Medical tourism—cure or malaise for the National Health Service: a mixed methods study

Abstract

BackgroundDespite increasing reference to medical tourism by politicians and reports in popular media, there remains little understanding of actual size, scope, and effect of inbound and outbound UK patients. Although evidence suggests that a growing number of patients travel to access (and pay for) medical treatment, including UK residents and, equally, that patients travel to the UK for treatment, little is known about the scale of these events and potential effects, including costs and income for the NHS. MethodsWe present findings of a 2-year project undertaken by researchers at the London School of Hygiene and Tropical Medicine and the University of York, which focused on understanding the effect of medical tourism on the UK NHS. It includes analysis of the International Passenger Survey (IPS) to estimate volume and direction of flows of inbound and outbound UK medical tourists. Additionally, investigators submitted freedom of information requests to 28 NHS Foundation Trust hospitals to obtain data for numbers and income from non-UK residents accessing treatment as private patients. Focus was not on patients who access the NHS without intention to pay. Trusts were selected with a focus on well known hospitals in London and other cities deemed likely to attract medical tourists. 19 trusts responded. Different information sources together form the basis for economic analysis estimating possible costs, income, and potential savings for the NHS resulting from medical tourism. FindingsIPS data suggest that there are more outbound than inbound UK medical tourists (63 000 compared with 52 000 during 2010). We estimated costs arising from medical complications in returning medical tourists on the basis of published figures. We explored different scenarios on the basis of types of complications reported, and scaled these up using analysis of IPS. The focus was on medical treatments for which patients are known to travel and for which complications have been reported, including bariatric, fertility, and cosmetic surgery. Analysis revealed costs of returning medical tourists who needed subsequent NHS treatment; estimates ranged, dependent on treatment, between £10 and £16 million per year. Findings also suggested possible savings in health and social service expenditure averted as a result of patients travelling abroad. This finding was specifically the case for bariatric surgery; albeit indicative, calculations suggest that combined savings from cost of procedure, future health expenditures, and additional income due to improved ability to work after weight loss surgery are around £28 million annually. Our analysis of income from inbound medical tourists was based on estimates of tourism spending by patients and their companions and figures for non-UK patients obtained from NHS Trusts. Findings show that overall only a small number of private patients treated within the UK NHS are non-UK residents (7%), but that these patients generate almost a quarter of private patient income. Findings also reveal income to be concentrated in a few large hospitals and non-existent or marginal in others. Findings presented are the most robust estimates of income, costs, and savings associated with UK medical tourists to date. However, limitations include small sample size and highlight the need for more reliable monitoring to enable robust calculations. InterpretationFar from present political rhetoric, findings suggest that the UK is a net exporter of medical tourism. There is need for greater monitoring of UK medical tourism, including whether patients access treatment in the public or private sector, to allow more accurate prediction of costs and savings. As the NHS is considering greater private revenue, incoming medical tourists may be a profitable target. FundingFunded by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (project HSR 09/2001/21). This abstract presents independent research funded by NIHR. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.