GETTING A nip, tuck an d a tan is becoming an in crea sing ly popular way of spen ding a holiday, but the number of tourists see king more complicate d procedures is on the rise, too – an d Singa pore is at the hea rt of the acti on. Geraint Price in vestigate s

“In 2005, Singapore received 374,000 healthcare visitors, many accompanied by one or more persons. The estimated tourism receipts in 2004 came to S$836m”
For decades, Americans have realised that medical care beyond their borders comes with significant cost savings: nipping over the border to Mexico for minor surgery or heading to Canada for prescription drugs. Even in Europe, Britons in need of treatment and not wishing to spend months on a National Health Service waiting list head to France for medical care. Earlier still, Romans went to Bath for the healing waters. The phenomenon is nothing new: the ancient Greeks came from across the Mediterranean to Epidauria, sanctuary of the healing god Asklepios. Today, travellers with a valid passport have a plethora of choices: India, Thailand, Singapore and Hong Kong are all popular medical travel destinations. Costa Rica, Argentina, South Africa and Brazil, specialising in elective and plastic surgery, are leading the pack in cosmetic tourism. For those who need help negotiating the world of discount medical care, an entire industry of middlemen has sprung up. Rudy Rupak, president of Planet Hospital, an agency that connects patients with 38 hospitals in 13 countries, says his website gets more than 45,000 unique visitors a month.

But as medical travellers venture further afield in search of cut-price treatments, it is Singapore that is capturing the lion’s share of the business.

At current rates, the US will be spending US$1 of every US$5 of its GDP on health care by 2015, yet more than 1 in 4 workers will be uninsured.

In 2003, Singapore had over 230,000 medical visitors despite the Sars outbreak, representing an increase of nearly 9 per cent over the 2002 level. According to Dr Jason Yap, director of healthcare services at the Singapore Tourism Board, medical tourism has impacted greatly on the island state’s economy.

“In 2005, Singapore received 374,000 healthcare visitors, many accompanied by one or more persons. The estimated tourism receipts in 2004 (spending on airfare on local carriers, hotel or accommodation, shopping, dining and leisure as well as medical care) came to S$836m, earned by the Singaporean economy from visitors specifically for healthcare and their accompanying persons. In addition, other visitors that also visited doctors and healthcare facilities during their stay spent an additional S$27m that year. When one considers that the tourism receipt for all visitors for 2004 was S$9.6bn the provision of healthcare services for international patients contributed 8.9 per cent of the total traveller-based national revenue.

According to the Singapore Tourism Board, the plan is to draw a million foreign patients yearly to the country by 2012. If this is realised, more than S$1.6bn in income could be generated, adding about 1 per cent to the gross domestic product.

Until relatively recently, the prospect of flying halfway around the world to seek the best medical treatment would have been sniffed at, but cultural chauvinism is giving way to practicality and, more crucially, the realisation that standards can be as good, if not better, away from home.

“Surgery packages can be booked with disarming ease. Coronary angiogram? Yours for S$1,900. Breast augmentation US$2,750, including one night’s stay, surgeon, anaesthetist fees and all medication. All at the click of a mouse”
Expatriates and wealthier locals would routinely fly to the US or Europe for something as straightforward as a check-up. But as the cost of medical treatment has soared over the past 20 years, patients are now looking at ways of lowering the expense.

Already, hospitals in the UK and US have begun to sub-contract some procedures – like transcribing medical records – to India; now it is the patients themselves who are being outsourced.

India, in particular, is aggressively targeting patients. Medical tourism is on the rise with more patients from the United States, Europe and the Middle East seeking Indian hospitals as a cheap and safe alternative to their own countries. A recent Bloomberg report said Indian doctors are setting up what could be a medical renaissance in their country and the next big boom for the economy. For example, the Tamil Nadu Tourism Development Corporation (TTDC) and Apollo Hospitals also collaborate to give TTDC tourists a 15 per cent discount on healthcare checkups in any Apollo centre in the country.

One glance at the figures and it is not difficult to appreciate why. Instead of paying US$200,000 for mitral valve surgery in the US, a patient could receive the same treatment in India for US$6,700. Similarly, rather than paying £15,000 for hip resurfacing in the UK, a patient can get the same procedure for £5,000 in India, including surgery, airfare and hotel stay. A study by the Confederation of Indian Industry (CII) and McKinsey Consultants in 2002 estimated medical tourism could be worth 100bn rupees (US$25bn). In 2004 some 150,000 foreigners visited India for treatment – and that number is rising by 15 per cent a year. With a large pool of highly trained doctors and low treatment prices, healthcare aims to replicated the Indian software sector’s success. Built on acres of land – often gifted to companies at peppercorn rents from Indian local authorities eager to promote business – the new, sleek medical centres of excellence offering developed world treatments at developing world prices. Closer to home, Thailand is now viewed as the region’s leading centre for not just cosmetic operations, but major surgery, with Bumrungrad International in Bangkok leading the charge. Here, surgery packages can be booked with disarming ease. Coronary angiogram? Yours for BT45,000 (US$1,475). Breast augmentation? BT90,000 (US$2,951), including one night’s stay, surgeon, anaesthetist fees and all medication. All at the click of a mouse.

And for the à la carte option, the hospital will gladly provide a quote by email. The website offers perks like “round-trip airport transfers, welcome massage, mobile phone, half-day Bangkok tour, two round trips to hospital with hospital outpatient registration and process orientation. Plus 24/7 assistance during your entire stay in Thailand.” Bumrungrad, which treated 430,000 non-Thais last year, has just expanded its Bangkok hospital and is now setting up in the Philippines and Dubai.