In recent years, Wellness Tourism Worldwide, has been forecasting wellness travel trends. Camille Hoheb of Wellness Tourism Worldwide argues that there are many revenue-generating opportunities in wellness tourism, but success depends on delivering services in the right niche.
Among the top wellness trends predicted for 2014 are:
• Matters of the mind
Consumers are increasingly interested in vacations that offer mental restoration such as yoga and meditation.
• A growing niche for wellness travel agents
Given the growing interest and demand for holistic vacations that promote health and well being, there is an increasing demand for wellness travel agents.
• Living the local life
There is a deeper appreciation by consumers for the indigenous culture and lifestyle of the host destination. Getting to know the locals in a meaningful way improves the traveller’s experience.
•The fusion of food and wellness tourism
Destinations have capitalized on the goodwill of their exotic cuisine by fusing culinary tourism with wellness tourism in a package. This is a fast rising niche as food and drink tourism is increasingly popular and generates much revenue.
• Holidays offering relief from stress
Holidays are a way of dealing with the stress of modern life. This is also linked to dealing with problems of obesity and the nagging physical ailments of an ageing society.
• The desire for personal enrichment
Personal well-being is a more holistic concept than just adhering to healthy food and regular exercise. So, weekend getaways, vacations and retreats all contribute to personal enrichment.
• A slower pace of travel
Advocates of “slow travel” encourage travellers to reduce the pressure of checking off the sites to see and things to do
• The growth of the affluent and altruistic traveller
Many better off travellers, who have been enlightened by personal discovery and valuable life experiences, tend to contribute more altruistically to charities and local communities. Combining a holiday with volunteering is becoming more popular.
• Secondary wellness
Many people may not travel for wellness, but when they are at a hotel may spend money on spas and other wellness facilities at the hotel, or even choose a hotel because it has these options.

• Spas in pursuit of wellness tourism
Spas are rebranding and repackaging their offering
to attract a bigger share of the wellness market

The Costa del Sol is promoting health tourism to encourage people to go to the area for treatment in private clinics, of which the province has plenty. The target is to bring in 40,000 health tourists by 2017.
The Costa del Sol Tourism Board is working with the national ministries of health and ministry of foreign affairs to create a health visa. Spaincares is the marketing brand that is the result of health and tourism ministries joining together at national level to collaborate and attract health tourists.
The Tourism & Health Spain group has been set up and membership includes several clinics in Malaga province, as well as spas, hotels, travel agencies and other companies in related sectors. The aim is to promote the Costa del Sol as an ideal area for health, as well as beating seasonality by attracting visitors all year round. Although some medical tourism is expected, the bulk of the business is the spa and health and wellness business that ties in easily with existing tourism.
The biggest target market is the UK, as British tourists account for 24% of the 60 million Spanish tourists every year, as well as there being 250,000 expatriates living there. The other key markets are also the main sources of Spanish tourism-Germany, France, the Netherlands and Scandinavia, countries that already know the Costa del Sol.
Costa del Sol is competing with Madrid, Barcelona, Pamplona and the Balearic Islands as a key destination for health tourists. The region has excellent connections by rail and air. Health tourists are expected to spend more than those that just go to Spain on holiday.

The SFU Medical Tourism Research Group in Canada has released details of a study on medical tourism in Chennai, India; ’ An Overview of the Medical Tourism Industry in Chennai, India’.
Chennai, once known as Madras, is the largest city in the southern region of India and the capital of Tamil Nadu state
At the Apollo Specialty Hospital, orthopaedic patients come from the US, Canada, Australia, Italy and the Middle East. They get 100 medical tourists a year for orthopaedic procedures. International and local patients pay the same fees, although locals are less likely to utilize the more costly deluxe and platinum wards.
Billroth Hospitals has been actively marketing its services to medical tourists for six years and has seen a growth in medical tourism patients. The majority of its international patients are from the Middle East, Nigeria, Tanzania, and Oman. 50 to 60 foreign patients attend the hospital each year, primarily for cardiology and oncology services.
Frontier Lifeline Hospital is very active, with 50% of their patients being medical tourists. The hospital specializes in pediatrics. Iraq is the main source of medical tourists. They also get many patients from Oman and other Middle Eastern countries, as well as Africa (particularly Nigeria), Bangladesh, and Sri Lanka, many of who are non-resident Indians.
Global Health City actively recruits foreign patients by sending doctors to work in medical camps in source countries. From these visits they receive get 200 queries a month, many relating to pediatric surgeries and transplantations. They receive the majority of their patients from Iraq, along with East Africa, the Middle East, Sri Lanka, Bangladesh, Pakistan, and Nepal. While costs for medical tourists are slightly higher than for locals, 30 to 40% of their patients are international and the numbers are increasing.
Chennai has been particularly effective at increasing its medical tourism industry. Some claim it has 40% of all medical tourists in India, with 200 international patients each day. Half of all patients receiving treatment in Chennai come from outside of the state of Tamil Nadu. The main countries of origin are Nigeria, Kenya, Burundi, Congo, Bangladesh, Oman, and Iraq; with others from Sri Lanka, Myanmar, Tanzania, Oman, and Iraq.
Chennai has done deals with foreign countries including Tanzania, Uganda, and Kenya, so their citizens are sent to Chennai on government-sponsored medical tourism. Tourism is important to Chennai, and medical tourism includes substantial numbers from other parts of India.

Phase two of Dubai Healthcare City (DHCC) will add destinations for medical tourism as well as spa resorts, sports medicine facilities, waterfront residences and nutrition centres all aimed at health and wellness tourists.
Phase one has two hospitals and also offers orthopedics, dentistry, ophthalmology, diabetes management and cosmetic surgery. It now has more than 90 specialties and 4000 licensed health professionals with 17 complementary and alternative medicine providers.
DHCC has appointed two specialist medical travel businesses to promote the city. They will connect patients to doctors and arrange for their travel, accommodation and transportation requirements from pre to post-treatment. Salamatak Healthcare Management was appointed at the end of 2013 and Meditour will open soon.

Barbados is seeking to develop medical tourism and hopes that the opening of a new laser eye clinic can help.
The Lion’s Eye Care Centre is equipped with ultra-modern state-of-the-art ophthalmology equipment and will open soon. At first it will just have one operating theatre, but there are plans to open the other two by 2015.
The aim is to target not just Barbados, but other islands as few other islands have modern laser eye clinics.
The clinic is part of the state owned Queen Elizabeth Hospital.

Florida state senator Aaron Bean wants to bring more medical tourists to Florida through an advertising campaign that requires at least $3.5 million in state spending a year for four years. Bean has proposed SB 1150, a medical tourism bill that would force the local development agency Enterprise Florida to market the state as a health care destination with substantial spending on marketing and advertising for the next four years.
In 2013, Florida had 92 million visitors from overseas and other US states, with 100 million expected for 2014. Bean’s logic is that medical tourists spend more money than regular tourists. So the bill aims to be a vehicle for local hospitals, clinics and hotels to ask to be included in a state sponsored promotion.
Attempts to attract medical tourists to Florida have been rather hit and miss with as many failures as successes. The Greater Miami Convention and Tourism Bureau has partnered successfully with seven hospitals and has attracted patients from South and Central America, as well as other US states.
One failure was when a group of Sarasota hospitals targeted Canadians seeking hip and knee surgery. Although a website still exists, the hospitals admit that it has attracted few patients, cannot justify spending any more money promoting the idea, and probably cost ten times the actual revenue it generated.
Bean’s bill also calls for matching grants to local economic development groups, which would coordinate businesses to respond to medical tourists’ needs. But opponents argue that the money should come from hospitals and clinics, not the state or local tourism budgets.
South Lake Hospital in Clermont has partnered with urology centre PUR Clinic, to attract international medical tourists. Numbers so far are small at 20 a month. But it has had patients from Australia, Belgium, Cyprus, Norway, and East Africa for this highly-specialized urology treatment
Whether the cost of promoting a hospital or region can be recovered in extra revenue is the debate that will determine the success or failure of Bean’s medical tourism bill. But it might sneak though on the basis that in a state getting 100 million visitors, even a few thousand medical tourists is hardly more than a drop in the Atlantic Ocean.

The Nigerian government and the national medical association have joined forces on in a direct attack on outbound medical tourism.
The Nigerian Medical Association (NMA) has applauded the new National Health Act, as it will help to substantially reverse the trend of frequent and sometimes unnecessary foreign medical trips, and could even make Nigeria a destination for medical tourism.
The new law has provisions that directly tackle outbound medical tourism and the resultant negative impact for Nigeria with substantial sums flowing out of the country. It seeks to stop the use of tax payers’ money where politicians, government officials and their families go free on foreign medical trips, for medical conditions that can effectively be treated in Nigeria.
Dr Osahon Enabulele of NMA explains, “Lots of Nigerians, including top political office holders travel frequently to other countries in search of medical care even for medical conditions that can be satisfactorily managed in Nigeria. Available evidence suggests that over 5,000 Nigerians visit India and other countries every month for medical tourism with lots of these Nigerians faced with various risks and challenges including misdiagnosis, legal and ethical issues, exposure to infectious diseases, as well as other complications, particularly post-surgical complications. On average, over $800 million dollars is lost annually by Nigeria on account of foreign medical trips.”
The new law provides a minimum package of basic healthcare services (including the provision of free medical care for children under 5 years of age, pregnant mothers, the elderly and people with disabilities), as well as improved funding for primary health care through the setting up of a National Primary Healthcare Development Fund to be mostly funded by national taxes. The aim is to offer Nigerians greatly improved access to quality healthcare services, so that deaths amongst Nigerians, particularly the rural poor, as a result of inability to pay for healthcare services (including medical care for emergencies) are drastically reduced.
The new federal minister of health, Dr Khaliru Alhassan is an opponent of medical tourism and seeks to get the Federal Ministry of Health to improve healthcare in the country: “There has been a lot of accusing fingers towards us that federal politicians are responsible for medical tourism. The Federal Government of Nigeria is losing billions of dollars because of us; a lot of people are looking at us that we are responsible for people going out of the country. I have a lot of work to do to change this perception.”
Although politicians have attacked medical tourism in recent years, many were at the same time benefiting from free state paid medical care outside of Nigeria. The difference now is that those wanting change have a new law and renewed vigour to tackle the problem, which will be good news for many Nigerians but bad news for a struggling Indian medical tourism sector.
The federal government now has a clear mandate to ensure that Nigerians are healthy by working with the states, local government and the private sector to deliver the promise of transforming Nigeria’s healthcare as laid down by the National Health Development Strategic Plan; and the cabinet has warned national and local politicians that it will come down heavily on anybody causing problems by setting one ministry against another, or otherwise allowing local politics to delay the national plan.

As Malta’s tourism industry recovers from recent woes, the government plans to promote niche tourism areas. One of these is medical and health tourism, where previous campaigns failed due to lack of co-ordination and lack of focus. The biggest reason for previous failures was that the government made encouraging noises but was reluctant to spend money or energy in positive help for local businesses.
Malta could attract a considerable amount of medical tourism ­ but not without government help, according to a German surgeon who has set up practice in Malta. Ulrik Rebers and his wife Xenia Lorenz Rebers have opened the International Knee and Hip Centre – Malta at the Prince of Wales complex in Sliema, offering knee and hip replacements at Saint James Hospital.
The surgeon has operated in Malta on thousands of people in recent years, but almost all of these have been residents of Malta, local and foreign, rather than people who went to Malta for treatment. He argues that it is now a good time to target other EU countries, “I was involved in marketing medical tourism from the Netherlands to our former base north of Dusseldorf but Malta is not branded overseas for medical tourism. If we tried it alone it would take four to five years to even get a foothold. To be effective it needs a coordinated thrust by the government
Rebers’ latest centre opened a few weeks ago, and uses computers to create 3D images to ensure the most accurate surgery available, aligning the new joint across various axes such as left and right, leg-length and rotation. He explains, “Research showed that almost a third of replacements did not achieve alignment for length and right/left tilt. And even a tiny difference can cause problems for life.” He uses new Swiss-made titanium and ceramic implants, and custom-made joints are also available to ensure as perfect a match with the original joint as possible.
One of problems of medical tourism is that most patients want the work done in one trip, but historically this type of surgery often requires several trips. With the latest materials and computer input, it can all be done within two weeks. -with a consultation two days prior to the operation, five days as an inpatient, and seven in a hotel recuperating under the scrutiny of the centre.
The surgeon sees the key target market as the UK and the Netherlands, not because it saves money, as such operations are free in both countries, but because both have long and lengthening waiting lists. The third market is Russia as it is cheaper to have the work done in Malta than at home. He argues that while Malta may be more expensive than Asia, Europeans feel more comfortable in a European jurisdiction. And it is a tourist destination that many British, Dutch and Russian visitors are already familiar that has good flight connections with no more than a few hours’ flight.

A new global advertising campaign called “Thailand Extreme Makeover” from the Tourism Authority of Thailand aims to attract medical tourists via the internet.
The campaign is part of the government’s aim to promote Thailand as the leading medical tourism country in Asia, particularly after recent political turmoil meant fewer travellers went to the country than had been hoped.
Thailand Extreme Makeover accepts online applications and three people will win a trip to Thailand to get beauty treatment and travel around the country. Winners have to agree to be filmed and have video clips of all activities uploaded to social media in a follow up campaign called “Happiness You Can Share”.
For the campaign the key target region is the Middle East, followed by Asia and then Europe. The contest is a form of reality TV where selected contestants undergo makeovers including various cosmetic surgery procedures. There is a $5,000 cash prize too.
Thawatchai Aranyik of TAT explains, “The campaign is a reality competition that will not only create awareness about Thailand as a destination for medical tourism and the excellence of our medical facilities, but also promote the kingdom as a travel destination with something for everyone. Thailand already has a great reputation for its excellence in medical care and people come here for operations of all kinds.”
Potential candidates send photos showing their face from all angles – straight on; at the left and right profile; from the back and from above. Candidates also need to include their personal health profile and reasons for wanting a makeover. The judging committee, made up of medical experts and beauty surgeons, will then select three candidates who will be invited to Thailand for their life – and face-changing trip.
During their stay in Thailand, each of the contestants will be videoed and clips uploaded to the special Thailand Extreme Makeover website. This will allow their friends and relatives to watch and follow the progress of the makeover as well as allow members of the public to vote for their favourite contestants.
In the end, the contestant with the highest number of votes will win the cash prize and a luxury tour in Thailand. The two runners-up will also be treated to their own luxury tour packages.The audience who follows their progress and votes for their favourites also get the chance to win various beauty rewards and prizes.

2013 saw an increase in medical tourism to the Czech Republic, almost all from Europe. Although exact numbers are not known, most clinics report a substantial increase in business.
Most customers come from Germany, Russia, Austria and the UK. The main treatment is cosmetic surgery. Breast augmentation accounts for half the business, the rest being liposuction, abdominal work and eye surgery. Also popular is a range of fertility treatment, with customers mostly from Germany. Local clinics estimate that 2013 saw 4,000 to 5,000 fertility treatment customers. The popularity of IVF treatment is that laws in the country are less strict than other EU countries, but strict enough to ensure more protection for customers than they have in Asia.
Although fertility centres, cosmetic surgeons and dentists all offer lower prices than many EU countries, they use the same quality of materials, are trained to the same standards, and offer surgeries of equal quality. There is nothing that the medical tourist cannot get at home, so the low price of treatment, accommodation and travel are the key factors.
Whether medical tourism purely based on price is sustainable in the long run depends very much on what happens in the countries where medical tourists come from. In the UK, with several price and treatment comparison sites starting to drive down local prices for dental care and cosmetic surgery, the potential savings from going to Europe may vanish. But as yet the same is not true for fertility treatment. At present comparison sites have not gained enough foothold in Europe to affect local markets, so with local prices stable or increasing, the Czech Republic can expect more business from Austria, Germany and Russia in 2014.
For the German and Austrian markets the country has an added bonus that parts of the country are German speaking as they used to be part of Germany. This attracts medical, health and wellness tourists.
Franzensbad, which for most of its life was German rather than Czech, has been a spa town for six centuries. The resort has expanded significantly to create a successful, bioclimatic spa. The carbonated water and hot mud are still available as appealing cures and sources of pain relief but now the spa offers even more specialized treatments to keep up with the demands of visitors. In addition to the anti-inflammatory mud baths and drinking cures, Franzensbad now offers to treat everything from cardiovascular and digestive issues to musculoskeletal conditions and skin diseases via therapies including dry, volcanic carbon dioxide baths, electrotherapy, reflexology and oxygen therapy. Franzensbad is two hours from Prague and offers numerous experimental treatments, twenty-six springs and many therapies. The waters, which reach an average temperature of 52 degrees, have been used for their healing properties for centuries as an aid for circulation, cardiovascular health, rheumatics and inflammation.
Franzensbad is typical of a historic spa town that has been expanded and restored to attract domestic and international health tourists. As well as the development of the Aqua Forum water center, there are new areas for cycling and hiking and a restored four-star Imperial Spa hotel.

Total health spending has fallen in one in three OECD countries between 2009 and 2011, with those hardest hit by the financial crisis most affected. This is a sharp reversal from the strong growth in the years prior to the crisis. This makes it all the more important that countries make their healthcare systems more productive, efficient and affordable, says the OECD.
The seventh edition of Health at a Glance provides the latest comparable data on different aspects of the performance of health systems in OECD countries. It provides striking evidence of large variations across countries in the costs, activities and results of health systems. Key indicators provide information on health status, the determinants of health, health care activities and health expenditure and financing in OECD countries. Each indicator is presented in a user-friendly format, consisting of charts illustrating variations across countries and over time, brief descriptive analyses highlighting the major findings conveyed by the data, and a methodological box on the definition of the indicator and any limitations in data comparability.
This publication takes as its main basis OECD Health Statistics 2013, the most comprehensive set of statistics and indicators for comparing health systems across the 34 OECD member countries. Spending per capita fell in 11 of 33 OECD countries between 2009 and 2011, notably by 11.1% in Greece and 6.6% in Ireland. Growth also slowed significantly in others, including Canada (0.8%) and the United States (1.3%).
Only Israel and Japan saw the rate of health spending growth accelerate since 2009 compared with the previous decade. Health spending in Korea has continued to grow at more than 6% per year since 2009 but more slowly than in previous years. Governments have worked to lower spending through cutting prices of medical goods, especially pharmaceuticals, and by budget restrictions and wage cuts in hospitals. More than three-quarters of OECD countries reported a cut in real-term spending on prevention programmes in 2011 over 2010, and half spent less than in 2008. Cuts to spending on cost-effective prevention programmes on obesity, harmful use of alcohol and smoking are a cause for concern. Any short-term benefits to budgets are likely to be greatly outweighed by the long-term impact on health and spending.
Reductions in the supply of health services and changes in their financing through increases in direct out-of-pocket payments for patients are also affecting access to care. After years of improvement, waiting times for some operations in Portugal, Spain, England and Ireland show some increase.
Across the OECD, low-income groups are worst affected and may be foregoing needed care such as medicines or check-ups for chronic conditions. This may have long-term health and economic consequences on the most vulnerable in society.
For the first time, average life expectancy exceeded 80 years across OECD countries in 2011, an increase of ten years since 1970. This trend shows no sign of slowing down. Those born in Switzerland, Japan and Italy can expect to live the longest among OECD countries. Chronic diseases such as diabetes and dementia are increasingly prevalent. In 2011, close to 7% of 20-79 year-olds in OECD countries, or over 85 million people, had diabetes. This number is likely to increase in the years ahead, given the high and often growing rates of obesity across the developed world. The burden of out-of-pocket spending creates barriers to health care access in some countries. On average in the OECD, 20% of health spending is paid directly by patients; this ranges from less than 10% in the Netherlands and France to over 35% in Chile, Korea and Mexico.

Medical travel to and between Gulf countries is a topical subject and some local doctors are trying to move the debate to practical matters.
Multiple factors play a role in the continuity of care in the GCC such as the location of the hospital, the availability of virtual consultation and follow up, as well as factors related to the patient’s age, medical condition and possibility for travel. All of these factors dictate the current climate for medical travel, and medical facilities and health authorities need to address these issues in order to facilitate medical tourism across GCC borders.
Dr Bariah Dardari of Al Zahra Hospital, Dubai offers insight into the solutions and obstacles, "The continuity of care across GCC is available currently on a small scale, especially for patients seeking medical attention and travelling between Saudi Arabia and the UAE, or Oman and the UAE. However, more can be done to encourage patients to use the proximity of the GCC countries for their continuous medical care."
Dr Dardari believes that any difficulty in the efficiency in the flow of crucial information and the continuity of care in a cross-border setting must be overcome, in order to further facilitate the process of medical travel, "I believe one can overcome any deficiency in continuity of care across borders by establishing a system that includes pre-and post-consultation communication. This can be attained via e mail, Skype or telephone. The risk of data misuse is minimal if certain patient privacy rules are established, for instance, test results should only be given directly to the patient via a secure email."
The main reason why parents sent their children abroad for treatment in the past was because centres in the UAE providing pediatric healthcare facilities were non-existent. In the past decade the UAE has made progress in areas such as neonatal medicine, pediatric orthopedic, and pediatric neurodevelopment. The opening of pediatric hospitals in the future, such as Al Jalila, will allow the much needed pediatric medical attention within the UAE instead of the need to find it abroad, and perhaps even encourage medical travel to the UAE.

In an attempt, partly to react to the problems of medical tourists, but mostly to stem the low tourism numbers for 2013, India’s government has extended the country’s limited visa-on-arrival scheme to tourists from 180 countries. The new scheme, which the government plans to implement by October, would allow foreigners traveling to India from approved countries to apply for a visa online and pick it up upon arrival at 26 of the country’s airports.
The current system, which has tourists in all but 11 countries wait several weeks after submitting visa applications to learn whether they have been approved, has long been seen as a major deterrent for potential visitors to the country. Internal resistance by various governmental ministries, most notably the Home Ministry (which has had objections to the issuing of visas to Chinese citizens in particular, due to a border dispute between India and China) has made progress on the initiative slow. But the currently dismal state of India’s tourism industry, which accounted for 6.6% of the country’s GDP in 2012, has proven to be a powerful motivator.
Travellers’ concerns over security, especially in the wake of several high-profile attacks against women, are widely credited for the hit the industry has taken. While it is sure to provide a short-term boost, the government’s goal of drawing 12.6 million international tourists by 2016 looks far-fetched as the underlying problems deterring travelers remain.
The Indian government has allowed free medical visas for Maldivian nationals for 90 days. The restriction on 60-days’ gap between two entries has also been lifted.
It is also agreed that medical visa holders will be no longer required to report to the Foreign Regional Registration Office (FRRO) if their visa is for less than 180 days.
Medical visas last for a year, or the period of treatment, whichever is less. They allow up to 3 trips to India in one year. As well as the patient, they cover up to 2 accompanying relatives.
India’s Ministry of Tourism has extended the Marketing Development Assistance (MDA) Scheme to include medical tourism. Under the scheme the ministry provides financial support to approved medical tourism service providers, subject to availability of funds.

Most medical tourism models take the patient to the hospital, while some take doctors to patients in another country. A Canadian version is to take the doctor and the patient from their home country to a remote island.
Two surgeons in Calgary, Alberta, regularly fly to the Turks and Caicos to perform operations on Canadian patients. The service is coordinated by Global MedChoices, a company based in Memphis, Tennessee. The company also offers the service to Americans and has two surgeons from the United States.
With just a one-hour flight from Miami, the Turks and Caicos Islands is an English speaking British protectorate that is part of the British West Indies in the Caribbean.
The two main hospitals on the Turks and Caicos are run by Canadian group InterHealth, and the one used was built in 2010 and has Accreditation Canada International status.
According to Global MedChoice, this is a niche market. The limited numbers and Canadian connection means that can be confident they are receiving high-quality care from an experienced surgeon from their own country. So the common medical tourism worries about the competency of a foreign doctor and the conditions of an overseas hospital, both vanish.
Having a Canadian surgeon also helps with post-operative care after the return to Canada. The Calgary physicians who operate in Turks and Caicos sometimes perform on their own patients, and can therefore provide follow-up care themselves when back in Alberta.
The Canadian surgeons and their patients benefit by jumping local waiting lists. And for the surgeons, having a few days break from a Canadian winter in a warm and sunny place (350 days of sun a year) with great beaches and diving is hardly a hardship.
Most Global MedChoices clients are Canadian or American. In the 18 months that Global MedChoices has been operating, it has provided more than 50 procedures and has reported no complications.
It is not major surgery but the more routine, although often painful knee, hip or shoulder surgery. So the motivation is more on being able to get on with their lives that saving money. While recovering, patients stay at exclusive personal condominiums or hotels that are minutes from the hospital and very close to Grace Bay Beach.

Leading US airline Southwest Airlines has selected 73 US nonprofit hospitals and medical organizations, with 99 locations, for the Southwest Airlines 2014 Medical Transportation Grant Programme.
These organizations can offer free roundtrip airline tickets to families who are facing serious illness and need to travel for specialized medical care. Being able to fly for free to receive the best medical treatment available eases the financial burden on families, giving those who are already facing so much one less thing to worry about.
In 2014, Southwest will provide more than $2.8 million in free transportation to caregivers and patients seeking medical treatment. Linda Rutherford of Southwest Airlines explains the logic, "Partnering with these hospitals and organizations to provide hope for those dealing with serious illness is an honour for us. It has touched our hearts to be able to connect our flights with the hospitals’ care, and see the amazing difference this unique programme is making to families in our communities."
The project began seven years ago, and since then more than 33,000 tickets, totaling $13.2 million in free transportation, have been distributed to organizations in 26 states, making a positive difference in the lives of more than 26,000 patients.
One grateful patient is Toby Shaw. Toby battles arthrogryposis, which affects the joints in his arms and wrists. With this free air travel he is able to travel from his home in Ohio to Shriners Hospital for Children in Philadelphia to receive the best treatment available for his condition. Dr. Dan Zlotolow, at Shriners Hospital for Children comments, ”I am grateful our hospital is able to partner with the airline to provide Toby and so many other patients like him the best treatment for their conditions, Together, we are able to offer our patients a long-term treatment plan without worrying about the burden of travel costs."
Southwest is the USA’s largest carrier in terms of originating domestic passengers boarded, and including wholly owned subsidiary, AirTran Airways, operates the largest fleet of Boeing aircraft in the world to serve 96 destinations.

A trip to the doctor costs six times more in the UAE than Oman, while a dental visit is four times as much in the UAE than Oman. Health insurance is most expensive in Bahrain due to the sky-high local cost of healthcare.
The latest Cost of Living Reports Middle East (CLR) says a mid-level GP visit costs $78.50 on average in the UAE. The second-most expensive country is Qatar at $54 per consultation at an internationally certified hospital, followed by Bahrain and Saudi Arabia ($27) and Kuwait ($26.50). In Oman, a trip to the doctor costs on average only $13.
Dental care is also the most expensive in the UAE, at an average $108 for a routine check-up, while the same consultation costs $80 in Bahrain, $71 in Qatar and Kuwait, $41 in Saudi and $26 in Oman.
While the UAE is by far the most expensive country for healthcare it does have the biggest range of care in terms of international hospitals and clinics in the Gulf.
In a separate report on the UAE, CLR notes that UAE public spending on healthcare had increased to above the world average at about 75 % of total spending in the sector. Over the next three years spending there on the healthcare sector is expected to grow by 16 % annually The CLR’s GCC report finds that in a like-for-like comparison of seven measures, Qatar came out the most expensive overall, followed by the UAE, Saudi, Bahrain, Oman and Kuwait.

Medical tourism is often touted as the cure for Asian countries with economic problems, but new research from Jeremy Snyder’s team at The Simon Fraser University Medical Tourism Research Group suggests this is far from a guaranteed success.
The team reports that the East Asian region is a dynamic and evolving destination for medical tourists, home to many of the most visible and well-known hospitals serving medical tourists from across the world. The remarkable success of established East Asian medical tourism providers in marketing their services to international patients has spurred interest among other countries in the region that aim to join these larger players.
The enthusiastic embrace of medical tourism by East Asian hospitals and governments is, in theory, well justified. Health services exports could potentially diversify regional economies. Industry promoters say it can increase foreign direct investment into the private health sector, help countries retain their existing health workforce, increase training opportunities for health workers, and ensure that the local health sector has access to the latest technological advances. Taken together, these benefits can provide local populations with the opportunity to access cutting-edge and high-quality health services at home.
But medical tourism also creates social and health risks for countries investing in the sector. Investment in medical tourism can drain resources from the public health sector and divert attention away from the less profitable health needs of the local population. High paying jobs in the medical tourism sector can increase the flow of workers from the public to private sector and from rural to urban areas, as has been the case in Thailand and Malaysia.
New, high-tech equipment and highly trained health workers will certainly be a boon to wealthy patients within these countries. But there is little reason to think that these services, targeted at privileged locals and foreign patients, will be accessible or relevant to the vast majority of the local population. Medical tourism may actively worsen health inequities in these countries. Increased investment in the private health sector in India has been accompanied with decreased public sector investment and promised public access to private facilities through public-private partnerships have generally not been realized.
The promised economic benefits of medical tourism are far from guaranteed. Growth in the sector has come through the lowering of trade barriers in the health services industry. Large regional players in this industry have the power to play governments in the East Asian region off one another, seeking the regulatory and tax environments most favourable to their bottom lines.
This competitive environment is favourable to those investing in the medical tourism industry, but it is less clear whether the host countries will experience similar economic benefits if tax concessions and other benefits are not matched by economic returns or if medical tourism developments fail to materialise.
Countries considering marketing their private health sector internationally should be cautious and aware that industry stakeholders have an incentive to inflate numbers about the market’s potential and exaggerate the potential benefits of this industry. As East Asia already hosts some of the most developed and high profile destinations for medical tourists, it is unclear if new markets in the region can successfully compete for the limited number of medical tourists, especially those from outside East Asia.
If countries do wish to pursue medical tourism development, they should focus on developing the necessary regulatory and healthcare financing conditions domestically that will encourage medical tourism to emerge and prosper.
In its worst form, medical tourism is the result of poorly regulated healthcare markets with insufficient domestic healthcare cover. So, medical tourism is primarily a symptom rather than a cause of inequitable health systems.
East Asian nations should focus on strengthening hospital quality and safety regulations while extending domestic healthcare cover universally and comprehensively. By focusing on affordability and quality of care, a well-functioning health system oriented to the needs of the local population first and the international market second can develop.
Developing the medical tourism sector in a way that provides sustainable social and economic benefits is a difficult task. Countries in East Asia looking to advance or grow their own medical tourism sectors should be cautious, given that it does not offer a sure prescription for providing economic benefits or addressing health sector ills. Focusing on strengthening core health system elements, such as financing and regulation to improve the quality, affordability, and accessibility of health services locally, may encourage international patients to visit while ensuring that the system is fair and accessible for locals.

Another Caribbean island has taken the next step into developing medical tourism.
Early in 2014 the governor, Peter Beckingham, announced the British overseas territory’s plans to develop a medical tourism policy as part of wider tourism campaign to extend the types of tourism on offer.
The Turks and Caicos Islands consist of 40 islands and cays, eight of which are inhabited. The islands are 550 miles southeast of Miami, Florida, just below the Bahamas chain and just to the east of Cuba and the island of Hispaniola (Dominican Republic and Haiti.)
The islands are home to 31,000 full time residents, and welcome more than 200,000 tourists annually. Upmarket tourism is centred on Providenciales. Coral reefs and 200 miles of beaches draw holidaymakers and divers, mostly from the US and Canada.
Wealthy retirees are among the more recent settlers. At the other end of the economic scale, migrants come from impoverished Haiti and the Dominican Republic. In turn, thousands of Turks and Caicos citizens take advantage of job prospects in the neighbouring Bahamas.
There is a modern hospital system comprising two state-of-the-art medical centres, managed by InterHealth Canada; Cheshire Hall Medical Centre on Providenciales and Cockburn Town Medical Centre on Grand Turk.
For major surgery or specialist care, locals go to the Bahamas or Miami.
Recently, two surgeons in Calgary, Canada, have occasionally been flying to the Turks and Caicos to perform joint procedures on Canadian patients. The service is coordinated by Global MedChoices, a company based in Memphis, Tennessee.
The territory’s cabinet has approved the setting up and membership of a medical tourism steering committee. But it gave it a short deadline of 12 months to develop clear policies for the operation of medical tourism activities in the hospitals in Providenciales and Grand Turk.

Germany reports the treatment of 224,000 foreign patients in 2012. But with over 30 million tourists, how many of these “overseas patients” may have been injured or sick holidaymakers?
Jens Juszczak at Bonn-Rhein-Sieg University estimates that 45% of the total (100,000) went to Germany explicitly for treatment. He also suggests that the number reflects a survey of hospitals, plus data from the statistics office and from different ministries. So, the actual number could be an under-reporting of up to 10% due to under registration. Allowing for increased numbers in 2013, this would give current numbers at around 125,000. But the error margin is wide; actual numbers could be anywhere between 100,000 and 150,000.
The quoted figures for 2012 were 8.6% higher than 2011, with the biggest growth from Russia and the CIS countries. With an estimated 8,300 inpatients and 12,400 outpatients, Russia is now the largest source market.
Where they come from can be skewed by including tourists. For example,. many tourists come from France and the Netherlands. Both countries also provide some medical tourists but the second largest medical tourist market is from the Middle East, particularly the UAE and Saudi Arabia. Juszczak says that Germany gets twice as many patients from the CIS and the Baltic States as from the Middle East, and that the number from the area has grown seven fold over recent years. But the mixing of tourists and medical tourists in the numbers makes it hard to know which countries are the main providers of medical tourists rather than tourists who needed treatment while in Germany.
Juszczak says 80-90% of treatment is in public hospitals, typically university hospital centres of excellence. Helios, Asklepios and Mediclin are the most active private health groups. This public sector bias reflects that many patients go to Germany for the sort of complex procedure that only university hospitals can deliver.
There may be arguments on actual numbers but there is no doubt that Germany is one of Europe’s leading medical tourism destinations with numbers increasing, particularly from Russia.

More and more foreigners seek paid health care services, mostly cosmetic surgery, surgical treatment of obesity and assisted reproduction, in the Czech Republic. Local health centres attract medical tourists from the UK, Germany, Austria and Russia as local clinics claim to charge half what the customers would pay at home for comparable treatment. Unofficial estimates from clinics put numbers up in 2013 compared to 2012, with the number of foreign clients attending Czech clinics more than doubling in the past few years.
František Lambert of ISCARE clinic told local newspaper Pravo, “In 2013, we provided care for over 1.000 clients from Germany, mostly for cosmetic surgery and assisted reproduction, with some obesity surgery."
One draw for couples seeking help to have children is that local legislation is less rigorous than other EU countries; allowing anonymous sperm and egg donation. Jaroslav Hulvert of ISCARE estimates that the total for local clinics was 4,000 to 5,000 couples seeking fertility treatment.

ISQua, the global organisation that accredits the accreditors, has awarded four-year accreditation to the regulator of Dubai Healthcare City for patient safety and service quality standards
Dubai Healthcare City only accepts hospitals and clinics with certain recognized international accreditations. Early in 2014, the state of Dubai agreed with the other UAE states that this logic would apply to all private clinics and hospitals across Dubai and all other member states by 2020.
The new seven-year UAE National Agenda announced accreditation in the health sector as one of the main objectives of the Agenda.
The Centre for Healthcare Planning and Quality (CPQ), part of the Dubai Healthcare City Authority (DHCA), has had its second ISQua accreditation for Outpatient Clinic Quality Standards.CPQ is responsible for the regulation and licensure of all healthcare facilities and practitioners within Dubai Healthcare City ( DHCC).
At present most hospitals and clinics in DHCC have international accreditation from JCI. JCI also accredits in other UAE states, while other international groups accredit a few hospitals and clinics.
Under discussion is whether the requirement for all hospitals and clinics to be accredited, will be allowed to use any ISQua accredited accreditor, or whether the long term aim is for all to be regulated by CPQ. If the latter option is chosen, then CPQ would need to get itself and the standards approved by ISQua for inpatient treatment too.
There is a precedent for a local regulator to take over. When certain UAE states began introducing compulsory health insurance for all citizens, residents and expatriate workers, part of the new legislation was that only insurers and brokers authorised by a local insurance regulator could offer cover. Offshore international insurance was not a legally allowed substitute.
ISQua’s accreditation gives confidence and credibility through formal worldwide recognition. Maintenance of this award depends on the submission to ISQua of two progress reports, one at 12 months post survey and the second at 30 months post survey.
Dr Ayesha Abdullah of CPQ commented, "Achieving accreditation for the second time by ISQua’s International Accreditation Programme is testament to our commitment of placing quality and patient safety at the forefront. It demonstrates to our stakeholders that the standards applied to outpatient clinic and ambulatory surgery centres in DHCC meet international best practice. Our standards have undergone a rigorous and credible development process in keeping with ISQua’s comprehensive criteria that included many of DHCC ’s healthcare facilities."
The DHCC is home to two hospitals, plus 120 outpatient medical centres and diagnostic laboratories. CPQ is an independent regulatory body responsible for licensing healthcare providers and professionals, and setting and maintaining international best practice in healthcare delivery and patient care within DHCC.

Blogging on new UK cosmetic dentistry cost and clinic comparison site Teethwise, founder Eoin Holohan claims that the number of people travelling for dental treatment from the UK has dropped significantly over the past decade. According to Eoin, cheaper dental implants and other cosmetic treatments are now available in the UK, so fewer patients need to travel.
Eoin Holohan explains, “The market has matured and many dentists are now travelling to see patients. The only foreign dentists who still have patients travelling for treatment are those who can offer consultations and other parts of the treatment in the UK.” “2005 was a great year for dentists in Hungary. Their country had recently joined the European Union attracting lots of European tourists including 250,000 UK nationals. Austrian dentist Alexander Schreiner opened up a clinic on the ground floor of a hotel in central Budapest to take advantage of the patient rush. At the time he was travelling to UK where he and a colleague would meet with up to a hundred patients over a couple of days in conference rooms, all interested in finding out about dental treatment in Budapest. Almost a decade later and Dr Schreiner sits in his clinic wondering where his UK patients have gone. The number of UK nationals travelling to Hungary has fallen by 38%. Whilst partly due to the economic climate, Hungarian dentists and dental tour operators have confirmed a significant fall in the number of medical tourists.” Holohan explains the reasons for falling numbers; “The two factors causing a drop in the number of people travelling for restorative and cosmetic dentistry are the economic climate and price pressures on restorative dentistry in the UK. Restorative dentistry or dental implants can be an expensive procedure for people and quite often it is not an expense they have planned for. Patients can expect to pay in the thousands whether at home or in cheaper locations. A full jaw replacement with 6 implants will cost from £9,900 in the UK and £6,000 in Hungary. Implants are rarely available on the NHS.”
He explains why competition has led to falling prices in the UK; “Increased competition in the UK has driven down the price of dental implants, which are now available from as little as £995. Agnes Tuba of London Dental Implants, who place implants in London and Hungary, has confirmed that it only makes sense for patients to travel if they require 4 or more implants. LDI can carry out parts of the procedure and any aftercare in London, which makes travelling for the main part of the procedure a more attractive option for patients.”
Holohan adds another reason for lower prices; “The cost price of dental implants has fallen. Low cost manufacturers have driven down the prices of implants as more and more dentists are offering a low cost alternative along with a premium implant brand. This has forced the established manufacturers to cut prices.”
He adds, "Some dentists have spotted the opportunity to establish specialised dental implant clinics. These clinics operate on a high volume basis. They attract patients by offering cheap implants and balance the books by fitting lots of them. This allows them to spread their investment in training and equipment over significantly more treatments thus increasing their margins.”
Holohan goes on, “Some Hungarian dentists and businessmen realised that patients are reluctant to travel for medical treatment, especially if they had not yet met their dentist. Rather than waiting for patients to come to them they decided to go to the patients and set up clinics in the UK. Vital Europe were one of the first clinics to offer treatment in the UK and Hungary and have told us that people are a lot more likely to travel if they can have a consultation carried out at home. These clinics that give patients the option to have treatment in the UK, in Hungary or a combination of both are the only type of Hungarian clinics attracting UK patients today.”
Hungarian dentists are still very busy, “Although the number of patients travelling from the UK has fallen, Hungarian clinics still get patients from countries with easier access or where dental implants are still expensive. London Dental Implants see many patients from Germany and Scandinavia at their Budapest based clinic and have recently opened a second clinic due to increased demand.”