Medical tourism – a new frontier?

Femke van Iperen investigates the role of the air ambulance sector in medical tourism, where untapped potential could lead to new business opportunities

More and more people around the world are opting to receive medical care in countries other than their own, sometimes on the other side of the globe. Although such people, who are often referred to as medical tourists, may choose to be transported by a commercial airline to and from their destination, many high-end tourists may prefer the luxury and medical provisions made onboard private fixced-wing air ambulance transportation. Others simply need a higher level of care than is available on a commercial flight. Does this mean that medical tourism has been having an impact on the air ambulance industry?
Back in 2008, the Wall Street Journal reported that ‘anyone might become a medical tourist sooner than they think’, and in its article talked about a ‘burgeoning medical travel industry’; it was described how hospitals in India, Israel and Ireland, and middlemen throughout the US, were ‘aggressively wooing older patients by offering joint-replacement surgeries and non-emergency cardiac procedures at 40 to 80-per-cent less than in the US’.1 Since then, medical tourism has been on the rise, and in 2012 an Air Medical Net article described how ‘a whole infrastructure’ was developing to ‘support the demands of health tourism’ and how some in the medical tourism industry have increasingly started using air ambulances as their preferred carriers.2

To the rescue
Dawn Cerbone, senior vice-president of sales and marketing for US-based REVA, Inc., said that her air ambulance company has experience transferring Western-region Americans and Canadians to Asian locations and Brazil for their chosen medical procedures and treatments. At the same time, Patrick Schomaker, sales and marketing director of European Air Ambulance (EAA), a company that generally receives medical tourist requests from the Middle East to Europe, has witnessed an increasing amount of medical tourists from the Northern US and Europe travelling to destinations such as Abu Dhabi, Bangkok, India, Mexico and Brazil.
South America, it seems, is one of the medical tourism hotspots, with hospitals geared for medical tourists developing around countries including Venezuela, which itself has a growing reputation for plastic surgery treatments. The Middle East, too, is already recognised as a fast-moving destination for medical tourists, Schomaker has found, quoting Dubai Healthcare City hospital as an example. This hospital, which claims to have ‘15 per cent of its patients as medical tourists’, boasts to house ‘over 140 medical facilities and 4,000 healthcare professionals’.3
Alberto Carson, CEO of San Diego-based Aeromedical Consulting Group LLC, has been witnessing an ‘exponential’ rise in medical tourism in the last 10 years. He has particularly seen this in the Latin American region, where his company has focused its business for the last 15 years, and where medical groups have been marketing heavily to North America, by ‘using large medical facilities in metropolitan cities, and more recently by expanding into resort areas creating a vacation experience to these types of tourists’, he said.
Over in South Africa, a growing medical tourism sector of wealthy expats, who traditionally would have travelled to Europe for medical treatments, and middle-class people from neighbouring Sub-Saharan countries, have been flying in for elective, planned medical evaluations, needing procedures related to oncology, gynaecology, orthopaedics, and neurology. These medical tourists mainly fly in on commercial flights, but when they do travel by air ambulance, their costs are covered by their insurance, their government, or by corporate or private means, and although these medical cases may not necessarily ‘contribute volume in terms of the total medical tourism mix’, they ‘can add large income value to the healthcare sector’, explained Lorraine Melvill, founder and owner of South Africa-based Surgeon and Safari, which offers private and corporate medical tourists a variety of surgical and other medical treatments, accommodation and holidays with a ‘total solution’. It does so by co-operating with air ambulances and other services within the private healthcare supply chain.
Tailored partnerships between medical facilities and air ambulance companies have started to emerge in different parts of the world too, and since EAA started offering medical tourist flights about five years ago, Schomaker has witnessed a rise in hospitals marketing themselves to international patients, and co-operating with air ambulance companies, to offer a ‘total package, including the whole transfer, as a complementary service for medical tourism patients that need or want an air ambulance’, said Schomaker.

Reason to believe
Medical tourists have different reasons for opting to travel abroad for their medical treatments; for example, those requesting EAA’s services might require a treatment that is not available at home, or they ‘have reason to believe that another doctor or hospital in another country would be able to do a better job’, said Schomaker. In addition, comparing a ‘hip replacement in the US costing maybe $50,000’ to ‘a good hospital in India where the same treatment would only cost $5,000’, Schomaker also highlighted the key issue of potential cost savings for the patient. Long waiting lists in a patient’s home country is another motivator to travel abroad for treatment.
But medical tourists, who are increasingly savvy about what types of treatment are available where, are not just after low cost – they also want high quality, and this is exactly what attracts medical tourists to South Africa from neighbouring countries that lack a developed private healthcare sector, according to Melvill. In fact, it is thanks to the ‘extensive, highly developed medical infrastructure in tandem with low-healthcare costs’ that Costa Rica, Panama, Malaysia, Thailand, and Brazil are growing to be what Cerbone referred to as the ‘top five medical-tourism countries’. “We help meet the needs of the rapidly growing numbers of Western-region Americans and Canadians choosing the Asian locations for their [cheaper but high-quality] medical procedures and treatments,” said Cerbone, who said that in the main, her medical tourist customers are private payers. From the company’s headquarters in Florida, REVA has also been able to support medical tourists going to Brazil, known for being a cosmetic surgery hub, and provide them with ‘care, comfort, and safety on their return home’.
Cerbone also asserted that Puerto Rico, due to its high-quality, lower-priced options and its reputation as an up-and-coming medical tourism destination, is not only attracting medical tourists from other countries, it also emits medical tourists to the US, Canada, Mexico, and South America in search of high-quality specialist treatments.
The medical tourists the Aeromedical Consulting Group refers are mostly from tourist areas, paid for either by insurance, or out of their own pocket. Carson explained: “There are also large corporate group plans that, instead of having premiums raised, offer employee payment plus additional fees for them to have procedures done in Mexico or Costa Rica.” He added: “We only arrange air ambulances for patients who require the intensive care unit, most fly commercially.”

Being ready for all scenarios
A medical tourist can choose to fly with an airline operator, with, if needed, a medical assistant at their side, but those that book companies such as EAA are usually ‘very wealthy, often from the Middle East, maybe travelling to London’, Schomaker said, adding that such tourists choose air ambulance companies like EAA because of the opportunity to ‘travel with four relatives, a doctor, a physician, a flight nurse, and the medical equipment they need, in a comfortable way’.
Although many medical tourists are patients such as those from North America travelling to India for spine or heart bypass operations and treatments, many that choose elective procedures such as cosmetic surgery in Brazil, are ‘left ambulatory and are well enough to travel by commercial airline with a medical escort’ said Cerbone. However, she has found this patient group too can often afford, and will choose, the private and infection-free environment of an air ambulance.
According to Carson, the most common procedures sought by medical tourists are hip replacement, cardiac angioplasty, cardiac pacemaker replacement, and various cosmetic procedures, and since such medical tourist flights are often scheduled in advance, they tend to be easier to conduct than a more critical flight. This means, for example, that while the required medical protocols are followed, there is more room for customer service. “Air ambulance companies really want to give the patient the best experience possible,” he said. “Testimonials are key and often posted on social media and on the provider’s website, which makes it a more service-oriented mission.”
In general, medical tourist missions have a tendency to be less urgent and therefore easier to plan. As Cerbone said: “The logistics are quite similar to transport for insured patients.” And there are a good number of international air ambulance companies used to carrying insurance cases.
“Medical cases vary from light injuries to intensive-care treatments where the patient is ventilated,” said Schomaker. Should a patient ‘have a serious illness that cannot be treated in their own country’, or present another urgent medical problem, air ambulance companies are well positioned to transport that patient ‘in a fast way to a specialised facility; cheaper and faster [compared to a commercial airline] because we have [more] immediate availability’, he explained.

Penetrating the market’s potential
The air medical industry has been slow to catch on to the medical tourism sector, Carson has found, because most treatments sought abroad are elective and non-urgent and, hence, most patients are suitable for commercial carrier transfer: “As of now, the air ambulance business sector has not properly penetrated this fast-growing market, largely due to high costs yet not much demand.” Nonetheless, Carson believes that air ambulance companies could capitalise on this market by finding new and dynamic ways to offer repositioning legs to this segment at lower costs. This, he says, could be done by ‘creating strategic alliances with companies that promote [medical tourism] services, as well as the third-party administrators that handle these cases for private and government insurance’ providers.
REVA, for example, has engaged with the Medical Tourism Association of Puerto Rico in order to be a certified provider of medical tourism air ambulance services in the area; and for REVA, medical tourism provides an opportunity that cannot be ignored. “With REVA’s established presence in Puerto Rico, it is logical business for us to grow our medical tourism efforts, as Puerto Rico grows its ability to provide the wanted services,” Cerbone said.
Although medical tourism will never replace international air ambulances’ main business of repatriation flights, EAA will continue to co-operate with hospitals on medical tourism flights and market itself to medical tourists too. As Schomaker concluded: “It is a part which we do not neglect, and we try to draw it in.” It will be interesting to see how the business of transporting medical tourists develops for air ambulance providers in the future, and with strategic alliances starting to form, business is already looking good.


  1. February 2008 article in the Wall Street Journal titled Health Matters: The next wave of medical tourists might include you
  2. ambulance