Since the European Union (EU) was expanded in 2004 - there are trends that point to the increasing importance of medical tourism in countries from Central and Eastern Europe.  These include countries such as Poland, the Czech Republic, Hungary, Croatia, Bulgaria, Romania, Armenia, Ukraine, Republic of Georgia, Turkmenistan, and Russia.  Although all regions in the world recorded a decrease in overall tourism traffic through the first half of 2009- Europe (-8%) is still enduring the impact of recession in a majority of its source markets and showing some encouraging improvement in the second half of the year.  With almost all European countries faced with rapidly aging populations, the continued pressures on their nationalized healthcare systems, and the large number of residents that are savvy international travelers (compared to the U.S. which only has 25% of its population with a Passport)- it seems only natural that this industry has great potential.  Many countries in the EU (particularly in the Central and Eastern region) are expected to benefit from increased liberalization of health-related labor markets and mutual recognition of healthcare certifications and qualifications.  There are possibly still some barriers caused by slight linguistic and cultural differences.  In addition, it is suggested that many of the former communist-bloc countries are still somewhat new to advertising, marketing and private healthcare.  However, there is no doubt that medical tourism is a strategic growth industry for this region and could even better the 35% growth mark suggested for the medical tourism industry by Deloitte in 2009.

There are some signs the EU is encouraging medical tourism by creating opportunities for international private medical insurance (PMI) providers and standardizing electronic medical/health records (EMR or EHR).  According to Frost & Sullivan, the European healthcare industry has seen many early initiatives to develop the infrastructure to make patient health records available to the various stakeholders and decision makers (and to make intra-regional medical tourism more feasible).  Although, individual physician practices/clinics and hospitals have been acquiring electronic medical records (EMR) systems at a slow pace, the industry has witnessed the implementation of projects involving the use of telemedicine technologies, regional healthcare networks and solutions like the electronic health-card systems which will continue to serve as a catalyst to this market.

Currently, it reported that promotional campaigns advertising medical tourism packages and medical vacation options are being aired on television in EU countries.  Right now, there are many opportunities for Northern and Western to get lower-cost medical and dental care as well as assess procedures that are either not covered or require long wait times in their nationalized systems.  Some brief examples of the growing importance of Central and Eastern European medical tourism practices are found below:

• Many Germans are travelling to Szczecin, Poland (which is less than 100 miles from Berlin), for low-cost, high-quality dental work;
• Sopron, Hungary (which is less than an hour's drive from Vienna, Austria) is reported to have more than 200 dentists and 200 optometrists, 10 times as many as would be expected in a town their size, and therefore is pursuing medical tourists from other European countries;
• Croatia is establishing itself as a location for low-cost treatments (suggested that they may be only a third of that charged in Western Europe) and high standard of care (particularly in dentistry, surgery and aesthetic surgery);
• Armenia is offering cosmetic or dental procedures such as laser hair removal and corrective laser eye surgery (as well as more complex procedures including open-heart surgery) and reduced rates from other EU countries;
• An American company (Stem Cells for Hope), which researches and develops the treatment of patients with stem cell transplantation therapy, made news by opening operations in both the Ukraine and the Republic of Georgia; and
• Patients from throughout Europe (especially from Italy, Germany, and Scandinavian countries) visit Ukraine for fertility treatments (including surrogate maternity, extracorporeal fertilization, and in vitro fertilization or IVF) because facilities in these countries meet all necessary legal regulation to offer these treatment and cost less than elsewhere in the EU.

This is leading to the rapid investment of state-of-the-art medical centers and even growth in the wellness market in Central and Eastern European countries.  For example, in Turkmenistan there is a $5 billion USD health/medical tourism project (funded by foreign investors) under way to create a center for health tourism including sanatoria, health centers, spas, hotels and other tourism facilities.  As reported at the Global Spa Summit, in terms of revenues, number of spas, and employment, Europe is the largest regional spa market in the world (with an estimated 22,607 spas earning $18.4 billion in revenues and employing 441,727 people).  Offshoots of traditional spa with include Medspas/Medispas or health spas (which combine both medical and wellness or spa procedures- includes bath house and sauna facilities) are becoming especially prevalent in Northern and Eastern European countries (particularly the former Soviet Bloc countries).  These are a fast-growing trend within medical tourism and Europe has a unique advantage because it has a large number of these health resorts that emphasize wellness, traditional healing therapies, and medically-based services. For example, in Russia and Eastern Europe, there are possibly thousands of sanatoriums (dating from the Soviet era) which now offer wellness-based healing/medical services.  Particularly when these facilities are modernized and branded as high-end health resorts that are meeting a very unique niche need for consumers.  Overall, it is reported that in 2007, health resorts and destination spas made up an estimated 27% of European spa industry revenues (and Germany, Russia, and Austria made up 3 of the top 7 EU countries in terms of numbers of spas).

Summary

In their HealthCast 2020: Creating a Sustainable Future report, Pricewaterhouse Coopers suggests that Europe's healthcare system and policy makers are learning to embrace competition.  Through the growth of medical tourism in the Central and Eastern regions of Europe, it is clear that competition is truly growing in this industry on the continent.  An interesting point to be made is that (according to the World Bank) in the Central, Eastern, and Baltic European countries, many of which have had to restructure their previously state-owned hospitals into public enterprises, there is reportedly more direct and hierarchical control over the administration of theses facilities.  This may actually lead to more entrepreneurial and aggressive business models than will be found in the rest of Europe.  As an area, the EU encompasses such a wide range of countries with vastly different levels of income and stages of economic development and maturity.  Reportedly, PPP GDP per capita in Europe ranges from under $2,000 USD in some of the former Soviet countries to over $60,000 USD in the most wealthy Western and Northern European countries (as of 2007).  Because of this heterogeneity, there are significant price differentials in the services offered by healthcare practitioners and facilities.  As these continue to be exploited and the quality (and reputation) of healthcare continues to rise in this region- it seems to be many medical tourism opportunities to be found in Central and Eastern Europe.

About the Author

David G. Vequist IV, Ph.D. is the founder and Director of the Center for Medical Tourism Research and a Professor at the University of Incarnate Word in San Antonio, Texas, USA.  He is also a consultant, author and speaker on topics such as healthcare trends and technologies.  He can be reached at vequist@uiwtx.edu.

References

Electronic Medical Records - European Perspective, 4 Apr 2004, Siddharth Saha Healthcare, Retrieved from: http://www.frost.com/prod/servlet/market-insight-top.pag?docid=17055864

Europe: Medical tourism development in Central and Eastern Europe, 13 November 2009, Retrieved from: http://www.imtj.com/news/?entryid82=167820&source=email&campaign=imtj_news_091113

Global Tourism Staging a Comeback, Says UNWTO, Monday, 12/10/2009, Retrieved from: http://www.caribbeannewsdigital.com/en/news/16223/global_tourism_staging_a_comeback_says_unwto

HealthCast 2020: Creating a Sustainable Future, PricewaterhouseCoopers, 2005

Hospital Governance in Latin America: Results from a Four Nation Survey, Richard J. Bogue, Claude H. Hall, Jr., and Gerard M. La Forgia, World Bank, 2007

International Mobility of Health Professionals: Brain Drain or Brain Exchange?, Stephen Bach, August 2006, United Nations

Medical Tourism: Updates and Implications, Deloitte, 2009

Medical Tourists Head to Croatia, Armenia, or Even Turkmenistan, 27 July 2009, Retrieved from: http://www.tourism-review.com/article/1744-medical-tourists-head-to-croatia-armenia-or-even-turkmenistan

Sharon Reier, "Medical Tourism: Border Hopping for Cheaper and Faster Care Gains Converts," International Herald Tribune, April 24, 2004

The Global Spa Economy 2007- Proceedings from the 2008 Global Spa Summit

The Center for Medical Tourism Research:
The First Center in the World Devoted to the Medical Tourism Industry

Another first is occurring in the Medical Tourism industry.  The newly launched Center for Medical Tourism Research (http://www.medicaltourismresearch.org/) is located in the H-E-B School of Business & Administration at the University of the Incarnate Word (UIW) in San Antonio, Texas, USA.  This center is the first academic research center in the world devoted to medical tourism research.  The center's founder and Director is David George Vequist IV, Ph.D. who is regarded as one of the leading academic speakers and authors on medical tourism.

The Vision of the Center

To serve as the premier academic center for Medical Tourism/Travel research in the world.  The center will provide high-quality research and thought-leadership in the economic, social justice, and societal impacts of the Medical Tourism/Travel industry.  The center will also uphold the Mission of the University of the Incarnate Word: Faith; Service; Innovation; Truth; and Education.

What Does the Center Do?

The center is aggressively pursuing primary data and accumulating secondary data to support the development of thought leadership, best practices, lessons learned, and policy formulation in the new industry of Medical Tourism.  As part of its purpose, the center will supply the myriad of stakeholders with leading edge research and the truth about the impacts of this trend on the countries, companies and people involved in this industry through both the Center websites and its various articles and papers.