At the Boao Forum for Asia earlier this month, Hainan Province published a plan to build a special zone for medical tourism, the first in the country. In one fell swoop, China's tropical island province is attempting to attract overseas medical institutions as well as patients.

At about the same time, it was reported that in 2012, China topped the US to become the first source of medical tourists going to South Korea, accounting for 63 percent of all medical tourists in the country.

But while neighboring countries like India, Thailand and South Korea have long had a head start in the global medical tourism market attracting many Chinese to their shores, China's medical tourism industry at home is in its infancy. Government support, strategy and infrastructure building will all be necessary if China wants to compete in this ever-growing market.

Liu Tingfang, a professor at the Institute for Hospital Management of Tsinghua University, has been pushing to develop medical tourism for over a decade. Back in 1996, while running a hospital in Hainan, Liu brought up the idea as a way to revive the hospital, which was going through a rough patch. But the hospital didn't have enough resources to develop this new commercial arm.

After years of lobbying by Liu and other like-minded people, the provincial government began including medical tourism into its five-year plans in the late 1990s, but nothing has materialized.

It was not until China announced plans to develop Hainan as an International Tourism Island in 2010 that the idea of medical tourism finally got some real attention. The Boao Forum for Asia 2013 featured a Health and Tourism Roundtable oriented around the potential for medical tourism and the International Medical Tourism Pilot Zone in Hainan Province.

Many medical professionals believe that China can be competitive globally, given its advantageous healthcare prices. Heart surgeries cost around one tenth of US prices while hip or knee replacements in Shanghai are more than 70 percent cheaper than in the US.

Carving a slice of the pie

Globally, the industry is booming. With an estimated 6 million people traveling to seek medical treatment each year, the medical tourism sector was estimated at $100 billion in 2012, and is growing at a rate of 20 to 30 percent annually. Thailand, Singapore and India are leading the medical tourism market worldwide.

Some hospitals in China have been treating overseas patients who found their way on their own. A travel company in Hangzhou has also launched a medical tour package that helps overseas tourists get dental work or TCM treatment but so far it has received no clients.

However, medical tourism involves more than this. It signifies offering tourists a complete set of services, from overseas patient inquiries, doctor consultations, trip planning, treatment and recuperation. Liu notes that it will take more than efforts from individual institutions to build up this industry.

Some concerted efforts have been made with Shanghai making a push for international recognition in the field after the Shanghai Expo in 2010.

In June 2010, the Shanghai Medical Tourism Products and Promotion Platform was established with the support of local government agencies including health and tourism bureaus. The platform was soon able to bring together over 20 participating hospitals in the metropolis.

Many patients from Argentina have been treated for cancer in Shanghai via the platform, including a cousin of the Argentinean president, according to Yang Jian, founder and CEO of the China Medical Tourism Company, which was registered in California and runs the platform.

The platform handles patient inquiries online, helps contact hospitals which can offer the right treatment and even arranges the entire trip. Target clients are those whose procedures would cost over $6,000 in the US and takes two to four weeks on average, said Yang.

However, dark times were soon to come as there were reports last year that Yang's company was on the verge of bankruptcy. Yang dodged the question, saying it was simply difficult to create a market niche at first but that things are looking up now.

He said they receive about 100 inquiries a month, but a patient may end up contacting the hospital directly and arranging the trip alone. He would provide no specifics as to revenue or about the numbers of patients that had arranged treatment in China through the platform. 

Shanghai East Hospital, located in the city's financial center, is one of the initiators of the platform. It treats about 50,000 foreign patients a year, but it's not clear what percentage of these qualify as being here for medical tourism. The platform's websites list a dozen of wide-ranging treatments on offer, from cancer treatment to cosmetic surgery to fertility treatment. 

Yang estimates that about 70 percent of overseas patients are looking for cancer immunotherapy in Shanghai. Many are interested in treatments that are restricted or unavailable in their own countries but are practiced or are legally fuzzy in China, such as stem cell therapy and body gamma knife surgeries.

Gamma knife therapy and stem cells are among the featured services on the website. Such procedures are not supposed to be the core product for medical tourists, but still, many foreigners are interested, said Yang.

Chinese characteristics

Liu cautions against the risks involved in carrying out such procedures, as it would be very difficult to sort out patient disputes due to a lack of regulation.

In the past, overseas patients sought organ transplants in China's poorly regulated donor market, but the country later clamped down on such surgeries for foreigners. 

Liu thinks that surgery should remain the core product for China as it's more profitable and he is confident that Chinese hospitals are on par with, if not better than, those in Thailand or India for infrastructure and doctors' skills.

Some have also suggested that China promote its traditional Chinese medicine (TCM) to draw in medical tourists.

Sanya TCM Hospital in Sanya, Hainan Province, has been promoting TCM therapies such as acupuncture, massage and cupping therapy to attract tourists. Since 2002, the hospital has received over 25,000 overseas patients, most of whom hail from Russia and Central Asia. The program has proven so popular that the hospital even set up a travel agency last year to help expand its medical tourism business.

But Liu thinks it would be a mistake to position TCM as the primary medical tourism product given the limited profit margins.

Julie Munro, founder and president of the Medical Travel Quality Alliance (MTQUA), which was founded in 2009 to promote standards and practices in the industry and certifies care managers and facilitators, has met with the leaders of several Chinese medical institutions.

"They are all enthusiastic and very proud of their hospitals. But that is not enough to attract medical tourists from abroad," Munro told the Global Times.

She said that Chinese hospitals don't quite measure up to "world class" hospitals as of yet. The alliance evaluates hospitals on many aspects such as international patient communication and management, patient safety and security, partnerships and value of service.

Even smaller details such as the hospital's website matter too. Most leading hospitals for medical tourism have clear, multilingual, informative and easy-to-navigate websites, a factor many Chinese hospitals lack. 

Munro added that "an international accreditation from the US, Canada, UK, or Australia is very important because China's own accreditation systems are still immature and unproven."

At the moment, about 27 public and private hospitals in China have been accredited and certified by JCI (Joint Commission International) but only a few of these are qualified to treat patients from abroad. 

"Aside from quality in medical treatment and care, there is a lack of infrastructure for care management that would create bonds of trust between the medical tourist and the provider of health care," said Munro.

Money-grabbing feared

One of the concerns for developing medical tourism is that China is in the process of healthcare reform and one of its primary goals is to strengthen the non-profit status of public hospitals. Some people are concerned that medical tourism, which is a relatively high-end form of healthcare, might take away resources needed for the basic healthcare of the Chinese population.

"I don't think there is a conflict," said Liu, adding that private hospitals in China are usually too small or not advanced enough to serve international clients. According to regulations, public hospitals are allowed to set aside 10 percent of their medical resources to VIP services. Some of these VIP service resources, as well as private and foreign investments, could be introduced to develop medical tourism, he suggested.

Everything seems to hinge on the government's resolve and commitment to developing medical tourism, since building the industry to be competitive would involve cooperation between a number of government agencies including health, tourism and immigration.

Taiwan only started to develop medical tourism about five years ago but has quickly taken off and now attracts tens of thousands of mainlanders, precisely because the Taiwan authorities have stepped up to promote it, said Liu.

There are signs that the authorities on the mainland are beginning to change their minds. Liu said that the Ministry of Health has approved a research project that would look into entry criteria for facilities engaged in medical tourism, as well as an operation process and an evaluation system, in order to guide the development of the industry.

"We need to set the rules of the game from the get-go, otherwise it could be chaos once more people caught on to the idea," he said.