Overview
The regional health tourism market is worth an estimated $2.5 billion. The current market leader is Jordan, which receives a steady stream of patients, mainly from poorer Arab countries, such as Yemen, Sudan and Egypt. Lebanon has been working hard to position itself to attract high net worth individuals and, since 9/11, has been welcoming an increasing number of Gulf Arabs as hospitals, health and beauty clinics see the numbers of foreign admissions triple in the traditional summer season. Currently, the country attracts en estimated 25,000 foreign nationals who spend anything between $1,000 for a nose job and $25,000 for heart surgery, creating a market worth between $125 million and $250 million.
While, Lebanon’s highly developed medical sector targets mainly fellow Arab countries, there is long term objective to lure European and North America health tourists as health care and insurance costs in those in those parts of the world continue to rise. Lebanon also has the – so far largely untapped – potential of promoting its sea and mountain climate as a health, relaxation and recuperative destination. It speaks for itself however, that attracting any kind of tourism into the country depends on a healthy political situation.
Definition
In the strictest sense, health tourism can be defined as travel abroad to obtain medical assistance, which in turn can be divided into two categories: essential and non-essential – i.e., open heart surgery or an organ transplant versus dentistry and/or plastic surgery as well as medical check-ups.
In other words, one doesn’t have to be sick to be regarded as a health tourist. Mary Tabacchi, a dietician and teacher at the Cornell’s University School for Health Management, defines health tourism as “any kind of travel to make yourself or a member of the family healthier.” In that sense, health tourism is not just about being cured, but also about preventing possible future illnesses. In fact, the lion share of the global health tourism market is made up of healthy people traveling to spas, meditation centers and fresh mountain air climates.
American websites, such as mindbodytravel.com and healthytravelnet.com, offer among other holidays an aromatherapy retreat in the French Provence, herbal health journeys to the Amazon, Ayurvedic diet trips to India and “a sacred woman’s tour” to Bali, where with lots of yoga and meditation you will be able “to connect to your inner woman.”
Brief history
Although health tourism may have a new age ring, it is by no means a new phenomenon. The ancient Egyptians would travel to the scared oasis of Siwa, just as people living along Lebanon’s coast would travel to take a bath in the temple of Eshmun near Saida. Bath in England and Baden-Baden in Germany have been famous for their thermal springs and spas since Roman times. Countries like Lebanon in the Middle East or Switzerland in Europe, both with alpine settings, have long attracted people with breathing problems.
Why Travel?
First, traveling for healthcare can be a result of a lack of professional care, equipment or expertise in the country of origin. In the Arab world, this is the case in countries such as Yemen and Sudan, both characterized by an underdeveloped medical infrastructure. In richer Gulf countries like Saudi Arabia, it is not a lack of equipment that makes people travel to the United States, France or Lebanon, but a lack of topnotch doctors.
Price is another factor that causes health tourism, which is why significant numbers of Canadians and Americans seek medical help in Cuba (see box), which offers state-of-the-art medical equipment and knowledge at a fraction of the price. The same is true for many European countries where the cost of medical care and treatment increases each year, making former communist countries like Hungary, Poland and the Czech Republic attractive destinations. Britain’s The Daily Express newspaper reported that a cataract removal costs $4,500 in Britain, $2,250 in France and $345 in India. In Lebanon, it costs $900.
Lebanon and the region
There is no doubt that Lebanon has the potential and capacity to become the region’s leading health center. The country has over 10,000 beds divided over 161 general hospitals and seven university hospitals, most of which are internationally accredited. A direct result of the civil war, in which each faction and confession built its own hospitals and clinics, the country is generally regarded as having an oversupply of beds. What’s more, most hospitals have state-of-the-art equipment with a lower patient ratio than many of the developed western countries. Lebanon has as many open heart surgery facilities, catheterization and lithotripsy centers as Germany and (perhaps even more than) the United States.
Since the oil boom in the early 1970s however, Saudi Arabia and the Gulf States have invested greatly in their own medical infrastructure, which includes top institutions with the latest equipment, such as the King Fahd Hospital in Riyadh. Jordan is currently the main recipient of Arab health tourists, with the bulk consisting of the some 80,000 Yemenis that seek medical assistance there every year. That part of the sector alone is worth an estimated some $350 million annually.
Last July, Lebanon signed an agreement with the Yemeni government to fly at least part of the health tourists to Lebanese hospitals. However, most experts agree that Lebanon’s competitive edge is not just its infrastructure and equipment, but also its wealth of human resources. The country boasts over 10,000 doctors, most of which are specialists. Some 37% of Lebanon’s doctors graduated from universities in Europe, varying from Moscow to Paris, and 11% from universities in America.
Since 9/11, Lebanon has been receiving an increasing number of Arab patients, who previously mainly traveled to top hospitals in the US. As a result of the general change in political atmosphere in the country as well as the hampering visa process, most Arab health tourists now prefer to come to Lebanon for everything from general check ups and plastic surgery to more complex procedures.
Seeing the potential of Lebanon as a health tourist destination, many projects have been underway to accommodate prospective patients. The newly established Beirut Government University Hospital includes a 50-room hotel for patients and their families, and the soon-to-open 105-bed Clemenceau Medical Center, which is affiliated with the American John Hopkins hospital, especially targets foreign nationals.
The AUH
Established in 1867, the American University Hospital is among the most respected institutions in the country. According to its director, John Rhoder, the Medical Center receives an average of 300 admissions a week, 20 to 30 of which are “foreigners,” mainly Syrians. In the summer, however, the number of genuine foreign admissions doubles, with most patients coming from the Gulf states – mainly, Saudi Arabia – constituting the majority of the health tourism market.
According to Rhoder, people do shop around while trying to find the best surgery for the best price, and even try to bargain down prices. In that sense, it’s a business like any other – not surprisingly, the price of a heart surgery varies between $6,000 in one of the less established medical facilities to some $20,000 in the country’s most well-known institutions.
Following a well-established American trend, the AUH last year opened the Executive Health and Travel Center (EHTC), which offers a health package specially tailored for executives, top managers and family members from Lebanon and the region. The two-day-program offers a personalized head-to-toe medical examination and lifestyle assessment to prevent illnesses. The patient or client stays in a special hotel-like suite in a separate wing of the general hospital. Depending on the package, prices vary from $1,500 to $4,300. Upon request, the EHTC can also arrange for airline tickets, hotel reservations and even a leisure program.
Plastic surgery
The bulk of foreign health tourists flock to Lebanon to have plastic surgery or other corrective procedures. In the summers of 2004 and 2003, numbers doubled and even tripled, reaching an estimated total of some 4,000 patients. In the past decade alone, the country has seen the number of plastic surgeons rise from less than a dozen to over 60.
One of the main bonuses of coming to Lebanon for elective surgery is, of course, the cheaper prices. In Saudi Arabia and the other Gulf states, plastic surgery procedures on average are double the price in Lebanon. A nose job in Lebanon costs between $600 and $1,000, whereas in Riyadh it costs $2,500. Other than the price incentive, privacy is another factor that appeals to health tourists, because generally, people do not want anyone to know they have had corrective surgery.
Marketing
As is the case in Europe, Lebanon is not allowed to advertise medical services. Marketing is done by word of mouth and follows the traditional path of PR through medical conferences and publications. However, the ethical climate is slowly changing. The Clemenceau Medical Center is currently working with Saatchi & Saatchi on an advertisement campaign for the Arab world. The final slogan has not been determined yet, but its theme will be something along the lines of, ‘Why travel thousands of kilometers if you can have the best medical care in Beirut?’ Some other hospitals and plastic surgeons have produced brochures and travel packages, which include visa, hotel stay and surgery for an all-in-one price.
An important role is played by K&M International Health Tourism (KMIHT) based in Hazmieh, which, as the name suggests, promotes Lebanon as a medical care and health destination. KMI is supported by all of the country’s medical orders, as well as the Ministry of Health, which according to owner Khalil Malaeb helps in “opening doors.”
KMI regularly travels alongside ministerial and trade delegations all over the region, such as Yemen. Apart from promoting Lebanon as a health destination, KMIHT operates as a travel agency, establishing alliances with travel agencies in Dubai, Kuwait and Yemen, offering all-inclusive packages including visa, plane ticket, hotel stay and surgery.
Malaeb prides himself on good contacts throughout Lebanon’s medical sector. Who he sends where depends on what the patient can afford and on the medical expertise of the hospital. For example, a bone marrow transplant patient would be sent to Al Makased Hospital, a brain surgery patient to AUH, a hip transplant to Bhannes, AUH or Hotel Dieu, while for a heart surgery patient, there are so many choices available that the budget is the deciding factor.
Box: Maradona & Cuba
Cuba may be regarded as a poor country according to income per capita, yet surprisingly it boasts one of the most developed medical industries in the world. Education, science and health were key themes in developing the country after the revolution in 1959. Though under a strict US embargo, Cuba exported pharmaceuticals, vaccines and biotechnology worth $250 million in 2002 alone.
What’s more, it receives up to 10,000 tourists a year who want to profit from high quality medical care for a relatively low price. People travel to the Caribbean island for a core of medical treatment facilities, yet especially for eye operations, skin treatments and its Multiple Sclerosis and Parkinson’s disease centers, as well as its drug and alcohol addiction recovery programs, which most recently had Diego Maradona as its most famous client. Most patients come from Latin America, which is characterized by an underdeveloped medical infrastructure, while ever-increasing numbers come from the US, Canada and Europe to escape towering medical bills.
