As healthcare globalizes at a rapid scale it introduces local complexities for a variety of players: patients and their families, countries, hospital providers and their staff, medical technology and pharmaceutical corporations, accreditation agencies and regulatory bodies. How we evaluate these trends will be critical in predicting future growth.
By now many are well aware of the heightened interest in analyzing the medical tourism market. This stems from a shared stakeholder incentive to quantify and measure the growth of this industry. For some corporations, medical technology companies, health insurance firms and hospital agents, an analysis of transnational medical travel hopes to generate efficient ways to improve their bottom-line during this global financial crisis.
Others seek to inform the economic or political agenda of the countries participating in this process. However, the analysis thus far precludes questions that are beneath the surface of numbers and charts. Specifically, the social, ethical and cultural explanations underlying the expansion of international medical travel require a much deeper empirical study to address the more cogent adjustments for demand-and-supplier-side participants.
In this cultural montage, the statistical trends must share their results and forecasts with qualitative and ethnographic findings that bring us closer to the human nature of the medical tourism process. Thus, as anthropologists have noted, we are not only seeing the movement of people across national boundaries that should hold significant weight in our analysis, but the accompanying technological, monetary and ideological movements are important factors.
Some authors have started to recognize the importance of the engaging, humanizing methods that anthropologists use to reframe the issue, and they promote the incorporation of this qualitative research into ongoing business innovation.
As such, this article outlines the issues that dive deeper into understanding the consumer demand for international medical travel and reviews some empirical evidence to inform ways in which stakeholders must welcome the complimentary qualitative research perspectives while playing a hand in this burgeoning market.
Problems With the Surface
The now well-attributed Deloitte Consulting survey on medical tourism asked over 3000 people ages 18-75 various questions about consumer healthcare. Representing an expansive demography of U.S. nationals, survey respondents were allowed a numerical rating on topics ranging from their perspectives and attitudes to their expectations and desires for adequate healthcare.
At a macro-level, this study paints a picture of a segmented patient market with self-sufficient incentives to manage their healthcare process and increase demands for better quality care. The findings suggest that by 2017, fifteen million innovation-seeking consumers will transfer $400 US billion (base case scenario) of healthcare spending from U.S. providers to hospitals overseas. This picture enables insurance agencies, providers and other stakeholders to paint new direction for improving and innovating domestic healthcare .
The very premise for this study (and many other case studies on medical tourism) in the U.S suggests that international travel extends a critical solution for the 46 million uninsured Americans and out-of-pocket patients faced with attenuating costs for care. Treatment abroad in places like India is sometimes 10% of the cost of domestic care (e.g. aortic valve replacement costs on average of $100,000 in the U.S. and $12,000 in India).
But the uninsured tend to fall in a lower income bracket, with poor advantages for tax-savings and a decreased buying power in which potentially only universal healthcare, not an expensive trip abroad, might ail their treatment demands . Who then are the people taking advantage of medical tourism and what are the myriad thoughts that help them decide to go abroad?
Are the affluent travelers and able patients in developed countries widening the gap between domestic and now international health access? The critical factor with these types of ‘non-guiding’ questions is the way in which responses are analyzed through qualitative methods instead of blanket categories with an all-encompassing label.
Thus, before becoming the authority for directing strategies on global healthcare, we must consider and compliment the issues that surveys or non-qualitative research methods potentially fail to uncover.
In the context of medical tourism, this requires unraveling the stories behind the patient decision making process, the personal moral and ethical values, and the shared experiences of a cultural mixing of local and global care. The following section implicates some of these issues and outlines other consumer related questions that are important for consideration.
Beneath Consumer Demand
International health consumers are believed to participate in “biomedical self-shaping” , in which patients transform into autonomous investigators of their own health and medical concerns. This is widely accomplished in developed countries through the advent of Internet literacy on various topics of science and medicine, and partially through online or local support groups, institutions and corporate stakeholders.
With such an advanced and complex channel through which patients can learn and share about the medical experience with others, investigate their doctors and providers, and learn about the intricacies of their medical condition , we can no longer assume that the incentives for health care travel can be explained through easily defined categories and trends.
Although insights with consumers are heightened through online interactions, we must question how much is actually known about medical tourists. As one researcher describes, there is little information about the consumers who seek these services; including their motivations, personal characteristics, ways they sought services abroad, their understanding of their condition, and their experience in a different cultural setting .
Even more, there is a serious disparity in the influences for medical travel between developed and emerging economies. Access to the Internet and other online channels are not even possible, let alone frequently utilized.
For example, although U.S. medical tourists save costs by receiving treatment in India, Yemen medical travelers find the same treatment option tied with a hard earned, debt inducing expense involving symbolic capital for a sick family member that has exhausted all options for care domestically.
The Yemenis ethnographic study also illuminates the heightened expectations that any medical traveler might have when going overseas. Patients show vulnerability due to their inability to understand cost and treatment comparisons, and discern the medical risks involved. For some travelers, medical tourism agencies and the international patient divisions at hospitals promote the fantastic success rates and positive foreign patient testimonials.
This could form an enigmatic and ostensive perception of “care abroad”. As result, the soon-to-be medical traveler demands for high quality life saving treatment places unintended pressure on doctors to provide for expectations that extend beyond medical service.
The aforementioned anthropological study is just one example revealing the differences in the consumerism process for transnational medical care. Further research and questions are required to develop an intimate understanding of the consumer process. For example, how does the doctor-patient relationship change during this global medical process?
Is a knee replacement surgery in India the same as a knee replacement surgery in the UK? Or, how do hospitals construct “global” spaces, like international airports and hotels, within their local culture in order to standardize healthcare? It is precisely these types of qualitative ethnographic and social science questions that will benefit the more penetrating associations between the medical tourism process and the macro-level comparisons of care.
Applying Complex Understanding
To recapitulate, we must contextualize ethnographic and qualitative research in the strategy discussions for improving the trade in global medicine. The quantitative analysis that helps us gauge and forecast the limits of growth must share concomitant objectives with the deeper, qualitative research in the field. On-site investigations in participating countries are required to digest the economic and health resource implications at the local, national level.
For example, it is critical that the promotion of foreign medical care in India through government and private incentives do not subsume the priorities for delivering healthcare to the millions of rural residents with poor access to adequate care. Ten years from now, the reflexive outlook upon global medical tourism should not frame a world where the inequalities in proper healthcare have irreversibly widened.
Thus, the studies that will provide the greatest enlightenment are not just the surveys and questionnaires that engage a statistically randomized representation of medical travelers. But, of greatest value will be those enlightening studies that should compliment stakeholder strategies for action are those that immerse in consumer communities, and follow the patients, doctors, technologies, regulations, ideologies and values across the medical cultures.
Nishant Bagadia is a former consultant in customer relationship management at Deloitte Consulting LLP USA. He is now a graduate student at the London School of Economics, conducting research at the BIOS Center for the study of biomedicine, bioscience and society. His current area of research is in the sociological and cultural relationahip of medica care between “Western” and developing countries; specifically, with a case study of medical tourism in India.
