Medical Tourism

Medical tourism is a popular mass culture where people travel long distances to another country, often overseas destinations such as India, Thailand, Japan, to obtain medical, dental and surgical care while simultaneously being holidaymakers at the same time.

Earliest Health Tourism Centers

Many of the earliest civilizations knew medical tourism in the form of sacred temple baths. Historical accounts of Mesopotamian, Egyptian, Chinese and Indian cultures speak of bathing and healing complexes constructed around therapeutic springs.

As early as the Bronze Age (2000 B.C.), hill tribes near present-day St. Moritz, Switzerland gathered around to drink and bathe in the iron-rich mineral springs of the region. Bronze Age implements, including votive drinking cups, have also been found around thermal springs in Celtic mineral wells in England, France and Germany.

In ancient Sumer (4000 B.C.), the earliest known health institutions were erected alongside mineral water springs taking the form of elevated temples with flowing pools. Although, most cultures following Sumer certainly understood and appreciated the healing effects of mineral-rich water, it was ancient Hellas and the Greek civilization that first laid the foundation for a comprehensive health tourism system.

Some of the earliest health centers built for medical purposes in the ancient Greek world were the Asclepia Temples. Erected in honor of the Greek god of healing and medicine, Asclepius, these places served as central locations for the treatment of the sick or virtually anyone who required it. People from around the region traveled to these temples in hopes of receiving the god's grace.

The healing powers Asclepius possessed allowed him to, among other things, revive the dead, reverse the aging process, cure blindness, etc. The Greek people’s love for Asclepius grew ever stronger as evidenced by the fact that by the 4th century B.C., Asclepian healing temples had been built throughout the Hellenic world, from Epidaurus to Tricca.

The treatment patients could receive in the numerous Asclepia Temples employed the same beneficial effect of mineral springs that the Sumerians used, however, most medical centers also included snake nurseries where serpents were farmed to perform mystic, healing rituals.

The longest-standing Asclepia Temples in Epidaurus consisted of bathing springs, exercise area (palaestra), a gymnasium, a dream temple, and snake farms. Patients were attended to by a retinue of priests, caretakers and stretcher carriers before they were granted an appointment with the head priest. The size of sacrificial payments made depended on the patient's status. As the culmination of the medical tourism treatment Asclepius would visit the patient in a dream and recommend a remedy for their illness or injury.

Around the 4th century A.D., treatments tended to become less ritualistic and more clinical. However, even at the height of alchemical and herbal medicine, priests performing the old ritualistic procedures remained in practice in certain parts of the Mediterranean. Other temple spas such as the Sanctuary of Zeus at Olympia and the Temple of Delphi spa center flourished throughout ancient Hellas, but on a much smaller scale.

Ancient Rome took the concept of Thermae - that is, hot water baths - one step further. They were not only used for their obvious medicinal benefits, but also served as important social networking venues for the Empire’s most privileged elite.

However, it was not only the elite that spent lavish amounts of money to access these health care centers. The Romans did not believe in Spartan healing methods. Anyone who could afford to do so wanted to enjoy the countless baths and hot springs that surfaced.

Similar to 21st century medical tourism hotspots, most of these elaborate Roman complexes included theater activities, lounges, art galleries, conference halls, brothels and sports
stadiums. According to written historical accounts, some of these health centers could even house up to 3,000 patients and patrons.

With the Empire's steady expansion, pilgrims, diplomats, kings and beggars from every corner of the known world flocked to the Mediterranean to seek medical counsel and health treatments.

Active trade with Persia, Asia and Africa necessarily brought about an age when Roman medical centers became places to receive Ayurvedic massages and Chinese acupuncture treatment, experience Buddhist spiritual healing methods and various forms of exotic treatment.

Early Islamic civilization is known for its various contributions to the field of healing and
medicine. It is not surprising that here we find an established system for the treatment of foreigners. Most certainly, the most famous medical tourism facility in the Islamic world was Mansuri Hospital in Cairo, started in 1248 A.D.

With its in-patient capacity of 8,000, Mansuri Hospital was the largest hospital of the time. In addition, it was the most advanced medical facility the world had ever known. The hospital complex included facilities for surgery, a separate department for eye diseases, separate wards for women, a pharmacy, a library and lecture halls.

No patient was to be turned away on account of race or religion, and no limits were imposed on a patient’s stay in the hospital. Well ahead of its time, - or even our time in many countries, - this medical care facility promised its visitors the following:

• The hospital will keep all patients until they are completely recovered.
• Treatment is completely free of charge regardless of the patient's residency, nationality, social status, literacy and the nature of their health conditions.

There existed welfare hospitals, called Bimaristans, in Baghdad and Syria as well catering to worn-out travelers from near and far. Accommodations at these medical tourism center always had enough place for new patients due to the fact that the buildings were actually opulently furnished palaces and luxurious lodgings donated by nobility inspired by the Islamic principle of charity.

When Japanese hunters traced their prey flying through the woods, they came to small bubbling pools of hot water where the animals drenched their bodies to tend their wounds and relieve their pain. These mineral springs, locally called Onsen, soon became known for the healing properties of water that was enriched by the surrounding volcanic soil, and tempted tourists from all over medieval Japan.

The elderly people farmers, hunters, and fishermen of the region realized that by bathing in the rich, hot waters they could effectively treat arthritic aches. Word spread. It wasn't long before soldiers of the various warrior clans began visiting favored hot springs to alleviate pain, heal wounds, recuperate, and replenish lost energy levels.

Due to the development of effective plumbing systems, most Japanese homes today employ big bathtubs designed and built to facilitate the enjoyment of the Onsen experience. In addition, traditional Onsen still attract lots of visitors. 1000 years after the Onsen became a cultural phenomenon in Japan, you can still see throngs of tourists, families, businessmen and elderly people swarming to these revered hot springs in places like Kyushu and other regions with volcanic activity. Some Onsen even employ mud pools and sulfur springs allowing bathers to receive rejuvenating mineral scrubs as they soak in hot, calming waters.

India is today considered the global center for health care tourism in Asia. India's offering to the public ranges form alternative Ayurvedic therapy to plastic surgery to coronary bypasses. As a prerequisite for India to be able to do everything contemporary health care does, the government invested huge sums to upgraded technology and absorbed western medical protocols in its health care facilities.

Since the end of the '90s, an economic liberalization process has taken place in India and private hospitals were able to adopt western technology and import medical goods in an effort to bring medical infrastructure for hospitals to western levels. Backed India’s successful IT industry, the returning of highly skilled doctors from overseas due to increasing salaries and a new-found confidence in a liberalized and less bureaucratic administration, India launched an impressive marketing campaign to make its medical potential known.

Buddhist pilgrimages, Yoga retreats, Ayurvedic meditation centers are just some examples of India's healing arts that attract an inordinate amount of health care tourists into the country. Ever since Ayurveda’s birth thousands of years ago, India has enjoyed a constant influx of medical travelers and spiritual students that came in hopes of mastering this most revered branch of alternative medicine.

With the birth of Buddhism about 2,500 years later, India has experienced renewed interest in its progress as the cultural, spiritual, and medicinal center of the East.

With Western clinical medicine eventually placing its focus elsewhere, India keeps offering its spiritually centered healing approach and places like veritable Meccas for all practitioners of alternative medicine. In the 1960s, the dawn of the New Age movement in the U.S. gave a new boost of support to traditional eastern medicine. Trends indicated that India once again was the destination of choice for throngs of pilgrims from the West.

India's committed stance towards further developing its health care technologies and infrastructure also channels a mass influx of medical tourists to one of the world’s oldest medical tourism destinations, making it more popular than ever before.

Although pilgrimages have played an important role during much of Europe’s history, leisure tourism, recreational holidays, and medical travel did not appear until the 16th century when Europeans became aware of the Roman baths again.

Whole communities developed around spa towns such as Baden, Aachen and Bath. The fact that Bath or Aquae Sulis became major medical tourism destinations is due in large to the heavy royal patronage and support that these cities received. With all the publicity drummed up by members of the ruling class, it wasn’t surprising that Bath became known as a hip wellness and recreation playground for those who could afford it.

By the 1720s, aristocrats and wealthy gentlemen flocked to Bath for cleansing and medical treatment, while socializing with the continent’s elite. Consequently, Bath acquired a great deal of social, financial and technological benefits, similar to today's modern healt care tourism hotspots. Bath became the first city in England to obtain funding for the creation of a covered sewer system (well before London). Paved roads, elaborate street lighting system and a host of famous architects labouring to dress up the facades of hotels, pubs, mansions, and restaurants ensured the massive in-flow of medical travelers ready to generate profit.

One of the most notable health care tourist of the time was Michel Eyguem de Montaigne, French inventor of the essay, who trawled Europe for nine long years seeking medication for his gall bladder problem. Thus, in the eyes of his later followers, De Montaigne became the father of luxury travel. He assisted with writing probably the earliest spa guides for medical tourists of the continent.

Medical tourism also flourished in other places. In the 1320s, a tiny village in east Belgium won overnight fame following the unexpected discovery of mineral-rich springs in its proximity. Although by the Romans the later Ville d'Eaux, or Town of Waters, was well-known for its therapeutic springs, it was only in the 16th century that the place grew up to its potential as a popular health resort. Visitors in search of relief from gout, rheumatism and intestinal disorders virtually swarmed to the Town of Waters. It was here that the word “spa” - from the Roman “salude per aqua” or health through waters - was coined applying to any wellness resorts that attempted to heal by unconventional means.

Native Americans maintained an impressive catalogue of therapeutic plants that easily compared to the amount of knowledge accumulated in the Europe of the time. They were masters of the difficult art of healing, a knowledge of which they were barely able to pass on to the European settlers, as these were much more concerned with securing their own portions of land than with building relationships with the natives, which could have served as a basis for broadening their knowledge of the New World.

Despite the Europeans' often obvious contempt for the red people, a form of medical tourism came to existence as colonists and settlers desperate for their lives frequently turned to local healers, shamans and witches spending the last of their hope for recovery. This is not surprising since at the time of the establishment of Virginia by the Virginia Company, 95% of settlers or indentured slaves sent to colonize America died of starvation or disease in the first 6 months.

However, what little knowledge the Europeans have brought with them, was put to good use in an effort to achieve a convenience level or standard of life somewhat reminiscent of what people were used to in the old continent. At the beginning of the 1600s, Dutch planters built log cabins near hot mineral springs of medicinal value. By the 1800s, many Americans took up the habit of journeying to remote springs in the West to soak in the bubbly hot pools and get rid of their various health problems. Today is the time of rediscovery for Americans. Due to historians and researchers of the mystic arts, various types of New-World-based alternative medicine have revealed its techniques for the descendants.

The Middle East has been a traditional source of medical tourists for Asian countries such as India, Malaysia and Thailand. However, in recent years, countries such as Bahrain and Lebanon and the United Arab Emirates has been striving to reverse this process and create their own medical tourism industry. For example, Dubai has developed HealthCare City to break into the Middle Eastern market and capture some of the health care travelers bound for Asia.

It was clear that the Middle East would not be able to compete on prices, therefore they sought to win clients' attention by raising quality levels. Dubai started employing highly-trained German specialists to ensure high skill standards, while Lebanon placed the emphasis on the fact that their doctors were trained at the best universities and clinics of Europe and North America. Another way for the Middle East to differentiate its services was branding. However, it is still a question of the future if Middle Eastern facilities such as Dubai HealthCare City will be able to cash in on their efforts to provide their elite, high- quality services.

Oman's efforts to attract specialists from European institutions such as the Bavaria Medical Group are fairly evident, as several contracts have been signed towards this end with both Qatar Airways and the Sultanate of Oman. Saudi Arabia has been trying to establish a link between medical tourism, with special regard to cosmetic surgery and dentist care, and pilgrimages to the country such as the Hajj, in an attempt to cash in on the influx of people from the Gulf states.

Living up to the reputation of their government communication, Iran has declared that no Middle Eastern country can pose a challenge for them when it comes to medical expertise and costs. They issued a report on the comparison of costs of pen heart surgery stating that Iranian doctors will do this procedure for half the price patients would pay in the US and one quarter of what would be the cost in the UK.

However, despite all the efforts of these states, Jordan remains the country that receives the most medical tourists with its low-cost services in the Middle East.

South Africa and other less obvious locations such as Costa Rica, the Baltic states, Belarus, etc. have also seen a sharp rise in medical tourism in recent years. South Africa has became a safe haven for cosmetic surgery offering costs less than half of those in the U.S. Hungary announced that 2003 was to be the Year of Health Tourism in the country.

Eastern European countries and Argentina have become prominent dental care and plastic surgery destinations. Jordan welcomes patients from all over the world to perform various kinds of surgical procedures on them; Israel accepts both Jewish patients and others specializing in high-risk pregnancies, female infertility and in vitro fertilization.

As for the Caribbean states, Cuba became one to specialize in skin diseases and skin care, while Antigua offers cheap and good-quality dental care for patients form the United States. In the Pacific region, Guam has developed into a regional dental care center for Japan, Palau and the Federated States of Micronesia.

The major medical tourism destinations in Asia, that is, Thailand, Malaysia, India, Singapore and South Korea, attract combined over 1.5 million health care tourists annually. This makes up an estimated sum of $3.5 billion worth of medical tourism in Asia only.

Thailand became known for sex change operations in the early '70s. The initial influx of medical tourists provided a springboard for the country to move on to less controversial areas such as cosmetic surgery. At the end of the '90s, when the Asian economic crisis set in, Malaysia, too, felt the need to get involved in health care tourism, especially because local patients could no more afford private health care and hospitals were forced to look elsewhere for clients.

Singapore has been watching Malaysia and Thailand rates and deliberately setting theirs just below these. The country employs to motto "Asia's leading medical hub." Having set up 9 hospitals and 2 health care centers with advanced research capabilities together with Joint Commission International accreditation and having JCI's Asia Pacific office in Singapore, the country's most targeted market is in the US. In addition, patients from neighbouring countries such as Indonesia and Malaysia have also discovered the advantages of this high-tech city. Singapore doctors are known for their expertise in many complex and innovative procedures such as the separation of conjoined twins and tooth-in-eye surgery.

The Philippines have everything a medical traveler might look for in an ideal destination. Competitive prices, highly skilled physicians, English language, compassionate and caring service providers, accredited medical facilities and tourist attractions of heart-stopping beauty all over country.

Over the course of history, the wealthy have always responded well to medical tourism destinations. Today, however, with the disappearance of technological, economic and cultural barriers, those with modest means can also enjoy some of the benefits of first-class health tourism.

Americans, used to high domestic prices, have discovered that they can get in shape in the Far East for a fraction of the price they would pay at home. The English, used to sophisticated medicinal conditions, can avoid long wait times by catching a flight to India, where they can receive the same world-class service that they would expect at home.

Affordability and time remain the most important reasons why patients are ready to cross borders for surgery. However, quality of care and 5-star treatments have become decisive factors as well. In truth, medical procedures abroad are sometimes even better than what you would receive in primary medical care centers at home.