"There is no way you can walk in a clinic on Friday in London and get your appointment for Monday," says Ladapo. "Normally, you would need to book three months in advance." Ladapo is one of an increasing number of European Dental Center's foreign clients, many of whom come to Prague to combine a holiday with timely and affordable medical care.

"It was an unexpected turn of events for me," says Eugenia Shterenberg, the clinic's director. "When I started this business in 2001 I was mainly targeting Praguers." Shterenberg was surprised to see her business surge significantly after the Czech Republic became part of the European Union last May.

Finding the market

Many local practitioners would like to know Shterenberg's secret. The clinic's success, she says, is largely down to the market niche she has carved out for her business — high-quality dental services intended for less price-sensitive clients. Dental care, along with cosmetic surgery and spa treatments, is the most sought after prize among medical tourists to the Czech Republic.

And if European Dental Center's success is any indication, there's clearly a market out there if it can just be tapped into via good marketing: The clinic's foreign clientele has nearly doubled over the past year and about 90 percent of new patients were referred by current ones.

Foreign dental clients mainly seek prosthetics, such as crowns and artificial teeth, that are up to five times cheaper than in some Western countries, said Irena Wildmannová, a dentist at a private clinic in Prague.

Beyond niche markets like spas, dentistry and elective treatments, EU membership has not yet resulted in a flood of West Europeans eager to book Prague clinics — much to the chagrin of many Czech doctors who hoped their fortunes would be sealed.

"I am rather surprised that the increase in medical tourism is much lower than it could be," says Milan Kubek, head of the Doctors' Union. One factor limiting the trend is a lack of coverage for Czech treatments by many international health insurers. Even so, EU citizens with health insurance in their home countries now get reimbursed for emergency treatment when in the Czech Republic — which has clearly boosted the sector as well.

"We have registered an increase in emergency treatment among foreigners," says Václav Janalík, spokesman for the Center for International Reimbursement. "There are tens of thousands of such cases."

Medical tourists come to the Czech Republic primarily for dental, eye and fertility treatments, according to the Czech Medical Chamber. In the first two cases, cheaper prices are the main draw, which makes even noncovered treatment worth the price.

"We always had foreign clients coming from all over Europe," said Jan Lešták, owner and head doctor of Private Eye Clinic, based in the center of Prague, though he adds he hasn't detected a recent rise.

Lešták's clinic, which during its 10-year history has also treated dozens of clients from Japan, Australia and the United States, has been getting more e-mail inquiries from foreigners with questions about the availability of specific treatments, he says. Most in demand is cataract surgery, which costs around 11,000 Kč ($440) in the Czech Republic, and accounts for many of the foreign patients who make up nearly 10 percent of the clinic's business.

Looking east

Medical tourism is not necessarily flowing into the country from only the West, says Janalík.

"A typical medical tourist in the Czech Republic is a Slovak citizen," Janalík says. Slovaks mainly come here for care they cannot get at home. They made up a good portion of the 418 foreign patients known to have visited the Czech Republic expressly for medical treatment in 2004, worth a total of 15.9 million Kč.

Elective medical care has long been popular among foreigners, say practitioners, and a dozen new plastic surgery centers have opened their doors in Prague over the past three years.

"We always had foreign clients," said Libuše Štecherová, director of GHC, a private clinic that provides ongoing treatment in a variety of fields. Dental care, cosmetic surgery and skin treatments are the most popular services among foreign clients, who are drawn by rates far lower than they're used to at home. Cosmetic surgery prices can be 50 percent lower than those charged in Switzerland or in the United Kingdom.

West Bohemian spa towns such as Karlovy Vary, which was a regular stop for Russia's Peter the Great, have been a favorite destination for foreigners for centuries. Over 130,000 foreigners visited Czech spas in 2004, accounting for 35.4 percent of all spa guests. The majority is from Russia but the Czech Tourist Authority is actively working to coordinate Czech spas and German health insurance companies to attract more visitors from the West. Czech company Royal Spa and German health insurer Techniker Krankenkasse signed the first such contract in June.

Meanwhile, luxurious facilities such as the newly opened Zámecké lázně in Karlovy Vary, offering the latest in carbon-dioxide and hydro treatments, among a dozen others, are an indication of investor confidence in the niche's future.

Legal fertility

One sector that draws patients less concerned with cost and insurance coverage is the brisk business of treatments that are illegal in neighboring countries. Many patients visiting Prague for fertility treatments seek therapies that remain banned in Germany, Austria and Italy, such as genetic testing that may include the destruction of flawed embryos.

"Different laws give patients uneven chances to get the treatment they need," says Tonko Mardešic, head physician at Pronatal, a private clinic specializing in fertility treatments. "That forces many patients to look for the treatment in other countries."

Mardešic argues that EU membership boosted the Czech Republic's credibility among foreign patients while prices remain substantially lower than in the West. A fertility treatment cycle costs 50,000–70,000 Kč in the Czech Republic, compared with about 250,000 Kč in Germany.

And, Mardešic points out, German law forbids the genetic testing of pre-implanted embryos. This treatment makes it possible to diagnose an embryo before it is transplanted to a woman.

"A whole number of couples either cannot get fertile at all without this treatment or are doomed to undergo repeated abortions," Mardešic says.

Although foreign clients account for for less than 10 percent of Pronatal's patients, the clinic performs about 1,500 successful treatments per year, he says. Most of the clinic's foreign patients come from the former Yugoslavia, where such care is not available, says Mardešic, a fluent Serbian speaker.