Astonishing new figures from researchers suggest that every year over a million Mexican and non-Mexican US residents travel from the US to Mexico for medical, dental, cosmetic and other treatment. Even on 2001 data, well before the establishment of a US/Mexico medical treatment industry with new clinics and hospitals, and before even more Mexicans settled in the US, it is reported that just under a million crossed the borders for healthcare. So..... if the research is accurate, it is reasonable to assume that 2008 figures are going to be over a million. It is believed that half of these medical tourists are Mexicans who are US residents and are coming home for treatment; this suggests that swine flu will have less effect on numbers than pessimists expect.  According to a new paper Heading South: Why Mexican Immigrants in California Seek Health Services in Mexico." published in the journal Medical Care, by researchers at the UCLA Center for Health Policy Research: Nearly one million Californians cross the border each year to seek medical care in Mexico. The figures do not include anybody travelling from other states such as Texas, Arizona or New Mexico. Cost was the primary factor in seeking health services. Lack of health insurance, cultural and linguistic barriers and immigration factors were also important motivators. Most come to Mexico for prescription drugs and dental care, and a smaller number go for surgery- but the latter may have risen since 2001. The researchers estimate that in 2001, 952,000 California adults sought medical, dental or prescription services in Mexico, and of these, 488,000 were legal Mexican immigrants. 13 percent of Mexican immigrants travel to Mexico for care, with the largest number visiting dentists. The paper is the first large-scale population-based research ever published on US residents who travel to Mexico for health services. It is based on an analysis of 2001 data from the California Health Interview Survey (CHIS), the nation’s largest state health survey.Lead author Steven P. Wallace comments, What the research shows is that many Californians, especially Mexican immigrants, go to Mexico for health services." Long-stay immigrants used Mexican health services the most, with 15 percent reporting crossing the border during a year’s time for health services. Half of these long-stay immigrants lived more than 120 miles from the border. Living within 15 miles of the border greatly increases the likelihood of someone obtaining health services in Mexico. Four percent of adult Californians travel to Mexico for some type of medical care. Immigrants who travel to Mexico for health services are not necessarily the poorest. One explanation: The cost of travel may offset any financial savings, creating a disincentive for the very poor to travel. The data that the researchers used is no longer collected, so updating the figures is going to be difficult. Assuming the figures are accurate, if you add those going to new Mexican hospitals and traffic from other states, a million medical tourists a year may be a reality. This has other implications, that people travel as much based on location and race, as on cost. If true, this makes Mexico the second largest medical tourism destination in the world, and perhaps even number one.

Licences of hospitals in the UAE will not be renewed by the Ministry of Health if they fail to upgrade their infrastructure. They must implement the latest systems and practices that meet international standards within three years. The accreditation rule will apply to both the private and government sectors. The ministry has signed a contract with an international accreditation body that will certify hospitals. Although not officially named, strong rumours suggest it is JCI. In the long run, clinics, medical professionals, nurses and technicians will also have to be accredited. The UAE authorities accept that unless it can convince local customers that hospitals offer a good standard of care at a reasonable price, and stop large numbers going overseas for medical treatment, any hopes of competing for a share of the growing medical tourism sector will fail. It wants to get business from other Gulf States, but to do that it has to build trust in local hospitals. It can never compete with Asian countries on price so has to promote other benefits.  The country is gearing up for the introduction of a compulsory medical insurance system that will require the accreditation of hospitals and medical professionals. The introduction of an integrated health information system will require hospitals to be more transparent about treatment costs and medical details, and all medical mistakes and errors will be recorded. Hospitals and other healthcare businesses will have to digitalise their patient records and billing systems so that a patient’s details will be accessible by all other hospitals in the network. Plans have been revealed to build two new world-class hospitals in the UAE by 2013. The new facilities will replace the existing Mafraq and Al Ain Hospitals.SEHA, the Abu Dhabi Health Services Company, will run both. The new Mafraq Hospital will have 690 beds, the examination and treatment rooms will be tripled from 19 to 60 and the outpatient clinic capacity will be increased by 70 percent to 147 rooms from the current 88.The new Al Ain Hospital will have 688 beds, of which 150 beds will be dedicated for rehabilitation. Once complete, the facility will serve as the regional Centre of excellence for rehabilitation with the first stroke unit in the UAE, and a centre of excellence in trauma, orthopaedics and sports medicine. The UAE now enjoys one of the world’s advanced and highly developed healthcare systems with Dubai Healthcare City, Shaikh Khalifa Medical City and other private healthcare providers. It accepts that it needs to bring other hospitals up to those standards. Dubai Healthcare City’s future projects include the Mohammed Bin Rashid Al Maktoum Academic Medical Center, The University Hospital, and Dubai Medical Suites. The Mohammed Bin Rashid Al Maktoum Academic Medical Center includes the 400-bed University Hospital, Harvard Medical School Dubai Center and Dubai Harvard Foundation for Medical Research. Shaikh Khalifa Medical City (SKMC) in Abu Dhabi aims to be the first hospital in the Middle East to receive Magnet accreditation, an internationally recognised award for nursing excellence and leadership.

Bulgaria, a fledgling member of the European Union, and a country with a seaside nestled at the crossroads between the East and the West, is increasingly becoming a popular tourism destination for visitors from the Gulf. The natural mineral springs and adjacent wellness therapy has turned Bulgaria into a preferred medical tourism spot. Medical tourism has potential for growth in Bulgaria as the country provides good conditions that meet the demands of Gulf travellers, says Hristo Barutchiev, manager of Rola Complex. On the southern Black Sea coastline, the Rola Complex in Pomorie combines a picturesque view and great climate, as well as mud and saline medical procedures that make it attractive to tourists. The first Kuwaiti visitors at the Rola Complex are scheduled to arrive in September, when the centre will open. Rola Complex is working with local partners, Kuwait International House, on the logistics for Kuwait’s travellers. There will be a direct charter flight from Kuwait to Bourgas International Airport, 8km from Pomorie. The complex offers a mild climate with cooler summer temperatures in the evenings soothed with a pleasant breeze. As well as the Gulf States, both the complex and hospital are specifically targeting Austrian, German and Israeli medical tourists.The Rola Complex boasts three different segments that cater to medical tourists - a medical centre, spa and anti-ageing centre, and balneology. Rola Medical Center will offer an IVF service with a proven success rate of up to 65 percent, as well as medical dermatology, including laser procedures for the removal of uneven pigmentation and acne, in addition to other various manipulations. Also, it will provide aesthetic dermatology applying a Brazilian anti-ageing patent, including fillers, surgical lifts, surgery-substitutes and rejuvenating therapies; as well as balneology, kinesiotherapy, and rehabilitation. Unusual specialities include mental health and help in giving up smoking. Rola Complex features 106 fully furnished apartments and studios in different sizes, half of which have already been sold. Each apartment is fitted with a kitchen, and a restaurant in the complex will offer Arabian cuisine. In addition, customers who own an apartment within the complex are entitled to discount prices in the medical centre. When completed, some two years from now, adjacent to the Rola Complex will be the most modern hospital in Bulgaria fitted with the latest medical equipment. Black Sea Hospital for Active Treatment will have five operation theatres for cardiovascular surgery, cardiology, transplants, aesthetic surgery and a modern and comprehensive diagnostic centre that will use the newest medical standards. Bulgarian doctor Professor Aleksander Chirkov, who has had extensive experience and practice in Europe and the United States, is now recruiting professionals from leading European medical universities and clinics. Once area it will focus on is a wide range of the latest stem cell treatments. Apartments and luxury villas will be constructed close to the sandy beach. When completed, the complex will include 4 swimming pools. private beach, bars and restaurants, sport facilities, children’s amusement playgrounds, and even water attractions at the yacht port, as well as yachts offering cruises in the Black Sea.

Declining tourism numbers are causing major problems for countries where the economy has become dependent on a continual rise in tourism numbers. Several countries in the Caribbean are desperately seeking a magic bullet to cure their tourism ills. They have seen the projections of 21 million American medical tourists going overseas for treatment every year. Some countries are being swayed by these magic numbers and are keen to capitalise on the anticipated hordes of medical tourists desperate to leave the US to come to their country for treatment. Should we be amused or saddened when we see another politician or tourism official planning to solve their tourism problems through medical tourism? The lack of infrastructure, medical tourism experience and accredited hospitals in some Caribbean countries has to be taken into consideration. The Bahamas wants medical tourists to replace lost holidaymakers. Their  target market is the 3 million Florida residents over 65. With the Jamaican economy suffering several recent setbacks, one financial analyst is calling for significant investments in health tourism to replace lost earnings. According to Keith Collister, purpose-built hospitals to attract foreign clients would more than make up for the earnings lost from bauxite and other ailing sectors, One such hospital based in Jamaica could replace the minimum likely damage to export earnings from the collapse of the bauxite industry whilst two such hospitals could generate enough revenues to replace the entire bauxite industry," he said at the launch of The Roxborough Institute, a new think tank. Another country where politicians are talking up the potential is the Bahamas, although more locals go to the US for treatment than come from the US. Antigua has made similar noises, despite the only attraction being one celebrity dominated recovery centre. The Barbados government has been talking for years of producing a health and tourism policy we are still waiting. At present, health spas and fertility treatment are available in Barbados. As an established holiday destination for the very rich, clinics and hospitals in Barbados targeting this sector may be a possibility. Trinidad and Tobago lacks medical facilities but is aiming to attract medical tourists. The Turks and Caicos Islands plan to enter the medical travel market when a new hospital is completed. Few of these countries have so far provided any detail on what they will offer. They face stiff competition from established medical tourism destinations who have spent time and money on promotion and accreditation.

A 2008 study by Deloitte identified Brazil, Costa Rica and Mexico, boasting professional costs ranging from 25 to 50 percent of the US average, as countries in Latin America with the greatest potential for inbound medical tourism. Other contenders were Argentina, Colombia, Brazil and Chile whose dental and cosmetic treatments are about 20 percent off prices in the US. With traditional tourism hit hard by the global recession, Costa Rica is seeking to draw foreign visitors by offering reasonably priced, high-quality healthcare. A combination of proximity to the US, excellent air connections, political and social stability and low crime stats make it an attractive proposition. Officials regularly quote the figure of 100,000 medical visitors to the country, but this may only be an estimate 20,000 a year is a much more realistic sum. To stimulate demand overseas, the government is enlisting the help of its tourism, health and trade ministries and planning a big publicity campaign. The Association for the Promotion of Costa Rican Medicine (PROMED) has also been established, consisting of six health consortiums, three private hospitals and several local universities and hotels. In Puerto Rico, medical tourism has become the hope for revenue resuscitation. Despite a dearth of healthcare facilities, tourism players talk of aiming for 120,000 visitors, but how this number will be reached is still the big question. Medical tourism to Panama for cosmetic and other surgery is increasing as the county boasts some of the most modern medical facilities in the region.   Many Panamanian doctors have studied in the US, Canada or Europe and speak English. However, lack of unity among the stakeholders such as the hospitals, clinics, tour operators and hotels is proving to be the obstacle to what could be a better growth picture. Brazil presents a deeply unregulated market. While local professionals do not lack for skills and do attempt to improve themselves, their community does not have a clear strategy to offer the global clientele. Few establishments can say they have international patient centres or staff trained to speak other languages and deal with the needs of foreigners. Marketing overseas has been known to be spotty, often done by word of mouth. Foreign patients do continue to seek treatment south of the border, but these have been mainly Americans and Canadians. Clientele from other parts of the world remain unconvinced that a cutprice proposition equals quality service.

About a million Indonesians go overseas annually seeking treatment, an exercise that amounts to well over US$1 billion, research by analysts Frost and Sullivan shows. The study, presented at a health forum in Singapore in April, indicates that despite the huge potential and spending power of Indonesia’s large population, the domestic healthcare industry has proven incapable of meeting their needs. Instead, countries such as Singapore, Australia, Malaysia and the US have been benefiting from the visits of wealthy local residents. Frost and Sullivan contend that Malaysia has been gaining over Singapore in attracting Indonesian patients. It said: Indonesian medical tourists going to Malaysia comprise around 70 percent of its total (inventory of) international patients, while those going to Singapore are only around 65 percent. Last year, Malaysian hospitals treated 288,000 Indonesian patients, up from  221,538 in 2007 and 170,414 in 2006. In 2007, Singapore hospitals treated 226,200 Indonesian patients, a drop from the 266,500 recorded in 2006. However, its revenue in 2007 from this market was recorded to have increased. Affordable pricing was Malaysia’s edge over Singapore, while political stability put it ahead of another rival Thailand. With Singapore’s healthcare infrastructure being world class, its treatment costs are higher than Malaysia’s as are accommodation and incidentals. This reality has led it emphasise quality, and focus on the highly affluent Middle East sector. A Muslim country, Malaysia has also decided to go for an Arab clientele, as well as those from destinations within the eight-hour flight range including China, Japan, Korea and the Asean.

Research group RNCOS says in its new report, Emerging Medical Tourism in Turkey, that despite the sluggish world economy, the industry witnessed impressive growth of around 40 percent in 2008 over the same period in 2007. Last year, the country received around 200,000 foreign medical tourists The study provides an in-depth analysis of the present and future prospects of the country in the medical travel arena, delving into the operations of key players such as The World Eye Hospital, Memorial Hospital, Anadolu Medical Center and Sanatolia Care. Growth has been fuelled by a cost advantage. In Turkey, fees for treatments range from one-half to as little as one-fifth the price in Europe and other developed countries. Its strategic location between Asia and Europe makes it accessible to travellers, and the capital Istanbul boasts good air connectivity. Turkey has proven especially attractive to European medical visitors, who are avid patrons of its spas. To promote these further, the tourism ministry has listed 17 registered thermal spa resorts with mud bath facilities, but there are an estimated thousand more unregistered. Istanbul Memorial Hospital was the first hospitals in the country to receive JCI accreditation.

A woman from Wales is suing a cosmetic surgery clinic in Belgium after she underwent cosmetic surgery a facelift. Mrs X, who is in her 40s, is taking the UK-based Elyzea Cosmetic Surgery Group to court for personal injury, following a botched facelift and upper and lower eye procedure in 2005. The woman is now too embarrassed to be seen in public, claiming that she has been left with prominent scarring around the eyes and the ears. She adds that she suffers numbness and a lack of symmetry on the left side of her face. To hide the scarring, she has had to grow her hair long. Although the surgery was performed in Belgium, she is pressing charges in the UK. If she succeeds, it could pave the way for other patients, who may have received below standard healthcare abroad, but want to go to court in the UK where they can expect bigger payouts. Elyzea, which has offices in London and Manchester, denies any liability, saying the procedure took place in Belgium, and thus, Belgian law should prevail. In that context, it is the attending surgeon who is legally responsible for any personal injury, not the firm he works for. A spokeswoman for Elyzea said they did not accept responsibility for the case, however, they did feel they had a moral responsibility to try to put things right. We are providing aftercare to correct errors. But generally patients are not reimbursed. Elyzea has offices in Paris, Utrecht, Manchester, London and Brussels. Europe lags behind the US in promoting insurance covering medical negligence. Many agencies, involved in arranging medical travel, don’t think they need protection or have the funds to buy a policy. Underwriters are reluctant to insure them because some are not licensed, appear to be new at the game or cannot present a professional way of selecting its roster of specialists.

A study by Jordan’s Private Hospital Association (PHA) reports that last year, 210,000 patients from 48 countries received treatment in local medical facilities. This was an increase compared with the 190,000 patients in the previous year. Most of the patients come from Iraq, Palestine, Sudan and Yemen. PHA president Fawzi Hammouri contends the World Bank places Jordan as first among the Arab countries and among the top 10 in the world when it concerns medical travel. In order to maintain this ranking, we have to keep the current markets in the Arab world and find new ones in Africa, Europe and the US, he said. We have already marketed in Chad, Nigeria, Russia, Azerbaijan and Kazakhstan. PHA is a private, voluntary, non-profit organisation established in1984 to represent the interests of 48 private hospitals in Jordan. It seeks to raise medical standards, supports national and international accreditation and promotes the Hashemite Kingdom as a medical tourism destination. To enable these ambitions to be fulfilled more quickly, it is planning to allow public and university hospitals to join its ranks. The new grouping will eventually be named Jordan Hospital Association. PHA is working with member hospitals to promote specially designed healthcare offers to Americans and Europeans. Hammouri explains: We will provide them with packages that are 25 percent below market prices. This includes the plane ticket, accommodation and a visit to Petra to encourage local tourism as well.

The European Parliament has approved plans to give EU (European Union) patients the right to seek healthcare within the bloc more easily and be reimbursed for the costs. MEPs (Members of the European Parliament) also want patients to be properly informed about their rights when they are treated outside their home member state. The draft directive on cross-border healthcare aims to eliminate obstacles for patients who seek treatment in an EU member state other than their own. It also clarifies patients’ right to be reimbursed after treatment in another member state rights that have been confirmed in European Court of Justice judgments but are not yet included in EU legislation. The directive does not change the right of member states to define the benefits that they choose to provide. If a member state does not include a particular treatment as part of the entitlement of their citizens at home, this EU cross-border healthcare directive does not create any new entitlement for its citizens to have such treatment abroad and be reimbursed. The new directive will not affect current patient rights, which are already codified under another EU regulation, or the regulations on the coordination of social security systems. Under the draft directive, European patients will have the right to seek healthcare within the bloc but member states may nonetheless introduce a system requiring prior authorisation for the reimbursement of hospital costs if the financial balance of the member state’s social security system could otherwise be seriously undermined. No state can do this unilaterally, it has to get at least majority approval from other states before it can include prior authorisation in national law. Meanwhile, MEPs want member states not the EU Commission as originally proposed - to define what hospital care is. They also stress that the prior authorisation requirement must not create an obstacle to patients’ freedom of movement. On the reimbursement of medical costs incurred, MEPs agree with the general rule that patients are to be reimbursed up to the level they would have received in their home country. They add that member states may decide to cover other related costs, such as therapeutic treatment and accommodation and travel costs. Since the proposed rules would in practice mean that patients needed to pay in advance and get reimbursed only later, MEPs added a provision that member states may offer their patients a system of voluntary prior notification. In return, reimbursement would be made directly by the member state to the hospital of treatment.  MEPs say member states must ensure that patients who have received prior authorisation will only be required to make direct payments to the extent that this would be required at home. The Commission is to examine whether a clearinghouse should be established to facilitate the reimbursement of costs. Parliament has added special rules for patients with rare diseases and disabilities that might need special treatment. Patients affected by rare diseases should have the right to reimbursement, say MEPs, even if the treatment in question is not provided for by the legislation of their member state and this shall not be subject to prior authorisation. Special costs for people with disabilities must also be reimbursed under certain conditions. Furthermore, all information must be published in formats accessible to disabled people. Parliament voted to exclude long-term care and organ transplants from the directive. To improve patients’ confidence in cross-border healthcare, they must receive appropriate information on all major aspects of such care, such as the level of reimbursement or the right of redress in the event of any harm arising from healthcare. MEPs back the idea that national contact points should be established but they also propose establishing a European Patients Ombudsman to deal with patients’ complaints regarding prior authorisation, refunds or any harm suffered, after all complaint options within the relevant member state have been explored. The legislation was prompted by a series of EU court rulings in the 1990s that established the right of patients to be reimbursed for treatment abroad. But the lack of legislation means there is still legal uncertainty for patients about under what conditions they are entitled to have their costs repaid. At the moment, just one percent of healthcare budgets are spent on cross-border healthcare. The law now goes back to the member states for consideration and will be only be taken up again in the parliament’s new legislature, beginning in September. This was the European Parliament’s first-reading position. This dossier is expected to require two readings and is unlikely to be concluded until the end of this year or possibly early 2010. Individual country legislation could be two to five years away. EU member states are still working to iron out a range of practical difficulties before the plan can be formally adopted. EU ambassadors will now discuss the proposal in early May as member states continue to wrangle over the practicalities of enhanced patient mobility. The plan has been discussed several times at meetings of EU governments this year, but Brussels insiders warn there is still much work to do before agreement is reached. Among the outstanding issues to be resolved are how much power member states will have to control the flow of patients to their health services from outside their jurisdiction. It is believed that the Czech EU presidency is now suggesting that countries should have greater freedom when demanding prior authorisation for treatment, particularly for "specialised and cost-intensive" care. The presidency is hoping for political agreement at a meeting in Luxembourg on June 8. Cooperation by member states on health issues is a thorny issue as healthcare is a matter for individual countries, and there are significant differences in funding models of health and social insurance systems across the EU. How this could affect medical tourism is not known. Those expecting a flood of state-paid patients to their hospital are likely to be disappointed. Much EU medical tourism is for cosmetic surgery, wellness, spas and dentistry-where there is limited provision in state healthcare. Some EU countries have an efficient state health system where patients do not feel the need to look overseas. But others suffer long waiting lists or poor provision. Much will depend on whether states are allowed to dilute the effect of the legislation by demanding that patients get advance authorisation, as countries where demand for overseas treatment is most likely are also those where health bureaucracy would make life difficult for those seeking state-paid overseas care. European medical tourism could benefit now from the proposals as opening people’s eyes to the idea of medical travel and that other countries may have better or cheaper private care than at home, will make more people aware of the benefits of medical tourism. What must not be forgotten is that the whole point of the legislation is to benefit patients -not states, politicians, hospitals or the medical tourism trade. UK Liberal Democrat MEP Liz Lynne reminds us that the legislation paves the way for European patients to access healthcare across the EU irrespective of income: Why should a patient have to lose their sight waiting for a cataract operation, or spend months in agony waiting for a hip replacement when they could get treatment sooner in another member state, sometimes at a lesser cost to the country of origin? If a clinician advises treatment and this cannot be provided at home, then we need a legal framework to ensure that they can seek it elsewhere."