As insurance premiums and medical costs in developed countries remain high, the falling cost and increasing ease of travel has seen greater numbers of people venture abroad for medical and cosmetic procedures. The Central American sub-region has been one of the world’s most proactive in picking up this slack. Organisations like Costa Rica’s official export promotion agency (Procomer) admit that figures published on the medical tourism market are, for the most part, “highly speculative”. Yet most agree that medical tourism to Central America is on the rise, with the vast majority of patients coming from the US, Canada, or elsewhere in the region.
Tourists travelling to Central America do so to receive a wide range of treatments. Among the most popular are cosmetic surgeries, dental work, cardiovascular surgery, orthopaedics, cancer care, fertility treatment, and weight loss procedures. As there are large numbers of highly-trained doctors in the region and the quality of care has frequently been of a high standard, Central America had been missing opportunities due to the image of the countries offering their services, and the efficiency of the industry. However, the medical tourism sector in Central America has streamlined and organised itself better to harness the burgeoning potential of the sector, while improved connectivity has also accounted for the rise in numbers. There are now more than 20 flights per day to Costa Rica from the US and Canada, and more than 25 per day to the Dominican Republic (DR) from the US alone.
Symposiums gather high-profile representatives of the medical tourism industry, a number of agencies facilitate the introduction of foreign clients to Central American medical facilities, while various countries have institutions devoted to the sector. For example, Costa Rica has a Wellness Tourism Association while the DR has a Dominican Health Tourism Association (ADTS). Advertising and marketing have also played a crucial role in attracting clients.
One of the greatest advances has been in making Central American services attractive to Anglo-American tourists through outreach marketing campaigns. Various bodies insist on their members speaking English, and special mention is always afforded to the overseas – usually US – institutions from which doctors have graduated. While there has been a concerted region-wide effort to streamline and coordinate the medical tourism industry, there have also been a number of country-level initiatives.
Medical Tourism Index (MTI), a private industry research group, releases a yearly ranking based on factors such as the allure of the country to foreign tourists, security, infrastructure, and the quality of facilities and services. The three best-established destinations in the Central American sub-region for medical tourists – Panama, Costa Rica and the DR – all feature in its 2016 index, ranking 13, 14, and 15 respectively.
Panama
In November 2017 the Panamanian Tourist Authority (ATP) estimated that as many as 20% of private patients in the country could be from abroad. At the time Temístocles Díaz, a health ministry representative, told reporters that “Panama has first world hospitals certified by international agencies and doctors trained in certified locations. We want the country to be a reference point for people who need complex operations and medical treatment.” “The large number of specialists who qualify at high-prestige international centres, along with investment in sanitation technology, has allowed Panama to stand out as a destination for medical attention,” said Edwin Villalobos, director of The Panama Clinic, a private clinic.
Dominican Republic
In the DR, ADTS president Alejandro Cambiaso says that significant savings are the biggest reason to come to the country for treatment, while the country’s location allows it to attract local tourists. According to Cambiaso, the premier national health centres claim that more than 35,000 patients visit the DR every year, largely from the Caribbean, US, and Canada. In order to ensure quality and attract North American clients, the ADTS requires its member doctors to belong to the Dominican Medical College (CMD) and speak fluent English, Spanish, or other languages.
Costa Rica
In the industry’s other regional centre, Costa Rica, the country’s tourism board says that between 2015 and 2016, the number of medical tourists arriving in the country rose 34% from 9,774 to 13,131 – the majority of whom came from North America – and on average, each patient spends close to US$7,000 per visit. According to Kenneth Rojas, medical coordinator at the Clínica Bíblica, a large private hospital in San José, the facility receives an average of 110 foreign patients per month. Massimo Manzi, executive director of the Costa Rican Chamber of Health, claims that “the chamber groups together 120 sector-leading private healthcare businesses. The Costa Rican Central Bank indicates that 70,000 international patients are treated every year: of these, 80% are from the US, 11% are from Canada and 8% are from Central America and the Caribbean; generating an income of US$475m.”
Guatemala
There is also growth in the medical tourism industry in other Central American countries. Guatemala has inaugurated nine health and wellbeing facilities for medical tourists – as well as five dental clinics – in 2016 and 2017 alone. The health and wellbeing section of the Association of Guatemalan Exporters (Agexport) announced that in 2016 the country made more than US$67m, through this sector, up 13% on the previous year. At the eighth Medical Tourism Congress held in Mexico’s Ciudad Juárez in August 2017, the president of Agexport’s health branch, Guillermo Contreras, asserted that a medical tourist in Guatemala spends up to six times as much as a regular tourist. According to the country’s tourist commission, 36% of medical tourists in Guatemala travel for dentistry work, 22% for other surgeries, and 12% for plastic surgery.
El Salvador
El Salvador has also seen encouraging growth in the medical tourism sector. In September 2016, the country’s tourism minister José Napoleón Duarte travelled to the US to receive the Emerging Medical Tourism Destination award at the World Medical Tourism & Global Healthcare Congress. As of May 2018, the tourism ministry reported that 16 Salvadorean companies (clinics, hospitals, and tour operators) belonged to the national medical tourism network with a further six companies due to join. According to the same tourism ministry report, as of end-2017 some 24,255 medical tourism visitors had been registered, spending some US$13m in the country.
Nicaragua
In March 2017, the local press reported that just 60 tourists per month were arriving in Nicaragua from Central America, the US, and Canada for medical tourism purposes – indicative that the sector is still in its infancy. The country has taken a slightly different route to others in the region, however, with its thermal springs becoming a selling point for natural treatments and appealing to a different niche in the medical tourism market. The president of the Nicaraguan chamber of tourism (Canatur), Lucy Valenti, said that she hoped that Lake Nicaragua, the largest lake in Central America situated in the south west of the country, could be the focal point for the industry’s growth, helping to diversify the amount on offer for medical tourists.
According to Andy Bezara Higle, a consultant with Costa Rica-based industry group Turismo Médico, “A patient generally considers various factors when choosing where to go for treatment: saving money, international accreditation of hospitals and clinics, short waiting times, quality of service, security, stability and connectivity of the country concerned, and a high level of English.”
The more ‘conventional’ sectoral treatments Nicaragua offers are at least 70% cheaper than in sender countries, according to Mayke Soto of the Vivian Pellas Hospital in Managua.