Taiwan’s Medical Tourism Boom

China does not provide socialized public health care for its 1.3 billion citizens, with health insurance covering about 40 percent of the population. The World Health Organization reports problems abound with China’s health system: Less than 15 percent of the nation’s medical professionals have a bachelor’s degree or higher; doctors outnumber nurses; and profit-taking leads to over-prescribing. Despite efforts to improve health care, China lacks comprehensive regulation, clinical treatment guidelines and adequate services in rural areas. With increasing wealth, more Chinese citizens seek high-quality health care at a distance, and as China loosens travel restrictions, some head for Taiwan, reports the Asia Sentinel. Taiwan’s medical tourism industry grew eightfold in 2009. Experts advise that medical tourism, while suitable for specific procedures, lacks the long-term prevention, monitoring and coordination provided by a public health system. That may change as Taiwanese entrepreneurs develop “health villages” at home and “health clubs” throughout China, with annual fees of US$6000. – YaleGlobal

Taiwan's Medical Tourism Boom

Chinese look for better medical care – in Taiwan
Jens Kastner
Wednesday, October 20, 2010

Many of the Chinese who will soon be permitted to travel to Taiwan individually won't either be indulging in strolling Taipei's night markets or the National Palace Museum. They are expected to flock across the Taiwan Strait for cancer screenings and cosmetic surgery.

The formula is appealing: stay a few days in a Taiwanese five-star hotel and get all the medical procedures done at one time. Taiwan's health care industry is rhapsodic, as well they should be. The growth rate of medical tourism to Taiwan has been spectacular. In 2008, about 5,000 visitors came to the island to undergo health checkups and cosmetic surgery. In 2009, that increased eightfold to 40,000, mostly from China in the wake of moves by the Kuomintang and President Ma Ying-jeou to open Taiwan to tourism from the mainland.

More than 100,000 are predicted annually, apparently as fast as Taiwan can staff up its hospitals. The market is set to expand several times more Taiwan opens to Chinese tourists on a foreign individual travel (FIT) basis in early 2011.

Taiwan’s hospital care is world-class. Despite a massive effort at upgrading its health care system, China’s is decidedly not. According to the World Health Organization, "most problems arise out of a lack of comprehensive regulation and thorough implementation. Hospital accreditation isn’t linked to comprehensive safety records, doctors and health institutions are unrestricted in their pursuit of commercial incentive programs, and there is a severe deficit of clinical treatment guidelines."

Currently, the WHO says, only 14 percent of the nation’s health professionals have bachelor’s degrees or higher, and poorer regions are often unable to attract and retain qualified medical staff. There are also imbalances within the health care profession; for instance, with a ratio of 1.3 to 1, China is one of the few countries where doctors outnumber nurses. With pharmacies tied to hospitals, overprescription of drugs is rampant. In some hospitals, as much as 70 percent of revenue is derived from prescription sales.

Taiwan's medical sector is thus bracing itself happily for Chinese who will come on their own, won't be plagued by tight itineraries as they were when they came with tour groups, and will head straight from the airport to receive the whole spectrum of high-tech diagnosis Taiwan has to offer. That includes positron emission tomography (PET), computed tomography (CT) and magnetic resonance imaging (MRI) as well as endoscopic surgery, laser vision correction and cosmetic surgery like injected micro cosmetic surgery and water jet-assisted liposuction.

Yet, whether having 10 appointments for early detection for cancer or cardiovascular diseases and liposuctions in half as many days is beneficial to the visitors' health remains another question.

"It may be not the best way to stay healthy; it's medical tourism after all, where the purpose is to get specific procedures done," David Silver, president of BiotechEast, a US service provider that brings together Taiwanese and international medical companies, said in an interview. "But visitors from China have trust in Taiwan's health care infrastructure and quality, which is a pleasing sign for Taiwan."

Two years ago, Taiwan instituted an ambitious "Action Plan for the Internationalization of Medical Service in Taiwan." To make the country appealing to foreigners seeking services of health care providers, the check box "medical care" was added to visa application forms. Still. Taiwan had a very hard time attracting Europeans and Americans not of Chinese origin.

The eventual turnaround has been coming with the gradual opening of Taiwan to Chinese tourists after Ma became president in 2008. Although for the time being mainlanders are allowed only group travel to the island, local health providers' business has been flourishing from the influx of cross-strait patients.

Resourceful Taiwanese businessmen based in have China set up "health and medical clubs" with annual membership fees starting from US$6,000. As what for the newly recruited Chinese members in essence was likely meant to be an alternative to additional private health insurance, they are taken by the clubs on six-day trips to Taiwan that include physical check-up services.

Taiwan's health care providers recommend the Chinese guests to spend the time between appointments at the doctor's while enjoying health food and hot springs visits.

It's not only health care providers that want to snap up a share of the cross-strait medical tourism cake. Taiwan's land developers have been jumping on the bandwagon. Entire "healthcare villages" are being built in sub-rural areas across the island in cooperation with Taiwan's large hospitals, themselves mostly located in the big cities. Medical professionals from Macau and Thailand, both of which have functioned as pioneers for medical tourism in Asia, are being invited to serve as advisors to the healthcare villages.

This intensive screening does have its downside. The services provided by the Taiwanese medical industry focus on early detection for cancer or cardiovascular diseases using PET and CT scans. PET is a nuclear medicine imaging technique which produces 3D images of functional processes in the body.

Although the practice is non-invasive, the patient is exposed to an enormous dose of radiation. Since PET and CT scans are almost always performed in one go, radiation exposure reaches 23-26 milliseiverts (mSv), defined as "the average accumulated background radiation dose to an individual in a year. In comparison, when a physician warns his patient not to have too many chest X-rays per year, he talks about something like 0.02 mSv per session.

CT scans, a supplement to X-rays and ultrasonography, like PET are normally only used for patients with a very high risk of cancer or heart disease. The practice of offering full-body scans for the general population is somewhat controversial. The additional risk of cancer mortality caused by the CT scans alone is estimated to reach as much as 1.5 to 2 percent.

Another screening method sought by Chinese tourists that doesn't seem too suitable for someone who walks into the clinic in a hurry is magnetic resonance imaging, with magnetic fields 60,000 times of the Earth's own. Providing a painstakingly accurate medical history to the person who operates the device is crucial for the patient's safety since even a long forgotten tiny metal fragment embedded in the body, e.g., through metalworking, could easily lead to fatal accidents.

Yet, the notion that it might be healthier to carry out a series of physical examinations in a matter of weeks or months rather than hours or days isn't going to put on the brakes to the cross-strait medical tourism boom. And as a sign that checking and scanning will become even faster in the not so distance future, Taiwanese researchers recently presented a technology that allow patients to undergo same-day CT and MRI scans.

Like David Silver of BiotechEast, Taiwan's medical experts acknowledge that for Chinese tourists coming to Taiwan to have all medical things done in one go isn't the most ideal way. Just as Jung-Der Wang, Chair Professor of Taiwan's National Cheng Kung University, told Asia Sentinel: "Many cancer markers frequently produce unnecessary anxiety when they are tested false positive. Therefore, I recommend being very cautious in the selection of items for such a trip of physical examination."

Nonetheless, Wang points out that Chinese don't need to worry too much as the health care service in Taiwan is generally of a high quality and comparable with those in Japan and Singapore. "I think in the end of the day seeking medical care in Taiwan is a cost-effective choice for anyone living in Asia having such a need."

Copyright © 2005 - 2010 Asia Sentinel.