Beywatch: Can Tunisia Cut Its Way Into the Medical Tourism

UNCLAS TUNIS 000313

SIPDIS

SIPDIS

DEPT FOR NEA/MAG - HARRIS; HR/EL DIVISION

E.O. 12958: NA
TAGS: ETRD ECON EINV SOCI TS
SUBJECT: Beywatch: Can Tunisia Cut Its Way Into the Medical Tourism
Market?

C O R R E C T E D C O P Y - ADDED ADDRESSEES


1. INTRODUCTION: This report is one of a series drafted by Post's
entry level officers which have the "Beywatch" caption. We believe
the perspectives offered in the following vignette will give the
reader greater insight into Tunisia. END INTRODUCTION.


2. SUMMARY: From Budapest to Bangkok, Western "medical tourists" are
swarming to private clinics and large hospitals to receive care for
a fraction of the cost they would pay back home. Travel agencies woo
clients with pictures of slim, perky waifs with perfect smiles
enjoying tour packages that include post-op stays at luxurious
hotels and the chance to visit cultural sites as soon as the
anesthesia wears off. Tunisia is trying to find its footing in this
relatively new sector of the global marketplace. Though Tunisia only
attracted about 500 medical tourists last year, local physicians,
hotels and tour groups are eager to capitalize on a solid medical
infrastructure and proximity to Europe. END SUMMARY.

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IF THE PRICE IS RIGHT. . .
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3. When comparing costs, it is not difficult to understand why
someone from a country like the United Kingdom or the United States
might choose to travel abroad for medical care. In the United
States a patient can expect to pay around US $8000 for a facelift,
but s/he saves almost 70 percent on the same procedure in India or
Thailand. Tunisian physicians can match the savings of these major
players on the international plastic surgery scene: a facelift in
Tunisia usually runs around 5600 TND (US $4251).

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"SEDUCING CLASSY CUSTOMER CATEGORIES"
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4. Tunisian doctors and clinics are starting to form partnerships
with hotels and airlines to offer patients discounted rates for
all-inclusive deals. Dr. Samy Dlimi, a plastic surgeon with a
private office in Tunis, however, noted one problem: "We don't have
the hotels other countries do," he admitted. He is worried he will
never be able to cater to a more upscale clientele until the
Tunisian general tourism sector gets a bit of a facelift itself.
While Tunisia's tourism industry made the country 2.56 billion TND
(US $1.98 billion) last year, foreigners often note that "five
stars" here do not equal five stars in much of the rest of the
world. The GOT has identified the lack of high-end tourist
facilities as a challenge, and the Ministry of Tourism website
insists that "Due importance is given to the quality improvement of
Tunisian products, which are climbing to the top end of the range
and are increasingly seducing classy customer categories. [sic]"


5. For now, Tunisian plastic surgeons cater primarily to
middle-to-low income Europeans. Dr. Dlimi explained that he gets a
large number of Dutch housewives, French students and Italian retail
workers. "It's not the jet set," he sighed. Dr. Sami Kamoun, the
director of the private Clinique Avicenne in Tunis, agrees and told
Conoff that if medical tourism is going to work here it will have to
be based more on cutthroat pricing than on the extra luxuries
offered to patients flying to places like Phuket or Rio.


6. Last year, about half a million Americans traveled overseas to
receive some sort of medical care. Dr. Dlimi hopes to increase
their numbers in Tunisia. "My dream is to build a bridge between
Tunisia and the United States," he confided dramatically to Conoff.
But Dr. Mohamed Smida, head of the well known Polyclinique El
Menzah, scoffs at the idea of trying to attract Americans, pointing
out that not very many Tunisians speak English and that Americans
can find better travel deals than flights to Tunis. (COMMENT: The
language barrier hasn't stopped British tourists from coming to
Tunisia for health care, according to doctors and clinics, although
the British Vice Consul had no knowledge of their presence. END
COMMENT.)

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QUALITY CONTROL
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7. "Label Esthetique," a large Tunisian agency offering packaged
medical tours, brags in its advertising that its doctors have all
received diplomas from France, and the Clinique el Menzah, a large
center for plastic surgery in downtown Tunis, details its
physicians' work experiences at hospitals in Milwaukee and St.
Louis. Doctors admitted to Conoff that although Tunisia's medical
education system has solid infrastructure Western clients simply
feel more comfortable working with experts trained in the very
countries in which they cannot afford healthcare.


8. But while Tunisia may boast of a highly skilled set of medical
professionals with international accreditations, there seems to be a
lack of regulations in the aesthetic surgery field. Dr. Dlimi
estimated that only half of all plastic surgeons practicing in the
country are government qualified in that field. Dlimi shook his head
sadly when describing dermatologists performing eyelid surgery,
trauma surgeons doing nose jobs, and general practitioners trying
their hand at liposuction. As plastic surgery is not a formal
specialty in the Tunisian medical education system, doctors wishing
to perform the procedures must either study abroad, or do so without
technical training or GOT sanction.


9. Dr. Kamoun has recently gone into partnership with two French
travel agents who want to set up an office in Tunis to handle the
logistics of bringing European clients to his clinic, but despite
his hopes to expand his client pool, he worries that if medical
tourism in Tunisia grows too rapidly, it could lead to shoddy care,
which in turn could result in the bottom dropping out of the market.
"If doctors aren't careful," Dr. Kamoun noted, "they will destroy
Tunisia's reputation by pushing commercialism over medicine." On
the other hand, many Tunisian medical students go abroad and stay
abroad to practice, because there are more of them than there are
patients. Kamoun noted that medical tourism, and the new clinics
and offices it would bring, could provide a reason for Tunisian
doctors to stay in Tunisia.

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LATE IN THE GAME, CAN TUNISIA STILL PLAY?
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10. Since tourism accounts for 7 percent of the Tunisian GDP, and 1
in every 6 jobs in the country is somehow related to travel and
tourism, it is not surprising that GOT representatives have been
pushing the country's hope of increasing its stake in the medical
tourism economy. Tunisia has already gotten its feet wet in many
ways; it has been treating Libyan patients for years, even during
the embargo. But Tunisia is about a decade behind its competitors,
and will probably have to work all that much harder to make itself a
household name for worldwide patient care.


11. There are also some marketing hurdles that Tunisia may be
facing as it competes in the global medical tourism marketplace.
Tunisia, like France, has laws forbidding doctors from advertising,
which is why you will only find their initials (Dr. F, Dr. P, etc.)
on websites. This may be acceptable for larger clinics posting the
resumes of a long list of physicians, but for individual doctors
trying to get their name out to potential clients, this represents
an impediment. Also, perhaps due to the low 8 percent internet
penetration rate here, the websites of Tunisian clinics and tour
agencies tend to be a little less attractive or technically sound
than those of their competitors. In a commercial arena driven by
the World Wide Web, tech savvy may be as important as surgical
skill, and Tunisia has some catching up to do.

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COMMENT
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12. There are many obstacles to Tunisia becoming a formidable
competitor for medical tourists. The doubts about the quality of
hotels and the tourism industry in general, language barriers, and
concern about sustaining professional medical standards, all call
into question whether Tunisia could be successful in such an effort.
It is doubtful that large numbers of American patients will ever
travel the distance to a country most of them have probably never
heard of for medical care, since they do not come in large numbers
for general tourism, and Westerners' apparent preference for
European-trained doctors may not bode well for the sustainability of
the sector. While some doctors and the Ministry of Tourism would
prefer to attract high-end travelers, a renovation of the tourism
sector aimed at charming the wealthy might make it difficult to
maintain, much less expand, the Tunisian client base of travelers
seeking affordable package deals and, in some cases, doctors. But
if the government begins to better regulate the practice of
aesthetic medicine, and investors refrain from a sudden glut of
discounted clinics, there may be hope that medical tourism may
continue to grow here, particularly in terms of market share among
middle income patients from Europe.
GODEC