Medical Tourism industry in Brazil
University of Pittsburgh, Joseph M. Katz Graduate School of Business
"You’ve never looked better! You should go to Brazil more often."
You can find this type of adds in almost every medical travel service provider’s brochure. This is from the website of SPHERA International, provider for plastic and cosmetic surgery.
“The best hospital is an air ticket to São Paulo”
, claims SPTuris, São Paulo Tourism Authority.
Why somebody should go to somewhere to get the treatment, and why to Brazil, to Sao Paulo?
MEDICAL TOURISM AS AN INDUSTRY
Why somebody should go to somewhere to get the treatment?
Why not? If this would be cheaper, or even better - the costs covered by the insurance; if this is same or even better quality services; if you will not have to wait long days, in reverse, it can turn into holiday, why not?.
Medical tourism is not as expensive as used to be some decades ago, and the health market is not limited to the boundaries of a country. Today, medical tourism turned into a commodity.
According to Euromonitor, Asia Pacific dominating the new industry with state-of-the-art hospitals like the Bumrungrad International Hospital in Bangkok, Thailand, and, most importantly, lower prices. So far, Thailand, India and Singapore together have treated over 1 million international patients and consistently led sales in this multi-billion industry.
According to experts, such unprecedented success was driven by three main factors – price, quality and access. Although it seems easy to construct a powerful health industry, it takes time and exceptional marketing to create a brand that is trustworthy.
Despite having excellent facilities and being fairly accessible, Latin American destinations like Brazil are not the cheapest, when compared to its Asian counterparts. For example, average cost of medical services in Brazil is 30-50 %; in Malaysia is 25%; in Thailand is 30 %, relatively to US:
Then why to go to Brazil?
COMPETITIVE ADVANTAGES OF BRAZIL’S MEDICAL TOURISM INDUSTRY
The prices of medical services in Brazil are not as low as in Asia; especially compare countries like Thailand, Malaysia and India. However, the costs are relatively low compare to US and Western Europe countries. See the example below.
Gastric bypass surgery||
In vitro fertilization||
Considering that pricing remains a major driver, Brazilian hospitals have to focus on less-price sensitive customers, emphasizing proximity and service.
But no-one will travel 10,000 miles to a country to receive medical treatment that is considered average. Medical tourists from developed countries, or less-price sensitive customers will travel only to receive the best quality services, in the facilities available worldwide, just for the comparable lower cost.
This is the case of some Brazilian hospitals in Rio de Janeiro and Sao Paulo. These hospitals made huge investments to become the world’s leading institutions and have got international accreditation etc.
Brazil, Sao Paolo
Reputation / Quality
Brazil's reputation in medical tourism started with Ivo Pitanguy, the world renowned plastic surgeon who opened a clinic 40 years ago in Rio de Janeiro.
Brazil has been a pioneer in the development of medical tourism; it has long had a reputation for plastic surgery and aesthetic treatments and was a "health travel" destination for visitors from the USA and Europe long before medical tourism became an industry.
Brazil is the second country in plastic surgery procedures, only after the United States. And São Paulo is the biggest center for plastic surgery in the country – 34, 4% of the total plastic surgeries in Brazil is done in São Paulo.
In 1999, Hospital Israelita Albert Einstein (HIAE) from Sao Paulo was the first hospital in South America and outside of US to be accredited by the Joint Commission International (JCI), the most important international healthcare accreditation group.
Today, The Joint Commission International (and partners) has accredited 15 hospitals and medical centers in Brazil, which are concentrated in Rio de Janeiro and Sao Paulo.
According to the SPTuris, Sao Paulo’s Tourism Authority, “there are 105 hospitals, 9,000 clinics of 50 specialties in the city. São Paulo is a leader in areas such as cardiology, orthopedics, oncology, neurology, and cosmetic surgery with a world-class hospital system and a wide array of diagnostic services”.
In order to keep the quality of healthcare services offered to tourists, São Paulo Tourism Authority (SPTuris), the company responsible for tourism and event promotion of the City of São Paulo work closely with Union of Hospitals, Clinic, Laboratories and Health Service of the State of São Paulo, Sindhosp.
For example in order to be able to offer medical tourism services, it is necessary for hospitals to be quality-certified organizations (like ISO 9001 or higher, Joint Commission International – JCI accreditation or National Accreditation Organization – ONA) and they must be under technical responsibility of professional doctors (except spas, natural areas and attractions).
Brazil is well-positioned to become one of main locations for healthcare travel due to its proximity to the U.S. (in terms of time zone, occidental culture, tourism options and people-oriented services), Europe and Africa.
According to the Ministry of Tourism, in 2009, 900,000 people came for some type of health treatment to Brazil; of these, more than 50,000 were foreigners. 20% of foreigners were from USA, 19 % from France, 18 % Angola, 17 % from Germany, 15 % from Paraguay, 9 % from Argentina and 2 % from other countries.
SPTuris claims that the number of tourists coming to São Paulo for health or aesthetic treatment has more than doubled every year.
Brazilians are known for their overall friendly and family-oriented culture. (They also boast the hosting of a variety of world-renowned celebrations).
Tourism service providers claim that, those who visit Brazil will never forget the cordiality and the hospitality of the Brazilian people.
Shorter waiting lists and special service
Compare to US and Europe, in Brazil medical traveler won’t have to wait to get the high-quality treatment. Because, the waiting lists are shorter; and travelers can use special tailor made service Hospital-day.
Ideal for travelers, this service is provided by several hospitals in São Paulo. Generally, this type of hospital receives clinical patients or those undergone to low complexity surgical intervention with fast 6-to-12-hour admission. They are equipped to attend patients with small and medium surgery indication or diagnosis and therapeutically procedures without needing to be admitted – as even more the health area has techniques less aggressive to the organism and making a faster and more efficient recovery. In most of surgery, it is possible to go back home at the same day. It reduces costs and the risk of hospital infection.
Most Brazilian hospitals accept worldwide international medical insurance. Not all insurance plans, however, cover costs of specific treatment abroad (when a policy holder travels for the sole intention of having surgery in another country).
But policies are evolving and insurance companies are increasingly offering options for out-of-country care. Because it is also win-win situation with the insurance companies itself, when company can provide the same quality service for the less cost and have substantial savings. For e.g., companies like CIGNA International and Aetna Global Benefits have been providing international healthcare to clients for years.
Therefore, the insurer should be consulted for the latest information on coverage with insurance company and the hospital, where he or she is willing to receive the treatment.
There a lot of firms that offers their services for the medical tourism. It is important to find a reliable one. A specialized São Paulo medical facilitator can help a potential patient ensure they choose an appropriate hospital and doctor for the procedure they plan to undergo. Services provided by a facilitator can include:
- Recommendations for medical care providers (hospitals, clinics, surgeons and doctors), accommodation, travel and tourism, as well as estimates of potential costs;
- Contact with the insurance companies regarding the coverage of costs;
- Pre-arranging all dates and accompanying a patient to doctor consultations and pre-op exams;
- Arrangements for direct admission to the hospital/clinic for surgery, post-operative care;
- Personal assistance, travel assistance etc.
HOW IT WORKS?
There are many options to start looking for a medical tourism trip to Brazil, Sao Paulo. A good starting point for information is hospital websites, which usually disclose doctor specialties and accreditations. Referrals for doctors can be obtained from the hospital or from friends or business acquaintances. Another option is the website of SPTuris, Sao Paulo Tourism Authority.
For example, we downloaded special guide on medical tourism from spturis.com. We found the names of best hospitals in Sao Paulo.
One of them, Hospital Israelita Albert Einstein
(HIAE) has been accredited for three consecutive times by the Joint Commission International since 1999 and possesses a number of ISO certifications.
Albert Einstein Hospital, official video
What they offer?
According to SPTuris, there is a special check-up program of Diagnosis Medicine at the Albert Einstein Hospital. This check-up program adjusted for the foreigners takes 6 hours, the results is possible to get at the front desk, fax, Internet, home or sent directly to the doctor.
“But the cost of such service may vary from patient to patient, and only might be calculated after preliminary consultations”, says Aline Lopes Bering, the representative of the International Patient Center at Albert Einstein Hospital. According to her, the only thin is needed for the preliminary consultations is to visit their website special section, International Patient section, and contact the hospital via email, fax, or phone.
Aline told us that, they launched the International patients program in 2000. 11 years ago this program was not as organized as now. But as demand for international patients program grew, it has become an organized service.
She claims that today the International Patient Service at Einstein Hospital provides total assistance to the foreigner patient in all stages (admission, treatment and discharge) with translation services, lodging, transfer, administration and finances; there is no need to go elsewhere, they can provide all what travelers need, even to arrange city tours, or to negotiate better rates with hotels etc.
Albert Einstein Hospital today generates 5 % of revenues through international patients program. Their patients are from Uruguay, Paraguay, and even from Angola, Africa. People from this location mainly come for regular checkups and for special treatment.
The patients from US and Europe come mainly for the surgery, because doing surgery here much cheaper compare to those places; also, hospital guarantees to them to provide the best quality services.
Einstein Hospital’s International Patient Center is located on Morumbi. Hospital itself does not look like the hospital, with the spacious and bright halls. I felt myself like in some luxury hotel, with restaurants and cafeterias, bank branches, ATMs, and convenience shops.
Even the patient’s rooms remind me the hotel rooms. The medical devices were well hidden under the special covers and walls.
Later, Aline Lopez told me that this is actually made with purpose; they want their patients to relax; to forget about the stresses and pressure of procedures.
But the nice building, and the latest technology and high-end medical devices might be not enough to attract the patients, in spite of high competition in Sao Paulo. Each member of G5, the group of 5 high standard and well-known hospitals in Sao Paulo runs the international patient programs, and they compete against each other not only in Brazil, but also in abroad.
When talking about the competitive advantage of Albert Einstein Hospital, Aline Lopez mentions the quality of doctors, besides the reputation, investments on technology, research facilities and customer oriented staff. She says “we have the best doctors, who work exclusively for our hospital”.
In order t attract the clients Albert Einstein Hospital use advertisement on TV, media, newspaper, on internet.
But as the cost of living in Sao Paulo and the entire Brazil rises because of the local currency is strengthening (according the Mercer’s Cost of living report-2011, São Paolo has jumped 11 places since the 2010 ranking and become the 10th most expensive city in the world)
the hospital is looking for new ways of making International Patient services attractive for the foreigners.
One of these ways is the negotiating with insurance companies the coverage of international patient’s costs. Albert Einstein Hospital has partnerships agreements with more than 50 international health insurance companies and is continuing negotiations to extend the list.
However, it is still long way to go, says Aline Lopez. “Medical tourism is something relatively new phenomenon for us, we are still learning and continuously improving our services’, she adds. But she assures that, Albert Einstein Hospital is not intending to focus on costs and give up on quality.
Taking into account the cost advantage that Asian countries have over the Brazil, the quality is the only way to win the competition in medical tourism game.
Nevertheless, in order to further enhance its competitive positioning, Brazil will need to first look into internal issues such as infrastructure. Airports, hotels, highways require developing, not only because the region is close to operating at its capacity, but also most importantly patients look for accessibility and comfort when travelling.
Brazil will also need to develop more collaborative actions between the government and healthcare institutions by creating multi-lingual signage/websites, and eliminating tourism barriers such as visas.
For the hospitals with the huge recourses, it might be easy to apply economies of scales to their international patients programs. For e.g., having their own hotels, having special term agreements with airlines flying to SP, and more focused marketing and collaborative partnerships in Europe an US could make it possible to build their own medical tour packages, for the European or American clients.
Also, according to Alex Lifschitz, the CEO of Sphera International, a health platform specialized in giving solutions to health institutions, the latest US Health insurance reform opens new horizons for the hospitals in Brazil. He claims that as more uninsured Americans will get health coverage, the onslaught of patients to an already burdened and expensive healthcare system will compromise access to care; forcing people to find providers and services outside U.S. borders, and Brazil will be ready to provide that care.
However, significant challenges remain. In Brazil, there are concerns that attracting too many medical tourists may crowd out healthcare for Brazilians. However, at the same time, there is the benefit that the revenue generated by medical tourism in the country could fund the expansion of health services for locals. Albert Eisntein Hospital’s social responsibility programs, such as Paraisopolis community program for the poor people from the slums, and volunteer program for the doctors, might be good example in this context.