Budapest: the “dental capital of Europe”

A recent visit to Budapest, the “dental capital of Europe” made me consider the perception of medical travel. Many people think that if you’re travelling abroad for treatment because it is far cheaper, then the standard of services can in no way match what you would expect in your home market. Hungary’s dental treatment providers provide a strong contradiction to this perception. I was speaking at the Business Travel Show in Budapest at a dedicated session on dental tourism, organised by the Association of Leading Hungarian Dental Clinics.

Aware of the number of new entrants into the dental tourism market, Hungarian dentists are keen to maintain their position as market leaders. They are also keen that the Hungarian government and tourism board take note of their success and provide support for the dental tourism sector.

Hungary was one of the first countries to exploit the healthcare needs of neighbouring countries and encourage patients to cross borders for treatment. It became common for German and Austrian patients to travel to Hungary for dental treatment in particular, and Hungarian dental clinics prospered in border villages and towns. When we launched Treatment Abroad five years ago, it was to some extent a response to requests from Hungarian dental clinics to increase their profile in the UK healthcare market. Having succeeded in attracting large numbers of German and Austrian patients, Hungarian clinics were spreading their wings and seeking to promote their expertise in other markets. Now, Hungarian dental clinics and services represent the largest segment of services on Treatment Abroad.

The Hungarian dental tourism market is one of the notable successes in the medical tourism market worldwide. In Budapest, the Association of Leading Hungarian Dental Clinics has been formed. The Association represents the interests of seven significant players in the dental tourism business:

• VitalCenter


• VitalEurope


• Bátorfi Dental Implant Clinic


• ImplantCenter


• Kreativ Dental


• Madenta


• Solydent

The Association has some clearly defined criteria for joining. For example:

• The practice must employ a minhmum of ten dentists / oral surgeons.


• The practice must be equipped with a minimum of 5 modern dental medical operating units.


• The practice must place a minimum of 1,000 dental implants a year.


• The practice must provide digital intra-oral and panoramic X-ray.


• The practice must ensure that all practitioners work within industry recognized protocols, including clinical governance and undergo regular internal clinical audits and assessments.

See the full list of Association criteria at ALHDC Code of Practice.

The number of patients from overseas that are going through these seven clinics is staggering. Association members carry out around 75,000 treatment sessions per year. Around 60% of these are for dental tourists. The Implant Center alone inserts around 1,800 dental implants each year. Each clinic has multilingual staff and dedicated cars and drivers for transporting international patients.

Although established markets such as the UK, Ireland and Scandinavia provide the bulk of patients, new opportunities are developing in France, Italy and Russia. I visited three of the facilities - ImplantCenter, Kreativ Dental and Vital Europe. Each has a different approach to marketing its services. Whereas Vital Europe focuses on UK patients and provides both consultation and treatment facilities in London and Manchester, Kreativ relies on its overseas agents to convince patients of their quality of service and flies patients straight to Budapest without prior consultation. ImplantCenter has also dental office in Dublin and London.

The expertise and extent of dental services in each individual clinic is quite something. Each clinic has around eight to ten dentists employed by the clinic, some general dentists and some with areas of specialty such as implantology or orthodontics. All three clinics have extensive dental laboratories on site, owned and operated by the clinics themselves.

There are few private dental clinics in the UK that can match the set up of thes dental facilities in Budapest. The challenge for Hungary is how it maintains its lead in dental tourism. New competitors are entering the market, such as Croatia, Czech Republic and Slovakia, some at even lower prices than those in Hungary. The challenge for these new dental tourism competitors is how they match the standards of the "dental capital of the world".

Dental tourism...Let's work together

The Irish Dental Association is the most recent medical professionals body to publish a "survey" raising doubts about medical tourism.
In a recent press release from the Irish Dental Association, they state that "3 out of every 4 Irish dentists are treating patients for problems arising from treatment abroad. Let's take a look at the background to the survey, and examine some of the real concerns that are raised.
The Consumers’ Association of Ireland has published research about the high costs of dental treatment in Ireland. The Irish Dental Association accepts that Irish dentists are not immune from the wider economy and the bottom line is that Ireland is a high-cost economy. As a result, significant numbers of Irish dental patients travel for treatment to minimise treatment costs. Some of these are cross border dental tourists. Many services carried out in Northern Ireland are between 25% and 45% cheaper than the same services in the Republic, according to the study published in the Consumers’ Association of Ireland’s magazine Consumer Choice. And of course, many Irish patients take advantage of low cost treatment in countries such as Hungary and Poland. Several Budapest dental treatment providers have offices or representatives in the Republic of Ireland.
According to the Irish Dental Association survey, 76% of Irish dentists in private practice [more than 3 out of 4] have had to treat patients for problems linked to the dental treatment they received abroad.
First, we need to examine the basis of this claim.

• There are approximately 1,700 dentists in private practice in Ireland at present.
• 440 Irish dentists responded to the survey.
• 334 said that they are treating problems arising from treatment overseas.
• So.... in fact 334 out of 1,700 said that they were seeing problems which is 20%. Obviously, this assumes that those who didn't bother are not seeing problems.

When reviewing such surveys conducted by on or on behalf of professional associations, we have to bear the following in mind:

• Inbuilt sample bias: People who see a problem are more likely to respond to a survey on that issue, than those who don't. We've seen similar bias built into surveys conducted by a PR agency in behalf of the British Association of Plastic Surgeons.
• Motivation: We always need to remember that professional associations represent the interests of their members. Losing patients to Belfast or Budapest hits the pockets of private dentists.

Nevertheless..... the Irish Dental Association has made some valid points. Are there concerns for dental patients who travel for treatment? Yes. Are the problems as big as the Irish Dental Association suggests. No.

At the end of the day, the Irish Dental Association also has the best interests of Irish dental patients at heart. Dr Donal Blackwell of the Irish Dental Association says that that one of the problems is that when considering travelling abroad for dental treatment, patients tended to focus on short term, aesthetic results rather than the long term quality of the care they receive and suggests that people travelling abroad for dental treatment actually don't know what they need when they enquire about costs. He's certainly right in some cases.

So, what's the solution and what's in the best interests of dentists and patients?

I'd like to see the following:

1. The Irish Dental Association issuing guidance for dentists and patients when considering dental tourism. See the UK General Dental Council's Dental Tourism Checklist on Treatment Abroad.
2. Irish dentists providing assessment and follow up of patients who travel abroad for treatment.
3. Irish dentists visiting some overseas dentists to get an understanding of how they work and their clinical skills and quality.
4. Irish dentists forming partnerships with overseas dentists, so that patients who need extensive treatment but can't afford Irish treatment have access to the treatment they need under the supervision of their own dentist.
5. Overseas dentists communicating with the patient's Irish dentist when a patient turns up in Budapest or Krakow - informing the patient's Irish dentist what work is to be undertaken, and providing post treatment reports on the work that has been carried out.

Common sense really. So, let's work together!

The challenge facing the medical tourism industry

The recent European Congress on Health Tourism in Budapest reflected some of the current issues and challenges facing the medical tourism industry, particularly those presented by a world recession. Budapest is Europe's dental tourism hub, attracting patients from countries such as the UK, Ireland, Germany, Austria, Switzerland and Scandinavia. If the recession is hitting medical tourism, then Budapest is going to feel it more than most.

There were workshops and presentations from various providers and industry players at the Budapest Congress. One of the more down to earth of these presentations was made by Dr Bela Batorfi of The Batorfi Dental Implant Clinic in Budapest. This impressive clinic usually carries out around 1,800 dental implants per year. But with the onset of the global financial crisis they have seen some worrying trends:

• The number of patients from abroad has fallen by around 30%. Medical tourists are harder to find!
• The average spend per patient has decreased from around £5,000 to £2,600. Medical tourists are spending less per visit.
• The average age of patients has increased. Medical tourists are delaying treatment.

The experience of the The Batorfi Dental Implant Clinic is reflected among many of the other dental treatment providers in Budapest. It's not the case that Budapest is losing patients and market share to other destinations. Understandably, many clinics are concerned about the fall off in business and how long it will continue.

Against the backdrop of the financial crisis, Hungary is one of the many countries planning a "medical city" aiming to attract patients from across the world to a centre of medical excellence. According to Balázs Stumpf-Biró, Executive Director of the European Medical Tourism Alliance (EuMTA), Hungary is planning to establish 100 hectares of land near Budapest’s international airport as a health complex, similar to Dubai Healthcare City.

Whether this development suffers the same fate as Dubai Healthcare City remains to be seen. The initial building boom in Dubai has come to a grinding halt. Building anything in the current financial environment is a risky business, and with the medical travel market to Hungary down around 20% to 30%, it's going to be a brave investor who lays the first brick.

Various estimates of medical travel numbers for Hungary put the number of incoming medical tourists at around 300,000 to 350,000 per annum. The vast majority of these are for dental treatment, and many may be "short trip/low cost" cross border visitors from Germany and Austria. But that's still a valuable market.

So what's the long term outlook for medical tourism destinations such as Hungary? Better than most, I would suggest. The medical travel market is here to stay and is here for the long term. Hungary has been at the forefront of medical travel in Europe for the last decade and it can retain that position.

But like most countries being encouraged down the medical tourism route it needs to tread carefully. We hear the usual overblown claims by industry proponents such as the Medical Tourism Association that "the biggest potential market for Hungary is the USA". I can just see hundreds of thousands of Americans getting out their maps of Europe, locating Budapest and booking their long distance flight via New York/London/Amsterdam for their dental implants. It isn't going to happen.

So where should Hungary be focusing its efforts?

Well... :

• There's a population of 550 million in the "United States of Europe" who may begin to exploit the opportunities within the EU Directive on patient mobility.
• Not so far away from Hungary, there are 140 million Russians who are beginning to spend their money on holidays all over Europe. Medical travel will follow this trend.
• And the UK dental problem is here to stay. See this recent article in the Independent: This may hurt a little: Rise in hospital admissions for last-ditch tooth extractions

My advice to Hungary... The same as you would get from business guru, Tom Peters (In Search of Excellence).

Stick to the knitting - stay with the business that you know!