The predicted economic power of emerging markets and the massive investment in China’s Belt & Road Initiative is changing global medical tourism. Ian Youngman assesses the impact.

The transfer of economic power from West to East is ongoing and it is thought that emerging markets will contribute 60% of global growth in 2028.

Growth in some maturing emerging economies will moderate, but this will be accompanied by more stable economic growth. This represents a move from growth quantity to growth quality. Irrespective of the moderation, the five-year-ahead growth differential between emerging and advanced markets is a still-strong 3.5%, according to new analysis from Swiss Re.

The emerging markets, the analysis predicts, will be the engine of growth for the global economy and insurance markets over the next 10 years.

China’s Belt and Road Initiative

The Swiss Re analysis predicts China will account for more than a quarter of global output over the next decade, and is set to become the largest insurance market in the world by the mid-2030s.

China’s Belt and Road Initiative (BRI) is seen as an unprecedented opportunity for development in emerging markets. To some, it is an immensely ambitious development campaign to boost trade and stimulate economic growth across Asia, Africa and Europe.

China has already invested more than US$210bn, the majority in Asia. The total investments in BRI projects until 2030 will amount to around US$7.4 trillion, of which more than 80% is expected to be in infrastructure. US$5.1 trillion of the total investments will be outside of China, with Chinese involvement as investor or contractor.

The BRI connects Asia with Africa and Europe via land and maritime networks along six corridors, with the aim of improving regional integration, increasing trade and stimulating economic growth.

It comprises a Silk Road Economic Belt (a trans-continental passage that links China with south east Asia, south Asia, Central Asia, Russia and Europe by land) and a 21st century Maritime Silk Road (a sea route connecting China’s coastal regions with south east and south Asia, the South Pacific, the Middle East and Eastern Africa, all the way to Europe).

Acceptance of this initiative varies. So far it involves over 70 countries, but it does not include the USA, UK and Japan. India is reluctant to sign up, but some regional partners such as Pakistan and Malaysia have enthusiastically joined in. Most of Europe has yet to make a firm decision on it, however recession-hit Italy has formed a China Task Force to investigate economic opportunities in China, including the possibility of endorsing the initiative. Critics claim that it facilitates Chinese economic and strategic domination of the countries along these routes.

China’s BRI does look set, however, to benefit many industries and countries through increased trade and cooperation in other sectors. The China-Pakistan Economic Corridor, for example, which includes investment in roads, ports and power plants will support economic growth in Pakistan by creating jobs, increasing trade, and providing power, which is desperately needed for industrial growth. The Mombasa-Nairobi rail project is the largest infrastructure project in Kenya since the country’s independence. The Thailand-China high-speed railway is the first of its kind in Thailand and could benefit the country once completed.

BRI and healthcare implications

Key to BRI is the building or extension of hundreds of cities, initially in China, with high-class transport infrastructure, new homes, hospitals and places to work. Although health is not at the core of the initiative, links between the BRI and China’s rising role in global health are evident: building medical facilities abroad, export of medical knowledge and technologies, and building healthcare in China.

China has signed a memorandum of understanding on medical and health cooperation with the World Health Organization, expanding cooperation to Belt and Road countries, regions and even the rest of the world. Chinese medical teams have travelled to more places to help prevent and cure diseases, improve medical conditions and train medical personnel for local health centres.

Fuwai Hospital the national centre for cardiovascular diseases in China has now signed several agreements with BRI countries for the management of heart-related diseases with Pakistan, Bangladesh, Thailand, Nepal and Malaysia. New Chinese hospitals in the Belt and Road Health Corridor are being built, many with international patient centres. The BRI has plans for creating 30 centres by 2020 to provide Traditional Chinese Medicine medical services and education, and to spread its influence. Centres have already opened in more than two dozen cities, including Barcelona, Budapest and Dubai in the past three years.

Impact for global medical travel

China’s BRI covers over 70 countries containing 70% of the world’s population, 30% of the world’s GDP, and 75% of world energy reserves. Such connectivity will undoubtedly ease the movement of people, and potentially medical travellers.

As economic power moves from the USA, through a confused and divided Europe and across Asia and Africa, to China, a new medical travel reality is emerging.  The often US and European-focus of medical tourism needs to consider that most medical travellers are, or soon will be, from Africa, Asia and specifically China, not from North America or Europe.

The big unknown here is the Middle East. This region has economic woes after the end of the oil boom and tourism, seen by some as a pot of gold, may be more myth than reality.

Will this region be more of a medical travel destination than a source of medical travellers? Much will depend on how Saudi Arabia, Turkey and the UAE decide to manage their regional political fractures, and whether these countries will be forced into aligning either with the USA or China on the BRI. How far the US and Europe goes in the Israel/Iran disputes may also decide the region’s future.

Given these changes, expanding medical tourism for some countries might move from being a useful choice to becoming a key sector that, with other tourism initiatives, saves the economy. If so, there will be fierce competition for customers globally as more countries, linked by the BRI, spend time and money on promoting medical tourism.

We’re seeing some countries already using sophisticated multi-level mechanisms to attract medical travellers, which are regularly tweaked and often expensive. Other countries are reluctant to spend money but still want the business. Some are spending money based on out of touch and out of date consultancy advice that fails to grasp how medical tourism and tourism has changed in the last three years.

The big question from these emerging markets and ongoing BRI-induced connectivity is this: are there enough medical tourists to go around and which countries will come out smiling?

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