Health tourism: UK out, Thailand in

British expatriates are now no longer entitled to free healthcare under the UK ’s National Health Service following a crackdown on what has been termed ‘health tourism’. But as the UK shies away from the health tourism phenomenon, countries like Thailand are welcoming it with open arms.

As of this year, British nationals resident outside the UK are no longer automatically eligible for free treatment through the National Health Service, according to the controversial proposal made earlier this year by UK Health Secretary John Reid.

The changes came about as part of the UK government’s crackdown on what has been labelled in the press as ‘health tourism’. As a result of growing concerns and criticism, a three-month public consultation was carried out late last year to determine how to amend the system. This followed fears that the accession of 10 additional states in May 2004 to the EU would lead to a further increase in ‘visitors’ taking benefit of the free health service and claims that the National Health Service was already under extreme pressure from asylum seekers needing medical attention. The result, from 1 April 2004 , is that only employed, tax-paying residents and their dependants are entitled to free services from the NHS and non-residents are not.

Since the original announcement early this year, little up-to-date information has actually been released by the government. However, according to the Department of Health press releases and their website, there are new guidelines as to the eligibility for free treatment. British expats who spend less than three months a year in the UK will no longer have automatic free access to hospitals, clinics and GPs, except for emergency treatment, such as for a heart attack. Those seeking medical treatment could be asked to prove their residency status by showing council tax bills, pay slips and records of National Insurance contributions. However, there are further guidelines stating that to be exempt from medical costs, British nationals living abroad need to have lived continuously in the UK for 10 years and either have not worked abroad for more than five years, or if they have, they need to have taken home leave to the UK once every two years.

Confused yet? So is the NHS it seems. To make matters worse, there have been reports in the press that some expatriates have been refused free access to treatment whereas others have not had such difficulties. How this will be checked and administered is not known, though it seems that the decision to accept or to refuse free treatment is left to the treating medical establishment. Furthermore, support from the British Medical Association is unlikely as the profession is split on the subject. They feel that it is not the job of a doctor to decide who is to be given treatment but realise that non-UK residents are taking advantage of free treatment while visiting the country.

While it is doubtful that those who choose to go back to the UK for non-urgent care such as a hernia operation will face a bill at the moment, it could only be a matter of time before free medical treatment becomes a thing of the past. With this in mind, international private medical insurance that is valid overseas, as well as in the UK , either for temporary visits or permanent return is likely to become of more importance.

Thailand attracting health tourism

Whereas the UK is discouraging health tourists, Thailand is aiming to do the opposite. Over the past few years, the country has started to market itself increasingly more aggressively as an international destination for medical excellency. As with Singapore , both have attained a reputation for high-level care and facilities for some time, but Singapore has never targeted patients in this way. More often than not, expatriates from surrounding countries have opted for treatment there due to its established nature and Western-trained staff rather than ‘risk’ local medical centres.

Thailand however is targeting a niche in the market that perhaps they themselves could have carved out. It has long been a country associated with spas, relaxing massages and friendly attentive service with the added bonus of stunning views and scenery. In marketing terms, an ‘idyllic paradise for rest and recuperation’.

A short time ago, the Thai government announced plans to promote health tourism after having clearly noted that Thai hospitals are achieving high standards that equal and often better those in the Western world. One only has to think of the NHS in the UK with their limited resources and the long waits for essential treatment for example. All this is boosted by the simple fact that Thailand has a cost advantage, especially as elsewhere in the Asia-Pacific region, costs of medical treatment have soared skywards. Who would have believed five years ago that China would have healthcare costs normally associated with Japan ?

The promotion of Thai health tourism has greatly benefited not just the hospitals but the ancillary services also. The government believes Thailand is an ideal place to have treatment, and then relax and recover. The main selling point is of course the cost, a fraction of the price of the US or Japan .In fact many Japanese companies are reportedly sending their employees to Thailand for annual check ups, the cost of savings far outweighs the airfare. Dental work, plastic surgery and other minor operations are also very popular with ‘health tourists’. In the majority of cases, the work is carried out by staff trained in Europe , the US and Australia much to the reassurance of incoming tourists.

In 2002, according to Thai government figures, some 632,300 foreigners sought out treatment in Thailand with estimates for 2003 set at 730,000 promising significant income for the country - not just in medical establishments but also in the traditional tourist industry. Working in cooperation with the tourist authorities and Thai Airways, the government and the ministries of Tourism And Sport, Commerce and Foreign Affairs have established joint strategies and integrated plans to increase these numbers. Recently, travel agents have also hopped on the bandwagon offering ‘Executive Medical Tourism Packages’. These packages included the usual hotel, airport transfer, sightseeing tours plus the added extra of an appointment with a Western qualified doctor for medical treatment!

Where would you go?

Although health tourism is not a new concept, Thailand believes that its success is due to its long-standing traditions, its predilection to welcome patients as guests, and its value for money. At the same time, the UK faces rising costs of a struggling health service based on free treatment open to all. In a straight choice between the UK and Thailand , there is surely little to reflect on, who wouldn’t would prefer treatment in Thailand followed by recuperation on the beach?!

Mr Andrews is currently managing the establishment of the HK regional office of the UK-based William Russell Limited, a leading provider of expatriate protection plans.

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