Types of medical travel companies
I began studying Canada’s medical travel industry with what I assumed was a straightforward plan to identify all medical tourism companies based in Canada. During the process of trying to establish how many businesses constitute Canada’s medical tourism industry, it became apparent that companies operate according to somewhat different business models. Of the thirty-five companies involved in coordinating medical travel, eighteen Canadian companies fall within the category of what most health researchers regard as medical tourism companies [21
]. These companies promote health services provided in such international destinations as Barbados, Costa Rica, India, Mexico, and Thailand. Seven additional companies share much in common with the eighteen medical tourism companies promoting medical travel to distant locations. However, instead of marketing health services in such distant countries as India or Mexico they restrict themselves to promoting regional, cross-border travel to the United States as well as private clinics within Canada. These companies, could, with some justification, be included in the category of medical tourism companies. However, it is helpful to note that some medical travel companies promote regional, cross-border travel, as well as intranational travel within Canada, instead of marketing travel to distant international health care facilities. These companies emphasize timely access to care rather than promoting holiday excursions. Two businesses promote medical travel but restrict themselves to marketing testing for CCSVI and “Liberation therapy” for multiple sclerosis. Three additional businesses advertise bariatric surgery and cosmetic surgery performed at sites in Mexico. Four businesses market private health insurance products that permit Canadian citizens to obtain access to health care in the U.S. and Canada. These companies also help arrange care at medical facilities in the U.S. and private Canadian clinics. Finally, one medical travel company markets health services primarily to uninsured and underinsured U.S. citizens. Medical travel companies can be sorted into different categories even though they all promote transnational health care. They occupy distinct market niches, promote different kinds of medical procedures, and offer different kinds of services to prospective clients. This article identifies different types of companies marketing medical travel and does not attempt to use “medical tourism” as a catch-all term for describing every business involved in promoting transnational and intranational medical travel [25
Locations of medical travel companies
Of the eighteen medical tourism companies, five are based in British Columbia, four are located in Alberta, one is based in Saskatchewan, one is in Manitoba, four are in Ontario, and three are based in Quebec.
Seven companies market cross-border, regional medical travel to the U.S. as well as intranational medical travel within Canada, Two of these businesses are situated in British Columbia, four are based in Ontario, and one is located in Quebec.
The two companies marketing diagnostic testing for CCSVI and Liberation Therapy for multiple sclerosis are based in Manitoba and Ontario.
Three companies advertise out-of-country bariatric surgery and cosmetic surgery. One business is located in Alberta. The remaining two companies are based in Saskatchewan.
Four businesses market private health insurance products that enable access to U.S. health care facilities. Two of these companies are located in Alberta, one is based in Ontario, and one is located in Quebec. In addition to offering insurance products these companies help their clients arrange care in the U.S.
The lone Canadian medical travel company marketing primarily to U.S. citizens is located in British Columbia.
Some medical travel companies based in Canada identify affiliate offices or company representatives located outside Canada. Where company websites note such information I have recorded where company representatives situated outside Canada are based. Additional file 1
lists company names, identifies where in Canada these businesses are located, and indicates affiliates and company representatives in those instances where companies had offices or agents situated outside Canada.
Destination countries and health care facilities
Of the eighteen medical tourism companies promoting global medical travel, seven marketed one country as a health care destination, two businesses marketed three health care destinations, three companies marketed five countries as destinations, one company marketed six destination nations, two companies marketed eight destination nations, one company marketed nine destination nations, one business marketed twelve destination nations, and one business listed thirty potential destination nations.
In total, the eighteen medical tourism companies promoting global medical travel list thirty-eight different destination nations. Eleven companies list India as a potential medical destination, nine companies list Coast Rica, seven companies list Thailand, seven list Mexico, six companies list the U.S., five companies list Singapore, five companies list Canada, three companies list South Africa, three companies list Brazil, three companies list Malaysia, three companies list Turkey, three companies list Barbados, two companies list Italy, two list Cuba, two list the Dominican Republic, two list Poland, two list Argentina, two list Panama, two list Colombia, two list Israel, and two list the United Arab Emirates (with one company indicating Dubai as a potential destination and one company identifying Abu Dhabi as a possible destination site). El Salvador, United Kingdom, Ukraine, Switzerland, Spain, South Korea, Ecuador, France, Austria, Bahamas, Belgium, Bulgaria, Germany, Hungary, Jordan, Lebanon, and Peru are all listed by a single medical tourism company. The list of possible destination nations, and the number of companies that mention them, reveals the variety of destinations marketed by medical tourism companies based in Canada as well as the most common destination nations promoted by Canadian medical tourism companies.
Of the seven companies marketing cross-border, regional travel to the U.S. and intranational travel to clinics within Canada, six companies indicate that tests and procedures can be obtained in both countries and one business restricts itself to sending clients to U.S. medical facilities. The lone company marketing medical travel primarily for diagnostic imaging is among the businesses offering access to health services in both the U.S. and Canada.
Of the two companies marketing medical travel for “CCSVI testing” and “Liberation therapy”, one business marketed diagnostic imaging in the U.S. and procedures in India. The other company markets both tests and procedures in India.
Three businesses market medical travel for bariatric surgery and cosmetic surgery. All of these companies advertise surgery performed in Mexico.
Four businesses market private insurance plans that enable access to health care in the United States. Three of the businesses note the possibility of obtaining some types of tests and treatments at medical facilities in Canada. One insurance program is restricted to enabling access to tests and procedures at three Mayo Clinic sites based in the U.S.
Finally, one medical travel company based in Canada targets U.S. customers rather than Canadians interested in travelling for medical care. This business markets access to medical procedures available in eight U.S. states as well as facilities in Canada.
It is important to make a distinction between how medical travel is marketed on company websites and actual practices of Canadians using services of medical travel businesses when going abroad for health care. When medical travel companies list various countries as potential destinations for their clients, it should not be assumed that Canadians have contracted with these companies and travelled to listed destinations. It is conceivable that clients of these businesses have never selected some listed countries. It is also possible that some nations are listed even though companies have no established relationships with health care providers in these countries. Acknowledging the possibility of a gap between how medical travel is marketed and behaviour of medical travelers, analyzing websites of Canadian medical travel companies provides insights into how these businesses attempt to market health services to prospective clients. Additional file 1
identifies locations of destination facilities marketed on company websites.
Types of advertised medical procedures
Most of the 18 medical tourism companies in Canada offer comprehensive baskets of health services. However, some companies take niche positions by advertising restricted range of medical interventions. For heuristic purposes, medical travel companies can be classified as “generalist”, “specialist”, and “intermediate” firms. The former category includes businesses offering, for example, orthopaedic procedures, infertility treatments, cosmetic surgery, cardiac care, ophthalmology procedures, alternative medicine, and dental surgery. A company limited to marketing cosmetic surgery procedures can serve as an example of a specialist medical tourism company. Of the 18 medical tourism companies promoting health care at global destinations, 14 businesses operate as generalist medical travel firms. Two companies are specialist firms. One of them specializes in cosmetic surgery. The second firm predominantly markets procedures related to administration of human umbilical cord blood cells. Two businesses fall between these poles and can be classified as having “intermediate” marketing models. Of these latter businesses, one company emphasizes in its marketing claims access to cosmetic surgery but its list of procedures includes cosmetic surgery, dental surgery, bariatric surgery, gender-reassignment surgery, and non-surgical interventions. Another firm claims that it primarily markets alternative health care but also advertises orthopaedic surgery and reconstructive surgery.
Of the seven companies marketing cross-border, regional medical travel to health care facilities in the United States as well as private clinics in Canada, four companies can be classified as generalist firms. Of the remaining three businesses, one company promotes access to many different kinds of care but places particular emphasis upon diagnostics and arranging second opinions, one company offers comprehensive services but emphasizes preventive medicine and access to diagnostic tests, and one business specializes in marketing diagnostic imaging.
Of the remaining medical travel companies, two businesses market testing for CCSVI and “Liberation Therapy” for MS, and three businesses predominantly market bariatric surgery and cosmetic surgery. Both of the latter companies emphasize that they focus upon providing weight-loss treatments. These companies can all be classified as “specialist” medical travel firms.
Four companies market private health insurance plans enabling access to out-of-province and out-of country health care. These businesses offer insurance products that cover range of medical interventions. However, since their main product related to medical travel is related to selling critical illness insurance that can be used to cover cost of care at private medical facilities, they can be classified as specialist firms.
Finally, one medical travel company that is based in Canada markets health services mainly to clients from outside Canada. This company operates with a generalist model and offers such health services as cardiac surgery, general surgery, orthopedic surgery, neurosurgery, High Intensity Focused Ultrasound for prostate cancer, and additional medical interventions.
In summary, of thirty-five companies marketing medical travel, nineteen businesses operate using a generalist model based upon advertisement of many different kinds of medical interventions or insurance products and customer service intended to promote access to health care. Additional file 1
lists health services and medical specialties promoted by Canadian medical travel companies.
Core marketing messages of medical travel companies
Most medical tourism companies promoting travel to global destinations use core marketing messages that emphasize access to affordable, timely, and high quality care. Of eighteen medical tourism companies marketing travel to global destinations, sixteen emphasize affordability of health care at international medical facilities. Access to timely health care is marketed by fifteen companies. All eighteen businesses market access to high-quality health care. Three businesses note that medical interventions can be obtained in exotic settings that appeal to tourists.
Of the seven businesses marketing regional, cross-border medical travel to the U.S. as well as intranational medical travel within Canada, six companies emphasize affordability of care. Six businesses also market timely access to treatment. Four companies emphasize the high-quality of care available at the destinations they promote.
Two companies market testing for CCSVI and Liberation Therapy. Both companies emphasize affordability and high-quality of marketed procedures; one business promotes timely access to treatment.
All three companies marketing bariatric surgery at facilities outside Canada emphasize comprehensive access to weight loss interventions. Their core marketing messages emphasize access to bariatric surgery and identify the variety of weight loss programs they offer. Their lists of specific procedures include cosmetic surgery.
Four businesses market insurance products that enable access to health care outside Canada or at private clinics within Canada. Three companies emphasize affordable access to care. All four companies promote timely access to health care and access to treatment at high-quality healthcare facilities.
Finally, the one medical travel company targeting non-residents of Canada promotes access to affordable, timely, and high-quality medical interventions.
There are variations in the types of themes companies use when marketing medical travel. However, messages concerning affordability of care, timely access to treatment, and access to high-quality medical interventions are common. Some companies use all three selling points to market health services at international destinations. Other businesses emphasize one or two key features of the health services they promote. Additional file 2
summarizes medical travel companies’ core marketing messages.
“Tourism” component of medical travel
Medical travel companies typically emphasize affordability of care, timely access to care, and quality of care rather than tourism-related activities in their core marketing messages. Some companies note that they offer access to care in “exotic settings”. However, incorporating rhetoric concerning holiday-going and tourism activities into core marketing messages is atypical. Acknowledging that medical travel companies place greater emphasis on advertising medical interventions than promoting tourism, many businesses nonetheless market services associated with travel and tourism. Of the eighteen companies marketing medical tourism at global health care destinations, thirteen offer to coordinate travel arrangements, seventeen advertise the service of booking hotel reservations or otherwise arranging accommodations for clients, and fourteen offer to organize tours to local attractions located near where medical procedures are provided.
Of the seven companies marketing cross-border regional travel to the U.S. and intranational travel within Canada, four offer the service of booking travel and three offer to make hotel reservations. The possibility of booking tours to local holiday destinations is not addressed by these company websites.
Two companies market testing for CCSVI and Liberation Therapy. Of these businesses, one offers to book travel, both offer to make hotel reservations, and one advertises tours.
Three companies market weight-loss surgery and cosmetic surgery at international destinations. All three businesses offer to book travel; two companies offer to make hotel reservations. None of the companies mentions organizing tours and side trips before or after medical care is provided to clients.
Of the four companies marketing insurance products enabling access to care in the United States as well as private clinics in Canada just one business clearly indicates that it books travel. None of the companies state whether they book hotel reservations and organize tours. These companies emphasize offering insurance products and ensuring that their clients can obtain timely access to care in the United States or Canada. They help arrange care at U.S. facilities but they do not organize logistics to the same extent as medical tourism companies and regional, cross-border medical travel companies. In addition, they do not promote tours and holiday excursions.
The one Canadian medical tourism company marketing care to U.S. citizens does not indicate whether it books travel, make hotel reservations, or organize tours and other holiday excursions. It facilitates medical procedures and does not advertise additional services.
In summary, there is considerable variation in the extent to which medical travel companies market coordination of air travel, hotel reservations, and holiday excursions in addition to promoting medical procedures. Some companies embrace the concept of medical tourism and combine marketing of medical procedures with holiday excursions in “exotic” locations. Other businesses focus exclusively on arranging medical care at international destinations and make no attempt to promote and organize travel, accommodations, and tours.
Additional file 2
identifies whether medical travel companies advertise travel arrangements, offer to organize hotel accommodations, and market tours and side trips in addition to marketing health services.