Power Ranking the Medical Tourism Categories
Preventative, Fertility, Stem Cells, Psychedelics, Cosmetics, Dental, Vision
While Google searches or Patients Beyond Borders say that medical tourism is an X or XX billion dollar industry, top-down estimates are sort of useless for two reasons.
Medical Tourism is a Complex Workflow
The first reason is that medical tourism is a complex workflow with many different stakeholders and parties.
If you are a facilitator or a travel agent, you are delivering value through information, service, and interfacing with patients, hotels, clinics, etc.
If you are a care provider — hospital, clinic, or doctor — you are delivering value through medical services, treatments, or therapies.
If you are in the surrounding industries of hospitalities and tourism, you deliver value through restaurants, flights, hotels, etc.
No single company would create or capture all that value, unless it was fully vertically integrated. And indeed, maybe one day, I’ll start an all-inclusive Carnival or ClubMed competitor that puts health and medicine at the forefront. But let’s set that aside for now.
Medical Tourism Has Many Permutations
The second reason medical tourism is not just one market is that it is naturally divided by home, destination, and medical category.
In terms of home, medical tourism seems relatively immature in the US, whereas it is fairly mature in Asia, Europe, and the Middle East. As an American, I’d start with the American market.
In terms of destination, these are different as well. Sending Americans to Mexico is very different from sending them to Thailand or India. Each country has its own nuances, regulations, norms, medical specialities, etc. Even within a destination country such as Mexico, there can be big differences between Mexico City and Tijuana, which is on the border.
Finally, and this might be the biggest factor, a medical tourism business probably needs to start with a particular category/niche. There is no such thing as a medical tourism company. It’s really a dental company, or a fertility company, or a cosmetics company, or a stem cell company, etc.
From a patient’s point of view, they would be comparing dental work in Costa Rica vs doing it locally. There is no general medical tourism company. Not yet at least ;)
Therefore, you have quite a few permutations that exist if we consider all these factors.
If you are open to the idea of other business models, we can add a 4th column and get even more permutations.
While you couldn’t necessarily swap in and out a business model for any of these treatments, there are probably bits and pieces of each that would contribute to a final, winning company in this space.
For example, telemedicine, community, and information aggregation are all probably different aspects if not core in building a good business in this space.
Factors to Consider for Evaluating Treatment Categories
Given that there are many treatment categories, which would I start with?
When thinking about medical tourism, these are the factors I think are important:
Cost — how much does would this cost the patient to do locally vs abroad?
Patient experience — how much better would this be if it were done abroad vs the US? Some medical categories are good in the US. Some, like fertility, are extremely tedious, slow, and just a bad experience.
Patient risk — how risky is this treatment? While I might be able to save people a lot of money by doing open-heart surgery in India vs the US, the downside risk is extremely high. At the other end is routine check-ups or lab work, which has no downside risk and just gives patients more data about their health.
Community value — how much value can patients create for one another? I could see a community for fertility or plant medicine being very useful. For dental, not as much.
Stickiness — how much could a patient use and reuse the service? Many operations are one and done, with varying amounts of follow-up care. However, I learned that cosmetic patients often have repeat usage. Patients develop a relationship with their doctor, and subsequently get work done on different parts of their body, i.e. start with face, then move on to breast, then butt, etc.
Threat of entrenched interests — how much would the existing establishment try to make a startup fail? Not sure how big of an issue this is, and definitely a good problem to have, but generally speaking, the incumbent healthcare institutions, associations, lobbies, etc. have a lot of interest in keeping things the way they are.
Founder market fit — how much can I relate to the patient community? I don’t think I’m a great fit for fertility and cosmetics, because those are female-centric categories.
Ranking the Categories
For these main medical categories of elective surgeries, I gave a score from 1 to 3 for each dimension. 1 is a low score (not good), and 3 is the best score. Let’s run through the Preventative category as an example. When I say “Preventative medicine”, I mean doing things like bloodwork, DNA tests, ultrasounds, and MRIs, proactively.
Cost: 2
MRIs can be a few thousand dollars in the US, and a couple hundred dollars abroad. My understanding is that doctors use the same machines, take the same scans, etc.
Bloodwork, I would guess, is not as expensive.
Ultimately, cost is more of a function of how frequently and to what extent you are doing it. Bryan Johnson easily spends tens of thousands of dollars each month on his blood tests, MRIs, ultrasounds, etc.
That said, preventative medicine is trending up, and it’s one of those things where if it were cheaper, I believe people would do it a lot more, increasing the market size.
Patient UX: 2
I don’t think getting bloodwork is too hard in the US, but it’s not super clear the best way to go about it getting it. There are quite a few companies working in this space, I just had my drawn today by one of them, so I hope to write about this more soon.
For things like MRIs, I would say the patient UX is pretty bad. Typically, you have to go to your primary-care provider and then get a referral. You can’t just schedule one. Typically in America, you wait until you have a noticeable tumor on your body, then get a referral from your PCP, then finally get an MRI, which is stupid and insane to me.
Patient risk: 3
Overall, people who do preventative medicine are likely healthy. Furthermore, the work they are doing isn’t a risky, invasive surgery, so no downside risk there.
Community: 3
Getting a community of people who care about preventative health seems useful and very doable, because preventative health can have deep and broad implications on lifestyle decisions around diet, sleep, social life, work, exercise, etc.
Stickiness: 3
Preventative health ideally has routine labs, scans, and back-and-forth with your clinician. It’s not a one-and-done thing.
Threat of entrenched: 3
I can’t imagine what institutions would get directly upset about Americans doing preventative medicine abroad, aside from the fact that the American healthcare system is largely set up to be reactive. I could see the FDA or big pharma or lobbies getting up in arms about other categories being done abroad, however.
Founder Market Fit
Finally, preventative health is something I identify with. I genuinely want to live longer and better and be at peak performance as much as I can, because I am a casual athlete and founder.
Given all of this, I should start a medical tourism company for preventative medicine! But wait, I’m not sure how that would work. Logistically, I don’t imagine Americans flying to Mexico City every month or even every 3-6 months, unless they had business or family there (in which case, what would they need me for?).
If there were a global network of providers that could share and access the same medical records, and you could use essentially the same service in different countries, including domestically, that would be a bit more compelling. But that seems far away.
In practice, trying to make medical tourism into a scalable business is quite hard. And that’s basically what I picked up from all the medical tourism people I’ve talked to! At the very least, it’s reassuring in a weird way to come to a shared conclusion.
Conclusion
To wrap this post up, I’ll end with a disclaimer that I actually have low confidence in many of the scores I put down.
I do not know that much about most of these medical categories.
There might be other factors to consider that I completely missed today.
Some factors should probably be weighed more than others, rather than them all being weighted the same.
I did not consider all treatment categories and use cases, such as medication tourism, wellness tourism, most non-electives, etc.
But, I wanted to think out loud and share the top-down framework that is starting to emerge from talking to people who have thought about this space.
What would you add, remove, or change to this analysis?
Hey hey - I do this already with my travel agency. Let me know if you ever want to chat. https://thewellnesstraveler.co/
I would argue that may you could start a 'medical tourism company'.
You are the one place people look to for info. Could start as just a content business to begin, then could branch out to offering services.
I think one major obstacle is people don't know about it. How do you reach someone who wants or needs a procedure but wants to pay less for it? In that respect, a niche could be easier to start with and then expand from there.