In this chapter, a number of definitions on Medical Tourism have been provided. The author has also included different aspects on this burgeoning industry namely its presence in the world as well as the degree of its penetration in Mauritius, the structure of Health Tourism passing through a SWOT Analysis related to the Mauritian context and then concluded with an overview on the existing legal frameworks.
Definitions of Medical Tourism by different authors
Medical Tourism or Medical travel is the act of travelling to different countries to undergo medical treatment such as cosmetic surgeries, dental surgeries, or general surgeries. Medical Tourism is a new term but not a new idea. Patients have been travelling since a long time in search of better care. Medical Tourism or health tourism has been defined by Connell (2006:2) as a “popular mass- culture where people travel often long distances to other destinations such as India, Thailand, and Malaysia to obtain medical services such as dental, cosmetic and non-cosmetic care and at the same time enjoying their holidays”. He also added that medical travel is the pursuit of medical care aboard and simultaneous engaging in a more conventional form of tourism.
Some reliable research literature has focused on the apparent motives of medical tourists in departing abroad for medical treatment such as financial reasons, waiting times, and the unavailability of desired treatment in the prospective medical tourists’ own countries of residence (Awadzi and Panda, 2005, Connell, 2006). Another definition was cited in the Medical Tourism report (2006), where Medical Tourism was defined as any type of travel from one’s usual place of residence to another destination to undergo medical cares. Health Tourism has also been defined by Goodrich & Goodrich (1987:217) as the challenge on the part of a destination to attract tourists by promoting purposely its health-care services and facilities adding to its usual tourist facilities.
Moreover, Medical Tourism is a phenomenon that occurs when international patients travel across boundaries for their healthcare and medical needs. For instance every day, millions of North Americans, Europeans and Arabs are travelling to different countries for medical treatment.
Medical travel can also be defined as “cost effective” medical treatment in association with the tourism industry for international patients willing to perform any types of surgical procedures (India Medical Care, 2007). Keckly and Underwood (2008) noted that Medical Tourism is when one is leaving his place of residents in order to receive treatment elsewhere. In addition, according to Horowitz and Rosensweig (2007) have argued that, “medical tourists” try to find latest health care at reasonable prices in countries at variable levels of development.
According to Awadzi and Panda (2005), the term Medical Tourism refers to the offshore provision of medical services in combination with the other tourism opportunities by using comparative cost advantage as the leverage point.
Researchers have documented that Medical Tourism is an action whereby patients of curable diseases choose to travel offshore with the purpose and confidence of receiving appropriate health facilities. These patients expect to be offered a high class treatment in a very comfortable atmosphere. Medical Tourism does not mean that the tourists will be satisfied only in the sense of site-seeing; rather it means that these medical tourists are undertaking a highly sensitive journey where their health is the main focus.
An anonymous researcher clearly defined the birth of Medical Tourism as “Knowledge, technology, equipment, medicines, and other elements of healthcare system while crossing the national borders without any constraint of nationality, race, religion or creed.
Hence, we can say that though different authors interpret the term Medical Tourism in their own way, at the end the meaning remains the same.
History of Medical Tourism
Medical Tourism is not a new concept. The history of Medical Tourism started with people travelling to other countries for medical treatment. This is related back when Greek holidaymakers were traveling from the Mediterranean to Epidauria, a region situated in Saronic Golf. It was said that the “Saronic Golf” is also known as the “Healing God”. Hence, it was recorded in the Medical Tourism history that Epidauria is the original destination for Medical Tourism. Later, in the 16th and 17th centuries, spa towns such as St Moritz and Bath became prime destinations for the European upper classes to soothe their illness. Hence, spas may be considered as an early form of Medical Tourism (Indian Tourism Medical Industry: growth opportunity and challenges by shikha Rastogi Grag & Anu Bhawraj).
During these centuries, people visited spas because it was said that the mineral water found there was treating diseases such as tuberculosis, bronchitis liver diseases, among many others. Dental surgery, cosmetic surgery and other types of surgeries are relatively a new phenomenon (Understanding medicaltourism)
Moreover, over the past few years, people have been travelling to many developed countries for medical treatment. However, since this field is being seen as a high source of income, even developing countries are promoting Medical Tourism. Medical tourists have understood this strategy and are progressively approaching developing countries due to their affordable medical services.
Health Tourism Structure
Health Tourism is the word coined to wrap the different constituents of providing healthcare facilities to international patients. Medical Tourism is of the branches of Health Tourism. The structure of Health Tourism has been illustrated in Table below. As stated in Chapter 1 of this study, the researcher will focus only on Medical Tourism.
Table : The structure of Health Tourism
Medical Tourism around the world
Medical Tourism is becoming an emerging universal fashion. Every day more and more people are opting for medical care aboard. We should thus ask ourselves: “Why do people prefer to travel for long distances rather than receiving medical treatment in their countries? “This answer relies in two elements: a) cost and b) quality of health care. That is they look for a place where they can get reasonably priced top-class health treatment. With time, foreign patients have been able to visit many parts of the world in order to meet the above mentioned two critical ingredients to qualify as a good Medical Tourism destination. Research shows that the below listed seven countries are the most preferred Medical Tourism destinations in the world:
Panama is classified as the top Medical Tourism destinations, by attracting mainly US and Canadian patients. It is considered as one of the best and famous place in the world to undertake costmetic and non cosmetic treatments. This is because of its outstanding healthcare services, latest technology, safety and low cost for medical care and hospitalization.Treatment in Panama is also highly regarded as doctors are bilingual, board certified and they used to work with the similar medical apparatus used by European medical tourism destinations. Factors contributing for the increase in health tourism in Panama are its natural attractions, cultural diversity and its strategic and geographic position. The common medical procedures undergo by international patients are cosmetic surgeries(healthtourism, all medicaltourism.com, Medical Tourism: Global Competition in Health Care by Devon M. Herrick)
Brazil can be said to be the international Mecca for cosmetic and plastic surgeries. It is categorized as the world’s second leading market for the treatment of plastic surgeries. Many tourists, particularly women, travel to Brazil to enhance their physical appearances. Brazil has lots of qualified surgeons and hospitals equipped with sophisticated technologies. Surgeons use the latest cutting-edge techniques to offer patients with treatments such as facelift, liposuction and breast implants. Cosmetic and plastic surgeries are the most demanded treatment of foreign patients (Nuwire Investors)
Besides its cultural, antique and natural charms, Malaysia is on the track to mark itself as a low priced and sophisticated healthcare hub in Asia ( By Elaine ANG). Malaysia is classified amongst the world top six Medical Tourism destination (Nuwire investors)Medical Tourism has been expanding rapidly during these recent years. People from several countries are seeking healthcare treatment there. Malaysia has become a centre of medical excellence because of its high quality medical facilities and services and also it has a great number of well trained and qualified medical specialists(Tourism Malaysia, 2007) Thirty five private hospitals have been identified as the key drivers for medical tourism for this particular country. The number of health travelers in search of healthcare services in Malaysia has increased from 75,210 patients in 2001 to 296,687 patients in 2006, representing an increase of over 290% over 5 years.
Moreover, the total number of medical tourist arriving in the country has reached 425,500 in 2009. It has also been estimated that in 2012 medical tourists in Malaysia would reach 689,000. International patients and investors are attracted to Malaysia because of its favorable exchange rate, political & economic stability and high rate of literacy ( Nuwire investors) The common medical treatments that international patients seek in Malaysia are: cosmetic treatment including rhinoplasty, eye surgery, facelift, cardiac procedures and fertility treatments.
Costa Rica is renowned to be both a popular tourism and Medical Tourism destination. It has excellent medical and health care facilities which are world widely certified. The medical providers in Costa Rica offer modern technology and protocols. Costa Rica is considered to be the only medical destination in the world that has 100% of private hospitals that have earned JCI accreditation which helps to boost up Medical Tourism in the country (costaricanmedicalcare). There are several factors that have contributed to the success of Costa Rica as one of the top destination for international patients and some are political stability, friendly environment, affordable price of treatments, high rate of literacy, geographically well located and quality of service. Some popular medical procedures in Costa Rica are cosmetic and plastic surgeries, dental treatment, orthopedic and ophthalmology.
India has the lowest cost and highest quality as compared to all Medical Tourism destinations (Report for National Center for policy Analysis, NCPA) Many hospitals are accredited by the JCI and there are lots of highly trained doctors. India’s Medical Tourism sector is expanding at a very rapid increase with approximately 500,000 medical travelers in 2005 as compared to an estimated 150,000 patients in 2002. Experts estimate that health tourism could bring about $2.2 billons in 2010 (University of Delaware’s u- daily news). Medical tourists prefer to choose India as their healthcare destination because of the presence of efficient infrastructures and advanced technology. Common treatments undergo by international patients in India cardiovascular, orthopedic, correction of eyes, dental care, cosmetic surgeries, cancer diagnosis and knee transplantation.
Thailand has gained the title as an incredible Medical Tourism destination. The Thai country has several hospital internationally accredited hospitals which offers diferent types of medical treatments, starting from organ transplants to dental and cosmetic surgeries. The hospitals use latest and sophisticated technology and delivers outstanding quality of health care to their patients.
Reasons for choosing Thailand as a medical destination
Personal care is provided to patients;
Extra services such as language translation which are of great help to foreign patients are offered;
High involvement of the Thai governement to promote Medical Tourism;
Presence of well-trained doctors from the United States;
Most of the doctors and staff speak English.
( Medical Tourism cooperation- Thailand official websites)
Singapore is known for its effectiveness in providing outstanding healthcare services. It is a multi-faceted regional medical hub, both for medical services and also the right meeting place where health conferences and fairs can take place. Singapore is classified as a leading healthcare hub in Asia. It attracts nearly 200,000 international patients per year. Singapore is a said to be a world class city. It is politically stable, peaceful and safe. One of the goals of the Singapore government is to attract over a million overseas patients in 2012. Its neighboring competitors are Thailand and Malaysia( asiasmedicaltourism)
Reasons for choosing Singapore as a medical destination
Top quality healthcare services
A very neat country
Low crime and high security rate
Medical Tourism in Mauritius
This section provides an overview of Medical Tourism in Mauritius. We will look at the healthcare facilities that are offered by the country to its patients. The reasons as to why Mauritius can be chosen as a Medical Tourism destination have also been set out. This section wraps up with some information on the medical infrastructures available in Mauritius.
An overview of Medical Tourism in Mauritius
Many researchers call Mauritius, “Magic Mauritius” as even without any fortune making natural resources, it has the ability to create economic pillars maintain its development. In its portfolio, sugar production, textile industry, offshore banking, tourism and ICT are included and now a new economic avenue looks reachable and it is called the Medical Tourism. With around 1000 medical tourists in 2005, reaching some 12,000 in 2011, BOI is targeting around 100,000 in 2020. “Every ten years, as if by magic, Mauritius has pulled out of the hat an economic pillar which has made of this island ‘the example’ to be emulated by African states”( Invest Mauritius 2011).
Over, the past few years, Mauritius has experienced an increase in the arrival of international patients. Having lot of qualified doctors, medical personnel and private clinics which are sophistically well equipped with the latest technology, Mauritius is also geographically well positioned to expand its healthcare sector. As said by officers of BOI: “Maurice is clearly on track to become the center of excellence in medicine and a hi-tech hub of Medical Tourism”(Muslim Times 2011) Medical Tourism is not a new concept in Mauritius as clinics have been treating tourists since 12 years. Medical Tourism is considered as a niche market for the tourism industry and continue to blossom due to the high service quality and treatment available in Mauritius. The prices of procedures equal to one third of the European prices and this is one of the main motives for the high influx of medical tourists. Moreover, Mauritius has an upper hand on other countries as apart from the core medical services, medical tourists have the opportunity to spend their convalescence period in an idyllic surrounding.
The Mauritian Government is not leaving any stone unturned in its effort to promote Medical Tourism. The most recent example lies in the Mauritian National Budget 2012, whereby the authority exempted VAT on cosmetic surgeries so as to make the cost of these procedures more competitive. The expected reaction to this measure is of course to boost the Medical Tourism activities.
As per BOI’s records, the medical sector in Mauritius contributed around 3.7% of the GDP over the past four years and the growth rate in this sector in year 2011 is 6.3% as compared to 2010. The number of medical workforce is also increasing to accommodate for the increase in demand for medical services. Figure below shows the change in the total number of medical staffs for the period 2006 to 2010(BOI survey 2012)
Figure : Increasing trend of Healthcare specialist over the past 5 years
Source: invest Mauritius
Reasons for choosing Mauritius as a Medical Tourism destination
Large network of professional private clinics
Political and social stability
Geographically well positioned
Most of the doctors or other medical stage are multilingual
State-of -art of medical facilities
Direct flight from and to Mauritius
Compared to other countries, Mauritius offers better treatment at lower prices
Latest development in term of technology and infrastructure
Most of the doctors are trained in European countries
Medical infrastructures in Mauritius
Mauritius is quite rich in terms of medical infrastructures. It also encourages trainings of the medical professionals. Due to the friendly relationship that Mauritius has with other countries, it benefits from the knowledge of universities of countries such as France, UK, China, Australia, Egypt, Russia amongst others. The availability of healthcare infrastructures is illustrated in figure below.
Figure : Medical Infrastructures in Mauritius
(Source: BOI brochure)
Key drivers/ Players of Medical Tourism in Mauritius
A number of key players/drivers are present in Mauritius to ensure the growth of Medical Tourism. Some has been listed below:
Apollo Bramwell Hospital (ABH)
Fortis Darné Clinique
Clinique du Nord
Clinique de Greffe de Cheveux in Trou Aux Biches
Apollo Bramwell Hospital (ABH)
ABH is the largest healthcare group in Asia. Since 2006, a branch has been implanted in Mauritius. ABH Mauritius is situated in the district of Moka. This hospital has been built in such a way that it can reach international standard of patient care. Under one roof itself, one can find a hospital equipped with superior technology and well qualified medical expertise. It has been constructed to provide first class medical facilities for both national and international patient. ABH Mauritius is the largest private hospital in Mauritius and in the Indian Ocean. It has all the necessary requirements in term of latest sophisticated medical equipment and expertise to cure international patients. Its aim is to ensure that patients are provided with top quality services and safety all level. Below is a list of medical services and advance technologies offered by ABH:
The medical Services provided allocated to different divisions namely:
Department of Plastics and Cosmetic Surgeries
Department of dermatology
Department of physiotherapy
Department of Paediatrics & Neonatology
Department of dental services
Department of otolaryngology
Super specialty clinics and other Centers
Moreover, the diagnostics department is fully equipped with the latest equipment and skills technicians. This consists of:
Picture Archiving and Communication System (PACS)
PACS technology is now used by most of the top hospitals of the world. It is an automated and filmless information system for obtaining, organizing, transferring, loading and presenting different types of medical descriptions comprising of x-rays, MRI and endoscopy. With this introduction, ABH are able to offer the utmost standards quality of services. PACS allows fast broadcast of images to doctors in critical areas thus minimizing delays in diagnosis.
Electronic Medical Record (EMR)
EMR refers to electronically maintained online medical records which replace the heavy and cumbersome physical files of the past which were restricted in accessibility. EMR can be accessed at multiple locations by multiple users for reducing errors in medication and delays in monitoring patients.
High Field Strength MRI
Magnetic Resonance Imaging(MRI) with Achieva 1.5T SE provides uncompromised quality in challenging applications like large field-of-view for abdominal and breast imaging, uniform fat suppression in all anatomies and consistent off-center imaging, across patients of all heights and body weight.
Whole Body MRI
Whole Body MRI is effective for evaluating the entire skeleton in patients with suspected bone metastasis (cancer that spread to the bone from other parts of the body) in a single imaging scan – and it only takes between 15 and 19 minutes. Besides its accuracy and quickness, the fact that it is an MRI scan means it is non-invasive and there is no radiation risk to the patient. Whole Body MRI can also detect metastases in other parts of the body besides the bones, such as in brain, liver or lungs.
Hence, it can be said with all its latest medical technologies, ABH is well situated to become one of the most popular clinic in the Indian Ocean attracting medical tourists from African and European countries
(Source: Apollo bramwell website)
Clinique Fortis Darne
Clinique Fortis Darné is one of the oldest clinics but yet modern medical service provider in Mauritius. Strategically situated in the centre of the Island, Clinique Fortis Darné provides first class medical facilities with the help of advances technology. Clinique Fortis Darné has lot of specialized departments in various areas of healthcare. The vision of Fortis Darné is: “To be a globally healthcare organisation known for Clinical excellence and Distinctive Patient care”. The clinic offers panoply of integrated services through different centers. Below are the lists of medical services that Fortis Darné offers
Table : Medical services offered by Fortis Darné
Maxillo Facial Surgery
Plastic & Reconstructive Surgery
Obstetrics & Gynecology
General Surgery & MAS
(Source: Fortis Darné Websites)
Clinique du Nord
At Clinique du Nord, Dr Mukesh Sookundun has been offering his services to Medical Tourists for the last past 12 years. It is a private clinic with luxurious rooms. This clinic is situated near a white sand beach of Baie du Tombeau. Clinique du Nord has a team of specialists, doctors, nurses and other trained staff. It is said that, they provide first class medical treatment to both their national and international patients. The specialists make use of latest equipment and techniques. Clinique du Nord is one of the most reputable private hospitals where there are international medical experts. Apart being the specialist in ENT, the hospital is mainly recognized for its medical facilities that it provides to medical tourists. Hence, there are a wide number of international patients who visit this Clinique. Below is the list of medical procedures that Clinique du Nord offers (Clinique du Nord Websites & brochures)
Table : Medical treatment offered by Clinique du Nord
Plastic& Cosmetic Surgeries
Breast Enlargement and Reduction
The Indian Ocean Hair Grafting, Cosmetic Dentistry and Plastic Surgery Centre
This clinic is situated near one of the most attractive beaches of Mauritius, namely “Trou aux Biches”. It is said to be a five star center for hair grafting, cosmetic and plastic surgeries. This particular centre has 12 years of experience. It makes use of the latest technology and techniques. Most of the doctors are world renowned professionals (Indian Ocean hair grafting websites)
Table : Medical Treatment offered by The Indian Ocean Hair Grafting, Cosmetic Dentistry and Plastic Surgery Centre
Breast lift/ reduction
Plastic& Cosmetic Surgeries
Dent Care is located in the garden of an old sugar cane factory at Labourdonnais (Mapou) in the northern part of Mauritius. It is well known in the world of cosmetic and dental surgeries. Most of the doctors are trained in France and United States. Most of them are bilingual. They make use of the most up to date technology. It is said that treatment at Dent care can cost around 50% less than in other countries. Available medical services are:
Veneers and crown
(Source: Dent care websites)
SWOT Analysis For Medical Tourism In Mauritius
The Strength, Weakness, Opportunities and Threat (SWOT) analysis is a useful technique and strategy for understanding strengths and weaknesses and also for identifying both opportunities and Threats that a business can face. A new entrant like Medical Tourism requires such analysis. This strategy will help to have a better idea on the position of Medical Tourism in Mauritius. This mechanism can thus help in the development of effective and efficient marketing strategies to promote Medical Tourism in Mauritius. The SWOT analysis for Medical Tourism has been designed as per table below.
SWOT Analysis Table
Table : SWOT Analysis
Already a well-known tourism destination
Mauritius has a large network of professional private clinics
There are political and social stability
Mauritius is geographically well positioned
Most of the doctors or other medical staffs are multilingual
State-of -art of medical facilities in Mauritius
Direct flight from and to Mauritius
High cost in term of formation of staff and equipment
Slow governmental intervention
Investment cost are very high
Less accredited hospital in Mauritius
Absent of framework for Medical Tourism
High cost of tickets fares
Compared to other countries Mauritius provides better treatment at lower prices
Latest development in term of technology and infrastructures
Most of the doctors are trained in European countries
Creation of employment
Lack of governmental supports
Competition- we can have the same treatment from other countries and at low prices. Example of close competitors are South Africa and Malaysia
2.7.2 SOME FACTS AND FIGURES OF MEDICAL TOURISM IN MAURITIUS
An intense research has been done to have the latest break down on the arrival of Medical Tourists in Mauritius; the researcher has received that of year 2010, which has been illustrated below. However, an important information concerning year 2011 was received following a survey conducted on healthcare providers in Mauritius whereby BOI made the following statement “Mauritius expects the number of foreign patients seeking medical care on the Indian Ocean island nation to increase by 36% in 2011 as compared to 2010” . The same source added that “the number may even increase to 15,000 and also Mauritius has set itself a target of attracting 100,000 foreign patients by 2020”. This will presumably contribute about $1 billion annually to the economy.
Figure : Number of foreign patients visiting Mauritius in year 2010
(Source: BOI survey)
The above Pie-Chart illustrates the countries from which patients are mostly from and also the number of medical tourists landed in Mauritius in 2010. Mauritius does not only have a clientele in the Indian Ocean but also in France and UK, with 22% of Europeans recognizing our medical services. These figures show that, little by little, Mauritius is creating an identity of it being a medical tourism destination.
Figure : Medical Procedures undergone by foreign patients in 2010
(Source: BOI survey)
Figure : Number of foreign patients seeking treatment in Mauritius during the period 2006 to 2010
(Source: BOI Survey)
According to this graph, we can see that the arrival of International patients to Mauritius is indeed increasing. Hence, we can say that Mauritius seems to have a bright future in Medical Tourism.
Price comparisons of common medical procedures Sought
Table : Price comparison in US Dollars for cosmetic surgeries
Mauritius is mostly sought by medical tourists for its cosmetic surgeries. In the view of having an idea about the price levels of these cosmetic surgeries, the above table has been worked out. The price of six cosmetic surgeries have been looked up and compared with seven other countries. The table shows that on average the charges in Mauritius are lower as compared to the other countries. It also looks that India can become a threat to Mauritius (Source: BOI Brochure)
Table : Price comparison in US Dollars for Non- cosmetic surgeries
Types of Medical Non Cosmetics Surgeries
(Cost in US Dollars ($))