Travelling for health purposes is a combination of two main themes, namely the importance of getting the best medical treatment as possible while having a good leisure time (Clift & Grabowsky, 1997).

Brief History

Travelling for medical reasons started around the sixth century BC in India, Greece and Persia (Douglas & Derrett 2001), and its early form was mostly concerned with the therapeutic values of particular environments, such as the famous spa of Bath in England. Obviously, medical tourism had to evolve in order to accommodate modern needs and changed significantly. According to Bookman and Bookman (2007:42), Medical Tourism is growing only one step behind providers’ imagination. Creative services that compete in novelty, quality, and relevance are popping up daily. As a result, it became an increasingly profitable market for many countries.

The 5 key drivers of medical tourism:

  1. Technology: Technological improvements like more efficient global transportation and communications systems drive medical tourism. Transportation according to
    Duval (2007) is one of the more ubiquitous global economic sectors and its growth shares synergies with growth in tourism. Moreover, artificial intelligence techniques can provide support in many areas relevant for tourism, like promotion, information access, decisions and actions, preparation for the visit, the visit and even after the visit. The flattening of the world through the internet and technology in the medical industry are improving the quality of services.
  2. Cost: When patients’ health insurance does not pay for the care they need, or they do not have insurance at all, then the cost of the care is automatically shifted to those patients who actually have one. This is known according to Jagyasi (2008) as ‘cost shifting’. The focus should not be to gain from the economy of other countries or build the tourism sector from needy to sick patients, but rather on providing care for patients. It is a fact that the cost of medical care in developed countries is extremely high. Hence, private, social and corporate health schemes are very expensive.
  3. Need: The emergence of new consumer needs, like avoiding long queues to getting medical treatment or the possibility to have the latest available treatment, requires new solutions which are not always available in a consumer’s home country.
  4. Demographics: Demographic drivers such as an ageing population due to baby boomers causing significant strain on national healthcare systems are a driving factor as well.
  5. Change: Hospitals are adopting the more luxury hotel concept rather than traditional unexciting general wards. After the surgical procedure, there is the opportunity to engage in attractive tourism, which is certainly a better change for the patient.

An understanding of motivation is key to understanding tourist behavior, and to answering the question of why and where people travel. Many texts associated with tourism utilize the concept of motivation as a major influence upon consumer behavior, taking into consideration general theories such as that of ‘Maslow’s hierarchy of needs’.

The 5 As of Medical Tourism

According to Jagyasi (2008), there are five major actors involved in the decision making process of medical tourists. He calls them the “5 A Factors”: affordable, accessible, available, acceptable and additional.

The EU Directive

The EU Proposal for a Directive on patient’s rights in cross border healthcare was published in 2008. It provides an added stimulus to the already growing number of medical tourists who seek hospital treatment elsewhere in the EU. Its aim is to create a formal framework for cross border healthcare and remove the obstacles that patients face if they wish to travel for treatment in other EU countries (Allen 2009).

The Directive has come about from a desire to create a European market in healthcare, and to some extent as a result of European Court judgments which have upheld the rights of patients to gain reimbursement for treatment in other countries where they have been subject to "undue delay" in their own country. The Directive proposes a number of developments in cross border healthcare, including reimbursement of medical tourists, patient safety and quality issues, European cooperation on healthcare, assessment of new medical technology and standards for e-health, and transfer of patient information between member states.

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