Medical Tourism is the catalyst that’s changing the face of the GCC healthcare landscape as we know it. All throughout the region, billions are being invested in new hospitals and healthcare cities, radically transforming the quality of care available in the region. With the industry currently estimated at US$100 billion and a 15 to 25 per cent growth rate in destinations who have implemented best practices, Medical Tourism is the No. 1 cause source of disruption and innovation in global healthcare. It’s one of the primary reasons for investment in new hospital projects, as well as the refurbishing of old hospitals into new, cutting-edge facilities. It’s an economic priority by many of the world’s most forward-thinking governments.

The most recent trend that the Medical Tourism Association (MTA) has seen isn’t just about attracting international patients as inbound tourists – it’s about minimising the colossal amounts of money countries are forced to spend while shipping their own citizens abroad to other countries, too. The GCC countries alone spend more than US$10 billion abroad on their citizens each year, sending them away for complex medical cases and conditions that can’t be treated locally. Now, these governments are hoping to change the narrative by curbing outbound medical tourism by investing billions in their own local healthcare sectors to build sleek, technologically advanced hospitals. A modern healthcare presence attracts inbound internationals and keeps its own citizens home, resulting in an economic boom for a country’s medical, hospitality and travel sectors.

Medical Tourism isn’t about cosmetic and dental care; it’s about complex medical procedures that involve cardiology, oncology and orthopaedic specialists, as well as other innovative treatments and clinical trials. Patients are demanding the highest level of care, and they are increasingly willing to travel to faraway countries if it means finding the best doctors or the most advanced medical equipment.

The result of all this is an international healthcare race, with more than 60 countries looking to buy sleek new equipment and build specially constructed patient wings catered specifically toward medical tourists.

One sector that has completely missed the boat on this global opportunity is the healthcare supply chain. Medical equipment, technology, pharma companies and others should be shifting their products, focusing their sales and marketing efforts toward how their solution will help that specific government, emirate or hospital in driving medical tourism dollars to their particular destination. At the end of the day, healthcare consumers are choosing hospitals based on what’s inside the hospital, not the outside shell, and the healthcare supply chain should be jumping on this opportunity.

Fuelled by globalisation

Medical Tourism is now a massive, 21st-century ecosystem, fuelled by globalisation, that is loaded with new business opportunities for everyone. Just as savvy governments are finding ways to capitalise or improve their position by becoming industry stakeholders, companies would be wise to reach out and discover how they can enhance their revenue by addressing the increasingly “niche” needs of the field. Understanding this dynamic is key to operating profitably inside the industry.

The UAE is a shining example of a regional hub for medical tourism. Dubai launched an internal medical tourism initiative many years ago and helped build the UAE into a globally recognised brand, bringing in hundreds of thousands of medical tourists every year. In 2019, Abu Dhabi launched its own medical tourism initiative in partnership with the MTA, aspiring to become the region’s leading medical tourism destination. With Cleveland Clinic Abu Dhabi already in place as a featured asset and the newly announced partnership between Mayo Clinic and SEHA, Abu Dhabi has positioned itself as the epicentre of high-quality healthcare in the Middle East. Together, with both Abu Dhabi and Dubai’s initiatives, the UAE will likely separate itself as a notch above many other existing markets.

The UAE is well-positioned in medical tourism because of its central location, easy access and friendly visa policies, in addition to the noticeably high quality of healthcare. Abu Dhabi and Dubai are attracting the GCC and China, as well as Russia and the CIS countries. After the MTA signed a long-term deal with Abu Dhabi to make it a regional healthcare hub, we learned about one of the unique advantages that Abu Dhabi has arranged – it’s one of the few destinations in the world where its own Tourism Department has partnered with its Department of Health. Intra–governmental partnerships are the key to medical tourism success and sustainability.

Measuring success

South Korea is another shining example of a well-coordinated, internal governmental support of a global initiative and long-term commitment. When the MTA partnered with the South Korean government almost 13 years ago, South Korea went from an absolute nobody in global healthcare to a top-five destination within only a few years. The investment in medical tourism (global healthcare) all those years ago has built South Korea into a dominant leader in medical technology and pharmacology.

The MTA measures the perception and ranking of destinations around the world through a tool called the Medical Tourism Index.

Regardless of whether you are Abu Dhabi, Dubai, Switzerland, UK or any other destination, the key to building a world-class global healthcare destination is in fostering amazing patient experiences and turning every patient into a walking testimonial who refers more friends and families to become global consumers of health.

Medicine is only half the prescription in medical tourism; the most critical part is always the patient experience. The airport experience, hotel, tourism, restaurants and local commerce and shopping all play a role in forming patient experience. Nearly 90 per cent of patients bring a companion or family member(s), electing to spend two-three weeks in the country they’ve travelled to. This is why the tourism element and the economic impact is such a big deal for potential destinations.

Many of the leading hospitals in healthcare have committed to the highest standards in medical tourism and have been accredited by Global Healthcare Accreditation (GHA), which is headed by Karen Timmons, the former President of JCI and COO of Joint Commission. Cleveland Clinic in Ohio, Bumrungrad in Thailand, which receives over 520,000 international patients from over 190 nationalities of patients, as well as many others have achieved GHA. This shows that these hospitals demonstrate the best practices in medical tourism. GHA facilities ensure amazing patient experiences, guarantee patient privacy, demonstrate transparency in their costs, and exhibit many other valuable elements that GHA grades as critical to the long-term sustainability of this industry.

Challenges

Many hospitals and destinations looking for inbound international patients make the mistake of thinking they can just put out a sign and say they are open for business. Unfortunately, this doesn’t really work. Most parties have a difficult time accessing the customers, or healthcare consumers. Education and marketing are both needed to grow both the industry and potential patients’ knowledge of it, as we are probably only at 5-10 per cent of the market’s true potential. After more than 13 years of leading and studying the industry, the MTA just consolidated all of its educational, consumer and research websites into one great site, www.MedicalTourism.com, to provide important information for both healthcare consumers and buyers. It’s a helpful survey of the market of medical tourism, provided by a trusted, transparent voice in a market filled with a lot of noise and confusion.

The other challenge the industry faces is too many operational silos. It is surprising to find that there are no audit trails, transparency, accountability, or reporting. Governments who spend billions of dollars a year on medical tourism do not appear to utilise any method of tracking how or where their money was spent. There is zero accountability and no audit trail. The industry needs continued investment in technologies and new solutions to disrupt the sector.

Leveraging tech

One new market entrant is Pulse Protocol, one of the first technology and future blockchain companies in medical tourism. Pulse has an opportunity to be the next “Uber” in healthcare, to disrupt the industry while bringing together the entire sector by allowing healthcare consumers to access medical tourism through their mobile phones. Pulse makes medical tourism more accessible by allowing patients from around the world to get second opinions, transfer medical records and make payments from their mobile phones. Currently, all these things are difficult to do, and we as an industry have created many barriers and obstacles for consumers to access global healthcare and new business to enter this space.

Pulse is bringing blockchain to medical tourism in a way that has never been thought of before, from allowing the review of doctors and hospitals that are verified through the blockchain after payment has been verified, to using blockchain as a means to credential doctors. More importantly, Pulse is putting the power of medical tourism into consumer hands, thanks to the power of smartphones. Blockchain investment in medical tourism can also help ensure patients traveling for care receive the right drugs, or that governments have audit trails of the billions they are spending in this sector. Proper tracking can result to more investments in the systems and processes.

Identifying right partners

Be careful who you partner with in this industry, and check your sources on medical tourism facts, research and figures. There is a lot of misleading facts and made up statistics that are published, as well as more than a few bad-faith actors. Too much of the research and statistics in medical tourism are actually made up out of thin air and has no basis in fact whatsoever. There are numerous companies peddling these false statistics as the latest in medical tourism statistics, which they would be happy to sell to you for US$1,000 or US$2,500, just to make a quick buck. Unfortunately, other research companies will republish these fake figures in their own reports, furthering a vicious cycle of misinformation. Investors have taken big risks on projects based on bad data and false assumptions.

This industry is a long-term investment; it’s not an industry where you should try to get rich quick. Many tried and failed. You have to be committed to excellence in every aspect of the field. Identifying the right quality partners in the industry can be one of the biggest challenges that face stakeholders.

As the industry grows, so do its biggest adopters. Medical Travel is now becoming a mainstream methodology at all the largest health insurance companies. Aetna, Cigna, United Healthcare, Bupa Arabia, Tawuniya and almost every other major insurance company now offers premium plans that cover treatment abroad and their programmes. Eighty per cent of African health insurance policies sold by AXA include a cross-border (medical travel) healthcare benefit. This is not just a trend; this is the new reality.

Healthcare consumers are demanding mobility within their insurance plans and willing to pay more for it. Medical Tourism has also made local healthcare providers have to up their game and invest in new medical technology, equipment and better outcomes for fear of losing local patients. If medical tourism has taught us anything, it’s that 21st-century healthcare patients now have access to the information they need to make intelligent decisions on whether to stay local or go global.

Medical Tourism hasn’t peaked or plateaued. As more patients have access to innovative solutions and gain more knowledge, more patients will travel. There is no longer one country or region that is the next innovator in healthcare. Now, every country can be an innovator in healthcare. You never know which country will pioneer the next medical breakthrough, the next cure, the next clinical trial. In the future, we will all be medical tourists. 

The journey of medical tourism in Dubai started back in 2012. The initiative was launched by His Highness Sheikh Hamdan bin Mohammed bin Rashid Al Maktoum, Crown Prince of Dubai and Chairman of the Executive Council, who gave the Dubai Health Authority (DHA) the responsibility for building a strategy around medical tourism. It was approved by Sheikh Hamdan in 2014 and since then the Medical Tourism office came into existence and was under the regulation department at the DHA. The department has had an organic growth and became the Medical Tourism Council in 2016. In 2018, with the change of the structure at DHA, it evolved into a department under the Health Regulation sector.

Dr. Marwan Al Mulla, CEO, Health Regulation Sector, DHA, shares: “Dubai strives to continuously provide high-quality healthcare of international standards through its world-class healthcare infrastructure. 96 per cent of the hospitals in Dubai are internationally accredited and offer some of the best healthcare systems and professionals. Moreover, health tourism and the healthcare sector in Dubai is well regulated to keep up-to-date with the latest in technology and expertise as well as to protect patient safety and provide patient centric care.”

Sheikh Hamdan launched DHA’s DXH initiative in April 2016. It serves as a continuation of ‘Dubai, a Global Destination for Medical Tourism’ project and forms part of the government’s efforts to make Dubai a global health tourism destination and a gateway to the finest medical experts and premier accredited healthcare facilities. The newly revamped website www.dxh.ae has two focus areas – Wellness Dubai and Medical Dubai. The medical one is focused on treatments while the wellness focuses on health check-ups, preventative care, as well as alternative medicine, which is regulated in the city.

Dr. Al Mulla adds: “To further strengthen the position of Dubai on the health tourism world map, DHA has recently revamped the DXH.ae website. The web portal receives more than 10,000 unique visitors each month and now includes five languages including Arabic, English, Russian, Chinese and Hindi. So far, we have seen a year-on-year increase in the number of patients coming to Dubai. Last year we had over 337,000 medical tourists coming into Dubai. Our aim in 2021 is to attract half a million health tourists.”

Digital transformation

Several factors are driving the Middle East’s healthcare industry such as the growing population in the region with longer life expectancy. Another is the steady shift to value-based healthcare at competitive costs. Innovation in technology and business models is also fueling growth within the regional health industry as well as better organisational setting, which is increasing efficiency in the patient flow.

Furthermore, the ongoing digital transformation efforts in the region have had a dramatic impact on the health tourism sector as well as the many relevant initiatives that help bring the health community together. Patients today are more empowered, as they prefer to take an active role in selecting the best and most appropriate treatments.

“This is what we try to provide to them through DXH, our digital gateway. The website provides an array of choices and information. We also try to keep visitors engaged through our social media channels so that they can make informed choices before they choose their next healthcare and wellness destination. DHA’s vision is to ultimately create a comprehensive journey that is easily accessible and inclusive of high quality healthcare coupled with unique health tourism experience,” says Linda Abdullah, Consultant, Health Tourism Department, DHA.

Furthermore, she highlighted that Dubai is gaining great progress in its bid to become a medical tourism hub worldwide given its excellent healthcare facilities, world-class medical professionals, easy visa procedures, and extensive health packages. This is illustrated in the fact that there are over 600 packages from 72 healthcare facilities that include 18 hospitals and 54 specialties centres. In 2018, the local sector’s revenue reached AED 1.163 billion. The number of health tourists during the same year stood at 337,011. Dubai also recorded a 9 per cent growth in the number of healthcare facilities vetted and included in the health tourism DXH Group member programme. DXH also continues to participate in several global events and roadshows to reinforce Dubai’s position in the international health tourism market.

Growth trajectory

The UAE will continue to play a major role as the region’s medical hub and Dubai will sustain its global appeal to health tourists, according to Ruhi.

She shares: “This year, we will see growing adoption of the latest innovation in the field of stem cells, regenerative medicine, 3D printing and telemedicine. Dubai is spearheading such innovative techniques in the region; moreover, DHA’s new and simplified healthcare licensing procedures will attract both investors and highly qualified medical professionals from around the globe. This will give us a strong foundation of trust that we are building with those that seek healthcare in Dubai.”

Additionally, she highlights that new investments will lead to the offering of technology-driven services delivered by the finest healthcare professionals. The services that will draw the most health tourists are dental, orthopaedic, dermatology, ophthalmology, health and wellness, aesthetics, and fertility. This will attract more and more health tourists to come to Dubai.

“This is giving us more confidence that we will continue our appeal,” says Ruhi. “We are always strengthening our USPs and will continue to create this unique experience in collaboration with our stakeholders. In Dubai, both the public and private sectors are working hand-in-hand to create a successful journey for the patient. What Dubai has achieved in this short span of time is proof that the city is working towards being the number one in whatever project it takes on. This is thanks to the higher leadership that continues to give us directions as well as directives to grow.

“From our end, we will continue to create a unique experience in the healthcare delivery standard; integrate and offer new medical and wellness service packages, and open new markets for Dubai. Our focus will remain on partnerships with key stakeholders and on our #DXHWellness campaign, which aims to promote a healthy and holistic lifestyle.” 

Key Facts

Dubai’s medical tourism sector’s 2018 revenue hit the AED 1.163-billion mark in 2018, reflecting the influx of global health tourists to the emirate. In terms of international patients, around 33 per cent came from the Arab and GCC countries, including Kuwait, Saudi Arabia, and Oman. About 30 per cent were from Asia, including India, and Pakistan and 16 per cent from Europe, including Italy, the UK, and France led the ranks from Europe. Some countries from the Africa region are also steadily becoming a source market. Health tourists come to Dubai mostly for wellness, dental, and orthopaedic treatments.

For many years, the governments of Bahrain, Kuwait, Oman, Saudi Arabia, and the UAE have met the healthcare needs of their citizens by funding treatment abroad when the appropriate treatment, care and expertise is unavailable in the domestic healthcare system. Irrespective of funding, countries with relatively small populations such as Kuwait (1.3 million Kuwaitis, 3.2 million expatriates) face challenges in providing a healthcare system that has the breadth and depth of services to meet the needs of the population.

Spending on treatment abroad

The number of patients who are sent abroad for treatment in such countries may appear small but it’s a major expenditure and significant financial burden on the state.

Kuwait was estimated to send around 650 patients abroad each month in 2018 at an annual cost of around US$1 billion. According to government statistics, 75 per cent of the cases go to three countries – the UK (28 per cent), the U.S. (24 per cent) and Germany (23 per cent). The remaining cases were distributed to France (14 per cent), Spain (3 per cent) UAE (2 per cent), and 6 per cent to other countries.

In 2016, the Dubai Health Authority (DHA) reported the expenditure on overseas treatment for Emirati patients at US$170 million.

In Saudi Arabia (30 million Saudis, four million expatriates), the Health Ministry stated that 2,400 Saudi patients were treated abroad at a cost of US$800 million. The United States, Britain, Germany and China were the four main destinations for Saudis seeking medical treatment abroad. One fifth of those patients were under the age of 14 and seeking specialist paediatric care abroad.

The spend on such patients is high, given that most are travelling for specialised treatment for major diseases. The average cost per case including treatment, travel, accommodation and allowances ranges from US$125,000 to US$340,000 per case, depending on the country. Costs of travel and accommodation, daily living allowances for patients and relatives account for a significant proportion of the cost.

Reducing the government’s healthcare burden

Pressure on government expenditure in the Gulf countries, partly due to a decline in oil revenues, has led to a rethink on how those governments manage the healthcare needs of their populations. There are three key trends:

• Tighter controls on government expenditure on treatment abroad.

• Development of hospital and healthcare facilities within the country.

• The introduction of health insurance schemes which attempt to shift the burden of costs from the government to individual citizens, their employers and their insurers.

In Kuwait, the purse strings have been tightened as a result of media criticism of the level of expenditure. Governments are exploring the opportunities to reduce costs by referring patients for treatment in lower cost destinations such as Malaysia, Korea and Thailand rather than the UK, U.S. and Germany. Oman has added Iran to the list of countries approved for funding of health services for Omani citizens.

In 2016, the Bahrain Health Minister stated that the government is intending to reduce the number of citizens sent for treatment abroad, by providing more medical services within the Kingdom. Bahrain intends to fly medical experts into the country as part of a cost-saving measure. Doctors from India, Singapore, Thailand, Germany, the UK, Belgium and the U.S. agreed to take part in the new scheme.

There has been a plethora of hospital developments in Gulf and encouragement for foreign hospitals and investors to drive healthcare development. In 2017, the Saudi Arabian General Investment Authority (SAGIA) announced that foreign investors can have 100 per cent ownership in health to boost private sector investment in healthcare in the Kingdom.

Furthermore, Aster DM Healthcare, one of the largest private healthcare service providers operating in multiple GCC states, has opened its third hospital in Oman.

Also, Dubai Healthcare City has set up a specialised oncology facility with Mediclinic Middle East to increase capacity in cancer care within the UAE.

However, the hospital building boom may be approaching its peak or may need to more focused on development of more specialised services. According to Raza Siddiqui, CEO of Arabian Healthcare Group and Executive Director at RAK Hospital: “It’s time that investors take a pause before putting in more funds to build more hospitals. They need to focus on niche health services rather than more of the me-too kind of primary and secondary facilities.”

Compulsory health insurance for both citizens and expatriates will help to reduce the burden on governments. Kuwait has proposed a law on a mandatory health insurance scheme for expatriates and may require visitors to have health insurance. Oman’s Capital Market Authority is preparing regulations for the implementation of mandatory health insurance in Oman for all local Omanis and expatriates not covered by public sector schemes. Bahrain’s health insurance law came into force in December 2018, although plans for launch in 2019 have now been scheduled for 2020.

Reversing the trend

So, will countries in the Gulf that historically have been sources of international patients become the medical tourism destinations of the future? There are certainly significant efforts to reverse the trend and to create medical tourism hubs within the Gulf that will service the needs of patients within the regions.

Dubai is the leader in these efforts. The Dubai Health Experience (DXH), a web portal and app, attracts 10,000 unique visitors each month and embraces four language versions – Arabic, English, Russian and Chinese, and a medical opinion service. According to the DHA, in 2018, 33 per cent of medical travellers to Dubai came from within the UAE and other Gulf States, mainly from Kuwait, Oman and Saudi Arabia. 30 per cent came from Asia, mainly from India, Iran and Pakistan and 6 per cent are from Europe, mainly the UK, France and Italy. Rather than highly specialised care, dentistry, orthopaedics and dermatology were the main treatment types for inbound medical travellers. The emirate hopes new initiatives will help attract more than half a million medical tourists by 2021.

The Cleveland Clinic Abu Dhabi has reported an increase of more than 16 per cent in the number of international patients in 2018 and saw an even stronger growth in 2019. The healthcare arm of Abu Dhabi’s Mubadala Investment Company has announced it has signed an agreement with Nirvana Travel and Tourism to work together to grow medical tourism from the Gulf region, Africa, Russia, China and India.

In Saudi Arabia, a five-year plan is being developed, which aims to encourage Saudi nationals to stay at home for their treatment and to attract medical tourists from other Islamic countries to Saudi Arabia. The Saudi Commission for Tourism and National Heritage has endorsed a proposal that combines religious and medical tourism to promote Saudi health services to the world’s 1.6 million Muslims who may seek spiritual solace during a health crisis.

Bahrain’s National Health Plan 2016-2025 has therapeutic tourism as a key national initiative but has made little progress so far due to the need for private sector investment.

So, perhaps the tide is turning for medical tourism in the Gulf region, particularly for those patients seeking less complex treatments. But, building new hospitals and clinics doesn’t create a medical tourism destination. The key to long term success will be to establish (or buy in?) the level of knowledge and expertise which patients have traditionally sought further afield and to ensure quality standards match those in alternative locations. The small population in some countries will be a barrier to that, as they lack the critical mass to support the development of specialised tertiary services and retain clinicians with the necessary expertise. Patients requiring highly specialised care will continue to travel.