There is no doubt that the UK is facing a rapidly growing healthcare dilemma. But how far would your...
There is no doubt that the UK is facing a rapidly growing healthcare dilemma. But how far would your clients, be prepared to go to receive treatment that meets not just their needs but their expectations?
The concept of 'health tourism', that is travelling overseas to access healthcare, is not a new one. So far it has not taken off. But with problems mounting in the private medical insurance (PMI) industry as well as the NHS, there is an increasing belief that some individuals will take radical steps to access cheaper, and sometimes faster healthcare.
Healthcare in the UK has in the main been accessed via the NHS and PMI but neither are meeting the needs of the British public.
On the one hand we have the NHS providing access to high quality treatment from some of the best trained medical professionals which is free at the point of use. The problem, is of course, one of funding. Waiting lists are getting longer, and increased use of rationing means that when we do become ill there is no guarantee we will be given the best drugs.
On the other, we have PMI. Waiting lists are practically eliminated and treatment is provided in the private hospital of your choice. But the high cost of cover puts insurance out of the reach of many and with costs not only high but spiralling many existing policyholders particularly those that are healthy and have not claimed are cancelling their policies.
With neither situation ideal, growing numbers are being forced to review the way they receive their healthcare. This has been testified by massive growth in the self-pay market.
According to the Independent Healthcare Association, during 1999, 160,000 people paid to have treatment both major and minor in the private sector, representing an increase of 40% on 1998 figures.
While the introduction of fixed price packages has helped individuals looking to self-pay, treatment is still expensive. Figures from BUPA show that cataracts can cost between £2,000 and £3,000 to be treated, hip replacements can cost anything between £6,000 and £9,000 while more serious procedures such as heart bypass surgery can cost up to £13,000.
PMI providers such as BUPA, Standard Life Healthcare, PPP and WPA have responded to growth in the self-pay market with the launch of high excess schemes, but policyholders still end up having to shell out large sums before their insurance kicks in.
No one system is ideal. But are people ready to volunteer themselves for treatment overseas?
Alister Percy, managing director of Health Enterprises, thinks they are. Until now if somebody wanted to go overseas for medical treatment they would have to make their own arrangements. However, Health Enterprises is set to launch a 'surgery package' deal that will enable individuals to travel to Thailand for a range of medical procedures. The attraction is that the package could cost a fraction of a fixed price package here in the UK.
Percy says: "There are people without insurance, or with high excess insurance who will not wait for treatment and need to put their hands in their pockets for treatment. The average cost of a procedure in Thailand is half what it is in the UK. Add the costs of flights and accommodation, and a package deal in Thailand can save people in the region of 35%."
The package includes processing of medical information, return flights, in-flight assistance where necessary, hospital costs, surgeons' and anaesthetists' fees as well as local travel costs, recuperation and aftercare costs back in the UK. Patients can be accompanied by a partner or family member.
The packages have been arranged via a link up with the Bumrungrad Hospital in Thailand. Described as a 'world class' hospital, the facility has been built to US standards and is operated by an American-led multi-national management team. Many of the surgeons are US or UK-trained.
The hospital is able to carry out most procedures, but Percy believes the spare capacity in its specialist heart and cancer centres will be particularly attractive. He says: "Irrespective of whether cancer treatment is received from the NHS or in the private sector, there is not enough kit in the UK to treat cancer patients. Even if treatment is private, there may still be a wait of 10 to 12 days before treatment can be received. We could do it tomorrow."
Recovering in the sun
He adds: "Patients in the UK can end up driving for an hour or so for treatment every day and at the end of the day have to drive back. It would be more therapeutic to receive treatment somewhere with nice weather and interesting surroundings."
According to Percy, another benefit will be the option to extend the trip into a holiday while recuperating. With the flights already paid for, patients could use the opportunity to take a cheap, but exotic holiday.
While this may be a big step, Percy is expecting the packages to be successful. "It would surprise me if we do not get between 200 and 300 cases in the first 12-month period. We think it is likely to grow on recommendation," he says.
Go Private, a company that brokes PMI and sources treatment for the self-pay market, says it is likely to consider packaging deals for people wanting to travel abroad for their treatment. Wendy Dawson, commercial manager for the company, says: "Some countries actively target their services to foreign patients and we would consider packaged deals where we arrange the treatment and flights." However, she adds this would be heavily dependent on checks on participating hospitals' clinical standards.
A slow start
Previous attempts to launch the 'health tourism' concept have not been successful, however. In the early 1990s, WPA launched a PMI scheme that provided customers with cover for elective surgery on the basis that cover was received on the Continent. The incentive for policyholders was premiums that were reduced by up to 50%.
The scheme was developed in response to the news that people were travelling to France for cut-price procedures. David Ashdown, communications director at WPA, says: "We found a man in Kent who needed his cataracts treated. There was a two-year wait on the NHS and he had no insurance. He saw a television programme looking at French hospitals and because he could not get a date for private treatment in the UK which would cost £2,000, he investigated surgery in France. His surgery was arranged for a few days later at half the price."
But it seems that this man was one of the few willing to take this step. It comes as little surprise that the WPA scheme did not prove popular.
Ashdown says: "Research at the time suggested people would go abroad for treatment. We made arrangements with Mondial, the repatriation company to handle it, but it did not take off."
He adds that the scheme was quite possibly ahead of its time. However, he believes the market may now be ready for such a concept. He says: "Attitudes have changed and there is a chance that this could now take off in the self-pay market. People are more aware of problems in the UK and their expectations are higher. We are also more used to travelling."
Shaun Newcomb, proprietor of specialist PMI broker, Healthguard, agrees that health tourism could play a role within Europe. "The trend of people heading across the Channel for treatment is known. As long as you involve your medical practitioners I cannot see a problem. Standards are as high if not better than standards in the UK."
Unlike Health Enterprises, however Ashdown thinks people will not travel far and will only do so if they are having a basic procedure. He says: "If people are suffering from something serious they will want and need to be near home, and the same applies if it is something that will keep them in hospital for a long time."
Newcomb is also cynical about people travelling great distances for surgery. He says: "I would like to see track records and more evidence of clinical practices to ensure a similar standard to our own hospitals if I was to advise a self-pay patient to travel further afield."
The recent spotlight on the spate of 'economy class syndrome' deaths, where people have developed blood clots following long haul flights, may also put people off. Newcomb says: "Surgeons often do not recommend flying after surgery, in particular following surgery to the legs and hips due to the increased risk of deep vein thrombosis when flying."
The Independent Healthcare Association also raised a number of concerns regarding health tourism.
Peter Fermoy, communications manager at IHA, says: "One of the major drawbacks of this would be that while costs may be cheaper you cannot have all your loved ones with you. Feelings of loneliness and isolation would not promote a speedy recovery."
A number of practical problems may also occur. "As part of your treatment in the UK, aftercare is included. A procedure such as a hip replacement will require a number of outpatient appointments this will be very difficult if the surgery was carried out overseas," says Fermoy. "Also, if things go wrong it will be difficult to go back people must put their health before money," he adds.
Health tourism clearly has its attractions: fast treatment at a reduced price, and if you go far afield, the opportunity to recuperate in a hot and sunny climate. But the downsides can weigh heavy.
Staying at home
This means it is worthwhile going to lengths to investigate exactly what is available in the UK. Dawson says: "There are some cheaper deals overseas, but there are also many good deals to be had over here. For example, there are a growing number of specialist centres, such as the Hernia Centre, that can often carry out treatment quicker and cheaper. If you get a good deal there may be a chance to match the costs of overseas treatment when the cost of flights are considered."
Shopping around can pay off. There are now systems that can help source treatment in the UK, such as more fixed price deals and from some hospitals, loans to cover the cost of treatment. And as with cars and houses, you can always haggle and beat the price down.
Rachel Williams is deputy editor
