HONG KONG - When considering where in the world to go under the knife for non-essential surgery, or life-saving operations, would-be medical tourists frequently look to nations that have carved out a reputation for their expertise and affordability.
The United States boasts cutting-edge cancer treatments, South Korea has a niche for cosmetic surgery, Japan stands out for its comprehensive medical check-ups, and Turkey has a voluminous industry for hair transplants, to name a few.
But China is not generally considered a go-to option for healthcare and treatments, according to global medical tourism guide Patients Beyond Borders.
Renji Hospital in Shanghai, though, is on a mission to change that. Founded in 1844, the first Western medicine hospital in Shanghai, and one of the oldest in China, has increasingly become a sought-after destination for paediatric liver transplants.
In the past decade, dozens of foreign children, mainly from Malaysia, have undergone liver transplants at Renji, which is one of the world's largest medical centres for the highly complex and technically challenging procedure.
"Boosting international medical tourism is now our top priority," explained the hospital's deputy director, Sun Yun.
"We're looking to bring what we're good at to more people abroad."
Boasting China's biggest population of expatriates, as well as the most inbound tourists, Shanghai is seemingly ideal for such a programme.
And the ambitious undertaking to carve out a piece of the multibillion-dollar global medical tourism market comes as the nation's healthcare system has fostered rapid innovation and technological development to serve the needs of 1.4 billion Chinese people.
But industry observers point out that the well-established standing among neighbouring regions could mean China has a long way to go.
Nonetheless, strides have been made across China's medical sectors in recent years.
The Boao township in the southern island province of Hainan, having opened a medical tourism pilot zone 11 years ago that now features dozens of institutions, has branded itself Hope City.
And Shenzhen, just across the border from Hong Kong, has joined Shanghai in deploying more resources over the past year to attract medical tourists.
Shenzhen's plan, announced in April, aims to identify 10 hospitals as pilot facilities with standardised services to foster international medical tourism.
The city lured 770,000 tourists for medical services last year, mainly from Hong Kong and Macau, as quality improved, while prices were far lower than at private hospitals in neighbouring cities, according to Shenzhen health authorities.
And a relatively small portion of patients came from the US, Canada and Japan, they said.
The value of the global medical tourism market, which includes healthcare, services and insurance, was estimated to be US$11.56 billion in 2020, and is expected to reach US$53.51 billion in 2028, according to market research firm Fortune Business Insights.
People wait at a waiting area of a hospital in Shanghai, China. (File photo: Reuters)
The 13 designated hospitals in Shanghai treated nearly 270,000 foreign patients in 2023, and they are working on a set of detailed standards for international medical services that are expected to be unveiled later this year, city authorities said in May.
Nearly 20,000 non-Chinese citizens are received by Renji every year, with about 15% travelling from their home regions and the rest comprising mostly expats in Shanghai, according to the hospital's Sun.
And she said most of those travellers are from Southeast Asian nations, as memorandums of understanding have been signed with hospitals in Singapore, Malaysia, Indonesia and the Philippines.
"Shanghai's high-end medical market has huge room for development," Sun said.
"We're targeting medical tourists as we have already built a large foundation for general inbound tourism."
The city of nearly 25 million people received more than 3 million inbound tourists in the first half of this year - marking an increase of 143% year on year - as China extended its 144-hour free transit visa to 54 countries to lure talent and investors.
Shanghai's competitive advantage lies in its experienced doctors, who can treat complicated diseases, which differs from the strategy employed by neighbouring countries in their medical-tourism drives.
"Medical technology is definitely the most important thing [in attracting cross-border patients]. We've established a reputation that makes people think of Renji when it comes to liver transplants," Sun said.
In comparison, the Boao pilot zone in Hainan, approved by the State Council in 2013, has been exploring a wider range of areas, including specially licenced healthcare services, health management, rehabilitation care and anti‑ageing aesthetic medicine.
With 29 medical institutions operating in the zone, it received around 300,000 medical tourists last year, up by 60% from 2022, according to official data.
However, cities in mainland China are still far from rivalling its neighbours in terms of attractiveness, as they have either built a reputation for quality service, such as Thailand, or at the lower end in terms of price, Taiwan.
"It seems likely that the combination of the Thai sector's determination to expand its offerings - into, for example, wellness - and the growing market for medical tourism, mean that the emergence of serious rivals need not be a great worry for Thailand," said Michael Montesano, an associate senior fellow specialising in Thailand at the Singapore-based ISEAS Yusof Ishak Research Institute.
"[Thai hospitals] bring the sort of hospitality for which the hotel business in Thailand is known [in terms of] reception of patients.
"This approach extends to nursing care, and the doctors who staff these hospitals speak English well and work with an appearance of real professionalism and often empathy."
Thailand's medical tourism sector ranked in the top five out of 46 countries based on "destination attractiveness" and cost, according to the International Healthcare Research Centre, an advocacy and research group.
A medical room at a hospital. (File photo)
Seoul resident Park Ji-won flagged language barriers when asked if she were willing to travel to China specifically for healthcare purposes.
"I believe Korea already has good medical services where everyone speaks Korean. So, I may go to a domestic hospital for a normal illness instead of one in China, which I lack knowledge of and has language problems," she said.
"But I may want to go on a traditional medicine tour, as I want to have a try and see the difference in traditional Chinese medicine services in Korea and China."
South Korea already has a mature healthcare industry, with the medical tourism market valued at US$1.9 billion in 2023, and it is expected to reach US$3 billion by 2032, according to market research firm IMARC Group.
South Korean officials see the sector as a "major national industry" and are working on medical, legal and policy strategies with a goal of attracting 700,000 foreign patients per year by 2027, scholars from two Korean universities said in a 2023 research paper.
A record of more than 600,000 foreign patients arrived last year, the health ministry said, according to The Korea Times newspaper.
Relatively high prices may also make people hesitant about travelling to China for medical services, according to analysts.
Paramitaningrum, an international relations lecturer at Bina Nusantara University in Jakarta, said Indonesians would only consider Shanghai or Guangzhou for serious illness, such as kidney problems.
"As far as I know, if the medical treatment can be done somewhere nearby, like in Penang [Malaysia] or Singapore, they prefer going to these two places, because they're close and cheaper than Shanghai," she said.
Taiwan, which ventured into the medical tourism industry before mainland China, is another competitor for its cost-effective healthcare at "competitive" quality levels, according to Hu Jin-li, a professor with the Institute of Business and Management at the National Yang Ming Chiao Tung University in Taipei.
"Taiwan's advantage is that medical costs are much lower than those in neighbouring economies, such as Hong Kong, Japan and South Korea, while the medical quality in Taiwan is competitive with these economies," he said.
"Taiwan's large hospitals are equipped with advanced devices under efficient utilisation and quality controls. Moreover, Taiwan has convenient transport, communications [and] hotels."
About 228,000 medical tourists received treatment in Taiwan last year, according to the government-backed Taiwan Task Force for Medical Travel.
But in Shanghai, despite Renji's early success, luring international travellers for healthcare remains difficult for some of the city's other hospitals involved in the pilot scheme.
Only two young patients, both from Europe, have been flown to Shanghai Children's Medical Centre - another of the 13 designated hospitals - for treatment since the city's initiative was launched in September last year.
"It's a trial, and it's still in a very early stage," said Cherry Jiang, who works in the hospital's publicity department.