Intuition Communications, which runs leading online medical travel portal Treatment Abroad, has appointed In Malta Online Group - its first overseas franchisee - to operate the Treatment in Malta website. The new site will be aimed at inbound medical tourists to Malta. The In Malta Online Group currently operates a number of online services and has invested in the franchise to expand its range of Malta-based web portals into the healthcare market. In Malta Group is the first franchisee that Intuition Communication has appointed. The new web site will follow the successful Intuition business model, and reflect the branding and content of Intuition’s other medical tourism. Intuition Communication will work closely with In Malta Online Group, and will provide web technology, business development, marketing and operational support to set up the website and ensure its success, once it goes live. Keith Pollard, who runs Intuition Communication, said: Franchising our business model and brand is a logical step for us in expanding our business, particularly into overseas markets. We see this as an opportunity to grow our revenues by licensing our technology and business model to web businesses and healthcare operators in other countries who wish to develop health information portals or medical tourism content. Franchising will enable us to benefit from the use of local sales and marketing partners/franchisees to achieve these revenues. We are looking for partners who, like In Malta Online Group want to extend existing web businesses or set up new web ventures, while minimising the investment required to develop and set up such a site. Our franchise will offer them the expertise, knowledge and ongoing support to build a successful portal within the health information sector of their own country. Aside from its main UK portal, Intuition Communication already has a local Treatment Abroad website in Cyprus, Spain, India and Hungary. These websites are owned by the company itself.

The International Medical Travel Association (IMTA), the world’s first ever not-for-profit medical tourism industry association, has elected Ruben Toral as its new president, succeeding Steven Tucker, who remains on the executive committee. Toral is a recognised authority in medical tourism and healthcare globalization. Formerly group marketing director for Bumrungrad International, Toral was instrumental in positioning Thailand and Bumrungrad International as a leading medical tourism destination. Toral has more than 15 years’ experience in building healthcare brands, businesses and physician networks in Asia and Latin America. As chief executive of Mednet Asia he works with international hospitals, insurers, employers and information technology companies to develop global healthcare delivery networks. Originally from the USA, he now lives in Bangkok, Thailand. Toral said: IMTA already has a solid membership base that includes many of the world’s leading medical tourism destinations. My mission is to expand our association by focusing on core issues that drive worldwide medical travel. Medical travel continues to generate headlines as a cost effective option. As an association, we must help healthcare buyers understand that medical travel is not only a significantly less expensive option, but also, in many cases, a better one. Toral’s appointment is part of a larger initiative to re-energise and expand the IMTA. A new executive committee includes vice-president Vishal Bali of Wockhardt Hospitals, secretary Jason Yap of Raffles Hospital, and treasurer Mack Banner of Bumrungrad International. IMTA is a global organization of stakeholders in the international medical travel industry, representing leading healthcare providers, medical travel agencies and related industry service providers worldwide. IMTA supports the development of international industry standards and best practices that promote and advance medical quality, safety, and transparency for the international patient, and that preserve and protect the doctor-patient relationship. IMTA was founded in 2006 and now has 40 full members who all have an active involvement in medical travel. Although seeking to expand membership, it is not prepared to offer membership to companies with little or no involvement in medical tourism, purely to generate income. Although it sponsors and takes an active role in conferences on global healthcare and medical tourism, it does not see a need to be a conference organiser with a proliferation of conferences to produce income, which it does not need as all the executive are unpaid volunteers. The association believes that with patient safety at stake, accreditation standards and processes must be vetted by internationally recognised accreditation organizations and government agencies. It has opposed trade groups and others seeking income by declaring themselves as accreditors or certification authorities as it creates market confusion. IMTA advocates that all international hospitals and other healthcare institutions be held to high standards, whether through a country’s own regulatory system or through internationally accepted standards set by recognised accreditation authorities.

Attracting more foreign patients has become of primary interest to the Korean medical community. Korea has advantages in high-quality medical services at relatively low prices. That is why the Korean government is allowing hospitals to market themselves to foreign patients. Foreign patients travel to countries with different cultures and languages and entrust not only their health, but also their lives to doctors in another country. But Korean hospitals are squeezing medical tourism into existing premises. The international patient centre is often in annex, staffed by doctors and nurses who can speak foreign languages. Foreign patients experience problems communicating at Korean hospitals, which lack foreign-language signs. There is a debate between those who want to spread the fruits of medical tourism around, and those who think that service quality can only be achieved by foreigner-only hospitals. The standard of medical care is high, but deficiencies in other service areas means there is a chance that Korea may end up losing foreign patients in the long term, despite some early successes. Reports suggest that some hospitals have not understood that while domestic patients may be content with delays and poor service, in medical tourism, the customer is king.   Last month, the Korean Medical Association conducted a survey of ten hospitals out of the 44 largest hospitals across the country, which are keen on attracting foreign patients. It showed that only four of them have assigned doctors to handle foreign patients, so nurses often have to act as translators. The Ministry for Health, Welfare, and Family Affairs (MIHWF) and the Korea Health Industry Development Institute (KHIDI) have established a foundation to attract foreign patients; the Global Healthcare Service Association (GHSA). The GHSA will become a private corporation, help with domestic and international advertising to promote Korean healthcare, train hospital staff to deal with foreign patients, and prepare brochures on treatment fees for foreign patients.

Medical tourism, one of the main sectors of the national economy, has not been negatively affected by the global economic crisis, says the PHA. Private Hospitals Association (PHA) President Fawzi Hammouri said Jordan is ranked by the World Bank as number one in the Arab world, and among the top 10 in the world, as a medical tourism destination. 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. New markets have already been opened in Chad, Nigeria, Russia, Azerbaijan and Kazakhstan, while plans are in place to open markets in Germany, the UK and the US. The high quality and competitive cost of healthcare in Jordan have made the country an attractive destination for foreigners seeking advanced treatments that are unavailable or unaffordable in their home countries. The medical tourism sector annually generates over US$1billion in revenues and the number of foreign patients seeking treatment in the Kingdom stands at over 200,000 per year, said Hammouri The PHA encourages hospitals to get Joint Commission International accreditation. There are 61 private hospitals, 48 of which are PHA members and four have JCI status. The PHA is working with hospitals to offer medical tourism packages to Americans and Europeans who come to the country for medical services with unprecedented packages. Hammouri explains, We will provide them with packages that are 25 per cent below market prices. This includes the plane ticket, accommodation and a visit to Petra to encourage tourism as well. Prime Minister Nader Dahabi wants the Health Care Accreditation Council (HCAC), and Ministry of Health, to enhance efforts to attract more patients, especially from Europe and the US. HCAC hospitals responded that it would help if the government made medical tourism exempt from sales tax. HCAC was established through a joint initiative between the Ministry of Health and USAID/Jordan as an independent national hospital accreditor; whereby HCAC hospital standards are accredited by an International accreditor of healthcare accreditation organisation ISqua.

Official figures for 2008 revealing that less than 1,000 medical tourists, rather than the 100,000 plus that the country has regularly claimed, shocked Philippine authorities and hospitals into a rethink. Existing marketing has been all talk, little action and a total failure; so new ideas are needed quickly. The Philippine Convention & Visitors Corporation (PCVC), a non-profit marketing division within the Department of Tourism, has appointed agency DM9 to develop a campaign to attract medical tourists. This could include road shows, videos for websites and brochures. Another agency, Campaigns & Grey has a project from Makati Medical Centre, the country’s premier hospital, to market the hospital ahead of its 40th anniversary. The brief includes promoting Makati’s improved facilities and boosting its standing among other medical centres. The Philippine Economic Zone Authority (PEZA) is helping develop medical tourism with incentives to health and wellness spas, and hotels; the latter being vital to places like Cebu, as there room shortages. PEZA has so far accredited two hospitals, St. Luke’s in Taguig and Cabrini in Cavite. St. Luke’s at the Fort is a 600-room, 1,000-doctor facility built at a cost of P9 billion and will open in October 2009. St. Luke’s Medical Centre promotes itself by pointing out that the cost of a heart surgery at $10,000,is just a tenth of the $100,000 in the United States, and a third of what hospitals in Thailand, Singapore and Malaysia charge. The problem with cut-price offerings is that medical tourists are wary of prices that appear too low. The country will struggle until individual and national marketing understands why offering ultra-low prices backfires and scares potential customers away, and how other approaches are vital. The Cebu city government here has given money to the Cebu Health and Wellness Council to help promote Cebu and its local health-and-wellness centres, hospitals and resorts as an international player in medical tourism and wellness. Hospitals, clinics, hotels and travel operators that are partners of Cebu Health and Wellness will soon launch special packages for tourists where tourists can combine an executive medical check-up with a holiday. Cebu Doctors University Hospital in January received 60 overseas patients, compared to an average of 10 a month in 2008. The hospital now aims for 100 foreigners a month for the rest of the year. It has rolled out a project to build suite rooms to accommodate foreigners. Most patients are Europeans in need of outpatient procedures, executive checkups, gastrointestinal procedures and heart surgery, not the Americans that everyone talks about.  Cebu Doctors has new partnerships with hotels, travel operators and spas. The group sees Cebu as a top destination for spa and wellness, as an adjunct to medical services. The Medical City has opened a satellite office in Tamuning to ease the paperwork for patients from Guam who want medical treatment at The Medical City. All these projects are good, but the individual impact is small. What the country needs is for all those officials and politicians who have spent the last four years talking up how much they want medical tourists to come to the country, and making bloated claims on numbers, to spend money on proper marketing campaigns with selected targets, measurable results; combined with ensuring there are sufficient good quality hotels and hospitals to deliver the goods. Also, if the country wants American medical tourists, having just two JCI status hospitals is not enough.

It is well documented that thousands of Britons leave the UK every year for dental and cosmetic surgery, with a minority going for medical treatment. But global medical tourism is a two way process: travel into the UK for healthcare has existed for many years, well before medical tourism became a business.In the UK, although numbers are unknown, anecdotal evidence suggests that it is concentrated on hospitals with an international reputation, almost all being in London. Some private and NHS hospitals actively seek out international patients, whether self-funded, insured or paid for by their governments. Others passively accept the business that has come to them for decades. The UK is more expensive than Asia but cheaper than the US or Middle East. Great Ormond Street Hospital for Children trust is also looking to grow its international business both from Europe and further afield over the next few years. In the UK, HCA International owns six leading London hospitals; The Harley Street Clinic, The Lister Hospital, London Bridge Hospital, The Portland Hospital for Women and Children, The Princess Grace Hospital and The Wellington Hospital. Since the 1970’s many international patients have travelled to London for specialist patient care. The International Patient Centre (IPC) caters to the needs of patients from abroad, across all the hospitals. With offices in Kuwait, United Arab Emirates, Pakistan, Nigeria, Greece, Cyprus, Libya, Egypt, HCA offers an extensive network of access points for the medical tourist. HCA will also look for expansion in countries where high quality specialised medical services at an affordable price are needed. Other hospitals have already taken opportunities abroad. Moorfields Eye Hospital has a clinic in Dubai; Moorfields Eye Hospital Dubai has seen over 2000 patients since opening in July 2007 in Dubai Healthcare City. Moorfields currently treats a significant number of patients in the UK from the Middle East.

Although Malaysia is an Islamic country, tourists from the Middle East make Thailand and Singapore their choice of destination over Malaysia when it comes to getting medical treatment, said a top Malaysian official. Making this statement, Secretary General of the National Chambers of Commerce and Industry Malaysia (NCCIM), Datuk Syed Hussien Al-Habshee said the lack of effective marketing strategy was the reason for Malaysia being left behind the two countries in medical tourism. Although we have the clear edge in terms of religion, Muslim hospital staff, halal food and other aspects, Middle East tourists prefer to go to Thailand and Singapore. Due to this, the country continues to be left far behind the two neighbouring countries in the sector which is growing annually.’ He says that in 2008 6,000 medical tourists from the Middle East went to Thailand for various forms of treatment in the country’s hospitals. Syed Hussien argues that there is an urgent need for more integrated strategies from government agencies. The three ministries involved, namely the Ministry of Health, Ministry of International Trade and Industry and Tourism Ministry should have a strategy to promote and market Malaysia as a premier medical tourism destination, rather than leaving it all to the private hospital sector, he said. A recent study by the National University of Singapore shows that the process of transforming Malaysian healthcare into a global commodity is well under way. This is underpinned by the Government’s effort in institutionalising various incentives such as tax support, accreditation, sales promotion and marketing activities to promote the country as a healthcare hub. The report echoes Syed Hussein as it says that the initiatives are fragmented and that the private healthcare sector has been tasked to be the driver of medical tourism in Malaysia. Among the factors working to Malaysia’s advantage, are its cost-competitiveness compared to the regional and international markets, the good infrastructure, and the fact that English is widely spoken. It has highly-trained and skilled medical personnel, state-of-the-art diagnostic equipment, modern facilities, accreditation based on international healthcare standards, competitive cost of treatment, and excellent hospitality. Malaysian hospitals are known for their resources and expertise in cardiology, orthopedics, cancer treatment, fertility treatment, and reconstructive surgery. What it is poor at is integrated marketing, promotion and advertising. The private sector has 230 private hospitals and 4000 medical and dental clinics. 35 private hospitals have been recognised by the Malaysian Ministry of Health for the promotion of health tourism. As a step to promoting itself in the Middle East, The Ministry of Health and the Association of Private Hospitals of Malaysia (APHM) recently took ten leading providers of medical care, wellness, health tourism and healthcare technology to MSE 2009, a trade exhibition in Dubai, with a forum on ’Malaysia - Your preferred healthcare destination’. After achieving JCI status, Prince Court Medical Centre (PCMC) in Kuala Lumpur wants to become a leading healthcare provider in Asia and promote medical tourism, says chief executive Stuart Rowley,  "We are targeting the Asian region, Middle East and there is a lot of existing demand coming from Australia and New Zealand for medical tourism."

A Medical Travel Facilitator’s Professional Certification is now in development.  Unlike any other programme offered in the industry, it denotes that an agent with this certification has successfully demonstrated skills and mastery of the body of knowledge needed to coordinate patient care and travel arrangements for people who travel for medical treatments. The new programme is being offered by the newly established Council on the Global Integration of Healthcare (CGIH), a global organisation incorporated for the development and advancement of global health policy in medical tourism Through exams, case studies and field demonstrations, CGIH certification denotes ability to use the body of knowledge on medical tourism for practical application. The council’s purpose is to provide the largest and most comprehensive body of knowledge for medical tourism without being distracted by commercial enterprise or personal ego trips. Its executive board, advisory board and membership represent a cross-section of industry, private business, government and academia.  It is now recruiting members. CGIH certification has a three-step process. These are:    1. An applicant must submit a portfolio of information about his business history, professional liability insurance and business establishment, and professional references to demonstrate that he/she is actively engaged in the profession of medical travel facilitation.    2. The applicant studies for a written examination covering all core areas of the Body of Knowledge.  A passing score of 92 percent is required for certification.    3. To continue to Advanced Status and Fellowship, a third step is to select one project that will serve as the applicant’s thesis. This project may be completed as part of the applicant’s job or as a result of their training/education.     A peer review panel has to approve the subject and methodology of the thesis project and will afterwards be tasked to evaluate the finished thesis and the required oral presentation to be presented at the Annual Institute of the council. The council is enlisting the assistance of psychometrists who will validate the testing and metrics to ensure that the programme meets its professional development objectives. CGIH is now working with specialists on business law, travel planning and clinical information to author study guides, pre-test and final exams for self-directed courses. Course         Description 0010      Basic travel planning for medical travellers 0200      Understanding travel service terminology 0020      Medical travel facilitators and travel agents: role differentiation 0030      World geography refresher 0100      Understanding customs and visa requirements 0110      Introduction to international airline reservations 0120      Introduction to international connections for medical travellers 0130      Introduction to hotel accommodation reservations 0140      Introduction to ground transfer arrangements 0150      Counseling clients about trip interruptions and lost baggage 0160      Introduction to destination management services 0170      The role of the medical concierge 0180      Travel planning for clients with special dietary restrictions 0190      Travel planning for clients with mobility impairments 0210      Travel planning for clients with visual impairments 0220      Travel planning for clients with hearing impairments

Healthcare providers are not recession-proof, as the two major players in Singapore illustrate. At Raffles Medical Group, revenue continued to grow but the speed of growth has dropped. Parkway Holdings, the city-state’s biggest private hospital operator, suffered a seven to eight percent decline in foreign patients in 2008 and the pace of growth slowing. It successfully achieved revenue growth by targeting foreign patients in new markets, such as Bangladesh, the Philippines, Vietnam, Cambodia, Pakistan and Russia. The result is double-digit growth in revenue and admissions from these foreign patients at the Singapore hospitals. Parkway and Raffles are the two biggest private hospital groups in Singapore. Both have robust operating margins, brand equity and a more diversified patient base than a decade ago. Both groups have been taking steps to deal with the downturn in business. Parkway has cut headcount and slashed senior management salaries. Raffles has been keeping its staff costs stable and with a new international marketing head - Singapore Tourism Board healthcare services director Jason Yap, it appears to favour tackling the situation by increasing demand, particularly for the complex cases which offer higher average revenue per patient. Neither is sitting back and waiting for business, they are marketing in targeted countries, promoting high- value medicine rather than the low-cost approach of most rivals, and if people overseas will not come to them, are taking healthcare provision to them.   Raffles Medical Group has hospitals in Hongkong and representative offices in Indonesia, Vietnam and Bangladesh. ParkwayHealth has 15 hospitals around the region, including in Brunei, India and Malaysia. plus 45 International Patient Assistance Centres across the globe including Bangladesh, Brunei, Canada, China, Hongkong, India, Indonesia, Malaysia, Myanmar, Pakistan, Philippines, Russia, Sri Lanka, Thailand, United Arab Emirates, United Kingdom and Vietnam.

Healthcare accreditation specialist CHKS Limted has been acquired by the Capita Group Plc for £11.6 million (US$15.17 million). Used to be owned by Healthcare Knowledge International, CHKS provides healthcare intelligence and quality improvement services to healthcare organisations. CHKS employs around 80 staff who are based mainly in Alcester, Cardiff and London. CHKS pioneered the UK healthcare intelligence market with hospital benchmarking in 1989. Capita is the UK’s leading outsourcing company and operates in nine key markets, ranging from financial services to local government, and has a strong and growing presence in the health sector. CHKS has developed a range of solutions for over 400 healthcare clients in 15 countries, offering online healthcare performance and governance tools. One of the attractions for Capita was CHKS contracts with the NHS and its development of on-line accreditation programmes. The international hospital accreditation programmes are internationally recognised by ISQua (International Society for Quality in Healthcare) and certificated by UKAS (UK Accreditation Services) to award ISO 9001:2008 certification. The CHKS international accreditation programme has been designed to be adaptable to the local cultural, legislative and professional framework of the host country. Individual hospitals or healthcare organisations or entire countries can implement the CHKS programme. CHKS has accredited one hospital in Cyprus, two in Denmark,various British forces medical centres in Germany which are only for British troops, one in Gibraltar, four in Ireland, and ten in Portugal. It also certifies another ten to ISO standard In Cyprus, Italy, Portugal and South Africa. In the UK, another 50 hospitals and care homes are accredited or certified.

Much of what is written about medical tourism in the US and the UK makes the assumption that worldwide medical tourism depends almost entirely on Americans and Britons. Figures from several countries over the past year have proved that this is not true, as the main sources of business are Continental Europe, Asia and the Middle East. The number of Americans leaving the country is debatable. Despite major reports, there are no real figures around. Those desperate to sell their services to overseas hospitals and government bodies have a vested interest in using the largest figure possible. The once regularly used 250,000 has mostly been replaced by either 500,000 or 750,000. These are all conveniently big and nicely rounded up numbers. The higher figure came from Deloitte which last year suggested that by 2010 a massive six million Americans would go overseas. The real truth is that these are wild guestimates with no statistical backing. No advocate of any version has ever cited a believable source. They have become medical tourism folk tales. There is some evidence that the number of Americans going overseas is growing slowly, but particularly with US healthcare reform, the giddy heights of six million is now pure fantasy. Deloitte’s report entitled Medical Tourism: Consumers in Search of Value also estimated that in 2008 over 400,000 people came into the US for medical treatment, and that numbers were growing. A much faster growing trend, but as yet with no statistics, is domestic or internal medical tourism where Americans travel within the US for medical treatment. For one, Healthplace America offers self-insured employers access to a specialty network of 31 US hospitals and clinics. It has signed contracts covering a total of 600,000 workers at companies since January 2008. Chief Executive Ken Erickson said he expects the contract total to hit US$1.3 million by the end of this month and 1,500 employees to use the network in 2009. Erickson said Healthplace America’s network can offer self-insured savings of 30 to 50 percent over rates negotiated by traditional insurers because the company pays the providers up front in cash based on fixed per-case rates. Typically, insurers pay providers after the surgery has been done. Other agencies now offer similar services, but individuals paying for their own treatment tend to deal direct with hospitals, which is why estimating numbers is so difficult. Uninsured Americans are shopping around for surgery in the US in record numbers, and using new services such as Healthbase, one of several medical tourism agencies that are either offering the US as an option, or see so much potential in inbound that they have followed Healthplace America in ceasing to offer treatment overseas. Meanwhile, Florida medical facilities actively, if quietly, market to attract overseas business. Many offer special services geared toward foreign customers with international services divisions that help patients with everything from applying for tourist visas to scheduling airline reservations and hotel stays. Miami Children’s Hospital, for example, has negotiated special hotel rates for its international patients and their families. In Jacksonville, Mayo Clinic Florida draws between 1,400 to 1,500 international patients each year with very little marketing. Much of the international patient traffic results from relationships that Mayo cultivates with physicians around the globe. Last October, the Mayo Clinic opened an information office in a large medical office building in Guatemala, a country from which it receives a large number of patient referrals. Baptist Health South Florida treats 12,000 foreigners each year, many from the Caribbean. The Laser Spine Institute in Tampa is aggressively marketing laser surgery, so now 70 percent of the facility’s customers come either from foreign countries or other US states, which would be 4,000 people in 2009. American hospitals, clinics, tourist boards and cities are all starting to actively market their service to patients from overseas or other states at a much faster pace than Deloitte envisaged last year. By the end of 2009, inbound and internal medical tourism in American could together outnumber outbound.

PROMED or the Council for the Promotion of International Medicine was recently created in Costa Rica with the aim of making the country into a medical centre of excellence within 10 years. The group, whose 21 members include hospitals, medical tourism agencies, was formed to raise the below-par country. Costa Rica is an increasingly popular destination, particularly for Americans. But there are only a few hospitals and clinics servicing medical tourists, and organisations marketing the country have not been working together. Reports from the Costa Rican Institute of Tourism ((ICT) say that the country’s cosmetic surgery maintains a 15 percent growth rate and that in 2007 Costa Rica helped 5,000 patients in search for the best healthcare solution. This means 2009 will see 6,500 medical tourists. The organisation does not say where they come from, but other industry sources suggest that the main source is not North America but Europe, Mexico and Central America. The ICT says that there are two niches; one is "health tourism" for people who want skin treatments, mud baths and other treatments in mountain hotels and spas. The other is medical tourism’ at private hospitals and clinics where the country has attractive prices. In the US, a heart bypass is US$100,000, but in Costa Rica is US$25,000. One problem that has restricted growth of medical travellers from the US is that few hospitals have international accreditation. Two have JCI status, Hospital Cima - San José and Hospital Clinica Biblica in San Jose. The only other one known to be seeking JCI is the third of the big San Jose hospitals, Hospital La Catolica. A new Cima hospital in Guanacaste for 2011 is also expected to join this small group. Cima is part of the International Hospital Corporation (IHC) with hospitals in Brazil and Mexico.