices which remain affordable for them despite their additional expenses for travel and accommodation.
In other situations, people engaging in medical tourism decide to travel to foreign countries due to the fact that there they can receive better-quality services than at home. Typically, these people are not concerned about prices and will be ready to pay extra for the chance to undergo treatment in a foreign clinic. Moreover, there also instances when individuals undertake medical tourism in order to receive services which are illegal in their countries. For example, many U.S. citizens travel abroad to undergo a stem cell transplantation surgery due to restrictions imposed by the Food and Drug Administration (Greene, 2019). Thus, people are forced to seek options elsewhere to receive treatment, which can be vital for their health.
Disadvantages of Medical Tourism from the Perspective of the Destination and the Customer
Negative Effects for the Destination
Countries with a strong industry of medical tourism also experience certain problems caused by the success of this phenomenon. For example, Beladi et al. (2017) noted that the development of medical tourism might cause shortages of professionals in host countries since many healthcare specialists focus on acquiring skills which cater to foreigners’ needs. On the other hand, the number of medical tourists usually does not surpass the size of the local population, which means that destinations’ public healthcare systems still can meet the demand of the citizens. Yet, Cohen (2017) stated that the supply of professionals in the destinations is not elastic, which negatively impacts the destination’s ability to increase the number of specialists to respond to the citizens’ needs. This eventually may cause healthcare prices for the locals to rise, which can prevent some demographics, especially the most vulnerable segments of society, from receiving appropriate medical treatment and services. Thus, destinations have to be aware of the potential problems caused by medical tourism and take measures to ensure that a balance between the demand and supply is observed.
Negative Effects for the Customer
People traveling abroad to receive treatment also may face certain challenges related to the process of medical tourism, which can potentially affect their health and wellbeing. For example, such individuals can suffer from low-quality services due to doctors’ incompetence or failure to follow proper guidelines for a procedure. Such situations are more likely to occur in less developed countries where lax regulations exist concerning the healthcare sphere. As a result, doctors may receive certifications despite failing to pass the exams required for their qualification. People who travel abroad to decrease the costs for a medical procedure can accidentally become patients of unskilled doctors and potentially experience harm to their health.
Additionally, problems concerning the language spoken in the destination country may occur, which can also entail significant implications. For example, a tourist can incorrectly understand the cost of the procedure or certain contraindications relevant to them and suffer serious damage to their wellbeing. Moreover, patients who undergo surgeries tend to require follow-up visits in their home countries, and all the healthcare records related to the procedure performed abroad can be absent. Finally, medical tourists risk their safety when traveling to remote locations and especially to countries with high crime rates where they can be robbed, manipulated, or even murdered by the locals.
Medical Tourism’s Popularity in Asia
Government Policies
Asia is one of the primary medical tourism destinations for people from all over the world, and there are certain factors which contribute to this situation, including political leadership’s decisions. For example, in Singapore, the government introduced public-private partnerships in the sphere of healthcare and created the “Singapore Medicine” initiative to promote the country as an international medical hub (Ganguli & Ebrahim, 2017). The involvement of the public sector in the process of building a system which welcomes foreign patients became a significant force behind the success of Singapore as a medical tourism destination. Moreover, private companies provided important resources and financed building new facilities and training staff in order to offer advanced medical care, which constitutes the country’s competitive advantage. Thus, by working closely with the government and the private sector managed to make the country a popular place among people willing to receive medical services abroad.
Focus on International Visitors
Another major factor which enabled many Asian countries to become successful in the sphere of medical tourism was the Asian financial crisis. As a result of this event, many locals, especially in the countries such as Malaysia and Thailand, could not afford paying for private healthcare, which forced the hospitals to focus on foreign customers (Kim et al., 2019). Many medical facilities received international accreditations to attract visitors from abroad and gain a competitive advantage over other players in the industry. The plan to become tourists-oriented was successful and made Asian nations extremely popular among people from other countries. Thus, many of the hospitals in Asia specialize strictly in providing services to foreign clients, which allows them to be independent of the local demand and, as a result, financially stable. This lets these institutions have enough resources to upgrade their facilities and equipment to attract even more customers.
Low Costs
Finally, the most significant reason why medical tourism in Asia is popular among international visitors is the fact that for foreigners, it is often much cheaper to go overseas to receive treatment. Hospitals in countries such as India and Thailand are able to provide medical services at a fairly low price even compared to other destinations in Asia, including Singapore (Ebrahim & Ganguli, 2019). Moreover, these countries offer a large variety of possible procedures and surgeries which can appeal to patients with different conditions. Ultimately, competitive pricing and good quality of services attract numerous clients from other parts of the world and promote further the popularity of these destinations.
Status Quo of Medical Tourism in Asia Pre-Pandemic
Stable Growth
As it was mentioned earlier, the sphere of medical tourism is a significant one and has been developing rapidly over the past decades, which allowed some Asian countries to become popular destinations. Before the COVID-19 pandemic, the nations in Asia which provided healthcare services to foreigners experienced sustainable development and growth, attracting more patients each year. For instance, in South Korea, the total number of medical tourists increased from twenty-seven thousand in 2008 to more than three hundred sixty thousand in 2016 (Kim & Seo, 2019). This large influx of new clients positively affected the country’s hospitals, which gained significant income.
Moreover, South Korea is not the only example of a nation where medical tourism became extremely successful, there are also countries which relatively recently entered the market and already managed to reach good results. In 2018, Vietnam earned a total of one billion dollars in revenue from medical tourism, and the country welcomed eighty thousand patients from abroad (Thomas, 2019). It shows that before the beginning of the pandemic in 2020, Asian counties, both with developed and emerging economies, demonstrated stable growth. Additionally, there were indications that the trend for medical tourism would develop even further in the future.
Leading Positions at Home and in the World
It is important to determine how significant the industry of medical tourism was for the economies of Asian countries before the onset of the COVID-19 pandemic. According to one report, in 2019, in all of the ASEAN nations, private hospitals received at least one-third of their revenue from medical tourism, and the growth would continue (Thomas, 2019). This information demonstrates how important this sphere for the hospitals in Asia and makes it possible to assume that the pandemic had a significant impact on their financial stability. Nevertheless, it also shows that there is a lot of potential for medical institutions in Asia.
Moreover, this flow of international tourists to Asian countries contributes to its global standing compared to other popular destinations. For example, as of 2018, South Korea was ranked second among the world’s leading medical tourism destinations, and its industry was valued at six hundred and fifty million dollars (Michas, 2019). While Thailand occupied the fourth position with the value of six hundred million dollars (Michas, 2019). Nevertheless, the U.S. was ranked first, which shows that there is an opportunity for Asian countries to attract some portion of the patients who go to America.
Medical Tourism Destinations in Asia and Treatment Options
South Korea
As it was mentioned earlier, South Korea is one of the leading markets in the sphere of medical tourism, and it achieved this status due to the excellent level of services provided there. The primary area of medical services provided to foreign visitors there is esthetic surgeries, which are also popular among locals (Kim & Seo, 2019). The country has many exceptionally professional surgeons with great expertise in the sphere of cosmetic procedures, which attract people from other countries. One of the most popular surgeries provided by doctors in South Korea is double eyelid surgery, which creates a double eyelid after removing excess fat.
Singapore
Another popular destination in Asia is Singapore, which also has experts who can conduct the most advanced surgeries using state-of-the-art equipment. As a result, the country’s hospitals provide customers with complex procedures and diagnostics in the sphere of organ transplantation and oncology (Ebrahim & Ganguli, 2019). The prices for such surgeries are rather high, but clients from western nations still find them more affordable than at home. Thus, Singapore’s strategy is targeted at offering rare and sophisticated procedures for those who have enough resources and are willing to pay.
Thailand
Thailand is a developing nation, and its primary competitive advantage is low pricing for services, yet, there are still certain surgeries which are performed best in this country. For example, the local hospitals and clinics specialize in sex change, liposuction, and breast enhancement, in other words, niche services, which nevertheless attract many clients (Ebrahim & Ganguli, 2019). Thailand is a large market for medical tourism, and the range of treatment of options is extremely diverse, and it is obvious that there are other procedures offered here.
India
India is a relatively new player in the market of medical tourism since historically, it focused mostly on wellness options based on its traditional healing practices. Nevertheless, today the industry is growing, and Indian doctors offer various treatment options to foreigners, including orthopedic, craniofacial, and cardiac surgeries (Ebrahim & Ganguli, 2019). The country is able to provide low-cost procedures, facilities which received certification from international agencies, and have competent professionals who can conduct fairly complicated surgeries. It also has many private enterprises working in the sphere of medical tourism, which established ties with the hospitals in Africa which supply them with patients.
Effects of the Pandemic on Medical Tourism in Asia
The Reduction of the Number of Tourists
The COVID-19 pandemic had a significant impact on Asian economies and industries, including travel, which in turn severely affected medical tourism in these countries. According to World Tourism Organization’s World Tourism Barometer (2020), over the period from January until October, Asia experienced an 82% drop in the number of arrivals compared to the previous year. This was largely caused by the restrictions on travel imposed by countries worldwide in order to combat the spread of the virus. The lockdowns prevented potential medical tourists from going abroad to receive their treatment and instead forced them to use the services of the local clinics.
Moreover, there is also data concerning the impact of the pandemic on medical tourism worldwide specifically, which shows even greater effects. As reported by one agency, medical travel booking in 2020 decreased by 89% among the most popular destinations, including Asian countries such as Thailand and South Korea (Yeginsu, 2021). In Singapore, border closures led to the loss of the majority of foreign clients by the private healthcare groups (Goh, 2021). The implications of the worldwide pandemic have been immense for the industry of medical tourism in Asia, especially on the number of patients who could potentially visit local hospitals.
Economic Effects
As a result of the reduced flow of potential customers, the medical facilities in Asia, which focused on providing services to foreigners, also suffered serious financial losses. For example, Bumrungrad International Hospital in Thailand forecasted that in 2020 it would lose 28% of its potential revenue since half of its patients are usually from abroad (Tatum, 2020). This situation entails far more problems for such facilities since the lack of resources may result in the clinic’s inability to invest in staff training and new equipment. Moreover, if lockdown measures continue into the next years, hospitals oriented towards foreigners risk going bankrupt.
The Future of Medical Tourism in Asia
Reaction of Tourists
It is uncertain how tourists will behave after the restriction will be lifted, but there is still a variety of possible scenarios which may take place in the future. One of the potential effects of the pandemic can be people’s unwillingness to travel abroad, fearing for one’s safety and health. Individuals also may be scared to visit foreign countries since they will not be sure how to behave properly under the new circumstances. For example, in some locations, tourists may have to spend a two-week period in isolation before being allowed to enter the country. On the other hand, a recent study which explored the notion of the pandemic-induced “travel fear” showed that most affected people were ready to travel in four months after the removal of restrictions (Zheng et al., 2021). This makes it possible to assume that when the lockdowns are eased, medical tourists might gradually return to the Asian hospitals, not being afraid of contracting the virus.
Forecasts On Performance After COVID
There are also official forecasts concerning the sphere of tourism after the COVID-19 pandemic and the lifting of all the restrictions related to it. For example, World Tourism Organization (2021) conducted a survey which demonstrated that people expressed low certainty about the possibility of international travel in 2021 due to potential new restrictions. This means that medical tourism is not likely to quickly rebound this year, and hospitals in Asia will be left without a large number of foreign customers. On the other hand, the report also showed that domestic and close-to-home travel would be the major trend of 2021, which opens prospects for the healthcare providers. For example, facilities which previously specialized in providing services to foreign patients can now focus on the local population or the visitors from the neighboring countries. Thus, clinics will be able to partially compensate for their losses caused by the pandemic and the restrictions imposed on international travel.
There are already instances of situations when people travel to neighboring countries to receive medical treatment despite the pandemic and possible repercussions. For example, some American citizens do not want to overpay for certain procedures at home and choose to travel to Mexico. There are many developing nations in Asia and Southeast Asia which do not possess advanced medical facilities and need treatment for their conditions. The hospitals in Thailand and India could easily accommodate those individuals and provide them with cost-efficient services. Moreover, during the pandemic, some private clinics can admit patients with the virus, especially those who are ready to pay extra for comfort and additional services. The revenue from such activity will not match the profits which could potentially be gained by serving foreigners from wealthy countries, but it will still constitute a reliable way to earn money.
Latest Developments
It is clear that the COVID-19 pandemic had a substantial negative impact on the medical tourism industry in Asia, but it also brought new opportunities for the providers of services. Despite the fact that the recent events concerning lockdown and border closures decreased the inflow of tourists, new players still appear in the market. For example, in Singapore, opened the first confinement luxury hotel which offers both prenatal and postnatal care for pregnant women (TTG Asia, 2021). This shows that investors are still optimistic about the industry’s future and are ready to present customers with new options in the sphere of medical tourism.
Some Asian countries’ medical tourism industries suffered more severely as a result of the pandemic than others and have to rely on assistance from the authorities. In Malaysia, many healthcare providers hoped that in 2020 they would welcome numerous patients from foreign countries, but the spread of the virus interfered with their plans. The local government decided to help the members of the industry and allocated eight million dollars to promote the medical travel sector, as well as introduced tax exemptions for the clinics (TTG Asia, 2021). The move of Malaysia’s authorities is the right strategy to revitalize the market and ensure that the temporary changes in the demand will not eradicate the prospects of future growth.
Latest Trends
The pandemic also motivated some countries in Asia to start new trends and offer additional advantages for tourists traveling abroad for medical purposes. For example, recently, Thailand’s ministry of health developed a new educational module to promote the use of marijuana in cosmetics and meals (Chuwiruch, 2021). The local medical facilities also can benefit from this by implementing into their healthcare practices new remedies based on the plant. Visitors from other countries can be particularly interested in the innovative treatment options and opt for Thailand as their medical tourism destination due to this factor. This makes it possible to assume that this trend can be potentially espoused by other countries in Asia as part of their post-pandemic initiatives to attract clients and stay competitive.
Potential for Improvement
There are other ways which healthcare providers engaged in medical tourism can utilize in order to take advantage of the pandemic. For instance, clinics and hospitals can reassess their value chain and remove all factors which do not generate any profits. These can include superfluous workers whose duties can be shared among other employees, outdated or ineffective methods of delivering care, procedures which do not contribute to patients’ comfort. Hospitals also can introduce new treatment options by training the current personnel and providing them the most relevant knowledge about their areas of expertise. Essentially, all of these efforts must be aim at achieving a competitive advantage in the market by lowering prices or offering exclusive treatments to attract international customers reluctant to travel after the pandemic. According to a study conducted in the sphere of medical tourism, cost management and knowledge of foreign languages by the personnel positively affect the organizational performance of hospitals (Ghasemi et al., 2020). The period when there are not many clients is an excellent time for hospitals to better their internal operations, experiment with different approaches to improve efficiency and quality of services.
Conclusion
Answer to the Research Questions
The pandemic negatively affected medical tourism in Asia because it substantially limited the influx of foreigners into the countries, and as a result, the hospitals could not accommodate their customers and experienced financial losses. Nevertheless, the providers can take advantage of the pandemic and focus on refining the quality of their services by training the personnel, offering new treatments, and decreasing prices by cutting costs. These processes will increase organizational performance and attract new customers, especially those from neighboring countries, since the pandemic caused a trend of close-to-home travel.
Overview
Medical tourism in Asia is a popular industry, and it is important to assess the effects of the recent pandemic on this sphere, as well as to outline potential recommendations for future decisions. Visitors from foreign countries travel to Asian nations to receive healthcare services due to their low costs, and excellent expertise of the local doctors. The governments in some Asian nations also contributed to the development of the sphere by adopting policies which facilitated the activity of providers. Before the onset of the pandemic, the industry was extremely successful and exhibited stable growth over the course of the past decade. Yet, the rapid spread of the new virus and international travel restrictions undermined this development. Still, the providers are optimistic about the future and continue to open facilities, as well as offer new services to stay competitive after the pandemic.
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