Patient or tourist? Medical tourism in the Caribbean

As Caribbean countries seek to diversify their tourism industries, medical tourism — aimed at people who travel for treatment — should be on the agenda. Erline Andrews investigates

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In early 2008, as the global economic crisis was triggering a decline in recreational tourist travel, representatives from thirteen Caribbean countries came together in Barbados for a three-day “strategy meeting” on health and wellness tourism. They listened to presenters from Canada, the United Kingdom, Cuba, and Malaysia — all countries with established and successful medical tourism industries.

Medical tourists travel to other countries to access treatments that are not available where they live, or that are cheaper or more immediately available elsewhere. There is intra-regional medical tourism in the Caribbean, but participants at the meeting heard of a large, lucrative pool of potential patients outside the region.

“Health and wellness tourism is growing at a higher rate than that of global tourism,” said Barbados tourism minister Richard Sealy in his feature address. And Sir Henry Fraser, retired dean of the Faculty of Medical Sciences at the University of the West Indies, Cave Hill, explained via email why getting into medical tourism was “a no-brainer” for Barbados. “Which Canadian or American needing overseas surgery would not prefer Barbados, where we speak English and have high standards, to the uncertainty of a twenty-four-hour flight to the Far East, with poor communication in language and no follow-up care?” he asked.

Fraser co-authored, along with members of the Canada-based Simon Fraser University (SFU) Medical Tourism Research Group, the 2012 report An Overview of Barbados’s Medical Tourism Industry. And the meeting in 2008 was followed by a spurt of state activity to build up the region’s medical tourism. Barbados’s Ministry of Health created a task force that recommended, among other things, a package of incentives to encourage the setting up of private health care facilities on the island. Trinidad and Tobago’s investment promotion agency, InvesTT, commissioned a “draft strategy for medical tourism,” which included suggestions for how to rally the public and private sector around the idea of making the country a prime medical tourism destination. And the Jamaica Promotions Corporation (Jampro), which also commissioned a draft policy document, entered into an agreement in 2013 with an American organisation to build a facility targeting medical tourists, estimated to cost US$170 million.

But there hasn’t been talk of the project since 2013. A similar project in Barbados also seems to have stalled. In T&T, there’s been no action on the draft strategy.

So far only five institutions in the English-speaking Caribbean have accreditation from the US-based Joint Commission International, a key element in medical tourism success. Among the recognised facilities are the Barbados Fertility Clinic, accredited in 2007, five years after it was founded, and Doctors Hospital in the Bahamas, which has been in operation for thirty-six years but was accredited in 2010. Last year, the hospital did the first cochlear implant in the Bahamas, and also offers high-intensity focused ultrasound treatment for prostate cancer, stem cell treatment, and spine surgery.

In an interview in 2014, Doctors Hospital founder Barry Rassin said medical tourism accounted for eighteen per cent of the institution’s revenue. He aimed to increase that to fifty per cent. Meanwhile, the Barbados Fertility Centre already has eighty percent of its clientele coming from abroad, according to the SFU overview.

The centre and the hospital are models for medical tourism: they’re run by locals and offer services in highly specialised fields, thus ensuring demand from outside the country. But so far they have not been replicated elsewhere in the region. “There just hasn’t been the right level of investment in infrastructure,” says James Cercone, an international health care consultant who’s worked throughout the region. And despite the constant talk of medical tourism, the actual efforts to promote it in the region have been slow.

A 2014 article in the International Medical Travel Journal found there were long delays on the part of government agencies in granting permits, licensing, and other approvals. “The Bahamas is not the only country where politicians have made numerous promises of support for medical tourism, until it comes to the point of committing time, money, and resources,” the article concluded. And last year the IMTJ asked, “Why is Jamaica struggling to attract medical tourism?” It found the high cost of private health care was a deterrent.

The publication quoted Dr Alfred Dawes, past president of the Jamaica Medical Doctors Association. “I have received enquiries from Americans about the cost of weight-loss surgery, only to be told point blank that it costs way more than in Mexico,” said Dawes.

Cercone said that high duties on medical equipment and supplies added to the cost of health care in the region. “In the end,” he says, “it’s a question of paying the same thing to go to, say, the Bahamas or to go to Mayo Clinic in the US. I’d rather go to the US.”

But Paul Hay, a Jamaican project management consultant who’s written about health tourism, responded in the negative when asked if the Caribbean medical tourism industry was a pipe dream. He pointed to a few foreign-owned projects throughout the region, like the Hospiten Montego Bay, which opened late last year. It cost J$2.3 billion, and is run by the Hospiten Group out of Spain. “It would seem that such facilities require foreign investors or strategic alliances who can draw clientele from their own nations and deal with issues such as transportation, HMOs, etc, which are outside the control of our Caribbean institutions,” Hay says. HMOs — health maintenance organisations — provide health insurance in the US.

But Dawes cautioned against a reliance on foreign-owned facilities. “For medical tourism to be effective in growing the economy, the Jamaican people must be the owners, so they can benefit,” he told the IMTJ.

A paper about medical tourism in Jamaica published last year in the journal Globalisation and Health pointed to the prohibitively high cost of getting that much-needed accreditation. “Accreditation processes and the costs of the renovations they typically demand pose a large and immediate financial barrier,” said the paper. It also said that Caribbean health and tourism officials may have been misled into having too high expectations for medical tourism by “inflated projections” from “industry promoters and consultants.”

The future of Caribbean medical tourism may be in the hands of people like Trinidadian Aisha Carr-Noel, a former emergency medical technician who runs a medical travel agency with one other person. Right now, most of her customers are Trinidadians travelling to places within the Caribbean and Latin America. She’d like to expand her reach, but for the time being it would only be to customers elsewhere in the region.

Carr-Noel thinks health care officials should first focus on facilitating the exchange of health care services within the region, and improving the quality of health care citizens receive at home, before looking for foreign patients.

“We are the customers of our own services,” she says. “And if we can satisfy our own needs, of course we would be able to have customers internationally.”

 

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