Dental Services in Medical Tourism

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Adrian Lubowiecki-Vikuk,
PhD – lecturer and researcher.

A graduate of Poznan University of Physical Education (MA in Tourism and Leisure, PhD in Sport Sciences) and Warsaw School of Economics (Innovation Manager). His academic interests focus on the consumption of tourism, sports and leisure, and medical services in various social groups. He analyses trends in the medical tourism market in Central and Eastern Europe.

Creator of the innovative educational offer “Medical tourism management”. He is an advisor to the International Advisory Board in Harrington Park Press (New York, USA) and an expert in the Polish Association of Medical Tourism, the National Centre for Research and Development, and the Ministry of Investment and Economic Development

In basic, medical tourism involves patients purchasing specific commercial medical services outside their permanent place of residence. Although these services constitute the most important goal of their travel, they are frequently related to the basic tourism services, i.e. booking accommodation, transport (transfer from the airport to the clinic), and quite a narrow range of tourist guide and entertainment services.

Currently, the medical tourism market offers customised service packages (products) including additional services, such as spa & wellness, shopping, and insurance. Service providers care about the needs of friends or family members who accompany the patients, offering them conventional tourism opportunities and complementary services. The use of medical services most frequently refers to cosmetic and dental surgeries, cardio, orthopaedic and bariatric surgeries, and in vitro fertilisation, with dental services significantly prevailing over the rest to such an extent that the phenomenon can be referred to as ‘dental tourism’

Dental Tourism: What and Where?

The American Dental Association defines dental tourism as ‘the act of travelling to another country for the purpose of obtaining dental treatment’ [1]. Naturally, for the travel to be called tourism the patient has to stay in a given destination for not less than 24 hours. However, in dental tourism, the patients frequently are one-day visitors. They arrive at the destination on the appointment day, then use the services and returns back home. This applies to patients living in neighbouring regions or countries, as well as to those who have the opportunity to use cheap charter flights.

The tourist traffic is accurately demonstrated by the analysis of Youngman [2]:
• Patients from North America in order to use dental services mostly travel to Argentina, Costa Rica, Mexico and Peru
• People from European countries most frequently travel to Bulgaria, Croatia, the Czech Republic, Hungary, Poland, and Romania
• Patients from Asia mostly travel to India and South Korea
• Australians most frequently travel to Malaysia, Philippines, Singapore and Thailand

What is important is that patients regard dental services as non-invasive procedures (just prevention) which do not require hospitalisation. Therefore, dental tourism may pertain to both national and foreign tourism. Generally, these are business and leisure travels (bleisure), visits to relatives and friends, or shopping trips combined with the use of dental services [3].

The phenomenon itself is not a novelty. Dental tourism has been a reality for Hungary since the early 1980s. Currently, this type of tourism is well-known by professionals and effectively promoted by glossy magazines. Although the size of this market has not yet been fully determined, it is estimated that dental tourists constitute one-third of the total number of medical tourists worldwide.

Dental Tourist: Who?

To say that dental tourists are consumers who look only for the cheapest services would be an understatement. Naturally, the price of the service does matter but the opportunity to take a loan or pay on

an instalment plan is equally important, particularly for patients from poorly developed or developing countries. Decisions of the patients from Western countries are driven by a wide range of non-financial factors such as:

• Quality of services (including services provided by qualified professionals, the dentist who use state-of-theart technology and who present good communication skills in the patient’s language or at least in English)
• Accreditation of the dental clinic
• Accessibility of the clinic (including its location) and availability of the expected treatment modality
• Adaptation of the clinic to the needs of foreign patients (international standardizations, conditions and organisation of the premises such as room signage in foreign languages, offering foreign newspapers etc.)
• Promotion activities and public relations of the clinic, use of social media
• Recommendations from relatives, friends and/ or informal support groups, i.e. Internet, patient’s own experience and related associations directives

In dental tourism, the final price is not synonymous with the price of the dental service selected, as it also includes the costs of transport and accommodation etc. In dental tourism patients group, it has been shown that men are focused on “service and price”, whereas women are focused on ‘recommendations’, ‘treatment options’, ‘recommendation’ and “characteristics of the clinic’ [4]. If medical or non-medical relations with a specific destination is powerful, the probability of visiting the destination for “medical or dental services” will be higher. The study conducted among Germans and Britons, who declare Poland to be a potential or current destination of their medical travels (90.2%), demonstrated that they were over six times more likely to use dental services than any other medical services offered in the country [5]

Thus, there are two types of dental tourists in the medical tourism market:
• Classic dental tourists who travel to a foreign country to gain access to dental treatment, either for the sole purpose of dental treatment or as part of their holiday package
• Migrant tourists (diaspora dental tourist) who return to their native country for a holiday or to visit relatives and who then access dental treatment during their visit [6]

These are usually local patients and patients from neighbouring countries, whose recovery period takes less than 10 days. Most of them, arrive and leave the clinic on the same day.

It would seem that patient’ autonomy over practitioner choice, informed consent, patient safety and continuity of care are crucial when making a decision to participate in dental tourism [7]. At times, however, patients forget about the risk of possible complications, which makes it necessary for a dental practitioner to prepare a detailed treatment plan (before, during and after), including any possible risks to the patient.

Dental Tourism: How?

The medical tourism market offers a dental tourist package comprising three types of services:
•Dental services:
•Before departure for the destination (consultations, appointments, arrangements, planning and calculating cost of treatment)
•During the destination (services most frequently used by dental tourists: consultation, dental examination, scaling and polishing, dental implant, simple filling, cosmetic dentistry, oral surgery and crowns/bridges/ veneers)
•After returning back to home (continuity of care, e.g. maintenance and replacement elements for dental prostheses, communication, advice, blog)
•Conventional tourism services and activities (visiting a historical place, joining cultural attractions etc.)
•Complementary services that have a direct impact on patient satisfaction

Any dental service should be customised and tailored to the patient’s needs before it has been provided, during the procedure itself and after the patient has returned to their permanent place of residence. The package itself has to be flexible. Also, the choice of a suitable distribution channel seems vital. In this context, there is a significant role for medical tourism facilitators/brokers who in cooperation with care providers, insurance companies and travel agencies oriented towards providing service to medical tourists. In the case of direct contact by the patient, what matters greatly is the communication between representatives of the clinic and the individual. The Internet (including video consultations) plays a significant part in that communication, allowing both sides to build relationships based on trust, mutual understanding and partnership. What is also worth, specific solutions employed in the patient’s home country (e.g. meetings, events for present and prospective patients) have to be considered. So, a responsive website of the clinic which integrated with social media and adjusted to the type of potential customers is highly significant. Also, netiquette is essential, as the patient should be provided with reliable information and the total price for the treatment.

Cultural conditions constitute the main challenge for representatives of dental clinics. Customer service for Muslim patients or the use of animal-derived materials for transplantation requires special preparation. Beauty standards may be interpreted differently such as different shades of teeth.

Apart from cultural factors, there are numerous economic and legal conditions to consider [8], such as the form and type of patient insurance, the necessity to issue medical documentation in the patient’s mother tongue and in accordance with the requirements from their home country, procedures related to obtaining informed consent for treatment, the system of invoicing and payment in a foreign language and currency, as well as cashless payments (payment by card, cross-border transfers)

Conclusions

Currently, any dental tourism package requires customisation and a broad range of services. This seems possible only in modern dental clinics that offer accommodation (or cooperate with hotels) and employ a significant number of experts, including coordinators who service foreign customers.

Individual medical practices, on the other hand, are based on the reputation of dentists, the quality of specialist services they offer (e.g. prosthetics) and cooperation with foreign institutions. Such practices are more available, have a greater potential and are flexible in attending to patients’ needs. Their services are available all year round, 24/7, and can be paid for on an instalment plan. Patients are reached without the involvement of medical tourism facilitators/ brokers, word-of-mouth marketing being employed instead

References
[1] American Dental Association. (2009). Statement of the ADA Council on ethics, bylaws and judicial affairs on dental tourism – Ethical obligations of dentists. [Online] Available: http://www.ada.org/~/media/ADA/About%20the%20AD A/Files/statement_ ethics_dental_tourism.pdf (January 04, 2019).
[2] Youngman, I. (2014). Trends in the dental tourism market in 2014. [Online] Available: http://www.imtj.com/articles/2014/trends-in-the-dental-tourism-marketin-2014-30195/ (January 04, 2019).
[3] Lubowiecki-Vikuk, A. (2018). Consumption of dental services: Medical tourism in CEE. European Journal of Service Management, 27(3), 135–142, DOI: 10.18276/ ejsm.2018.27-16
[4] Rodrigues, H., Brochado, A., Troilo, M., & Mohsin, A. (2017). Mirror, mirror on the wall, who’s the fairest of them all? A critical content analysis on medical tourism. Tourism Management Perspectives, 24, 16–25.
[5] Lubowiecki-Vikuk, A., & Dryglas, D. (2018). Central and Eastern Europe as a medical tourism destination: A case study of Poland. Almatourism – Journal of Tourism, Culture and Territorial Development, 9(18).
[6] Jaapar, M., Musa, G., Moghawemi, S., & Saub, R. (2017). Dental tourism: Examining tourist profiles, motivation and satisfaction. Tourism Management, 61, 538–552.
[7] Lovelock, B., Lovelock, K., & Lyons, K. (2018). The impact of outbound medical (dental) tourism on the generating region: New Zealand dental professionals’ perspectives. Tourism Management, 67, 399–410.
[8] Gonczowski, K. (2017). Traps for Medical Tourism. Conference materials, The 2nd Krakow Congress of Medical Tourism, October 12–13, 2017.