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.