The global growth in the flow of patients and health professionals, as well as capital funding and medical technology, has given rise to a broadly defined, rapidly growing, multi billion industry of medical tourism. In the last decade, the medical tourism sector has captured particular interest globally.
Nations’ governments around the world have foreseen significant economic development potential in the emergent industry of medical tourism. Moreover, medical tourism is a source of lucrative foreign revenue for countries, inducing growth of economy, an opportunity to participate in global healthcare, to have better healthcare standards, to enhance the development of technically advanced and specialized medical services, better knowledge exchange, to turn around the brain drain: retaining or bringing back local healthcare professionals for political and social benefits. For these reasons, medical tourism has attracted the interest of large hospitals in Georgia too.
According to the experts, Georgia has great potential and perspectives in both medical tourism and wellness tourism. The country’s healthcare sector is indeed competitive in a number of medical services (cardio surgery, plastic surgery, dentistry, etc.); private clinics have excellent success rates regarding these medical services, state-of-the-art equipment, qualified health professionals and a lot of experience. Furthermore, in the above-mentioned directions, the country is price-competitive vs. other regional medical tourism destinations like Turkey and the UAE. Considering these factors and its geographical location at the cross road of Europe and Asia, Georgia has the potential to become a medical tourism hub in Transcaucasia and the region.
The development of tourism is one of the key areas in reforms that the Georgian government introduced in 2016. These reforms target the promotion of high-quality sustainable tourism development and the transformation of Georgia into a four-season tourism destination.
It is well known that in comparison with other branches of tourism, medical tourism has special features that support the competitiveness of the sector:
o Long stays of patients (due to treatment-based services, the amount of time spent is more than in the case of other tourism products, and for some procedures patients need to travel to the country of treatment more than once);
o Typically, patients very randomly travel alone: most frequently one attendant accompanies them;
o There is a higher specific expenditure due to the specialized services and tools and the high labor need of health tourism;
o Lower seasonality; the services of health tourism are usually independent of the weather.
Moreover, the total number of international visitors (tourists, transit and one-day arrivals combined) arriving in Georgia increased at a CAGR of 21.7% over 2008-17 and reached a record 7.5mn persons in 2017. In recent years, number of tourists visiting Georgia has been increasing drastically. To illustrate, in 2018, the number of international visitors was 8.7 mn (growth rate 17% compared to 2017) and in 2019, reached 9,357,964 persons (7.8% growth rate compared to 2018) (source: Department of Tourism).
Georgia’s healthcare market is quite unique in the world, as more than 90% of hospitals and clinics are private, for-profit organizations. Georgia’s Universal Healthcare financing system cannot be considered lucrative for the provider sector. According to the statistical guide published by Georgia’s National Center of Disease Control and Public Health, in 2018, 273 hospitals were functioning in the country. Total bed stock consisted of 15,909 beds, and the bed occupancy rate was 51.3% (187.2), suggesting capacity underutilization. The same issue is accentuated in a report published by Galt&Taggart in 2020, showing that the last six years’ average bed occupancy rate was 50%, dropping to 49% in 2019. Moreover, the average duration of hospital stays was five days, which illustrates the fact that, very frequently, ambulatory sensitive care conditions are treated in hospitals in Georgia. Consequently, management in the hospital sector faces problems in the raising of funds to invest in quality improvement or for the innovative development of medical services. One of the best solutions for these problems is to develop medical tourism in Georgia.
Currently, medical tourism in Georgia is at the development stage. Private clinics’ efforts in search of potential “source countries” and attracting medical tourists is fragmented, not governed at the system level, totally relying on the hospital sector and mediator firms, making it precarious with regards to patient safety, and detrimental for Georgia’s image as a destination country on the global market.
With the aim of exploring the potential and perspectives of Georgia in medical tourism, in the scope of healthcare facilities, medical services and customer service, and to identify barriers and challenges for medical tourism development in the country in the healthcare sector and at the system level, research was conducted in the University of Georgia (in the scope of a doctorate program). In line with the research goals, a qualitative study of in-depth interviews was conducted with major stakeholders of the medical tourism industry in Georgia: representatives of local and international medical tourism industry stakeholders, top managers of hospitals engaged in in-demand specialties (multi-profile, plastic/cosmetic, reproductive, cardiologic, dental and oncologic specialty clinics), the president of the Medical Tourism Association, the president of the Medical Tourism Council, a representative of the Partnership Fund, a representative of the Ministry of Health, representatives of the National Tourism Agency, and others.
Does Georgia have perspective in medical tourism?
100% of respondents of the research gave a positive answer to this question. According to the opinions of medical tourism facilitators and other respondents, Georgia has a real perspective to become a hub of medical tourism in the Caucasus region. Moreover, in Georgia, medical services such as cardio surgery, plastic/cosmetic surgery, assisted reproductive services and dentistry, are highly developed. The country has highly qualified specialists, a competitive advantage in Caucasus region and in comparison to post-Soviet Union countries. Top managers of international medical tourism facilitators claim there are many good clinics in Georgia which can compete with Turkey’s medical facilities, in quality of healthcare services and especially in price.
At present, the majority of medical tourists come from Azerbaijan, Chechnya, North Ossetia, and Ingushetia. Recently, an increasing number of patients has started to arrive from Kazakhstan and Uzbekistan, and medical providers are working to attract patients from Turkmenistan, Kyrgyzstan, etc. According to the results of the research, source countries of medical tourists arriving in Georgia differ by type of medical service provided. To illustrate, for oncological and cardio surgery services, patients mainly come from Azerbaijan, Armenia, Chechnya, Ingushetia, North Ossetia, Kyrgyzstan and Turkmenistan. Furthermore, for cosmetic surgery services and hair transplantation, patients come from Israel, Russia, Belorusia, Kazakhstan (Actao area), Azerbaijan, Uzbekistan, and Qatar.
In the scope of the research, data was requested from respondent health facilities on the number of foreign patients in 2017-2019 (three years, by country and by service type). However, only nine clinics (seven multi-profile clinics and two reproductive clinics) were able to provide the requested information. Based on this statistical analysis, the total number of patients from Russia was 9015 (33%), from Azerbaijan 8295 (30%), from Armenia 1589 (6%) and 8216 (31%) from other countries. Clearly, regional movement is observable in Georgia.
However, in terms of assisted reproductive service providers, the situation is different. Statistical analysis demonstrates that 23% of foreign patients coming to Georgia for such services in 2017-2019 came from China, 15% from the USA, 14% from Israel, 7% from Sweden, 4% from Australia, 4% from India, and 33% from other countries worldwide.
For dental services, patients mainly come from Israel, Qatar, and Kuwait. Opportunistic medical tourism is quite common in dentistry, with travel agencies offering a combination of treatment and travel to tourists coming to Georgia.
As to what motivators shape patients’ decision to travel to Georgia for treatment, all respondents said the same: an optimal combination of price and quality. Patients from bordering countries and post-Soviet Union countries come for better medical quality. The quality is higher in Turkey, but since the cost of traveling and treatment there is also higher, patients prefer Georgia. For Armenian patients, price is the determinant of travel. Medical services are well developed in Armenia, especially cardio surgery and plastic surgery, but prices for treatment are higher (cardio-surgery is, on average, 50% higher in cost in Armenia). In assisted reproductive services, the legal framework is more favorable in Georgia for commercial surrogacy and in-vitro fertilization.
The main barriers for medical tourism development in Georgia were identified as Georgia not being positioned as a medical tourism destination country on the global market; a lack of standardization in medical service providers due to the government’s weak role in regulation and monitoring of medical quality; the extremely low number of internationally accredited providers in the hospital sector, which can result in low trust levels in customers; the inexistence of a strategy for medical tourism development or the government’s engagement and integrated efforts among state entities; the absence of direct flights with target/source countries, plus the low quality of services and relatively high prices of tickets; the weak legal framework with regard to protecting foreign patients’ rights; the low levels of malpractice insurance owned by specialists in the hospital sector; and the lack of guarantees and reimbursement of damage for complicated cases.
Second-level barriers in the provider sector are: low levels of qualification and awareness regarding medical tourism among the management of medical facilities; the lack of communication, collaboration and cooperation among managers of clinics involved in this direction; problems related to inadequate communication skills, lack of operativeness and flexibility of personnel in medical facilities; delayed response or provision of a treatment plan (instead of providing in 24-48 hour interval); the language barrier (especially in low-skilled medical personnel, nurses, etc.); the pricing policy for medical services for medical tourists- the inexistence of a determined, competitive pricing policy in the sector; and the low utilization of various channels to attract medical tourists.
Third-level barriers are: low levels of cooperation and coordination among medical tourism mediators and medical facilities, given the small number of facilitator companies and agencies on Georgia’s medical tourism market working on inbound medical tourism; and problems responding to medical tourists’ various religious-cultural specifications.
According to the respondents interviewed, regulations and control regarding medical quality in Georgia are weak. There is a lack of standardization of medical services in the hospital sector; with little incentive for providers and regulations to improve the quality of care. However, with regard to international accreditation of medical facilities, there were differing opinions among the respondents. Likewise, there was a difference between what literature shows about requirements in this regard, and how respondents perceive needs. In particular, one-third of respondents found it absolutely necessary for medical facilities to possess international accreditation in order to develop medical tourism in the country, whilst the remainder did not perceive it as a necessity. In Georgia, only one clinic, MediClub Georgia, is accredited by the international accreditation agency JCI.
Based on the research results, using SWOT analysis, directions for a development strategy were identified:
1. Positioning the country as a medical tourism destination on target markets and globally.
2. Development and implementation of target and niche medical services for medical tourism.
3. Elaboration and implementation of a five-year plan for medical tourism development by the government; and strengthening the government’s engagement in the process.
1. Integrating the efforts of clinics and hospitals for medical tourism development;
2. Improvement of quality of medical services, standardization, accreditation;
3. Increasing the qualifications of medical personnel in communication skills and foreign languages.
1. To organize international conferences and info-tours to introduce the country’s medical tourism potential;
2. To penetrate new target markets;
3. To strengthen online activities on target markets.
1. Development of air travel, implementation of direct flights;
2. Development and improvement of general infrastructure in the country;
3. To strengthen guarantees for medical tourists.
According to the results of the study, the following recommendations were elaborated for medical tourism development in Georgia:
1. It is essential to position and promote the country on target markets to have Georgia recognized, globally, as a medical tourism destination.
2. The government must elaborate an appropriate strategic plan for medical tourism development, to strengthen its role and engagement, and be in a leadership position to integrate the efforts of various stakeholders.
3. The government should provide centralized regulation, medical service quality control, and standardization of medical services. For this purpose, it is essential to establish an accreditation system of healthcare facilities. Moreover, international accreditation of clinics should be encouraged by introducing financial stimuli.
4. Coordination and cooperation among medical tourism facilitators and healthcare facilities should be improved. Furthermore, the management and administrative personnel of clinics should be trained to increase qualifications and awareness about the requirements and specific features of medical tourism.
5. Cooperation between medical facilities and spa-resourts of the country should be encouraged to integrate the services of both sectors.
6. In order to improve the accountability of statistical data about medical tourists, it should be mandatory for medical facilities to register information about foreign patients in a pre-defined form.
7. To develop the medical tourism direction, it is important to establish direct flights with target countries.
To conclude, Georgia has considerable potential for medical tourism development. Its healthcare sector is quite competitive in the region and the country has the perspective to become a hub of medical tourism in the Transcaucasia region. However, there are number of significant barriers to overcome and challenges to respond to. Georgia, as a medical tourism destination country, should be put on the international medical tourism radar. In turn, this goal needs the united efforts of a governmental team and various stakeholders of the industry. A medical tourism development strategy should be developed and implemented with the consideration of all the above-mentioned barriers, challenges and factors.
Given extremely intense competition in the medical tourism industry, globally, experts find appropriate for Georgia to identify its role and occupy respective niche on an international market.