Just what the doctor ordered: Medical tourism is providing a fillip for sector expansion

As it emerges as an important medical and wellness tourism destination, in particular in the fields of cosmetic surgery – of which the kingdom was an early pioneer – and dental treatment, Morocco is making great strides forward. Although the segment is not as well-developed as in some Eastern European and Asian markets, and also lags behind neighbouring Tunisia in some respects, it benefits from a combination of advantages, such as proximity to Western Europe, a pleasant climate, the availability of numerous low-cost flights to the kingdom, and the fact that many Moroccans are fluent in both Arabic and French (and also, in the north of the country, Spanish), making it an particularly attractive destination to both patients from the Francophone world and from Arab countries, which are a lucrative and increasingly important source market for the country.

Challenges to the medical tourism industry’s expansion include the fact that the bulk of cosmetic surgery facilities are currently not located in the kingdom’s main tourism hubs – though construction work on a new health care city being built by an Emirati firm in the kingdom’s tourism capital Marrakech that will target foreign tourist and retirees seeking treatment is under way, highlighting an increased amount of investor interest in the sector.

CONCENTRATE ON COSMETIC: Medical tourism in Morocco is dominated by cosmetic surgery, as such procedures are not covered by government health insurance in most European countries and Morocco does not have agreements in place with European governments to allow patients to be reimbursed for treatment undertaken in the kingdom for conditions that are covered by their state insurance (unlike Turkey, for example, which has some such agreements with several Scandinavian countries).

The prominence of cosmetic surgery is fitting given that the kingdom has a long history in the field; in fact, the first cosmetic surgery centre to open its doors in the region was in Morocco. Although it soon lost its position as the regional hub for the activity to Lebanon, the segment is starting to expand again.

“There are about 50 surgeons operating in the country, compared to just four in 1990. The last 10 years has also seen the emergence of training programmes for plastic surgeons, and there are now five schools that issue official diplomas,” Dr Kamal Iraqi Houssaini, the president of the Moroccan Society For Plastic Surgery and a surgeon at the Clinique Casablanca Chirurgie Esthétique, told OBG. While liposuction is the most frequently-performed treatment, dental care and cosmetic dental procedures such as implants also represent a growing niche.

CHOOSING THE KINGDOM: As is the case generally in the medical tourism segment, the main incentive for patients to go under the knife in Morocco tends to be financial; cosmetic surgery and dental implant prices in the kingdom can respectively run as low as 30% and 50% of the cost for the identical procedures when they are conducted in France or other parts of Western Europe. In addition to lower operational costs, cosmetic surgery in Morocco is not subject to value-added tax (unlike in some European countries, including France), which further brings down prices. However, the kingdom also benefits from a number of additional advantages over other leading destinations for medical tourism, such as countries in Eastern Europe, East Asia and Latin America. These lie the combination of its proximity to Western and especially South-western European markets; the fact that both French is widely spoken at a native level (as is Spanish in parts of the north-east of the country) in addition to Arabic; the pleasant climate, and in particular the year-round warm weather to be found in the south of the country; and the availability of well-trained medical staff, many of whom have studied in the EU and the US.

The segment also benefits from the presence of large Moroccan immigrant communities in Europe with strong ties to the kingdom, which makes up a substantial share of health tourists. Morocco’s main competitor for the market in North Africa is Tunisia, which has carved out a niche for itself as a low-cost medical tourism destination, in particular for cosmetic surgery, and where associated infrastructure such as specialised travel agencies offering medical tourism package deals is better-developed. However, while Tunisia boasts many of the same advantages as Morocco, the kingdom also benefits from a full open skies agreement with the EU and, as a result, from the availability of numerous budget airline flights destinations throughout the country from airports across Europe (see analysis).

Tourism to the kingdom has been relatively unaffected by the recent Arab Spring uprisings in the region. However, fallout from the economic troubles in Europe remains a concern, according to Imad Barrakad, director-general of the Moroccan Agency for Tourism Development. “The only real challenge is the economic crisis in Europe, which has led to fewer people visiting the kingdom,” he told OBG.

FROM EVERY DIRECTION: Reports suggest that the segment’s key source markets are Western European countries, in particular France and Spain; however, some patients come from as far away as Canada (where there is also a substantial Moroccan immigrant community). The kingdom is also increasingly attracting medical tourists coming for cosmetic surgery from other areas in the region. “Morocco is becoming more popular as a destination for plastic surgery, in particular for people from Middle Eastern countries,” said Houssaini. The regional market for medical tourism more generally is a potentially lucrative one, with government-subsidised medical tourists from Libya, who are often accompanied by their families, pushing up hotel and apartment occupancy rates in Jordan in recent years, for example.

Although the segment is developing, it is still in its infancy. “While there has been a push to promote cosmetic tourism, as a niche it remains very small,” said Houssaini. “Even in a country such as Thailand, which is one of the world’s major health tourism destinations, the segment is still small compared to tourism overall.” Citing Moroccan cosmetic surgeon Salehedinne Slaoui, local press in 2011 put the number of cosmetic procedures taking place in the country at around 1200 per month, of which around 180 are performed on foreign patients. However the potential impact of the development of the segment on wider tourism revenues has been recognised by the authorities; the kingdom’s Vision 2020 tourism strategy cites health and wellness tourism as one of two high-value-added niches in need of development (alongside business tourism) and includes making Morocco a new international destination for health and wellness as one of its goals.

CONTINUING CHALLENGES: The segment faces a number of challenges. Industry players complain that it lacks a development strategy and that little in the way of resources have been devoted to studying it. While the cosmetic surgery market is developing, the country has relatively few spa facilities to take advantage of wellness tourism demand from Europe, particularly in light of its long coastline and compared to other countries in the western Mediterranean region. Another challenge, common to the segment in general, instead of just being limited to destinations such as Morocco, is that doctors in some European countries, such as France, on occasion will refuse to provide post-surgery care to patients who have undergone procedures abroad. In 2010 a benchmarking study by the Ministry of Tourism recommended that segment-specific legislation and regulation be put in place and also that the kingdom work on a strategy based around integrating medical and leisure tourism activities; however at the moment most plastic surgeons are based in the greater Casablanca-Rabat metropolitan area, while tourism from Europe is oriented more to southern cities like Marrakech and Agadir, in part due to warmer weather.

NEW HEALTH CENTRE: However, despite such issues foreign investors are increasingly seeing the potential in the segment, and tourism capital Marrakech will soon host a large new foreign-backed facility aimed in part at medical tourists. In December 2012 Emirati property and development firm Tasweek Real Estate Development and Marketing began work on the construction of a $40m, 1200-sq-metre complex, to be known as Marrakech Healthcare City.

The target market for the health city is foreign (in particular French) retirees and medical tourists, though the firm says that it is also aimed at Moroccan patients. The site will include a 160-bed hospital that will have a capacity to treat around 5000 patients a year and eight operating theatres capable of performing up to 85 procedures a day, as well as a 40-room hotel and 56 residential apartments. Construction began in December 2012 and is scheduled to be completed in late 2014. The complex will offer a variety of forms of medical care and procedures including surgery, cardiology and radiology.