Sun, sea and surgery
More people are going under the knife abroad
IN THE tiny Croatian town of Zabok patients arrive in their thousands each year from across Europe and the Middle East, seeking replacement hips or knees at the St Catherine hospital, which specialises in orthopaedic work. Some come for treatment they cannot get at home, others to escape long waiting-lists for public health care or high prices for private operations. Croatia is one of a number of treatment hotspots in the medical-tourism industry. Babies are made in Barbados, sexes are changed in Bangkok, teeth are replaced in Hungary or Mexico and hair is transplanted in Turkey (see map).
在克罗地亚小镇扎博克（Zabok），每年都有成千上万欧洲和中东的患者来到这里，希望在擅长矫形外科的圣凯瑟琳医院（St Catherine hospital）接受髋关节或膝关节置换手术。有些人是为国内无法获得的治疗而来，其他人是不想在公立医院排长队或在私人诊所花大钱。克罗地亚是医疗旅游业的一批治疗热点之一。做试管婴儿去巴巴多斯，变性去曼谷，做假牙去匈牙利或墨西哥，植发去土耳其（见地图）。
Precise numbers are hard to pin down, partly because of differences between countries in what is counted as medical tourism. Some national statistics include a mere spa visit or a tourist who falls sick. Allied Market Research, a research firm, puts the industry’s value at $61bn in 2016. Keith Pollard, head of LaingBuisson, a health-care research outfit that specialises in medical-tourism data, reckons it is much smaller, at around $10bn-15bn.
精确的医疗旅游人数很难确定，原因之一是各国对医疗旅游的界定不同。有些国家的统计数据把仅仅去了下水疗中心或在当地生了病的游客都算在内。联合市场研究公司（Allied Market Research）估算，2016年医疗旅游行业的价值为610亿美元。专门研究医疗旅游数据的医疗保健研究机构LaingBuisson的负责人基思·波拉德（Keith Pollard）估计的市场规模要小得多，约为100亿到150亿美元。
Rising numbers of middle-class patients in Asian and African countries mean more people willing to spend if they cannot find what they need at home. And consumers are incentivised to travel by substantial price differences across borders for the same treatment. The average heart-valve replacement, for example, costs €30,000 ($35,000) in Germany but only €15,000 next door in Austria, with little or no drop in quality. A hip operation can be had for €12,000 in Britain, €10,000 in Turkey and only €4,725 in Poland.
Governments are responding to rising demand. South Korea, Malaysia and Dubai have all invested heavily in creating regional centres of medical expertise to attract foreign patients. The Dubai Healthcare City seeks to attract patients from Gulf nations who have in the past been sent further afield by their health systems, to Europe or America. Some niche areas are showing particularly strong growth. Mr Pollard says that international travel for in vitro fertilisation (IVF) is increasing rapidly because many wealthy countries have restricted access to free treatment. A number of European countries, such as Germany, offer only three rounds of IVF and limit access to those with medical conditions or to younger women.
各国政府正在回应增长的需求。韩国、马来西亚和迪拜都投入巨资创建区域专科医疗中心以吸引外国患者。迪拜医疗城（Dubai Healthcare City ）想要吸引海湾国家的患者，过去这些国家的医疗系统会把本国的一些病人送到更远的欧洲或美国去接受治疗。一些利基领域的增长尤为强劲。波拉德表示，以做试管婴儿（IVF）为目的的国际旅行正在迅速增加，因为许多富裕国家已经对免费IVF做出限制。德国等一些欧洲国家只可以免费做三次，而且对患病或较年轻的女性都有限制。
Medical tourism is still hampered, however, by a lack of detailed, reliable information on the quality of hospitals and clinics and of their doctors and surgeons, notes Valorie Crooks, a professor of geography at Simon Fraser University in British Columbia. International hospitals are often verified by the Joint Commission, a non-profit organisation that awards accreditation to medical-services providers. These aside, patients have had to rely solely on reputation or on intermediaries that grease the wheels of medical travel. Patients often do not realise that these “facilitators” may be working exclusively with certain clinics; some receive undisclosed commissions. If things go wrong, patients may have little recourse to help. Doctors have long complained about people who return from treatment abroad with complications.
但是，由于缺乏有关医院、诊所及其内外科医生质量的详细、可靠的信息，医疗旅游业的发展还是受到了阻碍，加拿大不列颠哥伦比亚省的西蒙弗雷泽大学（Simon Fraser University）的地理学教授瓦莱丽·克鲁克斯（Valorie Crooks）指出。国际医院常获得国际医疗卫生机构认证联合委员会（Joint Commission）这一非营利组织的资质认证。但除此之外，患者只能完全依赖医院和医生的声誉或促成医疗旅游的中介机构。患者通常不知道这些“辅助机构”可能和某些诊所独家合作，有些还会悄悄收取佣金。如果出现问题，他们可能求助无门。长期以来，医生们一直对人们去国外治疗回来后出现并发症的情况怨声载道。
Two newish online firms, Qunomedical and Medigo, both based in Berlin, hope to improve matters. They allow patients to search for medical treatments from a large selection of providers, offering clear information about pricing and the quality of staff and services. Both take fees from the hospitals and clinics that they list, as disclosed on their websites; Medigo also earns money from patients and corporate customers in the form of fees. Patients write reviews, and human advisers are available to help with choosing where to receive treatment. Such information should make foreign medical treatments more appealing.
But making money out of medical tourism can still be hard. Variations in exchange rates can instantly make a destination less appealing. The market for “scalpel safaris” in South Africa has proved volatile, say people in the business, due to currency fluctuations. Sometimes demand fails to materialise. When work first started on a 2,000-bed hospital called Health City Cayman Islands, the $2bn project was expected to attract more than 17,000 foreign patients annually, mostly from America. But when the first wing of the hospital opened in 2014, the International Medical Travel Journal reported that fewer than 1,000 overseas patients arrived in its first year. One reason was that its backers based projections of customer numbers on a flawed study, according to a subsequent investigation by a government public-accounts committee. Fewer American patients came than expected partly because health insurers were not interested in sending people overseas.
但要靠医疗旅游赚钱可能仍然很难。汇率的变化可以让一个旅游目的地瞬间失去吸引力。业内人士表示，由于汇率的波动，南非“手术刀探险之旅”的市场变化无常。有时需求无法实现。当拥有2000张病床、名为开曼群岛健康城（Health City Cayman Islands）的医院开建之时，这个20亿美元的项目预计每年将吸引超过1.7万名外国患者，主要来自美国。但据《国际医疗旅游杂志》（International Medical Travel Journal）报道，当医院的一区于2014年建成开业时，第一年前来就医的海外患者还不到1000人。一个政府公共账目委员会随后的调查显示，原因之一是项目投资者对海外病患数量的预测是基于一项有缺陷的研究。美国患者人数少于预期的部分原因是医疗保险公司对把病人送到海外治疗不感兴趣。
In time, health-care providers are likely themselves to travel to serve patients. Vikram Kapur, a partner at Bain & Company, says that China has in the past been an exporter of patients but now American hospitals, such as Johns Hopkins, the Cleveland Clinic and the University of Pittsburgh Medical Center, are undertaking joint ventures with local Chinese hospitals to deliver services to patients closer to their homes. One way or another, health care is becoming more footloose.