Medical sciences / public health services
As. prof. Dubitskiy A.A., Kayupova S.
Medical university Astana, Kazakhstan

TO THE QUESTION OF THE FURTHER DEVELOPMENT OF MEDICAL TOURISM

Medical tourism has been recognized in the market in 80-90 years of the last century and now promptly develops [1,2,3]. The income of medical tourism for 2011 has made more than 40 billion US dollars or more than 27 billion euro [4]. Among the principal causes inducing patients to go abroad for reception of medical aid, the last mark the following: the big variety of offered procedures; high quality of rendered medical aid; considerable reduction of a waiting time of medical manipulations.

All these factors together taken lead to constant increase in demand of medical services abroad. From the countries having the developed structure of medical tourism Belgium annually involves more than 35 000 patients who basically come behind cosmetic and plastic surgery, and also behind reception of treatment of oncological and cardiovascular diseases, despite lacking the governmental advancements as rendered medical services and absence now national systems of accreditation.

The principal cause, a choice of the country for their treatment consists basically a short waiting time, low expenses, high quality and language skills [5]. Almost all medical workers speak German, French and English languages. Foreign patients can save 56% (in comparison with the USA) or 26% (in comparison with Great Britain). The majority of patients arrives from the Netherlands (60 %) and the surrounding European countries (19 %), thanks to the central arrangement in Europe. The British patients make 21 % many clinics in Belgium have agreements and cooperation with the British clinics. In Belgium possibilities for satisfied with requirements more than 50 thousand medical tourists every year [6].

Brazil also involves a significant amount of medical tourists every year. Only the share of citizens of the USA here reaches 95%, thus, that the country has weak enough system of public health services and is concerning unsafe. The reason for it, basically, the economy of means at the rate to 60 % in comparison with medical institutions of the USA [7] serves. Also many medical tourists unite the procedures with the Brazilian festival. In the country is available 20 JCI the accredited hospitals. Besides it, the big role is played by affinity to borders of the USA and absence of a visa regime. Basically patients address for plastic surgery [8].

In Costa Rica is to 150 thousand medical tourists a year, thanks to that is safe vacation spot, and also a close arrangement to the USA. Therefore to 95% of tourists come from the USA and receive on the average 25% of economy of expenses. Now the stomatologic help and plastic surgery [9] is developed and popular.

The Czech Republic is the potential competitor within the limits of the European medical tourism as offers to 17% of economy of expenses for citizens of Great Britain, Austria and Germany.

The country is known for a resort in Karlovy Vary and is popular vacation spot of tourists and maintenance of quality of the stomatologic help. The Czech Republic is the safe country which offers the developed infrastructure a part of the EU countries. Now to 9000 medical tourists annually comes, behind the help in a reproduction, however with the given procedure there was a problem because of national laws in the field of public health services [10,11].

Dubai now involves medical tourists basically from Germany (45%), Great Britain (27,8%) and Singapore (10,3%) and is a safe, rich place where speak fluently in the Arabian and English languages. Medical tourists choose Dubai because of short terms of expectation and quality medical aid. Medical tourism specializes on cardiology, orthopedy, oncology, cosmetic and plastic surgery and dermatology.

Development of medical tourism has increased with building Dubai Healthcare City, and there is a hope that medical incomes of tourism will increase by 1,9 bln. dollars of the USA (€1270 million) annually, with growth in 15% a year [12,13,14].

Germany involves on the average to 59 000 medical tourists from 163 countries annually thanks to the central arrangement in Europe and being a member of the European union. Despite the minimum economy of means (no more than 5-9 %), Germany is the popular country medical tourism for patients from the Netherlands (11,4%), France (10,2%), Austria (8,1%), Poland (8,9%) and Belgium (5,7%).

These patients come behind the help in cardiology, oncology and orthopedic treatment. There is a hope that, cellular therapy will increase development of medical tourism in Germany, the next years. Besides, Germany offers high quality, short terms of expectation and possibility to combine treatment with rest [15].

Being the pioneer in the field of medical tourism, India offers the new technologies alternative and experimental kinds of treatment along with doctors which freely know English. India has a wide spectrum of specializations such as cardiology, plastic surgery, stomatology, ophthalmology, orthopedy, transplantation and the help in a reproduction. For today India is the leading medical country of the tourism, widely developing, as at the governmental and private level, and also offering medical visas. These factors have in aggregate led to that India involves about 450 000 medical tourists in a year (basically from Great Britain, the USA and South Korea) in spite of the fact that the country is often perceived by many as слаборазвитой and unsafe. The economy of means ranks high, thus, it is possible to keep to 58% in comparison with the USA or 47% for Great Britain. Other factors, high quality of health services, availability of treatment and waiting time decrease is. By 2013 India aspires to involve to 1,2 million medical tourists [16].

Jordan is the largest medical center of tourism in the Near East and involves about 250000 medical tourists, basically from neighboring countries (38,2% of Iraqis, 30,9% of Palestin, 31,4 % Sudan). This country involves medical tourists thanks to excellent knowledge of language and high quality of rendering of medical aid. The country specializes in area of cardiology, orthopedy, plastic surgery and stomatology. The perception among the western patients of strict religious rules who exist in the country, reduces reputation of Jordan as development of medical tourism. Nevertheless, the potential of Jordan includes economy of 66% in comparison with the USA and 57% in comparison with the prices in Great Britain. By 2013 the country aspires to receive the income at the rate to 700 million euro from medical tourism in comparison with 4 340 thousand euro in 2009 [17].

Malaysia has already proved as vacation spot, and for today and as the country with the developed medical structure annually arrives to 350 000 medical tourists (2010), from Indonesia (70,4 %), Singapore (10,3 %), Japan (6,1 %), Europe (5,5 %) and India (3,9 %). These medical tourists are involved with a wide circulation of English language, and Malayan language is clear for Indonesians. The basic methods of treatment which the country offers the help in a reproduction, orthopedic, plastic surgery and cellular therapy. Developing the position in medical tourism, Malaysia hopes to increase incomes by 23%, therefore 390 million euro to 2012 [18].

Mexico involves from 150 000 to 500 000 medical tourists in a year, but it is figure can't be exact as to Americans (on which 95% of all entering medical tourists are necessary approximately) the visa to entrance to the country isn't required. Americans are involved with affinity and economy of expenses at the rate about 63%. Despite development only a private sector, Mexico has good reputation in granting of stomatologic services, cosmetic and plastic operations, orthopedic and cardiological procedures [19].

Philippines has proved in the field of medical tourism and receives to 200 000 medical tourists annually, since the USA and Canada (40,2%), Japan and Korea (20,7%), Europe (17,4%), the Near East (7,6%). Foreign patients go behind the help in cosmetic surgery, ophthalmology, cardiology, behind treatment of cardiovascular and oncological diseases. The choice reason is the quality of the medical personnel inherent in Filipinos hospitality. Foreign patients can expect economy of 68% in comparison with the USA and 54% in Great Britain. All it means that Philippines in hope to receive 700 thousand medical tourists the next years. It can be unreal because of a weak infrastructure and flowing brain drain among the medical personnel [20].

To Singapore arrives 600 thousand medical tourists a year, from the countries of the Near East (50,9%), Asia (45,4%) and Europe (5,7%). These medical tourists are involved with reputation of one of the richest and purest countries in the world, with well developed infrastructure, and these factors have found the reflection in high quality of system of public health services. Singapore specializes in cosmetic surgery, cardiology, orthopedy and neurology, along with it in therapy by deckman cages, gastroenterology and oncology. This wide specialization, and high quality of medical service in a counterbalance of the minimum economy of means. Thanks to existing development it is expected that the number of medical tourists will make to one million by 2013 and will bring in the income at a rate of 2 billion euro [21].

South Korea involves now 40 000 medical tourists basically from Japan and China, the USA and Canada, thanks to high technology in the field of oncology, cardiology, ophthalmology, orthopedic and stomatology. To introduction of medicinal visas and building of the medical center of tourism on island Cheju. Along with it hopes to increase reputation of South Korea as center of medical tourism for the West and increase in the driving medical tourists to 100 000 in a year [22].

Thailand was one of the first countries in whom, for the first time have seen potential in the medical tourist market and for today remains to one of the leading countries of a tourist direction. Thanks to a wide spectrum of specialties, beginning from alternative methods of surgical treatment of adiposity, and such, as cardiology, neurology and ophthalmology, and also world famous cosmetic and plastic operations. Thailand has one of the best reputations in the medical market of tourism. It is confidentiality, and also that fact that medical methods of treatment can be united with rest. Rather low level of safety in Thailand, can and not keep tourists, however 1,4 million patients till now there comes every year from the USA (33,2%), China (29,1%), Japan (18,7%), Great Britain (14,1%) and Australia (6,6%). Forecasts for the future for Thailand is that incomes will increase from 2 billion US dollars to 3 billion [23].

Turkey involves 165 thousand medical tourists a year, basically from Europe and Asia which involve natural resorts, and also 35 JCI the accredited medical objects. Economy on 58% and 40% in comparison with the USA and Great Britain accordingly. Turkey in the field of cardiology, orthopedic, artificial insemination, cosmetic and plastic operations and oncology specializes. Thanks to careful advancement of Turkey as the market of medical tourism, it is possible to hope that 36% from total amount of incomes of tourism will be made by medical tourism by the end 2013 [24].

On the basis of the resulted data of research, it becomes clear that medical tourism is an emerging market with huge potential. Nevertheless, exist various questions, consumers with an ambiguity of restrictions and laws, and also growing ethical problems make negative impact on development of medical tourism in the market of services. At present, except Thailand and India, there are rather some settled countries which have already seen potential in this branch. And in conclusion of prospect of medical tourism are positive, and under forecasts will grow on 66 % and will make the income at a rate of 67 billion for 2013.

The literature:

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