A healthy niche

A healthy niche

Kate Kolbina diagnoses how medical tourism is boosting the Baltic visitor economy

For Tamara Iudakhina, it was a long and hard road from her native Moscow to the waiting room of her son’s Latvian specialist.

Semjon,11, was suffering from suspected Klippel–Trénaunay syndrome (KTS), a rare condition that prevents blood and lymph vessels from forming properly. “I wasn’t able to obtain a full check-up for him in Moscow, because everything was getting stuck in Russia’s elaborate medical bureaucracy and doctors seemed reluctant to give us their full attention”, explains Tamara.

She decided to approach foreign clinics, turning to TopMedClinic.com, which aggregates information about world’s medical destinations.

“German and Italian clinics left my queries unanswered. In Israel and Finland we were immediately offered an operation on the blood vessels to remove the varicosity, which I thought was both expensive and unnecessary. The child is growing and changing! Wouldn’t the same symptom just recur? I didn’t see an urgent need for surgery”.

For Tamara it was vital that her son had a thorough examination by a qualified expert before conclusions were reached about his final diagnosis and further treatment.

After all this research, Tamara liaised with Baltic Health Tourism (BHT), a company which specialises in bringing patients to Latvia’s largest private clinic Veselibas Centrs 4 (VC4), and organises their stay and treatment. VC4 was the only clinic which seemed willing to look deeper into the problem and give the patient himself a proper examination.

Along with increasing numbers of people from around the world, Tamara had discovered for herself why Latvian medical tourism is proving to have an edge in a competitive world.
How did this come about? Put it down to the financial crisis, which had the virtue of giving rise to initiatives that would not be considered in times of plenty. The large Baltic clinics began to think seriously about medical tourism in 2008, just when they began to realise that demand from local “customers” was collapsing.

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General check-ups are one of the most popular services among medical tourists to Latvia, undertaken by not less than 40% of visitors. Tourists visiting for medical purposes stay in the country at least four times longer than other foreign travellers (five days compared to 1.2 days) according to data collected by Baltic Care, the Latvian alliance of selected medical institutions.

During this time, patients need somewhere to stay, something to eat, and things to do to entertain themselves and their families. These realities promote useful spill-over benefits into other sectors of the economy, so everyone wins: hotels, restaurants, and shopping centres. Having realised the potential of medical tourism as a “high value added” industry, each of the Baltic countries has since enshrined the economic role of the sector with a plethora of agendas, directives, and development plans.

But first of all, in order to attract the significant number of medical tourists, Baltic clinics had to fight unappealing stereotypes of Soviet-era levels of equipment and service culture.

While these prevailed, the Baltic States would never be seen as a first choice destination for medical interventions, at least not by fellow EU members. Nevertheless, the market was always there. According to a report by Eurobarometer, which in 2007 surveyed more than 27,000 residents of 27 EU member states, 53% of respondents would be willing to travel to another EU country to seek medical treatment. However, only 4% have actually ever done it. Little by little, perceptions changed. Guests from the West go for lower price and impeccable quality, whereas visitors from the East see less value for money, but come for the quality of medical technologies and staff. In general, there are more Eastern tourists than Western. For Lithuania, this division is roughly 65% and 35%, whereas for Latvia it is 53% to 47%.

A lot of the modern Baltic clinics resemble the hospitals of popular TV dramas: spacious and chic waiting rooms, smiling young reception ladies and of course, handsome doctors in impeccable white uniforms, operating the latest hi-tech contraptions in their consulting rooms. As Maris Revalds, head of the largest private medical company in Latvia, makes clear, it often comes down to material resources as much as expert personnel: “Our phlebologist [vein specialist] has four lasers and three radio frequency machines at his disposal, whereas the usual practitioner has only one of each”.

The Baltic medical sector contains comprehensive clinical expertise: general health monitoring, dental care, aesthetic medicine [plastic surgery], ophthalmology, reproductive medicine [including fertility treatment], drug addiction, orthopaedics, etc. There appears to be no specific emphasis on a particular area of expertise, though Latvia is particularly popular for overall check-ups, dermatology and phlebology, whereas to Estonia patients go for childbirth, oncology, orthopaedics, neurology and ophthalmology treatments.

As for prices, they tend to be 25-50% lower than in Western Europe. Linda Balina, from Wellslim medical centre, puts it this way, “when we tell the customer that a hydromassage costs €12, they usually ask to specify, whether it is the price per minute or the total”. Lithuania can boast significant value for money: for example, breast augmentation costs on average $3,225, whereas the same procedure in Israel would cost $4,040.

How did the Baltic States find their niche in this competitive international industry?

“Actually, it started from a negative situation – from the financial crisis,” says Revalds from Veselibas Centrs 4 with a smile.

“This is when the medical clusters were created by the Government, and when we created our own association Baltic Care, the alliance of 10 leading medical clinics in Latvia.” In order to capitalise on the potential of the industry, to make use of the designated EU funds and to create a development agenda for the years ahead, all three countries followed similar paths – organising medical “clusters”, aligning clinics with peripheral services with the general aim of promoting their members’ services to foreign markets, raising their competitiveness and drawing down EU money.

The clusters are taking care of members’ promotion through going to medical exhibitions, fairs, organising study visits and looking for co-operation partners. Since medical tourism is still relatively new in the Baltics, clinics themselves are not investing much into their promotion, but rather trying to co-operate and reach target audiences through common efforts. As Latvian cluster director Gunta Uspele presents it: “One of the cluster aims is to make complex products which include several cluster member services, and sell these packages to medical tourists. We also have representations of cluster clinics in cluster spa hotels”.

The Lithuanian medical tourism cluster LitCare puts the patient rather than clinic at the centre of its business, as Laimutis Paškevicius, its chairman, explains: “The cluster should cover the entire value chain of medical tourism, not only medical services, but accommodation, visas and trip planning, this would create more value for the patient.”

Glen Grant, the British-born owner of Baltic Health Tourism, which represents VC4 internationally, sees a problem with the clusters and indeed the Baltic Governments’ general attitude towards medical tourism. As Grant puts it: “Clusters lack business process thinking: their clinics don’t have client services. The patient doesn’t just need medical help, he or she needs advice on what to choose, where to go, where to stay. The Latvian cluster isn’t designed to provide all this.”

From a standing start five years ago, BHT’s own turnover now comprises at least nine clients per month, with each client relationship lasting about 1-2 months. This shows that there is a demand for companies like Glen Grant’s. This view is shared by another British businessman in the Baltics, Alistair Day-Stirrat, owner of the Odontika dental practice in Vilnius, Lithuania: “The Government has invested a lot in renovating and buying new equipment, particularly through the clusters mechanism, but not in generating new business”.

Glen Grant adds: “We cannot look for clients randomly, we have to target people who are [in need of treatment], and working B2B is not an option. Any partner organisation would get a bigger [margin] if they sent organised groups to Germany or Israel rather than to Latvia”. In fact, according to Revalds from VC4, many large Latvian clinics have already appreciated that medical tourists need a more tailored approach and are hiring their own specialists, who address all the needs of the overseas customers who turn to them.

Medical tourists could be reimbursed for receiving the treatment abroad, according to the 2011 EU Directive on Patients’ Rights in Cross-border Healthcare. As for local patients, their relationship with the private health establishments is complicated: in order to schedule an appointment there, one has to wait for several months. This is because the government allows too little quotas for them, and they are spread throughout the year. Historically, public medicine is the strongest in Estonia and the weakest in Latvia.

“This is another obstacle for medical tourists here”, says Revalds, “if you check the statistics, we have the smallest budget for state medicine in the EU”. However, there is a silver lining in that it has fostered the development of the private sector medicine, in some fields of which Latvia is amongst the strongest in the world (for example the vein clinic of Veselibas Centrs 4 is a proud employer of the vascular surgeon Dr Ints Udris, who is number four specialist in the world by the number of operations performed with “bio-glue”, one of the most innovative, painless and efficient ways to fight varicosity).

For Lithuania, health tourism is among the top four priorities in the development of tourism (alongside cultural, eco- and business tourism). Health tourism is seen by all Baltic governments as a hedge against the curse of seasonality, as demand is steady all year round.

Lithuania is focusing not only on its 40 large health and wellness centres, but also declared support for smaller public and private health care providers. Anyone who wants to introduce international healthcare quality standard LST EN ISO 9001:2000 can apply for governmental support. Quality standards are essential for attracting foreign patients. Proof of these is the first thing prospective patients look for when assessing the trustworthiness of a clinic.

The Latvian Government also directed its ministries to develop high value-added tourism, announcing that “Latvia has the resources and the potential of not only the traditional cultural and natural resource-based tourism product development, but also the development of products with higher added value, such as MICE (the collective name for a number of types of business tourism: meetings, incentive, conferences, events)
and health tourism.”

The three Baltic health tourism clusters as well as the Latvian and Lithuanian Resort associations have already signed a memorandum of understanding for the creation of pan-Baltic medical cluster. The objective of the planned new cluster is to enhance “co-opetition” (co-operative competition) among Baltic health and wellness service providers, and to promote the medical sector of the Baltic region in common.

The idea has been well-received, given that promoting the region as a whole would be easier in giant markets such as Germany, Russia, or CIS countries. Paskevicius from LitCare takes this idea further, suggesting that by 2017 the Baltic cluster could evolve into a Baltic-Nordic regional cluster. Private players also see a bright future. Glen Grant from Latvian Baltic Health Tourism is sure that “the market has huge capacity, and there is a chance for healthy cooperation between public and private sectors”.

As for Tamara Iudakhina, all the worrying questions about Semjon’s health were clarified.

Medical Centre 03“In Latvia we had the check-up extremely fast, and all my questions were answered. Fortunately, Klippel–Trénaunay syndrome was not diagnosed. Instead, doctors said that his shorter leg [local gigantism or shrinking is also one of the symptoms of KTS] was the result of genetic modification, and that this could be fixed when the boy grows older, hence no operation is needed at this stage”.

For Tamara and other satisfied patients, it’s not difficult to assess the strengths of the Latvian treatment: The prices here are higher than in Russia but the quality of medical intervention is way better. With fundamentals like that, it’s no wonder that this prosperous niche of the tourism market is healthy in every sense of the word.