This is the Healthcare Marketplace Specialization, Healthcare Marketplace Overview. I'm Steve Parente, and this is Module 5.1.2, Medical Tourism, Evolution and Growth. So what is medical tourism exactly? It's a funny term. It's a term that's arisen recently, and it's been a rapid growth industry. The idea is that people will come from all over the world and are traveling to other countries to obtain medical, dental, surgical care. But at the same time, they're not that infirm, so that they'll actually do a little bit of touring, vacationing, and really experiencing the attractions of other countries that they might be visiting along the way. So, while it's growing a lot today, it's actually not a new concept. It's really, honestly, thousands of years old. In ancient Greece, pilgrims and patients came from all over the Mediterranean to the sanctuary of the healing God. There were, in the 18th century, wealthy Europeans who traveled to spas from Germany to the Nile. There were also reverse migration of hot springs going on in Europe, itself, for folks to visit. So, if we look actually across a much wider span of history, we can see that hot springs were really one major area to travel forward, the notion of thermal springs. There was an exception, a desire to find the Fountain of Youth in the 16th century. The term spa really gets on the way quite a bit in the 17th and 18th century, in terms of where people were going for dealing with tuberculosis, otherwise known as TB. Folks would look for sea and mountain air to help them out. And then we get to the 20th century, we have different areas that are health farms or places where you can sort of lose some weight along the way and be rejuvenated. So it's a pretty strong and long arc. Now in terms of actual medical tech, it's a little different. So, when we think about the different types of technologies, it's not just coming for spa treatments. We can actually have, say, if you look at the different places here, say organ transplants in certain spots. India does a tremendous amount of cardiac care. There's Lasik procedures that are done there as well. Dental treatment is one area that goes pretty well in different places. There's cosmetic surgery done in Cuba. So, when you look at the numbers of people visiting, it's pretty substantial. Honestly, Thailand's amazing actually if you look at the number. This is an older statistic posted from the US and the UK. Granted they were hurt a little bit by the tsunami prior to this, but it's a lot of money that's actually making it into the doors there. So what's driving this? So there's an estimated number of 47 million Americans that had no health insurance prior to ACA. Now that number is roughly about 38 million that still remain. There is an issue though for those 47 that, many of them were getting high deductible health plans, and so there's actually a lot of money that gets paid out of pocket, and they might decide to go abroad and not pay it in the US. There's also a much more substantial number, 108 million people in the U.S. that are without dental insurance. And what you find is that nearly two in five adults or approximately 77 million people struggle with medical bills, even with ACA, and they have lots of medical debt. And so the thought is if they can find a cheaper source to essentially get their care and avoid medical bankruptcy, that might be a very desirable thing. So, just to give you a sense of, why would they go abroad? So, in the US, just for example, a knee replacement, right, might run somewhere between $27,000 and $32,000. You go to the UK, and say a private hospital there, that could be $16,000 to $18,000. Those aren't pounds, those are dollars. But if you go actually over to India, the Max India Healthcare Center is a major thing, or even to Singapore, $6,000. And the quality is actually very comparable. When we look at CABG, or what's known as cardiac artery bypass graft surgery, $30,000 in the U.S. $6,400 that are here. Now, you might ask, why the difference? One of the things that's a major difference, particularly in India and Singapore is that, much more so in India, India is operating on a cash based economy. Singapore, to a certain extent, is as well. They have a lot of very high deductible plans that are there. There's a certain amount of cash that the expectation is, pay for the initial services unless it's really extraordinary care, then the insurance will kick in. And so when you have essentially a cash based economy, you don't have as much of, if you will, the moral hazard risks we talked about in module 3 that could occur. Now is it essentially a three-fold difference a moral hazard risk? Maybe, but clearly, these are the prices. And what's also interesting is that the physicians that are many times doing some of these procedures in Singapore, Thailand's the case, as well, might very well be Western-trained physicians that are just visiting and bringing their families while they do the medical procedures at the same time. So, how might this work? In terms of a supply chain process, if you will, for getting in, basically a patient has to figure out if they are a candidate for international care. They have to figure out what their transports going to be. They have to get there. They have make sure that everything is sort of squared with the actual country that's operating the facilities, Ministry of Health. They have to figure out their own scheduling components, so what's there. And then ultimately get treated, make sure everything is okay. And if they're, in their pre-operative steps, doing just fine, they could actually structure a tourism plan. Which on the one hand, you're like, that's kind of crazy. But honestly, for some of the cardiac procedures, the recovery is relatively quick. So you might even have a situation where within three, four days, you're really expected to be up and about a little bit, and moving. And that could be tied to a resort that's really more of a recuperative facility. And then once you're sort of done with all that, you could go home. So it may seem a little bit extreme, but depending on the technologies we're talking about and recovery times, it could be given the cost, actually much cheaper in the end. So here's a discussion prompt for folks to think about. Is medical tourism a sustainable phenomena or simply a passing fad? If so, why? If not, why not? And how is medical tourism going to affect healthcare in the developed countries, say the US, England, and Canada, and then the developing and underdeveloped countries. Whether we're talking about Africa for potentially some of the underdeveloped countries, and developing or merging economies, China, India, and elsewhere. This concludes our module on medical tourism.
