全球海外醫療旅遊業蓬勃發展

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 (see map).

每年都數以幾計的患者從歐洲和中東來到克羅埃西亞的小鎮扎博克，在從事整形外科手術的聖凱瑟琳醫院(St Catherine hospital)尋求髖關節或膝關節的替代手術。有些人是因為在自己國家無法得到治療，還有些人則是不想公共醫療保健體系內漫長地等待，或是受不了私人醫院高昂手術費用。克羅埃西亞是醫療旅遊的熱點地區之一。現在,人們選擇在巴貝多生子，在曼谷變性，在匈牙利或墨西哥換牙，在土耳其植髮。

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.

很難算出準確的數字，一個原因是各國對醫療旅遊的界定方法各不相同。一些國家的統計數據甚至只包括水療或患病遊客。研究機構Allied Market Research認為，該行業2016年的價值為610億美元。專門從事醫療旅遊數據的衛生保健研究機構LaingBuisson的負責人Keith Pollard認為，醫療旅遊業的規模要小得多，大約在100~150億美元之間。

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 €30,000 ($35,000) in Germany but only €15,000 next door in Austria, with little or no drop in quality. A hip operation can be had for €12,000 in Britain, €10,000 in Turkey and only €4,725 in Poland.

在亞洲和非洲國家，中產階級的患者數量不斷增加，這意味著如果醫療需求在自己的國家內無法滿足，越來也多的人願意花更多的錢去國外治療。同時，如果國外價格較國內廉價，而享受的待遇卻是相同，消費者也更多地願意前往國外。例如，在德國，替換心瓣膜平均成本為30000歐（35000美元），而在鄰國奧地利只有15000歐，質量卻基本相同。髖部手術在英國為12000歐，而在土耳其和波蘭分別為10000歐和4725歐。

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.

各國政府也正對需求的增長做出反應。韓國、馬來西亞和阿聯酋都在大力投資創建地區醫療專家中心，以吸引外國患者。迪拜醫療城（Dubai Healthcare City）希望吸海灣國家的患者，這些患者之前曾因自己國家內的醫療休系的問題而到前往歐洲或美國等海外國家。一些細分領域的增長尤為強勁。Pollard表示，由於許多發達國家限制了免費治療的範圍，因此,到海外進行試管受精(IVF)的人數迅速增加。德國等歐洲國家只提供三輪試管受精，並對有醫療條件的患者或或更為年輕的女性做出限制。

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.

不過,加拿大不列顛哥倫比亞省西蒙弗雷澤大學地理學教授Valorie Crooks指出，由於缺乏關於醫院和診所的質量及醫生和外科醫生的可靠詳細信息，醫療旅遊業仍受到一定阻礙。國際性醫院經通常是由一個名為「聯合委員會」（Joint Commission）的機構認證。聯合委員會是一個非營利組織，向醫療服務提供商提供認證。除此之外，患者不得不完全依賴醫院的聲譽或在推動醫療旅遊業的中介機構。但是,患者往往沒有意識到這些「潤滑者」可能只與某些特定診所合作，甚至有些中介結構會接受秘密傭金。一旦出現問題，病人可能沒多少求助的辦法。長期以來，醫生一直在抱怨那些在國外接受治療的病人回來後患有併發症。

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.

德國柏林的兩家新成立網站Qunomedical和Medigo希望能改善現狀。它們允許患者在大量的醫療服務提供商中尋求醫療服務，並提供關於價格、員工和服務質量的明確信息。這兩家網站都從所列出的醫院和診所收取費用，正如他們在網站上披露的那樣。Medigo還從患者和企業客戶那裡賺取費用。病人可以寫評論，人工諮詢員還會幫助病人選擇治療地點。這些信息應該會增加國外醫療的吸引力。

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. 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.

但想要從醫療旅遊業中賺錢仍然不易。匯率變化會立刻降低旅遊目的地的吸引力。業內人士表示，由於匯率波動，南非的「手術刀+狩獵（scalpel safaris）」市場出現了一定波動。有些情況是需求不夠。當一個有2000個床位的名為「開曼群島健康城」的醫院首次開工時，這個價值20億美元的項目預計每年將吸引超過1.7萬名國外患者，其中大部分將來自美國。但當醫院的第一棟樓在2014年開放時，據《國際醫療旅行雜誌》的報道，第一年來年海外患者只有不到1000名。其中一個原因是，根據政府公共賬目委員會隨後進行的一項調查顯示，該公司的支持者對消費者數量的預測基於一項有缺陷的研究。由於醫療保險公司對將患者送往海外治療沒有興趣，因此,前來的美國患者數量少於預期。

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.

隨著時間的推移，醫療服務工作者很可能自己出行服務病人。貝恩公司合伙人Vikram Kapur表示，中國過去是輸送病人出境治療的一方，如今，Johns Hopkins、克利夫蘭醫學中心以及匹茲堡大學醫學中心等美國醫院正與中國本土醫院合作成立合資企業，為中國的患者提供更接近居住地的醫療服務。不管怎樣，醫療保健業受到的束縛將越來越少。

編譯：賈毅榮

編輯：翻吧君

來源：經濟學人（2018.07.28）

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