A ‘New Normal’ in GCC-Asia Health Cooperation?

A significant element of the growing trade in healthcare is the movement of patients across national borders in pursuit of medical treatment — a phenomenon known as “medical tourism.” For years, patients from the Middle East, especially from the Gulf Cooperation Council (GCC) countries, have travelled to Asia for this purpose. Indeed, it has become quite common to see Arabs in their traditional dishdasha or abaya walking around hotel-like private hospitals and signs posted in Arabic in Asian medical hubs. 

Yet, COVID-19 has disrupted this mutually beneficial relationship by shaking the foundation upon which it was established, namely the freedom of international travel. Under unprecedented international travel restrictions, patients from Gulf Arab countries undergoing treatment overseas find themselves unable to return home to their loved ones. Families are unable to visit or care for them. Meanwhile, those with severe or life-threatening conditions at home are also unable to seek medical attention abroad. These developments are likely to reshape the GCC-Asia medical tourism market.

Medical Tourism between the GCC and Asia

Medical tourism is an important form of cooperation in the health sector between the Gulf Cooperation Council (GCC) countries and Asia. The increasing flow of patients from the Gulf to Asian for medical treatment in recent years has been underpinned by a feature of GCC countries’ healthcare systems that is unique, namely government sponsorship of overseas medical treatment. This article discusses the immediate impact and possible implications of the Coronavirus pandemic for GCC-Asia health cooperation.

GCC countries have lacked expertise in certain specialized fields; therefore, they have opted to finance patient travel elsewhere, including Asia, where quality medical treatment is accessible and affordable. While the exact number of outbound patients is often not disclosed, it is estimated that around 650 patients in Kuwait were sent abroad each month in 2018.[1]

Meanwhile, several Asian countries have been actively promoting medical tourism and welcoming patients from overseas. Thailand, for example, has prided itself as a premiere medical hub known for its affordable quality healthcare services as are evident by the country’s 69 Joint Commission International (JCI)-accredited hospitals — among the top quarter in the world.[2] Singapore alone has at least 15 hospitals that cater to the needs of medical tourists, and English-speaking medical workers who are accustomed to the needs of foreign patients.[3] Malaysia has an advantage when it comes to Muslim patients, as their medical workers are knowledgeable about Islamic customs.[4]

Thanks to this complementarity, Asian medical tourism has benefited immensely from GCC patients. For example, in Thailand, it is estimated that as many as 58% of the total inbound medical tourists are from the Middle East. [5] The patients pay for medical treatment, while their accompanying family members spend generously on accommodation, travelling, and shopping, helping to contribute to the local economy. It is estimated that the average cost per case ranges from US$125,000 to 340,000.[6] According to the latest research by the World Travel and Tourism Council, Thailand is among the top five destinations of inbound medical tourism spending globally.[7]

A Downturn in Outbound Medical Tourism from the GCC

Even before COVID-19 paralyzed the world in 2020, the number of inbound medical tourists from the GCC in Asia had already declined. This is the byproduct of the GCC governments’ national health strategies, which aim to increase their domestic healthcare capacity in order to make their healthcare systems more sustainable, thereby effectively decreasing the need for overseas treatment.

For example, Saudi Arabia has set its sights on transforming its healthcare by developing domestic Health Graduate Programs “to contribute to the qualification of specialized health professionals.”[8] Qatar is seeking to build “a skilled national workforce capable of providing high quality health services.”[9] Oman aims to build “qualified national talents and capabilities that are pioneer in health scientific research and innovation.”[10] And Bahrain aspires to provide all Bahraini nationals and residents with access to quality healthcare through “developing, attracting and retaining health-care talent.”[11]

Consequently, GCC citizens and residents now have, or will soon have, access to quality healthcare services at home. For instance, Bahrain’s Dilmunia Health District and Oman’s International Medical City are examples of such projects that are underway.[12] Saudi Arabia has also been overhauling its healthcare infrastructure with state-of-the-art treatment facilities.[13] Meanwhile, the United Arab Emirates has itself become a medical destination, with inbound patients from its neighboring countries and even from Russia and China thanks to projects such as the  Dubai Healthcare City, which is “the world’s largest healthcare free economic zone” and a prime health and wellness destination for global health travelers.[14] [15]

While there is a slight chance that this trend could be reversed if the Asian medical hubs can somehow manage to raise the quality of their healthcare services so high that there is a significant discrepancy between the GCC and Asia, it is more likely that the fallout from COVID-19 is going to bolster this existing trend for several reasons.

First, the pandemic is a stark reminder to the GCC governments why their national health strategies are so vital and why those that are not doing enough must do more, while those are already doing well must strive to do even better. When the pandemic grinds international travel to a halt, the risk of GCC countries’ healthcare systems, which rely heavily on overseas treatment and foreign medical workers, quickly become exposed. Thus, following the pandemic, the GCC countries will likely amplify its efforts to ensure more self-reliance for their healthcare systems. With the national healthcare strategies already laid out, it will be more important ever that they not only talk the talk, but also walk the walk, in order to make sure that their peoples have access to adequate healthcare services in the face of an unexpected crisis.

Second, even when some GCC countries would choose to continue the overseas treatment programs, the global economic slowdown after the pandemic will most likely restrict their financial ability to subsidize costly overseas treatments. Kuwait and Oman spent as much as US$1.5 billion (2015) and $US492 million (2017) on outbound medical tourism, making them the second- and sixth-largest spender in the world, respectively.[16] This is unsustainable in the long run, especially when considering persistent low oil prices. Thus, the GCC countries are not likely to splurge on an expensive fix to their healthcare problems; instead, they are likely to begin earnestly investing in a more sustainable solution.

Lastly, strict international travel restrictions will probably continue to discourage some people from travelling at least for the next several years. According to S&P Global Ratings, it is predicted that international travels will not recover at least until 2024.[17]

A ‘New Normal’ in GCC-Asia Health Cooperation

While the effects of COVID-19 will not make GCC patients disappear entirely from Asia, Asian medical hubs will have to embrace the probable scenario that there will continue to be a significant decrease in the number of patients from the GCC in the foreseeable future — a trend that is only to be aggravated by the rising costs of treatment and living in Asia as well as the strengthening of Asian currencies.[18] 

However, the Asian medical hubs should not equate this trend to a decline in their overall health cooperation. While it might be true that after the eventual resumption of international travels, patients from other Asian countries, especially from China and CLM countries (Cambodia, Laos, and Myanmar), may help make up for the decrease in the number of patients from the GCC, the Asian medical hubs should not just turn their back on the GCC.

There are, in fact, still opportunities for the Asian countries to promote their status as medical hubs among the GCC countries even when GCC patients will not travel there. For instance, the Asian medical hubs have the expertise to help the GCC countries build their much-needed domestic healthcare capacity. While many GCC countries have successfully developed state-of-the-art facilities and equipment at home, they are still lacking in local human resources.[19] [20] Thus, Asian medical hubs can help support the GCC’s capacity building through initiatives such as exchanges of doctors, training, scholarships, and other health-related activities and collaborations. A good example is the Visiting Doctor Program between Prince of Songkla University of Thailand and the Ministry of Health of Bahrain, whereby Thai doctors are dispatched to Bahrain and Bahraini doctors can exchange knowledge with their Thai counterparts.

Another way to continue to promote Asian medical hubs is to invest in the healthcare services in the GCC, transferring the expertise and hospitality directly to the region. This is by no means novel, but it is now more relevant than ever. An example of Asian private sector that has already begun to invest in the GCC is Thailand’s Chiva-Som International Health Resort, which is set to open Zulal Wellness Resort in Qatar later this year — the first such resort in the Middle East.[21]

These are but only a few examples of how the Asian medical hubs can continue to maintain their image as leading healthcare providers for the GCC. This will not only help to reinforce their status as the world’s medical hubs, but also maintain the health cooperation between the GCC and Asia despite the downturn in medical tourism between the two regions.

Yet, it is equally important to acknowledge that there would be challenges in implementation. For instance, it is unlikely that the Asian medical hubs will have the bandwidth to send their medical specialists overseas for an extended period of time given the already high demand at home. Or there could be restrictions or barriers to foreign investments in the healthcare sector in the GCC. Or the Asian private sector too will have to face the economic recession at home, which may make them more risk averse to foreign investments in the foreseeable future.

Therefore, it is crucial that governments in both regions explore these new opportunities, building on the existing momentum and lending their support to relevant stakeholders where needed. A coherent whole-of-government strategy is imperative to prepare the two regions to take full advantage of the ‘new normal’ in their health cooperation.

Conclusion

In the aftermath of COVID-19, there will almost definitely be a decline in medical tourism from the GCC in Asia; however, this does not necessarily have to translate to a decline in the overall health cooperation between the two regions. In fact, the current trends have presented new opportunities for both regions. On the one hand, Asian countries have the expertise and capacity that is still lacking in the GCC. On the other hand, the GCC countries — more than ever — need to step up efforts to strengthen their domestic healthcare capacity.

Asian countries can still showcase their healthcare expertise by helping the GCC countries achieve self-sufficiency through health cooperation. It is incumbent on Asian and GCC governments and the private sector to work in tandem to adapt to the ‘new normal’ in their health cooperation. Success in this endeavor will both enhance people-to-people relations and lay a solid foundation for cooperation in other areas in the years to come.

Disclaimer: The views and opinions expressed in this article are solely those of the author and do not necessarily reflect the official policy or position of any agency of the Royal Thai Government.