Need surgery? Come to Spain

A world-class health system, prices below the European average and temperatures above it: Spain has all the ingredients to establish itself as a leading international healthcare and medical tourism destination. But it has taken an unprecedented recession to finally prompt the country's private clinics to begin trying to attract wealthy foreign patients either willing to pay for cosmetic surgery out of their own pockets, or have medical insurance that covers treatment in other countries.

Medical tourism is worth around 75 billion euros worldwide, according to the Organisation for Economic Co-operation and Development (OECD), which describes the sector as one with "further economic potential." Tour operators, business leaders, private hospitals, and state health authorities all agree that Spain has what it takes to be a leading player.

The US Medical Tourism Corporation, a leading provider of medical healthcare services, describes Spain in glowing terms: "There is more to Spain than bullfights, flamenco music and dance, exotic beaches and plenty of sunshine. The past few years have seen Spain gain prominence for its excellent medical system that offers low-cost and quality medical treatment for patients from all over the globe. Over the last few years, the Spanish healthcare system has improved in leaps and bounds and currently is something of which both the administration and the practitioners can be justifiably proud. US and UK patients stand to benefit much from the vast medical offerings that Spain offers."

Spain has gained prominence for its medical system," says one US provider

The company's website explains the cost benefits of undergoing surgery in Spain. Prices for medical treatment vary depending on the surgery or the corresponding treatment. However, patients can easily expect savings of around 30 to 70 percent, it says. For example, a nose re-shaping in a private UK hospital would cost a patient anywhere between 3,000 and 4,000 pounds, but in Spain the same surgery is available for around 2,400 pounds. In general, cosmetic surgery costs around 60 percent more in the UK than it does in Spain, and prices for knee or hip replacements are around half what they are in Britain.

Its reputation and high standards of care mean the Spanish healthcare system is currently ranked seventh in the world by the World Health Organization. Satisfaction levels among those who receive treatment here are also high and Spain has been ranked second in the world in that category.

This comes as no surprise if you look at the vast network of hospitals and the sheer number of employees now working in the Spanish health sector. Spain's Ministry of Health recognizes and supervises over 750 hospitals and over 450,000 doctors and nurses. In accordance with Spanish law, all doctors undergo at least six years of training before they can officially begin to practice medicine, while those wishing to specialize in one particular area must train for even longer before they are recognized as qualified in their field. Both private and state medical facilities in Spain have departments dedicated specifically to medical tourists coming over to receive healthcare in Spain.

Patients can easily expect 30 to 70 percent savings on procedures

Wellbeing tourism, which takes in spa and beauty treatments, has seen huge growth over the last decade, but the focus now is increasingly on medical treatments, many of them relatively complex, from orthopedics to cancer and even heart operations. Jesús Burgos, who runs a private hospital in Málaga and is the founder of Tourism & Health Spain, says Spain has little experience in medical tourism so far. He aims to change that, and has brought together a network of more than 30 private hospitals, hotels, technology companies and around 6,000 health-sector professionals in a bid to create a viable market.

The project was officially launched during the FITUR tourism trade fair in Madrid in late January. Burgos says an average middle-to-upper- or upper-class patient might spend around 10,000 euros a year on health services alone, estimating that Málaga province's private clinics could receive an annual overall turnover of 250 to 300 million euros, and that's not to mention the extra income generated for other local businesses through additional spending on leisure, maintenance and accommodation by patients and their families during their stays.

Burgos says Spain's main competitors in medical tourism are Mexico, Turkey, South Korea and India. Matching the latter three on price will be difficult, he admits, but he adds that Spain has many factors in its favor, above all for clients in North Africa and Europe: "First of all, we have to make people see that the Spanish healthcare system is better than Turkey's, Mexico's or South Korea's. Once we have convinced people of that, we can show the world that we have other things in our favor: our location, as well as stability and security."

An average patient might spend around 10,000 euros a year on health services

Meanwhile, another initiative set up in October also aims to turn the Costa del Sol into the center of medical tourism in Spain. "Our objective is to attract foreign patients to Málaga's many good private health centers," says Dr Miguel Such, head of cardiovascular surgery at Málaga's Clínico Universitario hospital and one of the three founders of the Málaga Health Foundation.

Dr Such says the idea is that healthcare centers, along with health food and drug companies in the area, will come together under the Málaga Health banner to provide a range of services that share a guarantee of quality. Among those who have already signed up to the scheme are the Xanit International hospital in Benalmádena, the Parque San Antonio in Málaga, and the Premium clinics in Marbella and Estepona. "Our aim is to put Málaga on the global healthcare map," says Such.

He says he came up with the idea for the foundation in 2011, along with four other professionals: Juan José Gómez Doblas, a cardiologist at the Hospital Clínico; oncologist at the Clínico, Emilio Alba; the head of the Málaga Law Association, Manuel Camas; and engineer José Alba.

Spain's main health tourism competitors are Mexico, Turkey, Korea and India

"We decided to do this after several leading physicians from overseas who come to the private clinics on the Costa del Sol convinced us that Málaga has huge potential," says Such. "Spain's tourism sector has ignored this market. We have been selling sun and sea without realizing that we could do much more. Our healthcare system is well regarded internationally, and there is significant demand from foreigners to use it." Such is at pains to point out that initiatives such as the Málaga Health Foundation have nothing to do with the efforts of the current government to privatize the health system: "Spain's health system is admired abroad and that is thanks to the public model, there is no doubt about that. If we want to maintain that health service, we will need to create more wealth and bring more money into the country. And we have seen that this sector could be a major source of revenue."

The scheme has been promised support from institutions such as Málaga City Hall, the School of Physicians and the Unicaja bank, and is set to sign an agreement with Málaga University. It is also in talks with the tourist board and the Andalusia regional government.

Medical tourism in Spain will be given an important fillip in October this year, when the EU's Cross Border Health Care Directive comes into force, allowing for the free movement of patients and healthcare professionals within the EU, with member states paying for the treatment costs of their nationals in other countries. "Now is the time to be getting ready," says Jesús Burgos.

Our aim is to put Málaga on the global healthcare map," says Dr Such

Juan Abarcas, the secretary general of the Institute for the Development and Integration of Health (IDIS), which promotes private healthcare, says Spain should take full advantage of the new directive: "We are moving toward a single health system in Europe and this is the time to be positioning ourselves."

Spain's Costa-based medical tourism sector will initially be looking to attract British and Dutch clients, but beyond the EU it believes it can tap into the US, Middle East and North Africa markets, as well as those of Eastern Europe, particularly Russia. Each country has its preferences. The British are mainly interested in knee and hip procedures, as well as treatment for heart conditions and cataracts, while the Americans are on the lookout for high-cost surgery not covered by their insurance policies: "It's cheaper for them to go abroad. In the US market we're competing with Mexico, which is obviously next door, and very professional," says Burgos. He says the Russian market is overwhelmingly made up of women looking for cosmetic surgery; while North Africans are usually interested in complex surgical procedures.

Another initiative launched this year, Med & Beauty Costa del Sol, brings together 13 different companies in the medical and beauty industries, with the aim of consolidating the Costa del Sol as a location for the kind of high-end health and beauty tourism that could attract wealthy Russians. It offers breast enlargement with a night's accommodation for two people at a cost of 4,500 euros, or two nights of executive wellbeing from around 500 euros, as well as a full gynecological checkup for 450 euros.

Up to nine million in Europe buy health or beauty tourism services each year

Javier González de Lara, the president of the Business Confederation of Málaga and, with Rafael Rodríguez, the head of the Andalusian regional government's tourism department, was at the launch of Med & Beauty Costa del Sol at FITUR. He sees health tourism as an "excellent opportunity" for the tourism sector to diversify. "At times of crisis we need to look for new options, and this is a niche sector that is growing. The Costa del Sol has much to offer, but lacked this until now," says González Lara, adding that recent surveys show that up to nine million Europeans purchase health or beauty tourism services each year. María Luisa Mesa, the head of the health division of Andalusia's Business Confederation, says around 600,000 visitors head to the region each year in search of private healthcare, and of those, 70 percent are return visits. She says the region needs to start marketing itself internationally as a premier healthcare destination.

Alicante, also home to some of Spain's best-known beaches, is likewise keen to develop its potential as a healthcare destination. The Clínica Benidorm private hospital, set up 25 years ago, has recently joined forces with the resort city's tourism department to develop links between the private and public sectors. Ana Paz, the hospital's director, says 65 percent of patients are from overseas. "We have to promote Spain much more. I have just been in Moscow and Norway, where they tell me that countries such as Israel and Turkey are being much more active in promoting themselves as healthcare destinations."

Paz says the hospital's clients are mainly from northern Europe, many of them already resident or retired in Spain, although growing numbers come specifically for treatment. Clínica Benidorm works with insurer UVIT, which provides health cover for 40 percent of the Dutch population. "Anybody with UVIT can use our facilities, exactly as if they were in Holland," says Paz, explaining that the hospital offers what it calls "dialysis holidays" that allow patients to undergo dialysis treatment while enjoying a vacation, attended by Dutch medical staff. It also offers a knee and hip surgery package, which includes three weeks' rehabilitation "in much more pleasant conditions than in cold, rainy Holland," says Paz.

Undergoing rehab in a warm climate is an important factor, and one that the Danish health system recognized in 1974, when it opened the Montebello clinic in Benalmádena, near Málaga. Run by the Nordsjaellands hospital based in the Danish city of Frederikssund, the center provides long-term rehabilitation to Danish patients with neurological problems brought on by illness or accident. It does not accept private patients, or Danish tourists requiring emergency medical attention.

Miguel Such sees the hospital as a model for other prestigious institutions around the world: "The long-term goal should be for hospitals like Cleveland Clinic or Mount Sinai in New York to establish a presence here."