Sun, Sea and Surgery

陽光、大海和手術

In the tiny Croatian town of Zabok patients arrive in their thousands each year from across Europe and the Middle East, seeking replacement hips or knees at the St Catherine hospital, which specialises in orthopaedic work. Some come for treatment they cannot get at home, others to escape long waiting-lists for public health care or high prices for private operations. Croatia is one of a number of treatment hotspots in the medical-tourism industry. Babies are made in Barbados, sexes are changed in Bangkok, teeth are replaced in Hungary or Mexico and hair is transplanted in Turkey.

在克羅地亞小鎮扎博克(Zabok)，每年都有成千上萬歐洲和中東的患者來到這里，希望在擅長矯形外科的圣凱瑟琳醫院(St Catherine hospital)接受髖關節或膝關節置換手術。有些人是為國內無法獲得的治療而來，其他人是不想在公立醫院排長隊或在私人診所花大錢。克羅地亞是醫療旅游業的一批治療熱點之一。做試管嬰兒去巴巴多斯，變性去曼谷，做假牙去匈牙利或墨西哥，植發去土耳其。

Precise numbers are hard to pin down, partly because of differences between countries in what is counted as medical tourism. Some national statistics include a mere spa visit or a tourist who falls sick. Allied Market Research, a research firm, puts the industry’s value at $61bn in 2016. Keith Pollard, head of LaingBuisson, a health-care research outfit that specialises in medical-tourism data, reckons it is much smaller, at around $10bn-15bn.

精確的醫療旅游人數很難確定，原因之一是各國對醫療旅游的界定不同。有些國家的統計數據把僅僅去了下水療中心或在當地生了病的游客都算在內。聯合市場研究公司(Allied Market Research)估算，2016年醫療旅游行業的價值為610億美元。專門研究醫療旅游數據的醫療保健研究機構LaingBuisson的負責人基思·波拉德(Keith Pollard)估計的市場規模要小得多，約為100億到150億美元。

Rising numbers of middle-class patients in Asian and African countries mean more people willing to spend if they cannot find what they need at home. And consumers are incentivised to travel by substantial price differences across borders for the same treatment. The average heart-valve replacement, for example, costs EURO 30,000 ($35,000) in Germany but only EURO 15,000 next door in Austria, with little or no drop in quality. A hip operation can be had for EURO 12,000 in Britain, EURO 10,000 in Turkey and only EURO 4,725 in Poland.

亞洲和非洲國家中產階級患者數量不斷增加，如果他們無法在國內得到所需的治療，就會愿意花錢出國解決問題。而且相同的治療在不同國家價格差異巨大，也讓消費者有動力出國治療。例如在德國，心臟瓣膜置換費用平均為3萬歐元(3.5萬美元)，而鄰國奧地利僅需1.5萬歐元，質量無甚差別。英國的髖關節手術要1.2萬歐元，土耳其要1萬歐元，而波蘭只需4725歐元。

Governments are responding to rising demand. South Korea, Malaysia and Dubai have all invested heavily in creating regional centres of medical expertise to attract foreign patients. The Dubai Healthcare City seeks to attract patients from Gulf nations who have in the past been sent further afield by their health systems, to Europe or America. Some niche areas are showing particularly strong growth. Mr Pollard says that international travel for in vitro fertilisation (IVF) is increasing rapidly because many wealthy countries have restricted access to free treatment. A number of European countries, such as Germany, offer only three rounds of IVF and limit access to those with medical conditions or to younger women.

各國政府正在回應增長的需求。韓國、馬來西亞和迪拜都投入巨資創建區域專科醫療中心以吸引外國患者。迪拜醫療城(Dubai Healthcare City)想要吸引海灣國家的患者，過去這些國家的醫療系統會把本國的一些病人送到更遠的歐洲或美國去接受治療。一些利基領域的增長尤為強勁。波拉德表示，以做試管嬰兒(IVF)為目的的國際旅行正在迅速增加，因為許多富裕國家已經對免費IVF做出限制。德國等一些歐洲國家只可以免費做三次，而且對患病或較年輕的女性都有限制。

Medical tourism is still hampered, however, by a lack of detailed, reliable information on the quality of hospitals and clinics and of their doctors and surgeons, notes Valorie Crooks, a professor of geography at Simon Fraser University in British Columbia. International hospitals are often verified by the Joint Commission, a non-profit organisation that awards accreditation to medical-services providers. These aside, patients have had to rely solely on reputation or on intermediaries that grease the wheels of medical travel. Patients often do not realise that these “facilitators” may be working exclusively with certain clinics; some receive undisclosed commissions. If things go wrong, patients may have little recourse to help. Doctors have long complained about people who return from treatment abroad with complications.

但是，由于缺乏有關醫院、診所及其內外科醫生質量的詳細、可靠的信息，醫療旅游業的發展還是受到了阻礙，加拿大不列顛哥倫比亞省的西蒙弗雷澤大學(Simon Fraser University)的地理學教授瓦萊麗·克魯克斯(Valorie Crooks)指出。國際醫院常獲得國際醫療衛生機構認證聯合委員會(Joint Commission)這一非營利組織的資質認證。但除此之外，患者只能完全依賴醫院和醫生的聲譽或促成醫療旅游的中介機構。患者通常不知道這些“輔助機構”可能和某些診所獨家合作，有些還會悄悄收取傭金。如果出現問題，他們可能求助無門。長期以來，醫生們一直對人們去國外治療回來后出現并發癥的情況怨聲載道。

Two newish online firms, Qunomedical and Medigo, both based in Berlin, hope to improve matters. They allow patients to search for medical treatments from a large selection of providers, offering clear information about pricing and the quality of staff and services. Both take fees from the hospitals and clinics that they list, as disclosed on their websites; Medigo also earns money from patients and corporate customers in the form of fees. Patients write reviews, and human advisers are available to help with choosing where to receive treatment. Such information should make foreign medical treatments more appealing.

柏林兩家成立不久的網絡公司Qunomedical和Medigo希望能改進現狀。它們提供了有關定價和醫護人員及服務質量的明確信息，讓患者能在大量醫療服務機構中查找自己需要的治療。兩家公司都向自己羅列的醫院和診所收取費用——這一點它們都在網站上寫明;Medigo還會向患者和企業客戶收取費用。患者在網站上撰寫評價，人工顧問協助選擇醫療機構。這些信息應該會讓海外醫療更具吸引力。

But making money out of medical tourism can still be hard. Variations in exchange rates can instantly make a destination less appealing. The market for “scalpel safaris” in South Africa has proved volatile, say people in the business, due to currency fluctuations.

但要靠醫療旅游賺錢可能仍然很難。匯率的變化可以讓一個旅游目的地瞬間失去吸引力。業內人士表示，由于匯率的波動，南非“手術刀探險之旅”的市場變化無常。

Sometimes demand fails to materialise. When work first started on a 2,000-bed hospital called Health City Cayman Islands, the $2bn project was expected to attract more than 17,000 foreign patients annually, mostly from America. But when the first wing of the hospital opened in 2014, the International Medical Travel Journal reported that fewer than 1,000 overseas patients arrived in its first year. One reason was that its backers based projections of customer numbers on a flawed study, according to a subsequent investigation by a government public-accounts committee. Fewer American patients came than expected partly because health insurers were not interested in sending people overseas.

有時需求無法實現。當擁有2000張病床、名為開曼群島健康城(Health City Cayman Islands)的醫院開建之時，這個20億美元的項目預計每年將吸引超過1.7萬名外國患者，主要來自美國。但據《國際醫療旅游雜志》(International Medical Travel Journal)報道，當醫院的一區于2014年建成開業時，第一年前來就醫的海外患者還不到1000人。一個政府公共賬目委員會隨后的調查顯示，原因之一是項目投資者對海外病患數量的預測是基于一項有缺陷的研究。美國患者人數少于預期的部分原因是醫療保險公司對把病人送到海外治療不感興趣。

In time, health-care providers are likely themselves to travel to serve patients. Vikram Kapur, a partner at Bain& Company, says that China has in the past been an exporter of patients but now American hospitals, such as Johns Hopkins, the Cleveland Clinic and the University of Pittsburgh Medical Center, are undertaking joint ventures with local Chinese hospitals to deliver services to patients closer to their homes. One way or another, health care is becoming more footloose.

未來，醫療機構很可能自己“出國游”以服務當地病患。貝恩咨詢公司的合伙人維克拉姆·卡普爾(Vikram Kapur)表示，中國過去一直是患者出口國，但現在約翰霍普金斯醫院、克利夫蘭診所和匹茲堡大學醫學中心等美國醫院正在和中國本土醫院建立合資機構，把醫療服務送到中國患者的家門口。不管怎樣，醫療服務正變得越來越不受地域的限制。

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