Chinese Market

Countries are beginning to notice an increase in Chinese citizens looking for healthcare services abroad, as Tatum Anderson reports

Around 483,000 people travelled from China for medical tourism in 2015, spending US$6.3 billion on treatment and US$3.4 billion on related travel and accommodation, according to By 2020, it is predicted that over 800,000 people will seek healthcare abroad. Given that Goldman Sachs reports that just four per cent of the Chinese population currently hold a passport, today’s healthcare tourism from China could be to be the tip of the iceberg.
Medical tourism destinations too are becoming more interested in Chinese travellers, partly because the Middle East is not as lucrative as it once was as a source market. As an example, the US Commercial Service, the trade promotion arm of the US Department of Commerce, is helping top-quality hospitals in Los Angeles and San Francisco build relationships with Chinese partners, according to Pete Read, CEO of consultancy Global Growth Markets. “The Middle East market is levelling off due to oil price issues as well as President Trump’s travel ban, which has an impact beyond the mainly Middle East countries directly affected,” he said. Also, security concerns and a cooling relationship with European nations has led Turkey to broaden its appeal by actively promoting itself as a medical tourism destination to Chinese tourists.

Asian neighbours
Understandably, the Chinese outbound market is today skewed towards nearby Asian countries whose proximity make them more convenient. Of the 483,000 patients that left China seeking health services in 2015, barely two per cent left Asia. Top destinations, in terms of volume, were South Korea, Taiwan, Japan, Hong Kong, Thailand and Malaysia. Travellers mainly travelled these short-haul distances for cosmetic surgery, IVF, dental, health check-ups, wellness and anti-ageing treatments.
The added attraction with some Asian countries is that they can boast culturally-relevant services – Chinese doctors or Chinese-run hospitals, Mandarin-speaking staff and signs. They may even embrace elements of traditional Chinese medicine.
Singapore is between 20 and 30-per-cent more expensive than other Asian nations, but still attractive because of its super-high quality of treatment and rigorous efficiency. Its population is almost three-quarters ethnically Chinese, and Mandarin is spoken by more than a third. The city state attracted around 9,000 Chinese patients in 2015, according to Global Growth Markets (GGM).
Malaysia, too, has invested heavily in its healthcare infrastructure and now offers cheaper value services to inbound tourists. Its population is around 23-per-cent Chinese and several Chinese languages are spoken here (Cantonese, Mandarin, Hokkien, Hakka, Hainan, Fuzhou).
Surprisingly, perhaps 150,000 medical tourists went to Taiwan in 2015 – despite China’s complex history with the province – compared with the 53,000 that went to Hong Kong, says GGM. That’s because Hong Kong does not have as many hospitals and, importantly, is more expensive than Taiwan, say experts.
But many outbound Chinese travellers are middle-class college-educated Millennials and aren’t just visiting traditional Chinese tourist hotspots. In 2015, 179,000 patients from China, spent over US$1 billion on hospital fees, travel and accommodation in South Korea for instance, according to GGM data. Interestingly, many are doing so for serious and often life-threatening conditions – complex paediatric cases, for example.

Further afield

More affluent patients are the ones who generally take long-haul flights to the US and Europe. When he was in charge of international patients for the Harvard hospitals group in Boston, which includes Brigham and Women’s, Edwin McCarthy (now at City of Hope Hospital, a cancer hospital in Los Angeles) noticed a huge increase in cancer patients from China. “When we started getting visitors from China, it was almost exclusively cancer patients would come to our hospitals in Boston,” he said. With so much research, there are constantly evolving protocols, new drugs and therapeutic approaches such as proton beam and immunotherapy. “So it’s a very rapidly evolving field, and that’s where the US and some hospitals in Europe are at the forefront of those things,” he said. “Serious diseases like cancer were perceived to be better handled in the West than they were at home in China.”
Tragically, says McCarthy, many journeys to the US were expensive last-ditch attempts by patients with stage-III or IV cancers that could not be treated.
The fact is, cancer is exploding in China. There were 4.3 million new cancer cases and more than 2.8 million cancer deaths in China in 2015, with lung cancer being the leading cause of cancer death. Heavy industrialisation has caused some of the worst outdoor air pollution in the world, as well as the contamination of soil and drinking water with carcinogens. In 2016, tobacco smoking accounted for about one-quarter of all cancer deaths in China according to the National Cancer Center in Beijing.
That Chinese citizens are prepared to leave home for such serious reasons could be seen as a reflection of trust – or lack thereof – in the existing Chinese healthcare system. It’s a system that was under-funded for years, says Josef Woodman of Patients Without Borders, which specialises in medical travel. Ten years ago, the country had just two JCI-accredited hospitals, when Singapore had 14 and the US had 28.
Things are changing, however. Today, China has almost 80 JCI-accredited hospitals and is embarking on an ambitious hospital building scheme worth $892 billion by 2018.
Despite that, its services are not well-trusted by its population. That’s because as well as building infrastructure, the country needs a working healthcare system with expertise; enough doctors, good medical schools and a surplus of nursing staff. “That takes a long time and they have to get it right,” he said. “You can’t just build a building and have healthcare. It takes a generation to build that.”
So that’s why countries outside China with high-quality care are attractive. “If they have money and a high acuity condition that demands a real diagnosis and a lot of nuance, they want to travel outside of China,” he added. “For those folks who don’t go to the US for care, there are choices,” he said.
Until their own healthcare system is trusted, a growing number of Chinese patients in desperate need of healthcare for serious conditions will leave, including both high-net worth individuals and middle-class tourists. To attract them, countries are allowing electronic visa applications, special multiple-entry visas, dedicated medical tourist channels at airports, Chinese language websites and freedom to transfer money into the country to pay for treatment. In Japan, hospitals such as St Luke’s in Tokyo have installed Chinese-language signs. The country’s authorities have relaxed visa restrictions and published a list of international hospitals.
Thailand is leading the pack when it comes to attracting health tourists, says Read. Bangkok’s Bumrungrad Hospital offers Chinese travellers premier and VIP suites, a 24-hour Mandarin hotline, an embassy contact service, airport transfers, a Mandarin reception service and visa application assistance as part of its five-star hotel-like medical tourism experience.
Some countries are establishing physician referral networks; doctors abroad can be referred cases that a physician may not be able to treat adequately in China. Others are making their presence felt in China. MHTC, which has an office in Hong Kong, is opening soon in Guangzhou to help locals get treatment in Malaysia.
Some are targeting specific treatment markets. Malaysia is actively marketing fertility packages in China to capitalise on the relaxation of the only-child rule. “Couples from China who are keen to pursue fertility treatments in Malaysia are mostly in the older age group of mid-30s and above,” says MHTC’s Azli. “The fact that fertility declines with age and the risk of chromosomal abnormalities increases with age pose a challenge in realising the dream of parenthood.”
As well as IVF, Malaysian hospitals are offering counselling services before treatment, nutritional advice, and relaxation therapy. Last year, Malaysia Healthcare partnered with Tai Orient, an IVF referral company that has 20 branch offices across first and second-tier cities in China.
Further afield, other countries are upping their game. German agencies and hospitals are actively targeting the Chinese market, developing local language marketing and creating tourism experiences for Chinese visitors.

Changing market
Of course many will be focusing on the super-rich segment, which is predicted to grow dramatically (China currently has 1.2 million millionaires, most of them middle aged or older, according to Patients Without Borders). Switzerland is emerging as a destination for super-rich Chinese travellers to try out anti-ageing stem cell therapy.
And other changes in China may fuel the growing market. Previously, China neither enabled its embassies to organise treatments, established bilateral healthcare agreements with other countries nor even allowed health insurance to include foreign healthcare provisions. Those seeking healthcare abroad have done so by paying out of pocket.
Things are changing, however. Loosening regulations in China could mean health insurance policies sold by Chinese firms might incorporate options for foreign healthcare. Today, 96 per cent of China’s population is covered by some form of medical insurance (through national health insurance or a rural co-operative medical insurance system), up from 45 per cent in 2006, according to Deloitte. But coverage is generally shallow, with low premium contributions and patients continuing to pay large outpatient fees.
In future, however, experts predict policies are likely to have more generous benefits that allow patients to go to the more expensive private hospitals in China – and then abroad.
And today many tiny organisations throughout China are able to make appointments at foreign hospitals, and translate medical documents. But they are often not sophisticated operations and do not last (some more sophisticated options, such as Saint Lucia, help patients to access US hospitals). But longer-term, say experts, hospitals hoping to tap directly into China should hire Mandarin-speaking staff and nurses, and train clinicians about Chinese perceptions of healthcare that are influenced by traditional Chinese medicine. Importantly, they should also consider accepting diagnostic test results from Chinese hospitals, rather than obliging patients to repeat the same tests. “This can be a deciding factor in the choice of hospital,” says Read of Global Growth Markets. Accepting WeChat payment, AliPay, Chinese credit cards such as UnionPay, as well as payments in Chinese currency would help too he adds.
Others suggest that building up very good relationships with mainland doctors is a good way to target Chinese customers; some doctors in medical travel destinations are providing second opinion services to physicians in China, says City of Hope’s McCarthy. Sometimes those opinions suggest foreign healthcare for treatments that aren’t available in China. Some new (and often more expensive) cancer medicines may not be on the Chinese formulary, but are available in the US, for instance.
City of Hope wants to offer healthcare services directly to customers in China – curiously – as a way of increasing healthcare travel. If it can treat patients nearer to home, then it will be able to refer those abroad for treatments that aren’t available in China. “We will expect to serve more patients who elect to come to our hospital in California. But most will be treated in China and appropriately so,” he said. “We think that’s the best for the patient and helps build our reputation by providing the right advice.”

Source: International Hospitals & Healthcare Review