According to Capgemini’s World Wealth Report 2023, poor macroeconomic conditions since the pandemic mean the number of high-net-worth individuals (HNWIs) – those with liquid assets of US$1 million or more – has actually dropped to 21.7 million. North America has the most HNWIs with 7.4 million, followed by Asia Pacific with 7.1 million. Europe has 5.6 million, and the Middle East 0.9 million. Despite the miniscule size of this demographic,

it is a market so lucrative that health insurers and hospitals create services just for it. HNWIs spent on average £120,000 each on health treatments and services in the 18 months following the outbreak of the pandemic, an increase of 20%, according to Private Client by Bupa, Bupa Global’s package designed specifically for this group. Indeed, health spending among the affluent was higher than that on luxury goods, clothing, technology and even holidays, suggesting that good health has become the ultimate status symbol, said Bupa. The pandemic appears to have been a wake-up call for many HNWIs. One white paper by Hawksford, a corporate, trust and fund administration services provider, said that Chinese HNWIs have realised that health is “the real wealth”.

Few insurers and hospitals chasing this market wanted to talk to ITIJ. Privacy is paramount for this group of individuals, said Josef Woodman of Patients Beyond Borders, who deals with individual requests for healthcare. He said there’s precious little data on HNWIs. “They tend to be very private. So if they want their healthcare activities sheltered, then that’s easy because hospitals and clinics respect that,” he said. “Many of those HNWI might also have high public profiles. They might be CEOs of companies who do not want the world to know about their healthcare activities.” Nevertheless, a higher socioeconomic position suggests this group has better health and life expectancy than most. They are also more likely to travel for health. Many are too busy to organise their own healthcare. According to Dr Helmy El Tanahy, Chairman of CONNEX Assistance and consultant of surgical oncology and laparoscopic surgery, HNWIs expect full concierge services when undergoing any form of treatment, including the organisation of all appointments, pre-operative evaluation and telemedicine consultations with the treating doctor before travel.  “They also expect all travel arrangements to be fully organised, including flights, local transportation to and from medical facilities, and accommodation for them and their families,” he explained. “This is part of the reason that we have seen patients access our concierge services from almost 60 countries around the world,” said Annabelle Neame, Vice President, New Markets and Innovation at HCA Healthcare UK. HCA Healthcare UK has a Medical Concierge Centre based in London, offering a 24/7 clinician-led service where, Neame said, all healthcare needs can be met. 

Patients will use concierge services for a range of reasons, whether that be the desire to be in a UK-based hospital or the need to overcome medical bureaucracy in the country they are in

“We specialise in urgent, time-critical admissions across all HCA UK facilities including international transfers and medevacs,” she said. Each HNWI has a single point of contact, and their medical pathway – from initial consultations, tests and screenings to diagnoses, second opinions and transfers – is tailor-made for them. “Our senior multidisciplinary nurse specialists support each patient throughout their treatment, allowing them to access consultants and treatments in our central London hospitals from wherever in the world they need to access them from,” Neame said.

Patients will use concierge services for a range of reasons, whether that be the desire to be in a UK-based hospital or the need to overcome medical bureaucracy in the country they are in, explained Neame. “International transfers, translations services and a team specialised in the cultural differences in medical care are also some of the reasons that underpin why patients choose to use [a] medical concierge service,” she said.

Yet there’s considerable heterogeneity in the HNWI group. Capgemini divides them into three discrete wealth bands: ‘millionaires next door’ – those with $1 million to $5 million in investable wealth (not including primary homes and other assets); ‘mid-tier millionaires’ with $5 million to 30 million, and ‘ultra-HNWIs’ – those with $30 million or more. Therefore, for some HNWIs, concierge services may not be required, according to Elizabeth Boultbee, Founder of Boultbee Health. She has dealt with medical travellers at some of London’s best hospitals, and said there are plenty of HNWIs who already have staff. Similarly, HNWIs often do not need hotels or driver services. Many Qatari HNWIs in London already own properties, for example (data is also skewed on this market segment because many Middle Eastern customers are also sponsored by their governments).

More interesting is what HNWIs travel for. Screening is very popular, Boultbee said. “People will go to hospitals in the States and spend $10,000 on a health screen – an all-over body check – to find out if anything’s going on,” she said. “What happens quite a lot within that HNWI group is they’re taking good care of themselves from a preventative perspective.” And while some travel for preventative medicine, others take advantage of foreign healthcare for serious illnesses they think they cannot get at home. They are also likely to travel for experimental, late-stage, last-resort treatments for serious afflictions – from cardiovascular to cancer treatments.

For HNWIs from the Arabian Gulf, London is widely regarded as a hub of medical excellence, the US is the main destination for cardiac problems, Germany is the primary destination for cancer treatment, and Switzerland is a top destination for orthopaedic surgery, said Dr El Tanahy.

For HNWIs from the Arabian Gulf, London is widely regarded as a hub of medical excellence

For patients from the Arab countries in North Africa like Egypt, patients tend to travel for treatment to France and the UK.  “Each country or hospital will have different reasons, all driven by the perception of superior quality of care at that destination,” he added.

In the Middle East region, particularly for HNWIs from the United Arab Emirates, Egypt and Saudi Arabia, HNWIs look for expertise in the treatment of coronary ischaemia by cardiac catheterisation or bypass surgery and open-heart surgery for other cardiac problems. They travel for cancer treatments, especially those for lung, pancreatic and brain cancers.

“Other illnesses we see where HNWIs travel include autoimmune diseases, retinal eye surgery, transplant surgery and congenital anomalies, especially of the heart,” Dr El Tanahy said. Some are even travelling to give birth, by vaginal delivery or caesarean section, and select birth destination as a form of selecting a passport.

Similarly, large numbers of stage 4 lung cancer cases from the most densely populated Chinese cities were heading to American hospitals just before the pandemic. Many seek paediatric services too. “The Chinese community is very much about technology they haven’t got, so like the proton beam therapy, or the da Vinci robot at one stage,” said Boultbee.

Given that the top four best hospitals in the world are American, according to Newsweek, it is no surprise that so many HNWIs stay in or head for the US. Some hospital campuses like Cleveland Clinic in Ohio are so large they have hotels and taxi services onsite. 

Mayo Clinic in particular is also singled out by Arab patients as a top destination for cardiac cases. Its affiliations to many centres in the Middle East can facilitate this care, said Dr El Tanahy, and this helps to popularise the facility among patients in the region. Regarded as the number one hospital in the US, if not the world, the Mayo Clinic said it did not have an expert available to talk about HNWI. Neither did IMG, Bupa, nor any of the top four US hospitals respond to requests for comment – supporting our earlier assertion about privacy being vital to hospitals serving these clients.

Germany in particular is a pioneer in several cancer treatment procedures, and this means patients and local doctors see Germany as being more advanced than other destinations. With cancer treatment, and autoimmune illnesses in particular, some protocols are available in the US and Europe but difficult to access in the Middle East. Transplant surgery in the Middle East is also limited as some countries have laws that only allow transplant of organs from direct next of kin.

Patterns of movement are changing rapidly for HNWI, however. Woodman said that people will often travel to specific locations for specific expertise. “They’ll travel to Brazil or Colombia if a surgeon who does what they want is there,” he said. And healthcare services have improved so much in so many parts of the world that HNWIs may not automatically go to the US, the UK or even Germany for their healthcare needs.

Boultbee commented that as cultural norms change, so does the direction of travel. IVF treatment was a big reason for travel some years ago but is less controversial now, so people often stay at home for treatments. That said, today, Chinese women are reportedly travelling for egg freezing services in Korea and Japan because this kind of fertility treatment can be hard to get at home. Places that offer gender reassignment clinics or sex reassignment surgery (SRS) are also accepting travellers, but whether they are HNWI is unclear. Addiction services are available too. “So, with a lot of discretion, there may well be clinics where people will go,” Boutlbee said. There are large addiction centres in the US, and one has just opened on Harley Street in London in the last year.

As cultural norms change, so does the direction of travel

As healthcare in the Middle East region improves, Dr El Tanahy agrees there is far more intra-Arab travel for treatment by high-net-worth individuals. “They are well informed on advances in medical care in the region and will travel to be treated by a specific doctor within the Middle East who might be internationally recognised as being distinguished in certain branches,” he said. 

Most experts, though, say Thailand is one of the best hidden gems for HNWIs. The healthcare system is exemplary, with institutions such as Bumrungrad and Bangkok General. But what sets Thailand apart is its fabulous customer service, according to Woodman. “I asked a clinician from Singapore about the difference between Singapore and Thailand and he said, ‘You know, we’ve got great healthcare; it’s probably better than Thailand. But nobody can outdo the Thais for hospitality.’ And that’s across the sector.”

But in the end, travelling to certain destinations can also be a habit. “Old habits die hard and if they’re used to going abroad when they can, they do it,” said Woodman. For example, China’s healthcare has improved dramatically, and now has some very good specialties for cardiac, lung, and burns. Yet, said Woodman, cultural considerations are still important to patients: “There’s just a general distrust of doctors and of course that’s going to change. But it takes a while.”

Travel with, and for, care

Geopolitical events can also affect the desire for and need to travel for treatment. With conflicts and instability seemingly around every corner, those with sufficient budget to travel outside of their home country for the care they need will undoubtedly continue to do so in ever-increasing numbers.