USA, UK: Inbound medical tourism to the USA and UK

Within the “conventional” wisdom of medical tourism is an assumption that the UK and USA are prime target markets. Almost every country, organisation and conference seems to suggest that these two countries are only consumers of medical tourism, and they are always high up on medical tourism target lists. The reality may be very different, as both are in the top ten international medical tourism destinations.

According to a dental clinic in Sussex, patients in Sussex who are thinking of travelling overseas for dental treatments can save themselves not only the time, the effort and a lot of money, as most of their requirements can now be met locally and at a similar saving. The most favoured country for Britons travelling abroad for dental treatments is Hungary and especially Budapest. Dr Bruno Silva of Brighton’s Implant Clinic in Hove, says,
“Our services are comparative in price if not cheaper than for patients travelling abroad. We have a great team of surgeons specialising in dental implants and advanced dentistry.”

Dr Silva also suggests that the big disadvantage of going abroad for treatment is that the cost of any follow up treatment and the cost of dealing with any complications must be considered, plus all the travel costs and accommodation. He argues that before people start thinking of making the journey they should look at all the options at home for dental implants and advanced dentistry. While you would expect the clinic to suggest treatment at home rather than overseas, that it attracts medical tourists from overseas may be a surprise. Brighton Implant Clinic has a chauffeur driven car for patients who require transport and in the past year has received patients for treatment from Scotland, Germany, Malta, France and many other parts of Europe.

Dr Bessam Farjo and his wife Dr Nilofer Farjo head up the UK’s leading hair transplant surgery. They carry out more than 300 operations each year at their Manchester clinic, The Farjo Medical Centre. More than 4,000 people have travelled from across the UK, Europe and as far as the Middle East, Australia and the United States, to the centre. The Farjo Medical Centre has an international reputation for not only using the latest hair transplantation techniques ? recognised throughout the surgical field ? but also for placing significant emphasis on developing pioneering ways to counter hair loss.

The USA is also an often forgotten destination. David Goldstein of Health Options Worldwide (HOW) explains, “The popular notion in medical tourism often defines it as Americans leaving the U.S. for inexpensive medical treatment and low cost surgery. However, the business model works both ways. In the world of medical tourism and medical travel, the United States is certainly a power player, offering high quality care and modern technology to attract international patients. Most people hear of medical tourism and they think of American patients seeking healthcare in Asia or Latin America where the services are much less expensive. But cost is not always a factor; quality is."

Goldstein argues, “Medical tourism is a huge business opportunity for American hospitals to bring in revenue. What is interesting about this trend is that international medical tourists do not come to the U.S. for healthcare because of economics. International patients are attracted by the quality of doctors and state-of-the-art medical technology for which the United States is renowned. American hospitals offer pioneer treatments that are not available anywhere else. Another factor impacting international patients is the fact that the wait for medical treatment in their home country is too long. But quite simply, many of these patients can afford the best and can find it in the U.S.Travelling to the U.S. for healthcare can be costly and complicated for international travellers. Usually, the patients are wealthy people who can afford high quality care. In this fast growing market the U.S. has a chance to be very competitive."

HOW says figures for international patient numbers going to the USA have grown over the last 12 months, and the industry can expect more growth this year. Patients come from: Mexico (21%), Middle East (14%), South America (12%), Central America excluding Mexico (11%) and Europe (11%). The most sought-out treatment areas were oncology (32%), cardiovascular (14%) and neurological (12%).

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BAHRAIN: Design firm chosen to help develop Bahrain Health Island

UK management and engineering firm Mott MacDonald has been appointed by Ithmaar Development Company to provide infrastructure design and supervision services for Dilmunia Health Island. The first of its kind, this new health island, is set to be an international health and wellness facility in a resort-style environment based on a 125 hectares man-made island off the north-east coast of Bahrain. The project is expected to cost $ 69 million

Designs for the health island were developed last year. The health island is expected to house a state-of-the-art diagnostic centre along with centres for nutrition and diabetes, cosmetic surgery, aesthetic medicine, women and children's health, alternative medicine as well as a sports medicine centre. Deluxe spas, boutique hotels, residential clusters, commercial facilities and recreational amenities are also included in the concept design.

Mott MacDonald's team in Bahrain will design and supervise the construction of all infrastructure services from roads, bridges, power network, water, sewerage and treatment services to a district cooling plant with associated distribution services and a canal which is all due for completion by mid 2013.

Mott MacDonald's Alan Worley says, "This follows successful completion of design work on Al Seef Tower in Manama for Ithmaar Development Company and is an endorsement of what we hope will be a productive on-going relationship backed by Mott MacDonald's local knowledge of Bahrain and world-class engineering design and management skills."

DP Architects from Singapore is the master planner. In early June, reclamation works were completed. In March 2008, site mobilization and reclamation works started. Ithmaar Development Company (IDC) was set up by Bahrain’s Ithmaar Bank in 2006 to manage major development projects.

The name Dilmunia derives from the ancient name Dilmu, often believed to be the original Garden of Eden. The island will be a lush green oasis offering physical, mental and spiritual equilibrium. The aim is to combine a balanced lifestyle with secure comfortable accommodation and expert medical help nearby. The experience of the various themed hotels reflects the alternative remedies such as Chinese medicine, Thai herbalist beliefs, French-inspired hydro remedies, as well as traditional health and wellness. Up market homes will be combined with top of the range entertainment, retail and leisure. Nature will be presented in a variety of themed gardens, waterways, wetlands, and parks. Dilmunia will be managed and operated by a core group of medical professionals with access to visiting world-renowned specialists. World-class medical facilities will be attracted to invest and locate there.

This concept goes against the current trend of (low) cost driven medical tourism. If the concept were to be launched today, it might face problems in the current market and economic climate. But we are talking about several years ahead, when hopefully global recession will be a distant memory. It may have advantages over land-based Middle East medical tourism, providing a contrast to soulless hospitals in characterless modern cities. Anyone doubting the potential should look at the many eco-hotels and spas that are successfully attracting upmarket consumers in the worst possible financial climate, in locations where conventional cheaper hotels struggle to survive.

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ISRAEL: Israel's medical tourism at the crossroads

Income from medical tourism increased sharply in 2011 and 2012 to reach $140 million in 2012, according to data collected by the Health Ministry and the non-government organization Hatzlaha.? The Israeli government is exploring whether to curb or regulate medical tourism; despite the revenue it brings in-with worries that locals could suffer. The ministry has a dilemma that many hospitals have cited commercial issues for refusing to co-operate with official enquiries on how many medical tourists they actually get, as nobody has been able to find out the real numbers.

The public hospitals took in NIS 291 million from medical tourism in 2012. Health maintenance organization Clalit reported that its 10 hospitals had revenues of NIS 70 million from medical tourism in 2012. Hadassah University Hospital in Jerusalem had revenues totaling NIS 108 million.
Private hospitals, including Assuta in north Tel Aviv, also had sizeable revenue from medical tourism but refused to provide numbers. One estimate indicates that Israel’s hospitals had revenues of more than half a billion shekels from medical tourism.

The public hospital with the highest medical tourism revenues was Sheba Medical Center, Tel Hashomer, with NIS 130 million a year ? up nearly 70% since 2010. It was followed by Ichilov Hospital, Tel Aviv, which had revenues of NIS 99 million (up 44% since 2010), and Beilinson Hospital, Petah Tikva, at NIS 39 million ? a 490% increase over the figure from 2010.Other public hospitals with medical tourism revenue were Rambam in Haifa, with NIS 36.4 million in revenues; Assaf Harofeh Hospital, Tzrifin, at NIS 15.9 million; and Schneider Children’s Medical Center, with NIS 13.6 million.

A subcommittee within the health ministry has been set up in an attempt to regulate medical tourism, which has no government oversight or standards. Many attempts have been made to set standards and regulations for medical tourism- all have failed to happen. In May 2013 the committee said that medical tourism should account for no more than 10% of a hospital’s revenues from operations. But it has yet to submit its recommendations, so this limit is not official, and it may be impossible to enforce.

Medical tourism is a very sensitive issue for Israel’s health system. Every medical tourist admitted raises the question of whether that person is taking the place of an Israeli patient, particularly given that the hospitals are very overcrowded and the wait for treatment is long.

Medical tourists come primarily from the former Soviet Union and from Mediterranean nations. They visit for a fixed duration, and may receive treatment ahead of Israelis.

For hospitals, medical tourists are very attractive and lucrative patients. Hospitals charge them much more than they receive from Israeli patients, and one of the reasons some hospitals refuse to co-operate with the ministry is a suspicion that they greatly increase the prices for medical tourists- so increased revenue may not equate with increases numbers- but be due to severe price increases and a concentration on more expensive surgery. Unlike insurers, the medical tourists pay the hospitals immediately, and in cash. The money goes into the hospitals’ parallel business operations, as opposed to the budget subject to government oversight, which means the hospital directors have more control over the money.

No authority in Israel has full data on medical tourism.? The Health Ministry has only partial data that includes the state hospitals’ revenue. It does not know how many patients are treated, or in which departments. Many public and private hospitals have refused to provide any revenue figures or numbers.

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GLOBAL: International comparison of healthcare systems

A new Commonwealth Fund report has assessed seven industrialized countries on the performance of their health system in five areas: quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives. The Commonwealth Fund is a private foundation supporting independent research on health policy. 27,000 patients and primary care doctors were surveyed across all seven countries as part of the study.

The Netherlands ranked first overall, closely followed by the UK and Australia. The UK performed well when it came to quality of care and access to care. In relation to access, the study says: "The UK has short waiting times for basic medical care and non-emergency access to services after hours, but has longer waiting times for specialist care and elective, non-emergency surgery." The Netherlands ranked very highly on all waiting times measurements. When it came to efficiency, the UK and Australia ranked first and second.

Despite having the most expensive health care system, the United States ranks last overall. While there is room for improvement in every country, the U.S. stands out for getting poor value for its health care dollars, ranking last despite spending $7,290 per person on health care in 2007 compared to the $3,837 spent per in the Netherlands, which ranked first overall.

Report author Karen Davis comments, "It is disappointing, but not surprising that, despite significant investment in health care, the U.S. continues to lag behind other countries. With enactment of the Affordable Care Act, we have entered a new era in American health care. We will begin strengthening primary care and investing in health information technology and quality improvement, ensuring that all Americans can obtain access to high quality, efficient health care."

On measures of quality the United States ranked sixth out of the seven countries. On two of four measures of quality ? effective care and patient-centred care ? the U.S. ranks in the middle. However, the U.S. ranks last when it comes to providing safe care, and next to last on coordinated care. On measures of efficiency, the U.S ranked last due to low marks when it comes to spending on administrative costs, use of information technology, re-hospitalization, and duplicative medical testing. On measures of access to care, people in the U.S. have the hardest time affording the health care they need, with the U.S. ranking last on every measure of cost-related access problems.

Overall rankings -

1. The Netherlands

2. United Kingdom

3. Australia

4. Germany

5. New Zealand

6. Canada

7. United States

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GLOBAL: Global initiatives for the medical tourism industry

KEMP Healthcare
With patient care and safety emerging as a major concern, a US/UK healthcare company plans to launch a certification service for hospitals in India in early 2011. KEMP Healthcare Ltd plans to launch a Quality of Care certification service that will bring to a hospital evidence-based quality improvement measures that have been tried and tested in international healthcare systems as reliable processes. The company is targeting hospitals that are keen and committed to provide better care to their patients and want to build on their existing strengths to excel on the 5 stars of quality, safety, timeliness, effectiveness of care, and patient satisfaction. Appraisal of successful incorporation of these 5 stars by KEMP Healthcare would result in achievement of certification and the hospital could promote itself as a 'KEMP 5 Star Certified Hospital'.

The aim is to enable consumers of healthcare in India to make an informed decision when choosing hospital for themselves and their families. The company says it will give the hospitals additional credibility, confidence and visibility within an increasingly competitive market and claims to make them more attractive to foreign patients visiting India for medical tourism. KEMP Healthcare is a trans-Atlantic co-operation that brings US and UK healthcare expertise together, to provide evidence-based solutions to healthcare systems globally so as to improve efficiency and deliver quality. How a company that has no international track record in this sector, and with a name that means nothing to medical tourists or agencies, plans to compete with established international accreditors and persuade hospitals to use it instead, is an interesting question.
Mercury Healthcare
Mercury Healthcare of the USA has launched a UK subsidiary in London to help it develop in Europe and Commonwealth countries. It will provide training, consulting, and support services to the Central and Eastern European medical tourism markets and government agencies throughout the Commonwealth and the European Union. Mercury Healthcare is also a medical tourism agency with a network of hospitals and other healthcare providers in more than 25 countries, including more than 200 hospitals and over 15,000 doctors, dentists and allied health providers.

MedRetreat
With global growth and many newcomers attempting to enter the business, hospitals may find it hard to decide whether an agency is reputable and likely to bring it volumes of good business, or one just seeing the industry as a quick way to make money with little effort and no long term concern on whether patients or hospitals get what they want. Patrick Marsek, of MedRetreat, a US based medical tourism agency warns, "The best agencies have trained staff, industry experience, and proven processes that guarantee a safe and stress-free experience for medical travelers. Unfortunately, some may not possess the qualifications necessary to ensure a positive medical travel experience. To ensure that the medical tourism industry continues to flourish, overseas hospitals must take great care when choosing agencies as affiliates. A single patient mishap can effectively put an overseas medical provider out of the health tourism business for good. Even if a hospital has provided superior quality care, it may lose business if a medical tourist who is dissatisfied with the service speaks to the media about having a bad overseas experience. That there is no official accreditation agency to identify and evaluate quality standards for agencies makes it difficult for international hospitals to know which offer top quality.”

Marsek continues- “Until such an agency exists, all international hospitals should take the following five steps before agreeing to an affiliation with an agency for the purpose of attracting patients.
??? ?Develop an affiliation approval process.
??? ?Verify that the agency is a legitimate business in good standing.
??? ?Insist that the agent visit your hospital.
??? ?Ask them to disclose their processes and fee structure.
??? ?Determine the level of service the agency provides.

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CUBA: Cuba relaunches Servimed medical tourism service

Cuba is one of the unsung heroes of medical tourism, as it has been quietly attracting people from overseas for decades. The government controls access to all local hospitals for overseas patients, and has just relaunched Servimed.

Empresa Comercializadora de Servicios Medicos de Cuba S.A., known as Servimed, is a state owned and run company that offers foreigners access to the 16 Cuban hospitals and clinics that provide more than 100 types of health services on the island, ranging from cancer treatment and drug addiction programmes, to dentistry and cosmetic surgery. As an organization, their work has been ongoing for more than 20 years, initially as Servimed; later as Cubanacan Tourism and Health, then as Tourism and Health, and now back to Servimed.

It has been hidden away, but as part of a more public international role, the for-profit medical services company relaunched itself before an international business audience at the recent International Havana Fair. The expectation that President Obama will fulfil his promise to do away with the rules that prevent most US citizens going to Cuba for tourism or healthcare is part of the reason for the new openness.

Servimed deals with private individuals but its main role is to coordinate the bigger-volume business of government-to-government services. Servimed provides for-pay medical services by Cuban personnel to governments of 15 countries; which includes medical tourism. For-pay medical services to other governments are not new. Panama announced in 2011 that it will pay for the hands-on specialty training of Panamanian doctors in Cuban hospitals. Also in 2010 Qatar agreed with Cuba to pay for an undisclosed number of Cuban doctors to work in a new 54-bed hospital in the oil-rich country. Cuba also agreed in 2010 to manage and staff eye surgery centres in hospitals in China and Algeria.

Servimed is providing services to 15 countries this year, including Algeria, China, Portugal, Jamaica, Qatar, Surinam and Ukraine. Cuban medicine has become a worldwide leader in healthcare services for people in poor and rural areas as well as in disaster zones; at least 38,000 medical workers from Cuba are currently deployed in 77 countries. Cuba is in charge of a $690 million plan to rebuild Haiti’s healthcare infrastructure. Since 1998, the Escuela Latinoamericana de Medicina (ELAM) in Havana has been training 7200 students from all over the world, and graduates 1500 doctors per year.

Many of these programmes are funded by Venezuela, and others by countries such as South Africa, Brazil and Norway, but many are subsidised by Cuba. Cuba has proposed to the European Union and Canada that its doctors and medical services could be part of triangulated aid service provided in developing countries; so far, no agreement has materialized.

Venezuela is paying at least $5 billion in oil and cash per year for the services of Cuban doctors and for training of Venezuelan and third-country medical students in Cuba. Venezuela has also funded Operacion Milagro, a billion-dollar programme led by Cuba that has given free eye surgery to hundreds of thousands of low-income Latin Americans.

Now, the government wants to use Servimed to make Cuba’s public health services sustainable and more efficient by generating revenues from paid for medical services and medical tourism and investing the profits in maintenance, repair and purchase of equipment for Cuba’s public health institutions.

Servimed is spearheading a Cuban effort to increase for-profit medical exports. A Public Health Ministry document published in December 2010 said that, as part of an overhaul of Cuba’s healthcare system, medical institutions should begin to sell services to foreigners wherever possible, “The medical services will remain free for poor countries. But they will be sold to those whose economy allows it, with the goal of reducing our expenses and contributing to the development of the national health system.”

The Cuban medical system now offers medical services for Canadians. Servimed’s individual subsidiary Health Services International began in January 2007. HSI is the agency officially recognised by Turismo y Salud and the Cuban medical system. It assists and guides medical tourists. In the agreement between HSI (Servimed) and Turismo y Salud, anyone who does speak Spanish will always have a medically trained person nearby who will act as an interpreter to help the medical tourist understand test results and to help when decisions are necessary. Many doctors and nurses do speak English and some speak French, also.

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GLOBAL: Satisfied customers encourage others into cosmetic surgery tourism

A study of the experiences of cosmetic surgery tourists, led by the University of Leeds, challenges widely held perceptions about the safety and motives of people travelling overseas for treatment.

The two-year study, ‘Sun, Sea, Sand and Silicone’, is the first to use in-depth interviews, video and photo diaries and questionnaires to analyse cosmetic surgery tourism from the perspective of the patient’s experience. The study was funded by the Economic & Social Research Council.

Findings are based on the accounts of more than 100 patients from the UK, Australia and China, as well as 100 people involved in the industry.

While bad experiences have typically grabbed headlines, the researchers found that 98% of the patients would repeat the procedure in the same country and medical facility. Many patients also praised the clinics for diagnosing and treating underlying health problems during pre-surgery tests.

The profiles of the patients also challenge the stereotype of a cosmetic surgery tourist as being a wealthy, glamorous and globe trotting Westerner who is exploiting low-wage economies.

According to Professor Ruth Holliday from the University of Leeds, “The patients we interviewed were ordinary people on modest incomes ? administrators, nurses, shop workers ? who travelled abroad because they could not afford to have the surgery at home.? Some patients from the UK commented that private surgeons at home viewed them as walking cheque books, whereas surgeons abroad saw them as a whole person.”

Investing in their physical appearance was only one of four motivating factors for opting for cosmetic surgery. Other reasons given by patients were correction, such as ear pinning and nose reshaping; repair, such as post-pregnancy breast uplift or tummy tuck; and anti-aging, such as a face-lift or hair transplant.

The findings also show that the quality of the surgeon, rather than the desirability of the destination, was the key deciding factor in choosing the location. Many patients reported that they enjoyed some sightseeing during their trip, but the emphasis was on travelling for affordable surgery and then returning home as quickly as possible.

When asked how they had selected a surgeon, the researchers found that people preferred reading reviews from other patients, while the advice provided by surgeons, clinics or cosmetic surgery tourism agents was often seen as being tainted by profit motives.

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UNITED STATES: Two firms link up to offer new medical travel insurance

Specialist American travel insurance intermediary Seven Corners has signed US medical tourism agency Healthbase as the first preferred partner for the bordercross worldwide policy underwritten at Lloyds’ of London. The insurance is for any nationality, but the patient must be travelling outside the country they live in.

Saroja Mohanasundaram, chief executive of Healthbase, said: "We are the only medical travel facilitator to provide a custom insurance programme to our clients as a further commitment to providing high-quality medical travel services at an affordable cost."

The insurance plan provides Healthbase patients coverage for the treatment of common surgical complications such as adverse reactions to anesthesia, stroke, myocardial infarction, deep vein thrombosis and infections.

Jim Krampen of Seven Corners said: "The medical complication benefits we designed for Healthbase clients will provide peace of mind and cover the cost to treat medical complications abroad and when they return home."

Healthbase has a large number of internationally accredited hospitals in 14 countries, including India, Mexico, Costa Rica, Singapore, Thailand, Panama, Turkey, Belgium, South Korea, Malaysia, the Philippines, Hungary, Brazil and the US.

Healthbase customers do not all live in the US. There are plans to add more destination countries soon - Canada, the UK, Jordan, Taiwan, New Zealand, Australia, El Salvador and Guatemala.

Seven Corners originally planned to only sell via medical tourism agencies, but progress on this has been so slow that they are now also offering to quote direct to medical tourists.

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SOUTH AFRICA: South Africa well placed to be top medical tourism destination.

South Africa can accommodate up a million medical tourists every year and is ideally placed to the become a destination of choice for medical and cosmetic surgical procedures, says Cawe Mahlati, organiser of the inaugural South African Health Tourism Congress (SAHTC) in Gauteng. Mahlati says a strong health sector could bring down the cost of healthcare in the country, at a time the country is seriously considering restructuring what the public and private healthcare sectors offer internally.

More than 300 delegates representing medical tourism agencies, hospitals and healthcare providers, dentists and doctors, government representatives and insurers attended the congress. The aim is to create a health tourism cluster, getting all parties to work together to market South Africa as a cost-effective, quality provider of medical and cosmetic procedures. In the last few years politicians and government bodies have offered no support or shown any intent to assist medical tourism. This will change as the congress has received the support of the government with both Deputy Health Minister Thokozile Xasa and Deputy Tourism Minister Molefi Sefularo speaking at the event. Xasa said that the government aims to complete a national strategy and implementation plan by the end of this year to develop the country as a destination for international medical tourism.

He also said that out of 9.5 million foreign tourist arrivals in the country last year, 410 000 were medical tourists, but organiser Mahlati is wary of trusting those figures. Trade estimates in recent years have consistently used a figure of only 20,000. She suggests that the creation of a health visa would make it easier to calculate real numbers. Xasa admitted that the country's service offering in medical tourism is sporadic,” The industry in its innate state is fragmented and consequently inefficient."
A pioneer in medical tourism, South Africa has long established itself as a destination for health tourists, with thousands of foreign patients electing to have cosmetic or medical procedures in local hospitals. But more organized rivals have overtaken it as marketing has mainly been left to agencies, with few hospitals prepared to promote their services.

The congress aims to stimulate the inbound health tourism market in South Africa. Deputy Minister of Health Molefi Sefularo said,” Although the private sector is the main beneficiary of health tourism, there is a slow stream of patients who are price sensitive and have seen the opportunity of using the public sector hospitals. There is much scope for collaboration between the medical, tourism, hospital and travel industries. It is therefore important for the public sector to utilize this opportunity in a co-ordinated manner, without negatively affecting access to the South African patients.South Africa has to position itself therefore as a destination of choice for medical healthcare ahead the 2010 FIFA World Cup."

South African Medical Association regulations prohibit commercial brokers from recommending patients to doctors, and restrict doctors from marketing their services directly or indirectly to the public.

The authorities sudden interest in medical tourism is due to an acceptance that leisure tourism in South Africa has reached saturation point, giving an impetus to new strategies that target medical and health tourism for high spending visitors.

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INDIA: New academic study on medical tourism to India

The various claims of how many medical tourists a country attracts are notoriously unreliable, even where there are monitoring systems in place. A new academic study suggests one simple reason for this; even major international hospitals are pretty poor at keeping simple records of how many medical tourists they have. And it is not just the usual problem of counting in expatriates, travellers and non-resident nationals who are in the country for reasons other than being a medical tourist. It may be the result of poor recording by hospitals; whether or not a patient is a medical tourist is not at all important, to staff already busy with other duties.

A new academic study ‘Medical Tourism in India ? Economic Development and the Global Healthcare Industry’, by Kristen Smith from the Centre for Health and Society, University of Melbourne, has been published on Academia.edu, a platform for academics to share research papers.

The research explored how medical tourism as both an industry and a practice fits within the world system. Using multi-sited ethnography. it investigated five large private hospitals in Mumbai in affiliation with the Tata Institute of Social Science. Observations were conducted in hospital waiting rooms, board meetings, administrative meetings, hospital wards, waiting rooms and consultancy rooms. There were 15 semi-structured, in-depth interviews.

The paper says that levels of international medical tourism are largely unknown due to inconsistent and irregular data at national and global level. Even at a micro level, few hospitals keep correct records.

Researcher: “Medical tourism, how many cases do you get a month?”
Hospital administrator: “ Oh, not just this thing but also walk ins, okay and..from the other people too...so around ten patients a month..., so we don’t know this exactly. “ ?

Examination of a wide range of data shows increasing international patient mobility, but different patterns are emerging geographically and socially.

The five hospitals were one corporate and four trust hospitals. The four trust hospitals differed in their age, reputation, management (two were corporate outsourced) and size (bed capacity). Two of the hospitals were built in the last five to seven years. One hospital was in the midst of extensive renovations. One had a multi-tower building being built behind it to increase capacity from 400 to 700 beds. One was acquiring more land for further building.

None were specialist medical tourism hospitals. Three hospitals had official tie-ups with different consulates including: Oman, Japan, Saudi Arabia, Kuwait and the UAE. One or more consultant surgeons with rooms at each of the hospitals have their own websites marketing to international patients. They all left the marketing of medical tourism to their consultants and to medical tourism agents. Each hospital paid two or more agencies for referrals.

Of the five hospitals, only three had websites selling medical tourism on the expectation that people would somehow find their website. These rather basic websites employ different tools to advertise their services, such as: patient testimonials, video footage of the hospital and staff or virtual tours; photo galleries; details of packages and pricing; doctor profiles and publications. Three of the hospitals in the study had special international package deals for a range of treatments, but only one had significantly different pricing scales for international patients compared to local patients.

The paper looks at three ‘facts’ on Indian medical tourism:
??? ?Medical tourism is a revenue driving industry, as it will increase export earnings through attracting foreign exchange into the country, lowering fiscal deficit and assisting the economic development.

The paper argues that medical tourism is just part of a boom in the Indian healthcare industry. The government is spending lots of money on the infrastructure in a hope that it will increase medical tourism.

??? ?Medical tourism will improve local health systems. The economic growth medical tourism generates results in an overall increase of national income, thus creating equity in access through allowing more of the population access to private care and allow funds to go back into the health system.

The paper argues that the logic employs the widely critiqued notion of the trickle-down concept, but is thinly veiled. With no mechanisms in place to ensure any profits of medical tourism are directed towards public benefit, there is no validity to this claim.

??? ?Medical tourism will improve health care standards. The promotion of medical tourism will raise the standards of health care across the country through competitive market practices, which will translate to an increase of the standards in the public sector.

The paper argues that while this may be the case, it is difficult to separate the varying results from medical tourism, the rise in private health insurance, a move to international accreditations and national accreditation. The key concern is that a move to international standards is likely to increase costs for local patients, as the infrastructure costs are higher. Although medical tourism is not the only impetus for increase of standards and prices, it certainly is one key driver both directly and indirectly.

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UK: New health insurances encouraging overseas medical treatment

A UK insurance broker has launched a critical illness cover where treatment is in the USA, and a health intermediary has launched a health cash plan that will reimburse customers for treatment outside the UK.

Insurance Tailors, an independent London insurance broker, has launched XN GlobalPreferred Care, a critical illness treatment product.

Traditionally, UK critical illness insurance policies have provided a one-off, tax-free, lump sum monetary payment upon diagnosis of a prescribed illness. This payment is designed to help ease any financial pressures that may arise from contracting the illness. This product takes a new approach by replacing money with treatment.

The aim is to maximise the chance of survival, which is the key to recovery from life threatening illness. Upon diagnosis of a covered critical illness, a policyholder is given a diagnosis verification treatment plan by experts at Harvard Medical School in the USA, reducing the risk of preventable medical errors, and an optimum treatment plan is created. Cover is then provided for travel to, and accommodation in the US for treatment and recovery in a top 1% rated US hospital.

Andrew Boldt of Insurance Tailors explains, "In the UK, our ability to treat critical illness is too often constrained by local thinking and financial constraints. It is widely acknowledged that the US is a global leader in research and treatment of critical illness and this offers UK residents access to these world leading treatments and specialist diagnostics."

Versions of this cover have been available in a few other countries for five years. It has been successfully operating in Asia, the Middle East and Europe, but this is the first time it is available to UK individuals and companies.

The diagnosis, travel and treatment are arranged by global patient organization PGH. The insurance is underwritten at Lloyd's of London.

Andrew Boldt of Insurance Tailors adds, "The launch of this product is in line with our mission to change the way that the insurance industry is perceived; in this case, by bringing to market a product that I believe gives people what they want. As the first buyer of the product in the UK for my own family I can evidence this myself. This product is different to other products in the UK private medical and health insurance markets in that it has been designed with a very specific goal; to optimise the chances of survival and recovery from critical illnesses, including all forms of cancer (other than non-invasive skin cancer and cancer in the presence of HIV). This outcome is made possible by not limiting patients to local treatment, but rather making use of global best practice, research, expertise, technology and innovation.”

Customers benefit from:
??? ?The experience and knowledge of the leading experts in any covered condition at Harvard Medical School to review the diagnosis of their condition and create a treatment plan that they believe will provide the best chance of recovery from the condition
??? ?A dedicated local care manager is appointed who will be the point of contact throughout the process, overseeing everything from logistics to explanations of medical treatment
??? ?Travel to and accommodation in the US is arranged and paid for by the policy
??? ?Treatment and recuperation within a hospital rated in the top 1% of US hospitals for the specific condition is paid for directly by the policy.

Perfect Health Cash Plans has a new insurance plan for families, the self-employed and businesses. Surgical Cash is a health cash plan that pays a fixed sum of money should customers need an operation. They can choose the treatment privately in the UK or abroad. Alternatively, they can keep the money and have treatment on the NHS.The customer has to make all arrangements for treatment and travel, whether in the UK or Europe, and gets cash back from the insurers after treatment.

Perfect Health Cash Plans is a specialist health insurance intermediary. Cover is underwritten by Compass Underwriting. Surgical Cash plan is insurance for when people are really ill and require a surgical procedure, but is much cheaper than traditional private medical insurance. Several dental and cash plans in the UK now allow customers to choose whether they get treated at home or go to Europe, but all work on a reimbursement basis where the customer pays out, arranges travel and treatment, then gets some money back from insurers.

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GLOBAL: New online medical tourism courses launched

US company, Medical Tourism Training, has launched five new online courses to provide fundamental information and skills vital to success, for industry professionals and consumers who want to learn about international health travel and medical tourism.

Developed by a team of experts including medical tourism experts with backgrounds in healthcare, business, education and law, the affordable and convenient course materials are based on international best business practices as well as experience in the sector. ?

The five courses-
??? ?Introduction to medical tourism
Focuses on five areas fundamental areas forming the basic understanding of medical tourism: its definition and history, factors driving the growth in the sector, major countries involved in international health travel and the services they offer; and current issues.
??? ?Basic medical terminology
Covers more than 225 words related to medicine and medical tourism. Throughout this class, words are spoken while each slide contains the written word, a phonetic guide to pronunciation, a definition, and images or photographs to maximize understanding and retention.
??? ?Telephone skills for the medical tourism professional
This is filled with practical advice as well as audio and video clips demonstrating the “Do’s” and “Don’ts” of telephone etiquette. It offers opportunities for you to practice and improve your telephone skills. Learn how to manage telephone interactions professionally so that you can consistently create positive impressions about you and your business.
??? ?Email etiquette ? netiquette
Proper business skills for communicating via email are vital to building and maintaining a global business. This course contains no-nonsense advice as well as audio clips demonstrating the “Do’s” and “Don’ts” of email etiquette. Sharpen your email communication skills to deliver improved customer service.
??? ?Essential skills for working with upset customers
This business skills development course provides essential tools to avoid or defuse negative situations as well as restoring business relationships following a harmful experience with upset customers. Through the use of narrative, audio and video clips, you will learn skills for better interactions with your clients, staff and management, and other professionals.

All are available individually or in any combination and reflect the company's emphasis on the importance of excellent customer service. Ruth Rietveld-Kirwan explains, "Online courses provide flexibility for busy people who want to learn in the convenience of their own home or office, at their own pace, when they have the time.? It is an easy way for a global audience to access the information, training, and skills needed to succeed in medical tourism. These introductory courses are for individuals interested in learning more about international medical travel.”

The courses are designed for a wide audience including medical travel agents; international care coordinators; medical professionals; support staff in hospitals, clinics, private medical and dental offices, spas; travel agents; hospitality professionals; as well as prospective or current medical tourism clients and anyone who is curious about the medical tourism industry.

Elizabeth Ziemba of Medical Tourism Training says,” Our objective is to design content-rich, visually appealing courses that are affordable to just about anyone, anywhere.? Through the use of audio and video clips as well as a variety of quizzes, individuals can learn essential information and practice skills, bringing a higher level of professionalism and excellent customer service to the international health travel sector. While we are busy developing additional courses that will be at an intermediate level, our team has created courses that are an excellent introduction to medical tourism".

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BELIZE: Local doctors oppose medical tourism plans for Belize

There is growing controversy over the potential development of medical tourism in Belize.? The policies are currently being drafted and could open up the market to new medical facilities that may offer health care exclusively to foreigners. The problem is that the government is working with investors, but refusing to include local medical professionals in any debate or discussion. Medical tourism could hurt the pockets of local doctors, as it seems that American medical professionals will provide exclusive health services that are already being offered by locals.

In a radio interview, Joel Cervantes, president of the Belize Medical and Dental Association said that removal of medical tourism services offered by local doctors could seriously affect the viability of well-established institutions,“ What is very important to realize is that medical tourism, at this point for Belize, poses a threat as there are a lot of interest both inside Belize?powerful businessmen, very politically aligned?and also foreign interests with a lot of money and they are interested in opening up medical tourism. In fact, there are a lot of advanced plans; we know that there is a place in the Free Zone; we know that there are plans for something to go on in San Pedro, and also down in Placencia. The only problem, in our view is that medical tourism should first and foremost be a national industry whereby we, as Belizeans, local doctors, dentists, nurses and all health allied personnel, should be the ones that are leading. But we have been left out of the picture.”

Most available medical procedures are cheaper in Belize than in the USA, but many residents head north into Mexico for treatment, where costs are lower, facilities are better and more procedures are available. Facilities, equipment and doctors in Belize are in extremely short supply, so the range of available treatments is limited.

Belizean doctors generally come from abroad and the vast majority work in publicly funded clinics or hospitals. A few run their own private medical and dental practices, with some advertising to foreigners. A few people have visited Belize as medical tourists, often enjoying Belize's laid-back atmosphere as a great place to recover.

The Placencia Group wants to promote the country as a health and wellness destination for Canadians, Americans and Europeans. The five star therapeutic and wellness resort will be part of an acute care hospital at The Placencia, 10 minutes from Placencia International Airport. The company claims it has government support for the venture that will also offer stem cell treatment.

It seems that the politicians are planning to develop medical tourism, without involving local healthcare professionals. Mike Singh of the Caribbean Export Development Agency reports, “The policies are currently being drafted and will open up the market to new medical facilities that may offer health care exclusively to foreigners. It was discussed at a forum spearheaded by the Caribbean Export Development Agency and the Inter-American Development Bank. There are inquiries coming in from medical professionals abroad that are interested in setting up facilities. It is an area that has quite a huge scope for development.”

The reason that local hospitals are not happy is that under current proposals, overseas organisations flying doctors in from the USA would get preferable tax treatment to Belize clinics promoting medical tourism.

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INDONESIA: Indonesia wants to become a health tourism destination

A tourism minister in Indonesia has stated that Indonesia has the potential to become a health tourism destination. Yet in 2012, a record number of 600,000 Indonesians travelled overseas for medical treatment. Two out of three go to Malaysian hospitals and clinics. This makes Indonesia the biggest outbound global medical tourism country source.

The number of Indonesians seeking medical treatment abroad in 2012 saw a significant increase from 2006 when nearly 350,000 people went overseas and spent $500 million. In 2012, it is estimated that 600,000 Indonesians spent $1.4 billion on medical treatment overseas. The increase suggests that they go overseas for quality and availability of care as much as for cost reasons. This is why the key destinations are Malaysia and the now high priced Singapore, with very few going to low priced India.

While Singapore is still a favourite medical destination for the well-heeled Indonesian, the majority of Indonesians, especially from Sumatra favour Malaysia. Indonesians from Sumatra form the majority of overseas patients at Mahkota Medical Centre in Malacca and Penang Adventis Hospital. The Malaysia Health Travel Council (MHTC) website is available in Bahasa Indonesian, and Malaysia targets the country.

Tourism minister Mari Elka Pangestu claims that Indonesia can become an international health destination because of its abundant natural beauty, with a huge potential to attract tourists looking for low-cost health and medical care, “Indonesia’s potential to become a health tourism destination is big because Indonesia has many attractive places. Indonesia has geographical proximity to many wealthy countries, such as Australia and China. There is much local and traditional wisdom on healing all measure of ailments. Indonesia has been named as the best spa destination in the world. A well-established health tourism industry can bring in revenue not only from foreign health tourists but also from our people who travel abroad to seek medical treatment.”

The response of health minister Nafsiah Mboi to the record number going overseas for medical treatment was, “We will start with action. We will immediately set up working groups and an action plan. The government has identified four hot spots in which to begin developing health tourism: Bali, Jakarta, Makassar and Manado.The four areas were chosen not only because the health facilities there are already advanced but also because there are many things to see. As well as spas, Indonesia also has potential in the medical sector. The country boasts many specialist doctors with good international reputations, but many people are not aware of that due to a lack of promotion. To attract patients from overseas, the government will have to collaborate with travel agents and increase cooperation between hospitals, clinics and spas. More Indonesian hospitals need international accreditation from the Joint Committee International.”

If medical tourism potential is large, why are 600,000 Indonesians going overseas? Nafsiah Mboi’s answer is: “Attitudes need to change so that those Indonesians seeking medical treatment will make the effort to find that treatment at home. I often wonder why Indonesian people like to get check-ups in Singapore. What is it that we don’t have? It turns out the answer is because of the service and the mental attitude. We don’t have any pride to serve. In Singapore, doctors are willing to spend time to listen to patients’ complaints and discuss the various medical procedures that are available.”

The Ministry of Health and the Ministry of Tourism have signed an agreement for the development of health tourism. The government will work with public and private stakeholders, including hospital representatives, spa providers, and health associations, to create the Indonesia Wellness and Healthcare Tourism (IWHT) working team, which will jointly design a work plan to follow up the agreement.

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TAIWAN: Taiwan approves amendments to allow foreign investment in hospitals

The Taiwanese government has approved a package of amendments that pave the way for foreign investors to open hospitals in Taiwan, although a decision has yet to be made whether or not Chinese investors will be eligible for the new measures. The law amendments must be approved by the legislature before they can be implemented, but that is only a formality. In line with the amended provisions, which provide tax incentives, investors in international medical services can establish hospitals in an exclusive biomedical park in northern Taiwan's Hsinchu County in the form of a corporation. They can also issue shares. Health minister Yaung Chih-liang said, “ This will help lay a foundation for Taiwan to develop international medical services and medical tourism.

The DOH has agreed to allow foreign investors or joint ventures to set up the hospitals based on the build-operate-transfer model on a 7.85 hectare plot within the planned 38-hectare biomedical park in Hsinchu. It is estimated that foreign capital will be attracted to Taiwan as a result of the plan. The DOH does not restrict international investors from setting up medical facilities in appointed zones, nor does it limit the number of such facilities, so Kinmen Island would also be an acceptable location.”

The government has been criticized for promoting medical tourism at the expanse of caring for the local population. So it argues that such international hospitals add to rather than take away from Taiwan’s medical resources, as they are profit-making establishments that target only the better off customer who must pay for all of their own expenses, with no subsidy from the government. Taiwan’s medical level is on par with international standards and can compete with Singapore, Hong Kong and Dubai, but the country has not attracted as many patients as it expected.

With the relaxation of rules on Chinese traveling to Taiwan, Taiwan Institute of Economic Research (TIER) says Taiwan had 40,000 medical tourists in 2009, and estimates for 2010 are at least that. But this is nowhere near the government’s target of 100,000 by 2012. The Taiwanese government is focusing on health examinations, cosmetic surgery, dentistry, laser eye surgery and Chinese herbal medication in order to attract Chinese from around the world to Taiwan. Although other nations are targeted, the country has found it almost impossible to attract Europeans and Americans not of Chinese origin. Scores of local hospitals have joined the top ones in targeting medical tourists, while entrepreneurs have set up clinics just to offer health checks.

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ROMANIA: Medical Insight launches website for health travel outside Romania

Medical services consulting company, Medical Insight, has launched healthtravel.ro, the first Romanian site containing information about foreign hospitals. The website targets those who want to travel from Romania for medical services and capitalizes on a developing trend on the Romanian market. Many Romanian patients ? including Romanian president Traian Basescu ? have chosen hospitals outside the country for major health interventions. Medical Insight, founded in 2010, is a company that offers consultancy to those who are looking for medical services in foreign countries.

Adriana Sarbu of Medical Insight says, “If in the past people used to go to Austria or Germany for treatment, now, according to our research, a lot of Romanians prefer Turkey for medical controls and interventions. This is a growing thing, considering that the quality of service is very high and that the prices are comparable to the ones in Romania and lower than those from the Western European countries.”

The site contains information about treatments, medical specialties and the country providing treatment, along with detailed presentations of hospitals based on the held certifications, reports of independent institutions and former patients reviews. The site also helps people who want information about health insurance or funding opportunities for treatments.

Romanian hospitals might be classified into five categories of competence from May this year, if the Romanian Health Ministry’s project is approved. The project contains the methodology for classifying hospitals, depending on jurisdiction and minimum mandatory criteria for hospitals classification in new categories. This should ensure efficiency by avoiding overlap and duplication between hospital units, ensuring equitable access to health services for citizens and lower treatment costs. Moreover, the classification based on this methodology will be used to establish protocols for transferring uncritical cases between hospitals. It will also play a key role in developing proposals for additional funding to hospitals and good planning, as well as procurement of medical equipment.

Private healthcare services operator Centrul Medical Unirea (CMU), the second largest clinic group in Romania, bought Euroclinc with a hospital and three clinics. CMU runs four hospitals in Bucharest, a hospital in Brasov and 20 clinics. It also owns half of the stem cell bank Stem ? Health Unirea in Bucharest. The company took over Euroclinic hospital and clinics from Eureko in September 2010. CMU is majority owned by investment fund Advent, and the rest of the shares are owned by founder Wargha Enayati.Despite such investment, the provision of health services in the country is still poor, which is why many people seek treatment elsewhere.

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USA: USA gets organized on inbound medical tourism

Until recently US hospitals all acted independently on inbound medical tourism so there was no co-ordination or co-operation. There are several new initiatives as part of the US government’s aim to make the country the top global destination for travel, to improve the economy, and discourage outsourcing to other countries.

The US Cooperative for International Patient Programs (USCIPP) was recently launched as a means to increase the global competitiveness of US healthcare providers and to improve access to healthcare in the US for patients from around the world.

USCIPP is a partnership of the International Trade Administration of the US Department of Commerce, UHC, and Rush University. The aim is for domestic providers catering to international patients to share best practices and potentially grow their business collectively.

In November 2010, the U.S. Department of Commerce awarded the Rush University of Chicago, in partnership with the University HealthSystem Consortium, a three-year $500,000 Market Development Cooperative Grant to help increase medical travel to the country. The idea is to stimulate growth through better data that tracks international patients and services, networking across institutions and the implementation of the best strategic business development practices. The grant is intended to support President Obama’s National Export Initiative, which aims to double exports (any form of U.S. medical care purchased by people outside the country) by 2015. The aim is to create millions of U.S. jobs with the influx of thousands of patients with a vast array of needs.

Plans include establishing a forum for international patient programme, creating a standardized set of data elements to be reported on international patients, determining the value of medical care exports, hosting a series of meetings focused on strategies to increase the global competitiveness of US health care providers, and developing strategic relationships with ministries of health and private payers abroad

The federal government has been making determined noises about encouraging international travel to the USA. The new Brand USA is a public private partnership with the mission of promoting increased international travel to the United States. The Department of Commerce is forecasting an increase in international arrivals of 6% a year in 2012-16. President Obama’s ambition is to make the USA the world’s top travel and tourism destination. In 2010, 59.7 million international visitors went to the America, generating some US$134 billion for the economy. The USA remains the world’s second most visited, after France. The US administration and UNWTO estimate that 62.5 to 63.0 million international travellers visited the USA in 2011. Tourism is already the USA’s most important export service industry. It is also seen as a way to boost job creation - an urgent priority in the current economic climate. Tourism represents nearly 3% of the country’s GDP and is responsible for some 7.5 million jobs, according to the US Department of Commerce.

Among the steps to be taken by the US administration to boost tourist arrivals is a streamlining of visa formalities. Efforts will be made to expand the Global Entry Program place this year, making it easier for frequent visitors to the USA (who have therefore already undergone a background check) to travel across US borders. More countries will be invited to join the list of those whose citizens are allowed to visit America without a tourist visa under the visa waiver programme. Steps will also be taken to accelerate travel formalities for booming markets such as Brazil, China and India.

Medical travel has representation in the new travel and tourism strategy, with the appointment of Steven Thompson of Johns Hopkins Medicine International, to the U.S. Travel and Tourism Advisory Board. Thompson is one of 32 member of the board, which advises the Commerce Department on policies and issues affecting travel and tourism. Steven Thompson commented,” There is a growing demand for US health services coming from the international community. The adoption of travel policies that encourage and support growth in international travel are vital.”

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THAILAND: Thailand seeks to restore medical tourism

Plans to position Thailand as a leading medical tourism destination are being revived, starting with an effort to persuade foreigners that it is safe to visit the country as political tensions recede, says public health minister Jurin Laksanavisit.The minister says his immediate priority is to listen to the concerns and proposals of people in health care and related businesses. As medical tourism is a key element, support from the Tourism Authority of Thailand will be required. “In the short term, we will require some roadshows to restore the confidence in safety among foreign patients when they come here to get medical treatment."

Concern about safety was heightened during the ten weeks of anti-government protests that culminated in violence and arson in mid-May. At one point the red-shirt protesters invaded Chulalongkorn Hospital, claiming it was harbouring soldiers. Images of the chaotic scenes as the hospital attempted to evacuate hundreds of patients were seen worldwide.

Thailand over the past decade has developed a thriving medical tourism industry, capitalising on high-quality, well-equipped private hospitals and skilled practitioners offering quality care at far less cost than in developed countries. Thailand has demonstrated good potential, proven by the increasing number of foreign patients, and worldwide recognition of Thai health care and other services such as massage. Traditional Thai and alternative medicines are likely to attract more foreign visitors for seeking treatment in Thailand. According to the Department of Health 1.5 million foreign patients visited Thailand last year for medical and health tourism, compared with 630,000 in 2004. Wattanosoth Hospital in Bangkok reports that foreign patients have delayed their visits recently because of political unrest and the imposition of a state of emergency. 35% of the hospital’s patients come from overseas, mostly from Southeast Asia and the Middle East.

Not everyone is convinced that stating that everything is now safe will be enough to restore tourism and medical tourism, as this year’s problems are just a continuation of earlier unsolved internal troubles. Apichart Sankary of The Association of Thai Travel Agents (ATTA) has serious doubts on Thailand's revised official tourist target for 2010 of 14.1 million “This is only the minister’s dream. It is not the reality we all recognise in the business. If we can reach 10 million, we will be lucky."

While the health minister may suggest that a few roadshows in countries that send people to Thailand will be enough, others disagree. Suraphon Svetasreni of the Tourism Authority of Thailand is among those believing that Thailand must restore confidence in Asian markets before advertising campaigns can be launched,” We have to restore confidence in Asian markets such as China, Korea, Hong Kong and Japan because these markets can recover quickly. Then we have to move to medium and long-haul markets to regain the business in time for the high season.”

Under the banner ‘Together We Can’, government officials and private sector businesses have agreed to brainstorm marketing strategies to rebuild confidence, although no specific dates, meetings or action steps have yet been announced. A medical tourism network to boost business in Thailand was launched recently in Bangkok. The Medical Tourism Cluster (MTC) intends to recruit a wide range of tourism players who offer wellness and medical services in Thailand. It will coordinate business contacts and sales leads between cluster members and overseas medical tourism providers. Network founder Prakit Chinamourphong says that the MTC could help boost medical tourism by connecting local companies to overseas markets and suppliers. Within Thailand, Phuket has become a major participant in the medical tourism sector and ranks second only to Bangkok in terms of the volume of foreign patients seeking treatments.

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PHILIPPINES Medical tourism development in the Philippines

An integrated medication tourism zone is planned in Nasugbu, Batangas, with completion due by November 2012. Local company Global Village Mobile Network Corp (GVMNC) has been approved by the Philippine Economic Zone Authority (PEZA) as a new ecozone medical tourism enterprise. GVMNC facilities will occupy a 24-hectare portion of the 52-hectare medical tourism park being developed by local group Camp David Investment and Holdings (CDIHI). PEZA has also approved CDIHI as a new medical tourism park developer subject to a presidential proclamation. CDIHI has allocated P318 million for the development of the park.

Facilities within the medical tourism park include a tertiary hospital that is designed to accommodate 100-bed in-patient suites, 8-bed intensive care units, 8-bed cardiac care units, 10-bed hemodialysis unit, 8-bed day care surgery unit, 3 fully functional operating rooms, a cardiac catheterization laboratory and a lithotripsy unit. A five-star hotel will accommodate visiting relatives and patients. The development also includes clustered home facilities for the elderly with long term medical care requirements. These are designed to provide programmed long-term care to 1152 residents, some locals but mainly Japanese retirees, with on-line telemedicine facilities. Other facilities in the park include healthcare, wellness and cosmetic surgery and spa; condominium administrative housing, country club complex, pavilion complex and satellite network hub facility.

The Cebu Health and Wellness Council (CHWC) is upbeat about Cebu’s potential in medical tourism. The group is seeing an increasing number of medical travelers in the province. It seeks to use the country’s growing expatriate Filipino workers, balikbayans, as envoys to promote medical tourism where they work.

CHWC is a private-public sector coalition developing and promoting the health and wellness industry in Cebu. It includes hospitals, doctors, dentists, spas, hotels, travel agents, tour operators and government departments.

The aim is to position Cebu as a premier health and wellness destination in Asia by attracting foreign patients through testimonies and first-hand experiences of balikbayans of local medical and wellness services. The Department of Tourism-Cebu wants to attract Filipinos around the world to come back home for health and wellness services and become ambassadors for the sector. So international Filipino communities with foreign friends would share by word-of-mouth their personal experiences of local health and wellness therapies. CHWC member-organizations are conducting talks with several Filipino communities abroad who could help bring in Filipino patients. Cebu also wants to attract Americans and Europeans seeking medical services and wellness vacation packages. The Philippines wants to catch up with rivals Thailand, India, Singapore and Malaysia.

This year’s Beauty, Health and Wellness Show will showcase the Cebu health and wellness industry. The BHW Show 2009 will take place on November 4-8, at the Ayala Center in Cebu. Organisers hope to better last year’s 47 exhibitors by targeting beauty salons, beauty clinics, hotel spas and day spas, fitness studios and gyms and health foods and restaurants. The show has changed from a trade show into a wellness event, and will feature dental and medical tourism forums.

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ISRAEL: Medical tourism increasing in Israel

Many countries welcome expansion in medical tourism, but the boom in Israel’s medical tourism has been attacked by a government official, the State Comptroller, in his annual report on healthcare; Joseph Shapira told Parliament, ”The booming industry luring foreigners to Israel for medical procedures infringes on the principle of equality in the provision of health services”.

According to the Health Ministry, revenue from medical tourism in state hospitals was NIS 54 million in 2009. But by 2011, it was 2.2 times higher, at NIS 119 million.

Medical tourism to Israel is also growing for private hospitals and is expected to increase more in the future. Future tourism and medical tourism will be easier after Israel's government approved an "Open Skies" deal to allow more EU flights, lower air travel prices and increase competition after April 2014.Tourism is a major industry in Israel, bringing in more than 3.5 million visitors a year.

The Health Ministry both owns and runs state hospitals, as well as supervising healthcare nationwide. There is an increase in private healthcare in public hospitals; while the ministry is helping private interests build and run a public hospital with private medical care in Ashdod. There is also an increase in private healthcare, with politicians and economists divided as to whether or not an increase in privatisation of state healthcare is good or bad for the public.

In the 2012 annual report, the comptroller notes that the ministry has very little data on what and how many services ? mostly elective surgery ? are provided by the 11 private hospitals around the country,” The rate of activity of the private system cannot be compared with the public system. Going to a private hospital for surgery enables patients to choose their own surgeon ? usually doctors who work mornings in the public hospitals and moonlight in the afternoons and evenings. There was a 22% rise in private hospital activity between 2005 and 2010 compared to only 14% growth in public hospitals during that period. The time may have come to prohibit patients in private hospitals from being able to choose their surgeon or consultant.”

Medical tourism and whether treating foreigners in public and private hospitals comes at the expense of Israelis is a vital issue raised in the report. The shifting of dwindling numbers of medical personnel to the care of outsiders may also harm the Israeli public, but the ministry has not examined the problem and set down rules. The ministry says that it is now doing so.

The government has often said it will regulate medical tourism, but the latest report and replies in Parliament suggest that new rules and regulations will be devised, but it could take a few years.

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GLOBAL: New portal claims to be first for medical evidence for spa and wellness therapies

The new SpaEvidence.com claims to be the world's first portal for medical evidence for spa and wellness therapies. It is an online resource dedicated to the medical evidence that exists for spa and wellness therapies. With thousands of clinical studies evaluating the effectiveness of approaches like hydrotherapy, massage or meditation, SpaEvidence makes it easy and free for people and medical, wellness and spa professionals to research what has been proven to work, what is not and for what conditions.

Professor Kenneth R. Pelletier of the University of Arizona says, “People assume that the clinical evidence always sides with conventional Western medicine, but the gold standard for medical research, the Cochrane Reviews, indicates that only 30%-35% of conventional medicine is adequately evidence-based. Increasingly more doctors agree that one of the largest bodies of medical evidence is the one demonstrating that lifestyle changes, mind-body approaches and stress-reduction have the largest impact, on the largest number of health conditions, for the largest number of people. This site is a breakthrough because the evidence already exists, but until now it has not been easily accessible.”

Dr. Daniel Friedland of SuperSmart Health adds, “The crippling costs of many traditional healthcare systems, which narrowly focus on sickness, pills and procedures - rather than prevention and lifestyle changes have become unsustainable for many people, governments and corporations. Hundreds of millions of people are now embracing smarter, prevention-focused, more integrative and personalized health approaches. But they demand the facts.”

SpaEvidence's key features:
??? ?Research: Users can search four of the most authoritative evidence-based medicine databases for studies on 21 spa and wellness approaches: Natural Standard, The Cochrane Library, PubMed and TRIP.
??? ?Spotlight: Highlights select medical studies for each therapy as a springboard to further research.
??? ?Studies-in-Progress: Visitors can investigate the clinical trials underway globally.
??? ?Conversations and contributions: Users can contribute studies and their own experiences/outcomes with spa/wellness approaches.

The portal's functionality will continue to expand, and additional spa and wellness approaches will be added regularly.

Susie Ellis of The Global Spa Summit says, “Our industries have long been accused of soft, anecdotal claims, when what was really missing was a resource to access the clinical research that supports so much of what we do. Some of the medical evidence for spa and wellness approaches is powerful, some is inconclusive, some is negative and far more studies need to be undertaken. But embracing transparency is the path to true legitimacy and industry growth, and I hope every spa and wellness center worldwide will use this portal, link to it and spread the word.”

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DUBAI: Slow growth for Dubai medical tourism

Despite major investment in facilities, marketing and government support, Dubai expects a modest single figure growth in medical tourism in each of the next three years.

Dubai Health Authority and the Department of Tourism and Commerce Marketing are working together to promote medical tourism. Marketing spend at medical tourism conferences and exhibitions as far away as Moscow and Monaco is substantial.

In 2012, Shaikh Hamdan Bin Mohammad Bin Rashid Al Maktoum, Crown Prince of Dubai told many of the organizations that he controls to do everything possible to finally deliver on the medical tourism investment that has been made for the last five years.

The Dubai Health Authority (DHA) and the General Directorate for Residency and Foreigners Affairs (GDRFA) have agreed to simplify and speed up the medical tourism visa process, so that overseas patients who wish to have treatment in Dubai can take advantage of a three-month medical tourist visa, extendible twice, up to nine consecutive months.

Part of the initiative is encouraging global healthcare providers to set up businesses and increasing both government and private investment in healthcare. The Dubai Health Authority has completed a comprehensive capacity survey of public and private healthcare facilities in Dubai under the Dubai Clinical Services Capacity Plan (DCSCP) 2020. Eisa Al Maidour of the DHA explains,” This information will provide investors with the necessary data for investment. The DCSCP will point out the specialities and sub-specialities where investment is needed. The data will definitely make Dubai’s healthcare environment attractive for investors.”

Marwan Abedin of Dubai Healthcare City (DHCC) estimates that 15% of its patients are medical tourists, and that the number of inbound medical tourists in Dubai was up 10% to15% in 2012; this is an estimate only. But growth for 2013 to 2015 is expected to be lower at 7.2 % a year. DHCC states that it attracted 410,000 patients in 2010, and 502,000 in 2011. Latest estimates for 2012 are at around 550,000. At various times DHCC claims 15% or 20% of patients as medical travellers; but this is actually all international travellers, including business people and holidaymakers. Exactly how many are real medical tourists is a question that remains to be answered;? it is likely to be around 50,000 and 80,000 and thus in line with other significant destinations.

Most medical tourists to Dubai are from the GCC and the wider region; as well as people from countries including Libya, Iraq, Iran, Nigeria, Tunisia, India, Pakistan, and Russia. The original idea that Dubai would appeal to Americans and Western Europeans has been abandoned.

Part of the initiative is to persuade UAE residents to stay home to get treated, rather than go overseas, and that is beginning to work as the number of UAE based patients were up 12% in 2012. Although the majority of patients living in the UAE prefer to be close to home, many others still prefer to be treated outside the Mena region? in Europe or North America. Some patients do so because the country lacks the specialisations they require, which can be found in other countries; while others do not trust the public hospitals, and the cost of treatment in Dubai is high compared to Asian competitors.

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RUSSIA: Attracting health and wellness investors and tourists to Russia

The tourism industry in Russia is expanding with health resorts a popular choice for vacations, says the Federal Agency of Tourism. Tourism is growing at a rate of 7 % a year and one in three Russians favour health resorts as their vacation destination. Grigory Sarishvili of the Federal Agency comments, "Health resorts are gaining popularity and in certain regions are fully booked all year-round.”

Russia is to spend up to $60 million on a six-year advertising campaign to bolster its image as a tourist destination, as part of the government's programme for the development of tourism through 2018. The $60 million earmarked for advertising will be spent on subjects and programmes about Russia on federal channels, promotion on social networks, exhibitions, the organization of presentations about Russia in foreign countries, promotional campaigns and the organization of press tours.

While the campaign is directed at both domestic and foreign tourists, the total number of foreign tourists visiting in 2011 is disappointing as European economic problems are affecting the chief suppliers of visitors to Russia: Germany, France, Britain and Italy. Of the 22 million foreign visitors in 2010, only 2.1 million were tourists.

Northern Caucasus Resorts Company (NCRC) is developing a massive system of ski, beach and natural heath spa resorts covering 50,000 sq km in the North Caucasus Mountains, stretching 1,200 km from the Caspian Sea to the Black Sea and bordering Asia. It is attracting Asia-Pacific investors seeking to diversify outside their domestic markets in a new national strategy to use public-private initiatives in tourism to spur much-needed economic growth in depressed regions of the Russian Federation.

Moscow-based NCRC was established last December to drive the massive tourism project, which will create up to 300,000 new jobs. A collaboration with the federal government, the development is part of a long-term strategy to address the economic lag that underlies social tensions in the North Caucasus region. The ten-year project is anticipated to require up to $30 billion to complete all phases, including a cluster of five world-class skiing and five modern seaside resorts, as well as an array of health spas that will take advantage of the area's legendary healing mineral and hot springs. The eventual aim is 150,000 visitors a day.

The Russian government has designated the entire 50,000-sq-km development area a special economic zone. State guarantees will cover up to 70 % of investments for three to ten years. The state will impose no corporate or transportation taxes for the first ten years, no land taxes for five years and no VAT tax will be applied on equipment imported into the SEZ. The project offers opportunities for foreign companies interested in hospitality, health and wellness, food and beverage, retail, real estate, logistics and warehousing industries.

The French state-owned banking group and long-term investor Caisse des Depots et Consignations (CDC) has signed a strategic joint venture with NCRC to provide advanced technical, legal, planning and environmental expertise to support the project. 20 French companies have already expressed interest in investing in ski lifts, hotels, airports, mountain tunnel and other construction projects.

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EUROPE: Developments in dental tourism

Eurodent has launched new dental treatment packages to Norway, there is a study into the competitiveness of the private dental sector in the UK, and low cost treatment in Eastern Europe is gaining popularity. ?

Eurodent, a company that offers dental services in Norway, has launched new affordable dental treatment packages. These includes various dental services, such as tooth extraction, dental implants, fillings, veneers, bleaching, porcelain crowns, root canal treatment, bridges, dentures, and cosmetic dentistry. Eurodent arranges travel and accommodation.

The increasing costs of UK private dentistry are making Eastern Europe an attractive destination for dental patients.? This and the fall in the number of people paying for dental treatment has lead to the UK Office of Fair Trading (OFT) to investigate why British dental charges, both NHS and private, are among the highest in Europe.

The OFT market study will examine whether the private and NHS dentistry markets are working well for patients. The UK market for dental services was worth ￡7.2 billion in 2010. Forecasts suggest this could grow to ￡8.2 billion by 2014 with much of the growth coming from the private market. While the OFT recognises that the UK has some of the highest standards of oral care in the world, it wants to examine concerns raised by consumer bodies such as Which? that many patients are confused over dental treatments and prices. The study will focus on how dentistry services are sold, whether patients are given appropriate information to help them choose between dental practices, the types of treatments on offer and different payment methods in the context of both NHS and private dentistry. It will also look at how easy it is to change dentists, and whether the current system for customer redress works. The study will also examine whether there are any unnecessary barriers to new practices entering either private or NHS funded markets, and consider the issue of professional restrictions on direct access to specialists or providers of auxiliary services, such as hygienists.

Sonya Branch of the OFT says, “Patients appear to be confused about the prices they are being charged and concerns have been raised that they may not be getting sufficient information or adequate choice over the dental treatments they receive. We also note that the costs of private dental treatment in England are among the highest in Europe. Given the current strains on people's finances, we think it is a good time to examine whether competition is working effectively to drive up the quality of private and NHS dental services and deliver better value for money for consumers.”

Consumer organization Which? has compared the average cost of a dental implant and crown in a few EU countries-
??? ?UK?? ? ?? ?￡2,200
??? ?Spain?? ? ?? ?￡850
??? ?Hungary?? ? ￡750
??? ?Poland?? ? ￡750

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CHINA, TAIWAN: Value as a medical tourism driver for Chinese people going to Taiwan

A new academic study on Chinese medical tourists who go to Taiwan suggests that they are looking for value for money. This in turn is a mix of medical quality, service quality, price and ‘enjoyment” of the whole process.?

Hsiu-Yuan Wang of Chung Hua University has produced a research paper ‘Value as a medical tourism driver’ for Emerald Group Publishing.

Purpose
The study contends that customers’ perceived value can drive medical tourism. To demonstrate this, this article proposes and tests a research model capturing elements of perceived benefits and sacrifice that, by affecting the perceived value of medical tourism products, influence the buying intention of potential customers.

Design/methodology/approach
Potential medical tourists from China are researched due to their cultural similarity to Taiwan, and the absence of a language barrier. Data from 301 usable questionnaires were tested against the research model using the structural equation modeling approach.

Findings
The results indicated that perceived value was a key predictor of customer intentions. As for benefits, perceived medical quality, service quality and enjoyment were critical components that significantly influenced the perception of value. Regarding sacrifice, the effects of perceived risk on perceived value were significant.

Research limitations/implications
The study targeted potential medical tourists. Therefore, a validation using another large sample of actual medical tourists is required to generalize the findings.

Practical implications
The findings can assist governments in developing policies that promote medical destination and provide insights into research on how destination countries can make medical tourism a win/win option for themselves and international patients.

Originality/value
The author claims that the proposed model is original and “Unlike most prior papers which take a conceptual approach to medical tourism, this study contributes to an understanding of the factors that influence the travel intentions of medical tourists through its empirical investigation, and especially in its targeting of customers’ value perception.”

This is valuable research that shows how price-driven medical tourism marketing is now out of date.

The study can be bought from

http://www.emeraldinsight.com/journals.htm?articleid=17053573

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GLOBAL: The globalisation of fertility treatment

A huge variation in the availability and practice of fertility treatment is revealed in a new survey of 105 countries from the International Federation of Fertility Societies (IFFS). The UK has 66 clinics, Germany 120, Spain 200 and Italy 360. Japan has 615 clinics, and in India there at least 500 clinics.

Surveillance 2010 was compiled by Professor Ian Cooke of the IFFS, who says: "What is considered acceptable varies from country to country. These great differences in clinical practice do not show up in other fields of medicine, indicating that social or religious attitudes, rather than the best practice of medicine, often drive what is allowed. In Italy, the legal need to replace fertilised embryos goes against all clinical thinking. The variation in international laws relating to infertility treatment is one of the reasons that cause couples to seek cross-border treatment. Whilst this is unavoidable we call for international standards to ensure these patients receive consistent advice and safe treatment. Although a country’s law or professional society guideline for treatment may reflect the overall cultural view in that jurisdiction, it does not necessarily mean that all that country’s residents have the same view. They may then seek access to the treatment abroad."

The survey shows that many Catholic countries have strict controls on the use of embryos. Costa Rica declared IVF unconstitutional in 2000 because it regards the embryo as a person from the moment of conception. Costa Rica is the only one of 43 countries where IVF is illegal. The huge variety of what is or is not allowed, helps create cross-border fertility treatment. Many people travel abroad for fertility treatment and have success with no legal difficulty. The review of reproductive health services highlights large discrepancies in regulations and practice in several nations. As a consequence, some patients who go overseas may face legal or medical issues. A third of the 43 countries do not permit surrogacy

The European Society of Human Reproduction and Embryology (ESHRE) and IFFS are concerned that the safety of patients crossing borders is no longer assured due to lack of uniform clinical and safety standards between the different countries. ESHRE, in co-operation with national and statutory organisations, is developing a code of practice on cross border reproductive care that will lay out a set of rules that protects and reassures patients, donors, surrogates and future children.
Francoise Shenfield, of ESHRE’s cross border task force and author of the first study of European patients crossing borders to obtain fertility treatments says, "Although in principle the care of foreign and local patients should essentially be the same and fit the best possible standards, there is evidence that it is not always so."

Both international organisations support the rights of patients to travel to receive the best treatment. Ideally this should take place in their home country, but if patients need to travel to receive the best treatment, both societies support this decision. At the same time, ESHRE and IFFS call for the harmonisation of national standards to increase the safety of patients crossing borders to obtain fertility treatments in the hope that uniform standards of practice can ensure equitable treatment for all citizens.

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SRI LANKA: Sri Lanka hospitals to increase capacity and seek medical tourists

The Lanka Hospitals Corporation is looking to increase capacity and expand into regions beyond Colombo. It is also exploring partnerships with investors. Lakith Peiris of Lanka Hospitals says, “Capacity increase at the current premises is being discussed and we will add 100 more rooms and new theatres and clinics this year. We are discussing with other parties and investors the possibility of partnerships or joint ventures to build new hospitals in the country. These discussions are at the early stages and we are still exploring the possibilities. On April 1 the first preliminary care centre will be opened in Malabe. This will house an outpatient department, laboratory, pharmacy, emergency care and also preliminary care. We will open six such centres in the Colombo suburbs this year.”

The hospital has plans to open an international patient care centre in a bid to cater to foreign patients. It will start to promote medical tourism this year, as it believes Sri Lanka is well on its way to be recognised as a medical destination. The former Apollo Hospital was rebranded as Lanka Hospitals in November 2009.

Another company believes that the country has potential. Ashok Pathirage of Softlogic Holdings adds, “ Sri Lanka has a well developed healthcare sector and the country should promote health tourism where there is a huge potential in the international market. The country’s medical sector is highly qualified and is capable of providing specialized treatment. Sri Lanka could be promoted as a health tourism destination with the expected influx of tourists. We could offer specialized services as the country has international standard hospitals and medical staff. Not only ayurveda treatment but western medication could be provided for the foreigners thereby earning foreign exchange. The focus should be to become a treatment centre similar to services offered by Singapore. The authorities should encourage modern private healthcare institutions to attract foreign patients. The sector needs incentives to upgrade its hospitals to be on par with international standards.”

Local conglomerate Softlogic Holdings plans to set up a state-of-the-art hospital in Kandy with a substantial investment. This hospital is at the design stage and will have 100 beds. The fully equipped hospital will be ready for the public in 30 months. The company also plans to set up a specialist cancer treatment centre and negotiations are currently underway. The company is getting ready to cater to the international market. Softlogic acquired shares in Asiri Hospitals in 2006 and in Asiri Surgical Hospitals in 2007.It has now controls the Asiri group of 4 hospitals consists of 4 hospitals and the newly planned one will be the largest private hospital in Colombo.

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USA: US cities explore potential for inbound and domestic medical travel

Several US cities and states are keen on promoting medical tourism, to boost the economy and as an alternative to declining numbers in tourism from other areas and overseas.

A recent study commissioned by Nevada recommended that the state leverage its medical/health sector to take advantage of opportunities in medical tourism. The study, by Brookings/SRS, urged Nevada to incorporate niche tourism markets, such as health and wellness travel, as part of its new economic development plan.

The Greater Miami Convention & Visitors Bureau (GMCVB) is a private, not-for-profit sales and marketing organization. It is a private-public partnership with more than 1000 private business members and four local governments. The GMCVB medical tourism initiative is aimed at marketing Miami as an international medical destination. GMCVB wants more local medical tourism members and offers a dedicated web page on MiamiHealthCare.org website, printed insert for inclusion in its medical tourism brochure, inclusion in ads of in-flight publications and the opportunity to participate in international media familiarisation tours

The Las Vegas Convention and Visitors Authority has produced a 176-page Las Vegas health and wellness destination guide. The guide contains information on medical and dental treatment, cosmetic procedures, corporate wellness programs and retirement living in Las Vegas and southern Nevada. Also included are a directory of medical facilities and travel information.

Las Vegas mayor Carolyn Goodman says that the recent opening of the Cleveland Clinic’s Lou Ruvo Center for Brain Health “has put Las Vegas on the map as a premier medical travel destination.”

Promoting domestic medical tourism with lots of marketing and brochures looks good, but not all cities or hospitals can deliver what individuals and employers want. Shai Gold of medical tourism agency International Triage, recently commented; “The challenge for most domestic destinations is that destinations typically do not offer a meaningful discount to the retail consumer. The wholesale client (self insured group, or insurance companies) does not need these guides as they already purchase healthcare services at substantial discounts via re-pricing networks. To attract retail consumers, healthcare providers will have to offer Medicaid level fee structures. Will the prices of medical procedures in Las Vegas and these other cities be competitive with what we can offer in Latin America, and the quality of care standardized in delivery and quality?“

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