Currently, the low-priced and convenient treatment in some developing countries (such as India, Thailand, Malaysia, and Mexico) attract developed countries’ citizens go overseas for medical service. This activity is named as medical tourism. Developing countries are competing to become a favourite destination of medical tourism because foreign patients contribute to the economy of destination countries.
However, because of definite rise of labour price, lack of insurance portability, and medical resources competition, this medical tourism model can not benefit developing countries sustainably.
On the other hand, in China, medical tourism does not just refer to low-priced medical service for rich countries’ citizens, but has boarder content. Membership-based Senior Medical Tourism (MSMT) is an emerging tourism model in China. This tourism model is located in the niche market of China’s senior citizens; also, the group of China’s senior citizens is big and fast growing. MSMT takes advantage of China’s current conditions, including: senior citizens’ particular demand, rest homes’ demand, and various physical environments. This tourism model is a sustainable way to develop medical tourism in China.
Keywords: medical tourism, developing countries, sustainable, MSMT, senior citizens, and rest homes
1.0 Introduction
The purpose of this article is to explore a new model of medical tourism in China. The new medical tourism model can be named as Membership-based Senior Medical Tourism (MSMT). This tourism system, which serves Chinese senior citizens, is mainly composed by rest homes in various territories.
First of all, this article will introduce the current conditions of medical tourism in developing countries and point out the limitations of the tourism model. And then, this article will introduce the emerging medical tourism model in China, analysis the elements in this tourism system, and clarify how MSMT works in practice. Finally, this article will demonstrate why MSMT is a sustainable way to develop medical tourism in China.
2.0 Overview of current medical tourism
Connell (2008) suggests that, “Medical tourism” or “Health tourism” is a term to refer to the tourism model that people travel to other countries or regions for health care and relaxation which are not available or accessible at home. Medical tourism is not a new thing; it was originally caused by pilgrimage in ancient times. Ailing Greeks travelled to Epidaurus to visit the sanctuary of the healing god, Asclepius, who revealed remedies to them in their dreams [Bookman M. Z., Bookman K. R. 2007, pp.5]; also, in ancient China, ailing Tibetan got used to travel to Potala Palace in Lhasa to beg their god for health. In nineteenth-century, British travellers sought out warm and dry climates to treat their lung and bone ailments. Over the ages and across the continents, people went to thermal and mineral waters and warm dry climates to improve their health. Yet, it was first designated as a commercial activity by the International Union of Travel Officials only in 1973. [Bookman M. Z., Bookman K. R. 2007, pp.5]
Loosely defined as travel with the aim of improving one’s health, medical tourism is an economic activity that entails trade in services and represents the splicing of at least two components: medicine and tourism. [Healthbase.com, n.d.] Tourists from the United States travel to Asia for organ transplants, plastic surgery, and artificial inseminations; West Europeans and Canadians bypass the long waiting periods that are part of their national health plans by getting medical care elsewhere. [Bookman M. Z., Bookman K. R. 2007, pp.5] Generally, the current trend of medical tourism is: people from rich countries travel to developing countries for lower-priced or more convenient medical service.
Basically, to become a medical tourism destination, a country or region must meet at least two conditions: high medical standards and low labour cost. Only the country or region which meets these two conditions simultaneously can ensure not only the quality, but also the economy of medical service for people from medical tourists-generating countries or regions.
Some developing countries become more and more attractive for medical tourists from rich countries; India, Thailand, Malaysia, and Mexico are all popular medical tourism destinations.
For instance, as Yanos (2008) indicated, the amount of foreign patients travelling to India for medical care in 2005 was approximately 500,000, compared to an estimated 150,000 patients in 2002. In monetary terms, experts estimate that medical tourism could bring India as much as 2.2 billion US dollars per year by 2012. [Yanos, 31 Mar 2008] Also, from 2001 to 2006, the number of foreigners seeking healthcare services in Malaysia almost tripled from 75,210 patients to 296,687 patients. The large volume of patients in 2006 brought approximately 59 million US dollars in revenue. This trend is likely to grow at a rate of 30 percent a year until 2010. [ETN, 28 May 2008]
As a fast growing developing country, China is not a main medical tourism destination yet, although it meets the two key conditions (high medical standards and low labour cost). Till now, medical tourists have mainly chosen Southeast and South Asia countries, such as Malaysia and India, but not so many to China. [MTC, n.d.] In purpose to obtain bigger medical tourism market share, Medical Tourism China, Inc. (MTC) was established. The company is registered both in the United States and Canada to mainly attract North American medical tourists.
3.0 Can current medical tourism benefit developing countries sustainably?
Outwardly, current medical tourism is flourishing and fast growing; it benefits both medical tourists and destination countries. Also, developing countries are competing to become favourite medical tourism destinations for people from rich countries. However, the current medical tourism- which mainly refers to citizens of developed countries travel to developing countries for medical service- has some definite drawbacks which limit its development:
3.1 Definite rise of labour price in medical tourism destinations
Lower priced labour is a significant component of the cheaper medical service in developing countries, compared to developed countries; it is the base of the current medical tourism. However, with the development of economy, medical tourism destinations’ labour price will rise inevitably. For instance, as OECD (2008) indicates, Mexico’s average annual growth rate of unit labour cost from 1997 to 2006 was 9.88 percent; however, the rate of the United States was 2.01 percent. [OECD, 2008] The gap of labour cost between Mexico and the United States is shrinking year by year. Therefore, soon or later, American will find it is uneconomic to travel to Mexico for medical service; because beside the approximate medical service price, they need to pay extra transport and accommodation.
3.2 Lack of insurance portability
As Benavides (2002) indicated, medical tourism in developing countries has taken off despite facing an unorganised demand based largely on cash transactions and word of mouth. The expansion of medical tourism would be several orders of magnitude greater if medical tourists-generating country health insurances extended their coverage to include medical services outside the country. If insurance were portable, demand for medical tourism would undoubtedly expand. Benavides claimed that “the non-portability of health insurance is the major difficulty hampering developing country delivery of health services to foreign patients.” [Benavides 2002, pp.59] According to the World Bank, “a major barrier to consumption abroad of medical services is the lack of portability of health insurance.” [World Bank, 2004, pp25] As a result, the lack of insurance portability is an obstacle for medical tourism’s development.
3.3 Medical resources competition
To avoid the long waiting period, people from developed countries go to developing countries for more convenient medical service. However, local citizens in medical tourism destinations have to wait longer time for treatment after foreign patients’ coming.
Particularly, some operations for foreigners exacerbate the medical resources competition in medical tourism destination countries. For instance, people from rich countries prefer to have organ transplants in China, because the price of this operation is much cheaper than in their countries. However, their participation made some Chinese people- who registered after them- waiting longer than before for same operations. Also, the resources of organ are limited; foreign patients’ participation decreased Chinese patients’ opportunities to get suitable organ. In March 2007, new organ transplants regulations were promulgated in China; according to the regulations, foreigners are forbidden to have organ transplants in China. [Ministry of Health of China, 6 Apr 2007]
Generally, medical tourism causes medical resources competition in developed countries.
In summary, with the continuing growth of labour price, cost in the “current” medical tourism destinations will be soon or later not economic any more. What’s more, the lack of insurance portability limits people’s demand to go overseas for treatment (to create a medical insurance system which covers both developed countries and developing countries is impossible). Moreover, foreign tourists’ coming exacerbates medical resources competition in medical tourism destinations. Therefore, the current medical tourism- which just refers to the activity that people go overseas for cheaper or more convenient medical service- is not a sustainable tourism model.
4.0 Where is the sustainable way for medical tourism in China?
The content of medical tourism could be more abundant. For developing countries, medical tourism does not just mean a low-priced medical service for people from rich countries. As a developing country which has huge population and broad territory, China should focus on its own national conditions, and explore a new way to develop medical tourism.
As Xian (2004) indicated, recently, a new tourism model- which can be named as Membership-based Senior Medical Tourism (MSMT) - is emerging in China. This tourism system, which serves Chinese senior citizens, is mainly composed by rest homes in various territories (including northern cities and southern cities, coastal cities and mountain cities). Rest homes are combined into an association; and then, once a senior citizen gets a membership of a rest home in this association, he or she simultaneously obtained the right to live in any other rest homes in the association within the expiry of his or her membership. Also, senior citizens can move from one rest home to another depend on season, temperature, and their interest before the expiry date. [Xian, 20 Aug 2004]
4.1 What elements are there in MSMT system?
Similar to whole tourism system, MSMT system has five elements: tourists, traveller-generating region (TGR), tourism destination region (TDR), transit route (TR), and tourism industries. [Leiper, 2004, pp52] To clarify each element in MSMT system clearly, a case of Tongtai Mobile Rest Home, which locates in Dalian- a northern city in China, is used here. [Xian, 20 Aug 2004]
Tourist
Tourist here was Mr Li, a retired professor of Liaoning Normal University, whose son was working in Shanghai. His purpose of tourism was to escape from the cold winter of Dalian; his request for tourism was relaxation, freedom, and economy.
TGR
Specifically, the TGR of MSMT refers to the region senior tourists from. For instance, Mr Li, an elder Dalianese registered a membership in Tongtai Mobile Rest Home; the TGR here was Dalian city, because Dalian was the region where the activity of senior tourists’ generating happened.
TDR
Then, Mr Li decided to move to a rest home in Hainan Island to enjoy the coastal view and escape from the cold winter in Dalian. Hainan Island here was the TDR.
TR
On Mr Li’s way to Hainan Island, he went to Shanghai by train firstly to visit his son’s family, and he lived in a rest home in Shanghai. Then, 2 weeks’ later, he went to Hainan Island by airplane, and moved into a local rest home. Finally, after 10 weeks’ holiday, he went back to Dalian by airplane.
Tourism industries
Tourism industries here includes: rest homes in Shanghai and Hainan Island, airway companies, airports in Shanghai, Hainan Island, and Dalian, railway company, railway stations in Dalian and Shanghai, travel agencies in Hainan Island, and Tongtai Mobile Rest Home- which take responsibility to arrange accommodations in Shanghai and Hainan Island for Mr Li.
4.2 How does MSMT work?
In the system of MSMT, the rest home- as a basic component- is a kind of “Time-Share” property. [Holloway, Taylor, 2006, pp.298] Sharers- senior citizens- do not have ownership of the beds in rest homes; they just paid for the right to use the beds within the expiry. However, it is neither a traditional property leasing business. It is an exchange of senior citizens among rest homes. For instance, once senior citizens obtained the membership of Tongtai Mobile Rest Home, they can move to any rest home in Tongtai’s system before the expiry date. Tongtai Mobile Rest Home here plays the role of a “time-share exchange organisation”.
Specifically, the process of MSMT’s operation is (in the case of Tongtai):
1. Senior citizens obtain membership of Tongtai
2. Senior citizens decide destinations
3. Tongtai negotiates with rest homes in destinations and arranges accommodations (beds in rest homes) for senior citizens
4. Tongtai books transports for senior citizens
5. Journey in process
6. Senior citizens decide next destinations and notify Tongtai
7. Tongtai negotiates with rest homes in destinations and arranges accommodations
4.3 Why is MSMT a sustainable way to develop medical tourism for China?
--Current conditions of China and how dose MSMT take advantage of them
4.3.1 Big and rising senior citizens population
China has about 1.3 billion people, which makes up the largest population in the world. With the enhancement of living standards and medical standards, the ratio of senior citizens keeps increasing in the recent couple of decades; China’s society is growing increasingly older.
According to a survey on China's urban and rural aging persons living status that was undertaken by China National Committee on Aging, the number of pensioners was increasing at 3.2 percent annually. The rate was five times greater than that of the country's entire yearly population growth. [Xinhua News Agency, 18 Dec 2006] The survey said that as of June 1, 2006, China had 146.57 million citizens aged above 60, accounting for 21.4 percent of the total number of people in that age group worldwide. In addition, China's “grey army” was equivalent to the total number of pensioners for all of Europe. [CNCA, 17 Dec 2007]
The big and fast growing senior citizens group offers abundant tourists resources for MSMT. On the other hand, senior citizens’ group is a niche market in tourism; to locate this market makes relevant tourism industries avoid much competition.
4.3.2 Senior citizens’ particular demand for tourism
The survey on China's urban and rural aging persons living status also revealed that 49.7 percent of elderly persons in urban areas lived in “empty nest families” (homes without other family members) in 2006, while 50.3 percent stayed with other family members. [CNCA, 17 Dec 2007] Normally, these “empty nesters” have abundant spare time for travel; also, as senior citizens, they have some particular requests for travel:
1. Relaxer and looser itineraries
2. Special care for elders
3. Economy
[Bull 1995, pp.30]
According to an interview with Mr and Mrs Li (two retired professors of Liaoning Normal University), “normal travel package is not suitable for us, because the itinerary is too tight, and we can not follow young tourists’ steps.” “Although we have abundant spare time, we have seldom choice about long period travel; besides, they are expensive.” [JF Daily, 14 Oct 2004]
To decrease cost, travel packagers shrink itineraries as much as possible. It makes a journey tight and busy; on the other hand, a long period travel cost much because the accommodation in hotels is expensive. What’s more, normally, there is seldom professional care for elder people in a hotel. Senior citizens special demand can not be met by the normal tourism.
However, MSMT can solve these problems. Because: Firstly, senior citizens can arrange their itineraries themselves. What’s more, rest homes can offer professional care for senior citizens. Moreover, the cost of long period MSMT is much cheaper than a normal travel, because the rent of a bed in a rest home is much cheaper than the cost in a hotel.
4.3.3 Various physical environments
China is very diverse in geography. As the third largest country in the world in area size, China has a land area of 9.6 million square kilometres, about 6.5 percent of the total land area of the world. [Chinadatacenter.org, n.d] There are various natural resorts in the extensive area, including: mountain, beach, river, grassland, and island, which offer abundant tourism destinations in China.
Also, great differences in climate are found from region to region owing to China's extensive territory and complex topography. The northern part of Heilongjiang Province in northeast China has no summer. Hainan Island has a long summer but no winter; the Huaihe River valley features four distinct seasons; the western part of the Qinghai-Tibet Plateau is covered by snow all year round; the southern part of the Yunnan-Guizhou Plateau is spring-like all the year; and the north western inland region sees a great drop of temperature in the day. [Chinadatacenter.org, n.d]
The various physical environments in China motivate senior citizens’ demand for MSMT. For instance, an elder couple who live in the north of China have the desire to move to a warm southern city to escape from the cold winter; a senior citizen who is suffered by asthma has the desire to settle in the Yunnan-Guizhou Plateau, which is spring-like all the year, to treat his breathing passage.
4.3.4 Current conditions of rest homes in China
Rest homes can be classified into two main categories in China, which are public rest homes and private rest homes. Specifically, the former one- which is supported by national or regional finance- mainly serves urban elder men who live in low living standards; the latter one- which is established by individuals- mainly serves elder men who with wills and can afford to live in.
However, the reality is: most of public rest homes are crowded, while the occupancy rate of private rest homes are low. [Chinaedunet.com, Sep, 2007] For instance, as Chen and Wang indicated (2006), in 2006, Harbin, China, 1700 beds in 5 public rest homes were all rent out; on the other hand, the occupancy rate of private rest homes which totally have 3000 beds was very low. [Chen, Wang, Nov 2006]
Currently, MSMT’s emergence meets the demand of these private rest homes; it can increase the occupancy rate of them. Hence, the operation of MSMT is welcomed and supported by the private rest homes in China.
4.4 Discussion
Overall, MSMT integrates China’s conditions and is located in a niche market: senior citizens’ tourism market. Also, it matches senior citizens’ particular demand for tourism. By getting the membership from any rest home in the system, an elder man can choose where to live depends on season and climate or his interest. [Douglas N., Douglas N.G., and Derrett R., 2001, pp420] For instance, he can move to a rest home in Hainan Island to avoid the cold winter in north of China; or he can move to a rest home which is located in warm and dry climate to treat his lung and bone ailments. If the senior citizen like, he can keep moving from one province to another within the expiry of his membership. He can spend a couple of months to stay in one place to have a relax trip without thinking about the cost on accommodation; because the price of a bed in a rest home is much cheaper than in a hotel, and he has pre-paid the rent when he got the membership.
In China, 2006, the rate of growth of pensioners was five times greater than that of the country’s entire yearly population growth. [Xinhua News Agency, 18 Dec 2006] The amount of elder population is becoming bigger and bigger year by year. The MSMT was particularly designed to serve them. As World Tourism Organisation (2001) defines, sustainable tourism meets the needs of present tourists and host regions while protecting and enhancing opportunities for the future. It is envisaged as leading to management of all resources in such a way that economic, social, and aesthetic needs can be fulfilled while maintaining cultural integrity, essential ecological processes, biological diversity, and life support systems. [Novelli 2005, pp.247-248] MSMT meets these conditions. Be different form the normal medical tourism which focuses on attracting foreign patients by the temporary low price, MSMT focuses on China’s huge domestic market and serves the increasing silver tourists. Therefore, undoubtedly, MSMT is more sustainable than the former one.
5.0 Conclusion
Although offering low-priced and convenient medical service to people from developed countries somehow enhances some developing countries’ economy, the medical tourism model can not benefit these countries sustainably.
On the other hand, in China, medical tourism does not just refer to a low-priced medical service for rich countries’ citizens. The emerging medical tourism model- MSMT- is located in a big and fast growing domestic market. Also, it takes advantage of China’s current conditions. This tourism model is a sustainable way to develop medical tourism in China.
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