Cebu Doctors’ University Hospital (CDUH) has obtained international accreditation, a development to boost medical tourism. CDUH is the first hospital in the Philippines to receive full-accreditation for two years by QHA Trent, a health care company owned and managed by a group of doctors and experts in the UK. QHA Trent is looking into accrediting more local hospitals.
The accreditation assures patients that the hospital has all safeguards, policies and procedures in place to ensure high-quality health care. Tim O’Carroll of QHA Trent says,” With the Philippines looking increasingly to promote medical tourism, the need for local hospitals to obtain international accreditation is increasingly important. QHA Trent’s doctors and experts are actively working within Britain’s NHS, the world’s largest publicly funded health system.”
CDUH and two other big private hospitals, Chong Hua Hospital and the Perpetual Succour Hospital, are spearheading efforts to make Cebu a destination for medical tourism. The three hospitals will work with the Department of Tourism (DOT), Department of Trade and Industry (DTI) and the Board of Investments (BOI) to make the plan a reality.
Macau is the first place in Asia to have a branch of The Malo Clinic medical spa that offers implant and cosmetic dentistry as well as cosmetic surgery. Currently the clinic can also be found in Brazil’s Sao Paulo, New Jersey in the United States and Lisbon in Portugal. Malo has three clinics under construction in Angola’s Luanda, Tokyo and Casablanca, which are all expected to be opened within the year. Four more clinics are under negotiation, two in Asia, one in the United States and another in Europe
The Malo Clinic sees Macau as a stepping-stone for eventual expansion of the business to continental China. Paulo Malo comments,” We decided to come to Asia for a simple reason. In Asia health care is not of a standard as what we have in Europe and the United States, especially dental health care that is very low quality. Quality of life starts with prevention rather than solving problems later. For Macau’s future as a possible medical tourism destination, there is no point of being the best in the world if people don’t know that you are here, so visibility is very important. If we had a cluster of brand clinics with different specialties then Macau would become visible in Asia.” The Macau clinic receives patients mostly from Mainland China, Hong Kong and South Korea.
Medical tourism promises to be a boon for the Philippines: the National Economic Development Authority expects the industry to be worth $3 billion, with an influx of about 200,000 foreign patients each year, by 2015.

Shanghai is expected to attract 50,000 to 100,000 foreign patients in the next three years, each spending an average of $10,000 to $15,000 per trip, says Dr Yang Jian, of China Medical Tourism Company, "We aim to turn Shanghai into Asia’s leading medical destination for advanced patient care."
Shanghai will promote medical tourism this year by increasing overseas marketing. It also has a medical tourism products and promotion agency, Shanghai Medical Tourism Products & Promotion Platform (SHMTPPP) which is jointly supported by five municipal bureaus to offer a link between patients and Shanghai hospitals. Fierce competition in the market means Shanghai will focus on its specialties, namely gamma knife therapy, traditional Chinese medicine and stem cell technology. Every year, more than 300 Argentineans come to Shanghai for gamma knife surgery, which is banned in some countries.
For some local companies, selling medical travel packages to growing numbers of Chinese customers wishing to receive treatment abroad is already big business. Now, Chinese firms want to promote their own facilities at home to growing numbers of foreign medical tourists. Medical tourism promoters Ciming Health Check Group and its partner, the China Medical Tourism Company, can no longer afford to ignore China as a medical tourism destination.
China’s major urban centers of Beijing, Shanghai and Guangzhou have already attracted growing numbers of medical tourists due to advanced technology, high quality of service, and affordable prices. Despite the ever-increasing quality of China’s medical facilities, lack of awareness as well as language and cultural barriers remain a challenge to attracting more patients.
Taiwan’s medical resources are on par with those found in Europe and the U.S., but it lags behind leading regional medical tourism destinations. 85,000 medical tourists visited the country last year for treatment. Taiwan has been seeking to expand its presence in this industry since 2004, but lack of funding meant that large-scale overseas promotion of the nation’s medical tourism facilities did not begin until 2007. The launch of direct cross-strait flights, along with the opening of Taiwan to more mainland Chinese tourists, has seen more visitors keen on cheap travel costs and a similar language and culture.
Although only 15,000 mainland Chinese will travel to Taiwan as medical tourists in 2012, the government believes this number is set to eventually hit 75,000, or 5 % of total visitor numbers. Taiwan attracts the new middle-class of Mainland Chinese looking for treatment overseas.
The Taiwan government plans to develop special international medical zones. It is currently seeking some private investment for the planned project at Taiwan Taoyuan International Airport that has a target of 40,000 medical tourists. Taiwan has at least three other such zones in the pipeline. But for these to go head to head with international competitors, the government must amend or at least liberalize the Medical Care Act under which hospitals and healthcare centers are banned from advertising for patients. It also needs to review laws covering the employment of foreign doctors.

In response to a question about why US health insurance won’t cover medical expenses incurred abroad, US president Barack Obama answered that his aim is to change the US healthcare system to discourage Americans from seeking medical treatment in India and Mexico. ”My preference would be that you do not have to travel to Mexico or India for cheap healthcare. I would like you to be able to get high quality treatment right here in the United States of America. Before we go down the path of you can go somewhere else to get your healthcare, let us work to see if we can reduce the costs of healthcare here in the United States of America. That is going to make a big difference. Prices of prescription drugs must be brought down so that you don’t feel like you are getting cheated because you are paying 30% more or 20% more than prescription drugs in Canada or Mexico."
The Indian press in particular has picked up on the comments. Watch the YouTube video – Obama targets India again.
While previously having stayed neutral on medical tourism, in the run up to the elections last November, Obama repeatedly brought up off-shoring to India and indicated how he intended to change rules to keep US jobs from going to India to save money. There has been a strong suggestion that Obama wants to reduce the US spending on overseas goods and services, partly to protect US jobs and partly to help solve economic problems; but the speech at a community college in Virginia is the first time that he has openly attacked medical tourism.
Although almost always promoting medical tourism to Americans as offering vastly cheaper treatment in India than in the USA, Indian politicians and doctors have taken offense at Obama suggesting that Indian healthcare is cheap. Health minister Ghulam Nabi Azad says, "Affordable healthcare does not mean our medicine is inferior to any superpower." Dr Naresh Trehan of Global Health adds, “People from advanced countries like the US come to India because the quality of medical treatment here is at par, at times even superior, and more affordable.” Dr H. Sudarshan Ballal of Manipal Health Enterprises, agrees, "Cheap means sub-standard. It is definitely not the truth about healthcare in India. The medical care here is on par with, if not better than, in the US." Dr Vinay Agarwal of the Indian Medical Association is unconcerned; " It only tells us that the US feels threatened by India as we are competing with them in providing quality healthcare at a cheaper cost. People in the US are conscious about quality but are still choosing India because all health technologies are available here while the cost is 10 to 15 times less."
In the college speech Obama said his plan is to ask the wealthy to pay more, which would save Medicare and Medicaid by making them more efficient, and would increase spending on education, energy research and roads. He described Medicare as one of the most important pillars of US social safety net. Medicare is a government run social insurance programme providing health insurance coverage to people aged 65 and over and Medicaid is a health programme for people with low incomes and resources. A Republican budget plan passed by the House of Representatives would gut Medicare and Medicaid to finance more tax cuts for the wealthy, Obama said.
Obama’s comments have to be taken in the context that he faces stiff opposition from Republicans on health reform and decreasing the budget deficit –while attempting a tight rope act of reducing government spending at the same time as increasing government spending on healthcare.

The Human Tissue Authority (HTA) has been selected as the body that will set standards for the quality and safety of transplant organs across the EU.The HTA has also been named as the organisation for England, Wales, Scotland and Northern Ireland, for the EU Organ Directive and will take the lead on developing a regulatory framework and implementation into legislation by August 2012.
It is the first time a formal regulatory framework has been developed for the donation and transplant of organs. The aim is to standardise the systems and processes used by member states. It will also assist in a more effective exchange of organs between member states on the small number of occasions where this is necessary. The ultimate goal is to ensure common high quality and safe standards for the donation, procurement, transportation, traceability and follow up of donated organs for transplant across the EU.
The intent is to:• Create an overall framework that will ensure the all organisations involved in organ donation and transplantation comply with the directive.• Develop a system to license procurement and transplantation.• Confirm arrangements for reporting serious adverse events and reactions.• Issue guidance to healthcare providers involved in all stages of the transplant chain.• Supervise organ exchange between member states.
The EU Organ Donation Directive will improve the quality and safety of organs to be transplanted into patients across Europe. EU member states must be compliant with the EU Directive 2010/53 EU by August 2012
The number of organ donations and transplantations has grown steadily across the EU and thousands of lives are saved every year through this medical procedure. Organ transplantation is now the most cost-effective treatment for end-stage renal failure. Currently, there are wide variations in quality and safety requirements between member states. A directive is needed to ensure a high level of health protection throughout the EU by establishing common standards of quality and safety of human organs intended for transplantation and for those exchanged between EU countries each year.
The HTA aims to maintain confidence by ensuring that human tissue is used safely and ethically, and with proper consent. The HTA regulates organisations that remove, store and use tissue for research, medical treatment, post-mortem examination, teaching and display in public. It also gives approval for organ and bone marrow donations from living people.
The EU Organ Donor Directive (ODD) is a European requirement that aims to bring all EU countries up to the same high quality and safety standards. With better organs available in the EU, more citizens may benefit from the availability of suitable organs transferred from across Europe. The ODD will affect governance and clinical practice in organ donation and transplantation.

A full copy of the EU Directive can be found here.

The European Society of Human Reproduction and Embryology (ESHRE) is setting the first ever standards in cross border reproductive care .The safety of patients, donors, surrogates and future children take centre stage in ESHRE’s Good Practice Guide for Cross Border Reproductive Care. The guide aims to ensure high-quality assisted reproduction treatment as defined by the European Union criteria for good quality medical treatment and the ESHRE position paper on good clinical treatment in assisted reproduction. Although in principle foreign and local patients should be treated the same and with the best possible treatment, there is evidence that this is not always the case.
The guide is based on the core principles in health care: equity, safety, efficiency, patient centeredness, timeliness’ and effectiveness. The principle of equity means that any difference between local and foreign patients should be justified, for instance the extra cost for a translator. Foreign donors should receive similar care to patients and local donors. No distinctions are to be made based on their origin and/or motivation. ESHRE recommends that national and foreign donors receive comparable compensation and that the recruitment criteria are the same. According to the ESHRE task force, the ideal is fair access to fertility treatment at home for all patients. However, often faced with no realistic alternatives due to legal restrictions, long waiting lists, lack of donors or unavailable or expensive treatments, patients travel across borders and may not receive adequate treatment in the country of their choice. Dr. Françoise Shenfield of ESHRE says.” Doctors should consider the principles of beneficence and non-maleficence together and aim at producing minimal risks with a maximum chance of pregnancy. Treatments should abide by good practice rules, such as a restrictive embryo transfer policy to eliminate high order multiple gestations. To prevent abuse of donors coming from abroad, intermediate agencies should be avoided, since this may lead to violations of the rules of good clinical practice and, in the worst case, to trafficking. Our recent study showed that an estimated 14,000 cycles of treatment are performed annually for infertile patients crossing borders in six European countries alone. The total number in Europe is therefore much higher. Together with collaborators such as egg donors or surrogates that also cross borders to provide reproductive treatment outside their home country, cross border care is a wide spread phenomenon.”
Patients should receive clear information about necessary tests, their costs and realistic waiting times; donors should receive a stimulation cycle that minimizes their health risk. In order to obtain information on repeated donations and to be able to verify legal restrictions on donations, ESHRE recommends the establishment of national registers of donors and for centres to participate in data registries. Legal advice about local rules should be given to patients at home and abroad. Potential legal problems in their home country should be outlined to patients. Clinics should follow up on children conceived after treatment at home and abroad.
Collaboration between the home practitioner and the receiving clinic offers the best chance of optimal care for the patient. The principle of patient centeredness includes adapting practical management to foreign patients. Counselling and psychological support should be available in a language understood by the patient. If this cannot be guaranteed, ESHRE recommends not treating the patient. This is important since the patients have to give proper consent. Clinics should provide patients with the details of their ombudsman or complaints department in order to give them the possibility to redress their grievances. The ESHRE task force aims to enroll as many signatures as possible to the good practice guide from regulatory bodies, fertility societies and clinics. The International Federation of Fertility Societies (IFFS) has already agreed to it in principle. Richard Kennedy of IFFS says,” ESHRE produces important European guidance. The movement of patients across international boundaries has emerged as an increasingly important global phenomenon providing significant challenges to safeguarding patient safety. In practical terms, this means that often patients will travel to countries where standards of care may be very different to that available in their home country, or where there is variability of care from clinic to clinic. It is inevitable in such a rapidly growing and internationalised field, that there will be wide variation in practice and development of services. We need to ensure the global infertility industry commits to common goals in standards of care to achieve the goal of maximum patient safety."

The Indian government should provide tax incentives to hospitals to promote India as a health and wellness tourism destination, says a report by Federation of Indian Chambers of Commerce and Industry (FICCI) and Yes Bank.
The report, ’Health and Wellness Tourism – Advantage’, offers a 10-point agenda for boosting health and wellness tourism in India. It recommends encouraging medical tourism by offering tax-breaks and export incentives to participating hospitals. It says that the focus should be to market the country’s health and wellness product in a way that would attract the maximum number of tourists, especially from America and Europe. It suggests that the marketing of alternative forms of wellness packages (ayurveda, yoga, naturopathy, unani), as follow up practices to surgery will lengthen the stay of the tourist in the country.
Another key recommendation is that there must be mandatory quality accreditations for Indian hospitals. It highlights the need to provide good quality accommodation, hospitals and post treatment recuperative centres. The study also suggests setting up a national organisation to provide information to foreign patients on Indian hospitals, and act as a marketing and sales agency. It also recommends setting up health care medi-cities on the lines of the Chettinad Health City in Tamil Nadu to further boost the sector.

Thomas Cook (India) Limited has a strategic partnership with the Indian Institute of Tourism and Travel Management (IITTM). Together they have designed a postgraduate diploma in management in international business, focusing on tourism. It will be a two-year full-time residential course offered at the IITTM campus in Gwalior (Madhya Pradesh). The course module will include business travel, medical tourism, tourism service quality, intercultural management and research. The teaching methods will be case based learning. The first course will begin in June.

“Geothermal water is Iceland’s white gold,” said health tourism consultant Csilla Mezösi at the annual meeting of the Iceland Association for Health Tourism. Iceland’s most famous commercial spa is the Blue Lagoon, which is visited by more than 400,000 people annually. Myvatn Nature Baths is a newer smaller version. Fontana Steam Bath capitalizes on a natural steam vent next to Laugarvatn Lake and is scheduled to open this summer.
Csilla Mezösi believes Iceland’s abundant supply of geothermal energy provides the opportunity for the development of health tourism, which is still in its infancy in Iceland, “Iceland has barely started tapping into this genre of tourism, although there is a lack of information on the number of tourists who actually visit Iceland with the purpose of improving their health. Reykjavik’s public geothermal swimming pools are of a high quality and clean so offer opportunities to build hotels next to the pools for greater convenience for foreign visitors. The country could organize dance parties in the thermal pools in winter to attract young tourists in the low season. It should get the Olympic handball team medalists to promote health tourism in Iceland. Health tourism incorporates both spa tourism, as well as medical tourism. However, a typical spa tourist focuses on different things than a medical tourist. Spa tourism involves a holiday whereas medical tourism involves cost-effective operations but more importantly a guarantee of a follow-up service after the treatment.”
Iceland offers many ways to relax and recover from life’s tensions through physical activity. The warm water that is found so abundantly in the Icelandic soil provides opportunities for relaxation and recreation. Every village or town has a swimming pool. In some places you can swim in natural bluish water, rich in minerals and soothingly warm. The country has very low levels of pollution and a high life expectancy.
The Blue Lagoon’s ecosystem is unique. Spa treatments and massages use the energy of geothermal seawater and its active ingredients: minerals, silica and algae. The treatments take place both inside and in the lagoon itself, in the open air. Floating in the mineral-rich water, in close proximity to the Blue Lagoon’s extraordinary environment, surrounded by the natural elements and pure Icelandic air, is a unique experience for body and mind. The geothermal seawater is led directly to the Blue Lagoon from wells as deep as 2000 m. and the water stays warm and inviting at 36-39° C/100-110°F throughout the whole year. An indoor Blue Lagoon and geothermal sauna are also on the site. The white silica mud gently cleanses and exfoliates the skin and has a revitalizing effect while the blue green algae nourish and soften the skin. The mineral salts balance and relaxes body and soul.

The Dental Council of Ireland has launched guidance documents for dental patients. A guide to assist members of the public in choosing a dentist at home or abroad has been issued. This is the first time that the council has issued guidance that has been aimed primarily at patients and members of the public.
All dental practices throughout Ireland will be obliged to display private fees from June 1. The Dental Council issued a Code of Practice making it mandatory for dentists to display private fees in a place where patients can view them before consultation. A single fee must apply for some procedures while the fees for others may be shown as a range, with a minimum and maximum clearly stated. Where a range of fees applies, it is not permitted to set a minimum price only.
Dr Eamon Croke of The Dental Council of Ireland explains, "Patients will be able to check fees in advance for a range of treatments including examinations, x-rays, routine and surgical extractions, root canal treatment and crowns. A single fee must apply for some procedures while the fees for others may be shown as a range, with a minimum and maximum clearly stated. Where a range of fees applies, it is not permitted to set a minimum price only.” The fees notice must be at least A4 size and be legible, accurate and up-to-date. The fees must be prominently displayed in the practice and must be situated in a place where the patient could reasonably be expected to see it before the consultation “Choosing a Dentist at Home or Abroad” is a guide to assist members of the public in choosing a dentist. The guidance also includes information for patients who may consider travelling abroad for treatment highlighting certain matters that should be considered in advance. It goes into great detail on what to look for, questions to ask, and things to consider. The document agrees that high quality dental care is available overseas.
The areas of investigation it suggests include-
· What qualifications and experience does the dentist have?
· What is he/she a specialist in?
· Can we understand each other?
· What aftercare is provided?
· Who pays for remedial work and related costs?
· What are my legal rights?
· Can remedial work be done at home?
· Who can I contact for advice?
· Can I have my records and what language are they in?

Jamaica tourism minister Edmund Bartlett says efforts are underway to use medical tourism to diversify Jamaica’s tourism product, and bring in much needed foreign investment with the construction of state-of-art medical facilities,” The growth of this form of tourism would lead to the development of new resorts that are conducive to recuperation and rejuvenation, present new possibilities for the employment of highly skilled and specialized health professionals locally, and recapture those health professionals who have migrated. The move to position the island to benefit from the lucrative medical tourism market is part of a thrust to diversify our growing tourism sector, as well as boost visitor arrivals and earnings.”
A task force has been established through Jamaica Trade and Invest to examine Jamaica’s potential as a medical tourism destination. The task force, chaired by the tourism ministry, will also guide the development of an appropriate policy and regulatory framework. The task force will see if Jamaica has a potential as a major medical tourism destination given its close proximity to the United States, which is a major source of travellers seeking outbound medical care, and which has a well established air transportation network that is conducive to quick and easy travel.
In Barbados, the Barbados Fertility Centre is advertising IVF holiday packages that bundle airfare and accommodation with airport and clinic transfers. IVF costs are not included in the package prices.
Guyana’s President Bharrat Jagdeo had secured an $18 million line of credit from India to build a new specialist surgical hospital. The new hospital will offer specialised procedures such as organ transplants and cosmetic surgery to medical tourists. Construction will start this year and end in early 2014. An Indian company will build the hospital and Indian medical specialists will operate it.
In Trinidad and Tobago, Umesh Rampersad of the Private Hospitals Association of Trinidad & Tobago (PHATT) is keen on developing the US medical tourism market. But local hospitals only have 325 hospital beds available. In Trinidad, private hospitals attract patients from neighbouring Caribbean territories. But to take it to the next level, the ministry of health and ministry of tourism need to develop a strategic marketing plan that would quantify and qualify the opportunity as well as describe the best way forward.
St Kitts has started constructing an 18-bed surgical hospital, which will offer the latest CT, MRI and cardiac equipment. The St Kitts American University Hospital is a joint venture between the American Hospital Management Company (AHMC) and the Royal St Kitts Beach Resort Limited (RSKBRL) and is to be opened in 2013. The St Kitts and Nevis prime minister, Dr Denzil L Douglas says, "This new venture will attract patients seeking a quality medical tourism destination such as St Kitts while also finding an effective way of increasing access to state of the art diagnostic equipment for the local population." Randall D. Arlett of AHMC says, "The St Kitts American University Hospital is being developed as part of the overall continuing development of the Marriott St. Kitts Beach Resort complex. This project is the result of an in-depth study on medical tourism.”

Controversy over a superbug has returned to haunt medical tourism in India following the latest claims made by British medical journal, The Lancet. A new article has claimed that a superbug is present in the water of New Delhi and that the Indian government suppressed the truth last year by threatening its own scientists. The study claims that the controversial New Delhi metallo-beta-lactamase gene has been found in water pools, overflowing sewage and drinking water samples in New Delhi.
Initial Indian reaction was to deny the claims. The Indian Medical Association said that water from US and European sewage should be checked for the presence of superbugs as the cass of drug resistance for high-end antibiotics is much less in India compared to the United State and Europe. The Delhi Water Board has also ridiculed the claims by saying that they are constantly checking water samples and there is no trace of the superbug. The Health Ministry of India questioned the credibility of the research and claimed that it is illegal for the researchers to remove Indian water to the UK for study. Some organizations in India have done themselves few favours by alleging that it is all part of a planned and concerted attack on India as a medical tourism destination.
According to a study published in the Lancet Infectious Diseases Journal, the New Delhi superbug has been found in water samples in the Indian capital. British researchers found the NDM-1 superbug in two of 50 tap-water samples and 51 of 171 samples of water from puddles in Delhi. Part of the argument is over whether or not people are at risk of infection from bacteria carrying this drug-resistant gene? No water anywhere is totally pure. While the superbug may be in the drinking water, for it to cause infections, the concentration has to be very high. As long you drink boiled water, most bacteria present in the water can be killed. But all hospitals need water for other purposes, and whether boiling can kill superbugs is a moot point.
The Lancet study found the NDM1-Superbug in eleven different types of bacteria, including those that cause dysentery and cholera. Last year, a Lancet study found only one type of bacteria with the NDM1 gene, now it has other even nastier types of bacteria. An article, 7 April 2011, “Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study” is by Timothy R Walsh, Janis Weeks, David M Livermore, Mark A Toleman. It argues that the presence of NDM-1 ?-lactamase-producing bacteria in environmental samples in New Delhi has important implications for people living in the city who are reliant on public water and sanitation facilities. International surveillance of resistance, incorporating environmental sampling as well as examination of clinical isolates, needs to be established as a priority.
According to the country profile of The World Health Organisation (WHO), India has environmental health risk hazards related to lack of safe water, inadequate sanitation and waste disposal, indoor air pollution and vector borne diseases. It says that the Indian government has identified six priority programme areas, including urban low cost sanitation, urban waste water management, and urban solid waste management; while the level of enforcement has been extremely poor and there is no comprehensive legislation on environment and health.
A Cardiff University-led team of scientists discovered new strains of antibiotic-resistant bacteria in India. It is the first time the bacteria, found in the drinking water supply of Delhi, have been located in the wider environment outside a hospital. The full findings of the Cardiff University study are published in The Lancet Infectious Diseases. Cardiff scientists were the first to identify the NDM-1 gene that makes bacteria resistant to a large range of antibiotics. Their UK research was extended when it was discovered that while most patients with the bacteria had recently spent time in hospital in India, some cases had occurred without recent hospital treatment. This then prompted the team to test the wider environment in Delhi. They collected 171 swabs of seepage water and 50 public tap water samples from sites within a 12km radius of central Delhi between September and October 2010.The NDM-1 gene was found in two of the 50 drinking-water samples and 51 of 171 seepage samples. Researchers then identified 11 new species of bacteria carrying the NDM-1 gene, including strains, which cause cholera and dysentery.
Professor Tim Walsh comments,” We found resistant bacteria in public water used for drinking, washing and food preparation and also in pools and rivulets in heavily populated areas where children play. The spread of resistance to cholera and to a potential-untreatable strain of dysentery is also a cause for extreme concern. This is an urgent matter of public health. We need similar environmental studies in cities throughout India, Pakistan and Bangladesh to establish how widespread resistant bacteria are."
The Indian Health Ministry argues that the study was unsupported by clinical and epidemiological evidence and patients were responding well to medical and post-surgical antibiotic treatment,” The environmental presence of NDM-1 gene carrying bacteria is not a significant finding. Bacteria exist naturally everywhere and there is no evidence that anyone had been made ill.”
A recent United Nations report showed 650 million Indian citizens do not have access to a flush toilet and even more probably have no clean water. The Delhi sewage system is also reported to be unable to cater for the city’s population. The research team said it believes that temperatures and monsoon flooding make Delhi ideal for the spread of NDM-1.
To its credit, the Indian government accepts that simple denials and attacking well-regarded doctors and scientists only reflects badly on India as medical tourists will retain nagging doubts over who is telling the truth. So it has formed a scientific committee to look into the findings of the New Delhi superbug study.

Offshore finance has been the subject of increased attention from US and European governments. Most offshore centres are losing out to major financial centres. Their other main income is tourism, which has also suffered recently. So medical tourism looks appealing. Many offshore financial centres are current or former British colonies or overseas territories that have lower levels of regulation than the UK.
The twice-yearly Global Financial Centres Index published by think tank, Z/Yen is a ranking of the competitiveness of financial centres .In the latest report, all offshore centres with the exception of the British Virgin Islands fell further in the rankings, continuing a trend since the financial crises began. The Cayman Islands and the Bahamas were the biggest fallers. The report explains that offshore centres are still regarded as tax havens and there has been significant pressure applied to these centres by many national regulators as well as international bodies such as the OECD and IMF.
Tax specialist F. Ron Jenkins of the Meridian 361 International Law Group in a recent presentation at the 9th Annual Off-shore Alert Conference in Miami Beach, Florida painted a picture of an embattled offshore financial industry, "Many of these offshore centers are going through a crisis and not all will survive, especially if they don’t learn to diversify their business models. For offshore jurisdictions with good tourism infrastructure already in place, medical tourism will allow for the transfer of technology, skills and know-how to create real economic development. This has economic substance and there are wealthy, motivated economic participants who will incorporate and launch businesses in these jurisdictions and achieve legitimate tax planning advantages," Jenkins has advised two clients on how to establish their medical tourism businesses
In May 2009, US President Barack Obama declared his intentions to curb the use of financial centres by multinational corporations and he singled out the Cayman Islands as a tax shelter. So while it remains an offshore centre, it is under increasing pressure to “clean up its act’ with tougher rules on tax. So it is surprising that Jenkins says jurisdictions need to relax many laws to be more appealing to medical practitioners, "They need to cap, restrict or make off-limits punitive damages and include provisions for no-punitive or pain and suffering damages, or capping damages to $250,000.00.Jurisdictions may need to relax their immigration rules to allow in the number and quality of professionals that successful medical tourism businesses need, relax land ownership rules, and generally codify a package of commercial incentives for such businesses.”
The Cayman Islands government has approved an extension of the agreement with Dr. Devi Shetty to build a huge medical tourism-hospital in Cayman. Local partner in the project, Gene Thompson, says both government and private partners agreed to amend the agreement to give both parties time to satisfy their obligations. These include granting of building permits, planning approvals and various duty concessions. The healthcare city will cost about $2 billion and include a hospital, medical university and assisted-living facility; and target American patients and insurance providers seeking deep cost reductions. Shetty believes it will draw 50% of its patients from the United States. The Caymans recently passed legislation that caps medical negligence claims at $600,000.
Tourism is Bermuda’s second largest industry, with the island attracting over one-half million visitors annually, of whom more than 80% are from the United States. Other significant sources of visitors are from Canada and the United Kingdom. Bermuda has often talked of becoming a medical tourism destination but has no national strategy on it.

Taiwan’s private sector is trying to involve more industries in its effort to promote medical tourism, with the latest trial drawing interest from a local airline, according to a local travel agency. Sammy Yen, of Lion Travel’s medical tourism unit, says the company has partnered with Taiwan’s second largest carrier, EVA Airways in an experimental campaign that began April 1 to provide medical package tours for travellers from Hong Kong and Macau. He believes that only through similar cooperative strategies among different sectors will medical tourism in Taiwan thrive,” By working with airline companies or hospitals, we can establish a network instead of relying on random points of business."
Yen also hopes that independent medical tourists from China will soon be allowed to visit Taiwan, as they would also provide a boost to the sector, "Individual trips offer visitors more flexibility and privacy in their tours, which will help contribute to medical tourism." Chinese travelers are currently only allowed to visit Taiwan as members of tour groups rather than on their own. Alex Hung of Shin Kong Wu Ho-Su Memorial Hospital, a proponent of medical tourism, who works with Lion Travel, believes the government has to do more to expand Taiwan’s medical tourism, "We need to promote medical tourism more actively to international travelers and tell them what Taiwan’s strengths are."
Taiwan president Ma Ying-jeou expects the arrival of individual Chinese tourists for self-guided tours in Taiwan by the middle of the year, but will not give any dates. Tourism industry representatives from Taiwan and China have held a new round of talks in Hong Kong to remove obstacles for the plan. Taiwan now has to compete with Japan, Korea, Singapore, Thailand, India, and Mainland China for medical tourism. The self-guided trips by Mainland Chinese to Taiwan will generate business for the hospitals and hotels.
President Ma Ying-jeou says Taiwan must quickly work to relax rules to remain competitive in medical tourism. He believes that while Mainland China is unable to attract Taiwanese hospitals to set up base there, it is possible to woo Taiwanese doctors. Now the government has plans to set up an international medical service area in Taoyuan County, northern Taiwan. A government official said that it would take at least six months to revise related rules for the area. He said that it would be at least two and a half years before the area would yield results.
A record number of people visited Taiwan in the first two months of this year, while the number of Taiwanese travelers to Hong Kong and Macau has fallen, according to the latest government statistics. Tourist arrivals reached 850,000 between January and February, representing a daily average of 14,476, both of which were new records for this period. China provided, by far, the largest source of tourists, with Chinese citizens making 220,000 visits, accounting for a quarter of all total visitors. Japan followed; contributing 200,000 visitors, while Hong Kong and Macau came in third, at 110,000 visits.

West Australians are increasingly seeking cut-price treatment in Asia. Restored Beauty Getaways, a Perth-based medical tourism agency takes up to 50 people a month to Thailand for a range of cosmetic surgery procedures, the most popular being breast augmentation, breast lifts, tummy tucks, facelifts and liposuction. Dental work, lasik eye surgery, Botox, and teeth bleaching are also popular. Favourable exchange rates, lower labour costs and lower running costs mean that these medical procedures can be offered at prices well below those available in Australia. Travel agency Travel.com.au sends Australians seeking medical procedures to Thailand, India, Malaysia, the Philippines and South Africa.
While cost drives Australian outbound medical tourism, Indonesians are driven overseas by the poor quality and unavailability of local healthcare. Many Indonesians travel to Malaysia or Singapore as they feel that hospitals in those two countries offer a higher quality of care, better standard of service and better prices than the best hospitals in Indonesia. Seeking medical treatment abroad has become a common practice for Indonesians who live in Sumatra; treatment in Penang or Malaka is a convenient option. Richer patients from Jakarta can travel to Singapore for treatment. Indonesians spend about US$11.5 billion a year for healthcare abroad, according to the Health Ministry.
Malaysia and Singapore are quite close, while competitive hospital fees in Malaysia have attracted more and more Indonesians. According to a report by Frost and Sullivan, Malaysian hospitals treated 288,000 Indonesian patients in 2008 and Singaporean hospitals treated 226,200 Indonesians in 2007. Major private hospitals in Malaysia and Singapore have special referral systems and international customer departments that specifically cater to the needs of international patients.
Indonesia plans to improve local healthcare. Health Minister Endang Rahayu Sedyaningsih claims that Indonesia will soon have world-class public health care services as the government is now preparing three public hospitals to pursue full accredited status from Joint Commission International (JCI), a global accrediting agency, “They are ready to attain world-class status to enter the international competition arena.” Three Indonesian private hospitals have JCI accreditation. The government plans to increase its accreditation assistance for 66 public hospitals in the eastern part of Indonesia.

A new survey for UK based cosmetic surgeon group Liberate, who operate from 60 locations in the UK, claims that women need to be better informed about what can go wrong with cosmetic surgery and the importance of knowing the qualifications and experience of their surgeon, to help them make an informed decision.
Liberate surveyed 3,000 women between the ages of 18-34 and found that 30% had undergone cosmetic surgery with breast augmentation being the most popular procedure (28%) followed by nose (17%) eyes (11%) and liposuction/tummy tuck (15%). However, the survey suggests that many women do not receive the service they deserve from their cosmetic surgery provider. Even though 74% felt it was important to know and see their surgeon throughout the course of treatment, the reality was that 30% of women who had surgery never saw their surgeon. The group fails to explain how you can actually have surgery without seeing the surgeon!
The Liberate survey also highlights the need for women to be better informed of the dangers of cosmetic surgery abroad and in the UK. 40% said that they would consider having surgery abroad if it was cheaper. 50% would have cosmetic surgery if cost were no object with 17% prepared to take out a loan to cover this.
James Murphy of Liberate says, "Although people claim safety is the most important decision when considering cosmetic surgery, many will still be influenced by price regardless of the physical cost. Cosmetic surgery is a medical surgical procedure and it should be treated as such. Without the tools needed to make responsible choices cosmetic surgery can end up costing people financially, physically and psychologically, Liberate aims to give people the power to choose, providing them with a new and safer approach to cosmetic surgery.”
Liberate is not a trade body, but a promotional body for UK based cosmetic surgeons, who naturally are opposed to their customers going overseas for cheaper treatment; so their default position in their own words in a recent press release is “having surgery abroad is the last thing you should do, no matter how cheap it is.” The two cases they use to highlight their position are of a British woman whose surgery in a US hotel would have been illegal anywhere, and an Argentinean woman who had surgery in her own country.

Qataris spent £85 million on healthcare treatment abroad for 950 patients in 2009, the National Health Strategy document reveals. This works out at £90,000 on average with the top expenditure being £102,000. This shows that travelling abroad is not just driven by low price. According to the research for the government, 70% of costs are for non-medical items such as flights and accommodation. When Europeans and Americans travel for treatment they go alone or with another person and tend to keep the trip short. When Qataris and people from other Arab countries travel abroad such as to the UK or USA, they take a large extended family for a long trip that usually includes some tourism and shopping.
The National Health Strategy research says that because certain specialty services are unavailable in Qatar, some citizens pay for or are sent by government or companies abroad for treatment and every year, increasing sums are being spent on such treatment and associated costs.
Particularly where the state pays the bills, the research suggests that there is room for improvement through cost efficiency and management, which can be done without limiting access to care and that there is potential for enhancing quality through the standardisation of processes. It accepts that treatment abroad is a key element of the scope of care in Qatar now and for the foreseeable future as an increasing number of patients are being referred outside the country with a majority of cases being elective as most patients are travelling abroad for elective treatments than urgent cases.
The figures:• 2002 – 398 patients travelled abroad for elective medical care while 80 patients went for emergency care.• 2003 – 107 elective and 422 emergency patients• 2004 – 321 elective and 78 emergency• 2005 – 414 elective and 106 emergency• 2006 – 463 elective and 163 emergency• 2007 – 575 elective and 148 emergency • 2008 – 730 elective and 227 emergency
The research adds that no prior agreement is made with the provider of care regarding likely treatment costs and many cases are supported by multiple alternative funding sources, resulting in limited control of treatment and a likely increase in expense .The NHS recommends an establishment of a database containing selected preferred providers in order to ensure inclusion of the highest-quality centres; providing follow-up care in Qatar; negotiating volume contracts to control costs; making travel arrangements through a single source to realise better price points on airfares and hotels; and defining the eligibility to treatment abroad and for a transparent application and approval process.
The National Health Strategy is intended to propel Qatar toward the health goals and objectives contained in the Qatar National Vision 2030, with goals that will achieve:• A comprehensive world-class healthcare system whose services are accessible to the whole population.• An integrated system of healthcare offering high-quality services.• Preventive healthcare, taking into account the differing needs of men, women, and children. • *A skilled national workforce capable of providing high-quality health services. • A national health policy that sets and monitors standards.• Effective and affordable services in accordance with the principle of partnership in bearing the costs of healthcare.• High-calibre research directed at improving the effectiveness and quality of healthcare.
The National Health Strategy 2011-2016 is one of 14 sector strategies under the Qatar National Vision 2030’s new National Development Strategy. Qatar’s exceptionally rapid economic growth has stimulated numerous large-scale medical infrastructure and expansion projects. But medical treatment in Qatar is very expensive and the number of modern hospitals inadequate, so outbound medical tourism is likely for several years yet.

One year after President Obama signed the Patient Protection and Affordable Care Act into law, Americans are still divided on it, with 46% saying it was a good thing and 44% saying it was a bad thing. Many Americans are sceptical that the law will improve medical care in the U.S. or their own personal medical care. A year ago, Congress passed a law that restructures the nation’s healthcare system.
The current level of support for the bill, based on a Gallup poll this March, generally mirrors what Gallup found in polling conducted a year ago, just before President Obama signed the bill into law. At that point 49% said the law was a good thing, while 40% said it was a bad thing. Other updates asked over the last year show a similar divide.
Less than half of Americans believe the law will make medical care better either for the United States as a whole, or for them personally. In both regards, more believe the law will make things worse rather than better. Opinions on the impact of the healthcare law on medical care in the U.S. are divided in similar fashion to Americans’ overall reactions to the bill: 39% say it will improve medical care in the United States, while 44% say it will make it worse.
Americans are less positive about the impact of the healthcare reform law on their own medical care. 25% say the law will improve their medical care, 39% say it will worsen it, and 31% say it will not make any difference. These results are also similar to those found in July 2009.
Democrats and Republicans have totally different views of the healthcare law, as has consistently been the case since Gallup began measuring attitudes toward it. The law was proposed by a Democratic president, and passed by a Democratic-controlled House and Senate over the vehement objections of most Republicans in Congress. Republicans have also continued to criticize the bill since its passage, and Republican leaders in Congress are now pursuing efforts to prevent many of the bill’s provisions from taking effect.
8 in 10 Democrats say the law’s passage was a good thing, while 7 in 10 Republicans say its passage was a bad thing. Independents tilt toward saying passage was a bad thing. Reactions to the impact of the law on medical care in the U.S. are similarly divided.
Democrats are a little more muted in their views of the law’s impact on their own medical care, with about half saying it will improve their medical care, while most of the rest say it will not change it. 6 in 10 Republicans say the law will worsen their medical care, while nearly half of independents agree.
The American public’s reactions to the landmark healthcare law passed a year ago continue to echo the partisan nature of congressional debate. Democrats applaud the law and say it will improve medical care in the U.S., while Republicans strongly believe that its passage was a bad thing and that it will make medical care worse. Independents tend to be more negative than positive about the law.
These reactions reflect a lot of politics and perhaps less reality, given that a full assessment of the real-world effects of the law is not possible at this time, because most of its provisions have not yet taken effect. President Obama and Democratic leaders who supported the bill currently face a public that is less than overwhelmingly positive about the bill and its promised ability to fix healthcare problems in the U.S.
The importance for medical tourism is simple. Despite numerous speeches and articles for or against reform, and strong opinions whether it will encourage or discourage Americans from being medical tourists; the reality is that it may be another five years before we know the effect.

Medical services consulting company, Medical Insight, has launched healthtravel.ro, the first Romanian site containing information about foreign hospitals. The website targets those who want to travel from Romania for medical services and capitalizes on a developing trend on the Romanian market. Many Romanian patients – including Romanian president Traian Basescu – have chosen hospitals outside the country for major health interventions. Medical Insight, founded in 2010, is a company that offers consultancy to those who are looking for medical services in foreign countries.
Adriana Sarbu of Medical Insight says, “If in the past people used to go to Austria or Germany for treatment, now, according to our research, a lot of Romanians prefer Turkey for medical controls and interventions. This is a growing thing, considering that the quality of service is very high and that the prices are comparable to the ones in Romania and lower than those from the Western European countries.”
The site contains information about treatments, medical specialties and the country providing treatment, along with detailed presentations of hospitals based on the held certifications, reports of independent institutions and former patients reviews. The site also helps people who want information about health insurance or funding opportunities for treatments.
Romanian hospitals might be classified into five categories of competence from May this year, if the Romanian Health Ministry’s project is approved. The project contains the methodology for classifying hospitals, depending on jurisdiction and minimum mandatory criteria for hospitals classification in new categories. This should ensure efficiency by avoiding overlap and duplication between hospital units, ensuring equitable access to health services for citizens and lower treatment costs. Moreover, the classification based on this methodology will be used to establish protocols for transferring uncritical cases between hospitals. It will also play a key role in developing proposals for additional funding to hospitals and good planning, as well as procurement of medical equipment.
Private healthcare services operator Centrul Medical Unirea (CMU), the second largest clinic group in Romania, bought Euroclinc with a hospital and three clinics. CMU runs four hospitals in Bucharest, a hospital in Brasov and 20 clinics. It also owns half of the stem cell bank Stem – Health Unirea in Bucharest. The company took over Euroclinic hospital and clinics from Eureko in September 2010. CMU is majority owned by investment fund Advent, and the rest of the shares are owned by founder Wargha Enayati.Despite such investment, the provision of health services in the country is still poor, which is why many people seek treatment elsewhere.

12 Taiwanese companies from the tourism and medical industry recently held a presentation in Beijing to attract Chinese citizens to Taiwan for medical procedures. The companies promoted the advantages of Taiwan’s health care, cosmetic surgery, and dental implant industries. Danis Chen of the Taipei-based Chinese Tourism Industrial Development Association, said Taiwan’s medical services are advanced without being overpriced, making it an ideal place for those who want to get health checkups or cosmetic surgery. But he called on the Taiwanese government to allow independent travellers from China into the country, arguing that this will appeal to many Chinese travellers and it would contribute significantly to Taiwan’s tourism industry. Chao Mei-chen of Show Chwan International Medical Center added that she knows Chinese retirees want to come to Taiwan for health checks, and plan on bringing their family and friends along for some leisure travel as well, but are not prepared to go on a membership club group tour. Cheng Huishan at the Beijing-based Taiwan Travel Service Information Center said tourism prospects for Taiwan look good and that many Chinese would love to visit Taiwan,” I hope independent travel would be allowed soon."
Despite claiming to promote medical tourism and promising to help, Taiwan’s government currently prohibits mainland travelers from visiting Taiwan on their own, and has so far not delivered on promises to allow Chinese tourists to go on an independent basis. The Taiwan medical tourism industry is frustrated that this artificial handicap holds them back.
That the various government departments of Taiwan are not working together is further illustrated by the health department’s plans for a proposed special medical tourism zone. The health department needs a new law before a special medical tourism zone, but plans to take a large slice of income for its own uses. Health minister Chiu Wen-ta says, "Development of an international special medical tourism zone would be limited, as it would require special authorization. First, national health insurance would not be accepted and all medical costs would be out of pocket. And 20 % of the profit from medical tourism would be injected into our health insurance reserve.”
The Taiwan External Trade Development Council (TAITRA) continues to promote medical tourism among Chinese visitors, with business limited to five groups of 30 to 50 Chinese visitors for medical tours each month, for health checks and medical services. So until individual /family trips are allowed, the potential is only producing some 2500 Chinese medical tourists a year.
Meanwhile, Hong Kong hopes that international hospital accreditation will help its lacklustre medical tourism business. The Hospital Authority (HA) of Hong Kong says that that four public hospitals have been awarded full accreditation for four years by the Australian Council on Healthcare Standards (ACHS) subsidiary ACHS International. The hospital accreditation is a process of continuous quality improvement. ACHS conducted surveys in Queen Elizabeth Hospital (QEH), Caritas Medical Centre, Pamela Youde Nethersole Eastern Hospital, Tuen Mun Hospital and Queen Mary Hospital. The five hospitals were all in the pilot scheme of hospital accreditation launched in 2009.

A new report ’The future of healthcare in Europe’ from the Economist Intelligence Unit and sponsored by pharmaceutical group Janssen, argues that across Europe, healthcare is barely managing to cover its costs.
Not only are the methods for raising funds to cover its costs inadequate, but also, of even greater concern, the costs themselves are set to soar. According to World Bank figures, public expenditure on healthcare in the EU could jump from 8% of GDP in 2000 to 14% in 2030 and continue to grow beyond that date. The overriding concern of Europe’s healthcare sector is to find ways to balance budgets and restrain spending. Unless that is done, the funds to pay for healthcare will soon fall short of demand.
The financial meltdown is being caused by two interconnected trends: the ageing of the population and the parallel rise in chronic disease. Those financial burdens are being exacerbated by the rising cost base of medical technologies. On the positive side, the prospects for vanquishing many diseases are improving rapidly with the mapping of the genetic make-up of people who develop cancer, diabetes and heart disease. This prospect makes it all the more imperative to agree on a survival strategy for Europe’s healthcare systems.
The basic problem is the spiralling cost of healthcare, which is expected to continue. European governments and other payers are trying to slow that upward spiral, but they are far from agreeing how best to do so. A key question is how healthcare systems can be redesigned without damaging the foundations upon which they were originally built. Europe’s healthcare system is paid for by the population at large, with the risks of medical expenditure essentially pooled. Most European citizens agree with this shared-risk principle and would resist any efforts to change it and thereby remove the promise of universal healthcare coverage. However, the financial contributions required for healthcare have risen steadily, to the point where governments realise that further increases are no longer possible or politically acceptable. Yet the rise in the cost of healthcare systems continues to outstrip economic growth and shows no sign of slowing down.
The Economist Intelligence Unit interviewed 28 leading healthcare experts between December 2010 and March 2011. Each expert was asked to give his or her hopes, fears and predictions for Europe’s healthcare in the year 2030. This report is based largely on their comments, detailing the factors driving the fiscal crisis in healthcare and the major forecast trends for the next two decades. The analysis of past trends is, in turn, the basis for five scenarios for healthcare in 2030.
Healthcare costs are rising faster than levels of available funding. The rising cost of healthcare cannot be met with current levels of public funding, raised via taxation and insurance. The main drivers of rising healthcare costs in Europe are:• Ageing populations and the related rise in chronic disease.• Costly technological advances.• Patient demand driven by increased knowledge of options and by less healthy lifestyles.• Legacy priorities and financing structures that are ill suited to today’s requirements.
The future of healthcare will be shaped by seven separate, but interconnected, trends-• Healthcare spending will continue to rise, not only because of inflationary drivers, but also because of growing recognition by policymakers that improved health is linked with greater national wealth.• Keeping the universal healthcare model will require rationing of services and consolidation of healthcare facilities, as public resources fall short of demand.• General physicians will become more important as gatekeepers to the system and as co-coordinators of treatment for patients with multiple health issues.• More effective preventive measures and fundamental lifestyle changes will be promoted to encourage healthy behaviour.• European governments will need to find a way to improve collection and transparency of health data in order to prioritise investment decisions.• Patients will need to take more responsibility for their own health, treatment and care.
The report identifies five extreme scenarios for European healthcare in 2030:• Technology triumphs and cures chronic disease, while e-health takes a prominent role in the management of healthcare.• European nations join forces to create a single pan-European healthcare system.• Preventive medicine takes precedence over treating the sick.• European healthcare systems focus on vulnerable members of society.• European nations privatise all of healthcare, including its funding.
The five scenarios make clear that, although there may be great debate across Europe on the details of healthcare reform, what is needed most is adaptability. The current debate is driven in large measure by self-interested factions, such as insurers, doctors and government bureaucracies. Over time, citizens may succeed in shifting the discussion so that it focuses where it should: on the best ways to maximise the health and wellbeing of Europe’s population.

Turkey is attracting over 100,000 medical tourists a year, thanks to an increase in the number of private hospitals, and even larger numbers of wellness tourists. The Health Tourism department of the Health Ministry and Gazi University faculty of commercial and tourism education have taken an inventory of health tourism in Turkey. According to the study, the number of health tourists coming to Turkey for medical treatment has been increasing regularly for the past three years. While 74,093 patients came to Turkey in 2008, there were 91,952 in 2009 and 109,678 last year. The total number of patients who came to Turkey in the past three years is 275,723. Among those patients, 94 percent received treatment in private hospitals while 6 percent went to public hospitals.
According to the study, foreign patients choose to receive treatment in Turkey because of its reasonable prices, high quality of service, pleasant climate, abundance of vacation opportunities and short waiting time. The infrastructure, competent doctors and reputation of hospitals are listed among the other reasons. The eye, brain surgery, orthopedic and cardiology departments attract the largest number of patients.
Turkey attracts the largest number of medical tourists from Germany, the Netherlands and France, where the population of people with Turkish roots is high. Patients from Balkan countries and Turkic republics are also among the largest groups. The study further shows that Istanbul, Kayseri, Adana and Gaziantep are the provinces that attract the largest number of foreign patients.
In addition there are many wellness tourists in the 34 thermal spa centres of Turkey that are marketed as a choice destination with various treatment options such as balneotherapy and thalassotherapy. Anatolia is located on a major geothermal belt and has several thermal baths and spas. These thermal spas are promoted as cures for various illnesses due to the high density of minerals in their waters.
The thermal spa treatments in Turkey attract travellers every year, especially from the adjoining countries of Greece, Bulgaria, Russia, Georgia, Azerbaijan, and Iran, which accounted for about 25 % of all wellness-related visitors to Turkey in 2009.
Apart from the thermal spas, medical procedures such as IVF, eye, dental and cosmetic surgery are also gaining popularity. The geographical location, US dollar exchange rates and added tourist attractions make Turkey a medical tourism destination with potential. The number of medical tourists is expected to increase by 15 % in 2011

To the immense relief of the local medical tourism industry, the Indian state government has agreed not to impose the 5% service tax on healthcare services that was introduced in this year’s Union Budget after strong protests from several quarters that estimated that it would have increased local medical tourism prices by between 7 and 12%. Finance Minister Pranab Mukherjee had proposed a 5% service tax on air-conditioned hospitals with more than 25 beds and on diagnostic services, but he has announced a complete u-turn, "The purpose of the new levy was not merely to mobilise revenue, but to pave the way for introduction of the general service tax However, I have decided to exempt the new levy in its entirety both in respect of services provided by hospitals as well as by way of diagnostic tests until general service comes into force.” So the early rejoicing at the decision may be a trifle early, as the government still plans to include healthcare within a wider general service tax while extra taxes on restaurants, air travel and hotels will make India a more expensive travel destination. At a time when other countries are waiving fees to encourage tourism, India is the one of the few countries that has raised taxes.
Dubai-based DM Healthcare plans to invest nearly $335m in the next five years in India as its looks to expand operations. The company is setting up MedCity in Kochi, a medical college and hospital at Wayanad in Kerala and it also plans to open specialised eye care centres. The company will spend two-thirds of the money over the next three years, including funding for the first two phases of MedCity. The healthcare company runs hospitals, polyclinics, pharmacies and diagnostic centres under the brands Aster and Medcare in the UAE, Qatar, Oman and Saudi Arabia.
Azad Moopen of DM Healthcare says, “We plan to invest $335m in the next five years to set up MedCity at Kochi. Work has already started for the 500-bed hospital. The first phase will be completed by 2013, and MedCity will include a large hospital, six centres of excellence, a resort hotel, a convention centre, a medical college and other facilities. Hopefully in the next two years, we will be able to admit the first patient.” The company will also invest in 4-5-specialist eye care centres in the Delhi region. It has also acquired a 65 % stake in a 100-bed hospital at Kolhapur and is planning to add another 200 beds to it. The group is also planning to acquire hospitals across India has finalised a deal in Pune, while a new hospital is being planned for Nagpur. DM Healthcare is also exploring options in Delhi and its adjoining townships to expand its operations. It has already launched Aster-Eye Care eye care centre in Faridabad (Haryana), and plans to open four new similar centres in Delhi and another 20 across India by 2015.

Nearly 3 in 10 adults living in Texas do not have health insurance, making it the state with the highest uninsured rate in the country in 2010. Mississippi and Louisiana also have high rates of uninsured residents, with about one in four lacking coverage. By a significant margin, Massachusetts — where state law requires all adult residents to have health insurance — continues to have the lowest percentage of uninsured residents, at 4.7%. Connecticut, Minnesota, and Hawaii also have relatively low uninsured rates, with about 1 in 10 adults not carrying health insurance in each.
These state-level data are based on daily surveys conducted as part of the Gallup-Healthways Well-Being Index from January through December 2010, encompassing more than 350,000 interviews with American adults. Gallup and Healthways began daily tracking of American adults’ health insurance coverage in January 2008. At the national level, 16.4% of adults were uninsured in 2010, statistically unchanged from 16.2% in 2009, but up from 14.8% in 2008.
Southern and Western states have a disproportionately large percentage of uninsured residents, as they did in 2009 and 2008. This geographic pattern is likely tied at least in part to these states’ larger Hispanic populations. Gallup finds Hispanic Americans are the demographic group most likely to be uninsured in the United States, at 38.9% in 2010.
Seven out of the 10 states with the fewest uninsured residents are in the Northeast, similar to past years. Most states saw a rise or no change in the percentage of uninsured residents in 2010 compared with 2009. Wyoming was the lone state where the uninsured rate decreased to a significant degree in 2010. More Americans in almost all states, however, were uninsured in 2010 than in 2008. For example, the percentage of adults without healthcare coverage in Texas rose from 25% in 2008 to 27.8% in 2010. The uninsured rate is up the most since 2008 in Kentucky, Utah, Florida, and Louisiana.
Nationwide, Gallup has measured a decrease in employer-based based healthcare and an increase in government health insurance, which includes Medicaid, Medicare, and military/veterans’ coverage, since 2008. As long as unemployment remains high, the percentage of Americans who get health insurance from an employer is unlikely to increase. The increase in government healthcare, which Gallup finds across all age groups, is causing financial problems for states when they are already grappling with reduced revenues. Many states are now looking to cut back on government-funded health services with an eye on Medicaid programs in particular, which serve some low-income Americans, a group that is among the most likely to be uninsured. Depending on the extent of states’ cuts to Medicaid and the overall economic situation in the United States, the uninsured population could grow in 2011.
The new healthcare law, which seeks to expand coverage, may fill the voids in care that state budget troubles and unemployment are creating. However, the government will not fully implement all pieces of the legislation until 2014, and many of the new programmes could take time to ramp up.
The Commonwealth Fund 2010 Biennial Health Insurance Survey estimates that 9 million adults lost their health insurance in the last two years. In the USA the loss of a job also often comes with the loss of health insurance. Without their jobs, the unemployed have had great difficulty finding affordable coverage. An estimated 29 million people have used up all of their savings to pay medical bills, while 22 million were unable to pay for basic necessities like food and 4 million declared bankruptcy.
The survey’s authors note that the Affordable Care Act provisions that are already in effect are bringing some relief in the form of pre-existing condition insurance plans, allowing young adults up to age 26 on their parents’ plans, small business tax credits, elimination of lifetime limits on benefits, and required coverage of preventive care without cost-sharing. Once the law is fully implemented in 2014, nearly all of the 52 million currently uninsured American adults, including those who became uninsured during the recession, will have access to comprehensive health insurance coverage through expanded Medicaid, private health plans with consumer protections, and tax credits for those with low and moderate incomes to purchase insurance. In addition, health benefits will have to conform to an essential benefit standard, and no one will be denied coverage or charged more because of a pre-existing health condition.

US company, Medical Tourism Training, has launched five new online courses to provide fundamental information and skills vital to success, for industry professionals and consumers who want to learn about international health travel and medical tourism.
Developed by a team of experts including medical tourism experts with backgrounds in healthcare, business, education and law, the affordable and convenient course materials are based on international best business practices as well as experience in the sector.
The five courses-• Introduction to medical tourismFocuses on five areas fundamental areas forming the basic understanding of medical tourism: its definition and history, factors driving the growth in the sector, major countries involved in international health travel and the services they offer; and current issues.• Basic medical terminologyCovers more than 225 words related to medicine and medical tourism. Throughout this class, words are spoken while each slide contains the written word, a phonetic guide to pronunciation, a definition, and images or photographs to maximize understanding and retention.• Telephone skills for the medical tourism professionalThis is filled with practical advice as well as audio and video clips demonstrating the “Do’s” and “Don’ts” of telephone etiquette. It offers opportunities for you to practice and improve your telephone skills. Learn how to manage telephone interactions professionally so that you can consistently create positive impressions about you and your business.• Email etiquette – netiquetteProper business skills for communicating via email are vital to building and maintaining a global business. This course contains no-nonsense advice as well as audio clips demonstrating the “Do’s” and “Don’ts” of email etiquette. Sharpen your email communication skills to deliver improved customer service.• Essential skills for working with upset customersThis business skills development course provides essential tools to avoid or defuse negative situations as well as restoring business relationships following a harmful experience with upset customers. Through the use of narrative, audio and video clips, you will learn skills for better interactions with your clients, staff and management, and other professionals.
All are available individually or in any combination and reflect the company’s emphasis on the importance of excellent customer service. Ruth Rietveld-Kirwan explains, "Online courses provide flexibility for busy people who want to learn in the convenience of their own home or office, at their own pace, when they have the time. It is an easy way for a global audience to access the information, training, and skills needed to succeed in medical tourism. These introductory courses are for individuals interested in learning more about international medical travel.”
The courses are designed for a wide audience including medical travel agents; international care coordinators; medical professionals; support staff in hospitals, clinics, private medical and dental offices, spas; travel agents; hospitality professionals; as well as prospective or current medical tourism clients and anyone who is curious about the medical tourism industry.
Elizabeth Ziemba of Medical Tourism Training says,” Our objective is to design content-rich, visually appealing courses that are affordable to just about anyone, anywhere. Through the use of audio and video clips as well as a variety of quizzes, individuals can learn essential information and practice skills, bringing a higher level of professionalism and excellent customer service to the international health travel sector. While we are busy developing additional courses that will be at an intermediate level, our team has created courses that are an excellent introduction to medical tourism".

Due to government support and world class infrastructure, the number of medical tourists in Malaysia will increase 17% a year until 2012, says a new report by analysts RNCOS, “Malaysia Medical Tourism Outlook 2012”.
Malaysia has become one of the top health tourism destinations in the world for medical tourists seeking cost effective treatment. The total number of medical tourist arrivals in the country reached 425,500 in 2009, due to a good healthcare infrastructure, government support through promotional programmes, and skilled medical professionals. It is estimated that, the total medical tourist arrivals in the country will reach 689,000 by 2012.
The report says that competitiveness in cost of medical treatment is a driving factor for the Malaysian medical tourism sector. The country offers complex medical treatments and services at considerable low prices compared to the developed world. For instance, the cost of knee replacement in Malaysia is US$8000 compared toUS$ 40,000 in the US for the same treatment.

Tropicana Medical Centre (TMC) in Kota Damansara, Petalaying Jaya, the flagship hospital of TMC Life Sciences, plans to increase its foreign patients to 30 % over the next three years. At present, foreign patients account for 5% of its total number and TMC aims to increase that to 10 % this year. Francis Lim of TMC explains, "If you look at successful hospitals in health tourism locally, they get 25 % to 30 % patients from overseas and we want to do that as well."
TMC is increasing the number of partnership deals it has with organizations in Indonesia, and planning strategic affiliations with corporate partners from Bangladesh and Indo China this year to expand its services to a wider market and boost its visibility locally and regionally. TMC gets 20 Indonesian patients a month and hopes to increase that to 200 a month.
Deputy Minister of Health, Rosnah Abdul Rashid Shirlin, says India and Thailand are role models for making Malaysia an attractive destination for medical and healthcare tourism as it can generate a huge income for the country. The government intends to expand the healthcare sector through the 10th Malaysia Plan because there is a high demand at international level,” We should view India and Thailand as role models because they are the most popular in the world as a pioneer of healthcare industry where they give quality services and competitive price. We must continue to work hard to place Malaysia strategically as a medical tourism destination of choice. Malaysia can compete in the sector because the country’s health industry is on par when compared with others in the world.” The government will reform the healthcare system with focus on four key areas, transforming healthcare delivery, increasing capacity and coverage and improving quality of the healthcare structure, shifting towards wellness and disease prevention rather than treatment, and increasing the capacity and capabilities of human resources for health.

All private hospitals in Qatar must be accredited by an internationally recognised body within the next four years, says the Supreme Council of Health (SCH). It will be compulsory for the private sector to obtain an international accreditation until the National Accreditation Standards (NAS) are available.
Dr Kamal Khanji of SCH says it will approve the accreditation of all private hospitals in the country, “We will request all private hospitals to achieve accreditation within the next four years because developing our own standard will be easier when they are all already accredited by recognised bodies internationally. The programme will help all hospitals in the country to further raise their standards. Of course it will require a lot of effort but it will improve the healthcare sector significantly and change the face of health services in the country. We are going to help the private sector by providing them with some publications to guide them to a list of well-known international accreditors. We will guide them step-by-step towards achieving the accreditation, which will position them as an attractive destination for visitors from around the world thus helping Qatar achieve the planned status as the health tourism destination in the region.” SCH has announced that a broad national health insurance system with universal access for citizens, expatriates and visitors will be set up within the next 3 to 4 years.
The Kuwait government is working on a strategy to bolster health care facilities with an additional 3500 beds. The private sector will be instrumental in the execution of this strategy and the development of the sector. Kuwait has long offered its citizens an expansive cradle-to-grave welfare system that has involved the dispersal of the nation’s oil wealth through a number of free services. The government has been moving towards implementing a comprehensive health insurance scheme, despite criticism from some opposition circles. In 2010, the government drafted two bills for comprehensive health insurance for Kuwaiti nationals and the establishment of an independent health authority to regulate the system. Under the proposals, the government would pay health insurance fees for citizens, while additional optional services must be met through out-of-pocket expenses. This free insurance would also partially cover overseas treatment for Kuwaiti citizens. The government hopes that such proposals, which are yet to be put before parliament, will dramatically improve the level of care and reduce the outsized bill for overseas treatment. They will also lead to significant private investment opportunities in the country.
While wars and protests in the area hit the headlines, the impact on inbound medical tourism is as yet unknown. Libya, Bahrain, Oman. Iran, Lebanon, Syria, Yemen, Saudi Arabia and Iraq have very few inbound medical tourists. The leading local inbound destination is Jordan, where protests so far are limited. Egypt, Tunisia and Morocco do attract medical tourists, mostly for cosmetic surgery and dentistry, and mainly from Europe; the unknown is whether or not recent unrest has or will deter medical tourists.
The great unknown is the effect on outbound medical tourism. The ministry of health said that over 1 million Libyans went abroad in the last few years for healthcare-this is not for one year but an unspecified period. That is nearly 20% of the population. They went mostly to Jordan or Tunisia. That has now stopped. A Frost and Sullivan report suggested that one in five global outbound medical tourists come from the Middle East/Gulf region, but many in the business have serious doubts over this figure. What is agreed is that while much medical tourism traffic in the area is between countries, there is outbound traffic to Asia, Europe and the US, mostly from Saudi Arabia and the UAE.

Medical tourism is encouraging Americans to look at overseas options to reduce high medical costs. Until recently, most Americans opting for medical care abroad went for dentistry, cosmetic surgery and other procedures not typically covered by insurance. With the poor economy and insurance cutbacks, more individuals are considering travelling for medically necessary surgery, such as hip or knee replacements or reconstruction, and even heart procedures. Nationally, more patients are looking at options in Southeast Asia, Mexico and even Cuba. Some are seeking care abroad because certain technologies, such as stem cell therapies and alternative cancer therapies, are not readily available to them in the U.S.
Yet patients who are considering surgery options in other countries need education far beyond potential cost-savings, according to Dr. Nicholas Abidi of US hospital Santa Cruz Orthopaedic Institute, “ Hospitals overseas market their facilities as top-flight and promote the expertise of their clinical staff, many of whom have been educated in the U.S. Yet the marketing can obscure the reality of conditions and risks associated with overseas surgery options. If they encounter unexpected findings during surgery or post-op problems like blood clots, can the doctor and the hospital respond in a timely fashion that is up to U.S. standards? There is also always the chance of infection post-surgery, and many doctors here are reticent to take on such patients. Many overseas hospitals do not have access to the type of equipment that we use to monitor patients during surgery or install the implants. Artificial joints can also fail or be recalled, which will quickly eat up cost savings patients realize from opting for surgery abroad. Many foreign locations do not match U.S. standards for infection control and quality assurance. Accreditation standards are not on par with the U.S. Licensing standards, training of medical staff and accepted levels of staffing also vary among global locations. Should problems arise, there are not the same safeguards built into the U.S. medical system for patient recourse.”
Aptos resident Sandy Dini seriously considered having her recent hip replacement surgery done in India. Her primary care doctor felt there were excellent options overseas for certain procedures, such as joint replacement and shoulder surgery. She and husband Mark found, "The hip replacement surgery would have been $8000 in India, which included our airfare, a four-star hotel, follow-up appointments and a full-time nurse for a three-week stay. Total costs for the surgery here was close to $80,000 before the contracted insurance discount—that’s a huge difference. But, as we have insurance the costs were about the same after the insurance kicked in, so it made sense to have hip replacement surgery locally."
Medical travel was the focus of a webinar ’Should You Be in the Medical Travel Business?’ presented by American Society of Travel Agents (ASTA) for travel agents interested in the medical travel market. Chris Russo of ASTA explains, “They need to understand a variety of significant issues involved with providing medical travel services to patients. Understanding the issues and how to deal with them will allow travel agents to explore a new and highly profitable niche. There are legal and liability issues surrounding medical travel.”

Action to establish a more balanced charging regime for overseas visitors, including tackling health tourism has been promised by the UK government ’s Department of Health and Home, following a 2009 review that set out to examine the rules on charging overseas visitors for access to NHS services.
The Home Office measures for the UK to be included in new immigration laws include:• Anyone owing the NHS £1,000 or more will not be allowed to come to or stay in the UK until the debt is paid off. It is hoped the £1,000 threshold, which will be implemented later this year will capture 94 per cent of outstanding charges owed to the NHS.• To enforce this action, the NHS will provide information to the UK Border Agency to enable it to identify the debtors when they make their application to return or stay in the UK.
NHS measures for England include extending the time UK residents can spend abroad without losing their automatic entitlement to free hospital treatment from three months to six months. People living in the UK for part of the year, while also spending significant periods of time abroad risk being judged as not ordinarily resident and so not entitled to free NHS treatment, although some exemptions do protect this group. The current regulations allow residents a regular absence from the UK of up to three months per year before they risk being chargeable for hospital treatment. With people having increasingly mobile lifestyles, the time is right to review this regulation.
While the NHS remains committed to providing immediate or necessary care, as it is important that a balance of fairness and affordability is also struck, a full review of the rules and practice will be undertaken and will consider:• Qualifying residency criteria for free treatment.• The full range of other current criteria that exempt particular services or visitors from charges for their treatment.• Whether visitors should be charged for GP services and other NHS services outside of hospitals.• Establishing more effective and efficient processes across the NHS to screen for eligibility and to make and recover charges.• Whether to introduce a requirement for health insurance tied to visas.
Health minister Anne Milton says, “The NHS has a duty to anyone whose life or long-term health is at immediate risk, but we cannot afford to become an international health service, providing free treatment for all. These changes will begin the process of developing a clearer, robust and fairer system of access to free NHS services which our review of the charging system will complete." Damian Green, immigration minister adds,”The NHS is a national health service not an international one. If someone does not pay for their treatment we will not let them back into the country.” The NHS started charging those who are not ordinarily resident for treatment in 1982, although the UK has reciprocal arrangements with many countries allowing their residents to receive healthcare on the same terms as Britons. Emergency treatment will continue to be provided irrespective of status or ability to pay.
The new review is expected to complete in late autumn and the proposals will then be consulted upon. The UK has an international obligation to provide free NHS treatment to those seeking asylum under the UN Convention on human rights. It will continue to fulfil this obligation. Access for European Union residents is determined by separate EU regulations. The review will not consider changes to these regulations.
Many medical tourism sites confidently quote ’long NHS waiting lists’ .It may pay them to look at the real figures that are regularly produced. Bearing in mind that the figures exclude accidents and emergencies and refer to treatments that are not urgent, need planning around work schedules and often need a curse of treatment over several weeks, the NHS waiting times are short and compare well against how long it would take to arrange and complete private treatment at home or overseas. The average (median) time waited for patients in January 2011 was 9.1 weeks for admitted patients and 4.8 weeks for non-admitted patients. At national level, 90.7% of admitted patients and 97.3% of non-admitted patients completed their treatment within a maximum of 18 weeks.

Joanna Matsentides of Cyprus and Lebanon based medical tourism agency Sonomar Medical, has provided an update on the development of Cyprus as a medical tourism destination-• Many of the medical services available in Cyprus are of a high standard and the island is becoming increasingly popular as a destination for medical tourism.• As there are no medical schools in Cyprus, all doctors and surgeons study abroad and gain their experience at international institutions worldwide. As a result a wide range of information, knowledge and various techniques has been brought back. • One of the most sought after procedures is assisted reproduction or IVF. Numerous couples seek treatment abroad as the waiting list in their home country is either too long or the cost too high. There are a number of fertility clinics on the island and the majority have experience with overseas patients. It is important to have a clear understanding of the treatment suggested, the costs involved as well as the success rate. Also find out how long it is necessary to stay in Cyprus for each visit. • Cosmetic surgery is in high demand and Cyprus has a number of cosmetic surgeons. Check the surgeon’s credentials and ask how many procedures they have carried out. Photographs of their previous work will allow you to have an idea of what to expect. It is imperative the surgeon understands what is wanted and listens to your requirements.• Liposuction is not an ideal procedure for everyone, and is suggested for patients with localised fat who will benefit more and see better results. In some cases, it is better if you lose weight before considering various cosmetic surgery options.• Cyprus has a number of surgeons who carry out procedures by laparoscopic intervention. Recovery is very quick – normally one night (or at most, two) in the private hospital – and patients are generally fit to return to routine or fly back to their home country within the week.• Weight loss surgery is in high demand with an increasing number of people suffering from obesity and the consequences of being overweight, such as high blood pressure, diabetes, high cholesterol and heart malfunctions. • *Cyprus is very popular for dental procedures. The costs are far lower than in several other EU Member countries and there are a number of highly specialised dental professionals on the island. The most frequently performed dental procedures are veneers or smile makeover and dental implants. More complex procedures such as maxillofacial treatments are also offered.• Cyprus is gaining a reputation for offering specialised procedures such as minimally invasive spinal surgery, cancer surgery and facial reconstruction. The low costs, highly experienced medical professionals and desirable Cyprus environment contribute to its increasing popularity.• Most of the larger private medical facilities either have international accreditation or are in the process of gaining it.

Daniel Ordonez of Special Events USA, organizers of the Medical Tourism World Fair for consumers that will be held in New York in May, has put forward five medical tourism myths:

1. It is medical tourismWell, that is what it is often called but just like we say business travel and not business tourism, it is more about the provision of healthcare services across international boundaries than about sprinkling healthcare on vacations. So, medical tourism is really only a small part of medical travel. Incidentally, after that cosmetic surgery, your surgeon will tell you "no sun, no sea, no sand" so don’t believe the brochures.

2. It is new and boomingIt is a growing business but not quite so new. Medical tourism had thousands of healthcare visitors in 2010, and stories of patients (even heads of states) travelling for medical care go back decades. As to the boom, guesstimates vary and credible statistics on medical travel are few. Hospitals routinely report hundreds of thousands of patients because they are not counting individual patients but separate episodes of care (once today, once tomorrow or even once to the consult, once to the lab, once to the pharmacy!). Many figures include the local expatriates and holiday/business travelers who fall sick, who are not medical tourists.

3. Patients are going to cheap low quality healthcareCheap it may be relative to some Western countries, but comparing healthcare quality is hard. Healthcare systems are so different and low costs in themselves do not mean low quality. The USA spends less than 4% of GDP on healthcare (Editor: This figure is substantially incorrect. The USA spends over 16% of GDP on healthcare) but has more JCI-accredited facilities than any other country (Editor: JCI does not accredit facilities in the USA. The Joint Commission accredits health care organizations in the United states and its territories.) While the best healthcare in the world is undoubtedly in the USA, the average beats out the average in any other country. In any case, the world is now so flat that US facilities like Johns-Hopkins operate outside the USA as well.

4. Asian healthcare destinations threaten the facilities of the WestSounds logical, but consider the relative sizes of the economies. The USA alone has a two trillion dollar economy, while the entire annual foreign medical revenue from deliberate medical travellers to USA, Malaysia, Thailand and India barely exceeds one billion. How much can be siphoned away when supply is limited? The true danger in medical travel is not to the sending medical economies but to the receiving medical ecologies, as doctors are enticed away from public hospitals, prices escalate, foreign patients get preferential treatment and public healthcare systems become strained. Countries must pay attention to the public health implications of the medical travel industry, or risk hurting their own population and eventually their medical visitors as well. Globalization will happen. The risk for the overburdened payers in countries with expensive healthcare is that the early movers find the better quality healthcare for their insured/employees, and late adopters have nothing left.

5. There are many excellent healthcare destinations in the worldActually, there is not that many. Some countries have announced national programmes and many have marketed themselves as great destinations, but few really deliver. Too many patients had successful surgeries but bad experiences because of poor service, unsafe city streets, or heart-rending street urchin beggars. Beyond excellent, safe and trustworthy clinical services, affordable costs and good customer service, patients need a warm and non-threatening environment, cultural acceptance, ease of travel, safety for themselves and their families, and even opportunities for recreation and shopping for their travel companions. Few places in the world truly provide their patients the peace of mind when health really matters.

Located in the heart of the Mexican Caribbean is a dental clinic focused on and designed for American and Canadian patients. Cancun Cosmetic Dentistry is celebrating 10 years of providing quality dental care for thousands of North Americans.
The popularity and growth rates of dental tourism are a relatively new concept and the practice of traveling to have dental treatments is not only about saving money and time but not wanting to sacrifice quality and high standards. The costs of dentistry in Mexico can be as much as 70% less than at home in the United States and Canada. The high costs of dentistry in the United States (which thousands of Americans are not able to afford, and taking in consideration that millions are uninsured) drives people to look somewhere else for their dental needs. This is when they start looking for a dentist abroad, and Cancun is one of the top destinations for Mexican dental vacations.
Cancun Cosmetic Dentistry has an English speaking team of 14 dental specialists that have been helping American people with all type of dental treatments, from a simple resin filling to a complete smile makeover. The clinic gets between thirty to forty American and Canadian citizens every month seeking affordable dental work in Mexico.

Dental Implants Center in Tijuana has arranged new special dental patient rates for two of Tijuana’s top hotels, the Grand Hotel Tijuana and the Lucerna Hotel. Every year thousands of dental patients go to Tijuana from throughout the US and Canada to get high quality dental care at an affordable price. The special rates are at the Grand Hotel Tijuana, ($68 per night – regularly $140), and at the Lucerna Hotel ($65 per night – regularly $140). For those who prefer to stay in the US, the Western Americana Inn San Ysidro, with 2-way shuttle directly to and from the clinic, is only $79 per night including the shuttle service).
Tijuana is easily accessible by air and train, or only a short 15- minute drive across the border to get to the clinic. By using new Medical Fastrack Border Pass patients can cross back across the border in 20 minutes or less as the Mexican government has established a special lane that is reserved for just dental and medical patients.

Dr. Eduardo A. Santos of Beverly Hills 6750, a beauty and wellness clinic in Makati, is seeking regulation of the medical tourism industry and calling for the creation of a Cabinet-level council to oversee it. He argues that the Philippines has a fighting chance of getting a bigger share of the global medical tourism business only if it is able to surmount the negative perception over security and peace and order.
Bernabe R. Marinduque of Beverly Hills 6750 also says the industry should be policed to prevent the proliferation of fly-by-night clinics that may negatively affect the credibility of the country in providing medical tourism services. He argues that although the industry is regulated to some extent by the Department of Health, which accredits surgical facilities, and by the Department of Tourism (DOT), the Philippines has no single agency or a harmonized and unified standard by which procedures and facilities can be measured. Even marketing efforts by the DOT are sporadic, he argues, with various competing bodies all working independently.
Dr. Eduardo A. Santos says “ Government has to play a more active role in creating success in medical tourism because the Philippines is negatively perceived compared to Thailand, India and Malaysia .He is referring to such issues as infrastructure like airports and security of tourists, where various overseas governments such as the UK, have warnings to their citizens that parts of the Philippines should be avoided due to high risks of terrorism and crime. Santos argues that efforts should be sustained with the private sector players and the government working through one overall body rather than the current confusing collection.
Set up in 2006, BH 6750 has been posting a 20% annual growth, and opened a second branch in Quezon City in March.BH 6750 claims services at the multi-specialty clinic are 10 to 20 % cheaper than those offered by much bigger and older competitors. About a third of its customers are balikbayan (Filipinos who live overseas) who come home not only to visit relatives but also get healthcare. Santos says that compared to the United States, where most live, dental procedures are cheaper by 60 % while cosmetic surgery is half the price.
Although he has not yet succeeded in finding a hospital that he can partner with in Cebu, business tycoon Manuel Pangilinan will continue to search for other hospitals and clinics to add to the Metro Pacific Investments Corporation (MPIC) portfolio. It already owns four – Riverside Medical Center, Makati Medical Center, Cardinal Santos Medical Center and Davao Doctors Hospital. MPIC subsidiary Medical Doctors, Inc. (MDI) owns and operates the Makati Medical Center (MMC), a 420-bed hospital in Makati City, Cardinal Santos Medical Center, a 235-bed hospital in San Juan City; and Davao Doctors Hospital, a 250-bed hospital in Davoa City. It has invested in improving all three and plans further improvements. It recently signed a 20-year management agreement to run Our Lady of Lourdes Hospital in Metro Manila.
MPIC sees medical tourism as vital to financial success but Pangilinan admits that complex issues surround medical tourism, saying hospitals and the infrastructure have to be world-class before non Filipinos decide to get their medical services in the country in any real numbers. To attract foreign patients, he believes all need to get accreditation from international standard organizations. He is also concerned that foreign companies do not recognize local facilities, and unless they can get insurance company business paid direct by US insurers, medical tourism will not fully take off in the country. He sees Cebu as an ideal place to locate medical tourism and back in 2008, visited the Cebu City Medical Center and initially expressed interest in a major investment for a hospital in Cebu.

Turkey’s medical tourism sector is aiming to expand its share in the global market over the next two years. The Turkish Health Tourism Organisation (TUHETO) has been and will be promoting health tourism to Turkey at a number of events in Ukraine, Dubai, Switzerland, Azerbaijan and Kazakhstan during April, May and June. Scenes shot at private hospitals for Turkish soap operas broadcast in Arab countries have also notably contributed to the growth of health tourism to Turkey. Private hospitals are attracting more health tourism from Arab countries.
At a recent workshop in Kazakhstan, ?brahim Artukarslan of TUHETO said, “People from Kazakstan have been traveling overseas for health treatments and operations for many years now, with top destinations including Israel, India, Spain, the United States and Hungary. When we asked representatives of the local health sector representatives why Turkey is not among these countries, the response was that they are very keen about health tourism to Turkey but have not had the chance to meet with representatives of the Turkish health sector. We need to consider very carefully the legal and insurance aspects of package tours to Turkey, which include, for example, in vitro-fertilization treatments or eye surgery. One mistake in one operation could ruin our reputation.”
In an attempt to help Turkish healthcare establishments increase their presence in the market, Turkish Airlines is promoting a support package for healthcare institutions that invest in medical tourism. The package offers special discounts and incentives for patients travelling to Turkey for medical treatment.
Gokalp Yazir of Turkish Airlines says, "Turkey had 80,000 patients in 2009, mostly travelling from Europe and the Middle East. Turkish healthcare establishments have set new goals in the field of medical tourism to increase the number of incoming patients from 80,000 to 1 million by 2015.Substantial investment has been made in improving the quality of medical facilities in Turkey, training current and new staff, building new medical centres and promoting Turkey as a prime medical tourism destination. Turkish Airlines, with its large network and quality service, intends to support medical facilities that promote Turkey as a global healthcare destination. Turkey’s central location between East and West, as well as quality and cost-effective medical care make it easier for many people from not very wealthy countries to receive the care they need. Turkey offers the same quality of services as Americans are used to through its network of 32 JCI-accredited hospitals at a price level which is of one tenth of the US domestic cost."
The support package that Turkish Airlines offers is a 25 % discount for patients travelling from the US and a 20 % discount for patients travelling from other countries. In addition to the discounts, excess luggage allowances, waived re-booking penalty and discounts for two companions are also offered.
Turkish Airlines, together with nine accredited hospitals in Turkey, has sponsored a market research study on the contribution to the US economy of Turkey’s healthcare partnership, which is being prepared by Kellogg School of Management, Northwestern University.

Health and health insurance in Ireland will change dramatically in future years after the Fianna Fail ruling party was trounced in the elections. The new government is a coalition between Fine Gael and Labour. Fianna Fail oversaw Ireland’s greatest economic boom during its 13 years in office. That same government also witnessed the Irish economy’s demise as its swollen bank debts and credit driven economy ran the country into the ground. The EU bailout means that government spending on everything, including health, faces drastic cuts. Fine Gael says it will cut €1.1 billion from health service spending over the next four years.
There are many problems in the Irish health system where patients cannot access services quickly due to cost. During the election, Fine Gael was highly critical of recent actions of the state owned health insurer VHI, on high insurance price rises at a time individuals and companies are seeing falling income and rising outgoings, lack of progress on privatization, and embedded position to any changes such as those suggested by an independent report.
Ireland has an unusual health insurance system. It is not compulsory to buy insurance. The country operates a risk equalization scheme where companies with larger numbers of older subscribers receive financial payments, via the industry regulator, from rivals with a younger membership profile. So VHI gets payments from Quinn Health (whose parent company is in administration) and Aviva.The government has argued that a risk equalization scheme is essential to underpin the concept of community rating in the private health insurance market where everyone pays the same for identical products regardless of age. The Supreme Court has ruled that the correct interpretation of the term “community rating across the market for health insurance” means that each insured person within a policy must be charged the same premium, irrespective of their risk profile. The government has always argued that risk equalization is a fundamental prerequisite for the effective operation of community rating as it would guarantee all insurers proportionately share the costs. In 2009 the government changed the system with an interim scheme involving the introduction of age-related tax credits and a community-rating levy on companies in the health insurance sector.
The new government has instructed the Department of Health that from 2012 new transitional arrangements will be put in place that are planned to closely approximate the effect of a full risk equalization scheme. Legislation providing for the introduction of a new risk equalization scheme in the health insurance market is scheduled to come into effect in 2013.
The coalition means that both Fine Gael and Labour election promises are being modified into a new agreed plan on radical health reforms with a new equal-access universal health insurance (UHI) system based on the Dutch system, and including free GP care for all, with insurance for universal hospital cover introduced by 2016.The plan provides for a public insurer option, as well as private insurers, VHI will now be kept in public ownership to retain a public option in the universal health insurance system. A hospital insurance fund will subsidise or pay premia for those who qualify for subsidies. The universal insurance system will not discriminate between patients on the grounds of income or insurance status and the two-tier access system will end.
The system of universal health insurance (UHI) will be introduced in 2016. Insurance with a public or private insurer will be compulsory, with payments related to ability to pay. The State will pay insurance premia for those on low incomes and subsidise those on middle incomes. This scheme will provide guaranteed access for care in all public and private hospitals from 2016 on the same basis as privately insured people now have. Exchequer funding for hospital care will go into a hospital insurance fund that will subsidise or pay insurance premia for those who qualify for state subsidies. Under UHI, insurers will be obliged to offer the same health cover package to all and will not be allowed give faster access to procedures covered under UHI.Under UHI, hospitals will no longer be managed by the state but will be independent, not-for-profit trusts. Insurers will not be allowed to run hospitals. The programme pledges to abolish tax incentives for private hospital developments. A new Patient Safety Authority will deliver a national licensing system for hospitals.
It is not clear if dental treatment will be in the new system, but even if it is Irish people will still travel abroad for fertility treatment, cosmetic surgery and dentistry.

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The Bermuda Hospitals Board (BHB) is actively exploring medical tourism with one venture already generating 1,000 bed nights for local hotels. BHB says that new prostate cancer treatment unavailable in the USA has brought 200 medical tourists as well as their families and doctors to the Island since being introduced at King Edward VII Memorial Hospital (KEMH) nine months ago.
Bermuda only has two hospitals, both run by BHB, a government owned body and the second largest employer on the island. KEMH in Hamilton is Bermuda’s largest hospital. In February, BHB cut short by 18-months a five year deal where US medical consultants Kurron Medical had been tasked with developing a health strategy for the island, including medical tourism.
BHB believes that high intensity focused ultrasound could be one of a number of niche procedures to attract medical tourists. But Shadow Health Minister Louise Jackson warns adopting practices not accepted in the US could shatter Bermuda’s international reputation. HIFU, a non-invasive alternative to chemotherapy has not been approved by America’s Food and Drug Administration (FDA) BHB replied, “The treatment enables prostate cancer patients to travel to Bermuda to have a leading edge treatment. This treatment is proven and available in many countries, including Canada and Europe, and is currently in the final stages of clinical trials in the US. Until it goes through final approval in the US by the FDA, Bermuda’s proximity to the US and the fact we can offer recovery in a beautiful island setting make it a compelling destination for US patients. This is a benefit to the hospital and Bermuda.” Louise Jackson retorted, “We have got to ensure that the medical facilities here operate in accordance with recognised standards in care. This prostate cancer treatment has been brought to Bermuda, not FDA approved, and, we have our reputation in danger. At stake here is the protection of patients and Bermuda’s reputation. It is medical tourism of the worst kind.”
The Bermuda Democratic Alliance is calling for BHB to ensure waiting times for locals don’t go up as a result of medical tourism. Candidate Michael Branco said the BDA is keeping an open mind on the topic, “ Bermudians could suffer as a result of bed space being handed over to American residents, and that care on offer is of an internationally accepted standard. The BDA is opposed to the provision of services in Bermuda that do not represent internationally recognised good practice. Is there capacity within our system to absorb medical tourists? Bermuda has a duty to provide safe and effective health care for our residents, and if an influx of medical tourists will take up hospital beds and drain resources available to locals, this would obviously be undesirable. How does BHB plan to balance these issues, particularly in relation to allocation of operating room time.”?
BHB recently signed a deal with Paget Health Services, a consortium of local and international businesses, to design and build within 3 years, a new hospital to replace KEMH’s ageing structures.

The Council of the European Union has formally approved the European Parliament’s amendments on a draft directive aimed at facilitating access to safe and high-quality cross-border healthcare and promoting cooperation on healthcare between member states (6/11 + 6590/11 ADD 1 REV 2).
The European Parliament’s amendments reflect a second reading compromise reached between the Belgian presidency and representatives of the European Parliament in an informal trilogue on 15 December 2010. In line with article 294 of the Lisbon Treaty the cross-border healthcare directive has now been adopted. Member states will have 30 months to transpose the directive’s provision into national legislation.
The new directive provides clarity about the rights of patients who seek healthcare in another member state and supplements the rights that patients already have at EU level through the legislation on the coordination of social security schemes (regulation 883/04). It meets the Council’s wish to fully respect the case law of the European Court of Justice on patients’ rights in cross-border healthcare while preserving member states’ rights to organise their own healthcare systems.
More specifically, the new directive contains the following provisions:• As a general rule, patients will be allowed to receive healthcare in another member state and be reimbursed up to the level of cost that would have been assumed by the member state, if this healthcare had been provided on its territory.• Instead of reimbursing the patient, member states may also decide to pay the healthcare provider direct.• For overriding reasons of general interest (such as planning requirements for ensuring permanent access to a balanced range of high-quality treatment or the wish to control costs and to avoid any waste of resources) a member state may limit the application of the rules on reimbursement for cross-border healthcare.• Member states may introduce a system of prior authorisation to manage the possible outflow of patients. This is limited to healthcare that is subject to planning requirements, such as hospital care (defined as care involving overnight hospital accommodation) and healthcare that involves highly specialised and cost-intensive medical infrastructure or equipment, healthcare that involves treatments presenting a particular risk for the patient or the population, or healthcare which would be provided by a healthcare provider which could raise serious concerns with regard to the quality or safety of the care.• A member state may refuse to grant prior authorisation if the patient seeking cross-border healthcare will be exposed to an unacceptable safety risk, if the general public will be exposed to a substantial safety hazard, if the healthcare is to be provided by a healthcare provider that raises serious concerns relating to compliance with standards and guidelines on quality and safety, or if the healthcare can be provided in the home country within a medically justifiable time-limit.• In order to manage incoming flows of patients and to ensure sufficient and permanent access to healthcare within its territory, a member state may adopt measures concerning access to treatment where this is justified by overriding reasons of general interest (such as planning requirements for ensuring permanent access to a balanced range of high-quality treatment or the wish to control costs and to avoid any waste of resources).• Member states will have to establish national contact points that must provide patients with information about their rights and entitlements and practical aspects of receiving cross border healthcare, e.g. information about healthcare providers, quality and safety, accessibility of hospitals for persons with disabilities, to enable patients to make an informed choice.• Cooperation between member states in the field of healthcare has been strengthened, for example, in the field of e-health and through the development of a European network which will bring together, on a voluntary basis, the national authorities responsible for e-health; another example is rare diseases, where the Commission will have to support member states in cooperating in the field of diagnosis and treatment capacity.• Long-term care services provided in residential homes and the access and allocation of organs for the purpose of transplantation fall outside the scope of the directive.
The decision was taken, without debate, at a session of the Transport, Telecommunications and Energy Council in Brussels. The Austrian, Polish, Portuguese and Romanian delegations voted against and the Slovak delegation abstained.
The cross-border directive will apply to all EU member states; Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and UK.
It will also apply to any members joining the EU, including active candidates Croatia, Turkey, Macedonia and Iceland; and potential candidates Albania, Bosnia and Herzegovina, Kosovo, Montenegro and Serbia.
It is highly probable that other countries that follow the EU on many services directives and also are part of the current European Health Insurance Card system for travellers, will accept the principles of the directive; Norway, Iceland, Liechtenstein and Switzerland.

The small rural community of Ballylanders, County Limerick is taking a bite out of the dental tourism market and is to build a factory to produce crowns, dentures and veneers. The clinic was born out of a meeting between Monika Raffael of the Hungarian Cultural and Business Association, and John Gallaghue, a former mayor of Co Limerick, in Hungary two years ago. Gallaghue, who lives in Ballylanders, was amazed at the amount of Irish people visiting Hungary to combine cheap dental work with a holiday and saw an opening. His local development company supplied a premises and equipment for a Hungarian-operated clinic in the village and is preparing to build a dental factory which will employ 15 people. Other villages in Co Limerick are making inquiries about setting up similar clinics, which the dental factory could supply after next May.
John Gallaghue says, "We already have people coming from all over Ireland. When we expand after opening the factory we could look at marketing our own dental tourism in Britain." Hungarians are operating the clinic in conjunction with Ballylanders Development Association, will not charge religious people for cleaning and other minor work, and will give them a discount on major work. Dr Dilyan Bachvarov is very busy in the dental surgery with cleaning and scaling for as little as €40, an extraction €55, root canal treatment €195, and crowns from €300.These are way below normal Irish prices.
Irish dental health is an increasing problem as state support for dental care is now severely curtailed. From January 2010, the government curtailed all support for treatments that used to be covered by the PRSI dental scheme, other than an annual examination. Subsidies for routine treatments such as fillings and extractions are no longer available. The average private price for a dental check-up is more than €80. While some Irish health insurance policies either cover dental work or offer discounts, all the three major insurers have recently raised prices, sometimes as much as 45%, and sometimes for the second time in a year. One health insurer is part of an insurance company in administration, while the state owned VHI is technically insolvent.
An increasing number of Irish customers are taking advantage of the significant savings to be had in Northern Ireland. The promise of Northern Ireland prices south of the border is being offered by Smiles, which has 13 clinics throughout the country. Last year, the Smiles chain took the drastic step of dropping its prices by 30 per cent to match prices on offer in the North – and it has paid off with a 50 per cent increase in customer numbers. A clinic in Dublin’s Ranelagh called Access Smile is operated by dentists from Hungary who organised treatments for Irish patients in Budapest for a fraction of the price in Ireland.
Pellevé is the latest entry into the non-invasive or non-surgical face lift market, and was launched in Ireland by Kambiz Golchin from About Face Clinic. Pellevé uses radio frequencies to modify the collagen bundles deep beneath the skin giving an immediate tightening effect. Over the next six months the collagen begins to re-knit, continuously tightening which should give ongoing results. The application of radio frequencies causes a warming sensation leading to the nickname “face ironing”. About Face Clinic is offering the treatment at €650 per session, a significant discount on UK prices, where it can cost as much as £1,200 per session. Kambiz Golchin is a consultant surgeon at Beacon Hospital in Dublin. About Face Clinic is next to Beacon Hospital.

Bangkok Dusit Medical Services (BGH) has acquired shares which will give the hospital group an 11 % stake in rival private hospital operator Bumrungrad Hospital as the private health operator continues to strengthen the group’s position in the Thailand healthcare market. The move by BGH to invest in the highly regarded Bumrungrad Hospital is part of the group’s strategy to achieve synergies between medical operations in a bid to lower costs and strengthen its position in the expanding private healthcare market in Southeast Asia. The new partnership is expected to benefit both parties, as combined operations will help with the control of medical costs, resource management and general overheads at a time when healthcare costs are under pressure from inflationary increases.
In 2010 BGH merged with private hospital chain the Health Network Group (HNG) in Thailand. The deal includes Phyathai Hospital, Paolo Memorial Hospital and six other private hospitals in HNG’s ownership. BGH is now the second largest hospital group in the Asia-Pacific region outside Japan with 27 hospitals.
Patients Beyond Borders has released a stand-alone focus on Bumrungrad International Hospital, profiling the destination. Bumrungrad was the first hospital in Asia to receive Joint Commission International (JCI) accreditation in 2002. BNH Hospital in Bangkok is the latest to attain JCI accreditation.

Australian IVF clinic, Sydney IVF, is helping clients choose the sex of their baby by sending them to a Thai clinic it co-owns, avoiding Australian rules which allow the practice only for medical reasons. Sydney IVF has several clinics in NSW, Canberra, Perth and Tasmania. It is also part owner of Superior ART, a Thai clinic that provides IVF for family balancing, when families with children of one gender are seeking another child of the opposite sex. It costs $11,000 including flights and accommodation,
Australian fertility clinics are prohibited from offering sex selection for non-medical reasons by national ethical guidelines by which they must abide to be accredited. The National Health and Medical Research Council’s health ethics committee developed the guidelines as argues that Australians generally believe parents should not be allowed to choose their child’s gender to balance out their family. Sydney IVF maintains it is not in breach of the guidelines, as it would breach people’s rights to ban them from travelling overseas to have the procedure. It also argues, with support from the Fertility Society of Australia, that sex selection overseas is within the rules of Thailand and Australia has no right to interfere in the laws of another country. One in six Australian couples suffer from infertility problems.

Concerned that while national/international accreditation is essential for the hospitals and clinics it sends customers to, US agency WorldMed Assist has set up its own hospital quality evaluation programme to evaluate the quality of hospitals and health care facilities, purely on areas of importance to medical travellers. The company is only evaluating those hospitals it uses. It is neither a commercial venture nor an attempt to join the increasingly crowded international accreditation market. The programme was developed by Dr. Sharon Kleefield of Harvard Medical School.
WorldMed Assist has helped hundreds of consumer medical travellers since 2006. The quality evaluation programme is to stay ahead of the additional demands of self-funded employers as they have started to sign up for WorldMed Assist’s corporate medical travel services on a wider scale. The programme is claimed to be consistent with the best of US and international standards, but focuses on the additional requirements for those that accept medical travellers.
Wouter Hoeberechts of WorldMed Assist comments, “The objective is to be able to offer a high quality network that is safe for the patients. What we have found so far is that hospitals are very appreciative of our reviews since we provide them with input that allows them to become a better provider for international patients. It does not cost hospitals a single dollar. This is not a revenue generating programme, but only for the safety of the patient. Although we mainly use JCI hospitals we have a few in our network that are not JCI accredited, so we started with these. JCI is good, but our approach includes components of other bodies as well, allowing for a more rounded approach. It also includes our experience of having helped upwards of 600 international patients get treatment abroad. JCI only focuses on foundational and process metrics. We also include outcome metrics. We want to have our own, independent approach. It is impossible to keep up with what each accreditation organization provides and determine its merits/shortcomings. We also don’t want to rely on what other organizations do and see things with our own eyes.”
Hoeberechts continues, “Our focus is an internal one. Our approach is not trying to copy or outdo JCI. We cannot review hospital processes with a level of detail that takes several JCI accreditors hundreds of person hours. We simply don’t have the financial strength to do that, as much as we would like to. However, our approach focuses on reviewing the critical areas that, when passed, allow us to comfortably send patients to the reviewed hospital. The focus on outcome data is something that JCI does not have. We visit every hospital before sending any patients, and every 3 years after that. This is something that we have done from the outset. We have had our own review process in place from the outset as well. The new programme is a more rigorous, thorough and standardized approach. We are only looking at the nine hospitals in our network and those that we are considering adding to our network. We made a strategic decision very early on to keep our network small so that we are a relatively large player for each of our providers, get to know doctors, management, logistics very well, all of which leads to a better relationship, ultimately leading to a better and safer patient experience.”

The Polish market for medical tourism had a very weak 2010, as the global downturn hurt demand among foreigners for medical treatment in Poland, but is expected to begin a solid recovery this year, according to the Polish Association of Medical Tourism (PTSM).The number of foreign patients who received medical treatment in Poland plunged by almost a quarter last year, to 250,000 from more than 330,000 in 2009, dropping well below the figure registered in 2008 (280,000).
For 2011, PTSM is forecasting robust growth of a 10-15% rise in patient numbers. In particular, it is anticipating a strong rebound in demand for dental care and cosmetic surgery services from Germans, Dutch and British medical tourists-the categories which saw the steepest decline during 2010.Other growth-supporting factors are expected to be substantial investments in the country’s sanatorium medicine infrastructure, as the sector is being transferred to private hands; and the availability of government grants for medical tourism projects, after the Ministry of Economy placed the sector on the list of 15 key export industries and earmarked €77m for export promotion projects over the next five years. PTSM will launch promotional and marketing efforts in promising foreign markets, especially in the United States and the Middle East.
But PTSM predictions may not come true as on January 1, a 23 % VAT rate was imposed on cosmetic surgeries. As a result, their prices have gone up almost a quarter. The owners of clinics are afraid that this could lead to a collapse of the market. Monika Chomiuk from Artplastica clinic says,” Our foreign customers now have to pay more, which reduces our competitiveness in the global market. Right now, our prices make us marginally more competitive than Belgium. However, we are not even trying to catch up with the Czechs because it is simply impossible. More and more Poles have their cosmetic surgery performed in the Czech Republic or in one of the Eastern countries.”
Commenting on the passing of the EU cross-border healthcare directive, Minister Hanno Pevkur said, "Estonia has always supported the free movement of patients, as we are a small country and the occurrence of a number of diseases is relatively small. Estonia could also be supplier of healthcare and not just a consumer. Estonian doctors are very professional and highly valued. Patients from abroad can bring supplementary revenue to our health care system."

Your Health First has added gastric banding and gastric bypass services to the long list of medical tourism, health and spa services it offers from hospitals, clinics and spas in in Lithuania. Primary destination cities are Vilnius, Kaunas, Trakai, seaside resort Palanga, plus spa cities Druskininkai and Birštonas.

According to a new report from Frost & Sullivan “Technology Trends in Cosmetic Procedures”, Brazil is a destination for global cosmetical companies and therapeutic equipment manufacturers to promote their products, as cosmetic procedures are poised to grow exponentially. Frost & Sullivan research estimates there is a demand for cosmetic surgery in a country that has created a reputation for procedures such as liposuction, breast augmentation, and buttock augmentation. The Brazilian Government offers lower tax rates and tax deductions for cosmetic surgery as a means of facing the global recession.
Medical tourism is set to grow globally because of innovative cosmetic procedures. The demand for non-invasive cosmetic procedures such as radio frequency and laser-based methods are increasing. However, with malpractice insurance driving up costs and health insurance not paying for cosmetic procedures, customers in western countries such as the USA and Europe are looking for economical alternatives in South America.
With regard to technology, more hybrid lasing techniques such as Triactive+, VelaShape, MedSculpt and MedContour are poised to dominate the cosmetic procedures market. High-intensity pulsed light is gaining more popularity and is accepted widely as a non-ablative alternative to microdermabrasion, chemical peel and laser resurfacing. Epidermal leveling is a relatively new procedure that offers benefits when combined with chemical peels and lasers. Among the existing dermal fillers, commercial fillers that mix hyaluronic acid and lidocaine reduce pain before and after the procedure with adoption increasing globally. Other fillers such as polymethlymethacrylate (PMMA) have proven to be long-lasting injectable microimplants for subdermal augmentation.
Guyana’s president Bharrat Jagdeo says his government has secured an $18 million line of credit from India to build a new specialist surgical hospital in the South American country. The new hospital will offer specialized procedures such as organ transplants and cosmetic surgery to medical tourists looking for inexpensive medical care abroad, a practice known as medical tourism. Construction will start this year and end in early 2014. An Indian company will build the hospital and Indian medical specialists will operate it.
Health Minister Dr Bheri Ramsaran adds, “A specialist surgical hospital will be a symbol of the country’s future. This will position Guyana in an advanced stance ahead of many Caribbean countries. This move will see not only Guyanese resident in Guyana, but Guyanese in the Diaspora and non-nationals coming to enjoy an international standard service while at the same time doing so at a facility that is located in a good environment. Plans are apace to promote the concept of health tourism.”
Finance Minister Dr Ashni Singh reveals that over $1billion has been budgeted for the construction and maintenance of health sector buildings and infrastructure nationwide, including $150M to begin this 150-bed surgical specialty hospital offering invasive cardiology and radiation oncology.

The Malaysia Ministry of Health has rolled out a number of activities in Southeast Asia to attract more foreigners for health tourism. The health tourism industry had been made a national key economic area and the Malaysian Healthcare Tourism Council will be restructured to coordinate the market promotion activities of the sector. The new downloadable Healthcare Malaysia magazine is proving popular.
According to the ministry, 400,000 foreigners were healthcare tourists in Malaysia in 2010, generating revenue of USD101.65 million for the country. It is confident that the major programmes implemented by the ministry on the promotion of healthcare tourism, are moving on the right track .The country expects to meet or exceed the target set by the Malaysian government and expects to generate USD116.5 million in earnings this year.
Private hospitals have been urged by the Ministry of Health to publish their rates on their websites. This is to ensure that patients are aware of the fees. Health minister Seri Liow Tiong Lai made the request at a recent meeting with the Association of Private Hospitals of Malaysia, “We have instructed private healthcare facilities to inform patients clearly about their charges, including any unanticipated charges due to complications. We are asking them to do so in order to avoid misunderstanding and disputes during and after treatment. By publishing the fees, patients will be protected and treatment costs better regulated in accordance with the ministry’s hospital fee schedule.
Fertility treatment is unregulated but the Ministry of Health has initiated legislation for it and other reproductive issues with proposed legislation – Assisted Reproductive Technique Services Act. The drafting exercise is expected to be completed by 2012. The act will address issues such as surrogacy, sperm and egg banking, and sperm donation. The proposed act for fertility and reproductive issues is in the consultation phase — involving legal parties, religious groups, non-governmental organisations, doctors and government ministries.
Dr Prashant Nadkarni of KL Fertility and Gynaecology Centre is concerned that legalising surrogacy could pose problems if not done carefully, "We could become a rent-a-womb country. In some countries, the only way out for poor women is to be prostitutes or surrogates. We do not want Malaysia to be a have for that. There are places in Eastern Europe and India known to commercialise surrogacy. In some countries, paying money to carry someone’s baby is common and it has become a part of medical tourism. If there are no enforceable guidelines, commercial agents will get involved and it will be no different than any other business. That is why we need to legislate properly and not discriminate against genuine cases. The main issue is identifying who the mother is. By law, the person who gives birth to the baby is the mother. If there is no legislation, the surrogate mother can turn around and refuse to hand the baby over to the commissioning couple. Christians, Buddhists and Hindus believe that if the surrogacy is to bring life without causing harm to anyone, then it’s okay. But in Islam and Catholicism, there should not be a third-party in a pregnancy. The current situation is that doctors are supposed to follow guidelines set by the Malaysian Medical Council which state that in a surrogate arrangement, a woman agrees to become pregnant and bear a child for another person/persons and to surrender it at birth."

For the first time in ten years, the US health insurance industry is expected to report no rise in medical expenses, according to a new study of 852 health insurers by Weiss Ratings, the nation’s only provider of independent insurance company ratings. Sceptics dismissing this as spin from a pro-insurance lobby group are wide of the mark as Weiss Ratings is far from popular with insurers as it offers free public lists of the 118 strongest and 100 weakest health insurance companies and regularly criticizes health insurers and Obama’s reforms. Weiss also predicts that future insurance increases will be far below what less informed analysts predict. With health reform meaning more Americans will have insurance, and with insurers paying only a fraction of the gross cost that those offering medical tourism compare themselves against, the analysis suggests that a key reason for Americans seeking overseas surgery unaffordable insurance will be a weaker driver than predicted.
Overall, health insurers incurred medical expenses of only $234.9 billion in the first nine months of 2010, representing a $3.7 billion, or 1.6%, decrease from the $238.6 billion in medical expenses reported during the same period in 2009. Weiss Ratings estimates that medical expenses for the entire year will decline as much as $9.8 billion, or 3%, from $323.1 billion in 2009 to $313.3 billion in 2010. Gavin Magor for Weiss Ratings comments, “This is a critical change from the steady and rapid increases of prior years. If it continues in 2011, it should help boost health insurer profits while pressuring companies to curb premium increases and give consumers some much-needed relief.”
The study also found that medical expenses increased sharply from 2005 through 2009, by 48%, an average annual increase of 10.3%, with double-digit increases in three out of the four years. The total number of individuals enrolled in health insurance was 145.0 million at the end of the third quarter, compared to 148.4 million one year earlier. The decline in medical expenses was reported by many companies.
Martin D. Weiss of Weiss Ratings says: “Most large insurers should be able to handle the increased medical expenses expected under the new health care reform.” Health insurers incur medical expenses whenever they pay out health insurance claims, a cost that represents around 71% of their total expenses. The Patient Protection and Affordable Care Act will require individual and small group insurers to spend at least 80% — and large group insurers to spend at least 85% — of their premium dollars on medical care and on efforts to improve the quality of care. Some smaller health insurers may withdraw from the market, be acquired, or fail. However, most of the nation’s largest insurers have the capital and efficiencies needed to handle the expanded coverage and buy out the smaller companies.
Another federal judge has thrown out a lawsuit claiming that President Obama’s requirement that all Americans have health insurance violates the religious freedom of those who rely on God to protect them. U.S. District Judge Gladys Kessler in Washington, D.C. dismissed a lawsuit filed by the American Center for Law and Justice, , on behalf of five Americans who can afford health insurance but have chosen for years not to buy it. The case was one of several lawsuits filed against Obama’s requirement that Americans either buy health insurance or pay a penalty, beginning in 2014. Kessler is the third Democratic-appointed judge to dismiss a challenge, while two Republican-appointed judges have ruled part or all of the law unconstitutional. Kessler decreed that the Supreme Court will need to settle the constitutional issues.
Kessler ruled that Congress has the right to regulate health care spending under the Commerce Clause and that the individual mandate must be viewed not as a stand-alone reform but as an essential part of the law Obama signed 11 months ago aimed at reducing overall costs. She also said that anyone who objects to having health care for religious reasons can choose to pay the penalty instead — as the lawsuit said all five plaintiffs plan to do. Judges George Steeh of Michigan and Norman Moon of Virginia dismissed suits against the individual mandate last fall. Henry Hudson in Virginia ruled the insurance purchase requirement unconstitutional in December, while Roger Vinson in Florida ruled the entire health care reform act unconstitutional last month. The Obama administration is pushing back on the two federal judges’ rulings that declare unconstitutional the linchpin of last year’s health care reform legislation: the requirement that citizens buy health insurance. The Justice Department has filed a memo asking Judge Roger Vinson to clarify his January ruling that struck down the health care law, after concluding the so-called individual mandate was unconstitutional. He has been put on the spot and asked to "confirm that the declaratory judgment does not automatically relieve the parties of their rights or obligations under the Patient Protection and Affordable Care Act." Separately, the administration has asked the Court of Appeals to reverse the Virginia federal judge’s ruling that strikes down the individual mandate. The government argues the provision is permissible under the Commerce Clause, the constitutional power that allows Congress to regulate interstate commerce.
All the state legal moves and politicking are ultimately no more than hot air as the U.S. Supreme Court will decide the issue. Meanwhile, the President has defused much opposition by agreeing to support bipartisan legislation giving states greater flexibility in implementing the health care law. This allows states to start designing their own health care plans in 2014, three years earlier than scheduled in the existing law.

The local government of Seoul district Gangnam aims to promote the district to medical tourists. Shin Yeon-hee has been orchestrating strategies to make Gangnam a more internationally friendly district since last July. She explains that Gangnam is a representative district of not only Seoul but also Korea as a whole, “Unlike other spontaneously developed cities, Gangnam is a planned area. As Korea becomes globalized, Gangnam is also growing into a truly international district. Gangnam aims to attract at least 30,000 medical tourists by 2012. Medical tourism also benefits hotels, transportation and the restaurant business, creating more economic effects than just sightseers. There are many hospitals and clinics in Gangnam, renowned for cosmetic surgery and dermatology.”
As Korea develops medical tourism, Yonsei Severance Hospital in Shinchon, northern Seoul is taking measures to ensure patient care is foreigner friendly. The international healthcare centre has coordinators for Russian, Chinese and English speakers.Yonsei Severance employs 13 bilingual interns to help manage the increasing inflow of foreign patients. A new international hospital in Incheon, set to open in 2015, will have features designed to accommodate international patients such as special beds to accommodate tall patients. Patients Beyond Borders will soon release a 32-page full colour standalone focus brochure on Asan Medical Center (AMC), profiling South Korea’s largest nonprofit hospital. It will feature the hospital’s world-class facilities, highlight its pioneering developments in areas such as organ transplantation and coronary artery intervention, and showcase centres of excellence. Established in June 1989 by Hyundai Motor Company founder Chung Ju-Yung, AMC’s mission was to create a hospital with an emphasis on caring for life and sharing with those in need and pain. Today, the main facility-one of the largest hospital campuses in the world-encompasses more than 4 million square feet and houses over 2700 beds. AMC also has longstanding partnerships with the University of Ulsan College of Medicine (Seoul), Partners Harvard Medical International (Boston), Imperial College London, and various hospitals across Asia. Josef Woodman of Healthy Travel Media comments,” Korea has some of the best healthcare and medical infrastructure in the world, and Asan Medical Center has clearly secured its place as one of the country’s leading providers. Revered for its high success rates with organ transplantation and treatment of cancer and vascular disease, Asan is also well known for disease prevention. And the savings are substantial-averaging 20% to 60% less than US costs."
Offering patient-centred care and international partnerships for post-operative care, coupled with full-time English-speaking specialists, patient escorts and translation services, and other international patient services, the centre currently attracts more than 3300 global patients a year.

Rare diseases cause great suffering to many EU citizens. Up to 36 million Europeans are affected, and need proper diagnosis and treatment. A new Eurobarometer survey EB74-3 reveals widespread support for action on rare diseases at EU level. 95% believe there should be more European cooperation in this area and that rare disease patients should have the right to access appropriate care in another member state.
John Dalli, European commissioner for health and consumer policy says, "I am encouraged to see that EU citizens want more European co-operation on rare diseases. This is important, because the required medical expertise may not be available within national borders."
The survey was conducted in all 27 member states between 25 November and 17 December 2010, in order to examine Europeans’ awareness and knowledge of rare diseases and their support for policy initiatives and actions taken at national and EU level. Key findings:• Good general understanding, but detailed knowledge and awareness remain low.• Strong support for action at national and European level.• Almost all agree that national health authorities should give support to those suffering from rare diseases (96%) and fully reimburse their medication, even if it is very expensive (93%).• 95% agree that there should be more European cooperation, and that those affected should have the right to access appropriate care in another member state.
The recently adopted EU Directive on patients’ rights in cross-border healthcare will benefit patients seeking safe and good quality treatment across EU borders. The directive foresees the creation of national contact points that provide information to EU citizens seeking healthcare abroad. It is especially helpful for rare diseases, where patients often deal with scarcity of expertise and delayed diagnosis. Measures foreseen in the directive will help with diagnosis when the best expertise is in another member state. The directive recommends that prior authorisation for cross-border treatment abroad should not be refused to a rare disease patient, without carrying out an appropriate clinical evaluation by an expert in that field. The new directive is expected to be fully integrated into law in 2013.
Yann Le Cam of Eurordis, a non-governmental, patient-driven alliance of patient organizations that represents more than 434 rare diseases patient organisations in over 43 countries says, “One rare disease may affect only a handful of patients in the EU, and another may touch as many as 245,000.There are between 6000 and 8000 rare diseases affecting 30 million EU citizens. 80% of rare diseases are of genetic origin, and they are often chronic and life threatening. Patients with a rare disease face common problems: lack of access to correct diagnosis; delay in diagnosis; lack of quality information on the disease; lack of scientific knowledge of the disease; heavy social consequences for patients; lack of appropriate quality healthcare; and inequities and difficulties in access to treatment and care.”
The European Commission has also joined forces with the National Institutes of Health, USA, to coordinate rare diseases research. Rare diseases affect 250 million people around the world. The definition of a rare disease is not the same around the world. In Europe a disease is considered rare if it affects one person out of every 2000 inhabitants, is characterized by being highly disabling, having no known medical treatment and the diagnosis is made on an average of 10 years after the symptoms are first noticed. In the United States, rare diseases include those that affect less then 200,000 people, and 30 million are affected by one of these diseases. There is a complication in that the availability of treatments for rare diseases differs from country to country.

Discover Motels is a startup hotel chain owned by the Silvex Group of Mumbai. The company is currently soft testing its 216 keys property at the foothills of Matheran in the picturesque town of Neral, Raigad District, Maharashtra. The hotel is a brand franchise of Best Western International, USA, which is the world’s largest hotel chain with more than 4,000 hotels in 80 countries. The project has been designed by SKM Consulting of Australia.
Discover Motels is the pioneer of condotel space in India and is currently expanding the network to 3 properties in Sri Lanka and one each in Alibag, Coimbatore, Mangalore and Chickmangalure. Over 500 rooms are planned each year for the next 5 years. A condotel is a condominium hotel, a hotel operating unit that is sold to individual investors where each owner acquires a room, whilst the whole enterprise is managed as hotel operation under a single brand. The business model is based upon value added services on the bare product, an extension of condominiums where groups of properties each with individual owners has in-house shared services.
The new condotels include “Born Again”, a residential curative treatment centre aimed at addressing lifestyles diseases including diabetes, bone disease obesity, skin disorders, aging, digestive health etc. A curative treatment centre is one that is an ayurvedic naturopathic clinic that offers services with beds. It is for patients requiring diagnosis, treatment (whole range of ayurvedic and naturopathic treatments) or care for illness, injury, deformity or abnormality using the Indian/ holistic system of medicine run by trained medical professionals.
Discover Motels plans to develop this into a high-end brand and expand it using the franchise model. Additionally it seeks to launch an assisted living and timeshare product when the other properties go into operation.
The unique model is a mixture of hotel, holiday home, spa, medical tourism, assisted living and timeshare opportunities in a unique manner. The 500 hotel rooms based on modular building technology so can be transported from one location to another and used in Goa in the winter and Ooty in the summer.
Radhika Mandrekar of Discover Motels says, “We are about to innovate and transform the hotel industry.” Charly Varghese adds, “Our focus is to deliver a great service product at the lowest cost in the sector. We also wish to aggregate small players across the country under the Discover brand to offer the customers a diverse offering in the economy resort market segment. Our target is to offer rooms at the US $20 to 50 range.”
The reason for the soft launch of the new condotel is that it has so many different features from a traditional hotel that the product may have to be adjusted based on what works and what does not work. Combining hotels, medical tourism, franchising, timeshare and assisted living may be overly ambitious or a genius idea-time will tell.

To obtain reliable information on the numbers of UK patients seeking cross-border healthcare under the EU Treaty provisions, the NHS commissioned the Health Economics Consortium at the University of York to carry out a targeted research and information gathering study to collect intelligence on public and patient knowledge, attitudes and preferences with regard to the proposed directive, and to establish what the NHS was doing to ensure patients were able to access these rights. The main bulk of the research took place between November 2009 and March 2010.
In a public survey of 1,004 adults, 62% would consider seeking planned healthcare abroad in the future with 50% citing avoidance of long waiting lists as the main advantages to going abroad. Disadvantages cited included not having family nearby, not being to speak the language and the costs of travelling.
To the year ending 13 November 2009 the NHS paid for 747 cases where people were treated abroad. There were less people than cases as each pre-operation assessment, inpatient stay, rehabilitation and follow-up consultation is regarded as a separate case, even if for the same person. 50% of maternity cases were Polish women who wanted to go home to give birth. Only 108 cases were non-maternity, representing 64 patients of whom only 47 were British. Only seven of these had requested treatment abroad. 3 lived or planned to live abroad, and of the 40 sent abroad by the NHS for specialist treatment, these included 36 where specialist treatment for conditions such as epilepsy or cancer as treatment was unavailable in the UK.That the NHS is sending people abroad due to long waiting lists is a myth. All the 47 were sent to one of 11 EU countries (as the NHS will not send people long distance to Asia or America) That 12 went to Belgium and 13 to France illustrates that people prefer nearby countries.
Taking evidence from the survey, the lack of translation of potential into current demand for overseas treatment could be that supply of healthcare in the UK meets current demand and so people do not need to go overseas. However, given the change in emphasis away from targets around waiting times, increases in waiting times or size of waiting lists may lead to more patients who seeking treatment abroad. Other EU studies agree that for state paid treatment, while many might consider travelling outside their country to receive healthcare, there is no evidence that numbers are likely to increase in the immediate future, although this may change several years in the future.
The report analysed historic NHS experiments sending people overseas at a time when there were very long waiting lists. 0f 300 patients in a 2002 pilot waiting for ophthalmic or orthopedic treatment, only 190 actually went abroad for treatment in Belgium and Germany. Another pilot saw 600 people have hip and knee replacements in Belgium and another pilot ending in 2005 saw 1,000 from London treated in Belgium. The consensus was that doctors and local NHS hospitals hindered the projects, there were travel problems, and with complex problems arranging treatment in European hospitals, everything took a long time to organise. A similar pilot that the Norwegian health authorities undertook, sending 1,200 patients to five German hospitals, ran aground due to high treatment, travel and transaction costs. The lessons from all these are that translating the theory of cross –border treatment into reality can be time consuming and complex.
Of 1,004 people in the public attitude survey, only 45(4%) had considered travelling abroad for planned treatment; and of the even smaller number who had previously travelled abroad for planned healthcare, only 3 individuals used the NHS as a primary source of funding. Younger people are more willing to travel but as this age group is less likely to require extensive treatment, this supports the notion that numbers requesting NHS healthcare abroad will not dramatically increase. When patient choice within the NHS was extended to allow patients to travel anywhere within the UK, few took it up, showing yet again that people prefer being treated near where they live.
In the small focus groups, people were asked about attitudes to treatment abroad, whether self-funded or NHS paid. Many of those who received healthcare abroad made use of family connections, which seemed a significant driver. Those who did not have family connections undertook research via the internet. Reasons for seeking healthcare abroad were associated with waiting times, receipt of what they perceived to be better quality care, or receipt of private health care in a country where costs were lower than in the UK. Those who sought private healthcare in the UK were concerned mostly about waiting times. The majority might consider seeking healthcare abroad for similar reasons for planned diagnostic tests or minor surgery, or to receive treatment not available in the UK. Participants were not wholly in favour of seeking healthcare abroad: there were concerns about what to do about aftercare and complications. Reservations were expressed about going abroad for major surgery. Many had received dental care successfully abroad, both planned and urgent. Interestingly, the group was divided as to whether they would seek dental care abroad; aftercare was again a concern.
Key findings:• Current demand for planned overseas healthcare funded by the NHS is very low. • While 60% do not appear to have any intrinsic barrier to receiving treatment abroad, the desire to be treated close to home in a system that is understood outweighs any perceived benefit from treatment overseas. • This lack of demand could be due to a lack of knowledge of rights EU citizens have to treatment abroad, especially to routine treatment where people may be more willing and indeed already be receiving treatment in the EU. • The new directive may raise the awareness in the population of their rights and so potentially raise demand. • An increase in demand could also arise if waiting times for treatment increase in the future as people indicate this as the main issue that would drive them to seek treatment abroad.• * Arrangements for NHS paid treatment abroad should be national rather than local commissioning.

Temos GmbH, a German based organization that specializes in quality assessment and certification of hospitals and dental clinics worldwide, has certified GMC Super Specialty Dental Centre as a member of the International Temos Network.
GMC Dental Centre, part of GMC Hospital based in Ajman in the UAE, is owned and run by the Thumbay group, a local company that owns several hospitals in the region. It is the first hospital or clinic in the Middle East to achieve this certification. The GMC dental centre is a state-of-the-art dental facility opened in 2010. GMC Hospital is the first private teaching hospital in the U.A.E with a capacity of 250 beds in the heart of Ajman.
Temos offers a seal of quality for internationally oriented hospitals and dental clinics. Its services are based on the international standard ISO / IEC 17020 and have been developed in cooperation with leading travel health, insurance and assistance services worldwide, with experts in quality management.
After a self-evaluation questionnaire, a team of Temos experts including an internationally experienced medical doctor and a quality management expert do an onsite inspection of the hospital. Based on professional judgment and together with the management, ways and options for optimized care and services are discussed and realized. Hospitals meeting the requisite criteria/demands set by Temos and passing the process obtain the Temos Certificate, the seal of quality for high quality medical services for international patients. Temos offers an objective means of being assured of the general quality of certain services. They evaluate a vast range of hospital activities and governance, including management, equipment, clinical audit, research, training, and education, as well as clinical/medical activity. When the hospital or service meets the criteria, three years full certification is awarded.
Temos has a new partnership agreement with Dr. Hashem Al-Fadel, who is now the regional partner for hospital and dental accreditation in Jordan and Saudi Arabia.

Several Middle East countries have worked hard and been encouraged to see themselves as major medical tourism destinations. But despite development of new hospitals, marketing campaigns and high-profile conference attendance, the reality is that many more people are going elsewhere for treatment, than are going to the region, while much of the existing traffic is between countries and states in the area.
For the Middle East medical tourism industry, the great hope has been the US market: if US patients and their insurers can be persuaded to undertake long–range travel, the industry will expand exponentially. But for the moment it is little more than a pipe dream, with surveys showing that US medical tourism numbers to be lower than hoped for. Insurance paid travel is held up by issues relating to liability, confidence and language, and show little sign of resolution.
According to Frost and Sullivan, the business research and consulting firm, the medical tourism industry is currently a USD 78.5 billion industry, with just over three million patients who travel around the globe for medical care. The Middle East is one of the key source markets for patients, with one in five healthcare seekers worldwide from Gulf and Arab states. Significantly, patients from UAE alone spend about USD 2 billion in healthcare travel on an annual basis.
While some Middle East organizations and countries are still hoping for an influx of business from other regions, others are realizing that their real markets are their own people who currently go abroad for treatment, and local markets. So competition between states is likely to increase.
A key area is to bring the number and quality of local services up to international standards. A recent example is King Fahad Specialist Hospital in Dammam that has achieved Joint Accreditation International accreditation. This accreditation recognizes its commitment to excellence in patient care with the highest standards of practice. The hospital had successfully carried out 48 kidney, two liver and four pancreas transplants without any complications or fatalities. Recently two liver transplants were successfully performed.
Some overseas healthcare providers see the region as having good potential for investment, mainly dealing with the increasing local nationals and the large expatriate worker populations-with any medical tourism as a bonus. The AST Rehabilitation Clinic in Cork has just announced plans for a major international expansion into Saudi Arabia. AST will be responsible for the establishment and management of a chain of clinics for the Saudi Arabian rehabilitation programme. AST have formed a partnership with Kussay Al-Rammah.The medical infrastructure is only beginning to develop in Saudi Arabia and Kussay has a vision of a first class health care system across the entire Arabian Peninsula. Adrian Tanzer of AST explains the new Saudi venture. “Initially, four treatment centres, catering for up to 300 patients per day, will be set up in different communities around the peninsula. These will be located in the provinces of Ad Damman in the Eastern Region, Riyadh in central Ar Riyad region, Jeddah in Makkah and Ha’il to the north.”

According to governor Lyel Imoke of Cross River State, tourism is one sector where it holds a comparative advantage over other Nigerian states, although development of a tourist economy is at a very early stage. The local tourism bureau has been reformed, and is now looking for the private sector to invest in tourism. Governor Imoke says, “We believe that there is a growing demand for standard healthcare and specialist healthcare delivery. We are also embarking on a project that will be the first medical tourism facility in Nigeria.”
Nigeria has a problem with outbound medical tourism, according to local doctors. A consultant orthopedic surgeon, Dr Felix Ogedegbe of Cedarcrest Hospitals, has been warning that the rate at which Nigerians seek medical attention abroad is gradually killing the country’s health sector and demoralizing medical practitioners in the country. He represents a group of doctors who warn of, “ The many risks involved when Nigerians decide to shop for medical treatment abroad, as in most cases they tend to compound their illness instead of curing it. Apart from the huge expenses involved, which if pumped into the health sector would yield positive result, many patients and their relatives have no clue about the doctors treating them and whether they are truly qualified to carry out the prescribed treatment. If this trend is not stopped and attention not focused on resuscitating the collapsing health sector, years from now the country will not have a health sector to boast of. Patients have returned from these countries with much more than bargained for. Some have had the wrong operation, unnecessary procedures and treatments and others have significant, lingering and life long complications. Although most hospitals have medical malpractice insurance to cover any unforeseen events, seeking damages is often impossible in cases of negligence, misdiagnosis or incompetence. There is a lack of follow up even when the treatment or operation has been concluded, demoralizing local doctors who feel unappreciated, leading to a brain drain of medical practitioners and most importantly the loss of $260 million to India for medical tourism.”
Another surgeon, Dr Biodun Ogungbo, alleges that some doctors in Nigeria encourage patients to go to overseas hospitals abroad in exchange for a percentage of the treatment fees for every referral, “We have heard reports of patients and their relatives being asked to become touts in Nigeria for some hospitals abroad for a percentage of the treatment cost. Nigerian should embrace the culture of suing hospitals and doctors who assault, maim or kill their relatives as misdiagnoses, wrong treatment and unprofessional conduct should be punished".
Although the Indian government is keen on promoting medical tourism, Indian High Commissioner Suresh Makhijani, perhaps unwisely, distances the government from any problems, “Medical tourism in India has nothing to do with the government. It is a private sector affair. Our duty here in the embassy is to grant visas to the patient and a family member. We have nothing to do with the hospital."
There may be a solution that keeps patients and doctors happy. Rather than patients going to India, Indian hospitals see a potential in opening hospitals in Nigeria. The 120-bed Primus International Super Specialty Hospital has opened in Karu, a suburb of Abuja. Achia Dewan of Primus International says, We aim establish a network of world class centres in health care by providing state of the art facility and the creation of ethical, compassionate patient care through professional excellence. The need to reduce the cost of travel for prospective Nigerian patients was a key reason for building the hospital.”The hospital is keen to encourage inbound medical tourism as it has set up a special division to look after the needs of international patients.

The Saudi Arabian market for both inbound and outbound medical tourism continues to grow, and a top destination for outbound Saudis is Germany. Lutz Vogt of German airline Lufthansa comments, "Saudi Arabia is an important source market for medical travel to Germany. And with the kingdom investing heavily in homegrown health care services and infrastructure as evidenced by plans to develop medical cities in Jeddah, there is a growing demand for inbound travel too. This augurs well for the industry and more health-related travelers to and from Saudi Arabia are to be expected.”
Germany is believed to have received 68,000 travelers for medical treatment in 2008, mainly from Arab countries and Russia. This is thought to have increased since then. Lufthansa’s home base in Germany is a major destination for medical tourists as there are more than 2,000 hospitals with over half a million beds, offering up to date high-class treatment and care. Patients recovering from a treatment can also choose rehabilitation centers in Germany. There are more than 1,300 preventive health care and rehabilitation centers.
Germany is not the only medical travel destination served by the airline. In Europe, Romania, Turkey, Bulgaria and Poland have become medical destinations, and in Asia, Thailand and Malaysia receive many international patients. Lufthansa has a network that connects 200 destinations worldwide via its hubs in Frankfurt and Munich- ideal for connecting patients to and from the United States, India, Turkey, Middle East and Western Europe as well as other popular medical tourism destinations.
The airline has developed a specialty as a provider of state-of-the-art medical transport. A growing number of medical travelers are using Lufthansa’s Global Healthcare Mobility Partner Program. Lufthansa designed this to simplify the travel process and cater to the needs of international patients with comfort, flexibility and affordability. Lufthansa claims to be the only airline with a medical facility, which can be installed onboard. The airline offers a Patient Transport Compartment (PTC) on scheduled long-haul flights, which make no stopovers, such as for refueling. Compared with air ambulances, the flight time with the Lufthansa PTC is up to 50 percent shorter, making it easier for the intensive care patients and the medical personnel. Lufthansa also provides a flight attendant with medical training to look after the patient. The entire process of transporting the patient takes three days: Day 1: arrival of doctor from Germany; Day 2: medical check up to ascertain patient’s transport fitness level and if approved for travel, installation of the PTC onboard of the next flight from Frankfurt; and, Day 3: boarding the patient, return and deliver to hospital destination.
The PTC can be installed within an hour on a Boeing 747 or Airbus A340-600 and is useable on flights to 62 destinations, as the demand for traveling with PTC has increased over the years. The PTC, is only used for cases with a severe condition preventing travel in a normal seat or using a stretcher, and is used 100 times each year. The airline also has 1000 cases a year where medical passengers travel on a stretcher, and thousands more as normal passengers.

Barbados Fertility Centre (BFC) has received the gold seal of approval from Joint Commission International. It has been reaccredited, meaning the clinic has maintained the highest standards since the gold seal was first awarded to them in 2007. BFC is the sole JCI accredited facility on Barbados.
Ann Jacobson at Joint Commission International says, “The citizens of Barbados should be proud that Barbados Fertility Centre is focusing in this most challenging goal – to continuously raise quality to higher levels.” Joint Commission International is a US health facility accreditation programme that sets health care industry standards across the world, to give patients assurance that medical establishments have undergone stringent testing so that patients can make an informed choice within a level playing field.
BFC was tested for patient’s pain assessment & management, the risk and safety assessment prior to treatments and medical procedures, the storage and handling of hazardous materials, the regular inspection and maintenance of equipment, the credentialing of staff including the ongoing and up to date training of medical staff and all areas of patient safety.
BFC continues to boost medical tourism in Barbados as it assures patients that the quality of care they will receive when deciding on BFC for IVF treatment is as good if not better than clinics in the USA or the UK.The accreditation process is considered by BFC to be essential in improving the quality of care given to patients, and that by investing in new quality measurement systems, resources and staff training they are providing the best treatment for continued high success rates in IVF cycles. These quality standards also ensure continuous improvement as they are continually monitored.
Since opening in 2002, it has year on year increased the number of couples conceiving through the creation of a stress reduced environment for couples under going IVF treatment. Couples from Barbados, the Caribbean, USA, UK, Canada and other European countries are now proud parents after successful treatment at BFC.
BFC is one of the first IVF units in the world to offer a combination of medical tradition and a holistic approach by treating couples both mentally and physically with massage, reflexology, acupuncture and counselling on managing the whole IVF procedure. BFC believes that the approach of allowing couples to relax with their healthy mind and body programme whilst undergoing IVF treatment is one of the reasons why it is so successful. Dr. Juliet Skinner at BFC says, “We believe our high clinical and laboratory standards, and the relaxing environment of our beautiful island contribute to our high success.”
BFC saw success rates in 2009 on women under 35 using Blastocyst with 71% achieving a pregnancy. In the under 40 age group they saw 56% success. For women under 38 who had IVF/ICSI at BFC success rates were 68%. This compares to a 42% success rate in USA and 22% in the UK in the same age group.
Barbados Fertility Centre has a new online forum for patients suffering with infertility so patients can talk to each other, share experiences and support one another through treatment. Anna Hosford at BFC says, "We realised the importance of patients being able to speak to one another and have for many years been introducing patients to one another. We also host regular support groups ourselves, it seemed the next logical step to create an online forum for infertility patients to talk to one another. The forum we have created is for both men and women that are suffering with infertility and is there as a support network, it is open to everyone, not just our patients."

The Ministry of Tourism has held a national workshop in Delhi on the promotion of wellness tourism and national accreditation standards for wellness centres. This was organized with the active participation of the Department of AYUSH, Ministry of Health, and the National Accreditation Board for Hospitals and Healthcare Providers (NABH).
150 participants representing the wellness industry were at the workshop to deliberate on the issues concerning ayurveda wellness centres, spas, skincare centres, cosmetic care centres, gymnasiums, fitness centres, preventive health care centres, and yoga centres. The objective of the workshop was to evolve a road map for formulating strategies for the development and promotion of wellness tourism to position India as the leading destination for wellness tourism, incorporating the country’s natural attributes including yoga, ayurveda, siddha, and spas; to increase the number of health tourists, lengthen the average stay and increase total expenditure by wellness visitors; and to increase professionalism and excellence amongst those delivering wellness experiences.
Four groups deliberated on the four key topics; accreditation and the way ahead, capacity building and training of wellness professionals; promotion of the different components of wellness; and promotion of wellness tourism in India and abroad. Each group was targeted to come up with five to six recommendations for sharing with all participants for further deliberations. The resulting five recommendations for each group were presented to the Ministry of Tourism to help it develop the industry.
The workshop saw the launch of the new accreditation standards for wellness centers prepared by NABH and approved by the Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH). The new accreditation standards for wellness centres provide a framework for quality of care for customers and quality improvement for wellness centres. The standards will help to build a quality culture at all levels and across all the functions of wellness centres. The NABH standards have ten sections incorporating 84 standards and 396 objective elements. There is now a complete set of standards for evaluation of wellness centers to enable them to be granted NABH accreditation. The standards focus on all aspects of service delivery including customer rights and education, infection control practices, trained and experienced staff, infrastructure, environment safety, processes and controls and statutory and regulatory compliances. The accreditation process involves a review of the documentation and two onsite visits by NABH assessors. Renewal of accreditation has to be done every 3 years.• Wellness is a state of optimal health covering physical, mental, social aspects of an individual.• Wellness centre is a healthcare facility that provides scientifically proven physical interventions with repeatable positive outcomes for improvement or maintenance of physical form, enhancement of functions or improvement of beauty for achieving the state of wellness of an individual-including gymnasiums, spas, skincare centres, cosmetic care centres, fitness centres, immunization centres, executive health checkup centres with associated advice. • Wellness interventions are those interventions that do not require overnight stay at the wellness centre for medical reasons; leaving the treatment after any stage should not cause any harm to the individual.
India is a leading wellness destination that wants to fully tap the potential of wellness systems, developed through centuries of wisdom. This is being done by positioning India as a centre of ayurveda, yoga, siddha, naturopathy and spiritual philosophy that has been integral to the Indian way of life. The Ministry of Tourism has highlighted wellness in a through publicity and promotional activities. The growth of tourism in the country and demand for wellness centers has led to a sudden surge in wellness centers across the country. This gave rise to the concern for quality service and standards to be followed. This is why a system of accreditation that is uniform nationwide has been developed by NABH and AYUSH. The Ministry of Tourism has extended its market development assistance scheme to wellness tourism service providers including accredited wellness centers.

Leading Midlands’ cosmetic surgeon Dalvi Humzah has warned the public to be aware of the risks associated with undergoing illegal cosmetic surgery abroad. His plea follows the death of British student Claudia Aderotimi who died after jetting to America for a low cost and illegal buttock enhancement operation in a hotel.
The key word in his warning is ’illegal’. There are good and bad surgeons in every country. It is easy for cosmetic surgeons to raise concerns about going to another country for cosmetic surgery by highlighting a small number of deaths or problems. Every country has poor and dangerous cosmetic surgery; although there are millions of successful surgeries conducted each year on satisfied patients.
Mr. Humzah’s private practice, Plastic and Dermatological Surgery is raising awareness of the dangers associated with any cosmetic surgery, whether at home or abroad. On both it is vital to check the official credentials of the person, place and procedure before agreeing to any treatment in a foreign country. At all costs avoid treatment that is too cheap or is undertaken anywhere other than a professional clinic or hospital. Humzah comments, “Cosmetic surgery is surgery – no matter how small it may appear it should be done by a fully trained surgeon and in the right clinical environment using the appropriate techniques. It is important that the facility where a procedure is being done is the correct environment for the specific treatment and certainly not a hotel bedroom. The use of injecting silicone for buttock augmentation in banned in both the UK and USA. If more young women decide to take an enormous risk in pursuit of a smoother, rounder bottom, it is vital they seek professional advice from a fully qualified surgeon on the best treatment available.”
A new group of 40 cosmetic surgeons who are all members of the British Association of Aesthetic Plastic Surgeons (BAAPS) and/or British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) have created an organisation called Liberate as a service that liberates the consumer by giving them direct access to a cosmetic surgeon from the very first consultation and through the entire process including aftercare. The service allows the client to get to know the surgeon before the operation allowing them to make an informed and responsible choice. The Liberate slogan ’BYPASS’ – Before You Pay, Ask to See Surgeon – highlights the need for individuals opting to have cosmetic surgery to take control and be confident in their decision for cosmetic procedures.
A new survey by Liberate highlights the need for women to be better informed of the dangers of cosmetic surgery abroad or in the UK. Claudia Aderotimi is not the only woman to have suffered serious damage after seeking to enhance her appearance with cosmetic surgery. Former Miss Argentina, Solange Magnano, died in November 2009 in Buenos Aires, due to complications following buttock surgery. Cosmetic Surgeon John Pereira of Liberate says, “ Cosmetic surgery is a medical surgical procedure and it should be treated as such. Research into the background and qualifications of the surgeon is critical for patient safety. Even in the UK, any doctor regardless of their qualifications can call themselves a cosmetic surgeon and legally perform surgery."
While deaths from cosmetic surgery tourism hits the headlines, it is worth pointing out that in recent years, most deaths and problems in the UK, USA and Brazil have been where people went for treatment in their own country, not abroad. UK businesswoman Penny Johnson is currently suing a cosmetic surgeon for £54m after her partial facelift in Leeds in 2003 allegedly left her with a facial twitch, pain around her right eye and grimacing. She claims her career has been dramatically affected. In the most high-profile case of alleged negligence involving cosmetic surgery in the UK, Denise Hendry, wife of ex-Blackburn Rovers and Scotland footballer Colin Hendry, almost died in 2002 after liposuction she had at the Broughton Park hospital in Preston went badly wrong.
Cosmetic surgery has the potential to be dangerous, and it is easy to demonize either cosmetic surgery or going overseas for any treatment. According to the American Society of Plastic Surgeons (ASPS), 13.1 million cosmetic surgery procedures, including those that are minimally invasive or surgical, were performed in the United States in 2010. Among the 1.6 million cosmetic surgical procedures -the top five were:• Breast augmentation (296,000)• Nose reshaping (252,000)• Eyelid surgery (209,000)• Liposuction (203,000)• Tummy tuck (116,000)

A new study in the Research Journal of Biological Sciences, funded by the Iran University of Medical Sciences, on the challenges and opportunities for medical tourism in Iran says that so far there has been little success and changes are needed. The report writer gathered data by questionnaires answered by health services providers in the private sector and analyzed the results with professional survey techniques.
The most important challenges faced by Iran are:• The need to create a dual market structure in health services.• Overcoming the lack of support of the private sector by the government.• How to increase access to potential medical tourism.• The need to grow private sector participation in health services. • How to decrease the number of patients from Iran who go abroad for treatment.
The Islamic Republic of Iran is the 17th largest country in the world, in the Middle East. The country has 31 provinces and 885 cities with a total population of 70 million. The country is bordered on the East by Pakistan and Afghanistan, on the North by Turkmenistan, Armenia and Azerbaijan, as well as the Caspian Sea, on the west by Iraq and Turkey and on the south by the Persian Gulf and the sea of Oman. 830 hospitals have 120000 hospital beds.
In the past, people from neighboring countries went to Iran for healthcare, but numbers fell due to local wars. There are no statistics on medical tourists other than various official guestimates in 2006 and 2007 of 20,00 or 30,000 that included spa and wellness trips. The study suggests that even a probably more accurate 2005 estimate of 17500 is too high for the current political and economic climate, and other local estimates put the figure as low as 7000. Patients go for cardiology, surgery, cosmetic surgery, fertility treatments and organ transplants.
The main reasons patients go to Iran are:• Quality of health services and low cost of treatments and drugs in comparison with other countries of the region (Middle East and Middle Asia).• Access to advanced and new medical procedures, equipment and qualified professionals and medical staff.• Similarity of culture and language in some regions of Iran with neighboring counties such as Iraq, Azerbaijan and lack of some medical procedures, equipment, medical professionals and health infrastructures in those countries.
Medical tourism in Iran has not developed with few hospitals seeking patients from other countries. The political problems between the US and Iran discourages Westerners. In Iran despite of its high potential for this industry focusing on low cost and high quality of healthcare services and access to Arab market at present, medical tourism has not grown well. Some hospitals and medical tourism agencies have begun to enter this industry but they have many challenges, particularly the one they have no control over, the image of Iran in the outside world.
The main suggestion in the report is that medical tourism needs a lot more government support with practical help in targeting potential local countries that could provide patients, quicker processing of visas, but no direct government interference in the private health sector.

As China starts the final year of its aggressive three-year plan to provide safe, effective, convenient, and affordable healthcare to all Chinese, about one in seven (15%) residents say at least one member of their household needed to travel to another community for medical care in the past year, according to a new Gallup survey. This percentage is lower than the average of 21% across 13 Asian countries Gallup surveyed.
One of the primary goals of China’s healthcare reform is that residents will not need to travel far for care. The government agreed the construction of more than 5,000 hospitals in 2009. More than 10,000 health institutions and about 70,000 village clinics have been built.
Healthcare services in rural areas of China lack the same level of access and quality present in urban areas, but rural Chinese are no more likely than urban Chinese to travel outside their city or community for medical care. The need to travel for medical care is more common in some regions of China where access to quality care may be less likely. Chinese living in the Southwest (8%) and largely urban eastern coastal regions (10%) are least likely to travel outside their communities for medical care, while those living in the Northwest (23%) and Northeast (20%) are the most likely.
As in many other Asian countries, travel for medical care outside the country is low — less than half of 1% of Chinese a year — across all regions. Adequate regional access to care in a nearby city or area, the high costs of obtaining visas, and transportation may be a few reasons behind this low figure. The lack of personal networks in other countries to assist with medical care arrangements may also be a deterrent. Many Chinese say they do not have relatives or friends living in another country on whom they feel they can rely if they needed help; about 2% of Chinese say they do have this type of social safety net.
Gallup results are based on face-to-face and landline telephone interviews with 4151 adults, 15 and older, conducted between June and July 2010 in China.

A table of all Asia provides an interesting comparison. Please note that this is travel outside their own town/ city –not travelling to another country.

In the past 12 months, have you or a member of your household had to travel to another city or area within this country to seek treatment for a medical condition?

Yes

No

Nepal

54%

46%

Afghanistan

38%

62%

Bangladesh

33%

67%

Mongolia

30%

70%

Sri Lanka

25%

75%

Vietnam

24%

76%

AVERAGE

21%

78%

India

21%

78%

Philippines

20%

80%

Pakistan

20%

78%

Cambodia

17%

83%

China

15%

85%

Malaysia

12%

86%

Indonesia

4%

96%

Surveys conducted April to July 2010: GALLUP.

According to European hotel bookings company EuroBookings.com increased stress directly correlates with a rising interest in health and wellness tourism in Europe. Professionals and business people looking for anything from a spa break through to medical treatment in Europe are not driven by price but by quality of care and the surroundings.
One of the top European destinations for medical tourism is Switzerland. Their medical facilities are world-class with the latest technology. Add the clean air, high-class accommodation and that the country is geared up for all types of tourism, and you get an attractive destination. People do not go to Switzerland to save money; they go for luxury care and attention. The Swiss have made a conscious effort to promote medical tourism. The prices are very high and the services are marketed to the well off. Russia is a key market.

Genolier Swiss Medical Network (GSMN) operates a network of clinics, and targets overseas patients for surgery. GSMN is a private hospital network operating mainly in the French-speaking region of Switzerland (Romandie). Its strategy is focused on building a national network by acquiring clinics and restructuring their operations. GSMN’s main aim is to offer first class hospital care to Swiss and foreign patients. GSMN manages six private establishments in Switzerland, including Clinique de Genolier, Clinique de Montchoisi, Clinique Valmont, Clinique Generale, Centre medico-chirurgical des Eaux-Vives and Privatklinik Bethanien, with 501 available beds. Medical tourists account for 5% of revenue, and this will rise as international promotion increases. The distinctive features of GSMN include its high quality services, its brand value, a pleasant working environment and an experienced management team with an entrepreneurial approach. GSMN ’s managing director, Antoine Hubert, is about to launch a public offer to the shareholders of the company, together with another unnamed investor.
GSMN’s clinics are among those used by Switzerland Clinic, an agency that only offers leading Swiss clinics and Swiss spas for international clients. The network takes a close look at each clinic in Switzerland and reviews it from a medical and clinical point of view before deciding whether or not it qualifies to be part of the network. It is also linked to VIP tourism agency Rayan Partners that offers a range of services including treatment for stress, and a network of other services that are chosen purely on highest quality, not price;Russians are a primary market.
Some regions in Switzerland are active in promoting and developing medical tourism while others are not. Switzerland is not competing with medical tourism destinations like India, Thailand, or Costa Rica. The clinics in those countries have a different business model and target cost-conscious medical tourists. Switzerland does not see those countries as competitors as it targets the top end of the price spectrum; it competes with Germany, UK, and USA and to a lesser extent, Singapore. In a recent survey of luxury travel who cater for upmarket travellers, the most important determining factors for clients when choosing a destination are:1. The right destination2. Value for money paid3. Once-in-a-lifetime experiences4. The services and activities available5. Price
Although the top end of the market is not attracted by price, several recent travel market surveys on this sector all come to the same conclusion; the biggest change in the last two years is that customers are no longer prepared to pay top figures just for a destination, it has to be combined with value for money inclusive packages where they are not continually faced with demands for more cash for extras. Value for money is completely different from lowest cost.

Philippines estate developer, Century Properties Inc, has ventured into medical tourism, starting off with the construction of a $100-million facility. Jose E.B Antonio of Century Properties explains, "The potential of healthcare as a business is unimaginable. It will be an outpatient medical centre focusing on anti-ageing and wellness programmes. Centuria Medical Makati is a mixed-use medical tourism project. The 28-storey Centuria building will cater to both local patients and medical travellers.
High-spending clients from the Middle East are giving a much needed boost to Philippine medical tourism. The main market is still Filipinos who work abroad or have migrated, mainly to the US and Canada, but numbers coming from the Middle East are increasing. These are medical tourists from Saudi Arabia, Kuwait, Qatar, United Arab Emirates, Bahrain and Oman. They come with at least one companion (many with their families), stay in hotels, travel and shop a lot – meaning, they spend more than just for medical expenses. Middle East clients include corporate buyers, such as the petroleum giant Aramco. In 2010, Saudi Arabia’s Ministry of Health spent $60,000 each for 80 patients it sent to Manila. That’s $4.8 million, excluding the expenses of travel companions for transportation, food and accommodation. Elizabeth Nelle at the Department of Tourism (DOT) says,” In a matter of months since we entered the Arab market, they started eye surgery visits to the Philippines and this opened their eyes to discover that the country has modern hospitals with state-of-the-art equipment and excellent doctors. This makes the Arab market a very good potential for medical tourism."
The next niche markets are Nauru, Papua New Guinea, Guam, Palau and Micronesia whose citizens can use health facilities and procedures in the Philippines that are not available at home. The secondary markets, where price not availability is the driver, are Australia, Japan, South Korea, Taiwan and Europe. The Philippines is trying to attract the secondary markets by showcasing tourist attractions and special itineraries for those who are interested in combining treatment with leisure. The DoT estimates that 100,000 medical tourists visited the Philippines in 2009, and on average spent $2000.The DOT target for the Philippine Medical Tourism Program is 200,000 medical tourists a year by 2015.The main attraction for tourists from the United States, Japan, Korea and the Middle East is cosmetic surgery.
To put health and wellness tourism in perspective, inbound visitors to the Philippines in 2010 reached 3.52 million surpassing the target of 3.3 million earlier set by the DOT.Visitors from East Asia accounted for 44.4% of the total visitor count in 2010 with Korea having the biggest share at 21% or 740,622 arrivals. This market grew by a hefty 48.7% against its 2009 volume of 497,936 arrivals, regaining its number one position among the major source markets. The USA ranked as the second main source market with 600,165 visitors for a share of 17% of total tourist traffic. Taiwan and Japan, which in the past years posted declines in arrivals, have rebounded with double-digit growth of 39.2% and 10.3%, respectively. Arrivals from China and Hong Kong posted 20.9% and 8.9% increases; this market is anticipated to pose continued growth as the DOT undertakes aggressive marketing and promotions to regain and re-establish confidence in the Philippines as a safe and secure tourist destination. Visitors from Australia recorded an all time high of 147,469 arrivals during the year, making it the fifth source market with 11.4% growth rate and one of the fastest growing. This market is expected to increase as JetStar Air commences flights between Darwin and Clark in 2011.Most European markets recorded double digit gain in 2010 with the Russian Federation growing faster at 33.6% followed by the Scandinavian countries (12%), France (11%), United Kingdom (6.5%), and Germany (5%). For the Middle East region, the United Arab Emirates and Saudi Arabia remained the key source markets as visitor arrivals grew by 21.4% and 16.3%. In addition, arrivals from Qatar and Bahrain exhibited significant growth at 15.2% and 10.6%.

Medeguide, a leading online international doctor directory, and the American Academy of Private Physicians (AAPP), a nationwide association of private doctors, have formed a partnership to promote global healthcare options to AAPP members and their patients.
Under the agreement, Medeguide will feature a dedicated section on its homepage listing AAPP physicians. The new section will debut in March 2011, and is intended to provide American medical tourists with names of doctors in the US that provide pre and post medical travel support.
According to Ruben Toral, founder of Medeguide, this collaborative effort will clear one of the biggest obstacles in medical travel today – continuity of care. "Working with the AAPP and its network doctors, Americans interested in medical travel will now have access to doctors around the country that understand it, support it and can help patients find the right doctor and medical treatment options internationally. Patients often travel for medical treatment without the support or supervision of their doctor. AAPP doctors will help fill that gap and make medical travel safer by providing medical support before and after treatment.”
Dr. Marcy Zwelling of APP believes the initiative with Medeguide is the first step in getting US doctors to engage in global healthcare, "There is no doubt in my mind that healthcare is globalizing, and our doctors need to be aware of the treatment options that exist outside the US. Health reform has done nothing but provide uncertainty in the marketplace, and the US healthcare system is at risk of losing its competitiveness. Consumers, not insurers, should be driving the conversation in healthcare. I want to be able to bring the world’s opportunities for my patients’ health right into the exam room."
By the second quarter of 2011, the partnership expects 250 AAPP doctors to be featured. Medeguide is an online directory of 2500 international doctors from leading hospitals in popular medical travel destinations. The site gives users the ability to search by specialty, hospital, country or procedure; recommend doctors; and request appointments.
Among US hospital groups increasnng their marketing drive to be destinations for inbound and domestic medical tourism is Cleveland Clinic. Patients Beyond Borders, a consumer reference guide for medical tourism, will in March 2011 release a stand- alone publication profiling the Cleveland Clinic. Patients Beyond Borders Focus on Cleveland Clinic will provide global healthcare consumers with in-depth information on the hospital’s top specialities and doctors, achievements, accreditation, international concierge services, and patient case studies, as well as regional travel information. Cleveland Clinic has a network of medical facilities throughout northeast Ohio, Florida, Las Vegas, Canada, and Abu Dhabi, and welcomes more than 3.7 million patients annually from the US and 103 other countries. Josef Woodman of publishers Healthy Travel Media says, “Cleveland Clinic has served the international patient long before medical tourism became a buzzword, and has much to offer the discerning global medical traveler.” Cleveland Clinic caters to international clientele through its global patients services department. Services for international patients range from coordinating travel arrangements and arranging leisure activities for travel companions to providing translation services and catering to special cultural and dietary needs.

A survey by the international cosmetic surgery portal Estheticon.com found that one in four cosmetic surgery procedures carried out in the Czech Republic in 2008/2009 were for international clients. This shows a significant rise from the year before when only one in five were from abroad.
According to the clinics, the main reasons for the rise were the economic crisis (people were prepared to travel for cheaper surgery procedures) and the increase in quality of treatment, including complementary services such as accommodation. The Czech Republic offers patients skilled medical treatment for an extremely low price.
Pavel Hilbert of Estheticon.com comments, “Many cosmetic surgery clinics have put great emphasis on their overall presentation together with quality, professionalism and range of services so there is no difference from reputable clinics in Western Europe. Good surgery alone is not enough nowadays. Clients expect excellent overall quality including consultations, professional staff, pleasant surroundings and various complementary services.”
The number of foreign clients differs across clinics. 38% of all clinics report that international clients make up not more than 5% of their overall client number. In contrast, 26% of clinics (especially the bigger ones) report that international clients can be very important at 30% to 50% of their total clientele.
Most of the international clients for Czech clinics come from Germany, Britain, Austria, Switzerland, Slovakia and the United States. A survey among doctors and clinics showed 92% of them stated that Germany is one of the top four countries for international clients, while 63% of doctors say that Britain is in the top four. Other countries mentioned ranked in the following order: Austria (one of the top four countries for 24% of doctors), Switzerland (20%), Slovakia (15%) and United States (11%). International clients also come from Italy, Canada, Ireland and Russia.
Pavel Hilbert advises that when considering patient safety there are a few general recommendations that patients should be aware of when choosing a clinic or doctor:• Cosmetic surgery qualifications.• Membership in relevant cosmetic surgery society.• Years of experience.• Number of treatments performed.• Rapport with and confidence in the doctor.• Time to reflect on the procedure after initial consultation (14 days is recommended).
A survey conducted by Estheticon.com in Germany showed that 44% would definitely not travel to another country to have surgery, however cheap the price is.

ISCARE Clinic is to exhibit at London medical tourism show Destination Health. The clinic opened in 1995 and since then has offered a range of services in assisted reproduction. It has a high success rate. The IVF team was trained by leading specialists from Israel, where the success rate in treating infertility is the highest in the world. In 2005 it added the treatment of obesity, including bariatric and surgical methods. In 2007 the clinic added gastroenterology and cosmetic surgery.

First appearing in 2009, the US based Asian Plastic Surgery Guide is an online global information resource on cosmetic care for people of Eastern and South East Asian descent. It aims to offer credible and balanced information in an intelligent format free of social network confusion, disguised marketing, bias or hype.
Founder Steffan Cris says “While there are patients who leave the United States to seek medical care elsewhere, the inflow of foreign medical travelers is overwhelmingly higher. The main driver of medical travel is higher quality and not lower cost”. He offers his predictions for 2011:
1. Due to its sheer size alone, China will easily leapfrog the United States and Brazil to become the country whose surgeons perform the greatest number of surgical and non-surgical cosmetic treatments per year.
2. South Korea will successfully defend its position as the country with the world’s highest per capita rate of cosmetic surgery, as long as war does not break out.
3. The rate of cosmetic medical tourism within Asia will continue its meteoric bubble-like growth as young and middle-aged patients travel from less developed to more developed Asian countries. Most Americans, however, will stay put, most likely until just before the bubble pops (which won’t be in 2011).
4. Threatened by this still small exodus of cash-paying patients, Western surgeons will up the number and urgency of their public warnings about the dangers of obtaining treatment abroad.
5. Tapping into what is perceived as a neglected domestic market, a crop of new surgeons in the United States purporting to be experts at Asian cosmetic surgery will add to the already sizable increase in self-proclaimed specialists who have materialized in recent years.
6. The young Asian female in both East and West will remain the world’s most vulnerable cosmetic surgery target due to her age-related naiveté, willingness to be influenced by celebrity-driven social advertising, uncritical embrace of fads and scams, view of surgeons as a uniform commodity, and strong emphasis on capturing the lowest price possible above all else.
7. The cost of cosmetic surgery will rise modestly in the East while trending lower in the West, the result of supply and demand but also of advancing Asian economic parity.
8. Stimulated by the recession’s effect on disposable income and the consumer’s newfound reluctance to spend, marketing of less expensive but unproven or ineffective minimally-invasive treatments now strongly hyped in the West will gain traction in the East as well.
9. A backlash against undergoing surgical Westernization, while still a minor force, will take firmer hold in East Asia as the region continues to make strong gains in economic might, world status, and global cultural influence.
10. While seemingly inexplicable, the number of American women of European descent asking their surgeons to make them look more Asian will increase.
11. An avalanche of breakthrough press releases on new miracle stem cell rejuvenation therapies will… um, let’s not even go there.
12. Continuing threats of hostilities between the two Koreas will place a serious but temporary damper on some of the above.

A new online travel company called Health and Fitness Travel has launched. Their philosophy is to inspire holidays for your body and mind, from land and water sport activities to bespoke health and fitness programmes. They cater for everyone with diverse destinations and experiences, believing in the next generation of health and fitness travellers.
Demanding workloads and longer commutes are eating away at free time, leaving the some Britons tired, unhealthy, and in need of a holiday to not only rest, but to put health and fitness back on their agenda. More people are choosing to move away from inactive type holidays and switching to more dynamic ones; holidays which offer health and fitness activities to break away and experience the associated physical and emotional benefits.
Paul Joseph of Health and Fitness Travel says, “The culture of society is growing in self-awareness and we are becoming more conscious of the very limited time we have in our lives to look after ourselves. Holidays that promote discipline in key areas of health and fitness gradually change our attitudes in promoting a healthier lifestyle for us. The average person puts on 4 pounds of weight after every inactive holiday, meaning investing more time in exercise when they return home which is counterproductive. By hand picking resorts and tailor-making individual programmes, we offer a one-stop shop for everyone wanting a perfect health and fitness experience on their travels”.
Health and Fitness Travel offers a varied collection of holidays from all inclusive health and fitness retreats in exotic locations to boot camp, spa, detox, ski, golf, tennis and yoga holidays in Europe and other destinations around the world.
The second series of the UK’s only television chat show dedicated to cosmetic surgery and aesthetic treatments, MyFaceMyBody, is on Sky. Presenter Stephen Handisides, a cosmetic surgery expert, is seeking experts in the USA, for a series in late 2011, and in Australia, for 2012.
According to Laurence Buckman of doctor’s professional body British Medical Association (BMA), the dramatic shakeup to the NHS could mean that,” patients will become internal medical tourists, flitting between doctors in search of new drugs and treatments in a system where affluent patients can shop around for GPs.”One of the key measures in the government’s NHS bill will force family doctors to band together to form GP consortiums to buy care for patients, controlling more than £70bn of taxpayers’ money. Dr.Buckman argues, “ GPs will have to compete to attract patients with emotive offers of treatments but only the richer ones will be able to exercise real choice. The more patients they attract, the more cash they will have to spend, and so family doctors will offer treatments such as expensive cancer care, IVF, weight reduction surgery or unrestricted kidney dialysis. I can see richer, healthy patients moving backwards and forwards in search of GPs that prescribe Herceptin [an expensive cancer drug], for example. This is the creation of internal medical tourism.” Under current rules, patients can only sign up with a GP within defined boundaries close to their home. Buckman explains the changes, "Once this is gone, I cannot see how doctors will fulfil their moral and contractual obligation. The scramble for patients could lead to GPs overspending and being taken over by multinationals. In recent weeks, a private firm has won a contract to run a hospital in Cambridgeshire and another is running a primary care trust in West London. We will quite quickly see failed consortia bought up on the cheap by foreign companies and see bits of the NHS run from abroad."

The Malaysian government is now in the final stages of amending the Dental Act 1971, to strengthen the image of the dental industry and promote dental tourism. Health Minister Seri Liow Tiong Lai says the amendment is expected to be tabled in Parliament this year to allow dentists to advertise their services as a way to attract foreign patients to Malaysia,” I am very confident that we can expand this market especially now we have a small number of dental clinics all over the country. So we are in the process of amending our law to allow dentists to expand and project a corporate image. At present they cannot advertise. So now we will allow them to advertise and have their own promotional website."

Global Capital & Development (GCD), a joint venture consortium tasked with the development of Medini, has announced a landmark deal with Malaysia’s leading healthcare provider, Pantai Group, to develop the Gleneagles Medini Hospital. The hospital will be in Iskandar at the southern tip of Malaysia in Johor. GCD is a consortium representing investors from the Middle East and Malaysia, including Iskandar Investment Berhad, which is partly owned by Khazanah, the investment arm of the Malaysian Government and Mubadala, the Abu Dhabi Government investment company.
As a member of Parkway Holdings, Pantai’s development comes as part of its overall strategy to boost the region’s medical tourism industry across Asia. The hospital will be developed on 15 acres of land located in Medini North, the city’s lifestyle hub, and will be positioned as one of the premium hospitals of Parkway Health. The 300-bed private hospital will be completed in stages and will be Pantai’s 12th hospital in Malaysia. The development complements Iskandar Malaysia’s vision to become a regional healthcare hub and will reinforce Malaysia’s reputation for delivering world-class medical services for both Malaysian and foreign patients. Keith Martin of GCD says, “We will work closely with Pantai to develop a world class facility that will put Iskandar Malaysia at the forefront of healthcare in Southeast Asia. Gleneagles Medini Hospital will adopt global best practice for quality patient care to ensure world- class clinical outcomes delivered through a programme of thorough clinical governance.”
Malaysia is one of the top five destinations for medical tourism in the world, with 35 private hospitals catering to the market. Its appeal lies not just in the low cost and world-class facilities but also the privacy it offers, particularly in cosmetic surgery, says Loraine Reinsfield of New Zealand medical tourism agency Beautiful You Holidays, a company which arranges medical trips to Malaysia’s capital city, Kuala Lumpur, “The cost advantage comes with the low cost of living and wages compared to New Zealand or Australia, coupled with the fact that there is no tax paid on treatments.” Rensfield credits the dedication of the Malaysian Government to install stringent accreditation and standardization processes to professionalize the industry. As a result the medical tourism industry in Malaysia benefits from the world-class facilities, expertise of its surgeons and excellent service.

Bahrain, with its proximity to Europe, believes it has the potential to become one of the best medical tourism destinations along with the UAE and Jordan in the Middle East.
The UAE and Jordan are attracting a large number of medical tourists from GCC countries and a few from Europe. Both have positioned themselves as medical tourism destinations. Bahrain has a first rate healthcare system that claims to be cheaper than both rivals and many Western countries. Bahrain is one of the fastest growing economies in the Middle East and is a peaceful nation.
The country seeks to create a niche market and target tourists for open heart and cosmetic surgery, hip and knee replacements, and dentistry at affordable prices. What Bahrain does not have is a master plan and determination to implement it as the UAE and Jordan have done. It also needs to invest in hospitals, clinics, staff and other infrastructure. It lacks a skilled workforce that is needed to handle accommodation, travel requirements, marketing and other services to attract tourists.
Bahrain plans to build Dilmunia Health Resort on one of its islands. The resort will include ultra-modern centres for diabetics, children with learning difficulties and other disabilities, maternity and neo-natal care, sport medicine and research. Medical tourism has investment potential for hospitals, specialised services, hotels and travel.

The European Cross-Border Health Care Organization (ECHO) is a new forum for the European cross-border healthcare sector, which aims to embrace members from all parts of the healthcare system, including:• Regulatory and supervisory bodies at all levels within the European Union, including national and regional participants.• State run and private health insurance companies as well as the national social security organizations.• Healthcare service providers including; hospitals and clinics; spas, rehabilitation and wellness; medical travel agents; and healthcare quality and accreditation bodies.
The organization will be registered in Brussels as a non-profit organization (ASBL). The aim is to provide an open and neutral platform for stakeholders, providers and customers involved in cross-border healthcare.
ECHO will offer its members:• A forum for debate and discussion on the route to the integration of cross-border healthcare.• An opportunity to influence and provide insight into the developments in cross-border healthcare. • Guidance in accreditation and certification.• Opportunities for networking within the industry.• Access to EU and other relevant documentation.• A newsletter on developments in cross-border healthcare.• Collaboration with events to help the development of cross border health care in the EU.• Access to institutions relevant to cross-border health care.• Information for patients about rights under the EU Directive.• Guidance to patients on questions of treatment in cooperation with national and international organisations in healthcare.• Advice on marketing cross-border healthcare services.• Provision of experts for special events, workshops and advice.• Listing of member details and contacts.
Jane Billinghurst Urresti is co-founder and chairman of ECHO. Dr. Uwe Klein from EMTC 2011 is vice-chairman. Other board members include co-founder Martina Todchuk, Keith Pollard from Intuition Communication, Dr. Constantine Constantinides from healthCare cybernetics, Dr. Claudia Mika from TEMOS and Paul Vincke (European Healthcare Fraud & Corruption Network (EHFCN)). ECHO will have three advisory councils; standards and practice, ECHO development, and legal. There will be five working groups on hospitals and clinics, agents, spas, insurance and government bodies. The head office is in Brussels, Belgium, while the two local offices are in La Coruna, Spain and Bielefeld, Germany
ECHO comes from a belief of Europeans in medical tourism that existing international organizations neither understand nor well serve the region at a time of great change. Several previous attempts at creating European medical tourism associations have failed to attract support. The most recent attempt, the Budapest based European Medical Travel Alliance, appears to have made little progress since being founded back in 2009.

Romania is often seen as a place other Europeans travel to for low cost dental and cosmetic surgery. A new study reveals that Romanians also travel overseas for treatment. The reasons that Romanians choose medical treatment abroad are wide and varied: greater confidence in the professionalism of doctors abroad, the benefits of modern technology that may not be available at home, costs equal to or sometimes even less than locally, and the lack of appropriate treatment in Romania.
In the first four months of 2009, 8500 Romanians received medical treatment in clinics in Hungary, Austria, Germany and Israel. The most sought-after medical services are cosmetic surgery, childbirth and stem cell transplants. In 2009 680 Romanians were treated abroad with the treatment costs paid for by the National Insurance scheme. To qualify for this money, they have to prove that the treatment they require is not available in Romania in a timely manner. The targeted replacement medical institution is preferably within the European area. Most requests come from patients suffering from advanced cancers, and hematological and cardiovascular diseases. Romanian doctors are increasingly familiar with the concept of medical tourism and guide their patients to hospitals that specialize in the needed treatment. A recent study shows that, among the Romanians seeking medical treatment abroad, 88% say they should choose this option only if they could not have access to it in Romania, and 83% would go abroad to receive better treatment than at home. 61% of those who choose medical tourism, choose patient care in a foreign hospital, and 57% to receive treatment in a shorter time than at home. Half say they would go abroad to have access to less costly treatment. According to the study, distance from home is the main reason why 66% would not choose medical treatment abroad. 42% say they would not go abroad for care because they are satisfied with treatment options in their country. 39% would not go abroad, because they do not know foreign languages and 67% because they cannot afford it financially. However, there are situations where some therapies and interventions that are prescribed in Romanian treatment schemes, for some reason cannot be achieved within the country.
Spa and wellness products from Romania could soon be included in travel agency TUI Vital’s offerings for both Germany and Scandinavia, says the Ministry for Regional Development and Tourism (MDRT). MDRT representatives and those of the German concern TUI had talks about collaboration between the two parties on the occasion of launching Romania’s tourist brand in the German market in Munich.
Albania’s tourism is a major factor in helping to turn the country into a modern European country. Captains of the tourist industry in Albania have created criteria for all business within this industry to work towards. These criteria are to be known as The Global Sustainable Tourism Criteria (GSTC) and are a set of 37 voluntary standards to help local businesses increase their revenue and success. The Global Sustainable Tourism Criteria and Authentic Albania Quality Mark will be launched in the next few months and will initially target accommodation businesses. Hotels and accommodation will be evaluated based on the Global Sustainable Tourism Criteria and then be awarded a gold, silver, or bronze classification that will be published on travel sites and in brochures and publications for foreign tourists.
Ravin Maharajah, Albanian resort developer, says" This set of criteria offers simple and useful advice to small businesses to help them up their game plan. At Lalzit Bay Resort & Spa we are very keen for all companies within the tourism and related sectors to make a success of their businesses. Our development is situated in 20 hectares of frontline land with 300 meters of private beach. The resort will benefit from a beach club, sports and tennis club and a wellness centre."

In 2010, John Yang was given the task of marketing Shanghai as a preferred destination for foreign patients seeking advanced medical care. The ambitious target imposed by the authorities is that by 2012 China should have 200,000 medical tourists a year with an average expenditure of $10,000 per patient per visit.
John Yang is chief executive of Shanghai Medical Tourism Products & Promotion Platform (SHMTPPP). His target is for China to compete with established competitors such as India, Thailand, Singapore, South Korea, Malaysia, and the Philippines. Many of these countries already have significant revenue from medical tourism. The country will soon take over from the USA as the world’s largest economic power, and has regularly confounded critics by becoming a major force and international investor in many industries. So a Chinese involvement in medical tourism could be a force to be reckoned with.
But China has many problems of lack of health services, poor co-ordination of services for tourists, local and national government intervention, and mind numbingly slow officialdom. John Yang commented in a recent interview, "Foreign patients are interested in coming to China, but they do not know who to get in touch with as there are no readily available numbers or names to contact. The coordination of diverging interests is difficult. How do we bring all parties – hospitals, travel agents, airlines, trade offices, translators, and official bodies together? The answer is the establishment of SHMTPPP as a sole point of contact for foreign patients and as a promotional tool for medical tourism to China, specifically Shanghai.”
SHMTPPP body has set up offices in Los Angeles and Jakarta, hoping to attract people of Chinese descent to Shanghai. The Los Angeles Chinese community alone numbers a million, while in Jakarta it is two million. In total, there are 40 million overseas Chinese globally. As some other countries have started to understand, targeting such a niche market that already has an affinity to the destination country is a huge advantage. Targeting this market also overcomes China’s problem that not enough people in the medical or tourist community speak good enough English to communicate effectively and safely with medical tourists, and very few are fluent in other European or Asian languages. Aiming at this community also overcomes the other barrier to medical tourism, widely differing cultures.
SHMTPPP acts as a third-party administrator/agent, organizing a foreign patient’s medical, travel, dietary, and transport needs, including dealing with the often complex official paperwork. John Yang says, "From the moment the patient touches down at the airport, we transport them to the hospital or hotel, and organize all the paperwork needed by the hospital.” Personal assistants, fluent in English, are on 24-hour standby, as many Chinese Americans are not fluent Chinese speakers. SHMTPPP uses the top 20 hospitals in Shanghai. This includes the 850-bed Shanghai East International Medical Center, which already has partnerships with leading institutions such as the German Heart Institute in Berlin, the University of Maryland Medical Center in the US, and Universit Paris Descartes in France.
The greatest attraction of China is the cost. The total cost of coronary bypass surgery for a foreign patient in a Chinese hospital is 40 % cheaper than in the United States. What may cause problems for competitors is that with high quality medical treatment, China is not the low-cost competitor that many expected. Shanghai hospitals are cheaper than Singapore, but slightly more expensive than India and on a par with Thailand. A combination of cost, quality and comparative culture could make China a serious competitor.
The hardest work for SHMTPPP is to get China accepted as a serious destination, It does not intend to rush the process as it will take time for local hospitals and doctors to treat medical tourists differently from local patients. But once medical tourism takes off in China, Yang predicts that it could grow by as much as 100% or 200 % annually for the first three years. It will be a surprise if SHMTPPP reaches its ambitious target by 2012, but for China it is likely to be a question of when than if.

A potential decline in physician office visits, record spending on health information technology, a total redesign of insurance markets, and the creation of accountable care organizations are among the health industry trends in store for 2011, according to a Health Research Institute at PriceWaterhouseCoopers (PwC) report based on an online survey of 1,000 U.S. adults to assess consumer perspectives on health reform, healthcare usage, and payment for healthcare.
The new health reform law will prompt most organizations to do strategy makeovers as they react to and prepare for new rules and payment models in 2011. Continuing cost pressures and new customer demands require a fresh look at existing roles of industry players. Industry changes wrought by health reform are far from over. In fact, they have only just begun.
Health insurance deductibles for people in employer-sponsored plans rose an average of 77% between 2003 and 2009, while premiums for family coverage increased by 41%, The Commonwealth Fund recently reported. And that trend will continue in 2011, according to the report. In 2010, the most common plan had deductibles ranging from $400 to $999.As deductibles rise; patients will forgo medical care to avoid paying out-of-pocket costs. Couple the rising deductibles with the struggling economy, and patients are even more likely to skip doctors visits. With more employees being squeezed with high-deductible plans and coinsurance, their increased cost sensitivity will push them to make hard decisions on how often to go to the doctor or what prescriptions to fill.
The primary focus of the insurance industry in 2011 will be the medical loss ratio (MLR) — which mandates the proportion of an insurer’s revenue that must be spent on patient care as opposed to administrative expenses — as well as the new health insurance exchanges. The Affordable Care Act (ACA) requires that, starting in 2011, insurers covering large groups must spend at least 85 cents per dollar of revenue on medical care or activities that improve healthcare quality (for small group and individual plans, they must spend 80 cents per dollar). Beginning in the second quarter of 2011, the federal government will provide grants to help establish insurance exchanges, and debate will intensify over what defines a qualified health insurer. According to the report, 13.8 million people are expected to enroll in health insurance exchanges in 2014.
The healthcare reform law will create a new care model, called an accountable care organization (ACO). An ACO will be a group of providers that works together to treat a set number of patients, and splits the payments it receives for the care provided. Government will begin offering providers the option of forming ACOs with the hope that the setup will improve patient care and save money. Consumers need a better way to understand the value of their health insurance coverage. States, employers and health plans need to gain a better view of what their customers value and what drives their decisions.
The US has often been portrayed as the driver of global medical tourism but the report does not even regard medical tourism as worth mentioning. In a country of 132 million, less than half a million travel abroad for medical treatment, compared to the UK figure of 60,000 from a population of only 60 million. The global medical tourism business needs to gain a better view of what US customers value and what drives their decisions, before government, employers, insurers and the public can take it seriously.
Karen Davis of The Commonwealth Fund adds. "The Affordable Care Act is already benefiting Americans. Among those already being helped:* Adults and children with preexisting conditions, who now have access to affordable, comprehensive coverage.* Young adults up to age 26, who can stay on their parents’ health plans.* Small business owners who receive a tax credit to cover a portion of health insurance premiums for employees.”
Karen Davis adds, “Many provisions in the Affordable Care Act will directly lower health insurance premiums such as increased transparency about insurance premium increases and rules on the percent of insurer premiums that go to administrative expenses and profits. By 2014, when key features of the law such as the state health insurance exchanges with subsidies for coverage and Medicaid expansions are in place, all Americans will have access to affordable coverage. The changes should enable us to enter an era of efficiency in health care that will make our health system truly sustainable. Health will provide all Americans with affordable health care and financial security.”

Japan has eased visa requirements for patients seeking care at Japanese hospitals in a bid to promote medical tourism, particularly among wealthy young Asians. Under the new Visa for Medical Stay system, foreign patients can receive renewable, multiple-entry six-month visas, compared with single entry, 90-day visas previously available. Chief Cabinet Secretary Yoshito Sengoku said, "My feeling is that barriers between nations have to be low in the field of medicine." The Japanese government seeks to promote advanced medical treatment and health checks to wealthy individuals and their families, particularly from China and other Asian nations. Previously, Japan’s stringent immigration rules discouraged foreigners from choosing Japanese hospitals for healthcare. The 90-day visa was too short for many patients. It did not allow multiple entries and did not grant any special visit status for family members wanting to accompany patients during their stay in hospital. The new visa is only on a one-year trial basis.
Japanese embassies have begun a campaign to promote the new programme. Hospitals in Japan are high quality but expensive, with some seeking to encourage a flow of wealthy travellers seeking medical treatment, as it improves their strapped cash resources. Last April Nippon Travel Agency Co. started to offer medical tours for wealthy Chinese tourists interested in PET scans. JTB Corporation launched a medical and health services centre in April that offers medical-related support services and medical tourism packages.

Raffles Medical Group (RMG) will open in an area being developed near JR Osaka Station. The Singaporean medical group’s inroads into Japan could help grow the local medical tourism market, as unlike local hospitals, it has medical tourism experience gained in other countries. Hankyu Hanshin Holdings, developers of 24-hectare redevelopment area Umeda North Yard, Osaka Station, invited RMG and hopes to have outline agreement by the end of March. RMG plans to open an outpatient clinic staffed by Japanese doctors fluent in foreign languages. The clinic will target foreign residents, their family members and wealthy medical tourists from China and Russia. The group also plans to offer treatment at RMG’s affiliated hospitals in their home countries or at hospitals in Singapore. The next step for RMG is to establish a general hospital in Japan – but to do this is has to convince the Japanese government to ease regulations so foreign doctors can examine patients in Japan. The group operates clinics and hospitals in Singapore as well as general hospitals in Hong Kong and Shanghai. It has treated more than 1 million patients in Singapore, one-third of whom are mostly the many foreign residents of Singapore, and a small but increasing number of medical tourists to Singapore.

The Development Bank of Japan has estimated potential demand for medical tourism in Japan at 430,000 medical tourists by 2020.

A recent detailed paper in the International Journal for Quality in Health Care by Charles D. Shaw; Basia Kutryba; Jeffrey Braithwaite; Michal Bedlicki; and Andrzej Warunek, raises interesting questions about healthcare accreditation in Europe.
Healthcare accreditation has grown rapidly since the 1980s but critics question the value of accreditation rather than certification or inspection. The paper investigates the development of national accreditation organizations in Europe. The researchers conducted detailed surveys in 24 European countries on national healthcare environment, incentives, government policy, legislation, regulation; programme governance, development and funding.
The survey identified 18 active national accreditation organizations in Europe. Older ones tend to be independent, profession-dominated, self-financing and rather slow growth. Newer ones have broad stakeholder governance, support from government policy and growth sustained by legal or financial incentives. Accreditation is moving towards a semi-regulatory model of external assessment. The principal challenges to sustainable accreditation appear to be market size, consistency of policy support, programme funding and financial incentives for participation.
The growth of healthcare accreditation programmes accelerated globally in the 1980s and in Europe in the 1990s as regional and national strategies to improve the quality of health care. The earliest programmes were based on the North American models of the Joint Commission on Hospital Accreditation and the Canadian Council on Hospital Accreditation (now Accreditation Canada). Many accreditation programmes, for political, economic or technical reasons, have failed to meet initial expectations but others have flourished.
ISO accreditation programmes were not included. Unlike ISO accreditation/certification of compliance assessment bodies, healthcare accreditation is characterized by peer review assessment of health care provider organizations against published standards that have been designed for that specific purpose. Eighteen national organizations were identified as active in Europe, providing accreditation services for secondary care at national or international level. Several accreditation organizations offer free online access to their standards, assessment procedures and indicative results (some including reasons for denial of accreditation), but this is restricted in older programmes.
The European Commission is moving to regulate industrial accreditation of competent compliance assessment bodies with respect to goods and services but not yet healthcare. Healthcare organizations that accredit or certify services may need to negotiate a common position, if only to agree to share an understanding of the use of the term accreditation as applied to the teaching and delivery of health care. However, few healthcare accreditation organizations currently have a working relationship with their corresponding national accreditation service or with the certification bodies that it regulates.
The original purpose of the international accreditation programme of ISQua was to build credibility and comparability for national organizations by harmonising standards and procedures on common international principles. Half of the reporting organizations in Europe claim to incorporate these principles in the design of their standards but only five have been formally assessed and recognized internationally.
Among the research conclusions is that national governments and international organizations need to consider whether a critical mass is needed to run a comprehensive accreditation programme. Scale, organizing structures and funding arrangements are necessary to support an accreditation programme. Sufficient size, health system resources and structural frameworks seem to be preconditions for programmes to succeed. In smaller countries, it is difficult to form peer review teams without any conflict of interest, and fixed operating costs have to be shared between a small number of institutions.
The question the researchers sidestepped, but hinted at, is “In the era of cross-border healthcare, would one accreditation body across the EU be more cost-effective, logical and easier for customers to understand?”

The federal Australian government is looking to cash in on lucrative medical tourism but the Australian Medical Association (AMA) warns that bringing in medical tourists could exacerbate pressure on the health system.
The government is poised to spend $50,000 on a scoping study after a discussion paper concluded that fostering a medical tourism market could prove a boon for the health and tourism sectors. The discussion paper from the Department of Resources, Energy and Tourism said that Australia should target sophisticated, wealthy consumers from developing countries who are seeking to access higher standards of care and procedures that are not available in their home country.
Australia could exploit its proximity to Asia, capacity in private hospitals, safe and clean environment, and niche medical expertise to attract medical tourists. Niches include implant surgical procedures such as hip and knee replacements, hearing and cardiac implants; laser, burns, eye, vascular, sleep disorder treatment; regenerative and stem cell treatments and cancer -says the discussion paper.
Dr Steve Hambleton of the AMA-an organization that has always been strongly opposed to outbound and inbound medical tourism- says, “Now is not the right time. We already know that we have a shortage of practitioners in this country. We have increased our number of medical students. We are having trouble with training those medical students.’ We need to make sure we do not utilise our expert medical capacity in a way that would impact on training or impact on service delivery for our own country.’’
The discussion paper highlights that ’medical tourism is not without risks- it could prejudice Australians’ access to health services, add to the shortage of health professionals, pose threats to public health and mean extra costs when patients suffer complications or are the victims of mistakes.
So when does the AMA think that it will be the right time for medical tourism? ’’In 10 years’ time when all those young doctors who are now graduating are trained, it may be a different scenario altogether’’
The scoping study will assess the current and future demand for Australia as a medical tourism destination, identifying specific markets and specialties; the capacity of the system to deal with this demand; and the broader costs and benefits associated with Australia’s growth as a medical tourism destination.
New research from Australian travel agency Travel.com.au suggests that one in three Australian women would consider going overseas for a medical procedure. The Travel Trends Survey conducted in June 2010 asked 500 Australian travellers ’Would you consider going overseas for a medical procedure?’
Lisa Ferrari of Travel.com.au believes that medical tourism will continue to become an emerging travel trend for Australians over the next few years, particularly as more countries promote themselves as medical tourism destinations, "Thailand, India, Malaysia, Philippines and South Africa are popular destinations of choice for Australian’s seeking a medical procedure. Shorter waitlists, less expensive procedures and the option to spend their recovery time in an exotic location, are amongst the factors contributing towards this trend. These aspects are enticing more and more Australians to weigh up the alternatives and consider heading overseas for medical procedures.”
Responses from different age groups did not vary with the exception of the 65+ age bracket where only 20% said they would consider going overseas for a medical procedure. Women from the Northern Territory are the most prepared to become medical tourists with 80% willing to travel for a medical procedure, Queensland came in second with 37%, followed by New South Wales with 34%, Western Australia with 31% and Victoria with 30%, South Australian with 24%. Lastly, those in ACT are not prepared to travel, with the result being 0%.

The Philippines will introduce special medical visas for foreigners, as the country seeks to grab a bigger share of Asia’s booming health tourism industry. The medical tourist visas, to be introduced later this year by the Bureau of Immigration, will allow foreigners to stay in the country for six months without having to apply for extensions, as regular tourists are required to do.
The government is banking on its English-speaking and internationally trained doctors among its advantages, as well as medical and surgical costs that are up to 50 % cheaper than the United States or Europe. It is optimistic that by offering this visa, it will get more medical tourists from Europe and the United States. The Philippines’ health department launched a programme in 2004 to promote medical tourism by encouraging state hospitals and specialised private institutions to compete with medical organisations elsewhere in Asia. But despite many initiatives, actual numbers have been far lower than set targets. The proposed visa will also help the government earn income from the visa fees and charges.
The Bureau of Immigration is preparing the proposed guidelines for the visa, for approval by the Department of Justice and the President. Under the proposed guidelines, the visa holder may stay in the Philippines for six months without having to secure an alien certificate of registration or identity card. Medical tourist visa holders will also exempted from paying the annual report fee levied on foreign residents. Visa holders will be required to post a bond based on the value of their airline tickets, to help ensure that the foreigners will not violate the conditions of their stay in the Philippines. But local medical tourism businesses are unhappy that making patients post a bond goes against the point of launching the visa; and if a customer has to pay visa fees and arrange a bond, it could drive them to countries with a less bureaucratic approach. The Immigration Act currently allows the extension of tourist or temporary visitor’s visas only to foreigners who come to the Philippines for business or pleasure. Foreigners are initially allowed to stay for either 21 days or two months that may be extended every month up to a maximum of two years.
India has now exempted foreign tourists from the mandatory two-month gap to re-enter the country for regular onward medical treatment. A circular issued by the Ministry of Home Affairs said,” For persons coming for medical treatment, there is a separate category of medical visa. Foreign nationals coming for medical treatment will have to come only on medical visa and not on tourist visa. But this is subject to their submission of a detailed itinerary and supporting documentation (ticket bookings."
Medical tourism in India has grown. The government estimates, although there are no real figures, that in 2002 150,000 foreign patients visited India for treatments, and this could reach 500,000 this year.
India has recently clamped new restrictions on foreign tourists visiting the country on tourist visas to avoid misuse of such visas which entailed tourists had to give a mandatory two-month gap before re-entering India. So foreign nationals holding Indian tourist visas with multiple entry facility have to make a two-month gap mandatory between two visits. India issues tourist visas to foreigners who do not have a residence or occupation in the country, will now allow foreign tourists who after initial entry into India plan to visit another country as part of neighborhood tourism-related travel and allow them to re-enter India before their final exit to have two or three entries.

The European Commission has provided answers to some frequently asked questions on the cross border healthcare directive.

Q A Polish woman would like to receive hip surgery in the country where her grandchildren live and work but how can she organise this from Poland? A Portuguese man seeks cataract surgery from a specialist in Spain but will he be reimbursed? These are just a couple of cases where a patient may need clarity on rights and rules for cross-border healthcare.
AA newly adopted EU law clarifies patients’ rights to access safe and good quality treatment across EU borders, and be reimbursed for it. Patients travelling to another EU country for medical care will enjoy equal treatment with the citizens of the country in which they are treated. It will help patients who need specialised treatment, for example those who are seeking diagnosis or treatment for a rare disease.
QWhat scale are we talking about?
APatients prefer to receive healthcare in their own country. That is why the demand for cross-border healthcare represents only around 1% of public spending on healthcare, which is currently around €10 billion. This estimate includes cross-border healthcare that patients had not planned in advance (such as emergency care). This means less than 1% of the expenditure and movement of patients is for planned cross-border healthcare, like hip and knee operations or cataract surgery.

Q What about the existing legislation in this area?
A• Citizens needing care (including emergency care) when temporarily abroad will continue to benefit from the existing regulations and be provided with the care they need.• For planned care, a patient can already apply for prior authorisation. This cannot be refused if he/she cannot be treated within a time limit that is medically justifiable.

QWhy do we need this new legislation then?
A• This Directive will not affect the benefits already offered to citizens through existing regulations. Although the existing rules have been in place since 1971, clarification was needed on the rights of EU citizens to receive healthcare in another member state.• In the case of hospital care, one of the main achievements of this new Directive is that patients will be able to choose their healthcare provider.• For non-hospital care, patients will be able to seek healthcare abroad without prior authorisation or formalities, and claim reimbursement upon their return home. This directive covers not only public, but also private providers.• For both hospital and non-hospital care, patients will have access to information on the quality and safety of the care they will receive.• This directive also seeks to address other practical questions: where can I find information on quality standards applied by the hospital? How much will I be reimbursed?

QDo I need authorisation from my national authority before going abroad for treatment?
ANational authorities can introduce a system of prior authorisation in three cases:1) For healthcare that involves overnight hospital stay of at least one night.2) For highly specialised and cost-intensive healthcare.3) In serious and specific cases relating to the quality or safety the care provided abroad.In these three cases, patients may need to ask for permission in advance from their national health authority in charge of reimbursement.

QCan this authorisation be refused?
ANational health authorities can refuse authorisation if the treatment in question, or the healthcare provider in question, could present a risk for the patient. Also, if appropriate healthcare can be provided at home in good time, authorisation can be refused but member states will need to explain why such a decision is necessary.

QWhat if I am refused authorisation?
APatients have the right to request a review of any administrative decision on cross-border healthcare for their individual case.

QHow much will I be reimbursed after receiving a treatment abroad?
APatients will be reimbursed the same amount as they would receive in their own country for the same type of healthcare. Member states where care is free of charge will need to inform patients about their reimbursement tariffs.

QCan I seek healthcare abroad if the treatment is not available in my country?
AYes, if a treatment is unavailable in a member state, the national health authorities cannot refuse authorisation to a patient seeking it in another EU country. However, patients will be reimbursed for such treatment provided it corresponds to the national health benefits package.

QDo I need to pay for cross-border treatment upfront?
AYes, generally the patient pays upfront and would then be reimbursed by their national authority as quickly as possible. The law also foresees that member states can choose to confirm the amount of reimbursement in writing upfront, on the basis of an estimate presented by the patient.

QWhere can I find more information about my rights to healthcare abroad?
AThis new law foresees the establishment of a contact point in each member state to provide information on patients’ rights to healthcare across Europe. These centres will exchange information between them and will be able to provide practical information to patients on conditions and levels of reimbursement, possible treatments, providers, procedures for redress, etc. Patients will consequently have a clearer idea on the quality and safety of healthcare provided abroad, which will lead to more informed decisions on cross-border healthcare.

QCan I transfer my medical data to the member state where I will be treated?
AThe country of origin will ensure that the healthcare provider in the country of treatment can have access to the patient’s written or electronic medical records. Enhanced cooperation on eHealth between member states will ensure that health IT systems will be able to talk to each other.

QWhat should I do if something goes wrong whilst receiving treatment abroad?
AThe new law sets out both the country of treatment and the country of reimbursement’s responsibilities with regard to complaints and redress. National contact points will provide patients with the information they need in this respect.

QHow can I be sure that the treatment I received abroad will be followed up properly on my return home?
ASeveral measures are foreseen to ensure continuity of care. The country of treatment will ensure that patients have access to their written or electronic medical records related to the treatment they received. The home country will ensure the medical follow-up is of the same quality regardless of where in the EU the treatment took place.

QWhat remains to be done?
A• At national level, member states will establish at least one national contact point that provides all relevant information to patients. • They need to ensure that administrative procedures on the use of cross-border healthcare and on reimbursement of costs are in place, including complaint procedures as well as mechanisms to calculate costs.• The Commission will set up networks to foster EU cooperation on health technology assessment and eHealth. It will also help facilitate the recognition of cross-border prescriptions.
QWhen will this law come into effect?
ANational governments have 30 months to integrate these measures into national legislation.

Last week, MEPs approved the EU Directive setting out patients’ rights to seek medical care in another EU country. The legislation clarifies the rules for reimbursement, including when advance authorisation may be required.
French MEP Françoise Grossetête, who led discussions in Parliament, commented: "Patients will no longer be left to their own devices when they seek cross border healthcare and reimbursement. This directive will at last clear up patients’ rights because until now they have been very vague."

John Dalli, European Commissioner for Health and Consumer Policy said, “This vote marks an important step forward for all patients in Europe. The Directive will benefit patients across Europe by clarifying their rights to access safe and good quality treatment across EU borders, and be reimbursed for it. Generally speaking, people prefer to receive their healthcare closer to home. No one wants to travel further than necessary when they are sick. However, sometimes the need for certain treatment leads patients to go abroad. Another reason could simply be that the nearest hospital lies across a border. In addition to providing a clear and coherent set of rules on cross-border healthcare, this Directive will benefit patients in several other ways. It will help patients who need specialised treatment, for example those who are seeking a diagnosis or treatment for a rare disease. It will bring about closer and improved health cooperation, including the recognition of prescriptions, between member states. Health experts across Europe will be able to exchange best practices and mutually benefit from innovations in health technology assessment and eHealth. I look forward to a swift implementation of this directive by the member states".
While most political groups in the European Parliament hailed the new legislation, left-wing MEPs denounced the implicit discrimination for poorer people who cannot afford to pay for procedures upfront and then wait to get reimbursed later back home. Dutch Socialist Party MEP Kartika Liotard said, "Care is not a commercial, tradable good; it is a basic need for everyone. The new EU directive will mean that insurers drive patients abroad in search of cheaper treatment. But patients – especially if they are seriously ill – just need care in their region, close to their family and a doctor who speaks their language. Health tourism will be a logical consequence of this law, with patients from rich countries able to travel to less expensive countries, where they may be given priority over the local, poorer patients.’
In the UK, reaction was mixed. London Liberal Democrat MEP Sarah Ludford said: “The new rules represent a real milestone for cross-border healthcare in Europe. They provide a coherent framework for UK patients seeking treatment in another EU country. The right balance has been found between protecting national health systems and strengthening patients’ rights. The new rules guard against health tourism, with foreign patients coming to the UK having to pay the full NHS cost of treatment.” But UKIP MEP Gerard Batten disagrees, “The financial burden of offering cross-border healthcare in the UK to all EU citizens falls on the British taxpayer.” John Lister of the campaign group Health Emergency, said: "Overseas patients could become the sought-after patients for NHS trusts, exactly like foreign students are for universities. It could have very detrimental effects in British hospitals that are already working to capacity.” But a spokesman for the NHS Confederation, which represents health trusts, said the rules contained a clause which made it an obligation for health services to prioritise their own citizens if necessary, “ This is particularly relevant for NHS organisations providing highly specialised services, for which a possible surge of incoming patients could lead to negative implications in terms of increased waiting times for NHS patients. The number of British patients seeking NHS funded treatment elsewhere in Europe in 2010 was just over 1000".
Medical tourism guru Constantine Constantinides says, “But if one reads carefully, it really changes things very little – prior approval is still in place; What constitutes in-patient and out-patient care is still very much a grey area – they talk about duration of care – less than a day – and more than a day – when a lot of surgery is now day surgery; what expenses will be reimbursed – and how and when; countries / hospitals are not obliged to accept all comers (besides, many of them have waiting lists of their own); The role of the private sector has not been clarified; only in 2013 will EU Member Countries start being pressured to comply; what about EU Member Countries like Cyprus which do have a national health system; and there also other essential sticking points that they conveniently avoid referring to.”
UK Liberal Democrat Liz Lynne comments, "I think we have found the right balance between protecting national health systems and strengthening patients’ rights. Crucially, patients will receive important information of the quality and standard of care, as well as the kind of treatment they are likely to receive in another EU member state. The new rules are not designed to encourage health tourism. Patients are only entitled to reimbursement for treatment that their home health authority would normally provide – travel or hotel costs cannot be claimed back. And patients from other member states travelling to the UK specifically for healthcare will have to pay the full NHS cost of treatment. NHS doctors will have to give prior authorisation for treatments abroad that can be reimbursed. But there will be clearer rules and guidelines for doctors, and decisions must be taken on a case-by-case basis. Crucially, patients will receive important information of the quality and standard of care, as well as the kind of treatment they are likely to receive in another EU member state."
Parliament’s president Jerzy Buzek says, "Patients will no longer be alone in the bureaucratic jungle of so many different health insurance schemes when they decide to get treatment in another EU member state. After long and hard negotiations with member states, parliament finally achieved what we were looking for: a solid legal basis for dealing with cross-border healthcare in the EU that was hitherto in a legal grey zone. We unified the different standards set by the European Court of Justice and we created thus a clear and objective system of references."
S&D deputy leader Dagmar Roth-Behrendt said parliament had achieved a balance between the right of EU patients to seek the best treatment and the protection of the "financial sustainability of national social security systems.” We have made sure that there will be legal certainty on reimbursement rules and on prior authorisation that have finally been introduced for hospital and specialised care. The directive guarantees reimbursement of healthcare costs for treatment in another member state at the same level as in the state of affiliation." UK Socialist Linda McAvan cautioned, "We shouldn’t get carried away. These rules will make little difference to most people who will want to be treated by staff in their local hospital. We have worked hard to put these new rights into place in a way that will give patients choice. However, we cannot allow a situation to develop in which people with personal wealth are able to access publicly funded treatment abroad, while those without large savings cannot."
The text approved by MEPs is the result of an agreement reached with the European Council, which must also give its formal approval. Once signed into law, member states have 30 months to make changes to their national legislation.

An historic vote in the European Parliament on 19 January paves the way for residents to seek health care anywhere in the European Union, expanding rights that will particularly help patients with rare diseases seeking advanced treatments, people living along borders where the nearest hospital is across the line, or those who work in one country but want to get treatment near family members in another country. The directive passed a second reading in the European Parliament in Strasbourg, so the new rules will apply across the EU in about two years’ time.
When a hospital stay is required, the directive says health services can request prior authorisation from doctors in the patient’s home country. The prior authorisation clause is intended as a safeguard against any unexpected surge in foreign patients. According to a parliament report, "the aim is absolutely not to encourage cross-border healthcare as such, but to ensure its availability, safety and quality".
Health systems are primarily the responsibility of EU member states, but in some cases, as confirmed by several European Court of Justice (ECJ) rulings since 1998, EU citizens may seek health care in other member states, with the cost covered by their own health systems. This can occur in instances where healthcare is better provided in another member state, for example, for rare conditions or specialised treatment. It may also be the case in border regions, where the nearest appropriate hospital may be in another European country.
Health services were excluded from the general Services Directive in spring 2006, despite many ECJ rulings that they are an economic activity and that Community law applies to them. To provide clarity and legal certainty on the issue as well as support for co-operation between national health systems, the European Commission decided to establish a EU framework to ensure cross-border access to healthcare services.
According to the EU executive, the current scale of cross-border mobility amounts to 1% (€10 billion) of overall EU-27 states public health spending (€1,000 billion). And the Commission estimates the cost increase under the new rules will be just €30 million a year.
The European Parliament adopted the cross-border directive in April 2009, but it had been stalled ever since at the European Council, where health ministers have struggled to pass the deal, and where MEPs, health ministers and individual governments all had their own –often highly contrasting views on the eventual shape of the legislation. The Cross-border Health Care Directive is now expected to come into effect in 2013. Exactly when it will come into operation in each country is uncertain, as several countries opposed to the principle and agreed detail are notorious for not implementing EU laws until several years after deadlines (e.g. an EU directive on timeshare holidays has a deadline of February 2011, but Spain will not pass its law until at least late 2012). But while the directive mandates a kind of EU universal health coverage, it is not universally supported. Portugal, Austria, Poland and Romania rejected it in the European Council, and Slovakia abstained.
UK Conservative MEP Marina Yannakoudakis says, ’’Cross-border health care can be a very useful tool in patient care, giving choice to the patient and taking pressure off national health systems in areas where a backlog exists.” To discourage health tourism, patients will only be reimbursed at home-country rates; so if a treatment costs more in another country the patient will have to pay the difference. There are other safeguards; in cases where the treatment is very expensive or the patient must stay in a hospital, the patient must get prior authorisation from their own national health system. The directive also includes an exemption for long-term care and organ transplantations. Although the United Kingdom supports the proposal, Nigel Farage, leader of the UK Independence Party, says, ’The rules will turn the UK’s NHS into a bureaucratic nightmare. Extra staff will be needed to chase up getting the money we are owed from countries such as Romania.”
The European Consumers’ Organisation (BEUC) is unhappy that bureaucracy (either ingrained or deliberate) will make the theory unworkable in some countries, with delays and form filling stopping patients accessing their rights. Ophelie Spanneut of BEUC says, “We are bewildered by the time limit. The vague time frame may lead to inequalities between counties and ultimately force health ministries to define what is reasonable before the European Court of Justice. We suggested a simple time limit of a response to a patient request within 15 days, but the final version allows individual countries to "set out reasonable time limits" to reply.” Under the directive, a request can only be refused if the treatment could quickly be obtained in the patient’s current country, or if there are doubts about the qualifications of the physician. Each country must establish at least one national contact point for patients to get information about health providers, reimbursement procedures, and when prior authorisation is needed. Patients can choose between public or private doctors. The Standing Committee of European Doctors was disappointed by the lack of information available to patients before treatment and that vulnerable or disabled patients will not receive special consideration. But the group is pleased to see a call for increased international compatibility on health technologies to share patient information, plus more references to data protection.
German MEP Dr. Peter Liese welcomes the agreement, saying it would improve access to treatment for patients and cut hospital waiting lists, but concedes that parliament has been unsuccessful in securing some of its demands during the protracted negotiations with the other EU institutions. These included a clear definition of "undue delay" and the possible grounds under which a member state can refuse a patient’s request for treatment abroad. I accept that it is a compromise but it is better to have a compromise than nothing at all. The directive is unlikely to lead to a dramatic increase in cross-border healthcare but will appeal to patients who have spent considerable time on a waiting list or live near the border of another country. I live in Germany, near the border with eastern France so it will be easy for me to go for treatment in Strasbourg. At present, the waiting list for hip replacement in the UK is over 12 months, so a British person waiting for a hip replacement will be able to go for an operation in France and be reimbursed for the bulk of the cost by the NHS in Britain. The directive is long overdue and will profit all patients. It will definitely give patients more rights and is to be welcomed. Patients’ rights will be more transparent and easy-accessed across Europe. Waiting lists in countries like the UK and Germany will fall as more patients go to another member state for treatment. I am confident the directive will have a positive impact on healthcare systems in member states with shorter waiting lists and improved quality of medical treatment. As the member state of residence in question has to reimburse the costs that would be incurred for the same treatment in their own country, I expect the responsible authorities will strive to keep the earnings and patients in their own country."
There are many amendments from what the European Council agreed. Ones that stand out are- * Costs incurred by the individual over and above the level reimbursed by the Member State of affiliation shall be borne solely by the person, unless the Member State of affiliation decides also to reimburse the person for the costs incurred in excess of that level.* Each country must list and advise the European Commission of healthcare that may be subject to prior authorization.* A Member State may provide for a system of prior authorisation if the absence of prior authorisation could seriously undermine or be likely to undermine either the financial balance of the Member State’s social security system; and/or the planning and rationalisation carried out in the hospital sector to avoid hospital overcapacity, imbalance in the supply of hospital care and logistical and financial wastage, the maintenance of a balanced medical and hospital service open to all, or the maintenance of treatment capacity or medical competence on the territory of the concerned Member State.* Prior authorisation application systems must be made available at a local/regional level and must be accessible and transparent to patients. The rules for application and refusal of prior authorisation must be public and available in advance of an application so that the application can be made in a fair and transparent way.
For full details of the Second Reading and how it differs from the previous European Council position see here.

Greg Bledsoe, founder of Freelance MD, an active community of physicians around the world who are early adopters, thought leaders, entrepreneurs, and influencers, asks what will make medical tourism a success? His perspective is from the USA.
According to Dr Bledsoe, “5 things will probably need to happen before medical traveling gains enough traction to be a real player in healthcare. In spite of research reports, white papers, industry analyses and industry marketing hype, professional medical travel/medical tourism is still an early stage industry looking for the correct formula for fulfillment.”
He continues, ’’For my part, five things will have to happen before professional medical tourism and global healthcare referrals come on traction:1) the advance of a sustainable business design2) global healthcare IT connectivity and integration3) doctor generated global healthcare referral network4) an international regulatory, legal and socioeconomic ecosystem5) patient awareness and acceptance.”
The Business model“Industry players including payers, providers, partners and facilitators continue to be searching for the most successful solution to make money and scale the work. With an eye towards what went down when Expedia disrupted the travel agency business, participants recognize that margins for traveling arrangement services are thin and therefore there exists high price elasticity for global health-related care. Few have realized the special moment key that suits the lock that opens the doors to profits. Payers and employers are hesitant to accept the significance proposition without a better method to reduce their risk and demonstrate tangible, meaningful personal savings to their insureds and employees.

Global healthcare IT connectivity and integration “The US national healthcare information architecture is evolving. Eventually, the network might be a portal around the globe and definitely will permit seamless, secure, confidential transfer of non-public health information thus assuring some continuity of care and quality improvement. Similarly, it will require some time for health information systems to evolve in host countries that may communicate with non-host systems. Temporary solutions, like personal health records or mobile health applications, might fill the void temporarily.”

Doctor generated global healthcare referral network“Most healthcare tourism models connect patients to healthcare facilities, bypassing doctors in the early stages. Doctors can get amongst people when the model feels better, and they’ve got the time and capability to make referrals to consultants directly. Given the rise of international members, professional health-related societies really should be more proactive in building global referral networks, as an alternative to seeing them as threats to existing domestic members.”

A global regulatory, legal and socioeconomic ecosystem“The barriers to adoption and penetration of health-related travel are numerous and include liability, reimbursement, quality assurance and impediments to continuity of care. As healthcare goes global, policies and regulations facilitate or obstruct its use. Why not consider a new world trade organization treaty on professional medical travelling?”

Patient awareness and acceptance“According to recent polls, 50% of consumers understand the term “medical tourism”. Online social network buzz and media stories discover the clinical traveling story sexy, particularly given all of the noise about escalating healthcare costs and consumers, employers and payers are hungry to read more. Moving patients from awareness to intention to decision to action, however, is going to take additional time and use innovative marketing approaches directed towards market segments.”

Several recent research projects have suggested not only that the “millions of outbound US medical tourists“ claim is an exaggeration, but also that there are probably at least as many inbound medical tourists, if not more. These figures are a hotly disputed topic within the industry, but what is undeniable is that there is much activity from US hospitals seeking inbound and domestic medical tourists. More importantly, many are succeeding in attracting business. Medical tourists going to the USA do so, not for cost saving, but because they want specialist care that may not be available at home. There is a huge variation in US hospital prices, over 100% between two similar hospitals for the same operation is not unusual, and between package and list prices. US hospitals are often forced to give insurance companies massive discounts on domestic business, so want medical tourists who will pay at or just under the full list price. More US hospitals are looking to bring in patients who pay the bills themselves.
Some US hospitals have a reputation for treating certain ailments, especially rare ones such as infant heart defects. Michigan hospitals, including Henry Ford Hospital, Detroit Medical Center, and Beaumont Hospitals draw patients from India, Brazil and Turkey who need procedures that are not widely available at home or who have rare conditions that cannot be treated there. Patients go to Michigan from all over the world to receive robotic procedures and high-beam radiation treatments for cancer, as well as spinal cord rehabilitation and treatments for epilepsy and blinding eye conditions in babies.
Individual hospitals are seeking affluent medical tourists from other countries, as they cannot compete on price. The University of Chicago Medical Center and Rush University Medical Center in Chicago both get overseas patients willing to pay $120,000 for heart surgery and $40,000 for a prostate operation. Canadian patients tired of waiting for procedures in their country’s national health system go to Michigan hospitals. Affluent Russians generally go to Los Angeles, New York or Miami. Baptist Health of Florida claims to have treated more than 10,000 international patients, mainly from the Caribbean and Latin America, over many years. Baptist and Detroit Medical Center and Texas Children’s Hospital in Houston all have international patient centres to offer packaged services foreign patients. 71% of Texas Children’s international patients come from Latin America, with most of the rest from the Middle East.
HCA-owned Wesley Medical Center, a 524-bed Wichita, Kansas, hospital, has agreed to buy physician-owned, 82-bed Galichia Heart Hospital in Wichita. The reason is that healthcare reform law includes restrictions on the growth of existing physician-owned hospitals. Galichia started to market itself as a domestic and inbound medical tourism destination in 2009, and is expected to generate $1 million for the hospital in 2011.

Las Vegas Bariatrics weight-reduction surgery clinic is seeking patients from across or outside the country. Also in Las Vegas, Cleveland Clinic sees medical tourism as a top local priority. Medical tourism has a long history in Las Vegas, but as even top hospitals have only a handful of medical tourists a day, it is unlikely to be the answer to the city’s dramatic fall in numbers of tourists.
Those investigating the potential for Las Vegas agree that for medical tourism to succeed:• Prices must appeal to a patient paying part or all of the bill. If an insurance company is involved, prices must be low enough to justify sending someone out of the provider network.• People will travel to a particular hospital only if it has developed a specialty generally regarded as superior to anything else within a radius of perhaps hundreds of miles.• People will travel to a hospital that has a wide range of specialties on site.• The image of the location itself matters. Las Vegas does not come to mind as a destination for the ill, but one for gambling and entertainment.
The availability of inexpensive international and domestic flights has made travel more accessible and affordable to everyone. Patients from around the state of Georgia and across the country are traveling for cosmetic surgery to Atlanta, where breast augmentation procedures are state-of-the-art and highly personalized operations. The Swan Center for Plastic Surgery has a new partnership with the nearby St. Regis Hotel Atlanta, offering discounted rates to patients.

Despite opposition, plans to let Europeans seek medical treatment in other countries in the 27-countries of the EU moved forward in late December when EU countries gave their stamp of approval at ambassador level. This paves the way for a vote in Parliament on 19 January and increases the chances that the cross-border healthcare directive could be in force as early as 2013.
Françoise Grossetête (European People’s Party) and rapporteur on the draft bill comments,” Negotiations have been tricky, since many member states were reluctant for a proposal for a directive. Patients will benefit from clearer rules when they decide to go to another EU member state to receive healthcare treatment.”
The new rules will especially help retirees living abroad, people with rare diseases and those living near borders to get the best health care. Currently, only about 1%, or €10 billion, of public health budgets are spent on cross-border health care yearly, although that figure could rise with standardised rules for authorisation and reimbursement.
The Parliament, Council and Commission agreed to some significant compromises in December including• Prior authorization will be restricted to what is necessary and proportionate, and may not constitute a means of arbitrary discrimination or an unjustified obstacle to the free movement of patients.• National contact points must be established in an efficient and transparent way and able to consult with patient organisations, health care insurers and health care providers.• If cross-border treatment exposes the patient or the general public to a risk that overrides the interest of the patient, the member state can refuse a request for prior authorization.• Patients with rare diseases are those with a prevalence of under 5 per 10,000, that it is serious, chronic and often life threatening.
In all there were an additional 106 amendments, but final negotiations still have to deal with some key problem areas on e-health objectives and health technology assessments.
Health systems are primarily the responsibility of the member states, but in some cases, as confirmed by several European Court of Justice (ECJ) rulings since 1998, EU citizens may seek health care in other member states, with the cost covered by their own health systems. This can occur in instances where health care is better provided in another member state, for example, for rare conditions or specialised treatment. It may also be the case in border regions, where the nearest appropriate facility may be situated in another country. Health services were excluded from the general Services Directive in 2006 despite the many ECJ rulings showing that they are to be considered as an economic activity and that Community law applies to them.
To provide clarity and legal certainty on the issue as well as support for co-operation between national health systems, the European Commission decided to establish an EU framework to ensure cross-border access to healthcare services. The European Parliament adopted the cross-border directive in April 2009, but it has been stalled ever since at the European Council, where health ministers have delayed on the deal and unsuccessfully tried to frustrate and obstruct the will of the Council and MEPs with private agreements that would have made the directive unworkable.
The latest agreement on the long-contested patients’ rights directive is an important step for EU health policy, although the draft is still narrower in scope than that originally envisioned by the European Commission. Crucially, the law will require patients to get advance permission from national authorities before going abroad if their treatment involves a hospital stay of more than one night, hi-tech equipment, is risky, or raises quality or safety concerns. National authorities can also refuse patients permission to go abroad if the treatment would expose the patient or others to risks (e.g. infectious diseases), or if the standard of healthcare in the other country raises safety concerns. Governments may also turn down requests to go abroad if they can justify the waiting time on medical grounds.
As the agreement was made just before the Christmas recess, the full paperwork has been delayed so full details of the agreements are not available. The European Parliament lost a bid to require national governments to reimburse patients their travel expenses and hotel costs. Instead, the draft simply states that governments may decide to do this. Member states also weakened provisions on European co-operation on e-health and safety standards, although they did not succeed in removing them altogether from the draft.
The draft still has to pass two formal hurdles – a vote in the European Parliament, expected in January, and approval by EU ministers, expected in February or March. This will pave the way for the law to come into force in 2011, although governments will have 30 months to write it into domestic law. 2013 is still optimistic as even if the Directive is in place it will have to be implemented in the member states, some of who are infamous for enacting EU legislation years after the deadline. Bearing in mind that at every stage and in every discussion so far, a host of amendments have been made, there is still plenty of scope for MEPs and ministers to make changes or even go back on what are assumed to be agreed deals, in a climate where several EU economies (Spain, Greece, Portugal, Ireland) are still on the brink of disaster.
Next Step* 19 Jan 2011: European Parliamentary vote.

Fortis Healthcare has global ambitions. In October they agreed to buy the healthcare assets of Hong Kong-based Quality HealthCare Asia and had previously tried to buy Singapore hospital operator Parkway but lost out to Malaysian state investor Khazanah after a bidding war.
Quality HealthCare is a physician led provider group offering an integrated range of healthcare services with a network of more than 580 Western and Chinese medical centres and clinics, and 47 dental and physiotherapy centres in Hong Kong, for residents and medical tourists. The group is likely to be renamed with Fortis added to the title.
In December, it bought a 30% stake in Dental Corp, Australia and New Zealand’s largest operator of dental practices with 135 practices located across Australia and New Zealand. Fortis’ latest acquisition, marks an important step in achieving the Singh family’s vision of creating a premier global healthcare group outside India.Malvinder Mohan Singh of Fortis Global Healthcare said, ’Their model of business partnership with principal dentists is a significant point of differentiation driving the success of the business and its rapid growth, while being the most effective way to manage high performing professionals. We believe there are tremendous opportunities for Dental Corporation’s expansion, both in Australia and beyond."
Fortis Healthcare in India has launched national stand-alone speciality medical centres, to concentrate on the cure of metabolic diseases, diabetes and hormonal disorders. Fortis now has 48 hospitals in India, with ten more in the pipeline, still plans to buy more, and is expanding into IVF treatment and medical spas.
Fortis has tied-up with RAK Hospital in Dubai and Regency Medical Centre (RMC), Dar-Es-Salaam, Tanzania through one of its subsidiary, Fortis Escorts Heart Institute (FEHI). FEHI will set up a pediatric interventional cardiac unit at RAK Hospital in Dubai. The emirates located hospital; RAK is set to extend its portfolio of cardiac care services by adding an array of cardiac surgeries. Ashish Bhatia of Fortis Healthcare said, “This association is in line with our vision to become a global healthcare service provider. As we move ahead, our focus is to set new standards in medical excellence and compassionate patient care, not just in India but also beyond. We look forward to serving the patients of Emirates & Africa. “RAK Hospital will establish Ras Al Khaimah as a destination of choice for medical value travel. “
Indian companies are hungry for overseas assets and have many overseas mergers and acquisitions in the past few months across Europe, America and Asia. Last year, cross border deals in and out of India were five times the total value of 2009.India is the world’s fastest growing large economy after China. Indian companies want access to European domestic and business consumers.
Fortis has been recognized as the ’Best Healthcare Service Provider Company’ at the Frost & Sullivan 2010 India Excellence Awards. These awards seek to recognize companies that have pushed the boundaries of excellence, rising above the competition and demonstrating outstanding performance across South Asia.
The high level of deals on healthcare from Indian, Thai and Malaysian companies is partly fueled by the view that within a few years, across Asia, healthcare and medical tourism will mainly be controlled by large groups with the muscle to spend on investment in services and marketing. Another deal driver is that South-east Asian countries have agreed to form a free-trade zone by 2015. It will be hard for small players to survive after then. The bitter battle between Malaysia’s Khazanah and India’s Fortis Healthcare for Parkway, Asia’s biggest listed hospital operator, last year, shows the increased competition in healthcare.

The government of China is to encourage the development of the private healthcare sector in the country. This paves the way for foreign firms to gain greater access to the Chinese private healthcare market. The State Council – China’s cabinet office –is backing investment from the private sector. The new policy will provide overseas healthcare companies with more flexibility in establishing a new business within the private health sector.
The move is designed to encourage investment from overseas business to meet the increasing demand for private healthcare services in the country stemming from its rapidly expanded economy. Economic expansion has brought increased affluence among the population of China, which in turn has lead to a growth in demand for private healthcare.
Current Chinese regulations only allow foreign firms to enter the private healthcare sector in China through a joint venture with a Chinese partner, together with a cap on the level of capital that may be held in a Chinese operation. There will be a gradual easing on the level of investment permitted by a foreign firm in the private healthcare sector. The new policy also allows the conversion of some government run hospitals into private medical facilities.
Joint-ventures will still be able to get official approval from provincial authorities, while the new arrangements for foreign firms wishing to set up a completely foreign-owned private healthcare facility will need to receive approval by the Ministry of Health and the Ministry of Commerce. This is to encourage foreign healthcare providers to establish larger-scale hospitals throughout China. The majority of partially foreign healthcare providers already present in China offer small to medium sized medical centers providing a range of procedures and healthcare services. These are predominately in the largest cities such as Shanghai and Beijing, taking advantage of demand from expatriates and the more affluent local population seeking private medical care.
Although it may take several years to happen, the opening up of China’s private-sector health system could allow the country to become a key destination for medical tourism, rather than as a source of business for Taiwan, Hong Kong and some Asian countries. China has very low labour rates and overheads that could lead to keen pricing to draw in larger numbers. Already, both private and government hospitals in China are quietly offering treatment to patients from overseas, although development of the medical tourism sector is in its early stages.
Initially wholly foreign-owned enterprises will encourage investment in central and western China and foreign investment will be permitted on a pilot basis with priority for investment from Hong Kong, Taiwan and Macau. As central government approval takes longer and may be subject to more stringed review, investors may be inclined to adopt a joint venture structure, particularly as the cap on foreign investment is lifted. Privately invested medical institutions will be eligible for the same land use policies as state-owned medical institutions and will enjoy the same prices as state-owned medical institutions with respect to utilities (including electricity, water, gas and heat). Positive support will also be provided to privately invested medical institutions with respect to construction, equipment purchase and personnel training.
Central government in 2009 instituted policies to extend health insurance to 90% or more of the populace by 2011. It is as yet unclear whether current restrictions on foreign investment in this sector, based on it being regarded as part of life insurance, will be relaxed to enable foreign-invested health insurance companies to play a larger role.

MediTour Expo announces its 2011 World Medical Tourism Conference: “Pioneering The Future in Global Healthcare.” The event will be held May 23-24, 2011, at the South Point Hotel Casino and Spa in Las Vegas, Nevada.
This two-day conference will feature specialized topics on the globalization of healthcare. Leading industry and legal professionals from the medical and wellness travel industries will come together to present and discuss international medical travel, tourism, investment opportunities, marketing strategies, insurance and legal issues in this rapidly growing industry. The conference will include presentations by some of healthcare tourism’s most influential leaders. Expecting to draw delegates from all around the world, this event is a must for people looking to increase their contacts in the international healthcare industry.
In addition to presentations, the conference will offer exhibit halls, discussion panels, and workshops. There will be numerous networking opportunities throughout the event. The conference will also feature the launch of a new non-profit organization, IntHealthCert – an international healthcare quality organization developed to ensure the highest standard of care for the medical traveler.
According to Ian Jacobs, CEO of MediTour Expo, “This conference will address both the risks and benefits of international medical travel. In particular, issues and concerns surrounding healthcare quality control will be examined, with a special focus on opportunities in Mexico.”
Below are some of the event’s highlights:
• New strategies for marketing medical tourism
• Business opportunities for travel and tour operators
• Integrating spa and wellness tourism with medical travel
• International MediTour Zones (IMTZs) – Healthcare facility development and investment opportunities
• Workshops in medical travel, insurance and international legal issues
• Private meeting rooms for business meetings
• Networking lunches and cocktail parties
For more information about the event, you can visit www.meditourexpo.net. For sponsorship and exhibitor opportunities, please e-mail: Joanne@meditourexpo.net.

The Middle East is one of the largest potential source markets of patients due to the high costs of healthcare and limited facilities in some states. Some trade estimates suggest that one in five global medical tourists and a significant percentage of health and wellness travellers are from Gulf and Arab states. Patients from UAE alone account for $2bn in healthcare travel on an annual basis. As a result, many countries are targeting the region.
Germany has long been a popular destination for those from the Middle East. Brenner’s Park-Hotel & Spa, in the Black Forest in Baden-Baden, offers a natural medical spa experience as part of the Oetker Hotel Collection – a European luxury hotel group. Brenner’s Park is a luxurious hotel and medical spa where specialist doctors offer advanced diagnostic techniques in aesthetic dentistry, dermatology, naturopathic detoxification and elimination therapy, in addition to nutrition coaching, weight-loss programmes and beauty packages. Samir Daqqaq of Oetker Hotel Collection explains,"The Middle East is one of the most important markets for us. Over the past few years, there has been a rapid increase in the number of GCC tourists to Germany.” Hans-Peter Veit, at Brenner’s Park-Hotel & Spa, adds, "We are happy to invite Middle East tourists to enjoy the world-renowned natural and holistic medical care on offer at Brenner’s – a hotel with an international reputation for over 135 years that has been a medical spa for over 25 years. We guarantee a unique experience for our guests – healthcare for the body, mind and soul and a medical spa like no other. With 20 treatment rooms and customized spa programs, our guests enjoy a comprehensive therapeutic care in comfort."
Statistics by the German Federal Statistics Office show that the number of overnight stays by GCC nationals in Germany during the first five months of 2010 was 243,759 nights – an increase of 16.4% compared to the same period in 2009. When compared to the same period in 2008, the number of GCC visitors to Germany rose by 30.3% – among the highest from any region in the world, making Germany the preferred destination for travellers and medical tourists from Gulf states.
Health and wellness holidays are one of the main marketing themes for Germany in 2011. The campaign features three key themes: spas/health resorts, wellness/beauty hotels and medical tourism, showcasing the modern and cutting-edge medical facilities, luxury hotels, spas and spa-towns. More than 400,000 tourists already visit Germany for health-oriented vacations, as do 70,000 medical tourists, and these numbers are growing. The German National Tourist Office markets “Wellness &Beauty” with a cross-media concept that centres on hotels and is supported by the independent hotel sector and wellness tourism brands.

According to a recent study of the comparative cost of dental treatment in nine countries, the most expensive country for dental care is England. Cost saving is the primary driver of outbound UK dental tourism.
This study determined that in nine countries the total cost of a standard filling ranged from €8 in Hungary to €156 in England. This total included the cost of the dentist’s time, overhead, drugs, materials, and X rays. Although dental care was the most expensive in England, at about €156 for a filling, it was closely followed by Spain at €125 and Italy at €135. The costs in the other western European countries were less than half that much and ranged from €46 in France to €67 in Germany. The primary purpose of the study was to determine differences in the costs of a filling.
The countries that were the least expensive for dental treatment were Hungary at €8 and Poland at €18 which are the primary destinations for dental tourists from the UK. Of the estimated 60,000 people who traveled abroad from the United Kingdom for medical treatment in 2010 it is estimated that half of them traveled in search of dental care.
That a considerable sum of money can be saved is why there are clinics and agencies that arrange for the dental treatment in lower priced countries. The most important driver of dental care costs is labour, which accounts for 70% of total dental care costs in the UK. England was closely followed by Spain and Italy, but costs in other Western European countries, such as France and Germany, were less than half the price of those in England. Unsurprisingly, the countries, which rated lowest in the study, Hungary and Poland, have emerged as the most popular destination for British dental tourists.
An increasingly large number of Irish people are heading abroad for cheaper dental treatment. Since cutbacks last January over a million people have lost financial benefits and now have to pay full-rate prices for dental care. New cuts announced in December for 2011 can only increase the problem that people are finding it increasingly difficult to afford treatment in Ireland and are choosing to travel abroad in a bid to save money on dental care. Many Irish people are now travelling over the border to Northern Ireland, where treatment is significantly cheaper and some are making the journey to Eastern European countries, including Hungary, Romania and Bulgaria for treatment; fees in this part of Europe are up to 60 % lower than those in Ireland so a considerable saving can be made even when you take the cost of accommodation and flights into account.
A group representing 32 national dental associations and chambers from 30 European countries and 320,000 dentists has warned of the dangers of dental tourism. Writing in a position paper for an EU directive on cross-border healthcare, the Council of European Dentists (CED) emphasises the importance of continuity of care and of a strong dentist-patient relationship,” Dental treatment often requires a series of visits to the dentist to properly plan and carry out the treatment, and to provide post-treatment care. Where patients spend only a short time in the vicinity of the dentist, as is often the case where patients receive care abroad, the overall quality of the health service is difficult to ensure. The CED therefore does not believe that patient mobility in the area of dental care should be actively promoted."
For any agency promoting dental tourism, The EU Manual of Dental Practice, freely available online from the CED, provides comprehensive and detailed information on the legal and ethical regulations, dental training requirements, oral health systems and the organisation of dental practice in 32 European (EU and EEA) countries, including Croatia, which is due to join the EU this year. The practising arrangements, the regulatory frameworks and systems within which dentists work in the respective countries are compared. There is also country specific information on the dental specialities that are recognised.

The International Federation of Health Plans, a group of 100 health funds and insurers across 30 countries, has released its ’2010 Comparative Price Report’ detailing its annual survey of medical costs per unit. The study is done to help member plans better understand why health care costs are so much higher in some countries than others. Prices for the same medical procedures, tests, scans and treatments vary widely from country to country. The survey data showed that, on average, U.S. prices for procedures were once again the highest of those in the 12 countries surveyed for nearly all of the 14 common services and procedures reviewed.
For example, total hospital and physician costs for delivering a baby are $2,147 in Germany, $2,667 in Canada, and an average of $8,435 in the United States. The survey shows that the cost for a hospital stay is $1,679 in Spain, $7,707 in Canada, but these costs can range from an average of $14,427 to $45,902 in the United States.
In addition to providing comparative cost data across the countries, the survey provides information about the wide range of costs being charged in the United States for common services, procedures and drugs. One example from the survey is hip replacement surgery costing $12,737 in the Netherlands, but ranging from a low of $21,247 to a high of $75,369 in the United States.
The differential between unit prices was greatest for surgery. One of the highest differentials was for cataract surgery; the range for cataract surgery ran from $1,667 in Spain to an average of $14,764 in the United States.
Tom Sackville of IFHP says, "As countries around the world look at the impact of their health care systems on their economies, the cost per unit of services, procedures and drugs is a key factor that needs to be understood. The total cost of care in each country is obviously driven very directly by the fees charged by the doctors, hospitals, and drug companies in that country. We hope the release of this updated report on our price survey will be a key step forward in creating a more informed base of knowledge for all our member countries and allow them to better assess the impact of unit prices on the cost of health care."
The IFHP’s survey covers current 2010 provider fees and drug costs in 12 countries. The 12 countries studied were- Argentina, Australia, Canada, Chile, France, Spain, Switzerland, Germany, Netherlands, New Zealand, United Kingdom and United States. The 14 items examined include angiograms, CT and MRI scans, office visits, newborn deliveries, appendectomies, cataract surgeries, hip replacements, hospital stays, bypass surgeries and angioplasties. Costs for three widely prescribed drugs – Lipitor, Nexium and Plavix – were also reviewed. The data for the report was gathered from IFHP member organizations in each country.

SpaFinder, the global spa and wellness resource, has identified global spa trends that will influence experiences for consumers and the industry in 2011 and for decades to come. The report called ’2010 International Report, Spas & the Global Wellness Market: Synergies & Opportunities’ is based on analysis from a large team of experts who visit hundreds of spas each year; interviews with top industry analysts; ongoing research across the spa, travel and beauty sectors; and data derived from SpaFinder’s relationships with over 9000 spas across the globe.

1 )Ageing customersBaby boomers are the fastest growing demographic in the world, and spas are showing more awareness of the needs of older spa-goers. Many spas are now incorporating physiotherapists, chiropractors and osteopaths who focus on rejuvenation of joints, pain relief and mobility. Thermal bathing is also seeing a renaissance as the benefits of soaking are rediscovered. Woe is the spa that attempts to label this active affluent group. The days of ’over 65’ as a catchall category will soon become ancient history. There is a huge difference between a 70 year old who plays tennis three times a week and an 85-year-old seeking pain relief.
2) Asia as a destinationAsia has had a profound impact on the spa industry. Yoga, Thai massage, Ayurvedic medicine and acupuncture are staples on many spa menus, and the Zen nature of Asian design can be seen in spas worldwide.There is an explosive growth of hotel/spa development within Asia (a market of 4.1 billion people), especially within the two fastest-growing world economies, China and India. These markets are developing at breakneck pace, unleashing massive opportunities for hotel/spa development. Asia-Pacific has the largest number of spas and hotels under development of any region in the world, and by 2015, China will have 100 million outbound travellers, many seeking a luxury break that includes a Westernised spa experience.
3) More saltHealing traditions that involve basking in salt caves or water may be centuries old, but they are coming of age in some of the most modern spas. The benefits to skin, breathing and rejuvenation are making salt therapy one of the hottest trends to watch in 2011. Clinical trials reveal salt is beneficial for respiratory illnesses like asthma and skin conditions such as acne and psoriasis. Spas are finding stylish new ways to recreate the natural salt cave microclimate, infusing salt and negative ions into the air. Some examples have encrusted, stalactite-drenched grottos of tons of imported Himalayan salt crystals, or have created hyper-modern rooms made of sea salt blocks.
4) Branding experiencesTraditionally the territory of standalone spas, the industry is moving rapidly in the direction of branded experiences. 2011 will be a watershed year for franchised/branded spas as consumers seek the consistency of treatments they know and love, and major players expand into new markets. Look to see a brand new world of spa lines going global and offering consumers a consistent experience wherever they travel.
5) Price dealsGone are the days when coupons were unfashionable things people snipped out of the newspaper and spas would not dream of using the term deal. Internet coupons and online group-buying deals have burst onto the global scene, and the old-fashioned deal has morphed into an online industry. With spa and wellness deals a mainstay of some sites, millions of people are now expanding their spa horizons, trying new experiences they would not have without the ’50%-75% off’.
6) Scientific proofIs there scientific proof that massage reduces stress? Are mudpacks and mineral-baths medically proven to alleviate pain? The answer, in many cases, is yes. Get ready for a new era where more questions about the effectiveness of spa therapies will be asked, as the emphasis on the science behind spa health heats up. With more medical professionals embracing integrative/alternative medicine, expect clinical studies to accelerate. These promising evidence-based initiatives may ultimately prove the bedrock for future industry growth.
7) Local sourcingA current trend that complements the move toward branded spas is the desire for authenticity and immersion in the traditions and elements of a spa’s local environment. It’s not just about sourcing the restaurant menu from local suppliers; there is an increase in spas who have fully embraced the local trend with the farm-to-table movement and have extended it to farm-to-massage". Locally sourced fruits, herbs and honey are grown on site, and then dished up in both meals and in spa treatments.
8) Search for beautyBeauty-seekers are taking treatments are far beyond Botox into stem-cell facials and plasma therapy. People are tolerating more pain as long as it delivers results. Derma-rolling hurts, chemical peels can be uncomfortable and the zapping of lasers is painful. Then there are boot camps, Rolfing and Bikram yoga, where pain meets pleasure.
9) Fast spas"In a New York minute" is jargon for how things move faster in hectic New York City. It is also the name of a suite of mini (15- to 30-minute) spa treatments. The spa industry is responding, with early and late-night opening for money-long time-short customers. The trend toward express, sampler or mini-sized treatments will continue to rise. The explosion of airport spas worldwide plays into the express trend neatly, as does the decline of elaborate rituals at many spas, to get right to the heart of the matter: the therapeutic treatment.The quest for stress-free spa efficiencies will mean more spa-goers embracing 24/7 online appointment booking, and mobile apps helping them find and book spas on the fly.
10) Special eventsIncreasingly, spas are developing distinctive specialty programs to draw customers seeking a unique group experience. While destination spas have been offering yoga and healthy cooking weeks for years, retreats now span everything including a high-flying trapeze experience. Spas and resort destinations will find creative new ways to attract consumers.

The idea of flying hospitals may sound like a fantasy, but there are organizations promoting this concept to provide travelling care to countries that need urgent help.
Global Flying Hospitals (GFH) is a charity organization with its US office in Palm Beach Florida, and its Asia office in Macau. It seeks to assist developing countries to become self-sufficient and sustainable with healthcare for their citizens who lack or cannot afford medical care. This vision includes the building of a fleet or aircraft with four Boeing 747’s, refurbished as teaching hospitals and each designed for a group of differing medical specialisms, four Hercules C130’s ferrying high-tech field medical clinics, medical equipment, emergency modular housing, sanitation, water purification and solar power equipment. And four Pilatus PC12 single engine turbine craft, for micro-insertion of medical professionals, patient evacuation and rendezvous of supplies or patients with the Boeing’s and Hercules. A special MediVac helicopter division is being planned.
Global Flying Hospitals says it is a comprehensive new model for humanitarian healthcare that totally supersedes the old band-aid methods and thinking of the past, caused by a lack of resources and dis-interest by the world towards developing countries. GFH offers a solution to the humanitarian medical challenges of this now uncertain and ailing world.
A completely separate organization is The Flying Hospital. The Flying Hospital is a 36 year-old aircraft; a refurbished 1974 Lockheed 1011, that is the product of the organization, “Operation Blessing International”, founded by Pat Robertson. A company was formed, The Flying Hospital Inc. to operate and manage the aircraft, receive donations and support. It was meant for launching various medical missions, for one and two week time-slots. Admirable work was conducted and thousands of medical procedures were undertaken, during its initial tour to a number of countries. The aircraft was grounded in 2001 and mothballed in the desert, in Tucson, where it has sat for these many years and is now nearing obsolescence. Although it is possible to resurrect the aircraft, it is old and not many Lockheeds fly, thereby making parts procurement very difficult and costly. Bill Horan of Operation Blessing states: “I don’t see it as impossible that this plane might fly again, but it is very unlikely for a variety of reasons. That being said, we continue to try and find a good home for this plane."
Global Flying Hospitals commends the efforts of The Flying Hospital, as it served humanity well. However, there is no relationship, connections or cross purposes in either organization. GFH explains that as far as it knows, only one other such organization exists, the charity Orbis’s Flying Eye Hospital.
The Flying Eye Hospital is a hospital with wings that brings together dedicated eye care professionals and aviators to give the gift of sight to developing countries around the world. Onboard the refurbished DC-10 jet aircraft, local doctors, nurses and technicians work alongside Orbis’s international medical team to exchange knowledge and improve skills. The mobile teaching hospital is a unique tool in the fight against preventable blindness in developing countries. In the 48-seat classroom at the front of the plane, doctors gather for lectures, discussions and live broadcasts of surgical procedures being performed nearby in the Flying Eye Hospital operating room. Prior to the start of a Flying Eye Hospital visit, local doctors pre-select patients whose conditions are relevant. Priority is given to children, individuals who are bilaterally blind, cannot afford to have the surgery otherwise, and represent good teaching cases. Local doctors maintain oversight of patients before, during and after surgery. Upon the Flying Eye Hospital’s departure, videos of the surgical demonstrations are left with local institutions to be used in further training. Since its first program in 1982, the Flying Eye Hospital has travelled to more than 70 countries and saved the sight of millions of people. By training local doctors and eye care workers, who in turn teach their colleagues; it is strengthening the capabilities of local health care communities in blindness prevention and treatment.
Both GFH and The Flying Eye Hospital welcome donations and volunteers, but The Flying Hospital is inactive. GFH warns that there are fraudsters purporting to be fund raising for The Flying Hospital to by accepting charitable donation. GFH states, “ At this date it is a fabrication and illegal.”

PHM International, a US based healthcare consultancy, claims that the current military skirmish between North Korea and South Korea exposes a fundamental challenge of medical tourism.
The company’s view is that board members, investors, executives, insurance companies and others that promote medical tourism can be put in jeopardy by referring patients to high risk countries. When a patient is referred to a medical treatment facility in a region of the world with known risks, that company has made a business decision that may prove detrimental to the individual patient. Known risks include military intervention, civil insurrection, drug wars, and natural catastrophes.
Hank Kearney of PHM International comments,” Risk management is more sophisticated than a disclaimer of responsibility and utilizes an array of tools to keep current of the constantly changing global risk map. Companies need to fully understand the risks, policies, and geo-politics of the global healthcare sector. Particularly for US companies, the liability exposure of medical tourism needs to be mitigated in a way to protect the patient, but also the company’s reserves, the board members, and investors. Disclaimers and sending patients to JCI accredited hospitals are simply not enough protection, particularly when that hospital is in a known high risk area.”
The possibility of legal comeback may seem a far-fetched scenario to medical tourism intermediaries accustomed to working in an unregulated market. In many countries, arranging travel and accommodation overseas as an intermediary is subject to regulation and licensing. In many countries, civil law is designed to protect consumers from businesses who put them in harm’s way. By calling themselves facilitators, some medical tourism agencies are either by ignorance or design, avoiding the issue that there is little difference between a licensed bonded and accredited travel agent selling a spa/wellness package to a customer, and an unlicensed medical tourism agent selling a medical check-up or dental treatment package to a customer.
Using the UK as an example; The Package Travel, Package Holidays and Package Tour Regulations 1992 are overseen by the government’s Department for Business, Innovation & Skills. In the UK, anyone who (other than occasionally) sells or offers for sale package holidays must comply with these regulations that set out travel organisers’ responsibilities to their customers and the remedies available should there be a breach of the regulations.
The definition of a package holiday is complex, but a package holiday must:

Be sold or offered for sale
Be sold at an inclusive price
Be pre-arranged
Include a minimum of two of the three elements of:

– transport
– accommodation
– other tourist services (not ancillary to transport or accommodation) accounting for a significant proportion of the package, such as a tour guide.
The Court of Appeal’s judgment in The Association of British Travel Agents v Civil Aviation Authority [2006] identified that in determining whether a package is being sold, a key question will often be whether the relevant travel services are sold as components of a pre-arranged combination or as separate services.
These regulations require organisers of package holidays to provide protection for money and to bring customers home if necessary. Although medical travel, health travel, health tourism, dental tourism etc are not specifically included within the regulations-neither are they specifically excluded either. UK civil law is based on “ what would the average person believe’ and using this basis, it would be difficult to persuade a court that a health travel package is not meant to be included within the regulations.
The regulations provide consumers with statutory legal rights against tour operators by making clear to operators that they have legal responsibilities to their customers. The regulations also enable dissatisfied travellers to pursue their case with a single supplier, the travel organiser, instead of with individual suppliers such as airlines, hoteliers, hospitals and clinics. UK agents needing advice on whether they are abiding by the Package Travel Regulations should contact their local Trading Standards Department.
The Department for Business, Innovation and Skills (BIS) regulates many of the UK laws, regulations and guidelines on advertising, package travel, pricing and product description that helps protect consumers and businesses from unscrupulous practices. They want consumers and businesses to be able to trust advertisements, fairly compare prices and find goods that are honestly labelled, and services that are properly delivered. And they want to help businesses know the rules and regulations that apply to them and not have to face unfair competition from other traders operating illegally. The Coalition government has a planned programme that includes tightening up consumer law and removing legal loopholes.

Governments must make their health care systems more efficient if they are to maintain quality of care without putting further stress on public finances, according to a new 200 page OECD report, ’Health Care Systems: efficiency and policy settings. The OECD warns that cash-strapped governments no longer have the option of boosting spending to improve health outcomes, as they have done over the past several decades.
Angel Gurria of OECD says, "Healthcare is now one of the largest government spending items, representing on average 15% of government spending across the OECD, and costs are still rising. The economic and financial crisis has weighed heavily on public finances, reinforcing the need to improve health care efficiency."
The OECD report recognises that the sharp rise in healthcare spending – which has grown by more than 70% per capita in real terms since the early-1990s – led to steady improvements in health outcomes across the OECD. Life expectancy has increased by one year every four years, survival rates from diseases like cancer are up, and premature births and infant mortality have dropped dramatically.
Cross-country comparative analysis highlights the uneven healthcare efficiency performance across the OECD countries. Australia, Japan, Korea, Switzerland and Iceland get the best health outcomes for money spent. Denmark, Greece, Hungary, the Slovak Republic and the United States have the widest margin for improving health outcomes without increasing spending.
The report says that exploiting efficiency gains would allow countries to continue improving the quality of care while holding costs constant. Adoption of best practices could reduce costs by nearly 2% of GDP by 2017 across the OECD, as compared to a no-reform scenario, while savings could be above 3% of GDP in Greece, Ireland and the United Kingdom. If all countries were to become as efficient as the best performers, life expectancy at birth could be raised by more than two years on average across the OECD area, without any increased health care spending. A 10% increase in health care spending would only increase life expectancy by three to four months, if the extent of inefficiency remains unchanged.
The new report is based on unique healthcare policy data gathered from 29 OECD countries, grouped into six newly-defined types of health care systems, ranging from those that rely principally on private insurance and markets to those where governments take the lead. The report investigates the links between policy choices and health system efficiency and makes specific suggestions for improvements on a country-by-country basis.
It seeks to compare quality of healthcare between the countries. It uses many criteria but admits that comparing quality is far from easy. Every country has minuses and pluses. What it does highlight is that simplistic comparisons such as healthcare/hospitals/doctors in country A are better than country B, are statistically unprovable and dangerous; you can suggest that country A has a higher admissions or lower fatality rate on a specific chronic disease such as heart failure than country B, but this is a very rough and ready comparison as there may be specific country factors other than healthcare that affect outcomes.
It says that increasing patient choice on where and when they can be treated enhances customer empowerment and stimulates competition. It highlights the increased patient choice in the UK, Norway and Sweden. It shows the many different ways countries seek to improve and regulate healthcare- some offering a free market, and others with highly controlled pricing. What it does highlight is the very different ways that countries offer healthcare, state v private, private insurance v state insurance, compulsory insurance v voluntary insurance etc. The message to any destination or healthcare provider marketing medical tourism, is that each of the target country markets has its own unique mechanisms on providing healthcare, and unique advantages/ disadvantages on price and care; you cannot lump all of Europe or all of Asia together and market to each country in that group in exactly the same way.

The Tourism Authority of Thailand (TAT) has told tour operators that Thailand tourism and medical tourism are back to normal following political clashes that took place in May. The country has welcomed 10 million tourists for the first eight months of 2010, a 30% increase over 2009.
TAT has launched its e-marketing campaign for medical tourism in Thailand. Suraphon Svetasreni of TAT said, “The online campaign will boost the number of medical tourists as well as increase the average time they stay in Thailand. And this will help other tourism related businesses, such as hotels, spas, and restaurants. It will benefit all the tourism industry and follow the Thai government’s strategy of promoting Thailand as the medical hub of Asia.”
TAT has just launched “Healthy Beauty Holiday in Thailand”. This sales promotion offers exclusive rates for dental treatments, Lasik corrective surgery, cosmetic surgery, holistic and anti-aging treatments, and medical check ups. For this campaign, TAT has joined with partners including Royal Orchid Plus, which offers 1000 mileage bonus points when booking medical services under the campaign. Websites are also taking part, including Asia Web Direct and Phuket Hotels and Travel Guide. December sees the launch of a “You are in Good Hands” campaign to emphasize the credibility and safety of medical services offered in Thailand.
TAT has chosen the 12 finalists of the Thailand medical tourism blog contest that attracted 219 applicants from 24 countries. The 12 finalists, selected on reputable profiles relevant to tourism and medical tourism, will compete in the final round in Thailand.Throughout their seven-day stay in Thailand, TAT has arranged visits for the 12 final contestants to over 50 health and tourist establishments, ranging from hospitals and clinics to spas in six destinations: Bangkok, Phuket, Chiang Mai, Pattaya, Samui and Hua Hin. And they will get to experience a variety of Thailand’s medical and wellness services, including medical check-ups, dentistry, skin laser treatments, botox courses and health spas. The 12 Finalists will then submit their blogs promoting medical tourism in Thailand referring to their experiences during the seven days. The blog with the most votes during the two-month voting period will win an assortment of prizes worth up to US$ 20,000.
The 12 Finalists come from the United States, the United Kingdom, Sweden, Malaysia, Singapore, Vietnam, the Philippines and Indonesia. Sansern Ngaorungsi of TAT explains, "From our research into the web blogs on tourism and medical tourism, there were few that mentioned Thailand and the services we offer. This meant medical tourists were not able to access information on Thailand’s comprehensive healthcare and tourism offerings. So we decided to launch this promotional campaign to encourage bloggers to write about their experiences in Thailand as medical tourists and serve as sources of reliable information for potential medical tourists around the globe. This campaign aims to create awareness and increase online information and on medical tourism in Thailand to make it more readily accessible. It will also serve to inspire confidence in the standards and quality of Thai medical tourism."

Dr Patric Rutherford of Andrews Memorial Hospital argues that the Jamaican government’s reluctance to cut customs duties on medical supplies is stifling the prospects of health tourism – an area that could earn significant revenues in the long term while boosting the local health sector, "It is not just equipment that we import. We have to import a host of supplies on a monthly basis, which are millions of dollars worth of goods, but they make the decision to keep the system as it is and not remove the duties,"
Rutherford argues that shortsighted policymakers do not understand that in return for losing the immediate taxes of health-related import revenues, they will get more revenue in the longer term from encouraging a local industry that needs help.
Andrews Memorial Hospital is a private Adventist-affiliated hospital, and Rutherford complains about the shortage of local qualified nurses and other health professionals. There are many Jamaican nurses that have qualified and work overseas.
Dr Evangeline Javier at the World Bank Human Development Department explains that a recent study indicates that although there is a skilled labour force in Jamaica, there is a shortage of workers, which is increasingly hampering the country’s competitiveness, "These shortages are being greatly felt in the health sector, weakening the quality and efficiency of health services. The shortage of nurses will get worse with the ageing of the Caribbean population.” An in-depth analysis of the report by World Bank officials indicated that migration was a major factor for the shortage, with more than 80 % of Jamaican nurses surveyed considering leaving the island. The report showed that approximately 75 % are dissatisfied with working conditions. Another problem is limited training facilities outside the classroom, and restrictive practices by local nursing bodies. Jamaica seems unable to compensate for health professional migration by attracting people from elsewhere; salaries are too low and working conditions poor.
A paper from The Private Sector Organisation of Jamaica agrees with Rutherford that Jamaica needs tax reform that promotes economic growth and acts as a catalyst for development, is characterised by simplicity, equity and competitive rates, and is administered in an efficient and effective manner.” The roadmap for tax reform includes legislation and implementation. It has to be put in context that there is a massive fiscal crisis faced by the government so that a single low rate of corporate tax is not possible in the upcoming budget. The second best alternative is to adopt a 10% rate of corporate tax for international traded services-including health tourism. The key is to put in place policies that encourage the growth of new industries and to create an actively enabling environment for areas of obvious additional potential, such as tourism and health services. Health tourism would be regarded as a reverse export and would pay corporate tax at only 10 per cent. US hospital groups would also be able to take advantage of Jamaica’s double taxation treaties to offset this tax against their US taxation. Rather than a cash-strapped government giving the new industry additional tax incentives, the government could give the business land in return for a quota of Jamaicans who would receive free health services. The Government could reform customs duties across the board to a low flat fee that would allow the importation of the very expensive specialised equipment that such a business would require. A sufficiently big industry of this type would produce enough revenue to cover most of the health needs of the entire Jamaican population – true free health care for all. “
Minister of Tourism Edmund Bartlett says that health and wellness tourism has great potential for development in Jamaica. The Minister urged Jamaicans to recognise and support businesses owned and operated by nationals. He was speaking at the launch of Jencare’s latest international clinic in Miramar, Florida, USA.Jencare Skin Farm started as a modest shop in Kingston, Jamaica. It quickly grew in Jamaica and has expended into international markets, with clinics in Miami, New York and Trinidad to cater for migrating Jamaicans as well as global clients.

Serbia’s Minister of Health Tomica Milosavljevic has stated that the accreditation of health institutions and licensing of health workers will increase the level of patient safety and improve efficiency in Serbian hospitals. He has set up an Agency for Accreditation of Health Care Institutions, tasked with developing an accreditation programme modelled on the most successful such programmes in Europe. The EU has endorsed this project with funding of €1.5 million. One of Serbia’s key partners will be the UK’s National Institute for Health and Clinical Excellence (NICE). NICE International works with individual governments or funding agencies to support local teams develop local solutions. It offers strategic advice, technical support, and input on strengthening existing or designing new decision-making frameworks. Recent European projects have been in Georgia and Estonia.
Snezana Manic is director of the Agency for Accreditation of Health Care Institutions and emphasizes those health workers and patients will benefit from accreditation. She notes that according to the law on health care, accreditation is voluntary, but the agency is contemplating the introduction of a form of obligatory accreditation so that all institutions will be forced to meet a minimal standard of quality and patient safety. External assessors have already been appointed and trained.
Serbia is a destination for dental tourism but not surgery. The government and local businesses see better long-term potential in spa and wellness tourism. Prime Minister Mirko Cvetkovic said at the opening of the renovated hotel Izvor in Arandjelovac that Serbia has potential to develop spa tourism. Cvetkovic called on investors to invest in other spas in Serbia, and pointed out, “2011 is the 200th anniversary of existence of Bukovicka spa. It is a great jubilee, which shows a long tradition of spa tourism. It is often thought that Serbia is not a significant tourist destination like some other countries that have sea and mountains. However, we can be proud of spa tourism. Businessmen have recognised this and this hotel in Arandjelovac confirms that it is time for Serbia to start with revitalisation of spa tourism. The support in this undertaking must be provided by local communities and the Serbian government as well.”
The five-star hotel Izvor in Arandjelovac has been opened after seven years of reconstruction. It is the first luxurious conference, spa and wellness centre in Serbia, whose reconstruction cost €35 million. The hotel can host 550 guests and has 165 rooms. The completely new facility has three equipped conference rooms, six swimming pools, wellness and spa centres, which can host 3500 people. ALCO group built the hotel. The group is building four other four and five star hotels in Serbia, while preparing to buy or build other hotels in tourist areas in Belgrade and other parts of Serbia.

A day after unveiling Rwanda’s first ever magnetic resonance imaging machine, King Faisal Hospital in Kigali, received the results of the final survey for an international accreditation program, with the hospital scoring a record high of 98 % from the surveyors from the Council for Health Service Accreditation of Southern Africa (COHSASA). To be fully accredited, a hospital has to score 90 % or more in every service element. COHSASA carries out internal and external assessments using international standards.
The quality improvement and accreditation process started in June 2008 after the Ministry of Health approved a strategic plan to turn the hospital into a world-class centre of excellence. The first assessment was conducted in February, where the hospital scored 86%. In November, the COHSASA surveyors went through all documents and evidence of the clinical and non clinical services at the hospital and were impressed by the major achievements realized by the hospital in only 9 months since their last survey in February 2010. Services provided by the hospital were evaluated for performance including management and leadership; access to care; management of information; prevention and control of infections; health and safety; quality management; and patient and family rights.
With this accreditation program, KFH- Kigali is the first hospital in Africa with the exception of South Africa government supported hospitals to attain this level of accreditation in a period of two years. KFH Kigali is also the first hospital in the region to get accredited. Founded in 1991, the hospital is Rwanda’s premium referral hospital and has 145 beds. It operates as an acute care facility with full-time specialists in most major fields.
Juliet Mbabazi of King Faisal Hospital Kigali says, "The accreditation will enable the hospital to stimulate integration and management of health services and provide better education and consultation to its patients. KFH has benefited from the accreditation process in the sense that is definitely helping the hospital improve the standards of care and accountability to our patients in our quest for excellence."
There are only 17 healthcare accrediting bodies in the world that are recognised by the International Society for Quality in Health Care (ISQua), the global authority that accredits the accreditors and the standards they produce and South Africa is represented among them. The Council for Health Service Accreditation of Southern Africa (COHSASA) in Cape Town has been operating as a not-for-profit enterprise in the field of quality improvement and accreditation in Southern Africa for the past 15 years and has conducted 683 external surveys in 437 facilities in private and public sectors with 104 of these currently accredited, including hospitals, clinics, hospices, rehabilitation centres, sub-acute care facilities and environmental health offices. Recently, four sets of healthcare standards developed by COHSASA have been accredited by ISQua as meeting principles set out by the international body. This is the third successive occasion that COHSASA has had its standards accredited and over the past decade and a half COHSASA has continuously refined and reviewed its standards to make them user-friendly, precise, easy to measure and easy to understand.
As well as South African hospitals, COHSASA now offers an international accreditation service for Botswana, Rwanda, Swaziland, Nigeria and Lesotho. While only 6 hospitals and clinics are currently accredited, 48 more are in the process.
In South Africa, the government is to establish an ombudsman-type office to deal with complaints of poor service provision by both public and private hospitals, in a move to improve the provision of quality health care in the country. Minister of Health Aaron Motsoaledi said the office of the health ombudsman will consist of an inspectorate to conduct regular and unannounced examinations of conditions at private and public hospitals and oversee the accreditation of such facilities, “ No health facility in this country will be under the national health insurance scheme unless it gets accreditation from this office of standards compliance. In other words if you are not accredited by the office, no NHI for that facility. Any member of the public who has a complaint about a broad range of things, like having been to hospital and been ignored for four hours, queuing for a long time, wrong attitude of staff, they can go to the office. The powers of sanction of the ombudsman will be dealt with during the processing of the national health amendment bill, which proposes the establishment of the office of the health standards compliance.’

Tourists from across the Middle East are travelling abroad for cosmetic surgery. Their destination is often Lebanon, a country whose obsession with physical perfection has transformed it into a specialist destination.
The Lebanese cosmetic surgery industry has flourished in recent years with surgically enhanced beauty becoming increasingly desirable among image-conscious locals. Lebanon’s First National Bank even offers loans of up to $5,000 for cosmetic surgery. With recent conflicts such as the 2006 war between Israel and Lebanon over, the country is attracting many more clients from further afield eager to take advantage of Lebanon’s medical experts.
Roger El Khoury at the Beirut Beauty Clinic reports that the clinic has experienced a 25 % increase in foreign patients over the past 12 months with clients arriving from other Arab countries in the Gulf and North Africa. There is also huge demand from Lebanese expatriates. Sami Saad, Lebanon’s representative at the International Society of Aesthetic Plastic Surgery, estimates that 20 % of business is people from abroad. The procedure most requested by foreign clients is rhinoplasty, nose jobs.
Dubai-based Image Concept is an agency set up to help medical tourists book their trip to Lebanon, finds them the right accommodation and the surgeons to perform the desired procedures. Zeina El Haj, Image Concept’s founder, launched her company in June 2009 to market the country’s cosmetic surgery industry. Since then, business has grown with clients mainly from the United Arab Emirates, Kuwait, Saudi Arabia and Qatar, and a handful from Europe, the United States and New Zealand.
Demand has been increasing. People want to look like the stars they admire — they want the nose, or the cheeks, or the teeth of certain celebrities. They want to look good. The country’s attraction is the affordability of its surgeons and its convenient location. Although Lebanon welcomes the increase in cosmetic surgery tourists, local specialist warn people to be wary of unqualified surgeons trading on the country’s reputation. Their advice is to ensure any medical procedures are performed by specialists registered with the Lebanese Society of Plastic Reconstructive and Aesthetic Surgery (LSPRAS), an internationally-endorsed body set up to regulate the industry. LSPRAS explains a problem, “The provision of information by physicians to their patients is at the centre of the process of valid consent; this however, must be distinguished from advertising, an issue of controversy for several years and strictly forbidden by Lebanese law and the Lebanese Medical Code of Ethics.”
The importance of getting the right surgeon is emphasized, as litigation against surgeons is almost unheard of and impossible to pursue successfully. Political stability is fundamental to Beirut’s role as a destination for cosmetic surgery in the Middle East. Tensions between Middle East nations and Israel and Iran could damage trade.
Although the Ministry of Tourism claims a slight increase in tourism in each of the last three years, neither it nor the trade have any real handle on the numbers coming into the country for cosmetic surgery.

Karin Schinagl becomes the new Managing Director of ADAC Service GmbH and will be responsible for the medical assistance area. Mrs. Schinagl replaces Alfred Mayr, who has left the company. In addition to her new responsibility, Mrs. Schinagl keeps her position as Manager Insurance Provider Management in the ADAC insurance sector.
Dr Michael Meyer, Medical Director in the third-party clients sector of ADAC Ambulance Service faces new challenges. From the beginning of this month he will assume the position of Medical Director for the entire ADAC assistance sector. Michael Meyer’s professional background is in Anesthesiology Emergency Medicine as Senior Consultant at the University Hospital in Erlangen. He replaces Dr. Michael Herold, who has been responsible for the ADAC membership/insurance programme for 10 years.

Fortis has recently added another hospital to its network deepening its presence in UP and making Fortis a 51-Hospital-strong network. The Vivekanand Hospital & Research Centre is a 150-bedded Multi Specialty Hospital located in Moradabad, Uttar Pradesh and offers comprehensive services with a special focus on Cardiology, Gastroenterology and Neurosurgery. The hospital has been signed up as a Fortis facility and reflects Fortis strategy to expand reach and provide access to quality healthcare to population in smaller towns in India.

The rechristened Fortis-Vivekanand hospital was initially set up in July 1989 by the Moradabad Charitable Trust with the intent to cater to the huge need for a well-established medical treatment centres in the district. The hospital has a built up area of 198000 sq ft and is located on a 6.3 acre plot, which also houses a Nursing College and Nursing School. It has four well-equipped Operation Theatres, a Cath Lab with a 10 bedded Heart Command Centre, and a Rotary blood bank.

Under this agreement, Fortis shall revamp the infrastructure, help overcome operational challenges faced by the hospital, add to depth and width of the medical programme currently being offered and fund the expansion and growth of the hospital. We will bring in the Fortis brand while introducing all of our processes and practices to this institution. Fortis Hospital Noida will act as a “Mother” hospital for the Moradabad Facility.

So, the growth story at Fortis Healthcare continues and these remain very exciting times in our organization.

In Kuwait, according to reports in the local media, Ministry of Health officials have found that dozens of Kuwaitis were improperly referred for medical treatment abroad after using forged medical reports. The fraudulent claims were reported by the manager of the ministry’s foreign medical treatment section, Dr. Mohammad Al-Meshaan, when he heard about the existence of a professional counterfeiting gang who had been using real senior doctors’ names and officials seals without their knowledge to forge the documents needed to receive medical treatment abroad.
There are suggestions that doctor, working in collusion with a number of secretaries and other ministry staff, may be responsible for the forgery operation. This could be very embarrassing for heads of ministry departments and doctors as their names and official seals and signatures were used in the transactions without their knowledge.
The gang got patients to pay for the forged documents to be sent to places such as London for a week for treatment. It is alleged that neither the patients nor their companions were actually ill, but just enjoying a holiday at the government’s expense. Allegedly, even doctors and nurses went with so-called patients for treatment abroad, despite all being in excellent health and with no need of medical treatment.
It seems that this is a considerable criminal operation, impossible to run without inside help from medical staff and government officials. It is embarrassing for the government as it both shows a large-scale fraud, and that despite attempts to promote the quality of local health service and develop medical tourism, is paying for residents to go abroad for treatment. The investigation is expected to reveal both the number of genuine residents being sent abroad, and the number who enjoyed a cheap holiday after paying for forged documents.

Saudi Arabia is another country keen to encourage medical tourism and stress the quality of local treatment. King Abdullah bin Abdelaziz al-Saud, 86 years old, is suffering from a painful but not serious condition that requires rest. Instead of being treated locally, he flew to the USA.

In Bahrain, a new private hospital, the four-storey Royal Bahrain Hospital with 670 beds has just opened. The hospital is run by the KIMS Management Internationale, a UAE subsidiary of an Indian medical group. The hospital claims to have one of the best cosmetic and dental surgery clinics in Bahrain. The hospital is targeting people living in Bahrain and aiming to promote medical tourism so that instead of going to European countries, Middle East patients will go to Bahrain.
In Iran, Mohammad Nahavandian of Iran’s Chamber of Commerce claims that the country is increasing its global share of medical tourists. He argues that low costs and hospital capacity, could make Iran an attractive destination. Others in Iran promote a hard to believe claim that it is already a top ten medical tourism destination with most of their patients coming from England, Sweden and Persian Gulf countries. It is probably true that it gets some patients from Persian Gulf countries. Whether those from Europe are expatriate workers, expatriate Iranians, business travellers or holidaymakers, is not stated. Like other countries claiming a top ten place (and there are many more than ten making that claim!) there is a lack of credibility as there is a complete lack of numbers and statistics. The claims were made on an Iranian television station, Russia Al Youm. The report suggested that people come just for spinal implant and cosmetic surgery, as the price is a quarter of that in America, Britain and Turkey.

Self-funded and fully insured employers are jumping on the domestic medical tourism bandwagon, offering the option in their healthcare benefit packages, says David Goldstein, of medical tourism agency Health Options Worldwide.
The agency claims that companies are moving away from traditional medical tourism where patients would travel abroad for surgery or other types of non-emergency medical treatment. The latest demand is for domestic medical travel, whereby patients seek low-cost alternatives in other regions of the United States.
David Goldstein argues that what is keeping patients in the United States as opposed to going overseas where the savings are substantially higher is that domestic medical travel’s largest appeal is comfort and convenience, "It is easier, physically and emotionally, for someone to travel within the US and obtain follow-up care than it is for them to go abroad. By encouraging domestic medical travel, employers can reduce employee downtime, improve employee retention and become more competitive in the marketplace."
Employers and insurers are offering enticing incentives to employees for using the domestic medical travel option. Cash bonuses, waived co-payments, free companion travel can be offered in return for using an American-based doctor or facility. Healthcare plans can also offer lodging and meal expenses."
According to Goldstein, several insurers including Anthem Blue Cross and Blue Shield, WellPoint, Health Net of California, Blue Cross Blue Shield of South Carolina and UnitedHealth are adding domestic medical tourism options or launching pilot programs to test effectiveness, “This is a big deal because these insurers, such as Blue Cross Blue Shield, have always been conservative. So to see these giants join the trend signifies that we are the cusp of something big in the healthcare market. The price differences are so substantial, it is a no-brainer. More insurance groups are offering domestic medical travel plans to employers and more employers are offering them to their employees.”
Devon Herrick of the National Center for Policy Analysis adds, “In the USA, healthcare providers often charge substantially different prices for medical procedures. This means there are opportunities to reduce costs by directing insured patients to a hospital across town or in another state. But health insurers and employer health plans must identify providers offering quality services at lower prices and reward enrollees who use them. Provider networks are competing on price for the business of insurers and employer health plans.”
Herrick has identified a trend, “Two U.S. hospitals in the same provider network may charge much different prices for the same procedure. In response to this price variation, some health plans are creating exclusive provider networks for certain procedures. This strategy, called selective contracting, lowers costs for two reasons: 1) Health plans are able to negotiate better prices with providers because they purchase large volumes of health services; and 2) Their bargaining power vis-à-vis providers is enhanced by the possibility that they will direct enrollees elsewhere, which encourages aggressive price competition.”
Goldstein believes that domestic medical travel will continue to gain momentum and offers the following tips in creating a destination hospital:• Stand out – Choose a key service that you excel in and market it. Be the market authority in that specific service, because the more popular hospitals have narrowly defined differentiation strategies that enable them to distinguish themselves.• Make yours a destination hospital in your marketing efforts – Emphasize that key service and shop it around to businesses, insurance companies and consumers.• Negotiate partnerships with businesses – Offer services in your key healthcare area, which will result in increased traffic, more staff experience and higher quality.
Steven Cyboran of Sibson Consulting advises that, in 2008, 40% of US companies were investigating overseas medical tourism, but the number now actually offering it is well under 1%. He suggests that the hesitation is due to concerns about the lack of data on overseas hospitals; the potential risks associated with political unrest, natural disasters, terrorist acts, or pandemic outbreaks; and questions about whether employees are willing or able to travel.
Rachel Fields of The Delta Group adds, “Driven by the need for high quality and low cost care, health plans are considering an alternative to overseas medical tourism or local treatment: sending members to high-volume, high-quality medical centers in another state or region. This trend means discounts for insurance providers and higher case volume for proven centers of excellence throughout the country. Shane Wolverton of The Delta Group, adds, “Medical tourism is moving from overseas travel to domestic travel. Employers are choosing to recommend domestic medical tourism to target those individuals who cannot afford to take time off work to travel internationally. And it is a lot more comfortable to travel from Greenville to Phoenix than to travel across the ocean. The packaged price of medical travel demands collaboration between physicians and hospitals to promote cost savings. Hospitals with a distinctive competency are most attractive to networks and patients. Those that will benefit immediately from the trend of medical travel are those that can promote an area of expertise that distinguishes them from other hospitals."

Headed by leading cosmetic surgeons, Avia TV is a new television channel aiming to provide accurate and balanced information on cosmetic surgery procedures
Avia TV has launched a search for men and women to receive up to £30,000 worth of free surgery each to make a real change in their lives. The successful applicants will appear in the company’s flagship programme “It Changed My Life” where some of the UK’s top cosmetic surgeons will offer anything from simple to complex cosmetic surgical procedures to help patients get their lives firmly back on track. Avia TV’s consultant surgeons are already well known for their work on such shows as Extreme Makeover, Embarrassing Bodies and The Ugly Face of Beauty.
Around 1.6 million people are estimated to be considering cosmetic surgery. It Changed My Life will tell some of their stories – why they want surgery and what they want to change. We will see them living their lives before surgery, meeting their surgeons to discuss their problems and learn how responsible surgical procedures can help. Only once the consultants are satisfied someone is a suitable candidate will they be accepted. Avia TV will then show the operations in detail, the patient’s recovery and reveal how surgery has really changed a life for the better. All of the Avia TV consultant surgeons are fully accredited and are on the specialist register of the General Medical Council.
Avia TV aims to cut through the myths about cosmetic surgery to provide accurate, reliable and balanced information. Online you can watch films about operations, how to choose a surgeon or a hospital and hear from the surgeons themselves about what they do and what motivates them. Avia TV also wants to inform and educate its audience and the medical profession about existing and emerging techniques in surgery and to invite viewers to ask the experts personally about procedures and their concerns.
Peter Arnstein of McIndoe Surgical Centre, a co-founder of Avia TV says: "Cosmetic surgery is sometimes a misunderstood and often controversial industry so we wanted to devise a web channel dedicated to giving the facts to enable patients to make the right decisions for them. We never forget that the safety and welfare of patients is paramount. It Changed My Life will take care of people and, we hope, will show viewers how responsible surgery should be done."
John Pereira, also of the McIndoe Surgical Centre and co-founder of Avia TV adds, "The new web TV channel is about giving information to viewers. People who appear on It Changed My Life will, through their experience on screen show others what happens during the process of consultation, decision making, surgery and recovery in a factual way that is easy to understand. We have to show people what surgery involves, including the new developments and constant evaluation and re-evaluation of techniques and attitudes. It is a myth that surgery is all about vanity. For me, that means someone who is already beautiful trying to go one stage further. It changes lives, as we see people who have lost all confidence in themselves and what they do in life. Grandmothers who miss out on time with their grandchildren because they feel too embarrassed by their tummy shape to put on a swimming costume and take them to the pool or seaside. Older ladies who have a rejuvenating facelift to restore their self-confidence and enable them to get back into their public lives.”
Stephen Cohen advises, “The web channel is just the first stage of the Avia TV project. From early 2011, millions of viewers will be able to tune in when we launch the broadcast channel on TV screens across Britain.” We are confident that the UK audience will seek out a dedicated source of information about cosmetic surgical procedures, which provide a unique opportunity to change people’s lives for the better. Too often, surgery programmes on television deal with what went wrong or just speculate about the operations celebrities may, or may not, have had done. We are creating a TV channel which gives viewers the facts in a calm and honest way.’’
The co-founders are not fans of cosmetic surgery tourism and argue, “A worrying trend has emerged as some are combining their holiday time with cosmetic surgery abroad and booking a sun, sea and surgery getaway. We would never advise this option. Frankly we feel that it is extremely dangerous to undergo surgery at an unfamiliar hospital in a country where you may not even speak the language. The Ugly Face of Beauty on Channel 4 recently highlighted the very real risk of surgery abroad, and McIndoe Surgical Centre saw those patients first hand when some of our surgeons were asked to perform corrective surgery on a number of ladies who had received substandard surgery abroad.”
McIndoe Surgical Centre urges patients to remain in the UK, and advises anyone considering surgery at home or abroad.• Aftercare is one of the most important aspects of surgery and ideally you should have somewhere within the UK where you can go for aftercare check ups, or for any questions that are linked to the clinic abroad. It is not easy to pop across to another country if you feel you are not healing properly.• Thorough research should be done into the clinic and the surgeon who will be performing your operation. Check they are registered with the GMC (General Medical Council) or that they have specialist qualifications and experience in performing the surgery you require. You should be able to meet your surgeon in the UK before booking the procedure so you can have a detailed consultation and ask plenty of questions.• The price of surgery is obviously important to many people, but be aware that the poor quality cosmetic clinics often do not charge any less than good well equipped hospitals or specialist centres because of the add on charges that appear on the final bill. Check the price quoted is fixed and includes surgical, anaesthetic, hospital, medicines and dressings. Ensure that you are guaranteed free revision surgery should your initial result be substandard and it is appropriate to make alterations.• The best advice of all though, if you want your holiday to be restful, worry free and relaxing is to leave the surgery until you come home and then use a reputable hospital close to home where you can be supported after your surgery. Every surgery comes with risks and to be thousands of miles from home is no joke if things go wrong.

Taiwanese health authorities plan to establish a special zone for medical tourists near Taiwan Taoyuan International Airport, the island’s major international airport in the northern county of Taoyuan. The government aims to attract local and international investors, including hospitals and hotels. Sources differ as to whether private interests are expected to provide all the money to develop the zone or the government plans to invest at least US$130 million in the project.
Health authorities expect that in its first four years of operation the zone will attract 45,000 foreigners. Taiwan has been promoting medical tourism in recent years, and mainly competes with Japan, Singapore, Malaysia, South Korea and Thailand.
The number of medical tourists who went to Taiwan to undergo medical checkups or receive cosmetic surgery in 2008 was about 5000, and by 2009 that increased to 40,000. Almost all are Chinese on group tours as members of medical clubs.
A legislative body that advises the government has suggested that there is a need for the government to amend medical laws to bar hospitals located outside special medical tourism zones from treating or seeking medical tourists. In its study of medical tourism, the Organic Laws and Statutes Bureau said the government should amend articles 61, 88 and 91 of the Medical Care Act to only allow medical institutions located within the special zones to offer medical tourism services. The bureau argues that this is needed to avoid a public backlash, and the government should never provide subsidies drawn from state coffers to such institutions. It also suggested that the government should amend the National Health Insurance Act to exclude medical procedures provided by those hospitals from National Health Insurance coverage. And in addition, the government should amend the Communicable Disease Control Act to bar hospitals in the special zones from attracting patients from epidemic areas and set a ceiling on the number of foreign patients allowed to travel to Taiwan for medical tourism to prevent outbreaks of infectious diseases.
Taiwan has endeavored in recent years to develop medical tourism. Although it has promoted the country, it is now clear that a divide has developed in the authorities, between those who want to encourage it, and those who want to limit and control it.
The Taiwan government is committed to the policy of allowing visits by individual Chinese tourists and business visitors but details of the plan are still being worked out.

Doctor Tomás Vargas Martinez of the Institute Against Blindness from Glaucoma says that health tourism has reached an importance as evidenced by in an increase in the number of foreigners and non-resident Dominicans who go to the country to get good quality medical treatment for their health problems. He wants the Tourism Ministry to promote the segment, rather than leaving it to a handful of agencies and clinics. He said patients from Puerto Rico, Jamaica, San Martin, Antigua, El Salvador, Honduras, New York, Boston, Miami and Atlanta go there for treatment, aware that the country’s specialized clinics are as advanced as those of any other nation in the region, including the United States.
Another speciality of the country is cosmetic surgery, with promotion by Dominican surgeons going abroad to contact patients. Other popular specialties include ophthalmology and prevention of blindness from glaucoma and diabetes.
The Ministry of Tourism reports that tourism in total, including medical tourism, to the Dominican Republic has, unlike most countries, grown in the last two years. During the January-October season in 2009 the number of tourists was 2.8 million and in 2010 it was 2.9 million.
The Dominican Ministry of Health announced that upon receiving information that a Haitian national was detected of having cholera in a Dominican hospital, it immediately isolated the patient and took all the necessary measures to avoid the spread of the illness. Wilmon Louwes, a Haitian national living in the Dominican Republic, is reported as the first cholera case in the Dominican Republic. He visited his family in Haiti, where he picked up the illness as there is a major cholera outbreak there. The Dominican health authorities, assisted by the Pan-American Health Organization, have taken extreme measures to prevent the spread of the illness. Following the protocol established by the World Health Organization, they quickly identified and isolated the country’s first reported cholera case. The Dominican health authorities explained that Louwes first exhibited signs of the illness during his return trip to the Dominican Republic. He was immediately assisted by the health authorities and is recovering in a local hospital. The Minister of Health has introduced various health control mechanisms along the DR/Haiti border in order to prevent the cholera outbreak in Haiti from spilling into the Dominican Republic. The Dominican authorities also ran a media prevention campaign and strengthened health controls along the border region.
All eight international airports are open and receiving commercial flights. All beaches, hotels, resorts and tourism businesses are conducting normal business operations. All security, health, communication and transportation systems are all operating normally and effectively.

Israel’s Health Ministry has appointed Dr. Ronny Gamzo to head an investigation committee to probe the medical tourism industry in Israel. The six committee members appointed by Gamzo includes hospital officials, public officials and academics. Their deliberations will be published before the end of 2010.
This follows a series of articles in Israeli newspaper, The Haaretz. The paper claimed that medical tourists to Israel enjoy medical conditions that Israelis can only dream of, including very short waiting times for procedures, the right to choose their own doctor and private rooms. Dr. Gamzo commented, "The issue of medical tourism is complicated and the question of how to wisely balance the industry’s advantages and disadvantages should be examined. The committee will check what the right balance is, and at the same time examine a way to increase resources that would allow the development of the medical tourism industry that does not come at the expense of Israeli patients."
Currently, Israel gets an estimated 30,000 medical tourists a year, mostly from the former Soviet Union, but with increasing numbers from Africa and the Middle East. Israel’s medical establishment is eager to get more medical tourists, as they are more profitable than local patients. Neighboring Jordan claims 210,000 medical tourists a year. The Ministry of Tourism launched a marketing campaign a few months ago aimed at attracting medical tourists, particularly Americans of Jewish ancestry and Western Europeans.
The committee is to investigate if medical tourism is a benefit. Advocates argue that it brings money into Israel’s perennially cash-strapped health system that will enable hospitals to hire new staff, open new wards and purchase new equipment. They say it is not at the expense of Israeli patients, because medical tourists are treated only after 3 P.M., when the official hospital working day ends.
Another area to be looked at is that there are no regulations on the use of Israeli hospitals and clinics for medical tourism, other than an ancient 1995 directive issued by the Health Ministry’s director general, which states that medical tourism must not come at the expense of the Israeli patient. The Health Ministry is concerned that medical tourism services will undermine the medical service given to Israeli residents.
How does Israel’s medical infrastructure compare to other Western countries? Israel has two hospital beds per 1,000 residents, compared to an OECD average of 3.8. Among OECD nations, only Mexico fares worse. One result is long waiting times for non-emergency procedures. A ministry report last year found that the wait for an ear, nose and throat operation was six to seven months at Sheba Medical Center in Tel Hashomer and 13 months at Western Galilee Hospital in Nahariya.
Danny Angel of the private Assouta Medical Center in Tel Aviv, argues, “Medical services received by tourists in Israel must be identical to those received by Israelis, with one exception. Service must be quicker in the diagnostic sphere. If a tourist has to wait 10 days for a CT or MRI scan, that would make his treatment significantly more expensive and less attractive.“ Opponents argue that if medical tourists are pushed to the front of the line for such tests, waiting times for ordinary Israelis will inevitably lengthen – especially in the departments most frequented by medical tourists, which include the cancer, cardiac and in vitro fertilization units.
The newspaper report says that the argument that medical tourists are treated only after regular hours is misleading as not only must you care for in-patients all day, but hospitals also treat many Israelis after regular hours. Doctors earn extra pay from the hospital’s research fund for such overtime operations, and it also reduces the pressure during regular hours. If medical tourism begins occupying more of the overtime hours now utilized by Israeli patients, then waiting times for all Israelis will grow. The newspaper also says there is no guarantee that hospitals will invest the revenues from medical tourism in new staff or equipment that would benefit all Israelis, as they might prefer to use this money for other purposes. It argued that medical tourists get preferential treatment and quoted examples of operations where Israelis would have to wait months, but medical tourists could be operated on almost immediately as a few appointments are reserved each day for them. It also claimed that while medical tourists are allowed to choose their preferred surgeon, Israelis are not.
The Health Ministry has avoided regulating medical tourism. If it restricts hospital activities, then hospitals will ask it for more money to compensate for the lost income. If it ignores it, Israeli patients who have longer delays, will be upset and exert political pressure. The committee could solve the problem for the government, or it could leave it in a worse position having identified pluses and minuses, but hovering between the two.
A handful of local hospitals are doing well out of medical tourism. Between 2005 and 2009, Tel Aviv’s Ichilov Hospital saw medical tourism revenues increase more than fivefold, while Assaf Harofeh Hospital in Tzrifin saw its revenues quadruple.
Professor Gabi Bin Nun of Ben-Gurion University is against medical tourism, "The right way to operate medical tourism is by first solving Israel’s existing problems. Given the existing problems, it is hard to understand how the Health Ministry can be interested in expanding medical tourism."
The Health Ministry will discuss options with the Tourism Ministry and the Finance Ministry once it has the report.

The rising cost of healthcare in Europe was put into focus when the German parliament passed healthcare reform to overhaul the country’s cash strapped mandatory health insurance scheme and plug a threatened 11-billion-euro shortfall in the public health system for 2011.
Germany’s highly regarded health system covers 72 million people via state health insurance and 8.5 million via private schemes. Mandatory health insurance contributions will require an equal split between employers and employees in Germany, with the contribution increasing by 0.6 percent from 14.9 percent to 15.5 percent of gross wages; the increase being from January 2011. Any future increases in mandatory contributions will be borne solely by employers. The reform in German health law is seen as a fair way to maintain the high standards of the Germany public healthcare system faced with an aging population and a shrinking German work force. The Federal Ministry of Health’s network includes 2,200 hospitals and 300,000 doctors, with the German healthcare system responsible for 4.3 million of the country’s total workforce.
The overhaul is seen as vital for Germany to stem increasing costs associated with its public healthcare system. The German public healthcare system is one of the most expensive in the world. Germany, like other western countries including the United Kingdom and the USA, has taken steps to undertake radical reforms in their healthcare systems to meet changing circumstances and rising healthcare costs. The German healthcare system is noted for the high standards of medical care provided.
Health insurance in Germany is not one state pool, but a collection of large and small private health funds that administer the scheme, and there is no price competition. Two of the largest health funds have dabbled in medical tourism for ancillary care such as spa and dental treatment, both covered by health insurance, but only in a few neighbouring countries. Germany is very pro-Europe, so it is highly unlikely that they would consider treatment outside of Europe, and almost certainly would not consider surgery outside of Germany. The reform aims for more competition among the health insurance funds to maintain diversity and increase efficiency and quality in health care provision; so some may want to compete by offering treatment in other countries for ancillary services.
The health system may seek to increase income from inbound medical tourism. Although they cannot compete on price with Asia, Germany is probably the advanced nation in the world on healthcare technology and treatment.

Dr Devi Shetty has signed an agreement with the Cayman Islands government to establish a heart unit at the George Town Hospital. The cardiac surgeon’s Narayana Group will fund and manage the special unit, which will give Cayman’s heart patients access to proper cardiac care for the first time. The unit will save money for government, as funding overseas health treatment was one of its biggest costs but would also save patients the need to travel. The unit will be up and running in about eight to nine months time as some modifications needed to take place in the operating room.
The gesture by the Indian surgeon will do home no harm to his bid to set up a medical tourism hospital /health city on the island. This is a harder task than once thought as it is now clear that the creation of new legislation and law reform are essential to the development of Dr Shetty’s proposed health city. The Cayman government must change the Health Practitioner’s Law and legislate for tort reform as well as introduce a new law to allow organ and tissue donation before the project goes ahead.
Dr Shetty believes American patients will come to Cayman, but as he plans to use doctors with Indian qualifications rather than with US ones, he needs the government to change the laws to accept Indian doctors and their qualifications. Despite it being a high cost to location to live in, he aims to attract patients from the US at 50-60% of the cost there in a place that Americans will feel comfortable. Shetty argues that Cayman is an attractive destination for quality medical staff, not just from India but also from the US, where the heads of departments at his hospital will come from. Critics argue that the flaw in his logic is that to offer care at such a reduced rate he must be paying doctors less than in the US, so with an increasing shortage of doctors there, why would they go to Cayman for less money than they can get in the US? Others point out that the number of Americans travelling abroad for major surgery, rather than weight-loss surgery or dentistry, is actually much smaller than most estimates and far below the projections that were around when the project was first mooted. Also he will have to compete with Mexico on price. And many Americans will go to Cuba for medical treatment once Cuba has opened up to the US.
Dr Shetty argues that Cayman, which already has the infrastructure related to existing tourism, could become a significant medical tourist destination. With its proximity to the USA and that the destination is considered safe, patients will feel comfortable going there to be treated and the necessary medical experts will also want to live there. Shetty argues, “We are confident Cayman will be a success because America will move to a social form of medicine where waiting lists will be introduced. Waiting lists will drive medical tourism because patients, especially elderly ones, do not want to wait. He pointed to the aging population in Florida that would increasingly need access to affordable and immediate health care, as well as assisted living.” Critics counter that even before healthcare reform, those using state healthcare get free treatment, while those paying for it already go private, so waiting lists are an irrelevance.
Shetty’s local team hopes to break ground sometime in the second quarter of 2011. They will not reveal which locations are being considered. But they admit that the start of the project is heavily dependent on the legislative changes and they cannot move forward until the regulatory issues are resolved.

Ireland is one of the EU countries suffering the most from economic problems, and has recently accepted a 90bn euro (£77bn, $122bn) rescue package from the EU to shore up its ailing economy. Ireland is set to unveil a four-year plan which will require total cuts of 15bn euros ($20bn; £13bn), or 11% of the Irish economy’s annual output. The cuts will inevitably impact the cost and availability of healthcare in Ireland.
The recession will make health inequalities in Ireland worse with growing evidence that the public is opting out of medical services they have to pay for, a survey has found. The latest annual Pfizer Health Index report, which surveys more than 1,000 Irish adults every year, has found that people are going to the doctors and taking screening tests less often and also not attending hospitals as much. The most vulnerable section of society is the C2s or skilled manual workers who constitute nearly a quarter of the population and have been especially hard hit by the recession. A third of them have neither a medical card nor health insurance while in general only one in four of the population has neither. Among the middle-class, two out of three have private health insurance.
Private health insurance in Ireland is becoming more expensive as it is a limited market of three major insurers, each with individual problems. Although prepared to pay for treatment overseas, or across the border in Northern Ireland (part of the UK) for treatment not available in Ireland, all have held firm against allowing medical tourism for their customers. None of the three is prepared to be the first to offer it.
Opposition party SDLP health spokesperson Tommy Gallagher has said huge savings and a better service can be achieved through cross border healthcare. Speaking at the SDLP Annual Conference, he said, “A joint North South study report commissioned by the two governments in 2007 includes recommendations on radiotherapy provision at Altnagelvin and transplant services. The Irish government has now committed the money to jointly develop the radiotherapy unit at Altnagelvin. The business case has now been completed by the Western Trust and it is for the Health Department at Stormont to now move ahead. Yet our health minister is refusing to publish the report on the grounds he is not convinced of the need. This position is at odds with the present realities.The list of cross border initiatives is growing every year. There is a cross-border diabetes network. There is a pilot study on ENT services based at Monaghan that might serve the people of the wider border region. There are numerous examples of ongoing co-operation between the health services on both parts of the island. The dialysis unit at Omagh hospital regularly takes patients from across the border when services at hospitals such as Sligo are under pressure. Northern patients receive treatment for brain injuries in Dublin. Ambulance and fire service crews frequently attend incidents on the other side of the border. In Dublin there is a high level of interest in planning for delivery of health services on a North-South basis because there are significant savings to be achieved for the government and there are of course better outcomes for the populations of border counties. Rural communities through out Ireland face problems to access hospital services because of the centralisation of key services in a small number of large hospitals. We have begun a dialogue on better North-South co-operation can deliver mutual benefits. There are difficulties to be overcome-and they can be overcome if the political will is there. Despite the government’s lack of interest the SDLP want to press ahead with these initiatives.”

With the proposed changes to online advertising rules some timely advice on how to keep online advertising and website sales copy on the right side of the law may be useful.
Jill Benbow of Keystone Law advises; “The web is the fastest growing medium and lets you reach a very targeted audience. It also allows you to monitor the success of your advert. There has been a lot written about how to advertise and how to use pay per click, but what should you actually say and not say in your advert? Here are some simple rules to help you keep the right side of the law when writing your own website copy-

Your businessYou do not have a free rein in relation to the content or arrangement of your websites. Certain details concerning the business must be provided on the site in an easily accessible manner. You must specify your business’s trading name and the name of any company it trades through, the names of the directors (or a statement that such names are available for inspection at your registered office), the address of your registered office and your company registration and VAT numbers. You must also make it clear where you can be contacted, by phone (legally you do not have to give a phone number, but can you afford not to?), email, fax etc. and a correspondence address should also be specified if it is different to that of your registered office. It is a criminal offence to miss out these basic details.

Your services The Trade Description Act applies to what you say on your website, just as it would to your paper adverts, as will the consumer protection from Unfair Trading Regulations. Traders must not make commercial communications to consumers, which are:• Actually misleading (by act or omission);• Aggressive, i.e., by suggesting that if you do not take this offer up NOW, something terrible is going to happen;• Accurate; it may well be the best service in its class, but to say so can lead to accusations that you have incorrectly described the service. One common way round this is to refer to survey results or an independent publication, e.g., ’eight out of ten people said it is the best in its class’, Try and stick to the facts, and steer clear of claims you cannot prove; • Complete; you must give the consumer sufficient information to make an informed transactional decision. An omission can be just as serious as an inaccurate description.
You will need to ensure that all of this information is either in one place, or can be read together, relatively easily, using links or references.

Promises madeIf a buyer of your service argues that a statement that appeared on your website which induced them to buy your service and the statement is subsequently found to be untrue, you are in trouble. Such statements are a representation by you about the service and they need to be accurate. Performance indicators often cause the biggest problem.

Do I really have to comply with these requirements?
Trading Standards are very hot on compliance with the law and have the power to take down your website. Consumers and buyers are often clued up on their rights and won’t stand for breaches of their rights. They may sue you and win or report you to Trading Standards. Cases of fraud or obtaining money by deception attract serious civil and criminal penalties. Lastly, and most importantly, in this day and age of rapid information transmission and so much choice, your reputation matters."

Singapore’s medical tourism business is growing slower than nearby countries such as Korea, Taiwan and Malaysia, as competition is intensifying.
According to research and consulting firm Frost & Sullivan, Singapore attracted 665,380 foreign patients in 2009 – a 3% increase on 2008 with 646,000, and 571,000 in 2007. Pawel Suwinski of Frost & Sullivan estimates that Singapore will get 725,264 foreign patients in 2010. In 2011 and 2012, he forecasts annual growth of 9 %. This is low compared to the 15 to 30 % growth that Malaysia, Thailand and South Korea are enjoying, but the higher priced Singapore gets more revenue per head. Dr Suwinski says, ’We have to remember that there are different business models in operation, with Singapore focusing more on quality rather than volume as in Thailand and India. This is best seen when comparing the revenue per patient figures, with Singapore the undisputed leader.”
Foreign patients in Singapore generated US$1.4 billion in revenue in 2009 – US$2111 a head. This is higher than in Malaysia, South Korea, India or Thailand, where revenue per patient ranged from US$227 to US$2,016. But India is closing the gap, with projected revenue per patient of about US$2100 in 2010. 2010 will also be the year that India overtakes Singapore in volume terms, as it will have an estimated 731,400 foreign patients in 2010. Thailand has consistently been at the top, despite its political woes. The company estimates Thailand received more than 1.2 million foreign patients in 2009 and will get 1.5 million in 2010.
According to the company, the high revenue per foreign patient in India is largely a result of outsourcing. An arrangement between India’s Apollo Hospitals and US insurance firm Blue Shield allows Apollo – India’s largest hospital group – to treat Blue Shield’s corporate clients, who usually are high value. Dr Suwinski adds: ’Hospitals in India are medically equipped to handle European and American patients during their stay after medical procedures. The cost and time of travel also become an incentive, with the US and EU relatively closer to India than South-east Asia.. He argues that if medical outsourcing is taken out of the equations Singapore is the regional leader in medical tourism, but should look at potential partnerships with Western healthcare benefits providers.
There are problems with the figures Dr Suwinksi uses. The latest available medical tourism statistics from the Singapore Tourism Board show that visitors who went to Singapore for medical treatment or related reasons grew 13 percent to 646,000 in 2008 compared to 2007. But 370,000 visitors actually went to Singapore for medical treatment. The other 230,000 are family members of the patients who accompanied them and had no treatment. According to The Tourism Authority of Thailand (TAT), Thailand currently gets 920,000 travelers visiting the kingdom annually as medical tourists. The often-quoted larger figure of 1.4 million is medical tourists and other non-nationals, including business and holiday travellers and expatriates.Indian tourism authorities recently estimated the figure for India to only be 500,000.This throws a different light on his comparisons to the other countries. And Dr Suwinski defines a foreign patient as a person who undergoes any medical procedure outside their home country. He includes people on business trips using medical services, (who are not medical travellers) but excludes expatriates. These different definitions of what a medical tourist is, makes it hard to directly compare figures for different Asian countries.
Singapore too should be wary of relying on US outsourced insurance business, as the actual numbers going to India are tiny and have no real impact on numbers. Information just emerging from the US shows the insurer he mentions as moving to domestic US medical tourism to cut costs and reduce travel times for customers (more on this story next week)
Dr.Suwinski warns that intra-regional movements are volatile and difficult to predict, as many countries – for example, Indonesia – will definitely try to reverse the tendency of their patients going abroad by providing better-quality care quality at home, “We can already see this trend, with modern healthcare facilities being established in Jakarta that boast the best equipment and personnel in the region. It is a warning to Singapore and Malaysia, as they are the biggest recipients of Indonesian patients annually. Between the two, Malaysia is in the more difficult position because it is focuses purely volume, which is highly price-sensitive, and any local competition can substantially decrease the traffic visiting another country.”

Dubai Healthcare City (DHCC), the world’s first integrated healthcare free zone, has successfully completed eight years of operations. DHCC provides a comprehensive range of medical services. Dr Ayesha Abdullah of DHCC says, “DHCC hosts over 2,000 licensed healthcare professionals offering over 60 specialties and speaking 30 different languages. The free zone is home to over 90 facilities with two internationally accredited hospitals. Our ambition is to create an integrated healthcare city. Our strategy is based on extensive research that highlighted significant expenditure by the UAE residents on overseas treatment, outflow of healthcare professionals seeking medical education and research opportunities, as well as a fragmented healthcare system that impacted patient outcomes. To ensure patients receive the highest quality care and clinical services in a safe and reliable environment, the Centre for Healthcare Planning and Quality (CPQ) was established jointly with Harvard Medical International, as the independent regulatory body. CPQ is responsible for implementing rigorous standards that are aligned with international best practice. DHCC has grown into a major medical community and we have greater plans to deliver health and wellness services that compete on an international scale.”
DHCC was intended to attract medical tourists, which it has but in much smaller numbers than expected, bearing in mind the large number of “international” hospitals and clinics on site. A more important function was to reduce the large numbers of Dubai and other UAE state citizens, going to other countries for healthcare. DHCC may have reduced the outflow but many still feel happier being treated overseas. Governments have consistently defended local health provision, but their citizens remain unconvinced. They are right to be wary as a recent leaked report shows.
According to Arab media coverage of the leaked report, in January 2010, a US-based organisation was appointed to review the status of 14 hospitals, 67 primary health centres, three dentistry centres, 10 preventive health centres, four nursing schools and the blood bank over six months. The media coverage says that poor nursing services and incomplete infrastructure prevent Ministry of Health facilities achieving international healthcare standards. The report identified the shortcomings that the Ministry needs to rectify in order to achieve international standards. The assessment of healthcare facilities, commissioned earlier this year by the ministry, is an attempt at acquiring international accreditation and improving the quality of health services in the country.
The healthcare facilities were also judged on the standards of interior environment, compatibility to emergency and disaster situations, human resources management, infection and patients’ safety control, information and medical records department, healthcare department, medical and technical staff, building safety, nursing treatment and services, quality assurance, medical reports documentation and patients’ rights.
The report did not provide the confirmation that the ministry expected…..that most facilities were ready for international accreditation. It has not been published, and information on it has been subject to long delays. The Ministry of Health created Federal Health Authority had approved the project for ministry hospitals and health centres. Officials will have to bring their hospitals up to a higher standard before they can apply for international accreditation.

A second company interested in offering health-related services from the Bahamas, boosting efforts to stimulate medical tourism, is expected to submit documentation to the National Economic Council (NEC) for approval, says the Minister of Tourism.
Nettie Symonette, owner of Nettie’s ’Different of Nassau’ resort on Cable Beach, has confirmed that she has received an offer for her property from addiction treatment providers, Ibocure – already with final approval from the NEC to set up in the Bahamas. Ibocure believes that her property as an ideal location for its addiction treatment centre. Ibocure’s owner, US-based Dr Mark Puleo, says the company – which has received the backing of the Ministries of Tourism and Health and the Bahamas Medical Association – could begin offering its Ibogaine drug to medical tourists by early 2011.The drug has not been approved by the Federal Drug Administration (FDA) in the US, and is said to eradicate substance abuse in less time than other addiction treatments. $2 million has already been raised to start-up the project, and several other US investors are investing. Dr Puleo no longer has the right to practice medicine in the US after being cited by the State of Florida for reselling and redistributing prescription drugs, an act that was prohibited under the supplier’s terms. Ibocure recently trademarked a treatment using the psychedelic drug ibogaine as "nature’s cure for addiction". Made from the root of an African shrub, Ibogaine is currently undergoing clinical trials in the US, where it has been illegal since the 1960s. It is said to eliminate drug craving among addicts with minimal side effects.
The Ministry of Tourism has declined to identify the second firm until it has submitted documentation to the National Economic Council for approval. The ministry says it has identified the business, identified the location and the investors who were prepared to fund it so the only things left are approval from the Medical Association and the NEC. It also says that other companies are expressing interest in potential medical tourism ventures in the Bahamas, particularly on cosmetic surgery, treatments that have been authorised in some developed countries but are still awaiting approval in the US, and treatments that require long periods of rehabilitation.
Medical tourism offers the Bahamas an opportunity to expand the economy and raise employment levels. The immediate advantages to medical tourism companies are a tax-free income and a more relaxed regulatory environment. The danger for the local tourist is of attracting companies because of looser regulation that may be unable to set up anywhere else. Healthcare consumer group Bahamas Patient Advocacy comments, "The cost savings of medical treatment in the Bahamas are a worthy consideration for medical companies: lack of regulatory effectiveness = lack of accountability = savings on operating costs = greater profits. There is nothing inherently wrong with a tax-free income that enhances profit. One likes to believe that the primary objective of a healthcare company is quality service and positive patient outcomes. But a company locating in the Bahamas intends to enhance the profit aspect of the business, because regulatory environment requirements are less, and the track record shows that such requirements as may exist here are not enforced. Economic benefits have to be balanced by effective provision for the welfare and safety of the patients, the same people expected to generate these economic benefits.”
Concern is real, as the island has had problems before. In 1997 American psychiatrist Dr William Rader opened a centre in Nassau to offer controversial stem cell treatments. He refused independent testing of his product by legitimate researchers and claimed to have discovered a cure for AIDS. A critical US television report prompted the government to close Rader’s clinic in 2000. The Immune Augmentative Therapy Centre opened in Freeport in 1977 promoting a treatment that claims to restore the body’s natural ability to kill tumours, although there is little evidence that it works. In 1985 there were reports of HIV contamination of treatment materials and the clinic was closed on the advice of the Pan American Health Organization. But after taking preventive measures, it was allowed to reopen. Despite this track record, local health groups accuse the Ministry of Tourism of favouring treatments that have been authorised in some developed countries but are still awaiting approval in the US; including high intensity focused ultrasound therapy for prostate cancer, and minimally invasive heart valve replacement.
The National Ethics Committee reviews all proposals on a quarterly basis. Facilities also must be approved by the Bahamas Investment Authority that seeks the advice of the Ministry of Health. Once approved the project must apply for a business license and any necessary work permits. This process can be lengthy.

On the Caribbean island of Barbados, the idea of health and wellness tourism is gaining popularity. Many businesses have been set up to offer services and treatments that cater to health, beauty and wellness. Such services include acupuncture, reflexology, yoga, reiki, ear candling, and fitness. They can be provided by medical practitioners or experts from local health spas. The Barbadian government is promoting and encouraging their health and wellness tourism.
The target market is mainly an aging population that has increased demands for fitness programmes, beauty treatment, cosmetic surgery, spas and retirement communities. But the island is also attracting younger customers keen on a healthier lifestyle, looking for vacation destinations that offer spa facilities, fitness and addiction treatment. The main market is Americans.
As the island has an established tourism infrastructure with high quality transport and hotels, it is as an ideal platform on which this new tourism market can be built. The climate is excellent, labour costs are low, communications and transport are reliable, Barbados hotel and tourism services are good, the population is well-educated and both public and private health and medical services have well-trained practitioners.
Many hotels are finding that it pays to have excellent amenities that support fitness and healthy lifestyles. Examples of hotels that provide fitness centers and spas are: Sugar Cane Club Hotel and Spa, Turtle Beach Hotel, The Crane Resort and Residences, Hilton Barbados, Accra Beach Hotel and Spa, Bougainvilla Beach Resort, and Divi Southwinds.
Barbados intends to create a tourism product that is unique amongst others in the Caribbean region. It is setting up a National Health Care Quality Council to attract more tourists for health and wellness. This intends to check that high quality standards exist so health tourism can be expanded within the island.
A report by the Caribbean Commission on Health and Development suggested that health tourism is essential to the region, but many obstacles hat currently hinder development need to go. The problems are medical practice, financing of care and insurance coverage, accreditation and standards, immigration and foreign exchange requirements and competition within the region. Despite several reports, many talks and conferences, there seems little real willingness for Caribbean countries to work together. They realize, without publicly admitting it, that their real competitors are not far off countries, but that they are individually competing for a limited local market on medical and health tourism.

Recent elections in the USA have led to speculation that Obama’s healthcare reform will not happen. Much of the speculation has come from Republicans and right-wing think tanks who are opposed to the reforms. The reality is that although reform may be tinkered with, it is now almost impossible to reverse the progress of the reforms which require myriad new laws and regulations on a federal and state basis. Those hoping that this new uncertainty will drive insurers and employers towards overseas medical tourism should tread carefully; employers will not make major changes to health care provision if they are unclear of the legal situation.
For a studied take on the probable effect on healthcare of the recent US elections, we turn to Paul Keckley of Deloitte Center for Health Solutions whose views can be summarized as follows:1. The Patient Protection and Affordable Care Act (PPACA) was a factor in the mid-term outcome and will likely continue to be one of the focus points.2. The promise to repeal and replace is problematic. The Senate is controlled by the Democrats and the White House has veto power so repeal may be difficult. More likely, certain provisions may be challenged in courts, and bi-partisan agreements may be reached on minor changes.3. The costs of health care entitlement programs (Medicare and Medicaid) will become a central focus as recommendations from the National Commission on Fiscal Responsibility and Reform are presented to Congress. The potential to reduce costs via PPACA’s delivery system reforms—Accountable Care Organizations (ACOs), value-based purchasing, bundled payments, comparative effectiveness, and medical homes—will be a focus of policy-makers.4. States will be the frontline as governors and new legislatures tackle PPACA requirements for health exchanges and insurance plan oversight and increased Medicaid and Children’s Health Insurance Program (CHIP) enrollment without additional federal funding and at a time when state deficits are soaring.
Health reform is more than PPACA; it is a series of legislative and regulatory actions intended to reshape the financing and delivery of care in the U.S. system. Americans are paying attention and have strong opinions—it matters!
President Obama offers a solution, “If the Republicans have ideas for how to improve our health-care system, if they want to suggest modifications that would deliver faster and more effective reform to a health-care system that has been wildly expensive for too many families and businesses and certainly for our federal government, I’m happy to consider some of those ideas. So there are going to be examples where we can tweak and make improvements. But I don’t think that if you ask the American people, should we go back to a situation where people with pre-existing conditions can’t get health insurance, should we allow insurance companies to drop your coverage when you get sick, even though you had been paying premiums, I don’t think that you’d have a strong vote for people saying those are provisions I want to eliminate.”
The reality is that national health reform is here. The health reform bills (HR3590 and HR4872) are now law and will trigger sweeping changes over many years. The PPACA signed into law on March 23, 2010, requires that beginning in 2011, insurance companies meet new medical loss ratio requirements designed to ensure premium dollars go to health care. The National Association of Insurance Commissioners (NAIC), an organization of state insurance commissioners, issued their Medical Loss Ratio Regulation (MLR Regulation) as required by the Patient Protection and Affordable Care Act to require NAIC to adopt uniform definitions and standardized methodologies to calculate the medical loss ratios of health insurers in the individual, small group and large group markets. Health insurers are required to pay rebates to their insureds if their medical loss ratio is less than the minimum established by PPACA (80% for the individual and small group markets, 85% for the large group market). The medical loss ratio is the ratio of premiums expended on reimbursement for clinical services plus expenditures on the improvement of health care quality and total premium revenue minus taxes and fees. The MLR Regulation becomes effective on January 1 2011.Until they have sorted out the practicalities of the new laws, insurers are going to very wary of considering medical tourism deals as nobody is certain if the travel and other non-medical costs would be counted within or outside the loss ratio figures. The law tasks the NAIC with a number of additional provisions to consider, including rate review and consumer information.

The US Supreme Court refused to hear a legal challenge to President Obama’s healthcare reform law, with the case not yet having wound its way through the lower US courts. The Supreme Court, the judicial authority of last resort, declined to hear the case brought by Steve Baldwin and the Pacific Justice Institute, which had filed a federal lawsuit in California challenging the new massive health care law. The plaintiffs asked the court to determine whether Congress has the constitutional power to decree that every American must purchase health insurance by 2014, as mandated in the law. The justices declined to take the case without comment. The case has yet to receive a ruling from an appeals court in California, making it premature for the Supreme Court to intervene.
Republicans recently took control of the House of Representatives, but Democrats maintained control of the Senate and still hold the White House. Both chambers would have to approve revisions, with President Obama likely to veto any changes to what has been a major domestic win for his administration. Obama has challenged the Republicans seeking to delay or derail the bill to come up with a better solution – the silence is deafening. David Cordani of Cigna warns those seeking to stop or delay healthcare reform. "Repealing the new U.S. healthcare law would be a waste of time, but there is room to improve it. I don’t think it is in our society’s best interest to expend energy in repealing the law. Our country expended over a year of sweat equity around the formation of it."
Evidence that reform is needed more than ever is shown by headline figures from the Centers for Disease Control and Prevention (CDC) – the full report is not yet released. 59.1 million Americans went without health insurance coverage for at least part of 2010, many of them with conditions or diseases that needed treatment. 4 million more Americans went without insurance in the first part of 2010 than during the same time in 2008. Dr. Thomas Frieden of CDC says, "Both adults and kids lost private coverage over the past decade. Congress passed provisions expanding free health coverage for children. As private insurance coverage fell, the safety net protected children, but did not protect adults. 9% of adults lost private insurance, and public insurance picked up just 5%. 22% of adults aged 18 to 64 are uninsured. The data allows us to debunk a myth about health care coverage. The myth is that it is only the poor who are uninsured. In fact, half of the uninsured are over the poverty level and one in three adults under 65 in the middle income range between $44,000 and $65,000 a year for a family of four – were uninsured at some point in the year." The analysis found that in the first quarter of 2010, an estimated 59.1 million people had no health insurance for at least part of the year, an increase from 58.7 million in 2009 and 56.4 million in 2008.
Blaming healthcare reform for the increased numbers is totally inaccurate, as it will be several years before the main thrust of almost compulsory insurance for all, actually takes effect. There is a much more basic reason. Thousands of American businesses have gone under and many have reduced the workforce and employee benefits such as healthcare insurance. One in ten Americans is unemployed, and many more are on reduced hours and pay. Millions have had their homes foreclosed; millions more are way behind with their mortgage payments. So health insurance is way down the list of essential purchases.
Before the medical tourism industry rejoices at a huge new potential market, it should stop and think that most of these people will not be able to afford any healthcare, however low-price or essential it is. The mood of the government, business and people is against overseas outsourcing of any services, as the US looks increasingly inward to rebuild the economy.

Whatever the final version is of the Cross-Border Healthcare Directive, it will only work if there is a revolution in health technology. New EU laws allowing patients to travel across borders for health care will be a driver for the development of e-health services in Europe. Incompatible IT systems are a major obstacle that unless overcome, will make the directive almost impossible to implement.
It is not just incompatibility between countries, and the language problem, but in many EU countries there are several incompatible systems within each hospital. Sharing test results and medical imaging between hospitals can prove challenging. Language and terminology differences, as well as data protection concerns, make sending information between member states a problem.
One of the aims of the EU Directive is to allow patients with rare diseases to access specialist centres anywhere in Europe, through eHealth. This would save time, money and stress associated with travelling to see specialist doctors. This, say patient advocates, can only be achieved if there is investment in technology. A major problem is, who will pay for the changes? Getting doctors and nursing staff on board will be the key factor that decides whether eHealth succeeds.
Clauses in the Cross-border Healthcare Directive covering eHealth were watered down by EU health ministers but have been strengthened by MEPs who see the new rules as a chance to boost quality of care, save money and stimulate a new market for high-tech companies. The Council of Europe, worried about costs, has weakened what the Directive says about eHealth but Parliament is determined to restore this and make sure it survives in the final compromise text.
Bulgarian MEP Antonyia Parvanova is convinced that eHealth can contribute to patient safety and innovation in the health technology sector. However, she says interoperability between systems remains a huge challenge as technology is now an indispensable part of health care and can provide real added value if national and European authorities cooperate. Patients will still need someone to interact with, says Parvanova, and the public will not be satisfied if they are expected to talk to a screen.
John Dalli, EU commissioner for health and consumer policy, argues that new technologies can help put patients’ rights, patient safety and access to health services at the heart of policymaking, "Technology will also save health professionals’ time if they don’t have to move around from one hospital to another to provide services. We can have a few centres of excellence accessible even to those who do not live nearby. For patients with rare diseases this is particularly important. We can have focal points of expertise that can then deliver services to all corners of Europe. Systems must be able to speak to one another within hospitals, between hospitals and ultimately across borders. Political will is needed to make eHealth a reality. Member states are responsible for health but we must bring people together to discuss cooperation if we want to make the most of eHealth and cross-border collaboration. When investing in healthcare, sustainability is essential. In economic terms, eHealth can help make savings by cutting out duplication of work and reducing the travelling costs for patients."
Health systems are under pressure from ageing population, rising costs of new technology and medicines, heightened patient expectations and global economic challenges. Everybody is looking for solutions. eHealth has an important role to play in delivering efficient and effective health care. Dr Simonetta Scalvini says it is time to stop caring for diseases and start looking after patients. She believes there is evidence that telemedicine can reduce mortality while increasing quality and cutting costs, but "The biggest problem in applying new technology is resistance from doctors. The medical profession must change its mentality". Pascal Garel of HOPE is positive about what technology can do to change health services but warns there is a long way to go before the potential is realized as health workers have seen a series of technological failures over the years which can breed a degree of scepticism.
Fabian Zuleeg at the European Policy Centre warns that public financing will be very scarce in Europe for some time to come, "Where will the investment come from? We have to look at business, public private partnerships and the profit-motive in the provision of health care. Some of the funding may have to come from the patients themselves."
Florian Lupescu of the European Commission’s directorate-general for the information society, makes the point that patients crossing borders have the right to receive the best possible care but Europe must ensure the appropriate mechanisms and legal framework are in place, "eHealth can make this possible. The possibility for systems to understand each other despite languages, and cultural differences is something we cannot afford to miss. We have the political commitment from health ministries. We have the support of stakeholders, patients associations, professionals, and consumers groups. Now we need the legal certainty."
The EU may have the political will to implement cross-border healthcare and technology, but getting that to work properly will take decades, not years. This offers the European medical tourism industry a window of opportunity as people will become more aware of the availability of treatment outside their own country, but for many years yet will be frustrated by practical problems if expecting the state to pay for treatment.

Cleveland Clinic has launched an international website focused on providing Middle Eastern visitors with streamlined access to information on diseases, conditions and treatment options. The site features an interchangeable Arabic/English option, enabling visitors to learn more about Cleveland Clinic’s world-class care in their native language.
The new website utilizes the existing internet platform with a focus on providing health information on diseases and conditions that are prevalent in the Middle East region. The site also provides contact information, resources to make travel arrangements easier and an overview of services available through the international patient office. For patients and families, there are translated resources to help with making an appointment and coordinating a visit. There are also condition-specific guides to better understand diagnosis and treatment including cardiovascular disease, women’s health and epilepsy. The website has profile information about 1,800 doctors, including languages spoken and diseases/conditions treated. Patients can select the best practitioner to meet their individual needs.
Bill Ruschhaupt of Cleveland Clinic says, "For many years, we have treated patients from all of the Middle East countries. This website is just one way in which we are continuing to provide all of our patients, and prospective patients, the best experience possible." Cleveland Clinic in Cleveland, Ohio, is a not-for-profit academic medical centre that integrates clinical and hospital care with research and education. It operates nine regional hospitals in Northeast Ohio, Cleveland Clinic Florida, the Lou Ruvo Center for Brain Health in Las Vegas and Cleveland Clinic Canada. Patients come for treatment from every state and from more than 80 countries.

Mayo Clinic has joined the medical network of UnitedHealthcare, making it cheaper for 20 million of the insurers’ commercial members around the country to seek care there. This is the first national contract Mayo has signed and is part of a move by Mayo to shed its aura of expensive exclusivity. UnitedHealth members will now pay in-network prices if they go to Mayo, which can offer significant savings over out-of-network prices. This national agreement with UnitedHealthcare covers all Mayo’s group practices and hospitals in Rochester, Jacksonville, Phoenix and Scottsdale.
Mayo had smaller, specialized contracts with UnitedHealth in the past. Since 2004, it’s been part of UnitedHealth’s transplant network. It also has contracts with other national insurers, but those agreements only cover people in some regions of the country. Mayo has a reputation for being more expensive per procedure while UnitedHealth has a reputation for driving a hard bargain with providers. The promise of more commercial business is attractive to Mayo because after barely breaking even in 2008, it only managed a small profit in 2009. Mayo treated 528,000 patients last year. Currently, 20 to 30% of patients travel more than 500 miles for treatment.
Cleveland Clinic is also benefiting from several company and insurers deals where US patients travel some distance for certain procedures. Lowe’s home improvement stores recently offered employees free trips to Cleveland Clinic for cardiac surgeries in return for lower cost sharing. 44% of its heart surgery patients are not from Ohio. Lowe’s deal, rolled out in February, is a success, with 19 employees (15% of those likely to be eligible for the surgery in any given year) taking advantage to date. Lowe’s expects to break even or save money on each operation, even after providing financial incentives such as waiving the deductible and paying all travel costs for the employee and a companion. One of the first employee patients, who faced a particularly complex heart problem, cost the company $469,000, compared with the $531,000 local hospitals would have charged.
US insurers and top hospital groups have accepted the benefits of US domestic medical tourism, and are embracing President Obama’s entreaties to increase jobs by increasing exports, and attracting medical tourists from overseas into the USA. President Obama is focused on promoting economic growth, to create job opportunities for US workers, and export opportunities for service providers. His administration sees Asia as a key target market for goods and services. The National Export Initiative (NEI) aims to double US exports by trade deals and encouraging US businesses to invest overseas. Ironically, this means that US businesses that may have considered medical tourism for employees are now in an environment where the government is actively against any overseas outsourcing of goods or services.

Medical referral patients who need treatment outside the Commonwealth island of Saipan may not have that option for a while after travel agencies stopped issuing them airline tickets due to the government’s nonpayment of $180,000 of arrears owed.

Department of Public Health secretary Joseph Kevin Villagomez confirmed to the Saipan Tribune that travel agencies suspended the processing of travel documents for off-island medical referrals. So far, five to 10 medical referral cases have been affected, all of which are for follow-ups. The CNMI government owes Wings Travel, Pacific Sky, and World Tour and Travel a total of $180,000, admitted Villagomez, and payment for each vendor has been delayed by over a month. “Right now, we are working with the Department of Finance to pay the travel agencies. They have not been paid for awhile so they stopped the processing of medical referral travels for now until they collected the $180,000 obligation.”
Villagomez is working out a payment plan for the government that is so broke that it cannot give a date as to when the payment will be released to vendors, “The Medical Referral Office are communicating with Finance, but I do not know exactly when the cheques will be released because of the cash flow problem of the government.” Payments for the medical referral vendors are separate from the budget of the Department of Public Health, which is too broke to finish its own website, because the money comes from other funding sources.
Since the news broke, only one travel agency allowed medical referral trips to Guam while a total ban was placed on trips to the Philippines and Honolulu. The two other travel agencies implemented a complete ban on all these destinations. Villagomez admitted that emergency cases are the biggest worry they have, “The affected cases are for follow-ups and there is no immediate repercussion if we will delay it by a day or a week. But if we have emergency cases tomorrow, what course do we have other than to plead with these travel agencies to at least temporarily lift the travel ban? We will pay the obligation and it is just a matter of time.” The Department of Public Health spent $16.3 million in the last four fiscal years, ending in fiscal year 2009, to send Commonwealth patients to various medical facilities off island for treatment.
Saipan is the largest island of the United States Commonwealth of the Northern Mariana Islands (CNMI), a chain of 15 tropical islands belonging to the Marianas archipelago in the western Pacific Ocean. The population is under 60,000. It is a popular tourist destination in the Pacific, 190 km north of Guam.
Travel to and from the island is via Saipan International Airport. Tourism has long been a vital source of the island’s revenue, although the industry has undergone a serious decline, while the other export earner, garment making, closed last year. Some major airlines have since ceased regular service to the island.
With medical facilities on the island poor, people go to Guam or further afield for treatment. In the last two years, other Asia-Pacific islands have had difficulty paying the bills for medical treatment overseas. Those medical tourism destinations seeking business from overseas governments should learn the lesson that it is not a risk free business, as they will certainly be paid late, and maybe not at all.

SpaFinder, the global spa and wellness resource, has unveiled the winners of its 2010 Readers’ Choice Awards – honouring spa-goers’ favourite spas across the globe, along with their top ten picks in 31 categories. Based on votes submitted worldwide at SpaFinder’s global websites and by readers of SpaFinder publications. Susie Ellis of SpaFinder says, "There are now more than 15,000 hotel, resort and destination spas worldwide."
In addition to nations traditionally recognised by the awards, ten new spa markets were added in 2010: Bulgaria, Chile, Cyprus, Czech Republic, Egypt, Hungary, Morocco, Portugal, Turkey and the United Arab Emirates.
The Crystal Award recognises the number-one spa on each continent.• Africa: One&Only Cape Town (Cape Town, South Africa)• Asia: Ananda in the Himalayas (Narendra Nagar, India)• Australia: Gwinganna Lifestyle Retreat (Queensland, Australia)• Europe: Hotel Adlon Kempinski Berlin (Berlin, Germany)• North America: Golden Door (California, United States)• South America: Kurotel Longevity Center and Spa (Gramado, Brazil)
Awards were given for the favourite spa in 29 other countries/regions-• Argentina: Four Seasons Hotel Buenos Aires• Austria: The Balance Resort• Bulgaria: Kempinski Hotel Grand Arena Bansko• Canada: Ste. Anne’s Country Inn and Spa• Caribbean: Parrot Cay (Turks and Caicos)• Central America: Tabacón Grand Spa Thermal Resort (Costa Rica)• Chile: The Ritz-Carlton, Santiago• China (Hong Kong): Four Seasons Hotel• China (Mainland): The Ritz-Carlton, Beijing• Cyprus: Le Méridien Limassol Spa & Resort• The Czech Republic: Mandarin Oriental, Prague• Egypt: Four Seasons Hotel Alexandria• France: Guerlain Spa at Trianon Palace Versailles• Greece: Porto Elounda De Luxe Resort• Hungary: Danubius Hotel Gellért• Indonesia: Conrad Bali• Ireland: Inchydoney Island Lodge and Spa• Italy: Lefay Resort & Spa Lago Di Garda• Japan: The Ritz-Carlton, Tokyo• Malaysia: Shangri-La’s Tanjung Aru Resort & Spa• Maldives: One&Only Reethi Rah, Maldives• Mexico: Rancho La Puerta• Morocco: La Mamounia• The Philippines: The Farm at San Benito• Portugal: Four Seasons Hotel Ritz Lisbon• Russia: The Ritz-Carlton, Moscow• Scandinavia: Blue Lagoon (Iceland)• Singapore: Willow Stream Spa at Fairmont Singapore• South Pacific Islands: Four Seasons Resort and Spa Bora Bora• Spain: SHA Wellness Clinic• Switzerland: Victoria-Jungfrau Grand Hotel & Spa• Thailand: Kamalaya Wellness Sanctuary and Holistic Spa• Turkey: Four Seasons Hotel Istanbul at the Bosphorus• United Arab Emirates: Burj Al Arab• United Kingdom: Gleneagles Hotel (Scotland)

Planet Hospital, one of the pioneering medical tourism agencies in the U.S., is hoping to send more medical tourists to Korean hospitals next year. The company has so far sent less than 20 medical tourists to Korean hospitals. Rudy Rupak of Planet Hospital says, "We would like there to be a lot more. We want at least 100 patients in 2011. We are also looking at opportunities in Russia. America is not the only place that tourists should be coming from. They should be coming from Europe, Africa, Asia and other developing countries as well." Planet Hospital is partnering with the Korea Medical Institute (KMI), which will take care of the medical tourists, and is working with the Korea Tourism Organization to promote medical tourism.
Korea is trying to build up its medical tourism program, in an effort to compete with Thailand, Singapore and India. Korea currently attracts around 50,000 medical tourists annually.
On the resort island of Jeju, the government is building Health Care Town, a 370-acre complex of medical clinics and apartments surrounded by 18-hole golf courses and beaches, to attract foreigners in need of medical care. At Inchon, a new town is being built to attract foreign visitors, including medical tourists.
South Korea clinics and the South Korean government are trying hard to attract these tourists, who not only bring in money for cash-strapped hospitals but also help the economy. The government has revised immigration rules to allow foreign patients and their families to get long-term medical visas and has altered laws to permit local hospitals to form joint ventures with foreign hospitals.

Wooridul Spine Hospital had 1,000 foreign patients in 2008, with patients from 47 countries, about a third from the United States. Wooridul plans to build a hospital, apartments, a concert hall and an art museum on the Jeju island as part of its medical tourism offering, in addition to the golf course it has already built. The government-run Jeju Development Center says the town will specialize in medical checkups, long-term convalescence, cosmetic surgery and dentistry.
A local survey of 29 hospitals showed that they treated 38,822 foreign patients – which includes holiday and business travellers and US armed forces but excludes long-term Korean expatriates – between January and August, compared with 15,680 in 2007, according to the government-financed Korea Health Industry Development Institute. It said 25 percent of those patients were from the United States, and 10 percent each were from China and Japan.

Seoul National University Hospital plans to open a marketing office in Los Angeles, and hopes to attract medical tourists from the pool of two million Korean-Americans.

The Philippines faces a tough task as it seeks to compete with established Asian competitors for medical tourists. For several years it has promoted its lower medical costs, advanced medical technology, caring healthcare workers who can speak English, and wide choice of destinations. But apart from Filipinos living overseas, it struggles to attract people, so continues to fall well short of targets.
An annual target of 700,000 medical travellers was set by the government in 2008, and the latest target is a million by 2015. Although higher figures are frequently quoted, the latest official national figures from the Department of Tourism is that 100,000 medical travelers visited the Philippines in 2009, each estimated to have spent at least $2,000.
Earlier this year the government and the private sector partnered to form HEAL Philippines, the Health and Wellness Alliance of the Philippines. The alliance includes hospitals, clinics, spas and other medical tourism providers. It is now educating local governments about medical tourism so they can make the much-needed improvements to the local infrastructure. 39 hospitals and clinics around the country, mostly in Manila, are accredited under the government’s medical tourism programme.
To achieve its targets, the government has to be very aggressive in its marketing efforts, says Elizabeth Nelle of the Department of Tourism. She argues that a bigger marketing budget is needed and a single agency must be tasked to carry it out, as Singapore has done, rather than the complexity of competing local organizations. She says that most medical tourists are people seeking cheap cosmetic, eye and dental surgery. In these areas, she says the country is cheaper than Thailand, Malaysia, Singapore and India. But for medical procedures, the Philippines can be more expensive than in Thailand, India and Malaysia. In recent years, says Nelle, most medical travellers to the Philippines have been Filipinos based overseas, mainly the United States and Canada. Eva Trinidad of Philippine Medical Tourism sees potential from Japan, but admits that Filipino health workers will also have to learn to speak other foreign languages, such as Japanese, to be able to properly deal with non-English-speaking patients. The Tourism Department says primary markets include the Middle East. Korea and Pacific island states and territories, while secondary markets include Australia, Japan, South Korea, Taiwan and Europe. Middle Eastern tourists are particularly lucrative because they come with their families, stay in hotels, travel a lot, and do a lot of shopping. Residents of Micronesian states such as Guam and Nauru choose the Philippines for essential medical treatment because they must go overseas and choose somewhere close by and affordable.
Where the Philippines is doing much better is wellness tourism, with thousands of spas all over the country, most of which promote traditional Filipino healing massage.

KEMP Healthcare With patient care and safety emerging as a major concern, a US/UK healthcare company plans to launch a certification service for hospitals in India in early 2011. KEMP Healthcare Ltd plans to launch a Quality of Care certification service that will bring to a hospital evidence-based quality improvement measures that have been tried and tested in international healthcare systems as reliable processes. The company is targeting hospitals that are keen and committed to provide better care to their patients and want to build on their existing strengths to excel on the 5 stars of quality, safety, timeliness, effectiveness of care, and patient satisfaction. Appraisal of successful incorporation of these 5 stars by KEMP Healthcare would result in achievement of certification and the hospital could promote itself as a ’KEMP 5 Star Certified Hospital’.
The aim is to enable consumers of healthcare in India to make an informed decision when choosing hospital for themselves and their families. The company says it will give the hospitals additional credibility, confidence and visibility within an increasingly competitive market and claims to make them more attractive to foreign patients visiting India for medical tourism. KEMP Healthcare is a trans-Atlantic co-operation that brings US and UK healthcare expertise together, to provide evidence-based solutions to healthcare systems globally so as to improve efficiency and deliver quality. How a company that has no international track record in this sector, and with a name that means nothing to medical tourists or agencies, plans to compete with established international accreditors and persuade hospitals to use it instead, is an interesting question.
Mercury Healthcare
Mercury Healthcare of the USA has launched a UK subsidiary in London to help it develop in Europe and Commonwealth countries. It will provide training, consulting, and support services to the Central and Eastern European medical tourism markets and government agencies throughout the Commonwealth and the European Union. Mercury Healthcare is also a medical tourism agency with a network of hospitals and other healthcare providers in more than 25 countries, including more than 200 hospitals and over 15,000 doctors, dentists and allied health providers.

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

A new legal ruling will affect new EU rules on cross-border health care. A series of rulings by the European Court of Justice (ECJ), beginning over a decade ago, established that healthcare could be sought by EU citizens in any member state, while patients seeking such cross-border healthcare were entitled to have their costs covered by their own health systems. This prompted the European Commission to adopt a proposal for a directive. The proposal was intended to provide more clarity about possibilities to seek healthcare in another member state and to set out rules on responsibility insofar as quality and safety of care in cross-border settings are concerned.
The proposal was confirmation of the ECJ rulings that citizens could seek treatment anywhere in the EU and be entitled to claim reimbursement in their home countries. Patients could therefore seek non-hospital care, such as dental treatment and medical consultations, without prior authorisation but they were obliged to obtain prior authorisation in relation to in-patient procedures, such as surgery.
A ruling delivered in October by the ECJ dealt with cross-border healthcare in the EU. It went one step further from the proposed directive. The court was asked by a Bulgarian court to give a preliminary ruling on whether the national health system of Bulgaria was obliged to pay for the medical treatment abroad of any Bulgarian who was unable to receive treatment in the country within the time normally necessary for the treatment, after taking into account the patient’s current state of health and the probable outcome of the medical problem.
Georgi Elchinov was diagnosed with malignant cancer in his right eye. Bulgarian doctors recommended eye surgery, a procedure that could be carried out in Germany, but could effectively save his eye, unlike the procedure carried out in Bulgaria. He applied with the national health insurance fund to be allowed treatment abroad, but since the case was urgent and the answer took a long time, Elchinov left for Berlin, only to learn later that payment for the surgery had been denied. He underwent treatment in Germany and his eye was saved. Elchinov sued the fund in the Sofia Administrative Court and won. The fund then filed appeal proceedings before the Supreme Administrative Court, and eventually the ECJ was asked to give a preliminary ruling.
In its decision, the European Court held that the refusal on the part of the health insurance fund was out of line, and maintained that the fund was obliged to pay for healthcare and treatment of Bulgarian citizens abroad if they could not receive such treatment in the country at all or on time, depending on the ailment. The court established that excluding in all cases payment for hospital treatment given in another member state without prior authorisation was unreasonable, especially in those situations where the patient is prevented from applying, or unable to wait, for such authorisation.
So, if a patient sought treatment abroad before having the agreement of the fund, the patient is still entitled to reimbursement in circumstances where the member state could not provide timely or alternative cure. In coming to its decision, the court rejected the argument put forth by the insurance fund and the Bulgarian government that the occurrence of such situations could undermine hospital planning and the financial balance of the social security system. The court ruled that Bulgarian law constituted an unjustified restriction on the freedom to provide and obtain services.
This legal ruling is significant, as the legislation of a member state cannot exclude across the board reimbursement for hospital treatment given in another member state to a patient without prior authorisation. While this judgement was given in relation to a specific case, national institutions of other member states are still obliged to follow the guidelines established by this ruling in setting out their own policy on entitlement to reimbursement for cross border healthcare since the court’s decisions are mandatory for all similar institutions with similar cases across the EU.

Rush University of Chicago, in partnership with the University HealthSystem Consortium (UHC), has been awarded a three-year $500,000 Market Development Cooperative Grant from the U.S. Department of Commerce to help boost medical travel to U.S. academic medical centres.
The goal of the project is to stimulate growth in the number of patients from abroad choosing U.S. academic medical centers for care through better data that tracks medical care exports, networking across institutions, and the implementation of best strategic business development practices. Medical care exports are defined as medical care in the U.S. purchased by individuals outside the country.
The grant is intended to help further President Obama’s National Export Initiative, announced earlier this year, which aims to double exports by 2015 in support of several million U.S. jobs. The U.S. is experiencing increasing competition from hospitals abroad for patients with specialty care needs.
In Rush’s Department of Health Systems Management, Andrew Garman and Tricia Johnson will develop the methodology to value medical care exports and assess the impact of these strategies on exports over the next 3 years. Garman and Johnson, in a study to be published later this year in Health Policy, estimated that in 2007 between 43,000 and 103,000 foreigners went to the U.S. for medical care, and between 50,000 and 121,000 U.S. residents traveled abroad for care. The outbound figure is significantly less than the numbers often quoted within the medical tourism industry. Under the Commerce grant, the researchers expect to be able to set up a system to better track these figures and obtain more precise numbers.
At UHC, Steven Meurer and Samuel Hohmann will establish a forum for international patient programmes; create a standardized set of data elements to be reported on international patients; host a series of meetings focused on strategies to increase the global competitiveness of U.S. academic medical centers and develop strategic relationships with foreign ministries of health and private payers. UHC of, Chicago, Illinois, formed in 1984, is an alliance of 107 academic medical centres and 246 of their affiliated hospitals representing approximately 90% of the nation’s non-profit academic medical centres.

ICON Group has a new 54-page report as part of its global series on medical tourism, ’The 2009-2014 European Outlook for Medical Tourism.’
This econometric study covers the outlook for medical tourism in Europe. For each year considered, the estimates are given for the latent demand, or potential industry earnings (PIE), for the country in question (in millions of U.S. dollars), the share in percent of the country in the region and the world. These comparative benchmarks allow the reader to quickly assess a country vis-à-vis others. Using econometric models that project fundamental economic dynamics within each country and across countries, latent demand estimates are created.
This report does not address specific players in the market serving the latent demand, nor specific details at the product level. The study does not consider short-term cyclicality that could affect sales. The study is strategic in nature, taking an overall view and long term, irrespective of the players or products involved.
This study does not report actual sales data (which are simply unavailable, in a manner similar or compatible in almost all European countries). This study gives estimates for the latent demand for medical tourism in Europe. It also shows how the pie is divided between the national markets of Europe. For each country, it shows estimates of how the pie grows over time (positive or negative growth).
The concept of latent demand is rather subtle. The term latent typically refers to something that is dormant, not observable or not yet realized. Demand is the notion of an economic quantity that a target population or market requires under different assumptions of price, quality, and distribution, among other factors. It is a measure of potential industry earnings (P.I.E.) or total revenues (not profit) if a market is served in an efficient manner. It is typically expressed as the total revenues potentially extracted by firms.
The latent demand for medical tourism is not actual or historic sales. Nor is latent demand, future sales. In fact, latent demand can be lower or higher than actual sales if a market is inefficient. Inefficiencies arise from a number of factors, including the lack of international openness, cultural barriers to consumption, regulations, and cartel-like behavior on the part of firms. In general, however, latent demand is typically larger than actual sales in a country market.
In order to estimate the latent demand for medical tourism in Europe, the author used a multi-stage approach. Latent demand functions relate the income of a country, city, state, household, or individual to realized consumption. For firms to serve a market, they must perceive a latent demand and be able to serve that demand at a minimal return. The single most important variable determining consumption, assuming latent demand exists, is income.
It considers the latent demand for medical tourism across all the countries in Europe. The smallest have fewer than 10,000 inhabitants. The countries included are Albania, Andorra, Austria, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Italy, Kazakhstan, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Moldova, Monaco, Netherlands Norway, Poland, Portugal, Romania, Russia, San Marino, Slovakia, Slovenia, Spain, Sweden, Switzerland, United Kingdom and Ukraine.

European Parliament MEPs have voted on new EU rules on access and rights to cross-border healthcare. The vote strikes a balance between guaranteeing patients’ rights to cross-border healthcare and safeguarding the provision of quality health services at national level. Patients have the right to get hospital treatment in other member states and be reimbursed as they would for receiving the treatment at home, however this right should not be at the expense of the viability of national health systems.
The proposal will allow member states to establish a reasonable system of prior authorisation for treatment, but MEPs succeeded in significantly narrowing the list of reasons for which a patient can be refused cross-border treatment. An important change from earlier drafts is that member states will not be able to refuse reimbursement after prior authorisation has been granted. MEP’s hope that The European Council will take these improvements on board, so that the legislation can be finalised as soon as possible.
At present if a European citizen wants to get treatment in another country they do not know if they will be refunded and how that may happen. There have been difficulties that citizens have brought before the European Court of Justice. So the European Parliament must legislate to solve this problem. This directive is designed to allow patient mobility. We already have mobility of workers and students. It is part of the fundamental rights of European citizens. This does not encourage medical tourism, but simply to allow a wider range of public health for patients, especially in border regions.
If the directive is approved, patients will have a choice about the place where they seek treatment and the possibility of having the best possible care. There will be centres with national contacts to access information relating to health care in other countries.

Cross-border healthcare * 1% of public health budgets spent per year on cross-border healthcare.* 30% of EU citizens are not aware of the possibility to receive healthcare outside their country.* 25 millions of European citizens suffer from rare diseases.
If someone needs permission to go and receive care in another EU country, the payment will be paid directly by the country of the patient to the country where the medical care is received. Many EU countries have resisted this proposal, as they fear an invasion of patients and an increase in healthcare costs. While most now accept the outcome as inevitable, some countries are reluctant. Poland, Slovakia and Portugal voted against the proposal in Council last month, and Romania abstained.
Cross-border medical care is only a very small portion of public spending on health. In most cases patients can be reimbursed for treatment in another country only if this treatment is covered by their national system, and the level covered in their state. For example, if in Germany patients are not entitled to dental care reimbursement and they go for treatment in France, Germany will not have to repay them. There will be no way for a patient to obtain a financial benefit related to reimbursement.
There were 227 amendments to the plan, and six consolidated amendments, but verbal agreements were made over the following three points:* Patients can seek medical care in another country without prior authorisation. However, for hospital stays and specialised care, patients could need pre-authorisation from their national health system.* A country can only refuse to authorise cross-border care in a very limited number of circumstances.* The 25 million Europeans with rare diseases will be covered under the proposed law.
Normally, people prefer to stay close to home and family when in need of medical care. They usually only travel far when they need specialised treatment, or when better facilities are just across the border. This is frequently the case in Luxembourg, where a lot of residents go to neighbouring France, Belgium or Germany for treatment. About 7% of the country’s medical payments are cross-border, the highest in the EU. Most countries spend 1% or less of their national health budgets on cross-border care.
The proposal now has broad support in the Parliament, and consumer advocates are in favour. European consumer organisation BEUC supports the European Parliament’s position, and says, ’’Patients do not like to be cared for far from home in another member state, but if they want or need to they should be entitled to the same rights for information, treatment and reimbursement".

Timeline July 2008: European Commission proposalApril 2009: European Parliament first readingJune 2010: Council’s of EU ministers reach their positionOctober 2010: Report scheduled for adoption in EP committee, 2nd readingJanuary 2011: EP plenary sitting, 2nd readingJune 2011: Adoption of the directive

South Africa’s ruling party, the African National Congress (ANC) has finalized the plan to mandate universal access to healthcare through a National Health Insurance Scheme. It has to be debated in parliament, and although details may be altered, the principle is unlikely to have enough opposition to stop it happening.
The ANC’s National Health Insurance plan aims to ensure access to healthcare is based on need rather than the ability to pay, with the intention of doing this through a single payer health insurance system. The initiative will focus on local primary care networks rather than large-sized hospitals. South Africa currently spends just over 8% of GDP on healthcare every year, almost all on the private healthcare system, even though 64% of the South African population relies upon the public system. The scheme will be funded by general taxation, while additional financing may be sought through a surcharge on taxable income; an increased value-added tax dedicated to the scheme, and payroll taxes for employers and employees.
The first phase of the project will begin in 2012, and will focus primarily on bringing services to areas with little or no access to quality healthcare. A number of other key areas of attention include investing and rebuilding the country’s public health infrastructure, developing human resources to fill the national shortage of qualified health workers, and establishing a national health fund that will operate autonomously from government departments. The plan is a long-term one, the first stage being for 14 years.
The South African government is seeking the advice of British health experts on the imminent implementation of the National Health Insurance (NHI) in South Africa. The scheme is an ambitious health reform. South Africa is to learn from UK experience of how health services can be delivered based on principles of honesty and respect, with a culture of safety, quality, openness, accountability and collaborative teamwork that can promote responsiveness to a patient’s needs. The objective is to put in place the necessary funding and health service delivery mechanisms that will enable the creation of an efficient, equitable and sustainable health system in South Africa.
The country’s five major hospitals are to undergo major rehabilitation to prepare them for the NHI. The hospitals are the Chris Hani Baragwanath, George Mkhari, Limpopo Academic, King Edward in Durban and Nelson Mandela Academic in the Eastern Cape. They will all be given a new look and in some instances may undergo a complete rebuilding. The government is likely to bring in a new system of hospital accreditation.
Affluent South Africans will still be able to use private healthcare, through the purchase of private medical insurance and use of private hospitals. The plan will effectively mean that public hospitals will have neither the time, money or bed space to offer medical tourism. But in the future, if more locals are dealt with for free, then the private sector, much of which has been rather condescending about medical tourism, may have to look at medical tourism to fill bed space.

A new US television programme on a national cable network from Bullseye Productions, ’The Health and Wellness Travel Show’ is recruiting American men with non-life threatening ailments such as lower back pain, adult acne, ED, irritable bowel syndrome, sleep apnea, migraines, and tinnitus. It wants to use them as guinea pigs for alternative medicines and procedures that claim to provide a cure or relief.
All the programmes will feature treatments available outside the USA. Volunteers will travel to the far corners of the Earth to witness first hand and take part in some of the world’s most amazing, extreme and ancient practices. Participants will work with a diverse team of local medical practitioners in exotic international locations – from traditional doctors to shamans and tribal healers – to explore the culture’s treatments for common medical ailments. Some will be a participant; others will just be an observer. This is not a magical cure for a serious health issue, or for people suffering from a life threatening or debilitating illness – this all-expense-paid trip is a health exploration around the world.

Germany plans to cash in on the worldwide wellness industry. 415,000 international visitors took a health-oriented holiday in Germany in 2008. This is in addition to 70,000 medical tourists. The main source market was Switzerland, accounting for 57% of visitors. Final 2009 figures are not yet available but are expected to be higher. According to the ’Quality Monitor’ German tourism industry survey, 40% of international visitors go to Germany for rest and relaxation while 14% specifically want to enhance their health and fitness.
The German National Tourist Board (GNTB) is gearing up to make 2011 the year of wellness tourism marketing. Petra Hedorfer of the GNTB explains, "We want to boost the number of overnight stays by specifically promoting Germany as a destination for health and fitness holidays." The 2011 theme year concentrates on three main areas: spas and health resorts, wellness and beauty hotels and medical tourism. One of its main marketing tools is the www.germany.travel website, which offers extensive information about health and fitness holidays. The theme year content will be expanded and a special section on medical tourism will be added in readiness for 2011. Print products for each area will be available in various languages. The GNTB will also promote the theme year and its three areas of focus on fact-finding tours, in workshops and at trade fairs and roadshows.
Germany’s spas and health resorts are a destination of choice for preventive care, rehabilitation and treatment of chronic illnesses. As preparation for the theme year, the GNTB has signed a cooperation agreement with the German Spa Association (DHV) to launch a global image campaign showing Germany’s spas and health resorts as unspoilt destinations offering innovative health treatments.
GNTB is marketing wellness and beauty with a cross-media concept that centres around hotels and is supported by the independent hotel sector and wellness tourism brands. They are joining forces to promote Germany’s wellness and beauty hotels as oases of calm and well-being, offering high-quality treatments with which guests can spoil themselves. The key markets of the global image campaign are the Netherlands, Belgium, Switzerland, Italy and Spain.
Germany already receives many visitors who come for medical treatment. German clinics are renowned for their excellent quality and reasonable prices. GNTB will reinforce this image, highlighting the top clinics for international patients and the tourist attractions of the nearby towns and cities. It is targeting the United States, Russia, the Arab Gulf States and selected European countries.
The wellness-hotel sector caters for the middle- to high-end market. For well over a decade, most 4-star and 5-star hotels have provided comprehensive wellness areas with high-tech saunas, steam baths and jacuzzis to their clients. Despite competing with Switzerland and Austria, Germany remains Europe’s largest wellness market. In the competitive, sophisticated market, client expectations are constantly on the rise, along with the growing number of services and providers. Four- and 5-star hotels must regularly renovate their facilities to stay in the wellness race.

To expand medical tourism, the Japanese government plans to make it easier for Chinese and Asians to obtain short-term medical service visas by providing information on websites of Japanese embassies and consulates. The aim is to make the country’s advanced medical services accessible to wealthy Chinese and Asians. Medical travel is now part of the government’s strategy to boost the economy. So the country is promoting medical services including routine checkups and treatment.
The government hopes to increase the number of medical tourists without changing the current visa system. For short-term visas for medical treatment in Japan, applicants are required to provide certification of their ability to pay for the travel, besides the documentation required for ordinary visas such as flight information. Currently, the websites of Japanese embassies and consulates provide information on documents required to obtain visas to visit relatives and acquaintances as well as for sightseeing and short business trips. However, those seeking information about medical service visas need to visit embassies and consulates. The government is also expected to issue multiple-entry visas for people who need follow-up medical treatment. On the websites, the government plans to add the category "stay for receiving medical services" and provide information on the required documents. Though medical visas have been available for some time, their existence is not widely known.

Dokkyo Medical University and the World Heritage-listed Nikko Toshogu shrine are partnering to help the nation’s tourism agencies and hospitals look into ways of attracting people to visit Japan for medical checkups. Hotels in the Kinugawa onsen hot spring resort, one of Nikko’s top attractions, are offering medical service packages, which include a hotel stay and a complete medical checkup. The packages are targeted at both the domestic and international tourism markets. Four Chinese visitors have visited the medical tourism department since it was set up in April with a resident Chinese nurse.
Dokkyo Medical University’s Nikko Medical Center and Nikko Toshogu have together launched the International Association of Tourism Medicine (IATM) –which is not a medical travel association but a forum. According to Takaaki Nakamoto of Nikko Medical Center, medical facilities in major Chinese cities like Shanghai are not much different from those in Japan, but the quality of medical technology and level of dependability are considered higher in Japanese hospitals.
The Nikko Medical Center has entered a collaborative arrangement with Tongji University Hospital in Shanghai, establishing a system for follow-up monitoring of their patients after they return to China. As comprehensive medical examinations are not yet widely available in China, Chinese patients have demanded not just check-ups during their stay in Japan but treatment as well. So IATM has been set up as a forum in which healthcare providers and other involved parties can review case studies and exchange information crucial to establishing a full-scale medical tourism industry. Since the founding of IATM there are plans to standardize the content of physical exams at all participating hospitals and collaborate with travel agencies.

Ireland has suffered badly from the economic crisis and has taken tough measures that have seen many people take a substantial salary cut. Included in the government cutbacks are reductions in the amount that the state pays for dental care. Ireland is an example of how government health cuts can drive people to look for treatment abroad. It is a pattern that is may be repeated in other countries.
The Irish Dental Association (IDA) called on the Minister for Health, Mary Harney, to carry out an immediate evaluation of the effects of the wide-ranging reductions to the PRSI and Medical Card schemes. The answer was blunt- no change, no review.
The government restricted the PRSI Dental scheme so that from 1st January 2010 eligible patients are only entitled to a free check-up. Previously, over 2 million Irish taxpayers and their dependent spouse or partners were entitled to free and discounted dental treatment (e.g. on fillings, extractions, root canal work or dentures) under the PRSI scheme.
Fintan Hourihan of the Irish Dental Association says, “The failure of the Department of Health to evaluate the effects of the cutbacks shows head in the sand thinking is alive and well in the department. The failure of the minister to evaluate the effects of the cutbacks on 1.9 million Medical Card holders beggars belief. We have warned that they are storing up huge problems for the dental health of the nation for the future. If people are denied treatments now, the remedial treatment needed in a few years time will be more painful and much more expensive. So these cuts are not just unfair they simply don’t make any financial sense. Whatever the reason it is grossly irresponsible and patients down the line will suffer. When implementing the cuts to the dental schemes, the government said it was doing so to protect services for children and those with special needs. The promise to look after children and special needs groups rings hollow.”
Reduced state funding to the dental benefit scheme has and will have serious consequences for those who cannot afford to pay for private dental treatment and have an impact on the income of those dentists who operate the scheme. Private dental treatment in Ireland is not cheap, and the IDA’s complaints are as much about protecting the income of their members as protecting consumers.
Problems of accessibility to dental services are not solely a result of the withdrawal or curtailment of state. Many patients find it considerably cheaper to travel across the border to Northern Ireland (which is part of the United Kingdom, while Ireland is an independent EU state) or to Eastern Europe for dental treatment. Many Irish people continue to travel to Budapest to get dental treatment that they find unaffordable at home.
The IDA has consistently defended what many in Ireland regard as the prohibitive costs of getting private dental treatment in Ireland. While state and private employees have been forced to accept substantial salary cuts, or lose their job in a market where getting a new one is far from easy, dentists, hospitals and clinics in the country may have seen a reduction in business, but show no willingness to cut prices.
In a biting recession health providers have to offer realistic and affordable treatment. With other countries following Ireland with lower salaries and drastic cuts in health expenditure, people will increasingly be driven into the private health sector. Whether this is at home or overseas, will depend very much on whether or not local providers can or are willing to offer cheaper services. So the growth of outbound medical tourism will depend not just what destination countries are offering, but whether local providers are prepared to compete for domestic and European custom.

The Tourism Authority of Thailand (TAT) has launched a new blog contest to promote medical tourism. It wants bloggers experienced in writing on the subject of either tourism, medical or/and medical tourism for a medical blog contest. A first prize is $10,000 in cash with a further $3,000 in hotel vouchers. Criteria to be amongst the twelve finalists will include; an ability to demonstrate knowledge of medical tourism and/or medical tourism in Thailand, innovative ideas for promoting a medical tourism blog, and the ability to show enthusiasm.
Between the 20th of November and the 26th of November, finalists will be treated to a luxury, all-inclusive seven-day medical tourism familiarisation trip. Finalists will travel either to Phuket, Chiang Mai, Pattaya, Koh Samui or Bangkok. During their times at these destinations they will receive familiarisation tours of hospitals and healthcare facilities. And they will enjoy special trips and excursions, put on by TAT, to help them both experience and better understand the many and diverse attractions Thailand has to offer as a world class tourist destination.
Whilst staying in Thailand they will have to write a blog of their daily experiences using stories, photos and videos. The goal for the contestants is to inform a global audience about the facilities available, for any prospective visitor. The blogger should also engage a reader’s interest sufficiently for them to want to seek out further information relating to medical tourism within Thailand. The overall winner must look to attract the highest number of visitors to their blog site. And they will also be judged on the accuracy, quality, clarity and persuasiveness of their blog.
Thailand has embarked on an aggressive digital campaign to win back tourists who were discouraged by reports of political violence in the country this year. It has also identified a new target market of retirees to whom it wants to market specialised, transparent and simple packages that include medical and wellness tourism. Meanwhile, tourism continues to grow. In the first half of this year, Asian countries contributed the largest number of foreign tourists, followed by East Asia, non-Scandinavian Europe and Scandinavia.
According to TAT, Thailand currently gets 920,000 travelers visiting the kingdom annually as medical tourists. The often-quoted larger figure of 1.4 million is medical tourists and other non-nationals, that includes business and holiday travelers and expatriates. The largest group coming for medical tourism is from the Middle East with UAE at 44% of the total, followed by Qatar 9% and Oman 6% and less from Bahrain and Kuwait.
TAT has also launched a new website ThailandMedTourism.com, to provide information on surgical procedures, health service providers, packages and promotions, destinations, and up to date articles and news. TAT has set ambitious targets for future arrivals. As part of their overall marketing strategy, in order to achieve these targets, the new website is designed to bring together a whole range of information to assist prospective visitors. Medical treatments available are listed and also explained. Each treatment carries a general description along with information relating to the length of treatment or surgery, benefits, ideal candidates, planning, preparation, recovery and potential risks, complications and side effects.
TAT is undertaking a proactive and interesting approach, with the aim of increasing current revenue to $2 billion annually, and reviving Thailand’s rather battered global reputation.

India’s national hospital accreditation programme- National Accreditation Board for Hospital (NABH), run and managed by the Quality Council of India, is going global. In India, 55 hospitals have formally received NABH accreditation while another 365 have applied for it. Accreditation remains a voluntary process in India.
NABH will begin in the Philippines and plans to extend into Bangladesh and Nepal by the end of 2010, and into Sri Lanka in 2011. Future plans are to extend into Middle Eastern countries, starting off with the state of Dubai. NABH also sees African countries such as Kenya and Nigeria as logical future destinations, as Indian hospital chains see great potential in Africa. NABH has set up a separate division to look after its overseas operation, National Accreditation Board for Hospitals and Healthcare Providers (NABH) International.
The driver to service international hospitals is the expansion of large Indian hospital groups into subsidiaries or joint ventures in an increasing number of countries globally. Girdhar Gyani of NABH explains, "The vision to go global has been there for a while but the opportunity arose when hospital managements which already have NABH accreditation in India started demanding accreditation for their overseas hospitals as well. We are ready for competition from the American, Canadian and other international accreditation agencies which are already present in the targeted countries."
Hospitals have been complaining that international accreditors in a competitive market are too expensive and inflexible on costs. NABH say that a three-year accreditation from JCI in the Philippines costs close to $46,000, while a comparable NABH accreditation costs a little over half that amount. Although initially aimed at hospitals and clinics, NABH International will also offer accreditation to spas and wellness centres.
Through its exclusive Philippine representative, HealthCORE, NABH International has been launched to improve conditions, systems, processes, and skills of hospitals and professionals in the country. Dr. Sanjiv Malik of NABH says, "Accreditation is a practical solution to one of the main issues in medical tourism, which is quality and safety assurance. NABH International allows hospitals to build credibility and confidence, which generates recognition among foreign patients, thereby promoting medical tourism." The Department of Tourism (DoT) believes that accreditation is the key for medical tourism to truly flourish in the Philippines, as it will recognize the Filipino healthcare providers to be at par with world-class standards.
NABH International’s accreditation process entails onsite visits to assess if standards on access, care of patients, management of medication, patient rights, and infection control are met. Standards on continuous quality improvement, good governance, facility safety, human resources, and information management system are evaluated by highly qualified and well-trained assessors who are doctors, healthcare administrators, or nursing supervisors.

Mexico is experiencing an increase in medical tourists and this year the number will comfortably exceed the 50,000 in 2009, says Health Digital System (HDS). Between January and September of this year, 44,512 foreigners checked in to Mexican hospitals, 25 percent more than the 35,610 who did so during the same period in 2009. Last year, some 50,000 foreign patients were treated in Mexico and each one spent an average of $13,000 per week on medical care, for a total of $650 million, according to an HDS study.
HDS expects this sector to continue growing and that in two years it will generate revenues of about $1.2 billion. The good quality of care and the low charges, which are about half the equivalent medical costs in the USA, spurs foreign patients to come to be treated in Mexican hospitals. Most come from the United States and Canada for everything from regular checkups to dental and cosmetic surgery, and more recently there has been an increase in those seeking major surgery. Jaime Cater of HDS says, "Mexico has managed to increase the development of its health system and in private hospitals as well as federal ones emphasis is being decisively placed on strengthening this type of tourism."
The Mexican government is working with U.S. insurance companies to get their customers treated in Mexico, but the stumbling block is that only 2% of the hospitals and clinics in Mexico have Joint Commission International accreditation. This is why the federal health department is working on new certification for hospitals both on the northern border as well as in the centre of the country.
These numbers actually understate the number of people crossing the US border into Mexico for treatment, as they would not count as foreigners, Mexicans who live and work in the USA and go back to Mexico for medical care. Neither do the figures include much of the mostly daycare treatment of the increasing number of cross-border insurance schemes that allow Americans and Mexicans living in border states, the option of treatment in the USA or in Mexico.
HDS estimates that only 300,000 U.S. citizens now travel abroad for medical care. According to some estimates, five years ago, about 750,000 Americans sought medical care in other countries. But there were just 540,000 medical travelers in 2008, according to a 2009 report by Deloitte Center for Health Solutions. Researchers at Deloitte predicted medical tourism would rebound in 2009 and 2010 from a pent-up demand for elective procedures, with an annual 20% growth rate. But that did not happen. In a local paper, Paul Keckley of Deloitte said, "The economy has beaten down the anticipated 20% growth," Patrick Marsek, of MedRetreat, an Illinois-based medical travel agency that was one of the first when it started in 2003, reported booming business in 2007, but says that business has been down 30% since the end of 2008. "The people we would normally service are the people who are struggling right now financially, who are trying to figure out a way to pay their mortgage and to pay for food."
Medical tourism experts thought the drop in health travel during the recession would be temporary, and that a substantial recovery would soon follow. Instead, the anticipated rebound has not happened due to the slow economic recovery in many countries, the uncertainties of health reform in the USA, and high unemployment. Individuals do not have spare cash to pay for treatment, while companies are reluctant to consider including medical tourism in health plans while the details of health reform are in a state of flux.
With fewer people traveling outside the United States for elective procedures, medical tourism agencies have had to make changes in their business plans or consider closing down. MedToGo of Arizona is finding fewer takers for elective procedures such as hip replacements and dental, so are offering bone marrow and kidney transplants, and other life-saving procedures. MedToGo is negotiating with two hospitals for the transplants to be done in Mexico.

Presenting to fellow European members of parliament her recommendations on cross-border health care for a second reading, French rapporteur Françoise Grossetête insisted she would be uncompromising on the issue of prior authorisation. While she does not question this principle, she rejects the quality and security criteria added by the Council, which would make it possible for a member state to arbitrarily refuse to grant authorisation to a patient, “I believe that this criterion is unacceptable because it would make it possible for prior authorisation to be refused at any time without explanation. It is inconceivable and would, in the end, lead to new appeals before the European Court of Justice”.
The objective of the proposal for a directive is to standardise case law of the Court of Justice of the European Union and avoid the ambiguity faced by patients. The Commission is attempting to clarify the rights of patients treated in another member state, including the issue of the reimbursement of care. As a general principle, it establishes that patients treated in another member state will receive the same level of reimbursement anticipated for the same treatment or for a similar treatment in their national health system, if they are entitled to this treatment in their country of affiliation.
Grossetete is an influential MEP and her stance could help influence changes in the Second Reading later this year. Her worry is that the latest version still enables member states to limit the application of rules relating to the reimbursement of cross-border health care by demanding prior authorisation for certain treatments. According to the rapporteur, prior authorisation must be based on the need for health care planning and rationalisation, but cannot be abused in order to deny patients the right to travel for treatment. She therefore proposes even tougher restrictions- limiting prior authorisation to hospital treatment (a stay of more than one night in hospital), specialised care or treatment that poses a particular risk to the patient or the population.
Grossetête believes that this text must be urgently concluded under the best possible conditions because the question has been open for too long. She makes a valid point that less than one per cent of the European population would even consider state paid healthcare in another country, as most people prefer to be treated at home. Her argument is that if states are offered the opportunity for prior authorisation and reimbursement, unless carefully controlled, the practice in some member states will make the whole concept unmanageable.
Grossetête will be intransigent on the issue of rare diseases, as she wants patients suffering from rare diseases to have access to care in another member state and be reimbursed, particularly if the treatment is not provided in their member state. She joins an increasing number of MEPs arguing that rare diseases must not be subject to prior authorisation. She points out an area that was not resolved in the latest version from Council, but appears to be yet another get out clause agreed earlier this year by health ministers. This is the stipulation that patients who have obtained prior authorisation must provide advance payment to the hospital .Her argument is that this makes a nonsense of the whole agreement and the logic must be that if any advance payment is allowed, then this should only be in those few countries where at home, the patient has to pay an advance fee to the hospital before reclaiming from the state after the treatment.

Medicare Europe is a British medical tourism agency that focuses on Eastern European countries for dental care, IVF, eye care and cosmetic surgery. It has set up a European office in Kiev in the Ukraine, as that country is increasing in popularity for offering high quality care at a reasonable price.
More patients from Western Europe are seeking dental care in Ukraine, as the treatment costs are much cheaper than most European countries. Originally, most dental tourists came from other post-Soviet bloc countries. Now, every year sees an increasing number from Canada, USA, Germany, UK, Ireland and continental European countries.
London based business consultant Panamedical Consulting, in cooperation with Ukraine based surrogacy agency IRTSA, has organised an information seminar for the public and medical profession.” Infertility Treatment and Reproductive Technologies in Ukraine" on 23 October 2010 at Nov NOVOTEL Hotel, on Southwark Bridge Rd, London. The seminar will cover a range of issues related to medical, organisational and legal aspects of reproductive medical treatment and technologies. Recent advances in reproductive technologies make it possible for men and women who previously were not able to have children to become parents. The seminar will cover common types of infertility treatment – IVF, egg sharing/donation, ICSI and surrogacy as well as most recent developments in the science of human reproduction.
Ukraine is one of the most popular destinations in Europe for couples or single individuals looking to become parents for the first time. Many prospective British and European parents go to Ukraine for treatment. Recently, Ukraine has become the top destination for same sex couples who, because of religious prejudice, governmental policy of lack of tolerance within the society cannot use assisted reproduction treatment in their own country. The seminar will cover this issue in depth and present various options open to same sex couples who want to become parents. Legal aspects of assisted reproduction treatment are of paramount importance. A child born in Ukraine to a European mother or to a Ukrainian surrogate mother will need to go home with his/her parents to their respective country. Different countries have different policies with regards to children born overseas and these will be discussed by Ukrainian medical and immigration lawyers.
Panamedical Consulting LTD (UK) is seeking entries for the launch of the first annual International Medical Tourism Directory 2011. The directory seeks to be a trusted source of useful information on medical and health clinics offering their services to clients around the globe in dentistry, cosmetic surgery, reproductive medicine, ophthalmology, orthopaedics, cosmetology, spa/wellness, and surgery.
The directory also provides essential information on medical technologies and tourist information on countries, currencies, accommodation, transport, regional cuisine and various helpful tips one may need in a foreign country.
The International Medical Tourism Directory 2011 will be available in business centres and offices of leading international companies, banks, law firms, hotels, sports clubs, and beauty saloons throughout Western Europe, Asia, Middle East, USA, Russia, Ukraine, Kazakhstan and other countries, and also distributed to high networth individuals and professionals. All entries have to be paid for. The 616-page colour directory will be published in English and Russian, with 8,000 printed copies in each language.

International consultant Deloitte has conducted a strategic study for an unnamed client investigating the potential benefits medical tourism could bring to the New Zealand health sector and the wider economy. Findings highlight the competitive advantages and potential benefits of medical tourism for New Zealand.
Key findings-

If the New Zealand health sector is able to attract medical tourists then the spare capacity in private hospitals could be filled with patients who bring a greater economic benefit to the wider economy. These medical tourists are likely to spend time in New Zealand after their operation recuperating, contributing further to the local economy.
The greatest and most lucrative market concentration of potential medical tourists for the New Zealand market is the West Coast of the USA. With only a 12-hour non-stop flight from either Los Angeles or San Francisco it makes New Zealand relatively accessible in comparison with Asian countries involved in medical tourism.
The level of care and skill level of surgeons and anaesthetists are similar to the U.S. in the core procedures being targeted for medical tourism. This is an important factor to reassure patients and medical insurers who are looking at offshore medical procedures that they would be receiving a similar level of care as in the U.S.
New Zealand is an attractive destination because procedure costs are less than half the cost compared to the United States, which makes it more affordable for uninsured patients paying for medical procedures and also for medical insurers.
New Zealand is a first world country with similar values and culture so is likely to make it a more attractive destination for medical procedures than countries such as Thailand, Korea, India and Malaysia.

Deloitte accepts that medical tourism, despite attempts to promote it to US customers, is so small as to be almost non-existent. It estimates that the current medical tourism market in New Zealand is very small, with 150 overseas patients a year. The New Zealand private health system could develop and capitalise on the competitive advantage identified. Opportunities to expand this potential market are now being explored by a number of organisations involved in private healthcare. Medical tourism as a viable way for private hospitals to supplement their current patients, and boost the utilisation of their hospital bed nights.
Agencies keen on promoting the country point out –

It has a very low level of violent crime and murder.
No terrorism problem
Political stability
Foreign travellers are welcome.
Extremely low rates of the infectious diseases MRSA, hepatitis A, VRE, tuberculosis, and HIV.
No need for vaccinations for typhoid, malaria, rabies, hepatitis A, and Japanese encephalitis. Traveling to New Zealand requires no vaccinations.
The food is safe and the water is clean.
Hospitals and clinics are clean and state-of-the-art, all using the latest technologies.
English is the primary language, a factor that is so important when discussing a major medical treatment such as knee or hip replacement surgery.
Direct flights from Los Angeles to Auckland in 12 hours.

For the second year running, New Zealand is the most peaceful nation on Earth, according to the findings of the Institute of Economics and Peace. The 2010 Global Peace Index ranks 149 countries according to their degree of peacefulness.

Medical tourism is one of the topics covered in a new survey of outbound US travellers. The ’Ypartnership/Harrison Group 2010 Portrait Of American Travelers’ is a survey of the travel habits, intentions and preferences of Americans living in the USA.The national survey of 2,524 US households who are active travelers was conducted in February 2010. The results provide an in-depth examination of the impact of the current economic environment, social values and media habits on the travel habits of Americans with an annual household income of $50,000 or more.
Ypartnership is a leading marketing services company serving travel, leisure and entertainment clients. The agency’s Insights group is a leading source of market intelligence on emerging business and leisure travel trends. Harrison Group is a leading market research and strategy consulting firm specializing in market strategy, market analytics, survey and forecasting services. This year’s survey was an in-depth examination of the impact of the current economic environment, prevailing social values and emerging media habits on the travel behaviour of American travellers. It seeks the underlying motivations with an emphasis on how they plan, purchase and share travel experiences; rather than a simplistic view of past travel habits. For the first time, the annual survey investigated medical tourism.
The survey is only about attitudes and the figures do not reflect anything on actual numbers who have travelled. In consumer research, attitude/intent is not necessarily transferred into actual purchase in any meaningful way. 50% of leisure travelers are now familiar with the concept of medical tourism, and 17% would consider having a medical procedure done outside the U.S. assuming it is perceived to be of comparable quality. 22% are not sure, suggesting they would also be open to considering this as an alternative to treatment at home if certain conditions were met.
Among adults who would consider traveling outside the U.S. for major medical care, 84% cite the lower cost as the primary reason why. 66% mention comparable or a better quality of care, while 43% cite access to medical treatments or procedures that are not covered by their insurance at home, and 41% mention shorter waiting periods to access care .22% cite access to experimental or non-FDA approved treatments and 20% mention concerns about privacy
Among countries measured in the survey as possible medical tourism destinations, Canada reigns as the number one choice. The top eleven countries:

Canada (42%)
United Kingdom (32%)
Germany (31%)
Sweden (28%)
France (24%)
Mexico (13%)
India (11%)
Singapore (10%)
Costa Rica (9%)
Brazil (7%)
Puerto Rico (7%)

These figures are on the basis that they are paid for by health insurers, financial incentives from insurers and/or employers are at least comparable to treatment in the USA, and quality of care is also equivalent. The figures do not reflect intent or willingness to travel for self-payers.
These results are another confirmation of a trend that many medical tourism experts accept, but others continue to deny, that travel time and nearness of destination are key to where medical tourists are prepared to go, not cost alone. American preference is within the American continent, followed by Europe, with Asia much less popular.

Medical tourism is to go under the microscope in a major new 18-month study from November 2010, led by an academic from the University of York, which aims to assess its potential advantages and disadvantages. "Inward and outward implications for the NHS of Medical Tourism" is funded by the National Institute for Health Research (NIHR), and will examine the motives people have for travelling across national boundaries to receive treatments such as dental services, elective surgery for hip or joint replacement, cosmetic surgery and fertility treatment.
Dr Neil Lunt, of the York Management School, will head a team of researchers that includes health economists, social scientists and clinicians who will research four aspects of medical tourism. They will spend the 18 months studying the economic impact, consumerism and patient decision-making, quality, safety and risk, and industry development.
In the UK, medical tourism is 99% privately funded and the researchers will seek to establish the amount people are paying for this healthcare and its economic impact. They will also examine the potential savings for the NHS that contracting out treatments to other countries might bring. This will be linked to a review of potentially negative impacts on the NHS, such as the need to ensure continuity of care for people who have been treated abroad and the cost of treating complications. The work will contribute towards understanding quality, administrative and legal dimensions of medical tourism as well as unintended consequences.
The research team will explore how patients make their decisions concerning treatments and destinations, what information they use – such as websites, friends, internet chat rooms – and how informed their choices are. Patients will also be asked about their experiences of treatment abroad. Neil Lunt says: “We will advance knowledge of patient treatment experience and how consumers think about choice, and how risk and safety are managed at the consumer and organisational levels. Our work will contribute towards understanding quality, administrative and legal dimensions of medical tourism as well as unintended consequences. The study will be of interest to those working within and making decisions about the NHS, policy-makers, regulators, providers, clinicians and consumer organisations as well as patients. My main research interests are around the organisation, management and delivery of health and social services, the role of research within policy and practice, welfare policy, migration and welfare, and medical tourism. I have particular interests in comparative dimensions of public sector reform and welfare restructuring (South Korea, Australasia, Singapore, China). I am keen to supervise PhD candidates on these and related topics.”
The research team includes Professor Stephen Green of Sheffield Teaching Hospitals Foundation NHS Trust; Dr Mark Exworthy of the School of Management at Royal Holloway, University of London; Professor Russell Mannion of the Health Services Management Centre at the University of Birmingham and Professor Richard Smith, of the Department of Global Health and Development, London School of Hygiene & Tropical Medicine.
The National Institute for Health Research (NIHR) commissions and funds NHS and social care research to support decision making by professionals, policy makers and patients. It funds open access research, not implementation or service development. The key objective is to improve the quality, relevance, and focus of research in the NHS and social care by encouraging initiatives that increase the potential for quality research to be widely disseminated and freely accessed. This is the first time that any UK government funded body has paid for original research on medical tourism.
Neil Lunt has published several academic studies on medical tourism-

Lunt, N. and Carerra, P. (2010) ’Medical tourism: assessing the evidence on treatment abroad’, Maturitas: an International journal of mid-life health, 66, 27-32.
Carrera, P. and Lunt, N. (2010) A European perspective on medical tourism: the need for a knowledge base, International Journal of Health Services, 40, 3, 469-484.
Lunt, N., Hardey, M. and Mannion R. (2010) ’Nip, Tuck and Click: Medical tourism and the emergence of web-based health information’, Open Medical Informatics Journal, Volume 4, 1-11, doi: 10.2174/1874431101004010001

http://www.bentham.org/open/tominfoj/openaccess2.htm

When it comes to advising people how to take care of themselves, UK based Wellbeing Escapes, spa and wellbeing holiday agents, say they are in tune with what makes people tick. Recognising that their clients lead stressful lives and as a response to the additional pressures many of them have been under this past year, they have launched Mind Unwind offering tailored breaks designed to give their clients the tools to cope with the strains of life and work, as well as tips and guidance once they return home to ensure long-term support.
The company says, "The state of the psyche is key to wellbeing which in turn affects performance, and an increasing number of people are beginning to realize the importance of addressing the health of the mind as a vital part of their keep fit regime. We are increasingly looking for guidance on how to take care of our emotional wellbeing, and searching for ways to stay in peak mental condition."
Meditation is a generic term for techniques used to quieten the mind into a deep state of relaxation. Meditation is considered as a serious form of treatment by the medical profession and used as an effective tool for depression, heart disease and diabetes.
Purported benefits include:
Productivity• Increased concentration and clarity of thought• Increased memory and stronger decision-making abilities• Increased efficiency and time management
Stress Levels• Reduced anxiety, depression and anger• Increased tolerance to minor irritations and preoccupations• Increased focus• Younger and healthier appearance
Creativity and happiness• Increased self-awareness• Increased ability for intuitive thought
Health conditions• Effective complementary tool in managing heart disease and diabetes• Preventative technique for avoidance of disease (reduced stress levels)• Can help in quitting harmful addictive habits such as smoking and excessive alcohol• Can help in reducing symptoms of PMS and menopause• Reduces insomnia
Each Mind Unwind holiday has been tailor-made to appeal to their broad client base, featuring packages aimed at de mystifying meditation and making it accessible for both newcomers and those keen to reconnect with the practice. Each package combines personal meditation instruction by experts with extensive experience and intensive practice with holistic activities and mind-clearing treatments such as Reiki and Indian head massage. While meditation can be done at home, a Mind Unwind holiday enables people to dedicate time and attention to learning to meditate without the usual daily life pressures, in a beautiful and comfortable environment.
Mind Unwind is aimed at the upper end of the market as it uses a selection of the world’s most luxurious destination spas, including; Ananda in the Himalayas, India; Kamalaya Wellness Sanctuary, Koh Samui, Thailand; Uma Paro, Bhutan; Longevity Wellness Resort, Portugal; SwaSwara, India and SHAWellness Clinic, Spain.

American academic Professor Glenn Cohen has been investigating some ignored legal aspects of medical tourism from the USA. ’Medical tourism: the view from 10,000 feet’ is a short paper in leading bioethics journal the Hastings Center Report. A longer just-published paper in the Iowa Law Review is ’Protecting patients with passports: medical tourism and the patient protective argument’.
In the longer paper Cohen looks at the motivations and demographics of medical tourists: • Some are uninsured or underinsured patients seeking cost savings (in some cases upwards of 80% savings compared to U.S. prices) on procedures like hip replacements or cardiac bypass by seeking them in countries like India or Thailand. • Some are part of a growing industry of insurer-prompted medical tourism — individuals who have insurance but whose insurers incentivise or allow treatment abroad. • And failed attempts (a bill that died in the West Virginia legislature) to have government prompted medical tourism where state health insurance schemes incentivise (or much less plausibly require) travel abroad for health care.
Cohen argues that these types of medical tourism raise significant legal and ethical issues:• "Domestically we treat advance contractual waivers of medical malpractice rights as unenforceable, such that you cannot bargain for a better price with your doctor by waiving those rights, even in the extreme case where you might not be able to afford the surgery without that price discount. How should we feel about the way in which medical tourists will (due to several interlocking facets of American civil procedure, and sharply less remunerative foreign law) essentially waive medical malpractice recovery rights by seeking care abroad in order to achieve costs savings? How should we regulate the insurer-prompted medical tourism market? Does the existing state insurance architecture of regulation suffice? What about self-insured plans? What are the dynamic effects on U.S. health care markets of competition from medical tourism centers? What are the effects of medical tourism on health care access in the destination country and should they matter to us? How will the recent Obama health care reform initiatives change the playing field?"
So far, much of what Cohen investigates is not new to the medical tourism world. But then he ventures into an area that few in the business like to consider, • "There is medical tourism for services illegal in the home country but legal in the destination country (abortion tourism, reproductive technology tourism, euthanasia tourism, stem cell therapy tourism) and for services illegal in both places but with grey or black markets in the destination country (organ tourism). Here we face questions of whether the USA should extend its domestic criminal prohibition extraterritorially in the model of the Protect Act (child sex tourism) There are also hard questions about the obligations of doctors in the home country as to patients who have returned with illegally purchased organs, as well as their obligations to inform or not inform patients about the option of going abroad."
’Medical tourism: the view from 10,000 feet’ highlights concerns on the single/dual illegality matter, • If a foreign country criminalizes organ sales but has a lax enforcement regime, that effectively tolerates a grey market. Should the USA use its criminal law against citizens that purchase organs abroad? US laws on child sex tourism are the nearest equivalent where the law can be applied to the acts of a US citizen outside the USA.• Another approach on such organ tourism is to extend Medicare regulations that require doctors to tell patients that if they buy illegal organs abroad, the doctor could refuse to supply aftercare or drugs.• Should US law default to what is legal in the USA or what is legal in the destination country?
Cohen says, ’If we try to reign in the activities of US citizens abroad, then we face legal challenges in designing regulation and detecting it where the activities are legal or illegal and not policed in destination countries. He mentions the dilemma of making Americans into criminals when US laws, government interference in research, and inadequacies of the system have created the US demand for organ and fertility tourism.
An area that Cohen touches on but ultimately skates over is whether or not the USA has any right to impose its views and laws on US citizens just because other countries have different legal ethical and medical views on areas such as same sex fertility tourism, organ transplants, surrogacy and assisted suicide. David Young-Cheol Jeong comments, "As for the legality of certain treatments, it might be interesting to think about overseas manufacturing activities at lower wage, lower occupational safety and health standards, or lower environmental regulations and enforcement. US multi-nationals run factories in China, Guatemala or Cambodia, so if you can establish the basis on criminal liabilities for rendering medical services, it might be applicable to multi-nationals who buy labour in violation of their home country laws. The punishment should come from the home country."
Cohen’s next paper will be a longer piece that looks at normative justifications for extending a state’s criminal law outside the USA, and what they can tell about medical tourism for services legal in the destination country but not the home country of the patient. Another area Cohen has investigated is whether medical tourism hurts access to medical care in destination countries by driving up costs and using resources in the country. He presented a paper at a conference in June but has yet to get it published in an academic journal. Cohen comments, "While one can specify triggering circumstances that would make a negative effects from medical tourism on destination country access to healthcare more likely, and while one can find authors making these claims and some anecdotal evidence for the effect, I have yet to find any empirically rigorous demonstrations of the effect. Even if the effect was demonstrated, there are interesting questions of whether this should create an obligation on the part of home countries or international organizations to prevent some forms of medical tourism due to this negative effect."

A leading Jamaican cardiologist Dr Ernest Madu believes a number of Jamaica’s health and economic problems could be solved if a proper infrastructure is put in place to establish health tourism on the island.
Dr Madu of the Heart Institute of the Caribbean (HIC), argues that Jamaica is not benefiting from the number of patients seeking health care outside of their countries, “The most booming trade now is health tourism, but they are not coming to Jamaica, and this is not just because the crime is bad; if they come we have to give them what they need and what is the international standard. To meet the required standards in health care it will require money for the importation of medical equipment and trained specialists, particularly where it affects heart diseases. Jamaica simply does not have the infrastructure to offer treatment to Americans who can go to India or Thailand. So we have to ask the question, why is it that we have not developed the facilities for them to come to Jamaica? Once the infrastructure is put in place, the problem of access would then have to be addressed. Cardiovascular diseases can be treated in Jamaica for 10 per cent of the cost in Miami. The Heart Institute is able to treat most of the heart disease-related cases, but more centres will have to be established.”
Jamaica’s investment and export promotion agency JAMPRO has secured technical assistance from the Commonwealth Secretariat for a development project on the growth of health and wellness tourism in Jamaica. This is a research project to find out if Jamaica could be a realistic destination, what the target market would be, and what is needed to make it happen. For this project, the Commonwealth Secretariat will provide funding to engage the services of a consultant, who will work closely with JAMPRO to identify the critical prerequisites and success factors for the sustainable development of health and wellness tourism in Jamaica. This partnership between the Commonwealth Secretariat and Jamaica represents the latest in a series of projects focused on the socio-economic development in the country.
JAMPRO will be driving the project, in collaboration with the health and tourism ministries, to primarily develop a detailed strategy and action plan aimed at creating investment promotion and industry development frameworks for the establishment of internationally competitive healthcare services.
Sancia Bennett-Templer of JAMPRO says, "As a critical part of our mandate, JAMPRO is charged with not only promoting established sectors for investments, but also identifying and diversifying Jamaica’s offerings for both local and foreign investments. We are committed to increasing employment, and the health and wellness sub-sector presents those opportunities. Much research has already been done in the area of medical tourism in Jamaica, with information dating back to the 1990’s. In partnering with the Commonwealth Secretariat, it is important to update existing information with new findings and avoid reinventing the wheel in the process. We will focus on developing a plan of action with key initiatives and important deadlines for stakeholders to partner with JAMPRO in executing, so that the required accreditations, guidelines for operation and legal requirements are in place early. This will make it easy for investors and medical tourists to do business and receive optimal care in Jamaica.”

A recent survey of American women aged 25 to 45, by Barbados Fertility Centre found that most women who would consider In Vitro Fertilization (IVF) would also consider travelling outside of the United States for the procedure.
74% of these women would be willing to travel if there was a significantly lower cost and higher pregnancy success rate. Among these women, better pregnancy success rates are a more compelling factor than lower cost (72% vs. 64%). However, having the procedure covered by insurance is also a motivating factor as 81% of those who would consider IVF at home say they would be likely to seek treatment abroad if this were the case.
Dr. Juliet Skinner of Barbados Fertility Centre, in Barbados says, “Dealing with infertility is an anxiety-ridden and costly experience for many American women and couples. I have seen significant increases in the number of American patients and inquiries over the past few years as IVF costs rise in the US. Our study shows American patients are willing to look beyond local medical providers when they find a cost-effective alternative that provides exceptional care. Over the past eight years, many of our American patients who previously had multiple unsuccessful cycles at home have had positive outcomes at our clinic.”
Depending on maternal age, the IVF success rate at Barbados Fertility Centre is 54%, compared with the US national average, according to the Centers for Disease Control (CDC) of 42%. Using blastocyst, Barbados Fertility Centre is achieving a 71% success rate for women under 38. The high success rate is attributed to both rigorous clinical and laboratory standards, as well as the level of relaxation patients experience while visiting Barbados. The centre is accredited by Joint Commission International (JCI), the US health international accreditation body that ensures operating and safety procedures are comparable or exceed US standards.
The high cost of IVF treatment in the US, particularly in California and New York where costs are the highest, can compound the stress of the procedure. The average cost of IVF in the US is $14,000 for one treatment cycle alone. In contrast, Americans travelling to Barbados pay an average of $5750, which is less than half the cost of receiving treatment at home. Even with the travel and medication costs factored in, the entire cost of the procedure is still significantly lower due to the rising costs of healthcare services in the US.
Other survey findings regarding medical tourism include that 42% would consider any medical treatment outside of the US. The most common reasons for not considering foreign elective treatment are perceptions that savings are not worth the risk (42%) and standards are just not as high (21%).
Since 2002, Barbados Fertility Centre has been helping infertile couples from around the world achieve their dream of having a child. The centre offers an attractive, affordable alternative for fertility treatment that has proven to be effective.
1936 adult American women aged 25-45 years were surveyed by Ipsos Public Affairs between June 7th and 14th, 2010. Interviewing was conducted via an online survey utilizing the Ipsos iSay pre-recruited panel in the US. A representative sampling matrix according to age, region and household income was utilized to ensure a representative sample of the target audience was achieved. An oversample in New York and California was used to ensure a more robust base size for sub-group analysis. Weighting was then employed as needed to balance demographics and ensure that the sample’s composition reflects that of the target population.

After much pressure on the Malaysian government to remove advertising restrictions that were harming medical tourism, it has finally relented. Private hospitals and clinics will now be able to advertise their services online and offline, following the government’s decision to liberalise provisions under the Medicines (Advertisement and Sales) Act 1965. 7,000 private clinics and 200 private hospitals will be affected.
Health minister Seri Liow Tiong Lai says this will allow private healthcare providers to advertise their services to potential medical tourists and is in line with the government’s plan to promote health tourism in Malaysia and raise the number of medical tourists by 20% annually from 336,000 visitors last year, “The immediate liberalisation of the provisions will allow private hospitals, clinics and dental clinics to advertise their facilities and services in newspapers, the electronic media and on the internet. They can also advertise abroad but they will have to abide by the laws in those countries as well as the laws here. They can mention the latest equipment or treatment they have but they are not to use superlatives like ’best’ or make comparisons. There should not be any laudatory promotion of individual practitioner’s skills or experience. Misleading claims with the intention of encouraging the public to procure unnecessary medical services should not be published. The use of superlatives, patient testimonials, financial inducements and downplaying of risks are not allowed."
Until the change, hospitals and clinics were only allowed to advertise through healthcare magazines and related publications and were not allowed to place advertisements outside Malaysia. But the state is not prepared to make Malaysia equal to competitors, as it still demands control over all advertising. Although the ministry’s Medicines Advertising Board has shortened the time to approve applications for advertisements under the latest advertising guidelines for healthcare facilities and services from six weeks to between three and five days, it will still watch for unapproved advertising and those flouting the law could face a heavy fine and a year or two in prison.
A Malaysian company plans to work with Johns Hopkins University from the USA, to set up a medical science teaching facility and a new hospital in Malaysia, within a new medical city in central Selangor state, to provide a boost to medical tourism in the country. The venture is a private undertaking being promoted and financed by investors from the United States of America and Malaysian. The agreement related to the project is expected be signed soon, when the parties to the deal will be revealed.

A firm that arranges surgeries for self-paying patients gets an increasing number of inquiries from surgical hospitals in the United States about its rates. When hospitals learn they need to provide steep discounts, four out of five never follow up, says Rick Baker. But the increasing number that agree to the discounts, ranging from 50-85%, are rewarded with substantial volumes with the bill paid completely before surgery begins. The agency, based in British Columbia, books five patients a day in U.S. hospitals for a wide range of treatments from simple hip and knee replacements, to complex cardiac bypass surgery.
North American Surgery uses 22 hospitals in 10 states, including Maryland, Oklahoma, Nevada, Arizona, Montana, South Dakota, Washington and Kansas. Most of the sites are physician-owned surgery hospitals with underutilized operating rooms, making the extra volume worthwhile, even with the discount. North American Surgery only sends American and Canadian patients to U.S. hospitals as it argues that other countries pose greater risks, such as parasites or typhoid fever, and the long plane ride home can harm recovery.
Two-thirds of Baker’s customers are Canadians and one-third are Americans who tend to be self-employed with substantial incomes but no insurance coverage. The company was founded in 2003 to provide immediate access to surgery for Canadians, who often wait two years for surgery, cannot buy private insurance at home, so seek to pay out-of-pocket for surgery abroad. The American division launched in 2006. The company does not negotiate prices as each hospital sets its own price, but to gain referrals, its discount needs to be in line with that of other participating hospitals. The patient pays the full cost before surgery in the form
Another US agency, BridgeHealth Medical of Colorado, originally just offered treatment outside the US, but demand has made them offer US surgery too. It says that self-insured employers can save anywhere from 15 to 50 percent by sending patients out of town. BridgeHealth uses 25 hospitals across the country for orthopaedic and bariatric surgery, heart valve replacement, and Cyber Knife, a radiation treatment. The company negotiates fixed rates with healthcare providers and then collects a fee from the insurer.
The company also has contracts with 35 hospitals in 15 countries, but is increasingly attracted by domestic medical tourism as it offers a higher comfort level for patients, with only short flights and no cultural differences. With BridgeHealth, the surgery and all after care are paid for up front at a flat rate. So even if minor complications occur and the patient spends more time in the hospital, the health plan doesn’t pay any more. The advantage for doctors, hospitals and surgery centers is they don’t have to wait as long as 90 days for insurance reimbursement to come in.
David Goldstein of Health Options, another agency promoting domestic medical tourism, acknowledges that overseas hospitals and doctors may be well qualified, but argues. "There is the question of legal action, if a patient were to have a malpractice case overseas – what recourse do they have? What if you were to experience complications on the way home? Domestic medical tourism is on the rise, because American healthcare providers are trying to remain competitive in this emerging market, and are lowering their prices in order to compete. With stringent medical regulations and legal protection, the patient is protected all around, eliminating the need to travel anywhere else for affordable healthcare."

The Grand Bahama Port Authority (GBPA) has been trying for several years to get plans for medical tourism started. It has had many problems with the concept, but the latest one could be fatal.
Back in October 2009, Hannes Babak, then chairman of GBPA, proudly announced at an economic symposium that the company was close to making Grand Bahama a perfect new location for medical tourism. A developer investor kit had been sent to the top 10 to 15 hospitals in the United States to bring them to Grand Bahama to build new hospitals. GPBA had also identified the need for specialist hospitals for cardiovascular medicine and orthopaedic medicine. Babak also claimed that to make medical tourism a success on the island they would have to be the best in the field, "We have to be a leader and not a follower, we want to lead medical tourism and that will help local practitioners and give them a great facility in terms of a hospital." The concept was to help a struggling economy and diversify tourism that had been hard hit by the US recession. The island was clear that the target was almost exclusively US medical tourists.
Minister of Health Hubert Minnis supported the venture, who said that once a plan was properly put in place with its guidelines the Ministries of Health and Tourism would work together to ensure its success, "This would be an excellent form of revenue so we are working aggressively and progressively trying to find new tourist markets. The island should no longer rely solely on cruise ships for the basic tourist product and is perfectly suited for medical tourism. We think that the whole idea of medical tourism is an excellent one. There will be opportunities for great facilities to complement the ones that currently exist. It will also provide an excellent boost for Grand Bahama to help with its unemployment rates. We are very much pro-medical tourism." Insurance companies were also expected to support the plan, as many persons were expected to travel outside of the United States for certain procedures because they would be cheaper than they are in the U.S.
A year on, Babak has left, the government has made it clear that the only support it will offer is words of encouragement, not hard cash. US insurers show no interest in using the island, at least not until there is a hospital there, and they certainly are not prepared to fund any ventures. The targeted hospitals also show a distinct lack of enthusiasm, and none so far has been prepared to spend development money.
GBPA president Ian Rolle recently told local newspaper The Freeport News that a couple of American medical tourism consultants had shown interest in assisting them to develop the concept. The stumbling block is that these consultants required a significant amount of money for something that was not guaranteed to ever get off the ground, "They basically required us spending an arm and a leg. While nothing is guaranteed we would at least felt some comfort that these people were working and earning their monies. We ran into some difficulties with people who wanted to be used as consultants."
While medical tourism may still be still on the GBPA’s long-term agenda, Rolle says that it is not high on the list of things to do, because he is not prepared to pay large fees to consultants.
A massive pine barren just over 50 years ago, the city of Freeport is now the commercial, industrial and tourist centre of activity on Grand Bahama Island. The Bahamas is member of the Commonwealth of Nations that became independent from the United Kingdom in1973. The official language is English. Grand Bahama Island is in the Caribbean, in the Atlantic Ocean, 200 miles west of Nassau, 55 miles from Southwest Florida and northeast of Cuba. The population is a mere 47000.

Cyprus’s commerce minister has presented a strategic plan to develop and promote health tourism in Cyprus. Antonis Paschalides says the target is to take the correct steps to promote Cyprus as the ideal destination for tourists in health matters. Alecos Ouroundiotis of Cyprus Tourism Organisation (CTO) adds that health tourism has two categories: medical tourism, which includes specialised medical therapy; and well-being therapy which includes spas, alternative medicine relaxation and rejuvenation, "The target is to combine health treatment with holidays, recovery with relaxation. Cyprus is the ideal location to attract this type of health tourism due to its climate and geographic location in conjunction with its excellent healthcare facilities."
Dr Michael Guiry from the Center for Medical Tourism Research comments that despite the many advantages that Cyprus has in attracting health tourists, there are also several disadvantages. These include Cyprus being associated with a history of turmoil and also that the island is mostly associated with recreational tourism as well as the fact that Cyprus does not have a medical school.
Dr Polis Georgiades of healthcare consultant firm Quale Vita argues that health tourism accounts for approximately 2.5 per cent of total international tourism but has direct competition from Hungary, Greece, Spain, Syria, Egypt, and Turkey. He suggests that rather than promoting everything to everyone, Cyprus should target specific areas such as cosmetic surgery, IVF, prevention therapy and dental treatment in an attempt to attract more health tourists. He concluded that Cyprus should adopt a value for money approach, as it could not hope to compete directly with the lowest budget health tourism countries such as India.
Local newspaper Cyprus Mail is not a fan of health tourism, and in an article targeted at those reading about the new promotion plans, made several points including -* In the last three years the government has spent €106 million sending patients abroad for medical treatment. For many cases this was justified, as the required medical treatment could not be provided on the island, but in others it was not. There could be no justification, it argued, in sending patients to Israel, the UK or Greece for open heart surgery, when this can be done at Cyprus’ private hospitals.* In February 2009, the Council of Ministers amended the regulations governing the sending of patients abroad for treatment, making it possible for someone to go abroad even if he or she could be treated in Cyprus. The old regulations had made it compulsory to use the local health sector, if the required treatment was available. The health minister makes the final decision as to where a patient would be treated.* The health minister recently went to Israel to negotiate better prices, after Israeli hospitals raised their prices.* Local hospitals still charge the rates agreed some 10 years ago.* Why would anyone come to Cyprus for medical treatment when the health minister has so little trust in local doctors and hospitals that he sends patients abroad for treatment they could receive at home?
A Cypriot fertility clinic has closed down after questions about its involvement in selling human eggs. The clinic, situated in the village of Zygi, Southern Cyprus, dealt mostly with donors from Russia and Eastern Europe, in violation of Cypriot law, which permits only donors’ expenses to be paid. It mainly targeted people from overseas, particularly Italy, who paid money out but have not received treatment.

A huge variation in the availability and practice of fertility treatment is revealed in a new survey of 105 countries from the International Federation of Fertility Societies (IFFS). The UK has 66 clinics, Germany 120, Spain 200 and Italy 360. Japan has 615 clinics, and in India there at least 500 clinics.
Surveillance 2010 was compiled by Professor Ian Cooke of the IFFS, who says: "What is considered acceptable varies from country to country. These great differences in clinical practice do not show up in other fields of medicine, indicating that social or religious attitudes, rather than the best practice of medicine, often drive what is allowed. In Italy, the legal need to replace fertilised embryos goes against all clinical thinking. The variation in international laws relating to infertility treatment is one of the reasons that cause couples to seek cross-border treatment. Whilst this is unavoidable we call for international standards to ensure these patients receive consistent advice and safe treatment. Although a country’s law or professional society guideline for treatment may reflect the overall cultural view in that jurisdiction, it does not necessarily mean that all that country’s residents have the same view. They may then seek access to the treatment abroad."
The survey shows that many Catholic countries have strict controls on the use of embryos. Costa Rica declared IVF unconstitutional in 2000 because it regards the embryo as a person from the moment of conception. Costa Rica is the only one of 43 countries where IVF is illegal. The huge variety of what is or is not allowed, helps create cross-border fertility treatment. Many people travel abroad for fertility treatment and have success with no legal difficulty. The review of reproductive health services highlights large discrepancies in regulations and practice in several nations. As a consequence, some patients who go overseas may face legal or medical issues. A third of the 43 countries do not permit surrogacy

The European Society of Human Reproduction and Embryology (ESHRE) and IFFS are concerned that the safety of patients crossing borders is no longer assured due to lack of uniform clinical and safety standards between the different countries. ESHRE, in co-operation with national and statutory organisations, is developing a code of practice on cross border reproductive care that will lay out a set of rules that protects and reassures patients, donors, surrogates and future children. Françoise Shenfield, of ESHRE’s cross border task force and author of the first study of European patients crossing borders to obtain fertility treatments says, "Although in principle the care of foreign and local patients should essentially be the same and fit the best possible standards, there is evidence that it is not always so."
Both international organisations support the rights of patients to travel to receive the best treatment. Ideally this should take place in their home country, but if patients need to travel to receive the best treatment, both societies support this decision. At the same time, ESHRE and IFFS call for the harmonisation of national standards to increase the safety of patients crossing borders to obtain fertility treatments in the hope that uniform standards of practice can ensure equitable treatment for all citizens.

Irish Labour MEP Nessa Childers told a seminar in Brussels, "Access to cross border healthcare will be considerably easier and more patient-friendly if the proposed new EU Cross Border Healthcare Directive is adopted."
Hosting the Second Forum Against Cancer in Europe, Childers said: "Patients with diseases such as rare cancers, and residents of border counties from Louth to Donegal will see considerable benefits from the proposed EU Cross Border Healthcare Directive. Under normal circumstances patients prefer to be treated near to their homes. But sometimes the specialist expertise they need, particularly in the case of those with rare cancers is provided in another member state and not in their own country of residence. If adopted the directive will allow patients such as those with rare cancers and other rare diseases to have access to the best clinical trials and specialised treatments available in the EU. It is envisaged that this will happen in a much more straightforward and responsive way than is currently the case. Clear and precise information will be available from designated national contact points where your rights as a patient will be clearly explained. Practical questions to do with the need to have prior authorisation for certain procedures and treatments and the payment of costs would be addressed here also. The European Parliament needs to advance the rights of patients to access the best available care. We need to clarify rules about access to healthcare in other member states and the basis on which it will be provided, including administrative procedures and guarantees of objective and timely handling of requests especially in the case of patients with rare cancers and other debilitating rare diseases."
Healthcare is primarily the responsibility of the member states and the proposed directive does not create any new rights. Rather it aims to achieve legal certainty for patients who need to travel for the best available treatment and care, codifying a series of European Court of Justice judgements about the rights of EU citizens to access planned healthcare in another member state and their right to reimbursement of costs from their national health authority.
On Monday 13 September in Brussels, the Council adopted its position on a draft directive on safe and good quality cross-border health care and to promote health care cooperation between member states. The Polish and Slovakian delegations voted against and Romania abstained. As a general rule, patients will be allowed to receive health care in another member state and be reimbursed up to the level of reimbursement applicable for the same or similar treatment in their national health system if the patients are entitled to this treatment in their home country.
The Council’s position includes a double legal basis in the draft directive, striking a balance between the case law of the European Court of Justice on the application of Article 114 to health services and the member states’ competencies recognised by the treaty for the organisation and provision of health services (according to Article 168 on public health).
The draft directive is part of the social agenda package of 2 July 2008, focusing on a triple objective: to guarantee that all patients have care that is safe and of good quality; to support patients in the exercise of their rights to cross-border health care; and to promote cooperation between health systems. The Council’s position will now be sent to the European Parliament for a second reading.

One in five households across 11 Asian countries say at least one member had to travel to another community for medical care in the past year. Nepalese households are the most likely to have had a member seek treatment outside the community, while those in Indonesia are the least likely. While Gallup has previously studied Americans’ willingness to travel abroad for medical treatment, these findings represent Gallup’s first measure of medical travel among households in Asia. In several countries, rural households tend to be more likely than urban households to report travel outside their city or community for medical care. While these disparities are clearly evident in South Asian countries such as Afghanistan, Sri Lanka, and India, they are virtually nonexistent in Southeast Asian countries such as Indonesia and Malaysia.
Asians are far less likely to report traveling to another country for medical care than they are to travel within their own country. Afghan households are most likely to report having someone leave the country for medical care in the last year, most often to Pakistan and Iran. War and occupation, a large refugee population among national porous borders, and lack of cohesive development of a healthcare infrastructure are possible factors that could make Afghans more likely to seek treatment elsewhere than their regional neighbors.
When a medical necessity arises, Gallup data show many Asians, particularly those in rural households, are leaving their communities for treatment elsewhere. Fewer are traveling to other countries for care. While the quality and availability of national and local healthcare services undoubtedly play a role in these results, the findings point to a willingness among Asian households to seek solutions to their healthcare needs wherever they can find them.
Results are based on face-to-face interviews with 17,141 adults, aged 15 and older, conducted between April and June 2010 in Afghanistan, Nepal, Cambodia, Pakistan, Malaysia, India, Philippines, Singapore, Bangladesh, Sri Lanka, Vietnam, and Indonesia. The question on within country medical travel was not asked in Singapore. The methodology and high sample numbers mean that the results are very accurate statistically.
Travelling outside their own community and travelling to another country are two completely separate concepts. Most of the travel outside their own town/village/city is within their own country, not to another country.
Nepal • 52% travelled outside their community• 5% travelled to another country• 47% stayed in Nepal
Afghanistan • 35% travelled outside their community• 18% travelled to another country• 17% stayed in Afghanistan
Bangladesh• 33% travelled outside their community• 1% travelled to another country• 32% stayed in Bangladesh
Vietnam • 24% travelled outside their community• under 1% travelled to another country• over 23% stayed in Vietnam
Sri Lanka • 20% travelled outside their community• 1% travelled to another country• 19% stayed in Sri Lanka
India • 19% travelled outside their community• 1% travelled to another country• 18% stayed in India
Philippines • 18% travelled outside their community• 1% travelled to another country• 17% stayed in Philippines
Cambodia • 52% travelled outside their community• 2% travelled to another country• 50% stayed in Cambodia
Pakistan • 16% travelled outside their community• 2% travelled to another country• 14% stayed in Pakistan
Malaysia • 12% travelled outside their community• 1% travelled to another country• 11% stayed in Malaysia
Indonesia• 5% travelled outside their community• under 1% travelled to another country• over 4% stayed in Indonesia

Merging clinical care and patient comfort Tooth enamel is the hardest material in human body. No wonder dentists have always resorted to tough tools to work on. Now there is a gentler way to fix decay and CTG HEALTHCARE has just launched this technology into their facility.

It’s more comfortable
CTG HEALTHCARE’s Laser Dentistry uses laser energy and a gentle spray of water to perform a wide range of dental procedures – without the heat, vibration and pressure associated with the dental drill. With many procedures, it’s possible to use less anesthetic, and often no anesthetic at all.

It’s more convenient
Your CTG Dentist can often get you in and out of the dentist chair faster, since it’s less likely that you’ll need an injection – research shows that the vast majority of patients don’t. It’s nice to avoid that shot, isn’t it? Not using anesthetic can allow your dentist to perform procedures that used to require more than one visit in a single appointment. Also, a CTG Dentist can perform procedures that once meant an additional trip to a specialist, saving you even more time.

It’s more precise
Lasers have long been the standard of care in medicine for many surgical and cosmetic procedures such as LASIK, wrinkle and hair removal and many others. Laser dentistry was approved for hard tissue procedures in 1998 and since has been cleared for numerous additional dental procedures. Thousands of dentists around the world have performed thousands of procedures with less need for shots, anesthesia, drills and post-op numb lips.

Patient comfort
Heat, vibration and pressure are the primary causes of pain associated with the use of the traditional dental drill. Since cutting both hard and soft tissues (teeth and gums) with the laser dentistry does not generate heat, vibration or pressure, many dental procedures can be performed with fewer shots, less need for anesthesia, less use of the drill and fewer numb lips! Additionally, using the laser dentistry for gum procedures reduces bleeding, post-operative pain, swelling and the need for pain medication in many cases.

Accuracy & precision
CTG dentists are able to remove tooth enamel decay (the hardest substance in the body), bone and gum tissue precisely while leaving surrounding areas unaffected. This conserves and allows you to keep more of the healthy tooth structure.

Reduced trauma
High speed drills can cause hairline cracks and fractures in the teeth that eventually lead to future dental problems. Laser dentistry reduces damage to healthy portions of the tooth and minimizes trauma.

Improved cavity fillings
Laser dentistry cavity preparations can increase bond strength of tooth-colored restoration resulting in longer lasting fillings.

Less bleeding & swelling
Due to its conservative, gentle cutting action and coagulating capabilities, the Laser dentistry performs many soft tissue (gum) procedures with little or no bleeding and less post-op swelling.

Fewer dental visits
Since you often do not need shots or anesthesia, a Laser dentistry dentist can perform cavity preps in all areas of the mouth in just one visit. This technology also gives trained Laser dentistry dentists the ability to perform many procedures that were previously referred to specialists.

Versatility
The Laser dentistry is extremely versatile. It can be used for a wide range of hard and soft tissue procedures. From decay removal, cavity preparation, root canals, smile design, gum and bone surgical procedures and many others.

Destination Health, the Europe’s only consumer event dedicated to health and medical tourism is set to return to London on 15 – 16 April 2011.
Treatment Abroad and IMTJ are once again supporting the event as media partners.
Destination Health 2011 is expected to attract an estimated 100 hospitals, clinics, spas and wellness resorts from more than 40 countries, who will have an opportunity to promote their services to medical tourists from the UK.
Commenting on the show, Event Director Nav Mann said: “Having launched the event in 2010 under extremely challenging circumstances, we are delighted to team up with Treatment Abroad and IMTJ to bring this event back to London in 2011. We have changed the open days to incorporate a ’trade day’ on the Friday 15th with Saturday 16th dedicated to medical tourists.
“We are also planning a major conference to run alongside Destination Health for the medical tourism sector as well as a consumer programme of seminars and demonstrations for potential medical tourists”, said Nav Mann.
The organisers are offering a 10% discount to medical tourism companies, hospitals, clinics spas and wellness resorts who are currently advertising on the Treatment Abroad and IMTJ websites. An additional discount of 15% is also on offer for the first 10 exhibitors to book their stands before 30th September.

A new analysis of UK inbound tourism reveals useful figures on medical tourism, and spa/wellness tourism. The UK is the sixth most visited destination by international tourists. Outbound travel from countries in developing parts of the world is growing rapidly, but international travel is primarily intra-regional rather than inter-regional, so Western European markets continue to offer growth potential for Britain’s inbound visitor economy.
VisitBritain’s latest report ’Overseas visitors to Britain, understanding trends, attitudes and characteristics’ is a detailed analysis of inbound UK tourism. The number of tourists (holiday, business and anything else) visiting the UK from the fast-growing economies of Brazil, Russia, India and China is set to leap. Visitors from China are predicted to rise by 89 per cent, bringing just under an extra 100,000 travellers to these shores, by 2014, the fastest increase in tourism to the UK from any country. While the bulk of the increase in tourism to Britain over the next four years will continue to come from the UK’s traditional European and North American markets, the speed with which tourism from these four countries is increasing is significant. In four years time, there will be 35,000 more from Brazil, 100,000 more from India, and 50,000 more from Russia. Although the acceleration among emerging nations is impressive, the largest numbers of new visitors will continue to come from France, Ireland, the USA, Germany and Spain – the UK’s traditional top five markets for visitors – bringing 3.3 million more visitors to Britain by 2014.
Tourists increasingly come to Britain seeking spas, health and beauty centres, separate from the numbers coming as medical tourists. Wellness has become more than a trend, it has become a need. Health is now about empowerment of self-treatment and exploring new medical techniques. Spa visits, medical tourism, anti-stress therapy, anti-obesity retreats and a long list of other therapies are one of the contributing reasons for people to visit Britain.
Technology is shaping how customers decide where to go. They use it to choose a destination, as well as book travel and accommodation. Most importantly, they now tell the world about their experience, with user generated content; moving from just posting comments on websites and social media, to uploading videos.
The report says that according to the independent International Passenger Travel Survey (IPS), in 2009, 50,000 medical tourists came to the UK. The IPS is a survey of a random sample of passengers entering and leaving the UK; over a quarter of million face-to-face interviews are carried out each year with passengers entering and leaving the UK through the main airports, seaports and the Channel Tunnel. Those who travel for medical treatment spend on average more than double the average tourist spend. Visitors from the Middle East account for more than 50% of spending by those who come for medical treatment.
Visitors are categorized as business, holiday or other. While few business visitors seek out spa and wellness treatment, other visitors do. In 2007, 2008 and 2009, the IPS found that just 2% of all visitors made use of a spa, wellness or beauty centre; so between 500,000 and 600,00 visitors a year. It is not possible to say if spa and wellness was the whole or partial reason for the visit, or just ancillary to a holiday or visiting friends/relatives.
The report also reveals a statistic that medical tourism has long sought. In the USA, the proportion of adults holding a passport is now 33% (94.5 million), according to Donald N Martin and Company. The number of US visitors to the UK has declined substantially in the last two years.
Other official ONS statistics show an increase in 2010 in both outbound and inbound travel. This is good news after figures showed that visits abroad by UK residents fell in 2009 by the fastest rate since the 1970s; 58.4 million, compared to 69 million in 2008, although the last quarter of 2008 also saw a fall.

The banking crisis in the last three years has hit countries that depended on offshore financial services being attracted to them by taxation, laws and other benefits. Many have seen businesses leave. This is a key reason why places like Bermuda and The Cayman Islands have suddenly become interested in medical tourism. The Cayman Islands hopes to set up a hospital mostly for medical tourists from the USA. The latest news from the islands is that the government is considering making organ transplants legal, so the hospital can target the long list of Americans needing organ transplants. While locals and organ transplant specialists are shocked at this news, it is not surprising as offshore financial centres have made their living by a liberal interpretation of national and international laws; attracting honest and some questionable financial organizations.
Many offshore financial centres are also expensive tourist destinations, and they have been hit a lot harder than most countries by the recession. Some of these countries seeing a decline in tourism and offshore finance are left with very little else bringing in income.
International consultant Mark Nestmann suggests that offshore financial centres are now less attractive for global banking and finance, as international pressure has forced OFCs into onerous compliance requirements while disallowing many advantageous features of their tax and legal framework. So the centres must look at alternatives, including medicine.
Nestmann says, "In the USA, medicine suffers from excess regulation and litigation. To avoid lawsuits, doctors practice defensive medicine. In the EU, the prevailing socialized medicine model has led to rationing of care. In both systems, it is cheaper for governments to let you die, than to treat you with whatever state-of-the-art medications or procedures are available." He notes that medical schools have set themselves up in offshore centres. So these countries should enact enabling legislation to establish themselves as favoured destinations for state-of-the-art treatment denied by medical bureaucracies in the USA and EU.
Nestmann adds that offshore financial centres have an existing infrastructure for captive insurance and other insurance products so could set up medical insurance, "Incentives can be put in place to allow doctors and patients to choose the course of medical treatment, rather than have the insurance carrier have a financial interest in your death (a potent moral hazard). Exploring new treatments or insurance options that aren’t acceptable in other locations isn’t much different than financial products that aren’t acceptable in other jurisdictions."
Nestmann is being deliberately provocative to make his point that offshore centre countries have to look at new ways of earning money, and that if they want to encourage medical tourism, just setting up a hospital will not work unless they can find a way to offset their uncompetitive high-cost base by using their long standing flexibility with finance and the law.

Malta is a small island in the central Mediterranean that is charming and relaxing. Throughout history, Malta has often been referred to as "the hospital of the Mediterranean", due to the prominent role the island played over the centuries as a prime location for medical treatment and the care of the sick. Today, Malta is building on this reputation and is an excellent destination where one can receive medical and surgical treatment. While it is a medical tourism destination, particularly popular with the British, it is also a spa and wellness destination.
Claire Zammit Xuereb, who manages some of the leading hotels in Malta, explains the current position:
• Medical tourism
Malta is also increasingly becoming a destination for medical tourism due to the significantly cheaper cost of treatment as well as its perfect setting and climate, ideal for recovery. Most Maltese specialists have trained in Malta, Europe, the UK or the USA and work in professional modern clinics, adhering to EU standards and regulations. Cosmetic surgery is becoming more and more popular all over the world, and no less in Malta. As a result there are now a number of procedures available on the island, including face-lifts, rhinoplasty, tummy tuck, liposuction, breast augmentation, breast reduction, and others.
• Health spas On this tiny island, you can find some forty spa and health centres, each with their own state of the art equipment and highly trained, professional staff. These vary in size and specialization and may include large spa facilities as well as smaller specialized centres. Oriental treatment clinics have recently opened in various localities to provide health and wellness treatments and massage.The treatments cater for men and women and are incredibly varied. These include mud baths, head massage, hand and foot massage, full body massage, 4-hand massage, hot stone massage, Swedish massage, stress buster massage, oriental treatments, body wraps, depilatory treatments, laser hair removal, Botox, professional acrylic or gel nails, several different facials, acupuncture and the use of facilities such as heated indoor pools, saunas, steam-rooms and plunge baths. These can be found at several 5 star hotels as well as other private institutions.
• Spa holidays
Choosing a spa holiday does not necessarily mean staying in an expensive spa hotel or resort. On the contrary, there are several Malta hotels that may arrange a package for you in collaboration with a spa centre in order for you to get exactly what you wish for. Alternatively you may choose a luxury hotel and visit the spa yourself or perhaps a different spa every day and choose to indulge in one or several treatments, as an alternative to whole-day packages provided by a leading spa hotel.
• Wellness Gyms and sports centres are also abundant, with popular classes including Pilates, dance, yoga, aerobics and kickboxing. During the milder season, hiking, cycling and country walks are popular. There are also several opportunities for a wide variety of sports including squash, rock-climbing, paragliding, diving, golf and even snooker.

St. Vincent and the Grenadines offers an unhindered and stable foreign exchange regime, stable labour relations, an independent and efficient judiciary system, significant tax holidays, tax-free status for international entities, a tradition of support for foreign private investment, excellent telecommunications and low operating costs among other investor benefits. One of this country’s major money earners, the tourism sector, may soon get a boost as a foreign company shows interest in investing in a medical tourism project. Government minister Saboto Caesar explains, "I was in conversation with Steve Ivankovish, an investor from Groupo Cé. And the issue of medical tourism was being explored. Here is an investor from the United States searching for a place to invest here. The global financial downturn will not last forever. The world will recover. And in the process of the recovery, we have to ensure that we have our international airport so that they can fly directly into St. Vincent and the Grenadines." Ivankovish has made it clear that the development of the Argyle International Airport is vital to the feasibility of the project.
32 islands and cays make up St Vincent & the Grenadines. The official language is English. The population is approximately 110,000 with around a quarter living in and around the capital, Kingstown. The ethnic heritage is predominantly African. St. Vincent and The Grenadines is an independent parliamentary democracy and member of the Commonwealth of Nations. It had 271 000 tourism visitors in 2009.

The International Wellness and Healthcare Travel Association (IWHTA) recently analysed where Indian medical tourists come from. Their analysis confirms that although Europe and the USA are often mentioned as a source of medical tourists, together they only account for one in ten travelers. The analysis provides the following breakdown: • Bangladesh/Nepal/Sri Lanka 19%• Iraq 18 % • Middle East 16 %• Africa 9%• Afghanistan 9% • Europe 6% • USA 4%• * Non resident Indians from all countries 22%
Naresh Jadeja of IWHTA also analyses the current position of India:• The last five years has changed Indian hospitals and services by adding thousands of hospital beds and a number of world-class hospitals with state of the art health care and technology. • Many Indian hospitals are not attracting international patients not because they are not up to the mark but because they are running at their capacity as both health insurance and the healthcare demands of India’s middle class rocket.• Although the Indian health care industry is advertising less it is enjoying a substantial share of international patients from around the world. More than 580 multi specialty hospitals and over 400 single specialty clinics in India are treating international patients.• A key market is non-resident Indians who visit their home town every year or every other year and opt for diagnostic and wellness tourism activities as it is time consuming and costly in their countries. Hospitals promoting executive checkups are trying to build trust through feel good visits to show people their quality commitment and technology.• IVF and infertility procedures are offered by hundreds of clinics in India.• Alternative medicine such as yoga and ayurveda is very popular and wellness treatments are attracting many visitors. Hotels with these options and medical spas are in big demand. • Dental tourism is a growth area.• There are two totally different types of patients going to Indian hospitals. Those from less developed countries do not expect any added services or soft skills from medical staff, but those from developed countries do expect this and more.

Jeff Chu of Taipei based travel agency, Grand Travel, wants Taiwan make a more concerted effort to enhance the appeal of its medical tourism sector, especially as interest in visiting Taiwan for medical checkups is growing among Chinese nationals. "The combination of sightseeing and getting a checkup or other procedures done in Taiwan is very appealing to many Chinese because Taiwan offers high-quality health care at a relatively low cost. At present, however, only a limited number of the more than 1 million Chinese who visit Taiwan annually can receive medical services in Taiwan because of visa and itinerary limitations," Chu urges China’s government to issue medical visas to citizens who would like to get treatment or checkups in Taiwan.
Chu also recommends that Taiwan’s medical institutions, health evaluation centres and spas work together to develop a new, integrated travel option for overseas visitors. Special customized tours, for example, could be arranged for people interested in getting beauty and massage treatments and having cosmetic surgery. Customized services can also be arranged to cater to the needs of individuals, such as people accompanying major trauma patients, who need to stay in Taiwan for a longer period of time.

Min-Sheng General Hospital’s Dialysis Center is promoting its services to medical travellers, by offering treatment to travellers with renal problems. When Prince Court Hospital in Kuala Lumpur, Malaysia, looked for a dialysis center to treat one of its patients planning a trip to Taiwan, it contacted Min-Sheng General Hospital to make the arrangements. This underlines the plight of thousands of people with renal problems who require dialysis several times a week, whether they are at home or travelling abroad. People with such condition should not be deterred from travelling; they just need more planning and attention.
The Dialysis Center at Min-Sheng Hospital is a 56-bed centre is equipped with the latest Fresenius machines and staffed with four nephrologists, forty-two nurses and two technicians. The centre offers conventional hemodialysis, high efficiency hemodialysis, high flux hemodialysis, and peritoneal dialysis. With a focus on quality care and safety, the centre implements strict infection control procedures; hollow fibers membranes are single-use only, all the equipment goes through stringent daily monitoring and is maintained by a team of in-house experienced technicians. In 2009, Min-Sheng General Hospital’s Dialysis Center was the first hospital in the world to be awarded CCP (Clinical Care Program) Certification for its chronic kidney disease program.
Min-Sheng Hospital is a 600-bed hospital in Taoyuan, Taiwan, near the international airport. It was the first hospital in Taiwan to receive the international JCI accreditation and is active in the field of international health care having a department dedicated to those patients. Min-Sheng hospital specializes in minimally invasive surgeries, bariatric, cardiac, orthopedic and urologic treatment.

Turkish Airlines has a new support package for hospitals and clinics that promote medical tourism. Deals have been signed with many hospitals in Turkey. The package offers special discounts and incentives for those who come to Turkey for medical treatment – • Travel from the USA to Turkey: Up to 25% discounts on first, business and economy class fares.• Travel from other countries to Turkey: 20% discount on first and business class fares, 10% discount on economy class fares.• 10kg excess luggage allowance.• No rebooking penalty if the rebooking is required because of medical complications.• Up to two companions travelling with the patient are entitled for the same discounts.
Passengers travelling for medical purposes must present an acceptance letter from a hospital or clinic in Turkey that has an arrangement with Turkish Airlines. Patients travelling from the USA have the alternative of presenting a referral letter from a hospital in the USA.
There are restrictions:• Discounts cannot be combined with other discounts. • No discounts on promotional fares. • No discount for stretcher.• Turkish Airlines flights only. Code share flights are not included.• 32Kg per piece maximum luggage allowance.• Passengers will be charged if upgrade is necessary or other fees are required.
In Turkey, there are six categories of hospitals – state hospitals (two categories), private hospitals, international hospitals, university hospitals and military hospitals. Turkish health care reforms must be put into the wider picture of a country that had to recover from a serious economic crisis early in the new millennium. Over the best part of the last decade, government efforts have focused on improving public health care whilst attracting investors to open private hospitals. Private health care is of a high standard while access to and general provision of public health care is improving.
A new market research report, “Emerging Medical Tourism in Turkey”, has been published by international research group RNCOS. Turkey has emerged as one of the most popular destinations in Europe for medical tourism. It is anticipated that the number of medical tourists will rise at an annual rate of 28% during 2010-2013 because of government support on promotional activities to boost the nation’s medical tourism industry. The country has one of the highest numbers of JCI accredited hospitals in Europe. With the very low cost of treatments and sophisticated technology equipped hospitals, the number of medical tourists will rise.

For many years, Brazil has been known as a destination for Americans seeking cheap cosmetic surgery. The local medical tourism industry claims that Brazil has grown from 48,000 foreign patients in 2005 to 180,000 in 2009, and that numbers are growing by 30% every year. These figures are at best, rough estimates, and may be accurate or a wild exaggeration; there is no way of knowing. Brazil now wants to attract more medical tourists from other South American countries, the USA and Canada, for cosmetic surgery, dentistry and surgery.
Medical tourism is part of Brazil’s efforts to increase the number of tourists expected around the 2014 World Cup and 2016 Summer Olympics in Rio. Attracting tourists is relatively easy, but attracting medical tourists who happen to come to watch football or athletics is not an easy task; attempts to do this in South Africa for the 2010 World Cup failed.
The country recently hosted its first medical tourism conference in Sao Paulo. Ruben Toral spoke of Brazil’s world-famous reputation for cosmetic surgery. Mariana Palha, of Prime Medical Concierge commented, “People don’t come to Brazil because it’s cheap; they come because it’s good. Brazil is known for its cosmetic surgery and also known for its beaches.” Panel discussions found that while people wanted the country to be famous for cosmetic surgery, they also wanted to promote other surgery. And while promoting quality, some also wanted to promote low prices. Others argued that they were not low prices, as they could not compete with India on price. Doctors from Sao Paulo’s prestigious Hospital Israelita Albert Einstein admitted they were only interested in promoting the hospital’s brand as the first internationally accredited hospital in 1999, not low prices. While Brazil has spare capacity on cosmetic surgery, some conference attendees pointed out that selling surgery was difficult as Brazil’s hospitals are already full.
The Porto Alegre Health Care Cluster is a public-private organization promoting medical tourism for local government, clinics, hospitals, doctors and others in Porto Alegre, the largest city in southern Brazil. The aim is to promote the region as a group, rather than leaving it to individual businesses.
Brazil’s health system is one of the world’s largest, with an estimated 16,000 facilities, including clinics, hospitals and local health centers that are staffed by more than 200,000 qualified physicians. The country provides some of the most advanced medical care, and treatment is among the cheapest. In recent years, the devaluation of Brazil’s currency against the US dollar has made the country a choice for low-cost, high-quality medical treatment for foreigners. In particular, Brazil has become world-famous for cosmetic surgery as millions of Brazilians use it. The wealthy have been visiting Brazil for years in order to maintain their youthful appearance and their anonymity.

Increasing numbers of foreigners are again seeking medical care in Poland. Although many in the nation complain about its national health system, medical treatment received by foreigners is bringing both private clinics and the state budget substantial revenues. According to the Izby Gospodarczej Turystyki Medycznej (Poland’s Chamber of Commerce for Medical Tourism), in the first half of this year 120,000 foreign patients spent over 125 million euros at Polish clinics. Each medical tourist spent on average 1,000 euros on treatment.
Like many other medical tourism destinations who had publicized medical tourism visitor numbers prior to the downturn, Poland failed to report numbers in 2009. Before the recession, the organization had reported annual growth of 10% to 20%. They and other organizations differed on actual figures, but it reported numbers of around 300,000, while travel bodies put it at a less believable figure of 500,000 for 2008.
Many medical tourism destinations have suffered significant falls in business between late 2008 and early 2010; a decline of anything up to 40% has been the norm. Getting actual figures is difficult….while everyone is happy to promote their medical tourism numbers when they are increasing, they tend to go silent when they fall. Although lower than previous figures, 120,000 for the first half of 2010 is encouraging, and could mean 250,000 or more for the full year. This is one of the first signs of recovery in the European medical tourism market. The Economy Ministry has already put medical tourism on a list of 27 sectors, from which by mid-September, the sectors considered to represent Poland most favorably and accurately will be chosen. The sectors that make it to the final list will receive substantial EU subsidies for promotion.
Foreigners decide to undergo treatment in Poland because it is much cheaper than in their home country, especially when it comes to cosmetic surgery and dentistry. Patients from the UK who need a dental implant can pay 1,500 euros and more ($1845) for one at home but only 500 euros ($638) in Poland. The vast majority of medical tourists to Poland are not from the UK, but from Germany, with an increasing number coming from Russia.
The association has over thirty members, and on satisfactory completion of a long detailed information questionnaire, and approval by the association’s medical council, offers annual quality certificates for dental clinics, clinics and hospitals, rehabilitation centres and medical assistance companies.

The Health Ministry of Indonesia has banned local hospitals from branding themselves as international hospitals. The ministry’s Farid W. Husein says, "By August this year, hospitals must have removed the word international from their brand unless they are internationally accredited." The Health Ministry added that ten local hospitals have planned to apply for international accreditation this year with The Joint Commission International. The ministry will pursue any hospital using global or international labels to which they are not entitled.
A number of the country’s private hospitals are now known by a new name following the government ruling barring hospitals from using the often misleading attributes: international, global or anything else referring to worldwide networks or high quality of health care. The Bintaro International Hospital (RSIB) has adopted its new name, Bintaro Premier Hospital. The hospital argues that the stripping of the international attribute does not necessarily mean a lower quality service, “The change of the name has been carried out because we have to meet the prevailing regulations.” The hospital formerly known as Omni International Hospital in Serpong, Tangerang, Banten, dropped its middle name, now renamed Omni Hospital.
Dr. Supriyantoro at the Health Ministry comments, “The existence of such international attributions did not guarantee the quality of a hospital’s service to the public.” The use of those attributes has been widely criticized by the public amid reported cases of malpractice involving doctors from several so-called international hospitals. In one recent case Prita Mulyasari was imprisoned and fined by a civil court for allegedly defaming an international hospital following complaints made by her via email over receiving poor medical services. The case sparked widespread protest and led to an unprecedented campaign over social networking sites such as Facebook and Twitter to raise money to help Prita pay off the fine. Public pressure eventually saw the court acquit the case, while the hospital has not yet retracted its lawsuit against Prita.
Dadang M. Epid of South Tangerang Health Agency has called on the hospitals that have stripped their international names to inform the public of the change, “With the announcement, hopefully, there will be no more misunderstanding among the public. People will no longer regard those hospitals as hospitals operating under international standards.”

The Pacific Asia Travel Association (PATA) aims to set up a healthcare travel advisory task force. PATA was formed over 50 years ago with headquarters in Bangkok. PATA is a membership association acting as a catalyst for the responsible development of the Asia Pacific travel and tourism industry; with over 2,500 members comprising 42 member destinations and their airlines, hotel groups, tour operators and travel agents.
The task force is being set up in conjunction with MEDICO Services International, Bangkok. PATA, is seeking volunteers and vital contributions from PATA members with knowledge of, and experience in, this fast-expanding niche market across the Asia Pacific region. The advisory task force will meet periodically and comprise of ten-15 members from all sectors of tourism. Meetings will be conducted either electronically or in the form of workshops, most probably alongside other major PATA events.
The two parties have already identified several key issues that should be addressed:

Liability issues of medical tourism.
Guidelines to creation of medical tourism destinations.
Medical travel insurance.
Increased cooperation across this niche market.
Networking and data exchange for medical tourism specialists.

Greg Duffell of PATA says, “We recognise the importance of this emerging tourism market segment. We are keen to identify both the opportunities and challenges in this niche for our members and potential new members. Medical tourists are customers for airlines, hotels, tour operators and insurance companies, as well as hospitals and wellness spas. I welcome expert contributions and expressions of interest in joining our new advisory task force. This new advisory task force will conduct surveys, gather opinions, enable debates, and push for solutions to share with the industry at large, which we hope will encourage new membership from businesses providing healthcare services to join PATA as an authority in this area. We also envisage a programme of specialised conferences and workshops for industry stakeholders.”
Dr Zadok Lempert of MEDICO adds, “Medical tourism is quickly gaining awareness in consumer markets. Over the past decade, Asia has been the preferred destination for many people seeking less expensive, but high quality, medical treatments. The increase is partially due to high medical costs paired with long waiting periods in the United States, United Kingdom, Europe and Australia. Specialised treatments, surgeries and therapies are being offered in Asia at a fraction of the cost yet with bigger perks, when it comes to hospitality and patient comfort. Waiting times are minimal. Favourable exchange rates with regional currencies in Asia make medical procedures an incredible value-for-money option to residents in Europe and the USA. Cheaper medical costs mean more money is available for family members and friends to accompany the patients. It is those family and friends that seek accommodation near the hospitals so they can visit the patients, yet at the same time, have a comfortable stay affording them access to the rest of the city’s or country’s attractions.”

Commissioned specifically for the 2010 Global Spa Summit in Istanbul, a report "Spas and the global wellness market" by research group SRI International highlights key areas of opportunity where the spa industry can take advantage of growth and partnership opportunities, including with medical tourism.
The wellness cluster is a US $1.9 trillion global industry made up of:• Spa — $60 billion• Complementary and alternative medicine — $113 billion• Healthy eating/nutrition/weight loss — $277 billion• Preventative/personalised health —$243 billion.• Wellness tourism — $106 billion• Medical tourism — $50 billion• Workplace wellness — $31 billion• Fitness and mind-body — $390 billion• Beauty and anti-aging – $679 billion.
SRI estimates that there are 289 million wellness consumers in the world’s 30 most industrialised and wealthy countries, and 81% of consumers are extremely or very interested in improving their personal wellness.
The report made recommendations-• Partner with the medical tourism industry to create complementary services for medical tourists.• Partner with conventional medical establishments to deliver complementary and integrated healing services to medical patients.• Partner with the medical industry to encourage and conduct evidence-based research.• Repackage existing offerings and develop new offerings to define and market spas as a wellness necessity.• Provide continuity of care to customers.• Deliver executive health services.
Another related new report is ’The New Priorities of Today’s Spa Consumers’ a survey by Coyle International on what currently drives consumers to spas; consumer internet adoption and the impact of online information; and what makes or breaks the spa experience.
Key findings• The number one reason consumers visit spas (89%) is for relaxation/stress management.• The primary reasons spa consumers visit websites are to find spa deals (62%); view spa menus (57%); and read customer feedback (48%).• The top three online resources that are used by global spa consumers: SpaFinder.com (44%); search engines (43%); Facebook (25%).• There is a disconnect between consumer adoption of/openness to online spa booking and the number of spas providing that functionality. Among spa-goers, 47% have booked a massage online, and 89% would, but only 30% of spas offer an online booking solution.• Social media usage for sharing spa experiences is growing: 59% are likely to email friends; 48% to write an online review; 41% to become a fan on a social networking site; and 37% to post on a social networking site.• 88% of consumers report that they would be comfortable receiving follow-up from a spa post-visit, with the number one preferred method being an email from a spa manager inquiring about their satisfaction with their visit (83%).
Taking the two reports together there are implications for medical tourism businesses:• Businesses should work more closely with the spa and wellness industry, which is more mature, has a good handle on customer needs, and co-operates without conflict. • Web presence and the ability to quote online is a given for any company.• Every customer should have a follow-up to determine levels of satisfaction.• Ignore social media at your peril.• Customer reviews are not a nuisance; they are vital to gaining (or losing) future business.

The medical travel business world is debating the potential merits and problems of using cruise ships as a base for medical travel. The majority view seems to be that using ships in international waters for surgery has many practical and legal problems, and that with increased competition for medical travellers, as cost savings can be made in many countries, the risk to investors and patients far outweighs the rewards.
Meanwhile, although the travel trade has suffered greatly from the global economy in recent year, cruise travel has gone from strength to strength with a record 14 new ships launching last year. A specialist area that shows an increase in popularity is health cruises. Cruises used to be for older passengers seeking rest and relaxation, but modern cruise passengers are as likely to spend their time swimming and exercising. Whichever category they are in, on a two or three week cruise, even allowing for days at various port stops, there is a lot of time to fill. So the use of spa and beauty treatments of all types is a good way to fill the time. Unlike many holidays, passengers have every chance of leaving the ship lighter, fitter and younger looking than they did at the start of the trip. Modern cruise ship spas are every drop as luxurious as you can find in the world’s premier hotel resorts. Costa cruise line recently introduced the spa cabin—a special class of cabin with easy access to the spa and amenities like special, high-end toiletries, yoga mats and Nintendo Wii machines with keep-fit programmes attached. Celebrity’s AquaSpas, offer thalassotherapy pools (treatment using seaweed and seawater minerals) and Rasul treatment, with quiet rooms, heated reclining chairs, fragrance rooms, robes and slippers and healthy snacks. These cruises are all about recharging mind, body and spirit. Cruises offer swimming pools, pilates, gyms with state-of-the-art equipment, tai-chi classes on deck and bamboo massage, to a younger clientele seeking activity holidays. For people not interested in the spa angle, Royal Caribbean International’s Independence of the Seas offers an18-night Mediterranean cruise this winter with 15 decks of activities, including a Flowrider surf park at sea, an onboard ice-skating rink, rock climbing wall, a children’s water park, a teen-only nightclub, basketball and volleyball courts and a miniature golf course. Celebrity Eclipse features a real grass lawn larger than eight tennis courts.
Jogging tracks and state-of-the-art fitness centres are standard on most big ships, but increasingly so are wellness education classes, metabolic testing and cutting edge fitness classes, from kettlebell workouts to TRX suspension training, which borrows technology from U.S. Navy Seals. The Epic, Norwegian Cruise Line’s newest ship, has a Pulse Fitness Centre offering a seminar ’Secrets to a Flatter Stomach. Princess Cruise Lines offer state of the art gyms where cruisers can play Wii Fit skiing and hula hooping games, or workout to exercise classes on stateroom TV. A new offering is Fit and Funny cruise seminars on selected Carnival Cruise Lines sailings from Galveston, Texas, aimed at developing healthy habits with a light hearted approach.
The new Norwegian Epic offers Botox treatments, acupuncture and shiatsu massage for couples, a hot stone massage, Rasul rooms (to cover yourself in mud and steam it off), a hydrotherapy courtyard and thermal suite. The 39 spa cabins include access to the hydrotherapy area and thermal rooms, and eight suites have their own in-room whirlpools. The Norwegian Epic has the largest spa at sea: 31,000sq ft with 24 treatment rooms. Similar facilities are available on P&O’s new Azura, where the spa package includes treatments, events and gifts, plus a priority spa service. The Oasis Spa has a private outdoor terrace for alfresco massage, and all treatment rooms have balconies for outdoor pampering. On MSC’s Magnifica, guests can enjoy a candle massage, or one using heated pink clamshells instead of hands and a facemask of scallop shells over the eyes to reap the benefits of colour through chromotherapy. On Carnival’s Carnival Dream in the Cloud 9 Spa, warm bamboo shoots soaked in essential oils are combined with deep-tissue massage. Celebrity’s newest ship, Eclipse, like her sister Equinox, has 130 AquaClass staterooms where guests receive a choice of aromatherapy scents and access to the AquaSpa relaxation room, the Persian Garden steam room and exclusive meals in healthy-eating restaurant Costa’s new Deliziosa has 52 cabins and suites with direct access to the adult-only parts of the two-deck 11,480sq ft spa. The spa package includes two exercise classes and two treatments from a range of massages and facials, including with hot stones. As well as access to the thalassotherapy seawater pool, thermal area, relaxation area and the wellness restaurant, guests get a low-calorie room service and a shower that filters impurities for super-soft skin. Silversea’s latest ship, Silver Spirit offers Botox and other treatment to help take the years off.

Domestic medical travel is an emerging trend with the ability to impact healthcare in the United States in a big way. David Goldstein of Health Options Worldwide (HOW), an online medical travel agency, says, "The reason we advocate domestic medical tourism is that we give patients another option besides going overseas for medical care. It is very possible to get safe, quality care that is cost-effective right in this country. The most important aspect in traveling to a hospital outside of your own region is to make sure that you are not only saving money, but you are getting safe, high quality care, and that is best guaranteed in the USA.One major benefit of domestic medical tourism is the ease of coordinating follow-up care between the patient’s local physician and the surgeon.”
US domestic medical tourism will only really take off if American hospitals can establish themselves as specialized centres of excellence. Orlando, Florida, which is already a well-established vacation destination, is beginning a citywide promotion to distinguish it as a medical tourism destination. The city is developing a 7,000-acre complex called Lake Nona Medical City, which will be attached to the new University of Central Florida Medical School, will include five local hospitals, and is expected to open in 2011.
Another major advantage of domestic medical travel is that all American medical facilities and physicians are regulated by accredited organizations. American physicians need to go through a rigorous credentialing process and complete an American residency program in their specialty to be board certified.
Other benefits to domestic medical tourism include:• Access to legal recourse• Low cost for elective high-cost major surgeries• No language or cultural barriers• Shorter traveling distance compared to international medical tourism
When it comes to domestic medical travel, HOW offers these helpful tips:• Research on the internet about any offered location on details on U.S. doctors, hospitals and healthcare facilities.• Check accreditation – Joint Commission accreditation is mandatory but also look for proof of excellence, especially in the surgical procedure you are researching such as proven evidence-based guidelines and comparisons with other hospitals.• Check doctor credentials – Find out how many procedures they have performed and their outcomes; more experience means better the outcomes.• Talk to the doctor – This will provide you an opportunity to get your questions answered.• Travel with a companion – This person will be your support and your advocate.• Find out hospital travel logistics – Usually a patient care department can assist you with this. Some hospitals allow companions to sleep in the hospital room during recovery.• Arrange follow-up care and set up a conference between your personal doctor and your surgeon – It is the best way to ensure continuity of care in case a problem arises.

Health travel is increasingly about prevention, rather than just seeking a cure for a problem. A particular type of healthy holiday may be totally contrary to what most people want to do on vacation.
It is easy to criticize the health systems in the UK and USA, but both governments are ahead of many other countries in encouraging healthy and fit living, rather than concentrating on the more expensive cures. It is fair to say that obesity is a serious problem in both countries, and the state systems can only afford to spend limited amounts on dealing with the consequences. This offers many opportunities for private weight loss treatment, including weight loss treatment overseas. But increasing availability of treatment and lower costs, mean that weight loss tourism could decrease as the comparative cost saving of going overseas reduces.
While governments can encourage healthy living, they cannot afford to pay for it. But this does not matter; as there is increasing realization that health and fitness are part of the move to decreased reliance on the state and increased personal responsibility. Private healthcare companies are seeking ways of encouraging health and fitness by making it enjoyable. Everyone likes having a holiday, particularly somewhere different at home or abroad. So it makes sense to combine holidays with fitness.

Fit for a Princess was first set up in 2003 as a personal training business. Then in 2006 the idea and a gap in the market was soon discovered – what about teaching a group of women in the great outdoors? This is where Fit for a Princess group outdoor workouts and bootcamps were created and expanded to 6 London locations. Requests to set up Fit for a Princess workouts outside of London led to national franchises, a pilot one is underway. Founder Janey Holliday created a unique concept of workouts that combine the fun factor with carefully put together exercise combinations that can change women’s body shapes and give women a more positive approach to training.
Janey Holliday explains the expansion into overseas holiday fitness, “Research demonstrates that exercising outside can burn up to 30 per cent more calories than doing the same workout indoors – a statistic that makes venturing away from the gym a tempting prospect. Couple this with further research that shows people who exercise in the morning are 75% more likely to still be exercising a year later, and you have the perfect excuse to re-invigorate your workout. Then throw in the motivation of a sunbed, a pina colada and a sun-kissed pool attendant and you have all the incentive you need to sign up to a Cyprus Bootcamp, where the motto is train hard in the morning, play hard in the afternoon. Following the huge success of our UK Bootcamps, we felt this was the natural next step to motivate our clients. We offer workouts all year round, rain or shine, but for those that just cannot face the thought of hitting their local common at 6am on a frosty autumn morning this overseas Bootcamp is the perfect alternative.” Janey will be leading the Cyprus Bootcamp that runs from Saturday 16th October to Saturday 23rd October at the 5 star Coral beach hotel where the Olympic teams trained and stayed before Athens.

20 Canadians seek organs for transplant on the black market in countries such as India, China and the Philippines each year. In doing so, they may be risking their own lives, suggested experts from four countries at the 23rd International Congress of The Transplantation Society. 5000 delegates attended the conference in Vancouver.
Transplant specialists are concerned about exploitation of the world’s most impoverished people who donate organs to get money. Dr. Graham Sher, of Canadian Blood Services, said the most recent data he has seen shows 215 Canadians sought transplants outside Canada from 1995 to 2004. It is not known how many clandestine transplant operations are being done in countries like China, India, Pakistan and the Philippines, but medical tourism is believed to be a small industry relative to the 100,000 legitimate transplants done throughout the world each year. Yet the consequences for even a small underground industry are grave.
Dr. Francis Delmonico, a transplant surgeon point out the dangers as evidenced by University of Toronto researchers in a study led by Dr. Ramesh Prasad, which revealed that new kidneys obtained through such means can result in far higher surgical complications, infections, transplant failure and even death. The Prasad study looked at the outcomes of 22 Canadians who purchased a new kidney and transplant in countries throughout Asia and the Middle East. One-third of all the patients transplanted outside of Canada required immediate hospitalization on their return to Canada, primarily for serious infections. Another third required eventual hospital admission. Two patients required repeat transplants and nearly 40 per cent had drug-resistant infections. Another 14 per cent got tuberculosis.
Despite countries making laws to ban or restrict transplant tourism, transplant specialists are worried that with an increasing number of desperate patients seeking organs outside North America, countries around the world have to do more to increase the number of donor organs. Dr. Luc Noel of the World Health Organization says, “Transplantation has become such a routine procedure that we all expect to get an organ if we need one.”
Israel was praised for passing legislation that prevents insurance companies there from paying for black market organ transplant procedures. In Canada, medical tourists who procure underground organs in other countries pay out of pocket and provincial governments in Canada will pay for the complications arising from transplant tourism. Canada’s doctors are the first in the world to develop an official policy in which they have the authority to refuse to treat transplant patients who ignore their medical opinion and insist on becoming medical tourists

Thailand’s troubles earlier this year hit medical tourism badly, particularly in and around Bangkok. Phuket suffered very little and is keen to promote itself as a safe and affordable destination, even at the cost to local rival Bangkok.
Medical and healthcare providers on the island of Phuket can expect to get a large slice of the 402.9 billion baht that the Ministry of Health (MoH) expects Thailand’s medical tourism industry to take over the next five years, says Dr Wiwat Seetamanotch of Phuket Public Health, “Over the past five years, Phuket has enjoyed great success in health services provided to tourists and earned a huge amount of money. In addition, health services here are cheaper than in neighboring countries.”
The MoH, according to its current five-year plan for 2010 to 2014, expects medical tourism to generate 400-billion-baht .The previous plan, for 2004-2008, concentrated on providing medical services to patients from abroad. Under that plan, the MoH aimed to make Thailand the centre of excellent healthcare in Asia through treatment businesses, health supplement businesses, health products and Thai herbs. The current plan targets developing the same businesses and products, but adds more services in the realms of Thai traditional medicine and alternative medicine. The move follows Thailand’s enjoyment of huge growth in its medical tourism over the past decade.
According to MoH statistics, although these are only estimates based on information from hospitals and include holidaymakers, business travelers and expatriates, 550,161 foreign patients received treatment or healthcare in Thailand in 2001, while in 2007 that number had swelled to 1,373,807. Most were Japanese, followed by Americans and Europeans. Although key markets claimed are Japan, Australia, New Zealand, USA, Myanmar and Indonesia, in reality, 80% come from South-East Asia including Japan and Indonesia. An estimated 70% of the foreign patients during that period were medical tourists, with 25% being expatriates and less than 5% being tourists. The most popular health services during that year were health checks, heart operations, knee replacements, cardiovascular surgery, cosmetic surgery, gender reassignment surgery, dental care and Lasik corrective eye surgery.
Dr Wiwat expects the number of medical tourists to Phuket to increase dramatically in the coming years, “In addition to three government hospitals in Phuket, there are also three private ones that are recognized as international standard.”
Julie Munro of InterMed Global thinks that Bangkok can regain its top place in Thailand, but it will require more work than the authorities are currently putting in: “Whether Bangkok can restore its prominence as a medical destination hinges on how the Thai government, specifically Tourism Authority of Thailand (TAT), acts to promote Thailand for medical tourists in the coming year. Sustained and cohesive promotion efforts are not likely to happen soon. While TAT has been working on a medical tourism marketing plan for almost a year, it has faced leadership changes and budget cuts. It has had to put other priorities, namely bringing back tourists – any tourists – ahead of promotion of medical travel and health tourism. TAT has, however, announced that it will continue promotion of Thailand’s spa, wellness and medical services in the Middle East, but not medical tourism. The private hospitals have their own problems.”
Munro also argues that hospitals have work to do, “With droves of expatriate foreigners having moved out of Thailand, hospitals like Bumrungrad International and Bangkok Hospital Medical Center are working on solidifying their home base and focusing efforts on bringing back local Thai residents, who often view these high end private hospitals as too expensive. Both hospitals continue to draw medical travellers from surrounding countries like Burma, Bangladesh and Indonesia, and from the Middle East. Thailand as a medical destination was not put on the medical travel map by government policies, it was the top hospitals, and they will continue to do this, with or without official government support.”
Without coordinated promotion of medical tourism by government and trade groups, will hospitals like Bumrungrad International or Bangkok Hospital Medical Center be able to maintain their position within the global or even regional medical tourism industry? Will Bangkok lose out to the northern city of Chiang Mai or the tropical island of Phuket? Munro argues, “What remains of Thai medical tourism will continue to favor Bangkok. Phuket has daily international flights by regular and discount airlines to dozens of regional cities, and it has lovely resorts – now mostly empty. But its two private hospitals, Phuket International and Bangkok Phuket, are considered by most local expat residents a clear second choice, and prefer flying into Bangkok for care. The two private hospitals are considered expensive, with high hospital costs and doctor fees.”
Phuket is to be the home of the country’s first purpose built “Health Promotion Hospital”, co-funded by the Chinese government. The Kamala Public Health Center will incorporate traditional Chinese medicines into its array of medical services. To be completed next year, it will initially offer health checkups and traditional Thai massages to both Thais and foreigners.

Surrounded by thousands of square miles of ocean, Gamma Knife Center of the Pacific is the only Gamma Knife center in Hawaii. Since 1998, Gamma Knife Center of the Pacific has treated more than 1300 patients, many not from the island.
The radiosurgery centre has retired its first Leksell Gamma Knife system and replaced it with Elekta’s latest generation radiosurgery system, Leksell Gamma Knife Perfexion. Gamma Knife radiosurgery is a gentler alternative to traditional brain surgery for illnesses such as metastatic disease, which is cancer that has travelled to the brain from elsewhere in the body. With pinpoint accuracy, the system delivers up to thousands of low-intensity radiation beams to one or more targets in a single session. Perfexion provides even greater speed and ease of use than previous models.
Neurosurgeon Dr. Maurice Nicholson explains, "Perfexion is a much faster, more efficient machine to treat multiple metastases in a single visit. This is important because the pendulum is swinging toward treating with stereotactic radiosurgery [SRS] rather than whole brain radiation therapy [WBRT]. Studies have shown that there is decreased mental function at four months in a higher percentage of WBRT patients. Perfexion will be good for the patients and good for doctors."
More than one-third of the 140 patients who come to Gamma Knife Center of the Pacific each year have brain metastases. The numbers are rising due to advances in tumor imaging and better screening, which result in earlier detection and diagnosis. With new treatments, people who are diagnosed with cancer live longer; therefore, there is a greater chance of developing metastases."
With Perfexion, the center’s staff of eight neurosurgeons, five radiation oncologists and one physicist is well equipped to handle increasing demand. The new system allows them to easily double the number of patients they have been treating. This extra capacity means the centre can now actively seek medical travellers , rather than just wait for them to approach.
Gamma Knife surgery is usually a single-day procedure with no specific convalescence associated with it, making this therapy ideal compared to radiation therapy or open surgery in which the combination of treatment and recovery may entail weeks or months. Gamma Knife Center of the Pacific has been the focus of this activity for years, treating patients from Australia, New Zealand, Samoa, Guam, Taipei and Canada.
Sean Nicholson says "Our location in Honolulu, just 10 minutes from Waikiki, presents a great opportunity for people seeking Gamma Knife treatment in close proximity to one of the world’s most famous vacation destinations. We always strive to provide access for patients outside of Hawaii. Our staff works closely with patients to schedule and coordinate appointments, assist with travel arrangements and lodging, provide cost estimates and work with insurance companies to secure payment."

Monterrey boasts four Joint Commission International (JCI) accredited hospitals within its city limits, half the JCI hospitals in all of Mexico, and many other private international specialty hospitals and clinics. Patients Beyond Borders has teamed up with Monterrey Healthcare City (MHC), to produce Patients Beyond Borders: Monterrey, due for publication in February 2011. Monterrey Healthcare City (MHC) is an association established by 10 local hospitals.
Readers will learn about Monterrey’s impressive commitment to healthcare (including two first-rate medical schools, the new Universidad Autonoma de Nuevo Leon and the Monterrey Institute of Technology and Higher Education) and why thousands of medical travellers are going to Monterrey for medical treatment, including cosmetic surgery, dentistry, bariatrics/weight management, IVF/reproductive services, orthopaedics, cardiology, cancer treatments, and more.
Jesus Horacio Gonzalez Trevino, of the Monterrey Health Care City Association says,
"We are very pleased to be partnering with Patients Beyond Borders to produce and distribute our Monterrey City Edition. With medical specialties and procedures at 30 to 70% savings over US prices, coupled with easy access from North America, it is no surprise to us that Monterrey is quickly becoming the choice of many looking for quality, affordable healthcare."
Monterrey will be the first in a new series- Patients Beyond Borders City Edition –where a group of medical facilities within a closely knit geographical area, usually close to a major international airport, can focus industry and consumer attention on the unique attributes of its medical infrastructure, leading facilities, and educational and research offerings. PBB City Editions are distributed digitally throughout the world, as well as to selected regions.
Medical Traveler Yucatan (MTY) has teamed with Dr. Elena Solis, cardiologist and a pioneer in performing the new Liberation procedure for Multiple Sclerosis patients in Merida, Yucatan. While still controversial in Canada and the USA, the procedure has apparently proven successful for most MS patients who are now travelling to countries that embrace the treatment. MTY works with Dr. Solis and Star Medica Hospital of Merida, Yucatan in making both medical and travel arrangements for American and Canadian MS patients.
Alan Graham of MTY says, “It is vital for MS patients in Canada and the USA to have access to this procedure. While their home countries are still debating, patients who have undergone Liberation treatment are reporting immediate and sustained improvement. Patients from Canada who are leaving Merida are reporting amazing results – movement and mobility where none existed before the procedure. This is a sound alternative solution.”
Liberation treatment was first undertaken by Dr. Paolo Zamboni of the University of Ferrara, Italy whose wife has multiple sclerosis. Zamboni discovered the role of blocked veins in causing the debilitation in MS patients. His research and subsequent treatment showed that MS afflictions could be lessened with a relatively simple – and low risk – angioplasty procedure.
MTY is now offering new specially priced all-inclusive packages for Canadians and Americans to Merida, Yucatan for this procedure. The special packages include all medical and non-medical arrangements, excluding airfare, and range between $9200 and $9500.

Singapore has seen an average annual 20% increase in medical tourists from the Middle East since 2006, according to figures collated by Singapore Tourism Board (STB). Common procedures and treatments undertaken by the Middle Eastern visitors include live donor liver transplants, in-vitro fertilisation, heart procedures, stem cell transplantations and cancer treatments. Jason Ong of STB says,” Middle East populations are realising the benefits of travelling to Singapore for a wide range of medical procedures, which has resulted in year-on-year double-digit growth in the number of regional healthcare tourists. Middle East patients can be certain that they will receive the highest quality of treatment and follow-up care in Singapore, which has repeatedly shown to be on par with the best in the world. They can also be certain that their cultural and religious needs are attended to with Arabic-speaking service personnel, Halal food and even Arabic TV channels, during their hospital stay.”
Once selling on quality rather than price, with fierce competition vying for medical tourists’ money, prices in Singapore have been depressed to one of the region’s lowest. This competitive pricing strategy the health-care companies are quietly taking is the only way the government’s targets of million foreign patients annually could be met. Singapore is viewed favorably by medical tourists from South-East Asia and China due to the better quality of health-care service, and now low prices too.
Parkway is Singapore’s premier healthcare provider, and although it is now Southeast Asia’s largest private healthcare group and has ventured into India and China, Singapore itself is still Parkway’s key market. Parkway operates hospitals, specialist and general practitioner clinics, health screening and professional radiology and laboratory services in Singapore. The Mount Elizabeth, Gleneagles and East Shore hospitals have 1008 beds in total. Singaporeans make up the majority of the patients of these hospitals, but 35% of patients of Parkway’s Singapore hospitals are foreigners. Of this, about 65% are Indonesians, followed by Malaysians at 25%. Parkway Novena Hospital may open next year or by 2012.It is designed as a luxurious hospital and the first private hospital to offer only single beds. It will have 333 beds.
Fortis Healthcare chairman Malvinder Mohan Singh says his plan to use Singapore to build a pan-Asian healthcare empire remains unchanged though he lost a bid to take over hospital operator Parkway Holdings. The quality of medical education and the public health care system, which produces doctors, nurses and other talent for the industry, makes the city-state an ideal hub, "All of these capabilities are available in Singapore, and they are available to anybody who wishes to leverage on it. I want to be in a position to be able to leverage on those skill sets, capabilities and talent, and to build on them."
The recent struggle between Fortis Healthcare and Khazanah Nasional for control of Parkway Holdings has thrown the spotlight on the local health-care industry, with new investors now looking at the potential.
Healthway Medical has a wide range of specialist clinics, making it the largest private medical service provider in Singapore in terms of clinic network with 4000 patients everyday, It is opening specialist clinics and screening centres, catering to the increasing number of people who are more health conscious – choosing prevention at an earlier stage through screening, rather than paying out more for a cure later on in life. Plans are underway to add six more clinics in China to its current two by end 2010, all of which are wholly owned and managed by the company. All eight Healthway China clinics will be in Shanghai, and are for expatriates as well as local Chinese. Viewing Shanghai as its strategic foothold into China, the company is set to expand into smaller cities nationwide. In Singapore, with over 100 clinics, it is increasingly targeting medical tourists.

An international group has launched an accreditation programme for hospitals, clinics, and wellness centres in The Philippines to improve healthcare services and promote medical tourism in the country.
The National Accreditation Board for Hospitals and Healthcare Providers (NABH) and its Philippine representative HealthCORE, has launched a global programme that accredits hospitals, clinics, blood banks, medical laboratories, dental clinics, spas, fitness centers, and cosmetic and skin care centers. The NABH standards aim to raise the quality of healthcare facilities and the level of professionals’ skills to meet international standards.
The Department of Health (DOH) and the Department of Tourism have been promoting the country as a medical tourism destination. But hospitals and clinics have yet to compete with leading medical tourism destinations in Asia such as Singapore, Hong Kong and India. One perceived problem is the lack of international accreditation. The Philippines has its own accreditation standards through the Philippine Health Insurance Corporation (PhilHealth). However, PhilHealth is limited by what the law prescribes for it to do. PhilHealth is a national body for accrediting health care services, focused on financing issues and accreditation of hospitals, maternity clinics and other medical clinics. The government wants to make PhilHealth an internationally recognized accrediting body, but as this could take several years, NABH International has been welcomed by the Department of Health.
NABH International is a subsidiary of NABH in India, where the program was developed. NABH is accredited by the International Society for Quality in Healthcare (ISQua), an international body that approves healthcare accreditation programs around the world. Dr. Sanjiv Malik of NABH, says that international accreditation is the practical solution to quality and safety assurance, two important factors in medical tourism, ’’International accreditation provides assurance to patients that they are in a hospital that follows protocols. It builds credibility and confidence, which generates recognition among foreign patients. This is the first time that NABH is taking its services outside of India. We have chosen the Philippines to be our first international venture because we believe that the Philippines faces similar healthcare challenges with India. In the first two years of NABH implementation, the quality of healthcare delivery in India has vastly improved, which helped us become one of the leading providers of healthcare in the world. We would like to carry out the same mission in the Philippines."
The leading laser and aesthetic center in Japan has opened in the Philippines, targeting the fast-growing market for medical tourism. The Shinagawa Lasik and Aesthetics Center (Philippines) in Makati is owned by the Shinagawa Clinic Group. Shingawa says it is the first-ever Japanese medical technology in the Philippines and seeks to boost medical tourism in the country by attracting foreign clients to try their laser eye service that uses the most advanced and safest facilities.
Medical Tour Experts, Inc. (MTE) is a new Filipino-American company engaged exclusively in the promotion of medical tourism in the Philippines. MTE believes that the Filipino’s caring attitude and warm personality will make for a strong selling pitch in this fast-developing business. It is the only Filipino-owned healthcare company in the USA promoting the interest of the Philippines in the medical tourism business. In the US, a simple cosmetic surgery like breast augmentation could cost $12,000. In the Philippines, such surgery is routine and it costs only around $3500. But it’s not all that easy because there’s also the question in clients’ minds: are these doctors and facilities abroad as reliable as they claim they are? Are they as competent as doctors in America? MTE allows patients in the US to talk via video phone to specialist doctors in the Philippines. The agency is promoting cosmetic and dental surgery, bariatric treatment, neuro surgery, laparoscopic surgery, heart bypass, knee and hip replacement, kidney transplant, hair transplant, and more.

Medical travel is a central feature of the Bahamas’ future tourism expansion strategy. Bahamas Law Chambers has successfully obtained approval from the Bahamas Investment Authority for a multinational company to operate a medical facility in the Bahamas. The company will service clients traveling to the Bahamas for medical treatment.
There are several reasons a company would consider opening a hospital in the Bahamas. Many companies offering medical tourism facilities are currently operating and servicing American clients out of Mexico. The Bahamas seeks to redirect the international clientele to its shores by informing the world it is open for business in the global medical tourism market. A big advantage the country has over competing jurisdictions in the Caribbean is its proximity to the United States.
Any company wanting to set up on the islands needs to incorporate a Bahamian company and then register trademarks with the industrial properties unit of the Registrar General’s Department, in order to protect the multinational company’s intellectual property rights in names and logos associated with the offered treatment. Bahamas Law Chambers specializes in trademark applications and advises its corporate clients to register trademarks in their names and logos and the names and logos of their products to prevent competing companies and competing products from stealing market share. The final step is to submit the application to the Bahamas Investment Authority. The application must include a business plan and letter from a financial institution evidencing sufficient funds to finance the project. An integral document is the project proposal form, which requires the applicant to report on, amongst other things: land requirements, proposed start-up-date, management/personnel requirements, capital investment and employment projection. The applicant must show that the project will benefit The Bahamas, usually by way of employing Bahamians, and that it has extensive capital resources.
On the submission of a medical tourism application to the Bahamas Investment Authority, approval is subsequently sought from the Ministry of Health and its National Research Ethics Committee. Only with the Ministry of Health’s blessing can the project progress to be reviewed and decided by the Bahamas Investment Authority. Obtaining approval from the Bahamas Investment Authority is not an overnight process. The application may be delayed while being reviewed by the Ministry of Health and its National Research Ethics Committee. Bahamas Law Chambers received approval in a moderate amount of time and was very satisfied by the outcome and process as a whole. Once approval from the Bahamas Investment Authority is granted, the multinational’s Bahamian company must obtain exchange control approval from the Central Bank of The Bahamas, obtain a business license and open a bank account in a local banking institution. Their attorney must also apply for work permits for any non-Bahamian medical experts and personnel and apply for a healthcare facility licence.
Bahamas Law Chambers anticipates a very bright future for the medical tourism industry in The Bahamas and has revealed the name of the business as Ibocure.The Bahamas Investment Authority (BIA) has given Miami based Ibocure a green light to operate in the Bahamas, with the Ministry of Tourism and the Ministry of Health also welcoming the idea. The Ministry of Tourism will help with promoting the business in the context of the destination itself.
A second medical tourism firm is currently being vetted that is close to approval and other interested parties in the pipeline. Ibocure, will service clients travelling to the Bahamas for medical treatment. As long as the company can raise funds quickly, Ibocure ’s addiction rehabilitation centre could open up in western New Providence as early as February 2011. Ibocure is offering a revolutionary drug called Ibogaine that is said to eradicate substance abuse in less time than other addiction treatments. While the drug has not been approved by the Federal Drug Administration (FDA) in the US, the company will be allowed to administer the drug in the Bahamas.
The company chose the Bahamas for its addiction rehabilitation centre because of its proximity to the US and its ability to meld the healing process with a relaxing atmosphere. The company is considering a location only feet from the beach in an area just east of Sandyport. Ibocure’s Bonnie Levengood says, "We want people to feel relaxed. We are attracting very high-end people and it will be expensive to go, so we want to create an idyllic location by the ocean so they feel like they can relax and attract their friends and family. It takes a stressful situation and makes it relaxed and therapeutic. We will take a very Zen-like approach to the development of the centre which will be a spa-like world class facility.” Investors have already raised $2million for the start-up of the centre that will be able to house at least 15 patients at a time.

Reported across the Arab press was the news that more than 4.3m medical tourists will visit the UAE this year, with the value of the industry projected to jump by 7% in comparison to 2009, according to data released by the government. The UAE is the Middle East’s biggest market for medical tourism. The local sector will be worth $1.7bn in 2010, with the second half alone seeing 13 % growth over the same period last year. Local experts have put these results down to better infrastructure, state-of-the-art medical centres, and modern technology.
But are these figures in any way believable? An analysis of these claims puts these figures in perspective.

4.3 million medical tourists would mean UAE attracts a million medical tourists than the combined numbers going to Thailand, India, Singapore, Malaysia, United Kingdom, USA, Poland and Hungary!
The volume of medical tourism traffic worldwide is estimated at between 38 and 40 million people. This would give the UAE a global market share of 10%.
There would be nearly as many medical tourists as locals, as the population of all seven states is only 4.6 million (UN, 2009)
The organization running DHCC says that in 2009 it had 220,000 patients of which 10% were from outside the UAE – and that 10% includes expats and business travelers. So…..the total number of medical tourists is at best 20,000 a year.
Where are they and their companions staying? According to a review of key cities in the Middle East by research firm STR Global and Deloitte & Touche Middle East, for June 2010; Abu Dhabi hotels notched up the biggest falls in revenue in the region with occupancy levels at 56.9 % and Dubai hotels at 73.1%.
Where are locals being treated? There is a massive hospital building programme across the region that is struggling to cope with the health needs of a local population. In the UAE, two of Abu Dhabi’s biggest projects include the complete refurbishment of both Al Ain and Al Mafraq hospitals, whilst in Dubai, a report by the Chamber of Commerce and Industry anticipates as many as 17 new hospitals providing 2,325 beds will be built in 2010 alone. The increase in demand, expected to hit a massive 165,000 beds by 2025, is partly due to a growing prevalence of Type 2 diabetes and obesity throughout the region, as well as increasing populations and a fresh influx of expatriates.
According to the World Health Organisation, on 2007 figures there are18.6 hospital beds in the UAE for every 10,000 residents. Even assuming the number of beds has more than doubled since 2007, this would give the country a total of 20,000 hospital beds. Even if we said every hospital bed is occupied by a medical tourist with an average stay of only one day there are only 3.6 million bed days….not enough beds. If the average hospital stay for a medical tourist is five days, then there are a few million beds short. Using Dubai’s figures that only one in ten hospital guests are from overseas, and assuming 3.6 million hospital bed days, and an estimated five day stay, this would mean the number of hospital bed days occupied by medical tourists is only 72,000. Put simply, for the figures to be true, medical travellers would be stacked six to a bed.
Although widely reported in the Arab press, no government department has either admitted to being the source of the figures or been able to say how they arrived at them.
The number of tourists to the UAE in 2009 fell slightly because of the economic slowdown, and is only slowly recovering in 2010, say reports by financial analysts Business Monitor International (BMI). But even they cannot check exact figures for Dubai as the authorities refuse to release any tourist arrival figures for 2009 or 2010.
According to the Department of Tourism and Commerce Marketing (DTCM) Dubai attracted seven million tourists in 2008. Dubai is the main attraction for the UAE, and as figures are stable, these figures would mean that more than one in two tourists to the UAE is a medical traveller.
Comparing the number of medical tourists with the number of hospital beds is hard, as the Ministry of Health has published no statistics of any kind since 2007.

Sadly, our conclusion has to be that ’ 4.3 million ’ is a figment of someone’s promotional imagination. Promoting overblown figures does damage, not just to the credibility of medical tourism in the UAE, but across the world.
The ability for the UAE to compete on price is a matter of concern, as the average cost of heart bypass surgery in the UAE amounts to $44,000. This compares with an average cost of $18,500 in Singapore, $11,000 in Thailand, $10,000 in India and $9,000 in Malaysia. Although the UAE is developing its medical tourism industry region, Asian destinations such as Singapore, India and Thailand are the market leaders for providing medical treatment to foreign patients. Further competition will be forthcoming from other countries seeking to exploit the medical tourism industry such the Philippines, Taiwan and Latin American nations.

Africa’s healthcare needs are huge and increasing, with most governments struggling to provide healthcare to their people. The private sector, with foreign and domestic investors, is becoming increasingly important. Estimates suggest that private healthcare now accounts for 60% of all African health care. The reason is Africa’s growing middle classes.
The tiny country of Lesotho has its first new hospital for many years. The 425-bed National Referral Hospital in the capital Maseru will replace the aged Queen Elizabeth II with eight well-equipped operating theatres, an intensive care unit and a laboratory when it opens next March. The building is a public-private partnership between South Africa’s biggest private healthcare operator, Netcare, the Development Bank of South Africa and the Lesotho government, overseen by the World Bank’s private sector arm, the International Finance Corporation.
Governments cannot afford to build and open hospitals from their own resources, so private finance holds the key to improving the continent’s cash-starved and chaotic healthcare sector. While some private clinics are opening, most African governments prefer the public-private partnership model as it allows treatment for millions who cannot afford healthcare, with hospitals financed by companies who will mainly make their money from private healthcare for the increasing number of Africans who can afford private care, either from their own resources or health insurances.
Netcare’s model is one it plans to roll out in Swaziland, Zimbabwe, Central African Republic, Ghana and Zambia and the DR Congo. Under Netcare’s structure, the Lesotho government will buy back the hospital over 18 years. Citizens get access to quality care in a hospital designed and operated by the private sector and the new hospital will offer better salaries and help retain Lesotho’s health professionals. At the end of the concession, the government gets a modern, well-equipped and maintained hospital.
The returns on investment may be lower than an entirely private venture but the partnership model avoids problems in unstable nations, where a change of regime could instantly take over a private hospital without compensation, or refuse to allow profits to be repatriated to the investor country. Over the long term, it puts those companies on good terms with governments across Africa.
Although much of the attention on health care in 45 sub-Saharan African countries centres on government activity, the private sector plays a surprisingly significant and growing role in meeting the region’s health care needs. Research by the International Finance Corporation (IFC) found that the increasing demand for health care due to improved economic growth across much of the region could translate into $20 billion of additional investment in the region’s private-sector health care infrastructure in the coming decade.
Governor Babangida Aliyu of Niger State has condemned the widespread practice of public office-holders going abroad to seek treatment. Speaking at the opening of the Umaru Musa Yar’Adua Hospital in Sabon Wase, Niger State, he called it a national disgrace and asked the Federal Government to end the practice. While some medical cases are taken abroad because the facilities for handling them do not exist within the country, many trips are not necessary. Medical check-ups can be carried out in Nigeria; while for other ailments there is effective treatment in private hospitals, if not in their public counterparts. There is a mood to make it harder for public office-holders and senior civil servants to embark on medical trips overseas, and increasing the capacity of local medical services to offer viable alternatives to going abroad. This will require commitment on the part of federal, state and local governments. Increasing the effectiveness of medical services within Nigeria is a longer-term project.

The Organization for Economic Cooperation and Development has issued a report calling for health care reforms in Korea. The report advises the government to license for-profit health care companies. It received a mixed response from the government. The Strategy and Finance Ministry liked the idea of regarding health care as an industry, while the Health and Welfare Ministry wants to keep it in the realm of social welfare. The previous administration had wanted to allow investment in hospitals and medical care facilities in order to expand the health care industry. But the policy hit a roadblock due to a dispute between the two ministries.
As the OECD pointed out, investment in hospitals and medical companies is a global trend, but the absence of an advanced infrastructure limited Korea’s medical tourism to just 60,000 patients to the country in 2009.There is a potential for Korea to move beyond the original base of cosmetic surgery to more expensive medical treatments for cancer, cardiac disease and neurological problems. With additional investment, the health care industry, and specifically the medical tourism industry, has the potential to become more lucrative.
Last year, the government included the healthcare industry as one of 17 sources for new economic growth and launched a Medical Korea marketing campaign. But medical tourism has difficulty competing in a tough market when hospitals and clinics are restricted by many restrictions and regulations.
One area that the country hopes will attract medical travellers, particularly from the USA, is a new proton therapy center within Korea’s National Cancer Center. Charm Lee of the Korea Tourism Organization says, "Korea is on the forefront of medical technology. Patients spend two months of proton treatment and have an interesting, inspiring, refreshing, and regenerating experience." Korea believes that the U.S., with its high prevalence of prostate cancer (less common among Asian men), is a perfect fit for a package that costs a patient $48,000 and includes airfare, accommodation, and daily transport to and from the hospital. This advanced form of radiation therapy is available at just seven U.S. hospitals. The National Cancer Institute estimates there will be nearly 218,000 new cases of prostate cancer in the U.S. in 2010 and more than 32,000 deaths.
Korea’s efforts to create the right image for its medical tourism program will be wasted if it does not first address issues such as the international accreditation of hospitals and language barriers, according to Geoff Moss of American medical tourism agency Planet Hospital speaking to The Korea Times, "Medical tourism isn’t just about marketing an image, their hospitals need to meet certain requirements. Certain agencies in Korea are too focused on selling an image and brand for Korea. A patient does not get influenced by a brand or image. They get influenced by service, innovation and the price. A lot of hospitals in Korea think they can just put up a sign that says ’welcome medical tourists’ and people from all over the world will show up. It is important that each hospital gets internationally accredited to assure the hospitals are up to international standards." The company is looking at Korean hospitals to add to its network. Moss feels Korea is on the right track to implement a successful medical tourism programme, but some aspects need to be addressed. Planet Hospital took 18 patients to Korea but encountered some setbacks. Geoff Moss explains, "We ran into problems such as languages issues, lack of follow-up care by the doctors, and nurses having no power to administer medication to sick patients. We have since fixed that problem by working with KMI International which handles all ground logistics for us and also provides full English speaking concierge services." Moss believes Korea’s attempts to get U.S. insurance companies to send their patients to Korean hospitals are pointless, "Insurance companies are not sending patients abroad in any large numbers. So no matter how hard Korea lobbies them, the insurers will not be persuaded because they are not ready." Moss says Korea should try to focus on companies who pay for their employees’ health care, since they are the ones who are ready to send their workers abroad for treatment. Global Korean companies such as Hyundai, Kia, Samsung and LG could also be given incentives to send their employees working in overseas offices to Korea for medical care. The agency does like the fact that Korean prices are much less than American ones, and sees potential in specialist areas such as proton therapy.

SimpleCare World Health-with offices in Miami, Florida and Malaga, Spain –is a new medical tourism agency offering international medical travelers high quality affordable treatment in a first world country-Spain. Non-acute operations and medical procedures (such as orthopedic surgery, hip and knee replacements, cardiac surgery including coronary artery bypass and heart valve replacement, bariatric surgery) are available for significantly less than what they would cost in other first world countries, especially the agency’s main target , the United States.
Spain is a world leader in medical tourism, offering state of the art facilities and the newest technology. Even with the travel costs involved the total amount spent on treatment for cancer care, cardiovascular disease and hip & knee replacements, amongst other procedures, still saves money for those who are willing to travel. SimpleCare offers English speaking medical specialists in hospitals in Spain, at prices 40-70% less than US costs.
The package includes-

Flights to and from Spain.
Airport pick-up and drop-off.
Cell Phone with $50.00 prepaid to stay in touch with family back home.
Consultation with the appropriate specialist.
Booking into a hospital for the operation.
Accommodation for patient and companion.
Concierge service for patient and companion.
Arrangements for aftercare while in Spain.

The medical specialists are all highly qualified, board certified doctors who have received some or all of their specialty training in the US or the United Kingdom as well as Spain. All speak English as their second or third language. Simple Care will partner with the patient’s own doctors in his or her home country. The agency has a network of 2500 specialists in 13 Hospitals throughout Spain. Included in the network are-Hospital Quiron with hospitals in Madrid, Barcelona and Valencia; Santa Elena Hospital, a private multidisciplinary hospital; USP Hospital in Marbella, that has an international patient services department; and Hospital Parque San Antonio, which is staffed by multilingual professionals. The hospitals are inspected regularly by the agency.

Dental implants already hold a substantial 18% share of the global dental device market, and are also expected to have one of the highest growth rates amongst all dental device submarkets. This is primarily because dental implants offer an effective treatment for edentulism and because of the rising demand for cosmetic dentistry worldwide across all age groups.
The global dental implants market is expected to grow from $3.2 billion in 2010 to $4.2 billion in 2015 at an annual rate of 6% from 2010 to 2015. Europe currently forms the world’s largest market for dental implants with a 42% market share, and is also expected to have the highest annual increase, 7%, from 2010 to 2015.
While the lack of consumer awareness in developing economies may hinder market growth, industry players still have immense growth opportunities as merely 2% to 3% of the global edentulous population has already received dental implant treatment so far. The aging baby-boomer population in developed nations offers an especially high-growth opportunity, as this consumer segment is characterized by high disposable income, and also by an increased need for dental care due to longer life expectancy.
The MarketsandMarkets report on the global dental implants market analyzes the market dynamics exclusively from the industry point of view. It aims at providing a two-dimensional picture of the market by focusing on all aspects of the dental implants market by reporting the key trends, which are further analyzed at the micro market levels, with market tables, drivers, restraints and opportunities along with the key players and competitive landscape. The report also provides more than 35 market tables for various geographic regions covering the sub-segments and micro-markets.
Dental implant technology has made great strides in recent years, providing patients with unparalleled levels of effectiveness, convenience, and affordability. This is one of the main reasons why so many dentists recommend dental implants as their preferred method to replace missing teeth. Dental implants can offer many benefits. Because they eventually fuse with the jawbone, they are more stable than dentures. People with dental implants may be able to talk and eat more easily because they don’t face the risk of their dentures slipping. Dentures require replacement when the gum tissue shrinks and changes the fit; implants are not affected by this problem. They don’t wiggle or slip, as dentures can, and they are healthier for the gums and bone. Most patients find implants easier to maintain than dentures.
There is a problem. An implant to replace a single tooth can cost $3000 to $4500 in the USA. Implants to replace a full or partial set of teeth can run from $20,000 to as much as $45,000.Implants typically involve the work of both a surgeon and a dentist. Several office visits may be needed to put in the screws and to add the prosthetic teeth.
The high costs of dental implants and the demand for cosmetic dentistry are seen as driving the growth in dental tourism. People are increasingly seeking treatment at a fraction of the cost abroad as the reputation of highly skilled dentists and state of the art technologies are reported. Americans tend to go mostly to South American countries while Western Europeans go to Eastern European countries such as Hungary, and Asia.

Dr. Pero Šutalo of Dental Implants Croatia, in Dubrovnik, Croatia comments on dental implants, "When it comes to dental treatment, let’s be realistic. We cannot offer an implant for 400 Euros because doing so is far below the standards of our clinics. We can offer quality implants from 700 to 1,000 Euros, made by global companies from the finest materials. Unfortunately, for all of us, choosing dental care providers just because they’re cheap is detrimental to the entire industry. It seems that some patients are not satisfied with saving up to 60 % on dental treatment abroad. We remain dedicated to the proposition of quality of the product as the main reason a patient should leave his home country and travel abroad. Quality patient care breeds loyalty, integrity and will build your business faster than offering severely discounted treatments and services.”

Countries involved in health and medical tourism vary enormously; some have a high profile about what they do; others have a high profile on what they plan to do. Many in Europe have a low international profile, but are doing as well, if not better, than those who make the most noise.
Slovakia is not usually thought of as a popular destination for health tourism, but its spas enjoy a long and highly regarded reputation. Each year thousands of foreigners travel to Piestany, Trencianske Teplice or Bardejov and many of them return annually, often several times a year, to receive special treatments with various kinds of mineral waters, or with mud, or just to enjoy the wide range of wellness procedures offered.
Slovakia has many deep underground springs with a variety of thermal and mineral properties. People have known the healing value of these waters for centuries, so treatments based on therapeutic mineral water are popular. But Slovakia also offers climatic treatment. There are more than 20 specialised resorts in the country providing professional spa treatments.

Avicenum is a travel agency specialising in wellness tourism, which regularly brings foreigners to Slovak spas, mainly from the Czech Republic, Poland, Germany and Austria, as well as from the Middle East, primarily the United Arab Emirates, Kuwait and Lebanon.
The recession has caused a few problems, but many hotels and spas have used the quieter times to redevelop and improve their offering, something they had problems doing when they were full for most of the year. The improved quality and cost–effective prices, are leading to an upturn in visitor numbers. This is despite Slovakian authorities failing to build its image as an attractive destination as rivals Austria and the Czech Republic have. Slovakia has no integrated development of tourism with agencies, tourism associations, hotels, and others working together.
The most popular spa destination for Slovak as well as foreign visitors is Piestany where the 200-year-old spa is also the biggest spa in Slovakia. It has natural springs of thermal mineral water. Last year 48,400 people received treatment there of which 24,750 were overseas tourists.
The second most-visited Slovak spa is in Trencianske Teplice: last year it recorded a drop in Czech and Polish clients but an increase from Austria, Germany and the Netherlands. Foreign customers account for a quarter of all visitors. Those from Germany, Austria, and the Netherlands are mostly interested in traditional spa treatments, rather than more modern wellness and relaxation stays. Visitors from the Czech Republic are more likely to come for shorter wellness and relaxation stays where the shorter travel distance plays a role. Here, foreign guests now account for about 80% of the clientele of the Flora Hotel, mostly from the Czech Republic and Germany
At the spa in Sklené Teplice that features a thermal cave steam bath, one in five visitors is from overseas and that is expected to increase as it has recently developed spa facilities, especially balneotherapy, accommodation and pools. Most foreign visitors come from the Czech Republic and the other two main markets are Germany and Russia. Most clients are repeat visitors.
A newer attraction for foreign health tourists is Dudince in southern Slovakia where visitors mainly come from the Czech Republic and Germany, with others from Poland and Hungary. The Diamant spa reports increased interest from Norway, Denmark and Sweden to add to existing visitors from Germany and Austria, and in 2009 foreign guests were 30% of the total numbers; most of the spa’s clients are aged 60 or over, usually for two- or three-week all-inclusive stays.

In 2009, the Romanian Tourism Ministry selected THR– Taylor Nelson Sofres to realize Romania’s tourism brand as a way to communicate Romania as a tourist destination. A few days ago the new Romania tourism brand was officially revealed: ’Romania-explore the Carpathian Garden”. Romania’s marketing community is not convinced that the brand will work with the message and the composition confusing those in Romania. Bogdan Naumovici, advertising expert commented after the launch “If they are going to invent something named Carpathian Garden, maybe it will work. I don’t know what that could be – maybe wellness tourism, bio crops or maybe they will invent a tourist area to promote.”
The relevance to wellness tourism is that earlier this year THR undertook a quantitative research study to find out how people from various countries perceived Romania. The countries selected were the eight most important markets, Germany, UK, Italy, Russia, Austria, USA, France and Hungary. After the study, the conclusion was that 80% of foreign tourists have no idea what Romania can offer them. The conclusion was that Romania had to invent its own brand. The study also found out that among the top six areas of interest to tourists to Romania was wellness tourism.

Romania’s 70 natural spas provide relief for many medical disorders and illnesses including rheumatism, endocrine, and kidney, liver, respiratory, heart, stomach and nervous diseases as well as nutrition, metabolism and gynecological disorders. Romania is home to more than one third of Europe’s mineral and thermal springs. Natural factors are complemented under attentive medical care by physiotherapy, acupuncture, electrotherapy and medicines produced from plants. Romania’s main spas include: Mangalia, Neptun, Eforie Nord, Covasna, Slanic Moldova, Vatra Dornei, Borsec, Herculane, Buzias, Sovata, Bazna, Ocna Sibiului, Baile Felix, Tusnad, Calimanesti and Govora.
If you are still wondering what the Carpathian Garden is; the website explains"Carpathian Bran Castle situated near Bran is a national monument and landmark in Romania. Commonly known as Dracula’s Castle, Bran Castle is marketed as the home of the character in Bram Stoker’s Dracula"

Medical tourists are heading to Poland for cheaper and quicker surgical treatments, says a new research report from TechSci Research that predicts more than 15% growth in the country’s health tourism market particularly from the UK and Germany.
In the new research report “Poland Medical Tourism Market 2013,” TechSci Research anticipates strong growth for the Poland medical tourism market in the near future. The market has been driven by favourable factors including low waiting time, low cost treatment facilities and proximity to most of the European countries. In recent years hospitals and clinics in Poland have emerged as highly sought after destinations for medical procedures among international travellers. A large number of medical travellers from European countries, particularly UK and Germany have visited hospitals and clinics in Poland, more for dental surgery and cosmetic surgery than medical treatment.
According to TechSci Research, the entry of Poland in the European Union in 2004 and implementation of standard regulations and policy framework similar to other member countries has also provided the push to the medical tourism industry. The hospitals and clinics in Poland will continue to attract large numbers of medical tourists from European countries because of world class treatment facilities at low cost and the absence of any visa requirement for travel within European Union borders.
As well as dental and cosmetic surgery, spas and health resorts are attractive for foreign customers. Spa residential costs are least 30-40% cheaper than in Germany. Damian Medical Centre in Warsaw offers cosmetic surgery, implants, eye operations and dental treatment at less than 50% of Western Europe prices.”
The report says that the current number of medical tourists was 300,000 during 2009 compared to only a few thousand visitors a decade ago. Most medical travellers have been visiting Polish clinics and hospitals for cosmetic surgery and dental treatment.
In the opinion of TechSci Research, Poland needs to focus more on promotional and marketing activities in order to attract large numbers of international travelers to its healthcare facilities. The absence of any marketing and promotional effort could affect the emergence of Poland on the global medical tourism industry landscape and could result in an opportunity loss of revenue for Polish health clinics and hospitals.

The Japanese government is seeking to encourage medical tourism to selected hospitals. The main market is wealthy people from abroad, mainly Chinese and Russians. The government owned Development Bank of Japan, estimates, from a base of almost no current medical tourists, 430,000 medical tourists to Japan in 2020. How the bank arrived at this substantial figure and whether it is a prediction or a target to aim at, is not explained.
The government is considering specific measures:• Creation of a medical service visa system designed to allow foreigners greater flexibility regarding the duration of their stay.• Establishing an authorization system for medical facilities eligible to accept overseas patients.• Promoting efforts to develop language-interpreting services at medical institutions.
Japan is a very late entrant to the medical tourism market and hospitals are focusing on health check services as a first step. Japan is a world leader in the use of high-tech examination devices such as magnetic resonance imaging (MRI) and positron emission tomography (PET) systems. Health checks combined with sightseeing tours are the current offering in Nagasaki and Fukushima for people from China, as direct flights are available between the two and Shanghai. Nikko Medical Center in Nikko, has launched a sightseeing medical service department to combine checkups with trips to temples and shrines. Other places are arranging tours based on health checks for diabetics.
Profesor Toshiki Mano of Tama University argues that a medical tourism industry based on health checks is not sustainable in the long term, "Japan is the only country that is trying to capitalize on health checks as a centerpiece of medical tourism. This can work for the present, since only a relatively small number of foreign patients from abroad are currently seeking medical treatment in Japan. However, there’s no telling whether the situation will be the same in 10 years time."
Mano argues that if Japanese hospitals continue to rely on medical examination tecnology to boost medical tourism, major targets like the Chinese and Russians will not come to Japan once such services become available in their own countries, and at a lower price than offered in Japan. Thinking long-term, he says that the government should work to provide foreigners with treatment for digestive problems, an area in which Japan is particularly advanced and should also make such cutting-edge medical technologies as regenerative medicine the core of medical tourism to this country in the future.
He also points to problems in long delays in government authorization of the domestic use of medical devices and products newly developed abroad, and the growing fear that Japan’s medical system will collapse due to the shortage of doctors. Mano argues of the danger in letting the treatment of foreigners take precedence over Japanese patients.
Others argue that as in Asia, to ensure that Japan’s medical services will have a good reputation overseas, the government should consider not only promotion of medical tourism but also the feasibility of exporting the country’s medical facilities and expertise. Yukihiro Matsuyama at the Canon Institute for Global Studies argues, "The world is shifting away from the age of medical tourism to the direct export of hospitals and university medical departments. If Japanese hospitals and medical schools are not strong enough to branch out overseas, there will be little chance of this country winning the battle with other nations for medical tourism."

Taiwan is promoting itself as a medical-tourism destination. Taipei has many hospitals with modern and sophisticated equipment. The cost is low compared to other countries; liver-transplant surgery costing US $91,000 compared with $300,000 in the USA.
Although Taiwan may want high spending Americans and Europeans, the reality is different. The low prices and expertise are attracting many people from China to go to Taiwan to have surgery. That has become much easier since restrictions for Chinese tourists to Taiwan were lifted in mid-2008. But they have to come in organized groups. The government recognizes this puts off independent Chinese travellers and has recently announced that Chinese tourists will soon be allowed to travel individually to Taiwan.

Lion Travel, the country’s biggest travel agency, hopes to grow quickly by offering medical and health tourism packages to attract Chinese tourists to the island. Lion Travel set up a specialist medical tourism section last year, soon after Taiwan began to see an inflow of Chinese tourists who, for the first time in 60 years, were allowed to visit Taiwan in tour groups. The company began by operating tour groups with medical services as part of the package, attracting wealthy Chinese with slogans such as “Mommy comes to Taiwan, and returns looking like your sister.” While the number of groups is still relatively small, the company expects business to grow about 30 per cent every year for the next few years, and much more if travellers can come on their own. Lion Travel has partnered with Chang Gung Memorial Hospital, the largest private hospital on the island, and one that has an international patient centre.
Taiwan’s current policy only permits controlled tour groups from the mainland, which limits options for Chinese who seek varied medical services. Under group-travel restrictions, tourists are told where they can go and when. They cannot deviate from the set itinerary. Dr.David Wang of the Taiwan Medical Tourism Development Association says, ”Chinese patients seeking operations can now plan ahead and book Botox treatments and cosmetic on their own schedule.” Wang travels to China once a month to promote his cosmetic surgery practice.
According to Taiwan government statistics, 972,000 tourists from China went to the island in 2009, a 195% increase on 2008. Chinese aviation officials recently announced a 10% to 15% reduction in fares for flights between the two countries. Over a million will visit this year. Exactly how many are health or medical tourists is unknown.
Richard Wu of Taiwan Task Force for Medical Travel says. "Our priority is to promote Taiwan as a brand name and then promote individual hospitals for services. That customers will now be able to travel to Taiwan individually will help. Few would join a group tour that lets everyone else know they are going for cosmetic surgery or other medical reasons.”

The Estate Vault is partnering with the International Medical Fund Trust to provide personal document management for the growing medical tourism market. The Estate Vault, based in the USA, provides electronic data management services for the medical, personal financial and legal records markets. The company is working with the British Virgin Islands-based International Medical Fund Trust (IMFT) and its New Zealand-based trustee company IMF Trustees Limited. The Estate Vault will provide a suite of secure and interactive personal data management tools that help patients take greater control of their personal information while travelling out of their own country to have medical procedures done.
Boyd Soussana of The Estate Vault says, “Americans and Canadians travel overseas to undergo a wide range of elective medical and dental procedures. And populations around the world are looking for alternatives to their own countries’ medical offerings because of price or access to time-urgent procedures."
Clients who sign up with the new membership service will have access to a range of plans for overseas medical travel, vacations, and medical procedures. They will also be provided with USB data storage cards along with a prepaid MasterCard. Customers will also be able to put all their sensitive personal data, medical files/x-rays and legal information into their own e-Vault that can be accessed anywhere in the world.
IMFT and Estate Vault will establish an international business company in the British Virgin Islands, which will become the provider of a range of products. This company will trade under the Estate Vault International brand name. Estate Vault International will also offer white-labelled products to strategic partners that are active in the medical tourism marketplace.
The Estate Vault personal health record is electronic, totally portable and can be reviewed online. It can be used without the need for an internet connection on any computer with a Microsoft operating system and provides a link between patients, doctors and the network of specialty clinics, hospitals and insurance providers. It is available to use on the web, desktop or via a USB card. People can choose to keep data on a USB card and a desktop version and not on the internet or any combination of the three.
While very few people currently have an electronic personal health record, many are interested in establishing them if connected online to their doctors so they can communicate with their doctor via e-mail to exchange health information and get answers to questions. Despite strong consumer demand, many are still concerned about the privacy and security of their medical information, which is why this protected system expects to gradually become popular.

50% of Europeans are overweight and obese and need to shed at least 5-10% of their overall bodyweight. By dropping the kilos, women and men will avoid other health challenges like diabetes and heart problems. US First Lady Michelle Obama has launched an aggressive campaign against childhood obesity, recognizing that millions of Americans are clinically obese.
The European Union is looking at ways to empower overweight and obese individuals by offering support, promote healthy lifestyles and ensure health coverage for effective therapies, encourage healthcare professionals to recognize obesity as a chronic disease, create clinical guidelines on weight loss and various interventions and evaluate best country practices throughout Europe.
The problem in Europe and America is that if you are dangerously obese then state healthcare or insurance may pay for surgery. But for the vast majority of those who are overweight neither state nor privately insured healthcare will pay for weight loss surgery or weight reduction programs. This has produced a global industry to help people lose weight, some of which is effective and cost effective, some of which is either hugely expensive or only effective in the short term.
There are many weight loss procedures, and some of the newer ones are not offered in a person’s home country. Also, many countries offer a range of weight loss treatments from spas to surgery, at a cost much less than in the USA or Western Europe. Many of these lower price countries benefit from lower staff and premises costs and offer medical tourists good quality and effective treatment.
Judging the quality of any weight loss programme is difficult, as effectiveness depends partly on the will of the individual to continue healthy lifestyles that keep weight down. Sadly, some hope for a quick fix with surgery and then expect to return to their previous lifestyle.
Obesity surgeons from BMI Healthcare in the UK are warning against having weight loss operations undertaken by unregulated surgeons abroad. Losing kilos whilst saving money seems like the perfect solution for people with weight issues but cost-conscious people need to be aware that they can be taking a gamble with their health, and some could end up having to pay out for corrective surgery when they return home. Anselm Agwunobi of BMI Healthcare warns, “There are risks if you choose to have your weight loss procedure done abroad. Patients who have surgery in some centres abroad may be putting themselves at a greater risk of infection, both on the operating table and in the ward. People should remember that weight loss surgeries can, at first, be very debilitating, so patients need to consider the comparative comfort levels and costs involved in recuperating in a foreign country until they feel well enough to safely fly home.”
Patients seeking a weight loss surgery should:• Check a surgeon’s credentials. Ensure that the surgeon is on the specialist register in the country they are in.• Choose a hospital where you will feel comfortable and at ease.• Find out about the support available. Request that you meet the team who will be treating you throughout your hospital stay, as well as the kind of aftercare you will receive. You need to be prepared and discern what advice can be provided. Ask how many post-operative visits are included within an aftercare package and when they are likely to be. Ask what happens if you are unhappy with the results or if things don’t go to plan.• Take your time. Do not be pressurised by special offers that demand that you make a booking or commit to having surgery quickly. Embarking on weight loss surgery is not something that should be rushed into. A good surgeon will usually encourage you to go away and consider all the information, therefore giving you the chance to thoroughly consider your options and talk to your friends and family to help you in the decision making process if you are certain about how to proceed.

India’s Fortis Healthcare has lost out to Malaysian government company Khazanah in the bidding war for Singapore based Parkway Holdings. Fortis’s main Indian rival Apollo Hospitals has links with Khazanah and expects to benefit from new joint ventures. The key to understanding why several parties were so interested in Parkway is that Apollo, Fortis, Parkway and Khazanah see many opportunities not only in their own countries, but across Asia and beyond. The simplistic version is that all see massive opportunities in attracting medical tourists to their hospitals. On this, they compete with countries and hospitals worldwide. Many of their competitors are happy to slowly expand in their home countries and attract domestic and medical tourist customers.
These four companies, although different in approach, size and management style, have a longer term and wider vision. They understand that there is a finite limit to how many people they can persuade to go to another country for surgery or a health check. They also understand that modern private healthcare is increasingly global. So their aim, on their own and with private and public partners, is to build new hospitals in countries where people will want treatment, but in their own country. Asia, and particularly China, is seen as offering huge potential, but other countries are under the microscope too. The trick is getting into a new country or area, ahead of local and international rivals.
Fortis saw Parkway as a vehicle for international expansion, particularly into South-East Asia. Fortis Healthcare will sell the 24% stake it currently holds in the Singapore’s largest hospital chain to Malaysia’s sovereign wealth fund Khazanah Nasional Berhad. So instead of borrowing money to buy Parkway, it will get money from exiting Parkway. Fortis can either try to increase its investments at home or look for other targets similar to the Parkway chain. Malvinder Mohan Singh of Fortis says, “We intend building a pan-Asian and global healthcare group and will explore other organic and inorganic opportunities within the region. Our vision for a global healthcare service provider which can cross leverage learnings across geographies, optimize cost and provide the best quality to the benefit of the patient has not changed. We hope to re-invest the value unlocked from this experience to support our vision to become a global healthcare provider.”
The acquisition of Parkway would have turned Fortis into Asia’s largest private healthcare network, with a presence in Bangladesh, Brunei, Cambodia, China, India, Indonesia, Malaysia, Mongolia, Myanmar, Pakistan, the Philippines, Russia, Saudi Arabia, Sri Lanka, Ukraine, the United Arab Emirates and Vietnam. Now Fortis will have to find other ways to expand. Fortis had hoped to use Parkway’s brand and secure a pan-Asia recognition that would help it promote medical tourism.
Demand for private medical services has been growing in Asia as incomes rise. Most of Asia’s medical tourism is intra-regional, or from the Middle East and Africa, with a flow of patients from countries with less developed healthcare infrastructure towards those with better hospitals, rather than the widely promoted opportunities for Americans and Europeans to get lower cost healthcare. Singapore was an early mover in medical tourism. Parkway has shown that middle class patients from developing countries such as Indonesia can be tempted to make the short flight to Singapore for a standard of healthcare that is difficult or impossible to obtain in their own countries.
Parkway runs three hospitals in Singapore, with a fourth under development, plus one in energy-rich Brunei, six in China and two in India. In addition, it runs 11 in Malaysia, including nine operated by the Pantai group, in which it has a 40 per cent stake, with Khazanah holding the remaining 60 per cent. The Malaysian government has identified private healthcare as a key sector for development, and recently announced a series of initiatives to promote the industry, including tax breaks for new hospitals aimed at medical tourists, simplified visa requirements for patients and incentives for medical specialists to work in the country. Khazanah has not revealed plans for Parkway, but unlike Fortis it does not run hospitals, it will probably just act as a source for funding new investments and may encourage Parkway to look for partners in joint deals, to give it the expertise in countries where it does not operate now.
Where does Apollo Hospitals fit? Khazanah has a stake in Apollo and Apollo has partnerships with Parkway. Apollo plans to build 100,000 beds per year for the next two decades. It has 50 hospitals in India and other countries. Apollo Hospitals owns, part owns or manages hospitals in Mauritius, Ghana, Nigeria, Yemen, Bangladesh, Kuwait, Seychelles, Sri Lanka, Caribbean islands and the Dutch Antilles. It has just agreed to manage the Indira Gandhi Memorial Hospital located in Male, Republic of Maldives. Apollo is also developing business by technical innovation. It is now offering endovascular treatment [liberation treatment] to patients with multiple sclerosis and has already performed this procedure on 35 patients from Canada and the USA. India’s oldest corporate hospital chain attracted 60,000 foreign patients in 2009.

There is healthy competition among hospitals, countries and agencies for medical tourism business. Agencies range from those who have business experience and a business plan, through to people who went abroad for treatment, thought they should offer the opportunity to others, and muddle along. Some who started off as amateurs have survived by becoming professional. Others open, last a year or two and close due to lack of custom and profit. In essence, medical tourism agencies are like any of those businesses highlighted on television programmes-no two are the same. But like any other types of small business, prosperity is a tough ask, and like the thousands of people worldwide who open a hotel, shop or restaurant the basis of “ it seemed a nice thing to try “ only the best survive. Many small clinics are also new to medical tourism and need help to do well.

RevaHealth offers some suggestions on how to turn leads into business-
* When contacted by a potential new patient do not take the easy way out and send an automatic email reply or personalised follow up email. To sell to these new customers you have to pick up the phone and call them. If you rely on email alone to convert your patient enquiries into paying customers you are cutting your new business by 80%. It can be difficult to do it promptly, and it is time consuming, but when you realise how much value it can unlock, there is no question but that it has to be done.* When you get an online enquiry the natural inclination is the reply to it immediately. Do not do this. Take your time read the customers’ requirement and research the right and call them.* The process should be:1. Send an automated response acknowledging receipt of the enquiry and letting the patient know when to expect a call.2. Research their enquiry – potential treatment options, prices, length of treatment etc.3. Call Them. If you do not get through leave a message and call them back. Never rely on email alone unless the customer has specifically asked not to be called.4. Remember the time zones of where the patient is when you call them.
Julie Munro of the Medical Travel and Health Tourism Quality Alliance (MTQUA) also has advice for agencies, “Medical travel agencies can no longer get away with putting up a website, signing commission agreements with hospitals, maybe visiting a couple of them, and declaring themselves open for business. Medical tourism today has become a highly competitive, segmented and specialized industry. To create a new medical tourism business is more challenging than ever. What I advise newcomers to the industry is very different now compared with five years ago.”
Munro has some questions to help new and established medical tourism agencies to renew and reshape their business plans.
* Will you be a full-service medical travel agency, a health tourism agency, a broker or facilitator or an on-site international patient care management service?
* Will your market have a global reach? Regional? Will it be defined geographically or will it focus on special interests or needs of a specific clientele?
* How will you select the hospitals, clinics, treatment and spa facilities and other support service partners?
* Will you formally or informally partner with recovery resorts, travel agencies, clinics, hospitals, doctors, or other medical travel agencies?
*. Will you be a general service or specialize in one or more of orthopedics, spine, cardiac, cosmetic, dental, IVF, alternative treatments, anti-aging, sports wellness, pediatrics, women’s health, oncology?
* Will you select a hospital or clinic based on location or facilities?
* Will you judge a hospital by the recommendation of friends or colleagues, independent research reports, magazine or newspaper articles, website review, certification or accreditation credentials?
* What credentials are most important to you as an agency? Do you know how these credentials differ, and what each is best for: JCI, Trent, Accreditation Canada, ISQua, ISO, MTQUA, TEMOS?

European health ministers met in June to finalise a political agreement on the draft directive on cross-border healthcare. Adopted by the European Parliament in April 2009, it was discussed by health ministers. MEPs in the European Parliament’s public health committee will now vote on the information to patients proposal on 28 September with the full plenary voting on 18 October.
The revised text was proposed by the Spanish presidency. Crucially, it addresses issues regarding reimbursement from affiliated countries, as well as providing the directive with a double legal base in Articles 168 and 114. The UK and Germany circulated an additional proposal to change the provisions concerning eHealth and interoperability (in Article 14 and Recital 38 respectively).
The text was widely approved, with strong opposition coming only from Poland, which issued an alternative text for approval, and from Portugal. Romania chose to abstain after the failure of the Polish text. Sweden, Slovakia, Ireland, Lithuania, France, Austria, Slovenia, Cyprus, Finland, Hungary, Malta, The Netherlands, Bulgaria and Denmark lent their support to the compromise bill and welcomed progress on the dossier.
The UK noted the importance of codifying the mass of European Court of Justice (ECJ) case law that has accumulated on this issue, so as to ensure legislators are setting the rules, rather than the courts. The Italian minister attacked the amendment offered by the UK and Germany, claiming it served only to water down the proposal and weaken its implication. Luxembourg and Estonia expressed their concern at the link between the directive and social services systems in member states, as much work would need to be done on the interoperability of these processes so as to retain compliance with social services provision, they said.
Latvia felt that the previous Swedish approach to prior-authorisation was better as the current agreement may create a disproportionate administration burden. Greece highlighted the overarching need of all member states to reduce expenditure, and the pressure this puts upon healthcare systems. Emphasising the public nature of healthcare, the Greek minister highlighted the danger of turning it into a consumer product ruled by market forces. The Czech Republic noted the possibility to adjust the salient details through negotiations with the European Parliament, whilst the German minister pointed to several ethical issue amendments proposed by the Parliament, which the Council might be able to support.
The Polish delegation said they could not support the compromise as it does not go far enough to guarantee equality of access to healthcare for Polish patients. Additionally, Poland asserted that EU law should delegate sovereign responsibility for healthcare systems to the member states, as in the Polish alternative text. The Portuguese minister concluded that their concerns regarding non-contractual private providers had not been met and they would therefore be supporting the Polish text, whilst submitting a separate written declaration to the Council.
The compromise agreement gives member states more power to control the outflow of patients by allowing a system of prior authorisation for certain types of lengthy or costly healthcare. GPs will also be allowed to act as a gatekeeper as is the case in the UK health system. The agreement also specifically clarified the issue of who should reimburse the healthcare of pensioners who live in a second EU member state and wish to receive healthcare in a third member state.
The British Medical Association (BMA) is an example of a medical group urging the European parliament to only accept the agreement if there are major amendments to make it workable. The agreement does not adequately address a number of the concerns that the BMA and other health stakeholders raised in previous lobbying (such as continuity of care, language issues and telemedicine regulation). The BMA will continue to push these issues in the coming months. MEPs are expected to adopt their second reading report in December with health ministers re-examining the issue at their December meeting as well.
The European Court of Justice (ECJ) has published another ruling on the provision of cross-border healthcare. The ECJ ruled that hospital costs incurred while travelling in the EU will only be refunded if the patient would have received the same treatment free of charge in his country of residence. The ruling followed a complaint by a French national resident in Spain and insured with the Spanish social security system who received care in France.

Within the “conventional” wisdom of medical tourism is an assumption that the UK and USA are prime target markets. Almost every country, organisation and conference seems to suggest that these two countries are only consumers of medical tourism, and they are always high up on medical tourism target lists. The reality may be very different, as both are in the top ten international medical tourism destinations.
According to a dental clinic in Sussex, patients in Sussex who are thinking of travelling overseas for dental treatments can save themselves not only the time, the effort and a lot of money, as most of their requirements can now be met locally and at a similar saving. The most favoured country for Britons travelling abroad for dental treatments is Hungary and especially Budapest. Dr Bruno Silva of Brighton’s Implant Clinic in Hove, says,“Our services are comparative in price if not cheaper than for patients travelling abroad. We have a great team of surgeons specialising in dental implants and advanced dentistry.”
Dr Silva also suggests that the big disadvantage of going abroad for treatment is that the cost of any follow up treatment and the cost of dealing with any complications must be considered, plus all the travel costs and accommodation. He argues that before people start thinking of making the journey they should look at all the options at home for dental implants and advanced dentistry. While you would expect the clinic to suggest treatment at home rather than overseas, that it attracts medical tourists from overseas may be a surprise. Brighton Implant Clinic has a chauffeur driven car for patients who require transport and in the past year has received patients for treatment from Scotland, Germany, Malta, France and many other parts of Europe.
Dr Bessam Farjo and his wife Dr Nilofer Farjo head up the UK’s leading hair transplant surgery. They carry out more than 300 operations each year at their Manchester clinic, The Farjo Medical Centre. More than 4,000 people have travelled from across the UK, Europe and as far as the Middle East, Australia and the United States, to the centre. The Farjo Medical Centre has an international reputation for not only using the latest hair transplantation techniques – recognised throughout the surgical field – but also for placing significant emphasis on developing pioneering ways to counter hair loss.
The USA is also an often forgotten destination. David Goldstein of Health Options Worldwide (HOW) explains, “The popular notion in medical tourism often defines it as Americans leaving the U.S. for inexpensive medical treatment and low cost surgery. However, the business model works both ways. In the world of medical tourism and medical travel, the United States is certainly a power player, offering high quality care and modern technology to attract international patients. Most people hear of medical tourism and they think of American patients seeking healthcare in Asia or Latin America where the services are much less expensive. But cost is not always a factor; quality is."
Goldstein argues, “Medical tourism is a huge business opportunity for American hospitals to bring in revenue. What is interesting about this trend is that international medical tourists do not come to the U.S. for healthcare because of economics. International patients are attracted by the quality of doctors and state-of-the-art medical technology for which the United States is renowned. American hospitals offer pioneer treatments that are not available anywhere else. Another factor impacting international patients is the fact that the wait for medical treatment in their home country is too long. But quite simply, many of these patients can afford the best and can find it in the U.S.Travelling to the U.S. for healthcare can be costly and complicated for international travellers. Usually, the patients are wealthy people who can afford high quality care. In this fast growing market the U.S. has a chance to be very competitive."
HOW says figures for international patient numbers going to the USA have grown over the last 12 months, and the industry can expect more growth this year. Patients come from: Mexico (21%), Middle East (14%), South America (12%), Central America excluding Mexico (11%) and Europe (11%). The most sought-out treatment areas were oncology (32%), cardiovascular (14%) and neurological (12%).

While local and international investors in Indian healthcare are primarily interested in local healthcare, there are companies identifying specific development opportunities based on medical and health tourism.
The TAJ chain will have a spa in every hotel, while Park Hotels has launched one in Chennai, and Delhi will follow. Oberoi Hotels has spas at its premium leisure and business properties, and ITC-Welcomgroup has announced its first major spa in Agra, where the recently renovated Mughal Sheraton is adding a 25,000 sq ft spa, the largest in north India. The belief, at least from major chains that offer high quality hotels targeting overseas visitors, is that spas are now essential in such hotels. The target market is also business travellers who want de-stressing. Some hotels run their own spas, others contract them out to international spa groups.

Narayana Hrudayalaya Dental Clinic (NHDC), a subsidiary of Narayana Hrudayala Hospitals, is setting up a chain of dental clinics across the country. NHDC has 18 in Bangalore and 2 in Kolkata. The company has given the go ahead to an expansion plan that will see it open 300 clinics by 2013 across India and abroad. Abroad, the first country is likely to be Malaysia where opportunities are similar to India. NHDC wants to be the largest player in dental care in the country. Over 80 % of the revenues generated for NHDC, since it began operations in 2008, is from cosmetic dentistry. Dental tourism is believed to account for 10 % of all Indian medical tourism, and estimated growth of dental tourism is said to be 30 % a year until by 2015. These figures are local estimates.

Sagar Hospitals, a leading private healthcare group, is targeting UK medical tourists for its hospitals in Bangalore. The group is developing a new 1000-bed super-specialty hospital near the Bangalore International Airport to add to its 665-bed facility at two locations in south of Bangalore. Sagar also wants to set up healthcare centres overseas. Its first overseas facility will be a polyclinic and day-care surgical centre in Dubai next month, followed by a polyclinic in Muscat in three months time.
One reason for the interest in building overseas, and even Europe is being considered, is that Sagar admits that medical tourism has not grown as quickly as expected in the country, A few years ago McKinsey projected $ 2 billion medical tourism revenue for India by 2012. But even at the time many felt this was an over-optimistic prediction, however much the estimate pleased the Indian authorities who paid for the report. And with recession, terrorist attacks, visa problems, increased competition in the sector, and recent reports from major hospital groups of relatively modest medical tourism incomes, some people in the industry think it is time to abandon these predictions. Dr.Saji Salam is likely to attract criticism for his recent suggestion that the $ 2 billion prediction should be downgraded to a more realistic $ 20 to 30 million .The problem with the original prediction and any downsizing is that there are still no reliable figures for Indian medical tourism, everything is based on estimates by those with a vested interest in an optimistic picture.
There is general agreement that medical tourism in India will continue to grow, but the pace of growth is debatable, as unless you know where you started, you cannot tell how well you are doing. Another strand of the argument is that it is still left to individual hospital groups to drive promotion, as the government makes the right noises, but does not deliver help.

Pakistan’s Ministry of Tourism has finally admitted that the country’s travel and hospitality sectors face an acute drop in business due to the combined adverse effects of terrorism, foreign governments advising their people of the risks of travelling and what the country regards as hostile media coverage all around the world. Looking to find other ways to keep the hotel and tourism industries afloat, officials have suddenly discovered medical tourism.
But there are a few snags. Few local hotels, airlines or tour operators understand medical tourism, and lack knowledge of the hair transplant, open-heart surgery, dental surgery and cosmetic surgery sectors. The ministry puts this omission down to lack of information and motivation, so plans a national conference on how to turn Pakistan into the best destination in the region for quality medical treatment at low cost.
The conference will be organized by the Tourism Ministry, Ministry of Health and Pakistan Medical Association. The invitees will be travel agents, tour operators, hoteliers, representatives of airlines, medical and tourism/travel associations and hospitals, doctors, marketing professionals, and relevant government officials. The Ministry of Tourism wants to help improve cooperation and coordination between local tourism and health sectors and begin the promotion of medical tourism in the country, which after the curtailment of the organ tourism trade three years ago, has dwindled to almost nothing. The ministry hopes that by working together for the promotion of medical tourism, health and tourism sectors will support each other and reap the benefits of an improvement in the economy.
The tourism ministry wants travel agencies, hotels, resorts, hospitals, spas, airlines and other related businesses to fully understand their role in this market and how they can tap into these so far untouched opportunities. While Pakistan is definitely low cost, it has problems on quality as even the government admits a lack of quality health care and shortage of specialised hospitals of international standards in the country. Tourism officials are pushing the government, financial institutions and private groups to invest in healthcare and medical tourism by upgrading basic amenities and hospital infrastructure, building international quality hospitals, co-ordination between health care and tourism sectors, and the creation of a resource pool of skilled manpower. The industry accepts that standardisation of services and accreditation of hospitals are both necessary before the country can attract large numbers of foreigners for medical treatment. Pakistan has a number of modern hospitals in Islamabad, Karachi and Lahore while some doctors and surgeons in Pakistani hospitals are often foreign qualified. A number of patients from neighbouring Afghanistan and Iran do travel to Pakistan for treatment, but considering the problems with terrorism in both countries with links to groups in Pakistan, that these are the main existing markets may not be the best thing to promote.
With the problems and solutions proposed, it is obvious that developing medical tourism will take several years, and is far from the quick fix to current economic and tourism problems that tourism officials originally hoped. Apart from a small handful of hospitals and clinics and entrepreneurs, business in the country has shown little enthusiasm for medical tourism. Until the major political and terrorism problems are solved, the debate is probably only academic, as Europeans will not visit in numbers while these problems remain.

The new CHKS international accreditation programme was recently launched. It is designed for any hospital or healthcare organisation in any country. Based on published international guidance and best practice, it helps to drive, assure and demonstrate quality of patient care.
CHKS has worked with clients in 15 countries, so understand the cultural differences and complexities of various healthcare systems and economies. From ministries of health and national quality institutes to healthcare providers and hospitals, it has a breadth of experience in international healthcare.
The new standards bring together international guidance and best practice to create a base to support quality improvement. Already being widely used by individual hospitals seeking external validation and recognition of the quality of care they provide, and private healthcare groups to ensure that all hospitals consistently apply corporate policies and procedures, the programme ensures that an organisation is working towards the best international standards.
It now incorporates a simple online tool so the survey and assessment process is streamlined to let the hospital focus on what really matters:• Quality improvement• Risk management• Clinical governance• Patient safety
Accreditation is an independent mark of quality for any healthcare organisation. Based on compliance against industry standards (regulations, legal requirements and best practice) and assessment by peers (experienced healthcare professionals), the process supports continuous quality improvement and innovation.
How does it work?• CHKS works with the hospital to assess the organisation against the standards.• The hospital and CHKS identify areas for improvement.• CHKS works with the hospital to support the change, providing advice support and access to other healthcare organisations that have done it before.• A team of peers assesses compliance against the standards.• CHKS recommends what must be improved and how to do it.
Once successful, the hospital gains accreditation, international recognition that it is providing a world-class service for patients.
CHKS has over 20 years experience working with countries from Macedonia to South Africa. It uses a resource of over 300 peer reviewers, all experienced healthcare professionals from leading organisations across the UK and beyond. CHKS is internationally recognised by ISQua (International Society for Quality in Health Care). CHKS is accredited to provide ISO9001: 2008 certification on service standards, and a these are not specific to healthcare or medical tourism, the organization has translated the standards into healthcare-specific terms, to ensure the hospital understands how the terms apply to them.
The international accreditation-• Provides a developmental framework to identify and target services where problems exist.• Provides assurance for the management team.• Formalises day-to-day procedures.• Provides an evidence-based solution of best practice for new policy development and implementation.• Improves communication and dissemination of information within the hospital and community partners.• Formalises patient feedback.• Promotes staff participation, engagement and satisfaction.• Provides a network of similar organisations for sharing ideas, solutions and best practice.• Formalises the audit and quality improvement process,

Brian Martin of Shanakiel Hospital in Cork, Ireland comments, “As CHKS works in the UK and across Europe, the standards were the best choice for us as a hospital in the Irish healthcare system especially where the standards reference compliance with EU directives or laws."

A few years ago, the novelty of Americans going overseas for treatment led to national and local newspapers, television and radio stations, websites and magazines, to produce thousands of items on the new idea. Outbound US medical tourism is no longer a novelty, and has not reached the numbers once predicted, nor achieved widespread support of employers and insurers. Now, the same media have discovered domestic intra-state medical tourism.
The domestic market is still mainly individual self-pay. Although a few employers and insurers are trying out the market, many are still wary. One reason for this is that even when companies and insurers agreed to outbound medical tourism, their employees and customers were less keen. They are also concerned that some of those organizations and individuals promoting the concept, originally promoted outbound medical tourism with the same fervour, and did not produce the numbers or cost savings promised.
Another reason is explained by Rick Baker of North American Surgery, a Vancouver, Canada-based agency that negotiates discounted surgeries in the USA for individuals who do not have health insurance. He suggests that while uninsured people are willing to travel, workers with insurance are often unwilling to travel, not just abroad, but from state to state. The North American Surgery network of U.S. health care providers offers access to high-quality surgical procedures at prices that are often 50% below U.S. hospital averages.
Employee resistance is a problem, as many do not see why they and their families should be inconvenienced just so their employer or insurer can save a few dollars. As yet, only a handful of the agencies and hospitals promoting domestic tourism have attempted to tackle incentivising the patient. Nobody really knows the size or potential of the domestic medical travel market. But by directing workers to US hospitals with high-quality care and lower prices, it could reduce employer costs by 20 to 40%, more than enough to cover travel expenses.
Home improvement retailer Lowe’s has negotiated flat-rate fees with the Cleveland Clinic for complex cardiac procedures. The retailer has a three-year deal with the Cleveland Clinic to send employees and their dependents there for open-heart surgery, valve repairs and pacemakers.
Domestic medical travel may be slow to catch on because state based insurers are wary of offering travel incentives for people to travel to another state, as it could annoy local hospitals by sending patients elsewhere for care. Employees may resist travelling any significant distance for medical care. The biggest problem is the innate conservatism of American workers, employers and insurers; the huge arguments over Obama’s health reforms proves that. Domestic medical travel will probably be driven by larger employers who are based in several states, and it could help drive down costs and improve the quality of care. Employers and insurers have sent patients to specialist hospitals for organ transplants and other complex procedures.
Some companies are providing financial incentives to workers. Several employers are known to be in discussion with hospitals. Alpha Coal West has sent employees from Colorado to Wyoming, a five-hour drive; and has arrangements with hospitals in three other states. Alpha Coal’s insurance programme reduces co-insurance payments from 20 percent down to 10 percent for workers willing to travel. It also covers hotel and travel costs for employees and their partners. To encourage workers to use the programme, Lowe’s waives deductibles and covers their travel and hotel costs. Whether domestic medical tourism is a long term trend or as with the threat of overseas medical tourism, it will just persuade hospitals locally to improve standards and offer better price deals, remains to be seen.

Ten years ago, Dr Steve Tomlinson opened the Chrissie Tomlinson Memorial Hospital in Grand Cayman. The surgeon and politician has been a leading critic of a proposed new medical tourism hospital. The proposed Shetty Hospital, Narayana Cayman University Medical Centre, is supported by the local government but with all development paid for privately. Recently, the terms of the agreement signed by the government for this project have been revealed. Critics argue that these terms could operate to prevent Caymanian entrepreneurs in the health care field such as Dr Tomlinson, from competing on a level playing field with foreign investors and promoters. The agreement signed by the Cayman Islands government with Dr Devi Shetty’s company for the construction and operation of the Narayana Cayman University Medical Centre contains an exclusivity clause that seems to prevent the establishment of any other large-scale medical tourism facility in the islands.
Specifically, from April 7, 2010, until a period of five years from the time the Shetty hospital commences operations, “no other non-Caymanian will be permitted to come to the Cayman Islands to compete in the field of large-scale medical tourism.” To back this exclusivity commitment, the government has undertaken to take “Such action as may be necessary to prevent a non-Caymanian from operating a health care facility involving the conduct of large scale medical tourism facilities” during the same specified time period. That period is likely to be at least 8 years and could be as long as ten years.
Also, until April 7, 2015, the government has undertaken not to grant “to any other entity in connection with large scale medical tourism facilities,” the same, up to 100-year concessions on various taxes, fees and import duties that it has extended to Dr Shetty’s company. This exclusivity applies to foreign individual or company investors. But in a curious restriction to the exclusion, it does not apply to any non-Caymanian company that currently offers medical services in the Cayman Islands; or any Caymanian who intends to establish health-care facilities of any kind in the Cayman Islands. Caymanian means an individual who has Caymanian status within the meaning of section 20 of the Immigration Law (2009 Revision); and includes an entity that is wholly owned by one or more such individuals but does not include an entity that is not so wholly owned. So a local company with majority Caymanian ownership will be prevented from competing with the Shetty hospital for period of time provided by the agreement and no one, Caymanian or not, could expect to get the same fees and taxes concessions until 2015.
These restrictions were not made public by the government when it announced the deal with Shetty, and only local media investigation has revealed the clauses in the agreement. The government may come to regret the exclusivity deals and will probably have to either renege on the Shetty deal or defend them in court. A group of local doctors and investors intend to develop a 120-bed hospital in Grand Cayman over the next four to five years at a cost of US$560 million. They aim the hospital at locals and medical tourists and with local knowledge and contacts expect to be able to build and open the hospital several years before the Shetty one, that still has no planning permission, is open. Dr Shetty and his partner investors have personally inspected several potential sites, but the final location of the proposed facility has not yet been decided. The competing group argues that the government has no right to restrict their business and the Shetty exclusivity deal is legally void as it would prevent them offering medical services to Cayman Islanders.

Many Americans and Canadians are going to Mexico for medical and dental treatment for substantial savings. Agencies, hospital and dental groups are making it easier to find high quality safe care.

Medical Traveler Yucatan (MTY) is a new American-Canadian managed medical tourism agency service based near Cancun in Merida, Yucatan. The company meets patients at the airport and accompanies them throughout their medical stay. Founder Alan Graham says, “It just doesn’t make good sense, health-wise and money-wise for patients to be deprived of a new heart valve or shoulder surgery. Or pay two to four times what they should for gastric bypass surgery or a face-lift or dental veneers, when Merida is less than a 2-hour non-stop flight from Houston or Miami.”
MTY matches medical travelers with board certified, English-speaking surgeons who have had training, continuing education, or affiliations in the United States. And MTY conducts consumer evaluations of the selected hospital. Patients traveling to Merida can expect substantial savings of 35% – 75% on US prices. The agency mainly uses Merida’s Star Medica Hospital, a new state of the art, and high-tech facility.

Angeles Health International, the medical travel division for the largest private hospital network in Mexico, has a new Joint Commission International (JCI) accreditation programme, working with the Phoenix Consulting Group. Hospital Angeles Tijuana is the first hospital in the Angeles network scheduled to receive its JCI Accreditation. Next, in order, will be Hospital Angeles Guadalajara, Hospital Angeles Lomas and Hospital Angeles Perdregal (both in Mexico City) and Hospital Angeles Puebla.
Paulo Yberri of Hospital Angeles Tijuana says, “JCI accreditation of Hospital Angeles network of hospitals is an important step for our Angeles Health International Medical Travel programme. In the past three and a half years, we have had 6000 medical travelers from the US, Canada, and Europe. JCI Accreditation will add to the reassurance factor so important to the medical travel process. The JCI Accreditation program will prioritize the Angeles hospitals most often selected by medical travel patients because of their convenient locations.”

DentiCenter, a small but growing chain of full-service dental centres on the U.S/Mexican border along California, Arizona and Texas, opened in 1991 and now faces record demand for its services. Numbers of patients have doubled since 2007. Last year, revenue topped $2 million. For 2010, it projects $3 million. All six centres are in Mexico but 97% of patients come from the USA. The company is preparing to open new clinics later this year; one near El Paso, Texas, and the other near Nogales, Arizona. Current plans are to have 14 dental centres
Founded by Juan Eng to attract American clients, it sets out to offer services as in the USA.So, unlike many small Mexican dental clinics, all clinics are modern and immaculately clean, with bright comfortable exam rooms. It looks and feels like a typical US dental surgery, except that the staff is Mexican and bilingual. To comfort Americans concerned about Mexico’s reputation for crime, Eng locates his clinics right at the U.S. border, often within sight of the crossing. All six DentiCenter locations are within minutes of the U.S. and Mexican border.
DentiCenter’s services cost about one-third of what they would in the USA, comprehensive orthodontic treatment costs $5600 in the U.S. At DentiCenter, the price is $1500. The low prices are partly explained by the salaries, dentists earn about one-third of what they would be paid in the USA. DentiCenter is the only Mexico-based dental company that complies with the strictest U.S. health guidelines to provide affordable, high quality dental care. It is an in-network provider of two of the largest U.S. dental insurance providers, Delta Dental and Aetna.

The Medical Travel and Health Tourism Quality Alliance (MTQUA) is offering online courses for individual medical tourism agents and patient managers in July and August. In the competitive world of medical tourism, agent professionalism is of increasing importance. While there are several competing medical and non-medical accreditors for hospitals, clinics and agencies, there are few courses or accreditations available to individuals working as medical tourism agents. They may call themselves lots of different names, but legally anyone who is not a supplier of goods or services, is an agent. There can be confusion as to whether the firm or individual is an agent of the hospital/clinic or of the medical tourist or both; and this can depend on who they mainly act for. While the responsibility of travel agents for selling dangerous or substandard holidays is well-established, the legal responsibilities of medical tourism agents is not tested. Much may depend on which country the agent is based in, which country the medical tourist comes from, and in which country the treatment takes place.
With new agencies opening every month, and existing businesses competing for survival and growth, only those individuals and companies that are professional in all aspects of their service and marketing will survive. Just offering cut price treatment in a far away country, and leaving the hospital and patient to sort out most things between themselves, may have been acceptable in the early years of medical tourism, but it is no longer suatinable.
Customers expect travel agents to be professional and have qualifications; and they will gradually expect this of medical tourism agents too. Few national or international qualifications exist. MTQAA is one of the first to offer qualifications to individuals. Certified professionals know they are putting their clients’ safety first, whether in medical planning and treatment, or in aftercare planning and supervision. The MTQUA Certification Program trains and certifies individuals involved in the care, management, and support of the medical traveller.
The online programmes are intended to provide a deeper understanding and appreciation of the complexity found within medical travel and health tourism. It is intended that those who successfully complete the programme will participate in the treatment and care of the travelling international patient with confidence and assurance that best practices are being applied and that the patient is receiving safe and quality care that is as good or better than that he or she would have received at home and managed appropriately for the patient’s cultural, social, medical, emotional and physical needs. It offers comfort to hospitals and employers that a certain common standard of patient care management is being practiced, and that the standard of patient care management follows best practices of the medical travel and health tourism industry.
Professional certification is a designation earned by a person to assure qualification to perform a job or task. Certifications are portable, since they do not depend on one company’s definition of a certain job. Certification is not licensing; licensing is a mandatory inspection process that focuses on enforcement of minimum expectations for programme/ hospital operations, is usually controlled by a government body or agency, and is country based.
MTQUA offers professional certification, not licensing, for individuals, globally. It intends that those who are certified medical tourism professionals, either Certified Medical Concierges (C.M.C.) or Certified International Patient Managers (C.I.P.M.), have the confidence and assurance that they are managing medical travelers using industry best practice standards. This certification has been created to meet the needs expressed by providers, patients and agents for standards and best practices in the medical travel and health tourism industry.
The online courses begin on July 21, July 22, and August 4.The course, Essentials of Medical Travel and Health Tourism for Patient Care (known as the Essentials course) is now being offered online. Previously only available as a classroom seminar, the online format lets medical tourism professionals around the globe obtain qualifications without having to leave their family or job at home. Individuals can become certified in just 6 weeks, or up to six months if they want to take it more slowly. The online Essentials course is offered in 3 formats, all of which cover the 12 hours of content completely and thoroughly. The 6-week accelerated schedule is an intensive, once-a-week seminar with discussion forums, readings and other course work. The standard schedule for the course covers the same course content in 6 months with a mix of live events, seminars, forums, special guest interviews and more. A special mentoring version of the Essentials course, completed in 4 months, provides special mentoring and personal guidance for medical professionals and entrepreneurs.
The Essentials course; • Understanding today’s global health care consumer• Sourcing patients and clients• Comparing medical destinations• Working with medical travel agents • Working with providers• Finding medical and health resources for medical tourists• Introduction to continuity of care in medical travel• Understanding the needs of medical travellers• The medical traveller’s rights and responsibilities• Expectations in the new international medical environment• Case studies

Seattle based The Icon Group has added to its domestic U.S. board certified physicians and surgeons recruiting business, to include sending them to medical tourism countries. This new business activity is branded “Escape from America.” Philip Slaton of Icon suggests that many doctors are, for various reasons, dissatisfied with the U.S. healthcare system. From his experience in producing business-to-consumer medical tourism exhibitions in the United States, he believes that medical tourism hospitals and hospital development companies can reduce their doctor shortfall by recruiting American doctors. This in turn will help them attract greater numbers of American medical touristswho feel more comfortable with U.S. board certified doctors from America. He suggests that despite many hospital claims to having US trained doctors, the reality is that American born and trained doctors are not currently working in large numbers in the international medical tourism industry.
Slaton suggests they could bring their own American patients with them. So far the two models or options that have emerged for the deployment of these doctors in medical tourism destinations are:• Starting their own parallel practice in a foreign country and bringing in their U.S. patients for surgical procedures, as well as developing new medical tourism patients.• Joining a practice, clinic or hospital and bringing their own patients, as well as developing new medical tourism patients.

Fortis Healthcare, India’s second largest healthcare chain, has offered US $2.3 billion, for the three-quarters of the Asian hospital operator Parkway Holdings that it does not already own. The offer from Fortis follows an attempt by Khazanah Nasional, the state investment fund of Malaysia and a major shareholder in Singapore-based Parkway, to take control from Fortis by raising its stake from 23% to 51%. Khazanah offered $835 million in May to gain the controlling stake in Parkway. Fortis’s bid is likely to prompt a counterbid.
Fortis sees Parkway as being the centre in Singapore of an international medical empire and a step toward building a pan-Asian presence. Fortis with Parkway would have 12,200 beds and generate $1 billion in annual revenue. The margins with Parkway are much higher than current margins in India as health care costs in India have traditionally been low. The long-term goal of hospital chains like Fortis is medical tourism. Parkway operates hospitals in Singapore, Malaysia, India, China, Brunei and the United Arab Emirates. In India, Fortis expects a 30% in medical tourism patient numbers. In 2009 Fortis had 4000 medical tourists that contributed 10 per cent to the company’s total revenue, with the number for 2010 is expected to be over 5000. Parkway’s hospitals attract patients from Indonesia and the Middle East.
Brothers Malvinder and Shivinder Singh, who run Fortis, are moving to block Khazanah from gaining control of Parkway’s 16 hospitals in Asian countries, where health-care spending is increasing annually. Khazanah owns a stake in Apollo Hospitals, Fortis’ main competitor in the Indian healthcare market. Malvinder Singh plans to integrate Fortis with Parkway and operate the combined group of 68 hospitals in eight nations, from Singapore.
The bid for Parkway is a bold one but local markets are not sure how the Singh brothers will pay for this bid and worry that they could be paying too much. Once Fortis is folded into the Parkway umbrella, the synergies of scale from collapsing the two entities into one will be significant. The Singhs are believed to be negotiating with banks for short term funding to support the bid. Fortis may have control now but the crunch may come if a bidding war escalates. While the Singhs are dependent on private finance, the Malaysia government has funds from various sources available. State-owned oil company Petronas, owns a luxury 300-bed hospital in the country’s capital, Kuala Lumpur, built two years ago in part to promote medical tourism, and has been looking for other investment opportunities in the sector.
The two offers share a common belief that rapidly growing demand for quality health services in Asia represents a unique business opportunity and that whoever controls Parkway will be in the best position to grow within Asia and beyond, and benefit from the rise in both medical tourism and health insurance in Asia. Malaysia’s state interest in Parkway is that it holds 24.1% of Parkway outright through Khazanah Nasional, the state-owned investment fund, and owns 60% of a Malaysian Parkway affiliate. Parkway also generates 26% of its revenue in Malaysia, while Parkway offers the opportunity to grab a leading position in high-end health care, an industry the government has singled out for strategic growth. For Fortis, Parkway offers a chance to expand from its base in India across the region, with both China and India representing big opportunities.

Frankfurt/Hamburg – Germany –
Travelling to Germany for medical reasons has just become as easy as visiting your local doctor. High quality medical treatment is no longer an issue of location. With Premier Healthcare Germany and Lufthansa, a Star Alliance member, patients will encounter perfect conditions in medical service and travel logistics.
The international patient consultant Premier Healthcare Germany, based in Hamburg, assists patients from around the world in selecting and obtaining high quality medical treatment in Germany. Germany is internationally renowned for its focus on quality, scientific research, and evidence based medicine while still maintaining an affordable cost for treatment.
It is not surprising that hundreds of thousands of patients travel to Germany annually to seek a variety of medical treatments. With the new agreement between Lufthansa and Premier Healthcare Germany, this type of medical travel has now become much easier. It will benefit the travelling patient as well as accompanying family in many ways:
• Reduced fares in economy, business, and first class due to the cooperation with Premier Healthcare Germany• Access to Lufthansa’s unsurpassed global network connecting more than 200 cities in 85 countries • Mixed cabin class option: fly to Germany in economy class and return in business class, e.g. after a hip replacement• Free itinerary changes offer patients flexibility in case of changes in their medical condition • Hassle-free medical trip planning due to combined medical and travel expertise of Lufthansa and Premier Healthcare Germany• An opportunity to earn miles in Lufthansa’s award-winning Miles and More frequent flyer program
“This cooperation is easy for Lufthansa to implement and it means so much for us, an emerging company that strives to make medical treatment in Germany accessible for everyone,” said Olaf Haase, Director of Clinical Affairs and one of the founders of Premier Healthcare Germany. “Being mobile and having easy access to Germany is the fundamental key to any medical travel. With this cooperation, we can offer transportation that goes far beyond the simple booking of a seat.”
Lufthansa is a truly competent partner in transporting patients in need of medical care. From attentive wheel chair service to complete intensive care units onboard its aircraft, Lufthansa has become a leading provider in medical mobility. This well-organized and highly tuned service-offer allows for transportation of even the severely ill, which brings treatment in Germany so much closer to the patients and their families. “We are in the unique position to cooperate with key partners that define the medical travel field in Germany,” said Michael Meurs, Director of Business Development at Premier Healthcare Germany. “Lufthansa takes care of transportation, hospitals with international acclaim provide medical treatment, and Premier Healthcare Germany ensures that all needs are met.”
Medical travel needs to be well planned and organized. It is for this reason that patients sometimes shy away from it. The task of travelling to another country for treatment often seems daunting. This is often due to the logistic efforts involved. Only the very few internet savvy and travel experienced individuals find it easy to plan and execute a medical trip. For others, it can be a project with unpredictable complexity.
Premier Healthcare Germany offers professional services specifically designed to tackle this complexity. For example, if a diagnosis has not already been established, Premier Healthcare Germany can provide a diagnosis upon arrival and then tailor the appropriate treatment to the individual patient. If the patient provides a diagnosis, medical reports, and other diagnostic data, Premier Healthcare Germany seeks and finds the right experts in Germany, organizes travel, manages local case agent support, talks to embassies about medical visas, tries to get health insurance reimbursement where possible, and follows up during treatment at home.
Providing comprehensive medical travel service is Premier Healthcare Germany’s key strength. As such, it believes that everyone should be able to “visit a local doctor in Germany…”
More information: www.premier-healthcare.eu
If you have any further questions, please contact:
Olaf HaaseDirector of Marketing and Clinical AffairsMember of the BoardPhone: +49 163 286 9344Mail: Olaf@premier-healthcare.eu
or
Michael G. MeursDirector Business DevelopmentMember of the BoardPhone: +31 651 26 9282Mail: michael@premier-healthcare.eu

Bronislaw Komorowski has been declared the winner of the presidential election in Poland. The centre-right candidate narrowly beat Jaroslaw Kaczynski, twin brother of former president Lech Kaczynski, who died in the Smolensk plane crash three months ago. The outcome of the vote has consequences for the country’s healthcare system and knock-on effects for medical tourism, as Komorowski plans to commercialise hospitals.
Dr Peggy Watson of the University of Cambridge, writing in the British Medical Journal, argues that the result could represent the final nail in the coffin of public health services in Poland, where hundreds of thousands of people cannot afford private medical care. The country’s hospitals, described as the last bastion of a publicly funded health service, have been the subject of a 10-year privatisation battle. In 2007, the last time the government tried to launch a commercialisation programme, Kaczynski vetoed the attempt. The policy will give Poland’s hospitals full market status and open the door to privatisation. Dr Watson says, "A system is emerging in Poland where better care is being offered to people who are better able to pay. Much has been said about the country’s growth, but levels of poverty are high. The hospitals are the last bastion of an even health service. There is a real danger that private companies would bring that to an end."
Even the previous government set contributions to healthcare deliberately low, in the expectation that it would lead people to seek more private care and that private health insurance would develop to fill the gap. Several health insurance companies had started activities in Poland, including PZU, Allianz, Generali, Inter Risk and Axa.
In 2009 the Polish private healthcare market was worth €6.4bn, according to a report by PMR, a research and consulting company, entitled “Private healthcare market in Poland 2010.” Private healthcare includes payments for drugs and medical equipment directly from patients’ pockets, cost of rehabilitation, diagnostic tests and doctor’s appointments covered directly from patients’ pockets, subscriptions offered by medical companies together with occupational healthcare services, and health insurance offered by insurance companies. Despite the economic crisis, the leading private medical companies developed their outpatient and inpatient medical services rapidly in 2009.
In the past, private medical companies competed with public bodies mostly over the delivery of outpatient services. As a result of the increase in interest in private healthcare services and the ensuing intensification of competition, combined with an increase in customer demand, private companies have been forced to focus on the development of their outpatient clinics and to build their own hospitals. Lux Med Group opened 11 clinics in 2009. The two private healthcare companies in Poland with the largest hospital chains are Grupa Nowy Szpital and EMC Instytut Medyczny. Grupa Nowy Szpital runs a chain of 12 hospitals, including Nowy Szpital in Olkusz, Nowy Szpital in Krosno Odrzanskie and Nowy Szpital in Szprotawa. EMC Instytut Medyczny operates eight hospitals in the Dolnoslaskie, Mazowieckie, Opolskie, Slaskie and Zachodniopomorskie regions.
The Polish market has recently seen the emergence of non-public hospitals that focus primarily on the provision of services paid for directly by patients, not covered by medical subscriptions or additional medical insurance policies. These hospitals include not only small establishments, which specialise in one-day surgical procedures but also larger, multipurpose hospitals. One example of such a project is the 150-bed St. Raphael’s Hospital in Krakow opened by Scanmed. The hospital now offers orthopedics, general surgery and cosmetic surgery, with plans to add cardio surgery. Luxembourg based health group Medicover opened the country’s first privately financed hospital in July 2009. Warsaw’s Medicover Hospital contains 180 beds, although the number will eventually rise to 270, and offers gynaecology, obstetrics, pediatrics, internal medicine, angiology and cardiology, in addition to surgery. At the beginning of 2010, Carolina Medical Center, in which Medicover holds a stake, opened a 34-bed clinic in Warsaw, which specialises in the treatment of orthopedic injuries associated primarily with sports. The Lux Med Group plans to open a hospital in Warsaw in mid-2010. It will be a small one specialising in one-day surgical procedures. In the long-term, the company intends to open a multipurpose, 50-bed hospital in Warsaw in 2012 or 2013. Medicover intends to open a Radiotherapy Centre in Warsaw and is planning to launch a chain of several small hospitals, which will provide one-day surgical procedures and diagnostic tests in Poland’s major cities. Swissmed, which already has a hospital in Gdansk, began to build a 44- hospital in Warsaw in the spring of 2010.
The combination of the new government’s policy on healthcare, the expansion of private healthcare, and the opening of a number of new hospitals and clinics not dependent on either government finance or insurance companies, will make Poland an even stronger medical tourism competitor in Europe. Private medical and dental care is now available at prices far lower than in Western Europe. It will also be well placed to take Russia and other Eastern European business, where medical tourists currently go to Asia.

The Economy, Trade and Industry Ministry of Japan plans to launch a new organization in 2011 with the sole aim of increasing medical tourism to Japan. The government has identified the provision of advanced medical services to foreign visitors at domestic hospitals as a potential growth area for the nation’s medical industry. A plan to increase the number of medical tourists was included in a recent government growth strategy plan.
The new organisation, to be jointly funded by the public and private sectors, is expected to be fully operational by 2012. The ministry expects it to promote medical tourism by partnering with overseas medical institutions and serving as a mediator between them and institutions in Japan. China, Russia and Middle East nations are among the likely target markets.
The ministry will have to seek money from government-affiliated bodies for funds. It has not even begun to ask private medical institutions, travel agencies and other private sector entities to invest in the organization, and at present there are few in Japan in any of those three sectors looking to promote medical tourism. A small amount has been allocated by the ministry to cover start-up expenses, but it will need considerable external funding to pay for ongoing expenses, marketing and advertising; as it will have to promote Japan as a destination from an almost non-existent base.
The ministry plans to start recruiting interpreters specializing in the medical field and other personnel from July. After that it will conduct a survey to determine which institutions in the nation would like to attract foreign patients, and the level of interest may well depend on how much the new organization expects hospitals and others to contribute to it.
The Japanese government wants to emulate successful medical tourism destinations Singapore and Thailand, but may not fully appreciate the amount of time, effort and expense it will take to persuade people to go to Japan when prices are higher than most Asian competitors. The ministry has been exploring specific ways to expand medical tourism since last autumn, when it set up an expert panel to research the matter.
Japan’s sudden official interest in medical tourism is partly explained by its economic problems where it has been overtaken globally by China. A new ten-year economic growth strategy to revive its economy, pledges to create five million jobs by focusing on green technology, healthcare, tourism and closer links with Asia. It hopes to create 1.5 million new health care jobs. Growing tourism from less than 10 million annual visitors now to 25 million by 2020, in part by easing visa regulations for Chinese and by increasing medical tourism, is a very ambitious target that few analysts think is achievable. Competing successfully with over 200 other countries on medical tourism from a nil base is a tough ask.
The latest in the consumer reference guides for medical tourism, from Patients Beyond Borders, is Focus On: Kameda Medical Center (KMC), profiling one of Japan’s leading private health hospitals. Japan’s first and only JCI-accredited 925-bed hospital, had just over 200 international patients in 2009. Healthy Travel Media’s Focus On series features 32-page, full-colour digital brochures and eBooks highlighting international hospitals in a fully searchable, consumer-friendly format. Published under the Patients Beyond Borders brand, the series offers health care consumers detailed information on specialties, procedures, costs, and travel planning. John Wocher of KMC says, "This will allow us to proactively promote to the international traveller with up-to-date, interactive information on our medical specialties, pricing, and the quality and safety of our medical services."

For 2011, the German National Tourist Board’s tourism campaign will focus on health and medical tourism. This includes health and fitness, spas, health resorts, wellness and beauty hotels, hospitals and clinics.
This 2011 campaign will showcase Germany’s modern and cutting-edge facilities, luxury hotels, spas and spa-towns. This is intended to appeal to travellers who value active and affordable holidays linked with culture and indulgence. The campaign will highlight the top German medical clinics for international patients as well as the tourist attractions of the nearby towns and cities.
Currently about 400,000 tourists visit Germany annually for health related holidays, and this number is growing. This is in addition to the estimated 70,000 medical tourists using German clinics and hospitals that are renowned for their excellent quality and reasonable prices.
Germany’s healthy climate, healing waters, natural therapies and countless hotels, spas and health resorts offer programmes to refresh the mind and reinvigorate the body. The offerings include health and beauty care involving fun and physical and mental relaxation using a wide variety of therapies, massages and treatment methods. Around 300 mineral and mud spas, hydrotherapy resorts, climatic health resorts and seaside resorts in Germany offer a wide choice of preventive and therapeutic well-being treatments. Germany is a land of spas and thermal baths promoting health, beauty and well-being.

Although most organ transplant tourism has been illegal in The Philippines since 2008, the country is struggling to eradicate the problem. The Department of Health (DOH) has issued two administrative orders to fight organ trafficking, in particular the selling of kidneys to foreign patients. It has issued tighter revised rules on donating and transplanting organs from living persons through Administrative Order 2010-0018, which seeks to ensure that organ donations are “voluntary and truly altruistic.” The new administrative order reiterates the ban imposed on foreigners from receiving organs from living Filipino non-related donors, and categorically prohibits health professionals from engaging in the kidney trade. Health Secretary Esperanza Cabral says,”We issued the order because we wanted to make sure that nobody is exploited during the transplantation, and that organs are donated only for altruistic purposes. We want to make sure that illegal traffic of organs that has victimized many of our countrymen for many years will not be repeated. Hopefully the international medical community will recognize that our country is indeed serious in curtailing illegal organ donation."
The DOH orders confirm that kidney transplantation is not a legal part of medical tourism in the country. In 2005, The World Health Organization identified the Philippines as one of the global hotspots for organ trafficking, along with China, Pakistan, Egypt and Colombia.
In the last decade the Philippines gained an international reputation as a hub for the illegal traffic in human organs from living donors, with some hospitals catering for wealthy foreign patients requiring kidney transplants. Following criticisms that her administration was promoting transplant tourism, in 2008 president Gloria Macapagal-Arroyo ordered a total ban on all kidney transplant to foreigners. Prior to the 2008 ban, 800 foreigners each year had illegal kidney transplants. In 2008 the country also signed an international declaration on organ trafficking and transplant tourism, but it seems that a handful of doctors still participate in organ transplant tourism, which is more lucrative than ever after many countries successfully killed the business.
The new order sets up a system for the allocation, harvesting and transplantation of organs from deceased donors to Filipinos to provide people who need kidneys with the kidneys they need as 9000 Filipinos develop permanent kidney failure each year. Each region must set up a designated organ procurement organization, which will become part of the Philippine Network for Organ Sharing (PHILNOS). The existing voluntary donation system is not effective.
Jerry Chapman of The Transplantation Society (TTS), an international association of transplant experts, believes that these guidelines are important for organ transplantation in the Philippines and offers to assist in training and development to allow the rapid and effective implementation.

DNV healthcare in the US is a division of DNV of Oslo, Norway, an independent foundation with 300 offices in 100 different countries. The group aims to target other countries including Brazil, India, Thailand, and the Czech Republic. DNV Healthcare offers an approach to accreditation that focuses on quality, innovation and continual improvement, embracing multi-hospital systems, community hospitals, major teaching institutions and regional medical centers. DNV Accreditation requires an annual survey and the organization’s continual compliance with the DNV accreditation process. DNV Healthcare offers the only Centers for Medicare and Medicaid Services (CMS) approved accreditation program that integrates the ISO 9001:2008 Quality Management System.
IASIS Healthcare has received DNV accreditation for all sixteen of its hospitals. Patty Scott of IASIS says,"DNV accreditation is strategically aligned with our goals for patient safety and medical outcomes. In addition to taking a best practices approach to hospital surveys, DNV’s accreditation framework fits well with the Hospital Medical Management and Quality Program (HMMQP) already in place at IASIS hospitals."
A key factor in the DNV process is a successful partnership between the accrediting body and the hospital. Instead of merely dictating standard policies and templates that may not be the best measurement and reporting tools for all hospitals, DNV guides its hospitals through an improvement process that enables hospitals to customize programmes that work best for them. In 2008, DNV Healthcare became the first organization in more than 40 years to be approved by the U.S. Centers for Medicare & Medicaid Services to accredit hospitals.

The European Society of Human Reproduction and Embryology (ESHRE) task force on reproduction and society has reviewed the economics of Medically Assisted Reproduction (MAR). Dr. Mark Connolly and colleagues have published a review paper in the journal Human Reproduction Update, based on their findings from key epidemiological and economic studies.
3.5 million MAR children have been born worldwide since 1978. These children make up a substantial proportion of national births with up to 4.1% in Denmark and 3.3% in Belgium. Affordability of IVF is one of the main drivers of treatment utilisation, choice of treatment, and embryo transfer practices, which ultimately influence the multiple birth rate and infant outcomes. Lack of affordable treatment can force patients and doctors to opt for cheaper fertility treatments such as stimulated intrauterine insemination and ovulation stimulation, which have less controllable means of minimising multiple births.
Restricted local treatment and limited financial access makes some patients seek cross border reproductive treatment in countries where cheaper or less restrictive treatments are offered. The ESHRE Task Force says that in a recent survey, of those patients that sought cross border reproductive care, only 13% received partial reimbursement and 4% total reimbursement in their own country. Different standards of care and less responsible embryo transfer practices are amongst the risks patients’ face when going abroad.
Considering an average treatment cost of approximately €15,000 to conceive an IVF-child, the costs of MAR treatment represent a substantial proportion of a patient’s annual disposable income, MAR typically represents less than 0.25% of total national healthcare expenditure. By comparison, obesity accounts for 10% and 2-4% of total health care spending in the US and Europe respectively.
46 clinics in Belgium, the Czech Republic, Denmark, Switzerland, Spain and Slovenia helped with the research. Patients came from 49 countries, with high numbers from Italy (31.8%), Germany (14.8%), the Netherlands (12.1%) and France (8.7%). The next most numerous patient countries were Norway (5.5%), UK (4.3%) and Sweden (4.3%). The majority of Italians go to Switzerland and Spain, the majority of Germans to the Czech Republic; most Dutch and French patients to Belgium with a smaller proportion choosing to go to Spain, and most Norwegians and Swedes go to Denmark.
Reasons for going from one country to another for IVF treatment vary by country. Legal reasons are predominant for patients from Italy (70.6%), Germany (80.2%), France (64.5%) and Norway (71.6%). Difficulties accessing treatment were more often noted by UK patients (34.0%) than by patients from other countries, and expected quality was an important factor for most patients
The ESHRE Task Force study is the first to provide data on patients crossing borders between different European countries in order to undergo assisted reproductive treatments. The study showed that 1,230 couples underwent ART treatment during the observed period of one month and estimates that 11,000 to 14,000 patients cross borders every year in these six countries alone.
The Danish government has provided reimbursement for assisted reproduction treatments with up to three treatment trials for married and unmarried couples, singles and homosexuals. To save money, a new law means that in future ART will no longer be part of the free public health services.

Israel’s tourism is booming and on course for a record 3.5 million tourists this year. There are many reasons for Israel’s current success in tourism, but the main factor is that it has shifted from positioning itself as a sun and sea destination competing with countries such as Cyprus, Egypt and Malta.
Israel now seeks tourists looking for added value: the Holy Land, the life of Jesus, history, culture, and religion. Israel’s tourism marketing has become more aggressive with a hard-sell strategy to sell Israel as a venue.
The health and tourism industries are discussing promoting Israel as a destination for medical tourism from developed countries. At present there is sporadic and not very effective marketing by individual agencies and hospitals that effectively compete with each other rather than promoting Israel generally. The consensus is that they need to join forces under a single brand for the country’s entire medical system, rather than marketing separately.
Israeli hospitals have a hunger for medical tourism, as most need the money. Those already involved in medical tourism are the country’s largest hospitals: Sheba Medical Center, Ichilov Hospital; Rambam Medical Center; Hadassah University Hospital, and Rabin Medical Center in Petah Tikva. Two smaller private hospitals, Assouta Medical Center and the Herzliya Medical Center, are also active.
Israel has specialist expertise in oncology, fertility treatment, bone marrow transplants and orthopedics. Israeli health care prices are also lower than in many Western countries, but more expensive than Asia or Eastern Europe. What could be a problem is that hospitals charge 50% more for treating foreigners than they receive for treating Israelis. Israel would also have to compete with locally active competitors in Turkey.
Hadassah Medical Organization reports that revenue from medical tourism in 2009 was NIS 60 million, compared to a starting point in 2003 of NIS 3.5 million. Hadassah actively seeks patients abroad for its two hospitals in Jerusalem. Assouta Medical Center reports four-fold growth over the past four years and now gets NIS 50 million a year. Sheba Medical Center reports NIS 60 million in 2009, a 50% increase on 2008.
Most medical tourists in Israel come from Eastern Europe. Russians and Ukranians can find doctors in Israel who speak their language and understand their culture. A recent conference suggested that Israel would prosper by targeting the USA and Western Europe. But there are problems with that scenario; Israel has yet to penetrate either market, and public opinion in many European countries is, after the commando raid on peace ships in international waters, very anti-Israel. Israel currently gets virtually no medical tourism business from the USA, UK or Canada; and after several recent political incidents, Israel is far from popular in the UK.

A new Commonwealth Fund report has assessed seven industrialized countries on the performance of their health system in five areas: quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives. The Commonwealth Fund is a private foundation supporting independent research on health policy. 27,000 patients and primary care doctors were surveyed across all seven countries as part of the study.
The Netherlands ranked first overall, closely followed by the UK and Australia. The UK performed well when it came to quality of care and access to care. In relation to access, the study says: "The UK has short waiting times for basic medical care and non-emergency access to services after hours, but has longer waiting times for specialist care and elective, non-emergency surgery." The Netherlands ranked very highly on all waiting times measurements. When it came to efficiency, the UK and Australia ranked first and second.
Despite having the most expensive health care system, the United States ranks last overall. While there is room for improvement in every country, the U.S. stands out for getting poor value for its health care dollars, ranking last despite spending $7,290 per person on health care in 2007 compared to the $3,837 spent per in the Netherlands, which ranked first overall.
Report author Karen Davis comments, "It is disappointing, but not surprising that, despite significant investment in health care, the U.S. continues to lag behind other countries. With enactment of the Affordable Care Act, we have entered a new era in American health care. We will begin strengthening primary care and investing in health information technology and quality improvement, ensuring that all Americans can obtain access to high quality, efficient health care."
On measures of quality the United States ranked sixth out of the seven countries. On two of four measures of quality — effective care and patient-centred care — the U.S. ranks in the middle. However, the U.S. ranks last when it comes to providing safe care, and next to last on coordinated care. On measures of efficiency, the U.S ranked last due to low marks when it comes to spending on administrative costs, use of information technology, re-hospitalization, and duplicative medical testing. On measures of access to care, people in the U.S. have the hardest time affording the health care they need, with the U.S. ranking last on every measure of cost-related access problems.
Overall rankings –
1. The Netherlands
2. United Kingdom
3. Australia
4. Germany
5. New Zealand
6. Canada
7. United States

New Jersey based chiropractor Dr. Peter Ferraro, nationally recognized for his work in spinal decompression therapy, is exploring the possibility of bringing medical tourism resort centres to Panama, beginning with a five-star health care facility for people from around the world.
Dr. Ferraro believes Panama is the perfect setting for people to incorporate a vacation with alternative, non-invasive treatments for a lengthy list of ailments, diseases and injuries. Advanced treatment in non-surgical spinal decompression therapy means the avoidance of going under the knife for many suffering from debilitating spinal injuries. When the therapy is performed at a medical tourism resort, a patient’s family can be by their side while enjoying a vacation at the same time. An added benefit of medical tourism resorts is the ability of the physicians to control the lifestyle of the patient being treated, enabling a healthy, speedy recovery. Dr. Ferraro explains, “A medical resort can create a path to recovery that encompasses the entire mind and body. As opposed to just prescribing a drug and sending a patient home, when they are at the resort their recovery may incorporate meditation, a special diet, detoxification programs and more.” The Panama-based medical resort would bring together physicians from around the world and offer alternative, non-invasive treatments for cancer, spinal injuries and anti-viral treatment.
According to Mike Cobb of ECI Development 500,000 American retirees pick up their monthly social security cheques at an embassy or other location outside of the United States, and what stops up to 4.5 million others from following them is concerns about healthcare. Cobb says that the standard of healthcare in many South American countries has improved greatly and the cost is low too. Many countries have at least one or two top-notch hospitals with U.S.-trained English-speaking doctors and state-of-the-art equipment, often with new technology such as 3D scans, not used widely in the USA.
ECI Development is in discussion stages with some doctors on partnerships to add assisted living care and medical centres to real estate developments in Belize, Costa Rica and Nicaragua. In an assisted living pilot exercise for a woman with M.S., her costs in the United States were $10,000-$12,000 per month for round-the-clock care; her costs at Gran Pacifica in Nicaragua were 25% of that for a quality of her care better than she was receiving in the U.S.Cobb feels that businesses in medical tourism are missing an opportunity by ignoring assisted living, perhaps because it lacks the glamour of surgery or cosmetic treatment, as the old and the sick need help too.
Pegasus Star, the developers of Hacienda Matapalo, a gated community on Costa Rica’s South Pacific coast, will partner with New York based Patients Medical to establish a holistic wellness centre to help residents discover health and rediscover vitality. Dr. Rashmi Gulati of Patients Medical says, “Our physicians will bring their multidisciplinary perspective of health and healing. Educated in conventional medicine, our doctors discovered the power of holistic medicine and now balance the two approaches. David Matluck of Pegasus Star adds, “Unlike the traditional medical clinic that we have planned for our commercial centre, the new holistic wellness center will actually be part of our gated community.”
Deepak Chopra, founder of the Chopra Center for Wellbeing in Carlsbad, California, is looking at Costa Rica as a potential location for a future centre.

Recent research from Post Office Travel Insurance suggests that nearly a third of UK holidaymakers have been on a health and wellbeing holiday in the last three years, with travelers venturing on health and wellness holidays for holistic treatments, alternative therapies and beauty treatments. Spa breaks, are the most popular type of wellness holiday, with 22 % of UK travellers opting for this type of break, with others choosing holidays which include low impact physical activities to help improve fitness. While it may initially be disappointing that the survey cannot identify how many went abroad for health tourism abroad, it helps remind us that medical and health tourism can be within a country as well as from country to country.

Operations Abroad, one of the UK’s first medical tourism agencies when launched in 2001, has been relaunched by the daughter of the original founder. Ruth Taylor has taken over the business originally set up by her late father Kenneth, a Manchester accountant who had noticed the variations in medical costs between different countries while advising a travel business. Based in Manchester, it attracted media attention when sending a patient overseas for a knee replacement and when TV crews followed one of its patients going for an operation in Greece. Kenneth Taylor’s sudden death in 2003 left it in business but with little direction. Ruth Taylor has re-established the business, and has spent the past 12 months travelling in Europe and beyond, seeking out leading specialists and expanding the portfolio of clinics and hospitals to 35 hospitals in 22 countries.
Low cost, high quality European dentistry has arrived in the UK with savings of up to 70%. In an innovative and groundbreaking move, Perfect Profiles UK has brought low cost European dentistry to the UK by opening the first UK based clinic to offer high quality dental treatment at European prices saving patients up to 70% on private dental costs. Working with its Budapest dental partner, the Vital Center, it is the first of its kind to offer patients the same high standards of dental care available abroad by bringing highly qualified teams of Hungarian dentists to the UK to its brand new clinic. Dental patients no longer need to leave the country, not only saving on treatment costs but travel costs and time too. Perfect Profiles has been sending patients to Hungary for dental treatment for over eight years.
Mike Silford of Perfect Profiles UK says: “we opened in the UK because after 8 years experience of sending patients overseas for dental treatment, we wanted to demonstrate that it is possible for dentists in the UK to provide low cost, high quality treatment for domestic patients. We are proud to be in the forefront of this radical change of offering dental treatments in the UK, at prices patients can afford and remaining competitive with costs found overseas.” Hungarian dentists have a well-deserved reputation for being among the best-trained and highly skilled dentists in the world. All dentists in the UK clinic in Houghton Regis, Bedfordshire, are General Dental Council registered. There is a roster of 6 dentists flying in from Hungary and one permanently living in the UK.

Extensive media coverage of outbound medical tourism focuses on US residents leaving the country for medical care. Stackpole & Associates, an independent research company, has completed a survey of US international patient departments to learn about patients coming to the US for health care services.
Stackpole & Associates surveyed leading US hospitals with international patient departments to examine the impact of inbound medical tourism on those health care providers. According to Irving Stackpole, “Much is written in the media about outbound medical tourism, travel for medical care to destinations outside the United States. What about international health travelers coming to the US for healthcare services? Who are they and how are US hospitals able to meet their needs? Our survey was designed to answer these and other questions”. The survey was conducted on-line in March 2010. 87 managers of international patient departments throughout the United States were invited to participate from 48 hospitals, and 46% replied while 26% of individuals completed the survey.
This independent survey of the top international patient departments in the United States creates a snapshot of the features of these departments as well as the patients they serve and roles they play within their institutions. The survey results reveal a compelling picture of small but influential departments that meet a variety of challenges with modest staffing and budgets. Inbound medical tourists from every corner of the globe travel to the US for a wide variety of health care services with a focus on cardiology, oncology, and neurological services.
The survey covered various topics relating to medical tourism and international patient departments including: staffing and financial resources; international relationships including referral sources; international patient volume and medical services utilized; current and projected flow of international patients; international patients served by country or region; support services provided directly or by third parties; training for international patient department staff; and obstacles to attracting international patients.
The general view was that international patient departments bring prestige to a hospital. On total international patient volume, the highest percentages within the international patient sector were oncology (32%), cardiovascular (14%) and neurological (12%). International patients on average represent 1.5% of total patient numbers, although numbers have increased over the past 12 months, and most expect further growth this year. Patients come from many countries and noticeable are Mexico (21%), the Middle East (14%), South America (12%), Central America excluding Mexico (11%) and Europe (11%).
Most international patient departments offer additional services such as interpreter / translator, pre arrival medical assessment, assistance with hotel reservations or housing options, special dietary needs and coordination of aftercare services. Less than half provide assistance with transport and / or tourism related services. The emphasis is on medical, not tourism.
The price of US healthcare is rated as the greatest obstacle to international patients and obtaining a visa was the second most difficult problem. Marketing is mostly word of mouth from patients and families, followed by referrals from doctors. Staff coordinate with outside services to provide support for international patients but these staff members receive little training to meet the needs of global health travellers.

Improved trading standards are being developed for the cosmetic surgery industry across Europe by the European Committee for Standardisation (CEN), a cross-border organization. CEN is a major provider of European standards and technical specifications. It is the only recognized European organization for the planning, drafting and adoption of European Standards in all areas of economic activity. These standards have a unique status since they also are national standards in each of its 31 member countries of 480 million people. It all began when the Austrian Standards Institute (ASI) lobbied CEN to develop European standards for cosmetic surgery services. A group of cosmetic surgery practitioners will provide guidance to help Project Committee, CEN/TC 403 ’Project Committee – Aesthetic surgery services’ develop regulations to ensure the sector is monitored and accountable for its practice. The British Association of Aesthetic Plastic Surgeons (BAAPS) has continuously campaigned for increased legislation for the industry. Nigel Mercer of BAAPS will be helping the project committee in Brussels design a framework of regulations to ensure patients will receive safe treatment and a high standard of facilities. He believes this move to monitor the cosmetic surgery industry is overdue, ’’The UK, as many other countries, has so far failed to put in place adequate regulations or standards to protect the public from unscrupulous providers who are mainly preoccupied with profit. I welcome a solid Europe-wide framework which will ensure patients can rely on safe treatment and facilities wherever they might be.”
The market for cosmetic surgery has increased dramatically in recent years. The growing availability of travel also means that cosmetic surgery tourism has become a reality. Few EU countries have adequate regulations or standards on how to provide these surgery services in a safe environment and consumers are not always fully aware of the risks. So there is a need from a patient safety perspective to ensure that patients can rely on safe cosmetic surgery interventions, whether it is at home or abroad. There is no date for the launch of the new standards. The first meeting of this new project committee is expected to be held in September 2010. European Standards are, from a legal point of view, voluntary, but their impact is significant and cosmetic surgery standards could become law as the European Commission develops patient safety services.
The International Society of Aesthetic Plastic Surgery (ISAPS) has published guidelines for patients considering travelling for their surgery. ISAPS says,” Patients will travel for their surgery to find lower costs, and to combine surgery with a vacation, because the travel industry and economic development ministries in many countries encourage it.”
In partnership with a major but not yet named insurance company, ISAPS has developed an insurance that offers patients cover if they encounter complications within a year after their return from surgery outside their own country. Cover only applies if both the surgeon performing the surgery and the surgeon managing the complication are ISAPS members; this may restrict the number of people able to buy the cover. To test the concept, and if people are willing to buy extra insurance, ISAPS will launch a pilot in the UK in September. What may be a problem for the pilot is that ISAPS says screening of patients is vital so it recommends a visit to a home country surgeon first, with the possibility of dissuading the travel altogether. Communication between the home country surgeon and the foreign surgeon, both ISAPS members, is key to the management of any subsequent complications. It is not available to anyone as it only applies to patients choosing surgeons from a list of screened ISAPS surgeons both abroad and in the home. The insurance is subject to more restrictions, as the patient must adhere to the requirements of the attending surgeon, such as proper recuperation time in the country where the surgery is performed. A number of UK surgeons have agreed to participate in the pilot. The ISAPS scheme will not promote any specific location or any one surgeon. The pilot faces several problems; people going overseas may not see why they should pay for a home country surgeon before or after travel as well; the insurance is complicated and restrictive; of ISAPS 1700 members only 33 work in the UK; and previous attempts to offer cosmetic surgery insurance in the UK have failed.

The Australian Medical Association (AMA) has urged caution after an Australian medical tourism agency was launched to offer cosmetic surgery and dental packages in Phuket and elsewhere in Thailand. Steve Hambleton of AMA argues that holidays and surgery should not mix, while the cost savings should be weighed up against increased risk and a lack of recourse should something go wrong, "If you go overseas, you do not have the sort of doctor registration systems that we have in Australia and we know that our training is excellent and our doctors’ standards are excellent. We would urge caution and we say to those people you are taking extra risks and do you want to take those risks with your most precious asset?" Dr Hambleton then argues that while some Australians do have hassle-free surgery overseas there have been recent cases of problematic joint replacements, followed by the prospect of costly corrective surgeries.

CosMediTour offers packages that include return flights, surgery, recuperation in a five star hotel and the potential to take a friend along for support. Run by Christyna Kruczaj and Greg Lemon, the agency takes groups from the Australian state of Queensland direct to the hospital or clinic where the surgery or dental work is done. Christyna Kruczaj says while prices vary depending on surgery type and by person, packages cost 20 to 40 per cent less than having the equivalent procedure in Australia. A breast enlargement package would cost $6,500 in Thailand while the procedure alone costs more than $10,000 in Australia,” All of our surgeons are accredited plastic surgeons and the Thai accreditation is based on the US system of plastic and reconstructive surgery. We have been researching and developing this for 16 months. The AMA’s response is predictable and a bit disappointing really. Patients only pay for an initial consult; flights and accommodation before leaving Australia and can opt out of their surgery in Thailand without financial penalty. The response we have had is immense. Many friends have gone over for surgery and they are all happy.”
But Australia too has had problems with cosmetic surgeons undertaking surgery that did not work and had problems. This is why from July 2010 all Australian doctors will be required to hold indemnity insurance under a new national registration regime. This is to ensure that patients entitled to compensation after a medical malpractice case will receive their payment. There is no similar requirement in Thailand. The extra insurance costs mean that Australian cosmetic surgeons have to chose between raising prices to pay for the insurance, and cutting into their profits; this helps explain the timing of the latest in a series of criticisms of cosmetic surgery tourism.
1 July 2010 sees the launch of the new national registration regime. The new national law has been passed in Queensland, New South Wales and Victoria. Adoption bills have been introduced into most other States and Territories and await debate. From 1 July 2010 medical practitioners across Australia will need to be registered with the Medical Board of Australia. All registered medical practitioners must have professional indemnity insurance for all aspects of their medical practice.
Australian medical professionals have been consistent in complaining about medical tourism. Their main complaint is that at a time when fewer people are paying for cosmetic surgery, and that many of those that do seek the most price-effective option; they are losing business to overseas surgeons. The Australasian College of Cosmetic Surgery has serious misgivings about the rising practice of medical tourism, but apart from vague warnings on the risks of a problem when the clinic is ten hours away by plane, can provide little hard evidence to support their expected antagonism to overseas competition.
Dentists and dental organizations are also regular complainers about competition, based on prejudice and fear of loss of business rather than any evidence that Thai standards are not equal to Australian ones. Two of Phuket’s best hospitals, Phuket International Hospital and Bangkok Hospital Phuket, are less than pleased about Australian slurs on their professionalism and counter that standards of surgery on Phuket are equal to or perhaps even better than those in Australia. A growing number of people who normally can only expect or afford care at day clinics in Australia are going to Phuket for hospital treatment. Doctors on Phuket acknowledge that after-care is more difficult once a patient has returned home, but they say this is always taken into consideration and several agencies do offer after-care services.

The new American Heart Institute (AHI) currently under construction in Nicosia, Cyprus, is due to open in September 2010. It is the first private hospital on the island to specialize in non-invasive and invasive cardiac interventions and the entire spectrum of adult cardiology and cardiothoracic surgery.
The hospital also has the distinction of being the first environmentally friendly hospital in Cyprus, Europe and the Middle East. Up to 80% of the energy needs of the building will be covered by utilizing renewable sources of energy. It will use geothermal energy for cooling and heating; solar energy for electricity generation, solar thermal for hot water production, special insulation, recycling technology for water and prefabricated construction techniques to minimize waste.
Patient comfort is one of the highest priorities of AHI, so the new building includes a welcoming, well arranged reception area, modern cafeteria, well equipped waiting areas with indoor gardens for patients and families. Each patient will have his own individual multimedia station with access to internet, skype, telefon, nurse call and personal entertainment. Additionally the patient will have the flexibility to order on line the menu of his choice from a high-end cafeteria-catering service on the premises. The new 50-bed hospital will be a centre of excellence in cardiology, performing the entire spectrum of diagnostic and therapeutic cardiology and cardiac surgery, supported by state-of-the-art technology.
Since Cyprus is already a well known tourist destination, AHI believe that it offers itself for postoperative recovery in a mild climate perfectly suited for rehabilitation, so seeks to attract patients from all over Europe and the Middle East. In the existing AHI hospital, 30% of AHI patients are non-locals, mainly coming from the United Kingdom. With the superior facilities in the new hospital, the % of overseas patients is expected to be higher.
The Cyprus Health Service Promotion Board in cooperation with the Cyprus Chamber of Commerce, the Ministry of Commerce, Industry and Tourism and Cyprus Tourism Organisation have a joint mission to London to promote the Cyprus health services, with a conference and exhibition in a central London hotel from 20 to 23 November 2010. The preliminary program includes presentations by the participating members of specialties and services offered, meetings with potential suppliers of business. The mission is particularly targeting the UK’s Greek Cypriot community. The organization of the event will be assigned to a specialized company in Britain.

Plans to position Thailand as a leading medical tourism destination are being revived, starting with an effort to persuade foreigners that it is safe to visit the country as political tensions recede, says public health minister Jurin Laksanavisit.The minister says his immediate priority is to listen to the concerns and proposals of people in health care and related businesses. As medical tourism is a key element, support from the Tourism Authority of Thailand will be required. “In the short term, we will require some roadshows to restore the confidence in safety among foreign patients when they come here to get medical treatment."
Concern about safety was heightened during the ten weeks of anti-government protests that culminated in violence and arson in mid-May. At one point the red-shirt protesters invaded Chulalongkorn Hospital, claiming it was harbouring soldiers. Images of the chaotic scenes as the hospital attempted to evacuate hundreds of patients were seen worldwide.
Thailand over the past decade has developed a thriving medical tourism industry, capitalising on high-quality, well-equipped private hospitals and skilled practitioners offering quality care at far less cost than in developed countries. Thailand has demonstrated good potential, proven by the increasing number of foreign patients, and worldwide recognition of Thai health care and other services such as massage. Traditional Thai and alternative medicines are likely to attract more foreign visitors for seeking treatment in Thailand. According to the Department of Health 1.5 million foreign patients visited Thailand last year for medical and health tourism, compared with 630,000 in 2004. Wattanosoth Hospital in Bangkok reports that foreign patients have delayed their visits recently because of political unrest and the imposition of a state of emergency. 35% of the hospital’s patients come from overseas, mostly from Southeast Asia and the Middle East.
Not everyone is convinced that stating that everything is now safe will be enough to restore tourism and medical tourism, as this year’s problems are just a continuation of earlier unsolved internal troubles. Apichart Sankary of The Association of Thai Travel Agents (ATTA) has serious doubts on Thailand’s revised official tourist target for 2010 of 14.1 million “This is only the minister’s dream. It is not the reality we all recognise in the business. If we can reach 10 million, we will be lucky."
While the health minister may suggest that a few roadshows in countries that send people to Thailand will be enough, others disagree. Suraphon Svetasreni of the Tourism Authority of Thailand is among those believing that Thailand must restore confidence in Asian markets before advertising campaigns can be launched,” We have to restore confidence in Asian markets such as China, Korea, Hong Kong and Japan because these markets can recover quickly. Then we have to move to medium and long-haul markets to regain the business in time for the high season.”
Under the banner ’Together We Can’, government officials and private sector businesses have agreed to brainstorm marketing strategies to rebuild confidence, although no specific dates, meetings or action steps have yet been announced. A medical tourism network to boost business in Thailand was launched recently in Bangkok. The Medical Tourism Cluster (MTC) intends to recruit a wide range of tourism players who offer wellness and medical services in Thailand. It will coordinate business contacts and sales leads between cluster members and overseas medical tourism providers. Network founder Prakit Chinamourphong says that the MTC could help boost medical tourism by connecting local companies to overseas markets and suppliers. Within Thailand, Phuket has become a major participant in the medical tourism sector and ranks second only to Bangkok in terms of the volume of foreign patients seeking treatments.

A medical tourism agency in Costa Rica, Great Sunrise Services Costa Rica (GSECR), wants agents to promote the services it offers, but there is a catch. Costa Rica’s popularity has been growing steadily over the years, although it only has three Joint Commission International accredited hospitals, all in San Jose. There are 6 major private hospitals, 22 public hospitals, and an unknown number of private clinics. The overwhelming majority of medical tourists visiting Costa Rica come from the USA. The agency suggests a figure of 20,000 patients a year, but this is only an often repeated estimate. The price of medical services is low and Americans can achieve cost savings of between 30 to 70% off USA prices.
The agency is seeking agents, but the agents have to pay an upfront on-off fee of US$6,000 that gives them;

Use of GSECR designation as a contracted agent.
Training in Costa Rica, helping them to market their medical service business
Ongoing and unlimited support.
Airfare from home city and airport pickup.
Hotel and meals included with no out-of-pocket expense.
Introduction, training and hospital-orientation field trips.
4% commission on gross billing for procedures arranged, with average billing quoted as $18,000 to $30,000.

Clamp down on stem cell clinics
Costa Rica is cracking down on an unauthorized stem cell clinics that have attracted hundreds of foreigners prepared to pay large sums when seeking relief from degenerative diseases and serious injuries. The promise is that stem cell treatment, using master cells gleaned from umbilical cords, fat and elsewhere, can cure or slow down the effects of many diseases that traditional medicine cannot cure or can only cure with long and expensive treatment.
The health ministry has already ordered the country’s largest stem cell clinic to stop offering treatments, arguing there is no evidence that the treatments work or are safe. The ministry’s Dr. Ileana Herrera comments, "If stem cell treatment efficiency and safety has not been proven, we do not believe it should be used. As a health ministry, we must always protect the patient.”
The clinic’s owner, Arizona entrepreneur Neil Riordan, has closed the clinic and admits the treatments, involving the removal and re-injection of stem cells, had not been approved by the U.S. Food and Drug Administration. The ministry said the clinic had a permit to store the adult stem cells, extracted from patients’ own fat tissue, bone marrow and donated umbilical cords, but was never authorized to perform the treatment. Since the Institute of Cellular Medicine opened in 2006, 400 foreigners, mostly from the United States, have undergone the experimental treatment unavailable in North America and Europe to treat multiple sclerosis, spinal injuries, diabetes and other ailments.
Stem cell treatment experts argue that without controlled clinical trials, there is no way to know if the treatment is making such differences or some other factor, and worry that such clinics exploit ill patients’ desperation with an unproven remedy. The International Society for Stem Cell Research has cautioned against stem cell tourism, as some clinics do not follow the careful procedures in a clinical trial, which involve checking patients given the treatment against patients who have no therapy to rule out the placebo effect.
Those advocating stem cell tourism argue that many patients will not live long enough to wait for official approval or clinical trials. It is unlikely that stem cell treatments will be approved for broad application in most degenerative diseases within the next 5 to10 years in the United States. Those in need of treatment must either wait until FDA clearance is given or seek treatment abroad. Trade estimates predict that the international cell therapy market will be worth $56.2 billion in 2010 and $96.3 billion in 2015.
The International Society for Stem Cell Research (ISSCR) has just launched “A Closer Look at Stem Cell Treatments“ a website offering patients, their families and doctors with information they need to make decisions about stem cell treatments. The launch is to counter the growing number of aggressive marketing campaigns offering stem cell treatments. The ISSCR urges individuals to be cautious and to learn the facts before making any decision. Irving Weissman of the ISSCR says, “Stem cells do hold tremendous promise for the treatment of many serious diseases. Yet there are organizations out there that are preying on patients’ hopes, offering stem cell treatments for large sums of money for conditions where the current science simply does not support its benefit or safety. ISSCR is concerned that stem cell treatments are being marketed to patients worldwide for a variety of medical conditions, without having the mechanisms in place to ensure safety or likely benefit. Without these safeguards, patients may be put at risk. “

A recent feature for a medical magazine by Doctor Peter Kovacs highlights the problems of fertility tourism. Here’s a summary of his findings.
Patients seek infertility services in a different country for various reasons. These procedures are regulated in most European countries, and the legal framework within which assisted reproductive technology can be practiced in a given country varies considerably. In some countries, the number of eggs that can be fertilized is limited (such as in Italy), the number of embryos selected for transfer is limited (such as in Germany), or the number of embryos that can be transferred is regulated (such as in the Scandinavian countries). In addition, certain procedures (preimplantation genetic testing, donor gamete use, surrogacy, or sex selection) may be allowed in some, but not all, European countries.
Neither the regulation nor the financing of these services is uniform. In some countries, the entire expense has to be covered by the patient, whereas in others, not only is the treatment reimbursed but the medication expense is as well. Restrictions in some countries prevent patients older than a certain age or with a certain reproductive history from undergoing reimbursed treatment. Availability and waiting times also vary. All of these factors drive patients to explore treatment abroad.
It is estimated that 20,000 to 25,000 European couples receive in vitro fertilization (IVF) care abroad each year. Under normal circumstances, assisted reproductive technology procedures are reported to national registries, and the data are forwarded to the European Society of Human Reproduction and Embryology (ESHRE) to compile the European IVF database. However, procedures performed abroad are rarely included in these databases and therefore are unaccounted for. The kind of assisted reproductive technology procedures that can be performed in a given country differ significantly throughout Europe. A classic example is donor egg use. About 10% of the patients undergoing assisted reproductive technology need this service, but it is not allowed in several European countries (Germany, Austria, and Italy). In other countries, such as Spain, donor egg use is allowed and the donor can be reimbursed for her expenses. Not surprisingly, patients from all over Europe choose Spain as their destination when it comes to donor egg use, and nearly half of all donor egg treatment cycles in Europe are performed in Spain. A United Kingdom study by The York Management School found that about one quarter of the multiple gestations in the UK were the result of fertility treatments provided overseas.
The assisted reproductive technology procedures that can be performed in a given country are influenced by the country’s ethical, legal, traditional, and cultural characteristics. These differences will always exist and may at times exclude some patients from services, and these patients must seek services abroad. To make it easier for such patients to receive the desired services outside of their countries of residence, physicians should assist in the evaluation and follow-up of these patients in coordination with the physician team that actually performs the procedures. This would be more convenient for the patient and would guarantee high-quality care and adequate follow-up. Insurance companies could also cooperate and arrange the appropriate financial coverage for these procedures. Until these measures are introduced, physicians should adhere to available international guidelines when treating these couples, and therefore, complication rates can be reduced to the minimum. It is imperative that global standards be developed and the USA, European, and other nations take an active role in setting requirements, including rights of citizenship and immigration.

Until recently, the 350 clinics offering surrogate mother services to the hundreds of medical tourists coming to India every week have been unregulated. But legal cases in India and other countries, mean that this profitable free-for-all will be replaced by regulated agencies being forced to comply with national and international law.
India’s Supreme Court has demanded urgent new legislation to regulate one of India’s fastest-growing industries. India has become the world capital of outsourced pregnancies, where surrogates are implanted with foreign embryos and paid to carry the resultant babies to term. In 2002, the country legalized commercial surrogacy in an effort to promote medical tourism. Indian surrogate mothers are readily available and cheap. A draft bill to direct assisted reproductive technology (ART) will be introduced this year in Parliament. The new legislation will make law the surrogacy guidelines of the Indian Council of Medical Research (ICMR) that are often ignored by Indian fertility clinics.
Many of the couples using India are from countries where surrogacy is either illegal or unaffordable. Surrogacy costs $12,000 to $20,000 per birth in India, compared to $70,000 to $100,000 in the USA. Most surrogate mothers are rural women in need of income. Indian surrogates are usually paid between $5,000 to $7,000 for their services, which is more than many of them would be able to earn after years of work. In some Indian clinics surrogates are recruited from rural villages, with most recruits being poor and illiterate. Surrogacy recruits are brought to the clinics where they are required to stay in the clinic’s living quarters in a guarded dormitory-like setting for the entire pregnancy.
There have been several cases in which babies born from Indian surrogacy arrangements were stateless, in which neither India nor the parents’ home countries recognized the babies’ citizenship. Japan considers the woman who gives birth to a baby, the surrogate, to be the baby’s mother. Until recently, two-year-old twin toddlers were stateless and stranded in India. Their parents are German nationals, but the woman to whom the babies were born is an Indian surrogate. The boys were refused German passports because the country does not recognize surrogacy as a legitimate means of parenthood. And India does not confer citizenship on surrogate-born children conceived by foreigners. Only after a long legal battle did Germany allow the boys German passports.
The new proposed government bill bans in-vitro fertilization (IVF) clinics from brokering surrogacy transactions. It also calls for the establishment of an ART bank that will be responsible for locating surrogate mothers, as well as reproductive donors. Fertility clinics will only come into contact with surrogates on the operating table. Clinics see this as unworkable as they want to perform medical and background checks. But the new rules seek to protect surrogate mothers with freedom in negotiating their fee and mandatory health insurance from the couple or single employing them. Firm legal standards will ensure that medical professionals only be permitted to implant three embryos in a woman’s uterus per attempt. The legislation will only allow a woman to act as a surrogate up to five times, less if she has her own children, and will impose a 35-year age limit. The new legislation will require that the international couple’s home country guarantee the unborn infant citizenship before a surrogacy can begin. If this stipulation becomes law it could kill the industry as few countries will or legally could guarantee citizenship before birth. Countries accepting surrogate-born children typically rely on DNA tests done post-delivery to determine the parentage of the baby.

MediBid, an online US marketplace for medical treatment, is now making it possible for Canadian patients who cannot afford long waiting lists to access the care that they need. MediBid is the one place where Canadians can access surgeons and facilities from around the world at a price they can afford, with the launch of Canadian website MediBid.ca.
MediBid’s founder Ralph Weber has been helping Canadian patients for over 13 years. As a Canadian with extensive experience in the US and Canadian healthcare sectors, he knows the effects of a long wait for surgery, "I want Canadians to know that US health care is affordable, often 80% less than what you might think. MediBid is a tool for patients to obtain the real prices for health care from a free market system. It was founded on five principles: access, quality, choice, value and privacy. Often, procedures in the US are billed at an inflated price. For example, knee replacement surgery can be billed as high as $50,000, but can be obtained at cost for as low as $12,000. If you weigh in the expense of lost income from missed work while on a waiting list, the value in paying out of pocket is apparent."
Timely access is what Canadians need, according to The Fraser Institute, "We are paying among the highest amounts in the world for our healthcare system that is actually delivering quite a poor service in terms of lengthy waiting lists, in terms of access to technology, and access to a family doctor." Lynn McLeod of Ontario Health Quality Council adds, "In many areas of care, too many people still wait too long."
MediBid is now offering Canadian patients the same immediate access that has been available to US patients since MediBid.com opened in January 2010.Patients on MediBid.ca can review bids and compare credentials, experience, and quality from a pool of thousands of physicians without the price being inflated by any third parties. Patients deal directly with doctors, not a third party agency. MediBid’s secure, needs-matching technology offers patients the ability to compare quality care with upfront, custom pricing in an interactive, online marketplace. Patients join to seek out surgeons, doctors, dentists, and other medical providers from both the US and around the world. Patients create a profile and a request for care online. Physicians review the request made by and give a custom bid to each patient based on their individual needs. MediBid does not get involved in the financial transaction between doctor and patient. The hospitals and clinics quote cash prices and accept only cash or credit cards at the time of service, not insured treatment paid for by insurers.

The first ever detailed study on health and medical tourism in Australia,’ Health tourism in Australia: supply, demand and opportunities” has been published by the government funded Sustainable Tourism Cooperative Research Centre. This technical report presents a robust understanding of health and wellness tourism in Australia, and to a much lesser extent, medical tourism. It provides information and outcomes relevant for future development of the wellness and medical tourism industries in Australia.
Australia does not yet offer medical tourism in any organised way as the number of international inbound visitors that meet the definition of a medical tourist is, according to the report, a consistent 7,000 a year from 2006 to 2009. While official figures suggest that there are over a million medical tourists in Australia each year, this is a definition that comes out of the unusual state based and insurance based healthcare systems in the country; so almost all of these are simply Australians travelling away from their home town/city, frequently a relatively short distance by Australian standards, but not by European standards, for medical treatment. There are a much larger number of health and wellness travellers, but again the vast majority of these are from within the country. There are very few hospitals or clinics offering facilities to medical tourists from overseas. This research suggests that Australia would benefit from developing niche medical tourism offerings based on Australian medical strengths/expertise, as has occurred with the Cairns Fertility Clinic and its IVF services. Possible areas for development of Australian medical tourism services include cardiology, urology, orthopaedic surgery and oncology. The report recommends that Australia seek a competitive advantage internationally by focusing on the provision of quality services at a lower price point than the United States, and based on niche medical offerings in which Australia has an international reputation and expertise.
There is no state or national government policy on or support of medical tourism and no particular recognition of this as an area of distinctive opportunity. The prospect of medical tourism is seen by all these governments as fraught with difficulties for governments concerned with voters’ perceptions of medical resources being handed over to private sector entrepreneurs. The research suggests that the best way forward would be for the national government to establish and fund a body that develops a nationally coordinated medical tourism policy and actively promotes Australia as an international medical tourism destination through trade shows and other forums. To encourage the development of medical tourism, it is recommended that submissions are developed and presented to government to illustrate the potential for medical tourism to contribute to the supply of medical services and facilities in Australia and to contribute export income to the Australian economy.
One problem identified is that the visa application process for medical tourists is so complex that most medical tourists enter Australia on a tourist visa rather than go through the process of applying for a medical visa due to the associated delay. It recommends that the application process for medical visas (long-stay and short- stay) be reviewed and streamlined. The report identified a problem on price as Australia does not have a comparable selling point on price to India, but Australian medical services are still considerably cheaper than in the United States and several treatments are also less costly than in South Korea.

Although the recent ministerial agreement on the cross-border healthcare directive is very important, members of parliament, doctors and patient groups say more work still needs to be done to amend the agreement to make it workable before the new rules can be implemented. The bill now goes back to the European Parliament, which has already backed a more far-reaching version of the directive. A majority of MEPs will have to vote in favour of a revised text before it can become law. One major concern is that the draft could allow governments so many freedoms when transposing it into national law that the directive would become so watered down as to lose the point of imposing it.

EPF, the umbrella organisation of pan-European patient organisations wants mechanisms to be set in place for alternative means of payment that would not leave patients to bear the whole costs of cross-border healthcare up-front. It feels that without such mechanisms, the vast majority of the population would not be able to benefit in practice from the new rights granted to them under the directive. Former MEP John Bowis of Health First Europe comments,” This political agreement is important not only because it puts health policy back on the European agenda but because during the negotiations politicians understood that values of quality and safety are of paramount importance for healthcare services in Europe."
The health ministers’ compromise will see patients reimbursed for medical treatment in other EU member states, but with a series of safeguards giving health authorities the power to prevent patients from travelling under certain circumstances. The agreement also agreed on who should pay for treating pensioners who take up residence in another member state during their retirement. The agreement says a French pensioner living in Spain will be reimbursed by the Spanish state if they seek treatment in Germany. But France would pick up the tab if that pensioner were to be treated in France.
The main problem is that the European Parliament had already agreed a more liberal view of how far the directive should go in patient mobility. Some MEPs have already said that the European Council’s compromise attaches too many conditions to patients’ rights. Patient and doctor groups want the language of the final text clarified in order to avoid variations in how member states apply the law. But politicians anonymously argue that "constructive ambiguity" is necessary in order to move it forward.
MEPs will debate the issue again before the end of the year, but it is too early to declare the issue agreed given the differences between the Parliament and member states. Influential French MEP Françoise Grossetête comments.” I want more equity and more justice for all patients, depending on their medical needs and not on their financial means. There is still a lot of work to do in the European Parliament given the fragility of the commitments made by some of the member states." BEUC, the European consumers’ organisation, calls on MEPs to address shortcomings in the agreement, “ The many new clauses introduced by the Council reduce the added value of the proposal and create more confusion for patients. We count on the European Parliament to address the shortcomings of the text and to make it more meaningful and ambitious."

The Accreditation Association for Ambulatory Health Care (AAAHC) of the USA has accredited Nova Dental in San Jose, Costa Rica, as the first ambulatory organization outside the USA to be accredited by the new AAAHC International accreditation programme. The clinic received a three-year accreditation. The accreditation survey was conducted by a team of US based AAAHC surveyors who are active practitioners of ambulatory health care, including a dentist.
John Burke of the AAAHC says, “The goal is to improve the safety and quality of patient care. Our peer-based survey process and our comprehensive education programs make our accreditation unique, and enable us to work closely with ambulatory centres to assess their services and assure they provide high-quality care.” Luis Obando of Nova Dental adds, “We offer a full-service dental clinic that specializes in cosmetic dentistry, and 95% of our customers are from the USA.The accreditation process was a lot of work to get everything together to meet the standards, but in the end it helped to improve our clinical and administrative processes.”
AAAHC launched its international accreditation program in Costa Rica, and other organizations in that country have begun the process toward AAAHC International accreditation. The organisation will add accreditation for ambulatory organizations in other countries soon. The logic is that Americans going overseas for care need certainty as to the quality of clinics, most of whom are far too small to be able to afford JCI accreditation, and that while overseas authorities may license doctors or dentists, few countries in South and Central America licence the clinic or hospital.
Care, founded in 1979, is the leader in ambulatory health care accreditation with nearly 5,000 organizations accredited across the US. The AAAHC accredits a variety of ambulatory health care organizations, including ambulatory surgery centres, office-based surgery centres, college student health centrers, managed care organizations, military health care clinics, and large medical and dental practices. It is an advocate for the provision of high-quality health care through the development of nationally recognized standards and through its survey and accreditation programmes.

Although UK residents going overseas for cosmetic or other treatment may be able to sue the hospital or clinic if it all goes wrong, many believe that the medical tourism agency cannot be held liable, as it has no medical knowledge. Specialist lawyers Blake Lapthorn do not agree, and point to travel law to back up this view.
The number of people undergoing cosmetic surgery has increased in recent years. With this escalation has come an increase in complaints and claims for compensation when the surgery does not turn out as expected. The impact of cosmetic surgery going wrong can be far wider reaching than standard surgery. Often the patient will have paid a large amount of money to have the surgery done privately and will have high expectations for the outcome. As with any procedure, the surgeon must obtain informed consent from the patient. This requirement often raises a conflict of interest. If the patient is made fully aware of all the risks of surgery, they may decide not to go ahead with the procedure, and will not therefore part with their money. The surgeon should always establish the patient’s reason for the surgery and be clear what the patient hopes to achieve. The surgeon should also explain very clearly in full the possible risks, complications and outcomes. A surgeon may also be open to criticism if he fails to contact the patient’s GP or conduct a full physical and psychological assessment beforehand. It is in the surgeon’s interest to do this.
Trying to establish the standard of care to which a patient is entitled when they undergo cosmetic surgery is often difficult. It will usually depend on the type of surgeon and what information and leaflets the patient is given beforehand. The relationship between patient and surgeon can cause further problems. This may be different to the normal patient/surgeon relationship, as here the patient is usually paying privately for the treatment, and creating a contract. The company employing the surgeon will often claim the surgeon is an independent contractor, meaning that any claim would have to be brought against the surgeon personally. This can cause further problems, particularly if the surgeon lives abroad, or is not insured and has no assets to claim against.
For cosmetic surgery abroad, the patient may sometimes purchase a package through a medical tourism agency that includes flights, hotel and surgery, as well as time for the patient to recover abroad. Such packages are covered under the Package Travel, Package Holidays and Package Tours Regulations 1992. Under these regulations, if the surgery goes wrong, the patient can sue the package provider (the medical tourism agency), as well as the clinic. The agent may also be responsible for non-medical items such as travel accidents. While travel agents and tour operators selling packages are obliged to have bonds and professional indemnity insurance, there are as yet no similar rules for medical tourism agents; and calling themselves facilitators or consultants does not change their legal status of being an agent if they are subject to the Package Travel, Package Holidays and Package Tours Regulations.
The lawyers say that as more people turn to cosmetic surgery, the burden on surgeons to ensure the patient is thoroughly informed and consenting is ever increasing. The list of holiday accidents that consumers can claim for includes personal injuries resulting from accidents that were not their fault includes accidents caused by air travel, road traffic accidents and coach crashes, and negligent medical/clinical treatment received abroad.
Blake Lapthorn’s approach to a consumer clinical negligence claim: “First we listen to your account of the medical treatment you received, and the injuries you have suffered. We will also involve our medically qualified staff in assessing your prospects of bringing a successful claim. Then we assign a lawyer, or team of lawyers, to your case. Our initial work sets out to establish the strength of your case and whether a claim is likely to be successful. It involves gathering evidence including medical records, and a report from a medical expert. If we can establish there was a breach of duty by the medical personnel caring for you, and that you suffered injury because of that breach, we can proceed with your claim. The claim will normally be brought in the country where the medical treatment was received. Our foreign language abilities, including fluent French, Spanish and German, and international network of agents, TAGLaw, enables us to pursue claims abroad efficiently and effectively. Once you have realised that the clinical treatment you received has caused you injury, it is vital that you start proceedings as soon as possible because the time limits vary, depending on the country in which the claim is brought. Most personal injury claims can be pursued at no cost to you. You may have legal expenses insurance or your claim may be eligible for a no win-no fee arrangement.”

NBK Capital, an investment fund owned by National Bank of Kuwait has acquired a 30 % stake in World Eye Hospitals and may increase that share of the Turkish company. World Eye plans an initial public offering (IPO) for part of the remaining 70 % stake, to offer its shares publicly. The IPO will only be after it completes investments, including opening surgical centres in Russia, Ukraine, Germany and the Netherlands. World Eye, which operates 15 hospitals in Turkey and overseas, plans investments of $20 million over the next 12 months with healthcare centres in the European cities of Kiev, Moscow, Munich and Amsterdam. It targets revenue of $100 million this year, which it aims to double in 2011.The group targets 50,000 foreign patients this year, and last year treated 20,000 non-Turkish patients, mainly as health tourists.
At Singapore-listed Parkway Holdings there is now a battle for control of this key medical tourism player. The saga began in March, when US private equity group TPG Capital sold its 23.9% stake in Parkway to Fortis Healthcare, an Indian hospital chain for S$959million. Fortis Healthcare has since increased its stake to 25.3% to make it the single largest shareholder of Parkway.
But there is another major stakeholder in Parkway, Malaysian government subsidiary Khazanah Nasional has a 23.8% share through its subsidiary, Integrated Healthcare. Khazanah recently made an offer to increase its stake to 51%, at a premium price to shareholders. If Fortis do not make a counter-bid, Khazanah wrests control from Fortis.If Fortis makes a counter bid, it will have to be at a very high price indeed, and would enable Khazanah to make a massive profit by selling their shares. There is a third player, the Government of Singapore Investment Corp (GIC) with a 6.8% stake .If Fortis opts to make a counter bid for Parkway, it would have to launch a full general offer for Parkway, as Singapore takeover rules do not allow parties who have bought shares in the last six months to carry out a partial offer. That could potentially cost Fortis at least S$3.1billion to buy out the remaining shareholders in Parkway. Fortis is discussing financing options with GIC, but GIC’s mandate is to invest abroad and this could constrain it from putting its money into a battle for control over a Singapore based company. Though Khazanah’s offer is an attractive one, there is no assurance that it will succeed. Khazanah, has a 60% stake in Pantai Medical, the other 40% is held by Parkway.Fortis has another option, a partial offering, but Singapore’s financial authorities would have to give special permission.
Fortis’ investment in Parkway is seen as a starting point for ambitions of rapid international expansion. For both Khazanah and Fortis Healthcare, a majority stake in Parkway Holdings is a good acquisition, as Parkway has 16 hospitals in Asia, with over 3400 beds throughout Singapore, China, Malaysia, India, Brunei, and the UAE; and plans to build hospitals in Vietnam and China. Parkway has huge strategic value for Fortis, and losing control over the Singapore-based healthcare chain would constitute a big setback for the Indian healthcare company. Fortis plans to use Parkway as its vehicle to realise the dream of building a leading global healthcare chain. An option for Fortis is to stay invested as a minority shareholder. But unless it is able to arrive at an understanding with Khazanah over management control, it may not make much sense for Fortis to be just a financial investor. Khazanah’s ace is that it has no global healthcare plans, and just seeks to make money from investments, so can play a long-term game. Khazanah’s attempt to raise its holding to 51% is related to its unhappiness that Fortis had the cheek to take control of Parkway, despite only owning a quarter of it, and disagreements over future strategy. Whatever the outcome, Parkway seeks a quick solution, as while it is business as usual at the group, a prolonged shareholder battle would be a distraction for the staff and offer ongoing uncertainty on corporate strategies.

Regulations have been laid in the Scottish Parliament that will provide certainty and transparency on patients’ rights to access healthcare in other European countries. Under European rules, patients can seek treatment in another member state, equivalent to the treatment that would have been provided in their home country. The patient also has a right to reclaim the cost of that treatment from their home healthcare system, up to the amount it would have cost if it were provided at home. Patients have the right to access healthcare in other European countries under Article 56 of the Treaty on the Functioning of the European Union. These new regulations are based on the existing law, not the recent EU draft agreement on cross-border healthcare.
Health secretary, Nicola Sturgeon, welcomed the clarification of the European rules on overseas treatment but stressed that falling waiting times in Scotland meant this was unlikely to be an attractive option for many Scottish patients, "The regulations provide clarity to NHS health commissioners about Scottish patients’ rights when seeking treatment in other European Economic Area countries and set out the procedures for obtaining prior authorisation and reclaiming the cost of that treatment. However with NHS waiting times currently at an all-time low I do not expect many Scottish patients to travel overseas for treatment that is readily available at home. Our latest figures show that almost all Scots wait no more than nine weeks for inpatient and day case treatment and these figures are continuing to come down. The NHS in Scotland provides first class care, with quality and safety at the very heart of all that it does. Lower waiting times mean that patients are now able to access the treatment they need faster than ever before and I believe this adds up to a quality healthcare package."
The National Health Service (Reimbursement of the cost of EEA Treatment) (Scotland) Regulations were laid in the Scottish Parliament in May 2010 and will come into force on August 23 2010.The regulations ensure that NHS Scotland, in common with the other UK administrations in England, Wales and Northern Ireland, is complying with EU case law and provides clarity regarding: reimbursement of cost, the circumstances in which prior authorisation is required and when prior authorisation must be granted. Patients can access state or private healthcare in other European Economic Area countries but the Scottish health system would only be obliged to pay the amount the treatment would have cost the NHS if it was carried out in Scotland. Where the actual cost of the treatment is less than it would have cost NHS Scotland, only the actual cost is reimbursed.

Dubai Healthcare City (DHCC) is under new management. DHCC parent Dubai Holding has had problems and has restructured. Tatweer, who used to manage DHCC, has been replaced by Tecom Investments.Tatweer failed to promote DHCC in the last 18 months, but Tecom seeks to be pro-active again. DHCC is a free zone in Dubai with a mandate to promote the emirate as a health care destination.
Dr Aisha Mohammad Abdullah of Tecom reports that although some clinics have closed, DHCC has seen 21 new clinics opened since 2009, taking the total number to 90. In all of the free zone, hospitals and clinics treated 220,000 patients in 2009, compared to 90,000 in 2008. Of these, 10% are not UAE nationals, but the company is not able to differentiate between the millions of expatriate workers, business and holiday travellers, diplomats and medical tourists within that 220,000 figure.
The challenge of reversing the trend from people travelling from the UAE for treatment, to the UAE in general and DHCC in particular, remains difficult. Dr Aisha comments, "The reason why people travel abroad is that they are looking for quality health care. DHCC is in a position to provide similar care. Perhaps what we have not done aggressively is to market what is available in DHCC. We have been in a developmental stage for some time, building infrastructure, both physical and soft. For us to compete in the international arena, we must have world-class facilities. We can build trust through emphasis on quality standards that meet and exceed international benchmarks. The focus on bricks and mortar in Dubai must shift to the content within.”
She said the public could take the quality of doctors at DHCC for granted as it ensures rigorous licensing with ongoing assessments to maintain best practices. DHCC also has 10 complementary and alternative medicine centres. Asked about the high costs of health care, Dr Aisha replied, "People have a misconception that quality care costs more. Our rates are comparable to any other private hospital or clinic in the UAE." This response fails to answer the criticism that the UAE is very expensive when compared to Asian countries, or even other Middle East ones. This makes it difficult to market on a cost-advantage, and the growth of hospital and clinic building, and international accreditation, in both those areas, makes it difficult for DHCC to argue it offers better quality or more modern facilities.
DHCC has 90% occupancy with two hospitals and 1,700 health care professionals. The Jumeirah Group-run hotel and hotel apartment towers will be open by late 2011.Work on the University Hospital has restarted and when completed, the teaching hospital will be the main tertiary care facility within DHCC, with 400 beds for acute and intensive care patients. The existing two hospitals are The City Hospital and American Academy of Cosmetic Surgery Hospital.
The problem that Dubai has is that other countries target residents of the UAE. South Korea, is the latest low-cost competitor to do so. In an effort to promote Korea as one of the world’s most competitive medical tourism destinations, the Korea Tourism Organisation (KTO) organised a Korea medical tourism evening in Dubai in cooperation with ALTA Travel Agency. Charm Lee of the KTO says, “A top priority for medical providers around the world has been to attract medical tourists from the Middle East for many years, but currently the trend is gradually reversing as the Middle East is seeking to attract medical tourists.” So to make Korea friendlier to Arab patients, the country has successfully introduced personalised services for Muslim patients, implementing guidelines, which include various aspects of clinical care, food services, and religious observances, and visiting arrangements. ALTA Travel agency in Dubai has developed some attractive medical packages for Gulf tourists in association with hospitals in South Korea.

Malta is preparing to launch the introductory phase of marketing the country as a medical tourism destination and discussions with all the relevant parties, including the regulatory ones, should be concluded over the coming months. Parliamentary Secretary for Tourism, Mario de Marco, said at the Malta Medical Tourism Summit that at this initial stage of the development of medical tourism to Malta, the focus should be on the services provided by private hospitals and clinics operating on the island. As it grows and evolves it will become possible to widen the scope to include other specialised health services.
The Malta Tourism Authority has defined medical tourism to exclude non-medical aspects of healthcare tourism such as wellness and spa, as these can be marketed better within mainstream leisure tourism. This also means that medical tourism needs special marketing outside leisure tourism. However, where wellness and spa treatment are part of a wider medical package, they can be marketed as medical tourism. Malta’s main strengths lie in private hospitals and clinics offering cosmetic surgery, orthopedics, ophthalmic, neurological, urological, oncology, diagnostic, bariatric and cardiac services.
Dr de Marco identified markets to target for the promotion of medical tourism to Malta. In order of priority; United Kingdom, the rest of European Union, Libya and Egypt, the Middle East, Russia and finally the USA and Canada. He emphasised that the development of medical tourism in Malta required that the health and tourism dimensions worked hand in hand for the successful development of this potentially lucrative segment, “We need to recognise that medical tourism revolves around an individual’s health and wellbeing which should remain topmost of any agenda involving the development, growth and expansion of this sector. The successful outcome of a marketing plan is very heavily dependent on the quality of the product or service being marketed. When it comes to the health of a medical tourist, there is absolutely no leeway for bad experiences to take place.”
Malta will be initially marketed as a medical tourism destination in the UK and then in the rest of Europe and North Africa. The attraction of medical tourism to Malta is that it is not seasonal, is very economically beneficial to the country and has the potential to add a new dimension to the tourist services already offered. Any surplus capacity at hospitals, clinics, health centres and hotels can be put to good use and allows for more of a return on investment, which in turn allows for the upgrading of facilities. As a hospital stay is normally followed by a period of convalescence, it necessitates accommodation and family or friends often accompany people travelling for medical reasons. Besides its central position, favourable climate, rich culture and history and good health services, Malta has a stable political climate, strong ties with neighbouring countries and many doctors who have worked or been trained in the UK.

Fifth largest Swiss health insurer, Assura, has linked up with Geneva based medical tourism agency, Novacorpus. The initial offer is cheap laser eye surgery in Turkey where it costs 1,400 francs for an operation compared to 9,500 francs in Switzerland. Elective laser eye surgery is not covered by Assura, so any treatment will not be paid for or contributed to by the insurer. Assura is simply offering the option to customers who want to save money by dealing directly with and paying Novacorpus for treatment in Turkey.
Assura has two objectives with this limited pilot. The first is to test whether customers are willing to leave the country for operations, as if they are not, any future deals are pointless. The other is to consider if in the longer term, it would be possible for patients and their insurance to offer the option of operations such as knee, hip or heart surgery in carefully selected foreign hospitals; and this may be rewarded by a lower premium in some way, possibly in the region of a 10 % saving. A good hospital in Istanbul could provide an artificial hip and including travel costs for 10,000 francs (between 10,000 and 25,000 francs less than in Switzerland).
There is a very good reason why the insurer cannot offer any insured medical tourism at present; it is illegal. According to the Health Insurance Act, customers must be treated, not just in Switzerland, but also within their canton (local government area). That restriction could be abolished within a few years; although Switzerland is not a member country of the European Union and as such not bound by EU law, it has trade and other links that would mean it would have to comply with any proposed EU freedoms of treatment. While the Swiss medical association in theory has no problem with freedom of movement for treatment, it does have the caveat that any such treatment must be of as good a standard as in Swiss hospitals, and that Swiss nationals must be treated equally with EU citizens. While it may be easy for Swiss insurers to find cheaper overseas treatment, ensuring the quality is as good as in the excellent Swiss hospitals, may not be so easy. Meanwhile, the real test will be if Assura customers are prepared to pay for laser eye treatment in Turkey, and if they are satisfied with the results. The Swiss are very demanding on medical services, accommodation and other facilities.

There is a great deal of advice on where US medical tourists should go and why they should consider overseas treatment, and many assumptions about what they want. But few attempts have been made to ask Americans what they actually think or feel about the subject. So US based global healthcare network Medical Tourism Connection decided to remedy that when it started an international patient series to address important questions that overseas hospitals and clinics frequently ask.
Although not a statistically accurate survey, Medical Tourism Connection took to the U.S. streets to ask people about their needs and wants. The company also believes that patient feedback is the very best way to establish a rewarding avenue for future referrals. Good patient references are a common goal that every facility strives to achieve; this is especially true in the medical tourism industry, past patient praise is a route to expanding your business.
The company makes what seems in hindsight, a glaringly obvious point. What American patients want and need now, in the past, and in the future may change considerably over time. Healthcare and healthcare travel are need driven and the first point of reference for Americans is what is available locally and at what cost. The availability and cost of care may vary drastically not just between New York and New Orleans, Los Angeles and Maryland, but even within those areas. Patient’s thoughts concerning the newly found information about global access to healthcare will continue to change, develop and even surprise. When it comes to answering what an American patient’s true needs are when considering services and price, there is nothing better than to simply ask the patient.
When asked what they really think about global healthcare, survey responses included:

Can it really be safe to travel for medical care overseas?
Finding a facility would be impossible; I would not even know where to start.
I had no idea that treatment was available, how can I find out if the treatment is available, are the treatments as good as I would receive in the U.S.?
I have never travelled outside of the U.S., I would not know anyone and I only speak English, I definitely would want a U.S. company to help arrange my treatment.
How and where are the doctors trained? Are they real doctors? How would I be able to know?
Where would I stay? I would feel much safer if the facility would tell me where to stay, what to do and what not to do while I am there for treatment. Do they do that?
Will someone meet me at the airport to help me make my appointments and find my way around? Would I be alone or does the facility help me through the process?
How do I pay? I would not want to send money out of the country to someone I do not know.
I know someone who has traveled for medical care, but they had travelled to the country before, can I receive treatment without visiting first? It seems like it would be difficult to set everything up.
I would never walk up to a hospital and get treatment without doing some research such as accreditation. Do people really do this?

Many “patients on the street” have never considered medical tourism as a solution to their healthcare needs. Medical Tourism Connection makes the point that however good a hospital is, if potential customers do not know you are there, you may as well be invisible.

One of the respected international hospital accreditors, Trent Accreditation System, recently had an unexpected shock. The UK government has to find savings on NHS spending; the local health trust that funded the accreditor decided to close the scheme. Their relationship with the scheme was a non-profit, non-surplus one, so in their opinion it was a venture that would never provide it with any income and so was deemed an unnecessary administrative burden. At no stage was there any suggestion of problems in the quality of what Trent’s surveyors were doing; many were NHS employees.
So when the organization that used to oversee the UK’s Trent Accreditation Scheme, or TAS, made the decision to withdraw from all hospital accreditation-related activities, the surveyors who had been very happy to donate their own precious time and duty leave to undertake surveys on behalf of TAS, thought that to let it die would be a waste. Surveying of hospitals and clinics was considered to be highly worthwhile, providing continuing professional development for those healthcare professionals from diverse professional backgrounds who were involved. It was obvious that there was a considerable pool of talent, expertise, experience and enthusiasm in existence just waiting to be drawn upon.
Although previously linked mainly to Hong Kong hospitals, recent years have shown that partnership with UK-sourced healthcare accreditation is an attractive option to hospitals and clinics around the world. So, a group of former surveyors took the decision to collaborate and to continue with accreditation work. It was out of this decision that QHA Trent has risen phoenix-like from the ashes of TAS.

Quality Healthcare Advice (QHA) is a new limited company based in the Trent region of the UK, and it is owned and managed by a group of UK doctors and healthcare executives. QHA Ltd will provide independent accreditation services under the banner of QHA Trent, and the plan is to: –

Provide services at highly competitive rates, on the fees charged and surveyors’ airfares and living expenses.
Be transparent on charging.
Ensure that QHA operating methods and health standards remain as high and as professional as is possible.
Seek to partner organisations with reputations for excellence in the field of healthcare quality and risk minimization.
Maintain an independent panel of experts drawn from a wide range of backgrounds to oversee the accreditation work of QHA Trent.
Ensure there is a strong bespoke element embedded into the co-development process for standards with partner hospitals.
Base the scheme on voluntary expert surveyors who are actively working in healthcare and relevant academia in the UK.
Offer the option to recruit and train additional surveyors drawn from the staff of QHA Trent’s partner hospitals around the world.
Offer high quality assistance at competitive rates for hospitals and clinics preparing for accreditation.

QHA Trent adheres to a developmental approach to the accreditation process, and the scheme can either survey and accredit individual hospitals or clinics with surveyors brought in entirely from outside the country, or work with a group of hospitals within a given locality to set up a locally-based system for surveying and accrediting those hospitals which makes use of surveyors recruited from the staff of those hospitals.

Wellness is sometimes represented as a passing fad or niche market, but a major study conducted by SRI International (SRI) reveals that the yearly worldwide wellness industry is poised to cross the $2 trillion mark. The report, “Spas and the Global Wellness Market,” represents one of the first analyses of the wellness industry and the consumer forces driving its growth. The study says there are 289 million active wellness consumers in the world’s top 30 industrialized nations, and that while medical tourism has been in the spotlight, wellness tourism and consumer travel to pursue holistic, preventive, or lifestyle-based services represents a market more than twice as large.
The study says that three mega-trends will ensure continued growth in wellness:

An aging world population;
Failing conventional medical systems, with consumers, healthcare providers, and governments seeking more cost-effective, prevention-focused alternatives to a Western medical/sickness model focused on solving health problems rather than preventing them;
Increased globalization, with consumers more aware of alternative health approaches at home and abroad.

Wellness is rarely defined, so the study suggests-

Multidimensional and holistic, integrating physical, mental, spiritual, and social approaches;
Complementary and proactive, not only treating illness, focused on preventing sickness and improving overall quality of life;
Consumer driven, relying on consumer choice rather than patient necessity.

Katherine Johnston of SRI says, “Governments, health professionals, and investors need to take consumer demand for wellness services very seriously, because, with the shortcomings in the global healthcare system, a shift toward wellness and prevention not only will, but must, accelerate.” The study says that the spa industry is one of the most logical sectors to take advantage of and lead the wellness industry. Susie Ellis of SpaFinder suggests “Consumers already associate spas with wellness, and increasingly modern spas are integrating fitness, complementary/alternative medicines, preventive health, advanced beauty/anti-aging, and weight loss/nutrition, as well as becoming a key player in medical and wellness tourism.”
Reinhard Petry of the European Spas Association (ESPA) says the global spa market is huge, and in Europe alone there are 180 million overnights per year at a spa or wellness center. Health tourism could be the fastest growing tourism market over the next 10 years. Petry says that while spas in Europe are very concerned with prevention and rehabilitation, together with the use of local national remedies and products, American spas are more devoted to enhancing overall wellbeing through a variety of professional services. Pointers for spa and wellness centers seeking the tourism market:

Good language skills
Good staff
Use the cuisine as a unique selling point
Include offers for the children
Have quality control by recognized enterprises

According to reader awards on tourism site TripAdvisor, the top five global spa destinations are;

Sedona, Arizona
Bath, UK
Reykjavik, Iceland
Bora Bora, French Polynesia
Ubud, Bali

And reflecting recent problems in Thailand, India, Jamaica, and Mexico, readers voted for the ten safest countries to travel to; Iceland, Norway, Switzerland, Japan, New Zealand, Singapore, Denmark, Cyprus, Luxembourg and Ireland.

The International Society for Stem Cell Research (ISSCR) has called for greater transparency and open evaluation of stem cell therapies. It is worried about stem cell clinics directly marketing to patients and using anecdotal evidence to support their medical claims. Most medical travel agencies venturing into stem cell treatments are quick to advise patients that many treatments are untested, and that not all therapies will work for all people.
Stem cell clinics are appearing all over Central Europe, South America, and Asia. Some are unlicensed, some don’t use stem cells at all, and many would have a difficult time proving that their treatments work, as the majority of stem cell use, embryonic or otherwise, is still in the clinical trial phase. Some people suffering from incurable or debilitating diseases neither can nor want to understand that it is mostly untested. The desperately ill are willing to take a chance, even a long shot to get healthy again. The longer it takes for tested and proven stem cell treatments to become available, the more questionable stem cell treatments will appear. Agents and hospitals need to keep this in mind.
The Indian Council of Medical Research (ICMR) warns that stem cell research in India is still in its infancy and cautions about claims by any doctor regarding treatment based on personal testimony. ICMR says doctors should not claim anything without exposing their findings in the peer-reviewed scientific journals. Professor Alok Srivastava comments "Such claims hurt the feelings of patients suffering from muscular dystrophy and spinal injury as they get false hope on getting a miracle cure soon."
Stem cells have excited researchers and raised hopes of patients because of their potential to relieve symptoms or treat many diseases. They have become promising areas of new advances in medicine, since they can replace the diseased cell in our body in contrast to existing practice where diseased cells are treated with drugs and antibiotics. But stem cell research raises many ethical, legal, scientific and policy issues. ICMR is setting up the National Apex Committee for Stem Cell Research and Therapy (NAC-SCRT) to regulate the scientific community on the crucial health research of stem cell therapy. It will monitor and review stem cell research, technologies, techniques and clinical practices.
In the UK, in April, the General Medical Council (GMC) ruled that Dr Robert Trossell, who operates a clinic in Rotterdam but is registered with the GMC and has consulting rooms in London, exploited a number of patients with multiple sclerosis. Dr Trossell was paid sums of between £6,000 and £11,000 by patients after he claimed exaggerated success rates for stem cell treatments based on anecdotal information and for stem cell treatments that had only been tested on animals.
Costa Rica has ordered the country’s largest stem cell clinic to stop offering treatment, saying there is no proof that it is
effective. 400 patients, mostly from the United States, have been treated at the Institute of Cellular Medicine in San Jose for multiple sclerosis, arthritis, spinal injuries and other
illnesses.The Health Ministry ordered the clinic, owned by Arizona entrepreneur Neil Riordan, to stop performing the treatment, in which stem cells extracted from the patients are reinjected into their bodies.The ministry says the clinic is not authorized to perform the treatment.
Are stem cells effectively used in human therapies today? Does the ability to reprogram adult stem cells mean we no longer need embryonic stem cell research? Is it true that the stem cells produced through genetic reprogramming may become cancerous? Embryonic stem cells are said to have so much promise, but when will they lead to cures? These questions are just some of those mostly frequently asked by a confused public searching for answers, according to doctors at the Stem Cell Program at Children’s Hospital Boston and they are among the primary reasons for launching a new website. Children’s Hospital Boston has long been a leader in stem cell research, contributing many breakthroughs to the fields. Dr. Leonard Zon says,” When it comes to stem cells, there is still a high level of misunderstanding or confusion. Our goal with this site is to be a reliable source of stem cell-related information." The new site seeks to explain the science in readily understandable terms, to correct misperceptions, and to illuminate the power and value of different types of stem cells to create potential cures for a range of diseases.

The Irish Dental Association has offered some curious and rather impractical advice to Irish residents who seek dental treatment abroad: it is recommending that they ensure that any dentist treating them abroad is registered with the Irish Dental Council. The advice also affects an increasing number of cross-border Irish patients who go over the border to Northern Ireland and vivit UK dentists where facilities and quality are as good, but prices usually much lower.
Dr Donal Blackwell of the IDA makes the sensible suggestion that before going abroad, patients should check with a local dentist to see what work is required and to get a valid price comparison. The National Consumer Agency (NCA) in Ireland has called for greater transparency of dentist charges in Ireland following publication of a new NCA survey that shows that seven out of 10 dentists do not display prices. Only 32% of dentists displayed a schedule of fees on their premises. There is significant regional variation in propensity to display price: 54% of dentists in Waterford displayed prices versus 9% in Cork. Prices charged vary considerably across different areas of the country. In addition, prices within local areas also display considerable disparity. Ann Fitzgerald of NCA says, "We need to have greater transparency in what dentists are charging consumers. Any service provider to the public should be required to display prices for routine services and there is no reason why dentists should be exempt. The professions should have a code of practice or a law should require transparent price display." Irish dentists have a major price disadvantage on dental implants as they are much more expensive in Ireland than in Northern Ireland, and very expensive compared to costs in Hungary or Poland.
A new survey by the Irish Dental Association seeks to suggest that in the past twelve months 6,000 people who travelled abroad for dental treatment have had to receive corrective treatment on their return to Ireland. According to the survey 75% of Irish dentists say they have provided treatment to patients in these circumstances. The survey was conducted by Irish market research firm Behaviour & Attitudes. A telephone survey of 120 interviews asked:

’And thinking about the past 12 months, has your practice treated any patients for problems arising as a result of dental treatment abroad?’ and
’How many patients in total would your practice have treated for such problems, in the past 12 months?’

The estimated number of patients treated for problems arising from dental treatment abroad in the past year among the survey sample was 621 and as there are 1,200 IDA dentists, the answer was multiplied by ten to get 6,210.
There are problems with telephone interviews of this type. On some questions, people unconsciously exaggerate, on others they consciously exaggerate if they think the people sponsoring the survey want a particular answer. If your doctor asks you how much you smoke or drink, few people tell the truth, they reduce the number; if you ask people what they earn, they tend to exaggerate the answer. So in the questions posed, interviewees might quite naturally, and mostly unknowingly convert two people treated in three years, to five people treated in the last 12 months. Instant recall on numbers is rarely accurate, and if any dentist were asked how many patients they had seen in the last calendar 12 months, few would guess near the reality.
There is a much bigger problem with the survey. It failed to differentiate between people who had gone overseas and those who had been treated in Northern Ireland, or to differentiate between a minor correction after new implants have been fitted, and a major dental problem. As a dental blogger says:
“It could just be that the bite was slightly wrong and the dentist just needed to adjust this or it could be that a full set of implants needed to be replaced. Without a breakdown of the severity of the problems, headline figures are meaningless. The focus should be on education of patients, helping people to identify a good dentist at home or abroad, highlighting what can go wrong with dental treatment and potential problems and why local treatment might be preferable to treatment further away. To try and scaremonger people into believing that all foreign treatment is bad and only an Irish dentist can treat you properly will push people away, when they investigate it further and find that this is just not always true, but that you have good and bad dentists everywhere.”
Local estimates are that Irish dentists treat a million people each year, and perhaps 12,000 go overseas or across the border for treatment. So if there really are 6,000 people who had a problem i.e. one in two who went abroad, every dental health site and dental tourist agency would be awash with complaints. They are not.
Some dentists treating dental tourists do a poor job, and the IDA is right to warn people that there are dentists doing too much dental work over too short a time frame, unnecessary work being done and poor materials being used. Philip Boyle of RevaHealth comments,” The IDA offers good advice to patients about informing themselves in advance about what treatment they need and about who is going to perform the treatment, advice that should apply equally to people being treated at home or abroad. “

Puerto Rican entrepreneur Michael Redondo is looking for investors from any country to invest in the first medical tourism hotel chain in Puerto Rico. The company is based in San Juan, Puerto Rico and speed of progress will depend on the availability of finance. Michael Redondo says,” We are a newly formed company in the healthcare industry. The purpose of our company is to establish a multilevel, comprehensive, integrated, continuum of care spanning different levels of intensity, which does not exist in Puerto Rico.”
The company plans• Sub-acute care: A form of post-acute care immediately after hospital treatment. It is generally thought as a transitional phase of care before the patient goes home or to a skilled nursing facility. Acute care is provided by hospitals but a contractor can provide ancillary care. The focus is on the care of the patient, including those recovering from: respiratory problems requiring ventilation, strokes, cancer, wounds, and other conditions.• Medical resort: The Gurabo project is a sustainable medical resort, which includes a clinic, a nursing school, and a care or rehabilitation center. The clinic will only focus on orthopedics and cardiology surgeries, since these are the highest billing surgeries and there are many specialized doctors available on the island.
Competition: • There are no sub-acute facilities or medical resorts in the island. Hospitals provide the services rendered at a sub-acute facility, however the hospital fee is 40% higher.
Target market:• Sub-acute- According to market studies there is a need for at least 3000 beds in the Metro Area (3 miles radius). The project proposes 183 beds, 0.07% of the available market.• Medical resort: medical tourists mostly if not exclusively from the USA.The company says 22,100 tourists a year will give it 100% occupancy.
Planned locations• Sagrado; 83 Sub acute beds; no competition, planned market share 0.07%• Civita; 100 Sub acute beds; no competition, planned market share 0.07%• Gurabo; 850 medical resort beds; no competition, planned market share 0.007%
Key proposition to potential investors;• Equity required fully warranted by land even at discounted values.• All projects eligible for Tourism Tax Credits.• All projects eligible for HUD 232 Financing- 90% Co surety.• Gurabo project eligible for agricultural, energy. Educational grants not considered in the feasibility but that can lower the costs of the projects.• Occupancy and debt service guarantee by payment of insurance companies- including Medicare.• No competition as no sub-acute centers in the island.• Cap rate is 13.5%.• 35%-40% gross profit of total billings (Tax free for 10 years),

The long political dispute between the governments of two countries over the use of the name Macedonia has not stopped thousands of Greeks from crossing the border into Macedonia in search of bargains. Dental surgeries in Bitola and other towns report a tremendous increase in visits by Greek customers. Residents of northern Greece are flocking across the border to find less expensive dental care.
According to Greek dental associations, private practices have seen as much as a 50% drop in business due to dental excursions to Bitola, Gevgelija and Strumica. The main cause is the current economic crisis in Greece. As many as 1,500 Greeks a day cross the border during weekdays, and twice that at weekends, all seeking products and services, which include dental treatment. It is not known how many just go for dental care.
Georgios Xanthopoulos, president of Florina’s dentist association says that local residents began making the 24km drive to Bitola for dental care in 2000, but with the economic crisis in Greece and problems with state-run dentistry, many more people are going elsewhere for lower prices. Many residents of the prefecture of Florina are insured by the civil servant’s health fund, but the fund has frozen dental care reimbursements at 1994 prices. Although it costs around 50 euros to fill a tooth cavity, the state-run fund only pays beneficiaries 7 euros, while in Bitolathe the same procedure costs around 15 euros. Similarly, a fitted denture costs 1,000 to 1,200 euros in Florina and Kilkis, but as little as 300 euros in Bitola. A routine root canal procedure is only reimbursed to the tune of 20 euros by the public sector health fund, whereas a Greek dentist charges a minimum of 150 euros.
Greek dentists in the Florina and Kilkis regions all agree that the number of people going to them has fallen considerably, some say by up to half, because of lower prices available elsewhere. People are heading across the border on foot, as well as in organised coach tours and by cars. Greek dentists argue that facilities are better in Greece and that Greek practitioners are more experienced. CE certification exists in Greece for equipment, something that is not required in Macedonia because dentists there are not obliged to follow EU regulations and bylaws. But with the cost of living in general dramatically lower in Bitola compared to Florina, Greeks who have seen their salary cut and their living costs increased, have little choice but to seek the lowest price.
Aleksandar Ivanovski, owner of the Estadent dental practice in Bitola, reports that Greeks account for a large and increasing proportion of his practice, due to a combination of quality of service, lower prices and the economic crisis in Greece.

Visas need to be issued faster, and infrastructure upgraded to international standards for India to tap the medical tourism market, which it stands to lose to Singapore, says Rajiv Verma of the Indian Clinical Research Institute (ICRI), "Bangladesh, Sri Lanka, Nepal, the Middle East and Africa, especially Nigeria, Ethiopia and Sudan are the biggest markets for India for medical tourism. As far as Bangladesh is concerned, which constitutes 50 per cent of the medical tourism market for India, the issue is the medical category visas. It takes 15 days to get MVisas here whereas in Singapore, you get it overnight. We are losing a number of Bangladeshi medical tourists to Singapore because of this, despite scoring high in quality and affordability. The other overriding factor is that we need to develop more good roads and more airports of international calibre. Above all, the government needs to play a pivotal role in promoting India as an attractive medical tourist destination, just like Singapore Tourism Board. 80 % of medical tourists from Bangladesh get split between Chennai and Kolkata, Bangalore gets 20 %.”
Dr. Devi Shetty of Narayana Hrudayalaya hospitals, adds that India needs to tap the Middle East and South African markets,” Visa regulations have to change. A person, when he or she is a patient, has to be treated differently. We must not only have more airports, but more direct flights and more airline operators. For India to become a top medical tourism destination, the hospitality sector needs to gear up in a big way like Thailand, which has 10,000 five-star hotels.” According to Vinay Luthra of Karnataka State Tourism Development Corporation, state governments have to realise the importance of wellness tourism and include it as part of their tourism master plan the way Karnataka has done, "The onus also lies on the national medical authority to lay down guidelines for accreditation of hospitals. The tourism department can then promote such accredited hospitals.”
The Medical Council of India (MCI) ’s main objectives are to maintain uniform standards of medical education, recommending the recognition/de-recognition of medical qualifications of medical institutions in India or abroad, maintaining a permanent registry of doctors with recognized medical qualifications and ensuring ethical practices in the medical profession. Following the arrest of president Ketan Desai and others on corruption charges, the government has formed an interim board of governors as a stopgap measure to carry out the functions of the MCI, with the intention of dismantling it. The cloud over the medical system in India has come at a time when medical tourism is picking up in India. This needs to be sorted quickly to restore credibility in Indian doctors.
A National Institute of Health & Family Welfare study ’Satisfaction Levels of International Patients in India may have only interviewed 49 medical tourists in 6 hospitals in New Delhi, but it comes up with some useful suggestions. Although satisfied with the overall level of service, there is a need for improvements in nursing care, room facilities and food. While medical care is generally excellent, in other service areas, hospitals are not meeting patient expectations of an acceptable standard of service; what may be acceptable to local patients is often seen as inadequate by international ones.

US health reform may make most health organization’s current business practices and markets irrelevant, says PricewaterhouseCoopers. PwC’s report “Health Reform: Prospering in a post-reform world” is a comprehensive analysis of health reform changes and how they will affect health organizations, including insurance companies, hospitals, physicians and other providers. Health organizations face more than 60 major regulatory deadlines over the next ten years to meet the timetable and goals of health reform, and the changes will create a profoundly different healthcare environment. Reform has opened the door for industries to work together to achieve change by thinking like a consumer, driving innovation, creating value and better understanding the needs of the new marketplace.
Kelly Barnes of PwC says,” To look at the implications of health reform only in the context of current business practices is not only futile but misses the point of the reform agenda. To prosper, health executives must reassess their businesses, find new market opportunities and sit on the same side of the table with unlikely new allies who now share common goals.”
New coverage, new fund flows and new regulators, will together create an entirely new health system that does not look like or act as it does today and will require sectors to work together on long-overdue changes to the cost, quality and outcomes of care. Much of the patchwork quilt that paid for the uninsured will largely be replaced by public or private insurance coverage. A stronger focus will be placed on paying hospitals and physicians for quality. Insurers will be highly regulated but have access to new customers through health exchanges. Individuals and businesses will face the choice of providing and paying for health coverage or paying penalties.
Hospitals • Beginning in 2015, a 300-bed hospital with poor quality metrics could be penalized by more than $1.3 million per year. Even more important, these hospitals could suffer reputation damage as these metrics are published online, which is now the most popular place for consumers to seek health information, according to earlier PwC research. • The number of Medicaid recipients will increase by more than 40%, from 2010 to 2019, so hospitals must learn to operate on Medicaid rates. Medicaid rates have never covered all costs, so hospitals will need to quickly address fixed costs.
Insurers• Many health insurers will have to lower administrative expenses to meet the new medical loss ratio (MLR) of 85% for the large group market and 80% for the small group and individual market. Currently, many individual and small market plans are not meeting the new required MLR, which governs the amount of premiums allocated to paying medical expenses.• Successful insurers will have to shift their attention from group to individual plans, which are expected to triple between 2010 and 2019. Over the next 10 years, growth in the Medicaid coverage will also increase substantially.• Health insurers will have to differentiate themselves on price, service, quality, and provider network in the insurance exchanges. With regulations requiring four standard benefit packages, essential health benefits, and limits on cost sharing, insurers will have to compete on factors other than benefit design.

People needing organ transplants should face shorter waiting times after the European Parliament approved a draft directive on quality and safety standards for human organs used for transplants. The directive covers all stages of the chain from donation to transplantation and provides for cooperation between member states. Over the past 50 years organ transplants have become an established practice worldwide. Yet the queues are long with 60,000 patients now on waiting lists in the EU, and every day 12 people on the lists die. This has sparked an upsurge in illegal organ trafficking, a practice which benefits criminal gangs and can have profoundly negative consequences, particularly for the donor. Common quality and safety standards are needed at EU level to assist the donation, transplantation and exchange of organs.
A key step is to designate the competent authority in each country responsible for quality and safety standards. These authorities will have to establish rules for all stages from donation to transplantation or disposal, based on the standards laid down in the directive. Member states can keep or introduce more stringent rules if they wish. The authorities will approve procurement organisations and transplant centres, set up reporting and management systems for serious adverse reactions, collect data on the outcome of transplants and supervise organ swaps with other member states and third countries. Traceability from donor to patient and vice-versa will be part of the system, while confidentiality and data security will be ensured.
Member states must ensure the highest possible protection of living donors. Organ donations must be voluntary and unpaid but living donors may receive compensation provided it is strictly limited to making good the expenses and loss of incomes related to the donation. Member states must ban any advertising of a need for, or availability of, human organs where the aim is financial gain. This aims to prevent anyone from within or outside the EU from advertising the availability of organ transplants anywhere within the EU.The Commission will set up a network of authorities and lay down procedures to transmit information between member states. Governments may also set up agreements with European organ exchange organisations.
Efforts to boost voluntary organ donation through public awareness campaigns have met with limited success. Some countries operate an opt in system where citizens are presumed not to be donors unless they actively choose to register. Others have an opt out system, whereby citizens are automatically registered as donors unless they explicitly choose not to be. Spain and others have boosted voluntary organ donation rates by establishing a network of transplant coordinators, who liaise with families of deceased people to discuss transplantation options. Over 80% of Europeans support the donor card but only around only 12% actually have one. There are also huge differences in donor numbers between member states. In Spain there are 34.6 donations per million people compared with 0.5 per million in Romania.
Trying to match donors and recipients separately in each member state seriously limits options, also leading to organ trafficking. Existing exchange organisations – Eurotransplant (Austria, Belgium, Netherlands, Luxembourg, Croatia, Germany, the Netherlands and Slovenia) and Scandiatransplant (Sweden, Denmark, Finland, Norway, Iceland) cover only limited numbers of EU countries. The creation of a European standard for organ transplants with harmonized quality assurance systems, improved cooperation between member states and higher number of donors through specific campaigns and administrative procedures could make a difference.
With a growing number of people resorting to organ tourism, the European Parliament is seeking tougher measures to prevent its citizens from travelling abroad to receive organ transplants with organs acquired through organ trafficking. The new measures will give every EU state an organised way of tracking donors, receivers, doctors and hospitals involved in organ transplants. This will make any kind of organ tourism targeting Europeans, very difficult, and possibly illegal. Even if someone goes outside the EU to get a transplant, unless that is approved by their home country, they will not be able to hide what they have done as they will need long-term aftercare. Evidence of how organs are obtained in China was presented to the European Parliament, so states will be on notice to carefully investigate the origins of organs. Individual states could decide to include in their national legislation, extra rules such as banning all organs from outside the EU.

Dr. Chan Kok Ewe, of the Penang Health Association, gave a speech at Glow 2010 in Kuala Lumpur recently. He made some interesting points-
One of the biggest challenges for healthcare professionals striving to expand their current business and market share is to reach out to new potential patients and customers. With faster, easier and cheaper communications, a treatment in another country does not seem so frightening to patients anymore.The medical tourism and global healthcare trend has opened many doors for owners and managers of hospitals and clinics all over the world. But how do you actually turn your healthcare facility into a global destination?Medical tourism and health tourism often get mixed up, even though there is a clear difference. Medical tourists travel to another country for medical treatment, while health tourists are more concerned with their general health and well-being.
So, what are the distinctive factors that all medical and healthcare facilities must achieve to be competitive on the global market?
Service factors• Facilities must be more comprehensive. The patient care and equipment must be better than what the international patients could find at home.• Better outcomes of treatment. The patient must be reassured that the result will be better than anticipated for the same treatment at home.• Shorter waiting times. Treatments for urgent procedures must be available very fast• Attractive comparative prices. The treatment, service and stay must be cost effective.• Comfort of cultural and language factors• Minimal personal adjustment. The hospital should adjust to the patient. The patient must not have to adjust too much as it might influence the healing process.• Offer an almost like home environment.• Easy setting for accompanying persons. The patients’ family or friends that come along for assistance and comfort should be able to stay with the patient during the visit.
Infrastructure convenience• Ease of entry, stay and exit. It should be easy for the patient to get to and from the facility, as well as the country of care.• Communication facilities to reach expectations .The means of pre and post communication with the patient must work well.• Safe and clean environment.• Simple payment. It should be easy and fast for the patient to make payments for their treatment.
Ready accessibility• Direct convenient rapid access. The patient must be able to get to the facility fast and easily.• Assistance in getting to treatment. Both airport collect and delivery, and transport to and from and within the facility each day.
Realistic targeting of potential• Current and future economic development of target markets. Carefully investigate your target market.• Keep an advantage.• Ability to cater to demands. With the raised level of quality, patients will also have greater demands that need to be met or surpassed.• Political alignment is not out.
Getting the buy-in• In-country presence .The healthcare facilities must have an agent or office in the country that they cater to.• Sharing of know-how in related areas.• Cultivation of goodwill.
Total patient satisfaction• Continual quality service upgrade.• Language proficiency. The healthcare facility must speak the patient’s language to bridge any potential gaps in communication and understanding.• Appropriate cultural responses through acquaintance. The healthcare provider must do its best to understand the patient’s culture.
According to Dr. Chan Kok Ewe, the effect of the economic downturn has hit all medical tourism markets during the last few years and growth is expected to be less than in many predictions. But this must not affect the service. Efficiency is always required, and there can be no compromise in patient safety. Instead, healthcare providers should use the time now to develop services, medical and other quality, or they will not benefit from future growth.

Barbados wants to develop its health and wellness tourism business to help overcome the country’s travel industry reliance on seasonality and the vagaries of the global economic climate. The Barbados Minister of Tourism, Richard Sealy, has said that health and wellness tourism is growing faster the general tourism and Barbados plans to develop its health and wellness market.
A recent study by the Barbados Hotel and Tourism Association (BHTA) found that Barbados needs to do more to capitalize on this profitable niche market. The government wants the private sector to lead the way, but the private sector responds that government has to lead. The BHTA study reported that as wellness tourism is not seasonal, there is year round potential for cosmetic surgery and non-invasive treatments. While many hotels on Barbados offer spa packages, there is a lack of other well-being facilities that package accommodation and treatment together to attract long-stay visitors. The BHTA report highlighted that Barbados can be a major player in fertility treatments, given the success of the Barbados Fertility Centre (BFC), which in 2005 launched an IVF package.
Senator Irene Sandiford-Garner, in a speech to a health and wellness conference saw a global potential in an aging population with increasing demands for cosmetic surgery, spas and retirement communities. The other target market she identified was among the younger population, particularly in the U.S., seeking vacations that offer spa facilities, fitness and addiction treatment. She says that the island’s established tourism infrastructure, with its capacity to support the movement of customers and provide world-class hotel services, is the platform for developing the country’s health and wellness tourism market, "Our markets offer attractive environments for the delivery of a health tourism product. Our proximity to the North American and European markets, climate and ambient environment, lower labour costs, reliable communications and transport infrastructure, first-class hotel and tourism services, an educated population, and well-trained practitioners in an established health and medical service in both public and private sectors, make Barbados a prime destination for visitors seeking health services."
A government Task Force on Health and Wellness Travel last year recommended that the government seek technical assistance to undertake a study and development plan; draft a Health and Wellness Tourism Development Incentives Act; establish a wellness council; develop new legislation to address medical tourism; and establish coordinating bodies to manage the six sectors outlined in the Health Tourism Continuum for Development in Barbados of; wellness promotion, complementary and alternative medicine, healthy food alternatives, assisted living, universal access to tourism products and services and conventional medicine.
Sandiford-Garner said that the establishment of National Health Care Quality Council is vital to ensure that health care standards are at world-class levels. The National Health Care Quality Council will be established to coordinate quality management in the health sector; provide annual reports on the quality of the sector; set benchmarks to measure performance; and establish performance standards and protocols. A wellness council has been established to act as the regulating body for wellness professionals.

The debate on how good Canada’s health care service is, whether it could be a market for inbound as well as outbound medical tourism, and the role of insurance, has become rather bitter internally; while much comment on it from the USA has been more concerned with ’proving” the speaker’s argument that it shows how good/bad etc is US healthcare reform.
So it is interesting to get an unbiased viewpoint from Europe. European health-care expert Johan Hjertqvist says that long waiting lists, a lack of patient rights and slow development of new medicines, are among the more problematic areas that make Canada’s health-care system inferior to European systems. Hjertqvist runs Health Consumer Powerhouse, a Swedish-based company that compares health-care systems from around the world, “This is a very old and sloppy system, and that should not be the case,"
Health Consumer Powerhouse and think tank Frontier Centre for Public Policy recently released a report outlining how Canada’s health-care system matches up to European systems. The 3rd annual Euro-Canada Health Consumer Index evaluates the consumer-friendliness of Canada’s healthcare system. It compares Canada to 33 European countries by assessing the extent to which each national healthcare system meets the needs of healthcare users. Overall, Canada finished 25th out of 34 countries. In Canada, wait times for diagnostic exams such as an MRI can last for months, while the typical wait time in top European countries is less than one week.
Hjertqvist said “According to the study, Canada spends over $3,500 per person on health care, one of the highest rates among the countries studied. Despite that, Canada has very long waiting lists in comparison with European systems. Canadians think it is reasonable that people should wait over one year or two years for treatment. Nowadays, you expect that you should be able to access a new mobile phone or whatever, and no one says it will take 18 months to get a new television. I think it is much more important to have a new hip than a new television, you should not have to wait 18 months for a hip replacement."
France, Belgium and the Netherlands have some of the best healthcare systems in Europe and have diagnostic and orthopedic surgery waiting lists of around a week, whereas in Canada, waiting lists can swell to years. The report highlights that having little access to health care, as in the case of waiting lists, has an enormous effect on Canadian budgets, because it is expensive to have someone not working and getting paid for sick leave. The Canadian health-care system needs more contracted private health-care providers in order to improve patient access to treatment. According to the study, Canada is behind several European health-care systems in terms of patient rights and information, and Canada needs a legislative guarantee of patients’ rights and an easier method for attempting to seek a second opinion. The development of new medicines has been a weak spot for Canada, although there has been some improvement over the past few years. One area in which Canada excels is patient outcome.
According to the report, Canada has a "Beveridge model health-care system, where a single organization handles the financing and provisions of the system. The Netherlands has the best overall health-care system in the study and uses the Bismarck model that consists of several insurance organizations that exist independently of the health-care providers in the country.”
The former president of the Canadian Medical Association (CMA), Dr. Brian Day, has always been an advocate for Canada promoting medical tourism, especially from the U.S., as a way to raise funds for the country’s financially stretched health budget. Day argues that it makes sense to seek additional sources of income and that the U.S. could be Canada’s major medical tourism source market. It could also attract patients from other regions such as the Pacific Rim. Day suggests that Canada can greatly discount treatment costs in the U.S. and offer world-class care, but it is not currently possible as the healthcare system is based on rationing and waiting lists. This prevents skilled health workers from obtaining full-time work and creates a peculiar paradox where, despite being in short supply, they are forced to leave the country. He argues that a Canadian medical tourism industry will increase training, recruitment and retention of health workers. It will create new, well-paying, long-term quality jobs and encourage investment in hospital and medical school infrastructure and new medical technology. Dr. Day says that British Columbia should be the first Canadian province to embrace the concept of international centers of excellence in Canada, and that a beneficial by-product of medical tourism will be the elimination of rationed access and waiting lists for Canadian patients.
CMA President Anne Doig says, "If we want to save medicare, we have to change it. While Canadians like to think that we have the best health care system in the world, the facts say otherwise. Transformation is needed to ease pressure that is increasing in all sectors of the health care system. 25% to 30% of people in acute care beds should not even be in hospital, as they need 24-hour supervised care, not hospital care. Either change the healthcare system or prepare for its demise.”

Turkey could see the size of its medical tourism market double if an effective promotion campaign is put in place, says Levent Ba? of Turkish medical tourism agency Gusib,“We are expecting to see an approximate 10 percent growth this year over 2009, but with effective promotion, the year-on-year growth in the sector could even exceed 30 percent. There is a huge potential as regards the future development of medical tourism in Turkey, a country that has the world’s second highest number of hospitals with Joint Commission International (JCI) accreditation. This is a clear indicator that Turkey is home to a well-developed medical treatment infrastructure and the country offers the most affordable prices possible in comparison to rivals such as India or Thailand.”
Bas continues, “There will be a remarkable boost in the number of medical tourists to Turkey if we can manage to promote ourselves as an attractive medical treatment location. The biggest drawback is the lack of effective promotion abroad. The Ministry of Tourism could take care of this; we are not asking them for incentives or financial support. The only thing we expect from the government is that they undertake the promotional aspect. Turkey deserves to become one of only a few countries in people’s minds when it comes to medical treatment abroad. It has a well-organized medical infrastructure and the advantage of geographical proximity to the large and promising markets of the EU and the Middle East. Ba? says there are four medical tourism businesses in Turkey, and while this is not enough, those who enter this business must be professionals; otherwise, the market could be adversely affected.
Gusib began in 2002 in Vienna to help people from Austria, but of Turkish origin, to benefit from lower priced high quality services in Turkey. The firm then offered the services to Austrians. Gusib now works with some of Turkey’s leading hospitals, particularly in Istanbul, bringing people over from Europe, the Balkans and Central Asia. The company is also interested in the US market, which could offer opportunities for Turkey. Gusib offers all-inclusive packages including return tickets, hotels and medical treatment.
Tourists from Europe prefer Turkey for their medical treatment because prices are low, while people from the Middle East and Central Asia primarily come for the high quality of service. Most patients come for a cosmetic, eye or dental services. There has been a particular increase in demand from Balkan countries over the past few years. The promotions offered by Turkish Airlines (THY) play an important role in attracting medical tourists to Turkey as THY offers a 25 percent discount to every patient and one person accompanying them on their visit to Turkey for medical treatment.”
Ba? is working on a new project that envisages attracting for long-stay winter care, particularly from Scandinavian countries, where the governments are looking for ways to minimize expenditure on retirees,” Norway is keen to send pensioners to Turkey as the government wants to pay less for their treatment and insurance, and we have enough capacity to host these people. We anticipate building village resorts where older tourists can receive the necessary medical treatment. This is a promising new field of investment and is also critical in diversifying services.”

In the first course of its kind, 250 staff members of the Ramada Plaza Herradura in San Jose, Costa Rica, completed a two day training programme, “Caring for the Medical Tourist”, created and delivered in Spanish by Medical Tourism Training. The hotel staff enjoyed the mix of information, demonstrations, discussions, and questions and answers, all aimed at helping them deliver better customer service to the hotel’s medical tourism guests.
Hotels and resorts are catering to medical tourists as a way to diversify and expand their client base while increasing revenues by offering services to guests before and after they receive medical treatment. The required changes to customer care vary depending on the type of medical care guests receive. The challenges and opportunities offered by serving medical tourists require careful planning and thorough preparation. Preparing staff members is a key factor to successfully serve the needs of medical tourists.
The two-session, interactive introductory programme is based on real-world scenarios. Each session is two to two and one-half hours long and covers topics including:• Introduction to medical tourism and medical tourists;• Cultural awareness and cultural norms;• Providing customer care pre-op and post-op;• Impact of staff behavior – body language, eye contact;• VIP customer care service for medical tourists;• Caring for accompanying guests;• Identifying and handling biohazardous waste;• Wheelchair assistance;• Recognizing serious emergencies;• ABCs of first aid;• What to do in an emergency;• What to do after an emergency.
Designed to ensure measurable results, the knowledge check component to the training sessions confirms that the participants are able to identify and recall the key points. A post-training evaluation ensures that the program is meeting the needs of the organization. Following the training the trainers prepare a report containing the results of the programme evaluations as well as actionable steps for senior management to improve their medical tourism services.
The training focused on the unique demands of international health travellers and is the first completed by new company Medical Tourism Training. Medical Tourism Training’s affiliated company, healthcare consultancy firm Stackpole Associates, compiles quarterly surveys of the hotel’s current and past guests, of all kinds, to evaluate their awareness of medical tourism and to plan for improved hotel services for medical tourists. The company is developing other training programmes designed to have a broader appeal to healthcare providers, agencies and others in the medical tourism field.
Medical Tourism Training’s Elizabeth Ziemba says that healthcare providers lose customers because they are not meeting the service expectations of international health travelers, “Prompt and polite communications are essential to success in this sector that is relationship driven. Every phone call or e-mail that goes unanswered or employees that react poorly to foreign customers lose business. Our programmes train staff, instilling effective, proven skills that can transform relationships with medical tourists.”
The company is also offering "Medical Tourism Guests: The Right Choice for your Hotel or Resort?” This 90-120 minute presentation is designed for senior management teams that are expanding services for medical tourists and their accompanying guests. It addresses the planning and management issues vital to creating and tailoring services for the medical tourism market:• Background information about medical tourism opportunities.• Issues and challenges associated with serving medical tourists and their accompanying guests.• Management and planning tactics including:o Changes/additions to physical environment;o Designing and delivering VIP customer care;o Staff training and preparedness;o Developing relationships with key ancillary services.

In a recent speech on patient safety, John Dalli of the European Commission, responsible for Health and Consumer Policy, said, “Access to safe and good quality healthcare is critical for patients, not only in their own country, but also across borders. The differences in access to healthcare between member states are alarming. The European Union has already made some progress towards securing equal access to safe and good quality healthcare across its borders. You will, no doubt, be aware of the European Court of Justice rulings confirming that patients have the right to be reimbursed for healthcare received in another EU Member State. Yet only a few patients are aware of this and only a few can afford to exercise this right. I hope that member states will soon give their green light to the European Commission’s proposal on patients’ rights in cross-border healthcare, which will enable patients all over Europe to access safe and good quality treatment across borders and be reimbursed for it. “
Spain’s minister for Health, Trinidad Jimenez, together with John Dalli presided over an informal meeting of EU health ministers in Madrid in April. A debate took place on the guidelines on the rights of patients to cross-border healthcare and the work of the Spanish Presidency in order to try and harmonise the different points of view of the member states to offer sufficient legal security and guarantees of quality to patients. Although not on the agenda, and as an informal meeting not subject to the usual EU rules on reporting who said what or even which countries attended, those ministers not prevented from attending by volcanic ash clouds, also discussed cross-border healthcare.
Spain has led the resistance to the directive on cross-border health care, and at the meeting it tried to broker a draft compromise to take the discussions forward, that just happens to benefit countries such as Spain whose climate attracts large numbers of EU expatriates as a permanent or winter home. Most of these expatriates are retired, with one in four adults in the EU now over 65. The deal engineered by Spain seeks to overcome the main problems that led the Council to reject the Swedish EU Presidency’s compromise, in December 2009, on the legal basis, the underwriting of costs and prior authorisation. Spanish Health Minister Trinidad Jimenez was at pains to argue, “This is just a working document, not an official text. It was not presented in detail to the ministers, but their reaction was positive and we hope to reach agreement in June.”
One of the provisions on which the 2009 discussions faltered was the definition of the member state of affiliation: who has to pay for retired people who live in a state other than their state of origin? For instance, who would pay for a retired British national who lives in Spain and receives health care in France? The Mediterranean countries, principally Spain, have concerns about situations of this type. For the Spanish, the directive has to resolve this question in detail, covering all potential cases. In the case, for example, of a Dutch national living in Spain and wishing to receive treatment in the Netherlands, the Dutch state would have to bear the costs. However, if this Dutch national decided to seek treatment in Italy, then the cost could be taken on by the country of residence, namely Spain, but under certain conditions. The costs would only be paid if the patient is not hospitalised, is not treated using sophisticated technologies, and the cost of the treatment must not be greater than equivalent treatment in his country and if the treatment is not experimental. The patient must also have received quality services. So if a citizen from one country who lives in another, wants to be treated in a third country, they would have to obtain an authorisation from his or her doctor for the transfer and only at a hospital where the quality is guaranteed by the country it is in, but even if these conditions are met, there would be a ban on the patient actually being admitted overnight, or from taking part in any experimental treatments. The idea of such restrictions is to make the person either return to his or her country of origin, or to remain in their country of residence for treatment.
This sounds more complicated than the original plan; you may be confused as to who pays for what and wonder how the average consumer would ever understand it, let alone the health bureaucracies of some EU countries. Some countries have free state healthcare, in others you pay and try to get it back from a mixture of state and private insurance, and in others health plans are compulsory but available from hundreds of private providers; so trying to work out payment from what may be three different types of systems is an administrative nightmare. But that is the Spanish plan, to comply with the principle of the directive, but in practice to make it so complicated and difficult for any consumer to get healthcare paid for by complex mixtures of state bodies and insurers, that it may effectively kill the concept. Part two of the plan is that the 27 health ministers gets so tangled up in details, and with several countries facing pressure on health expenditure due to economic problem wanting to avoid anything that adds to costs, that the proposal fails due to inaction and neglect.
Most countries are staying quiet on whether they are for or against the original directive, and /or for or against the Spanish plan. This is complicated by changes in the ruling party in some countries, even since last year. The UK’s Labour administration was firmly behind both Spain’s antagonism to the proposal and the concept of complexity making it unworkable, but the attitude of the new Conservative-LibDem coalition is as yet unknown. Portugal, Poland, Greece and Romania are known to have supported Spain last December in opposing the original proposals to legislate along the lines laid down by the court as tabled by the European Commission in 2008. Health authorities and politicians in other EU countries are known to support Spain simply because they feel that their patients should use their own domestic system, and there are reports that as many as 15 EU health ministers agree with the latest Spanish suggestion.
The main problem with the original proposal is that it attempts to reconcile vastly different healthcare systems. Britain mostly relies on its state-run National Health Service to deliver procedures, while the Netherlands relies on a network of private insurers, and in Spain their health system is administered by the regions, which have trouble dealing with each other, let alone foreign providers. In theory, the cross-border healthcare directive is on the agenda for approval in June, but in practice, the process looks like running for months, if not years, before any conclusion.

The German National Tourist Board plans to promote wellness travel in 2011 in three areas to highlight Germany’s modern and cutting-edge spas and health resorts, wellness and beauty hotels, as well as surgery medical tourism.
The German National Tourist Board estimates that German clinics and hospitals treat about 70,000 medical tourists plus 400,000 on health, wellness and spa trips. The latter number is growing faster than the former.
The 2011 campaign will focus on Germany’s luxury hotels, spas and spa-towns. The campaign will highlight the top clinics for international patients as well as the tourist attractions of nearby towns and cities. It will show that those visiting Germany for health-oriented vacations can get a range of treatments from traditional Kneipp treatments to Aryuveda therapy. Germany has a long history of wellness travel and the country promotes its thermal spas and resorts as an experience that combines a health experience with one on German culture.
The German National Tourist Office says the country has more than 350 spas and health resorts, plus 500 spa and wellness hotels offering a variety of therapies, massages and treatments. At present the office does not offer special online information to either consumers or the travel trade about health, wellness or medical tourism.
One area that the tourist office lacks is any facility for training travel agents and tour operators on the wellness travel sector, or advising customers of travel or medical tourism agencies that offer the sector. It appears content just to market destinations to consumers and travel professionals. But there is still time to rectify these campaign deficiencies.

Worldwide, many new medical tourism agencies have entered the market in recent times.. In the USA, there are many opening with the hope of cashing in on an emerging industry. As with all small business ventures, many will fail, while others will stay the course and succeed in what is a much tougher business than many imagine.
Founded in 2003, Illinois medical tourism agency MedRetreat is one of the surviving pioneers. Patrick Marsek of MedRetreat warns international hospitals that not all agencies are created equally: "The best agencies have trained staff, industry experience, and proven processes that guarantee a safe and stress-free experience for North American medical travelers. Unfortunately, some agencies may not possess the qualifications necessary to ensure a positive medical travel experience.” Marsek continues, “To ensure that the medical tourism industry continues to flourish, overseas hospitals must take great care when choosing agencies as affiliates. That is because a single patient mishap can effectively put an overseas medical provider out of the health tourism business for good. Even if a hospital has provided superior quality care, it may lose business if a medical tourist who is dissatisfied with the service provided by the agency speaks to the media about having a bad overseas experience.”
Marsek adds, “The fact that unlike hospitals there is no official accreditor in place to identify and evaluate quality standards for agencies makes it difficult for international hospitals to know which agencies offer top quality. Until such an accreditor exists, MedRetreat would like to encourage all international hospitals to take the following five steps before agreeing to an affiliation with an agency for the purpose of attracting North American patients:• Develop an affiliation approval process.• Verify that the agency is a legitimate business in good standing.• Insist that the agency visit your hospital. • Ask the agency to disclose their process.• Determine the level of service the agency provides.
Shortly after a 10-minute pitch describing a medical tourism agency that she plans to launch, Dorothy A. Owens was taking questions from a potential investor who wanted to learn more about the concept. Owens’ presentation was among 18 sales pitches that took place at the Tennessee Innovation Conference and Venture Showcase to connect venture capitalists and angel investors with entrepreneurs who need capital to make their ideas reality or to expand. Owens, a new MBA from Vanderbilt University, seeks $400,000 to launch Constellation Medical Travel, "I think the timing in the market is better, the market is starting to grow and come around, people are more familiar with medical tourism, and insurers are actively seeking a solution and looking abroad."
Jack Schafer of Atlanta based agency Global Surgery Providers (GSP) wants to train and license US travel agencies to handle patient leads, "There is a desire for retail travel agencies to get involved in this business, but those of us dealing with the assurances that the trip experience and the procedure are perfect, need local representatives who are able to work one-on-one with patients/clients as well. This is a natural fit. We need these agencies now as we need to have hands-on representatives around the country." GSP plans to start turning over all of the leads generated from 32 medical tourism related internet sites, and by 2011 they will be strictly wholesale operators, expecting upward of 100 licensed agencies around the USA. The licensing program aims to develop a distribution channel involving local agencies with exclusive territories for travel agents. GSP uses a network of 16 JCI accredited hospitals in India, Panama, Costa Rica and Mexico

Major US health insurer Aetna has followed several competitors in introducing a new health plan that allows members and their families to access health care in California or in the Mexican cities of Mexicali, Tecate and Tijuana. It does so through an agreement with Mexico’s Sistemas Medicos Nacionales (SIMNSA), a health management organization that operates similar deals for several other insurers. These are cross-border plans for Mexico and specific border states, not policies with medical tourism options outside Mexico. Unlike other countries, insurance in the US is regulated state by state, so insurers mostly offer individual state plans for individuals, even when they are major international insurers. These cross-border plans accept that many workers in Southern states are Mexican, or of Mexican descent, and that for many their main language is not English, so feel uncomfortable discussing healthcare in English. Some Mexicans live in Mexico but travel across the border to work in the USA, on a daily basis, or just returning home to their families at weekends.
Beth Andersen of Aetna says,” Aetna recognizes that it is important for our members to be able to receive health care in a language and cultural setting they understand and feel comfortable with. Vitalidad PlusSM offers employers an affordable health option that lets their employees receive care in whichever setting they prefer. People are more likely to get routine care and stay healthier when they have a primary care physician they can relate to. With access to Aetna’s provider network in California as well as the SIMNSA network in Mexico, we believe we can help members achieve their optimal health. Members will be able to participate in Aetna’s maternity management, heart health, diabetes and weight management programs, as well as other disease management and wellness programmes."
SIMNSA is a comprehensive health care service plan that was developed to provide quality healthcare for the growing U.S. workforce who prefer to receive their healthcare coverage in Mexico. SIMNSA is one of the leading Health Maintenance Organization (HMO) programs in Northern Mexico, and was the first Mexican HMO to be licensed as a health care service plan by the State of California. The network extends through the border cities of Tecate, Mexicali and Tijuana. It offers network services for treatment in Mexico on a range of its own health plans and for various US health plan providers including Cigna, Health Net and PacifiCare.
Vitalidad PlusSM California con Aetna is an HMO plan that features 100 percent coverage for qualified preventative care, including immunizations and child and adult wellness exams. Employers can select four different co-payment levels for employees. Members and their family members will select a primary care physician in California or one of the SIMNSA physicians in Mexico. Plan documents and customer service are available in both Spanish and English. In addition, members can visit Aetna’s Spanish language web site to search for participating doctors and hospitals, and obtain information on a variety of Aetna health programs and products.
Sarah Horton, assistant professor of anthropology at the University of Colorado, Denver, has published extensively on immigrant health and the U.S. health care system and is currently writing a book about cross-border health care for the University of California Press.
Research a few years ago claimed that a million people travelled from the USA to Mexico for dental and healthcare, but the figures were very old and the statistical method curious. Gabriel Senior, founder of Travel for Care, a Mexican medical tourism agency sending U.S. and Canadian patients to hospitals in Tijuana and Monterrey estimates that of the 50,000 Americans who travel to another country for medical treatment every year, about 35,000 travel to Mexico. The remaining 15,000 are to destinations in Central America and Asia. Of the 35,000 people who go to Mexico, a large proportion are Hispanic who come naturally to the country on business or visiting family. SIMNSA points out that healthcare needs differ when a border is crossed as insurance may be bought by employees and their families at home in Mexico, while at the same time protecting them from emergencies on the job in the U.S. The failure to understand that people may live in Mexico but work in the USA accounts for why earlier studies overestimated medical tourism by failing to differentiate between where people work and live.

Syrian Qatari Holding (SQH) has agreed to co-develop Syria’s first world-class medical city with a group of US-based Syrian physicians acting within the framework of the Syrian American Medical Center (SAMMC), The medical city will have a 200-bed hospital and several specialty medical centres. This agreement follows successful feasibility studies of the project and agreement on the final outlines of the future medical center. Work on site has already begun.
The medical city will be located in Damascus, in the West Mazzeh area of Syria. The site is near to the Mazzeh highway, and within easy reach of Damascus centre and rural Damascus. It will be built on a land area of 10,000 sq.m. The medical complex will include the 200-bed general hospital facility with individual medical clinics, plus other medical related trades and businesses, as well as accommodation for medical staff and visitors.
The Syrian American Specialty Hospital will include several centres of excellence on heart, pulmonary disease, gastroenterology, gynaecology / obstetrics / pediatrics unit, oncology, musculoskeletal / orthopedics, and neuropsychiatrics. There will also be general surgery and medicine supported by a radiology centre. It will have state-of-the-art equipment and will implement the latest technological advancements in patient care. It will be staffed by well-trained medical practitioners, support staff and nurses and will provide an international standard of medical treatment and care.
The hospital will benefit the Syrian population, and will encourage patients from across the Middle East to come to Syria for treatment. Hassan Mukayed of SQH explains, “Syrian doctors practicing in the USA and Europe are known to be among the best physicians in the world. It will both retain the patients who today travel out of the country for special surgical operations and procedures and encourage Syrian experts who live abroad to come back to Syria and work in a medical city that aims to become the first choice for treatment in Syria and the surrounding region.” The hospital will be the first Syrian hospital seeking JCI accreditation.
SQH will develop and manage the project through its fully owned subsidiary, Syrian-Qatari Healthcare. The total project cost is estimated to be around US$ 112 million, and the development of the entire complex will take between three and five years. Founded in 2008, and based in Damascus, SQH is equally owned by the governments of Syria and Qatar.

An online nationwide survey of 3,700 business executives conducted by Crain Communications publications, Workforce Management and Business Insurance, in April 2010 indicates most U.S. employers are unlikely to stop offering health care benefits in the wake of federal health care reform law. Previously, some medical tourism pundits have suggested that rising healthcare costs will mean many US employers will drop health insurance.
Health insurance in the US is far from perfect, but as most large and medium sized companies buy via professional insurance intermediaries, the effect on the corporate market is of interest to the insurance world.
This survey for a leading insurance magazine refutes the suggestion that US companies are contemplating dropping health insurance, or will actually do so.
In the survey, 52.5% strongly disagreed with the statement that it would be better for their organizations to stop offering health care benefits and pay a fine under the new law. Another 15.3% somewhat disagreed with the notion of dropping coverage and paying the fine.18 % might look at the idea of dropping coverage; but only 14.1% strongly believe their organizations would be better off in dropping benefits.
Under the health care reform law, beginning in 2014, employers with 50 or more full-time workers must offer health care coverage or pay a fine of $2,000 per full-time worker per year. Among the largest employers—those with 25,000 or more workers—64.9% strongly disagreed with the statement that their organizations would be better off dropping health care benefits. Another 12.4% somewhat disagreed; 14.2% somewhat agreed and 8.4% strongly agreed.
It is not as simple as a yes or no to health insurance. The health reform law includes provisions intended to boost employer-provided wellness programs and make them a more widespread way to help increase the overall health of the population. They are intended to encourage employers to offer wellness programs, provide employers with support in doing so and make it possible for them to offer employees a financial incentive to participate in programmes that promote greater health and healthier lifestyles.
The law makes federal grants available to small businesses to enable them to provide employees access to comprehensive workplace wellness programs. These programs include: health awareness initiatives, such as health education, screenings and health risk assessments; initiatives to change unhealthy behavior, such as counseling, seminars, online programs and self-help materials; and supportive environment efforts, such as workplace policies to encourage healthy lifestyles, healthy eating, increased physical activity and improved mental health.

RevaHealth.com has unveiled some interesting figures on the treatments UK, Irish, US and Canadian medical tourists consider going abroad for. The data is based on enquiries for treatment not actual travel and only covers people who have used their website. Although statistically flawed, it does provide some insight into consumer intent in April 2010 and over the last 12 months.
UK patients seeking dental treatment abroad;Patients from the UK heading abroad for their dental work are still interested primarily in the top end treatments such as veneers and dental implants, but the number one treatment enquired about in April was teeth whitening, traditionally one of the cheaper cosmetic dental treatments.
UK patients seeking treatment abroad;Looking at what treatment areas British people are looking for when travelling abroad, the top four are dentistry, cosmetic surgery, bariatric surgery and fertility.
Irish patients seeking dental treatment in Northern Ireland; Northern Ireland remains a very popular alternative for dental treatment for Irish patients, accounting for 26% of all Irish dental enquiries in April. Expensive treatments dominate the enquiries, with braces, teeth whitening and dental crowns leading the way.
Irish patients seeking dental treatment abroad; The favourite treatments are veneers, teeth whitening, dental implants and braces.
Irish patients seeking treatment abroad;Irish patients looking for treatment abroad are increasingly interested in cosmetic surgery, as well as fertility and bariatric surgery. Dentistry remains the most popular area.
USA and Canada patients seeking treatment abroad;US and Canadian patients are mainly looking for dental treatment, although this may be due to the specialties of the site rather than a general trend. Other popular areas are cosmetic surgery, fertility and urology. Mexico remains by far the most popular destination, followed by the Philippines and Costa Rica.

A year after the South Korean government began allowing local hospitals to market medical treatment to foreigners hoping to boost its medical tourism industry, progress has been slow, according to a survey conducted by the Korea Chamber of Commerce and Industry.
The chamber asked 460 local medical institutions, including general hospitals and clinics, about the level of satisfaction in the policy. 93.9 % said progress has not met their expectations. The survey suggests that the number of foreign patients in the hospitals is similar to that of the previous year. 18.6 % of hospitals said they saw a rise in foreign patients while 67.5 % said they saw no change at all. 9 % said the number of foreign patients dropped. This may seem contrary to other figures coming out of the country, but this is explained by the increasing numbers being almost entirely people seeking cosmetic surgery, rather than surgery. One out of five hospitals recruited an average of 2.2 employees to promote medical tourism. Projecting this figure to the 460 hospitals means that the costs of some 180 extra people have to be covered by additional medical tourism revenues.
Most of the surveyed hospitals want to attract more foreigners, but suggest there is a need for improvement in marketing, tourism programmes, communication in foreign languages, and level of services. Also, Korea should focus on providing specialized treatment rather than basic services and promote a high-end image to differentiate itself from other medical tourism destinations.
Korea’s medical tourism industry is still in its infancy. Considering Korea’s high medical standards and its price competitiveness, there is more room for the industry to grow. The Korea International Medical Association, a government-sponsored institution, aims to raise the number of foreign medical tourists from 60,000 in 2009 to 140,000 in 2012.
More than 60,000 foreign nationals received medical treatment in Korea last year, with their spending amounting to $50 million, says the Ministry of Health and Welfare. A total of 60,201 foreign patients including 4,576 American soldiers based in the country went to Korean hospitals for treatment, exceeding the government’s original goal of 50,000.The figure is more than double the 27,480 in 2008.The data was based on reports from 1,468 medical institutions of the total 1,547 registered to offer services to foreigners.
People from the United States (32.6 percent) and Japan (30.3 percent) accounted for the majority of foreign patients, followed by Chinese (11 percent), Russians (4.1 percent), Canadians (2.3 percent), Mongolians (2 percent) and those from the Middle East (1.4 percent). Medical services mainly used by foreign patients were health checkups and cosmetic surgery.

Medical tourism is in its infancy in Japan, but hospitals, schools, travel agencies and even the government are moving to improve services and promote growth. Their efforts have shown signs of success, with a handful of patients from the Untied States, China and elsewhere increasingly visiting Japan for surgery, checkups and other medical services.
The Cancer Institute Hospital in Tokyo treated 22 medical tourists in 2009; compared to 9 in 2008.Kameda Medical Center in Kamogawa has also seen an increase in overseas patients. The hospital treated 50 people from abroad last year and receives five or six inquiries from foreign countries daily. Last August, Kameda became the first hospital in Japan to earn accreditation from Joint Commission International (JCI). Currently, four Filipinos training to become nurses in Japan work there, and it plans to hire Chinese with Japanese nursing qualifications by the summer. It plans to devote one floor of a 13-story building to international patients.
Inter School, which trains interpreters and translators, has started year-long courses for Japanese-English medical interpreters at its five branches around Japan. About 80 students signed up. Next month, the school will begin similar courses in Chinese.
In April 2009, Nippon Travel Agency started offering tours for wealthy Chinese seeking positron emission tomography, a medical scanning technique. By late February 43 people had been on the tours, which include sightseeing. Fujita Kanko began similar tours this spring. JTB, the largest travel agency in Japan, has created a section devoted to medical tourism.
The government is supporting these efforts. In 2009, the Ministry of Economy Trade and Industry invited 24 people from overseas for health checkups to locate any problems in medical interpretation and the immigration system. The ministry plans to use the results to improve practices in medical tourism. The Japan Tourism Agency is also expected to establish a medical tourism booth at the Asia Luxury Travel Market trade show in Shanghai in June.
Numbers travelling to Japan are still very small, but exact figures are unknown as official travel bodies have previously issued figures and targets that claim to be for all medical travellers to Japan, but have subsequently been found only to be medical travel on trips where they are involved in the arrangement process, so ignoring anyone who travels independently to one of the few Japanese hospitals welcoming medical tourists. Estimates are still low, probably no more than 200 a year.

Bulgaria plans to launch a national policy for inbound dental tourism. Ventsislav Stoev of the Bulgarian Association for Health Tourism says that Bulgaria has suffered, as with no national policy for health and dental tourism, each clinic worked on its own without any coordination with others: “After some discussions with authorities in our parliament, we have a national policy to organize dental tourism all over the country, and to include more highly qualified dentists in it.”
Bulgaria has a large number of dentists and low labour costs. 7,800 dentists in Bulgaria own clinics with good equipment and laboratories. Foreign patients go to Eastern Europe where the quality of the dental treatment is similar to that in developed countries but at significantly lower prices. To begin with, people made their own arrangements, but now dentists and tour operators offer to combine dental treatment and tourism, particularly for visitors from Germany and Italy. Bulgaria has two advantages to develop its dental tourism: highly qualified dentists who speak foreign languages, and high level clinics located in tourist areas.
Twenty years ago, visitors from Scandinavia, Russia and the Middle East were regular guests in Bulgaria’s spas that specialised in treating medical conditions varying from gout to sterility. But this almost vanished as Bulgaria concentrated on becoming a cheap holiday destination. In recent years, new investment has once again begun to make Bulgaria a spa destination.
Spa tourism has attracted some $5.4 billion in investment in the past five years, according to the Bulgarian Union for Balneology and Spa Tourism. Companies from Israel, Russia, Kuwait, Qatar and Oman have already invested or shown interest.
The industry wants 10% annual growth. It is advertising at travel trade and consumer shows in Germany, the Balkans, Israel and Russia. But to compete with the Czech Republic and Hungary, Bulgaria’s biggest spa competitors in Eastern Europe, the government must start spending more on marketing and improving the run-down roads, railway and bus transport.
Sigrun Lang of the European Spas Association says Bulgaria’s rich natural resources, long-term traditions in balneotherapy and well-qualified specialists in the sector may come to nothing if the country does not market itself, " Marketing is most important because if nobody knows that you have great locations, people cannot come."
The government has allocated a tiny budget to tourism advertising, and seems unwilling to promote dental and health tourism, as it is still locked into the Soviet-era thinking that if you have good cheap offerings, customers will find you without advertising or marketing.
The spa industry has managed to change the misconception that spa resorts are beneficial only to the elderly and ill. Bulgarians account for four out of five visitors in the high-end wellness hotels.

As part of the 2010 Survey of Health Care Consumers, the Deloitte Center for Health Solutions examined the behaviors, attitudes and unmet needs of 400 adult Americans – from a variety of regions, ethnicities, age groups and other key demographics – and on a variety of issues and trends. Not surprisingly, there were significant differences in how people view the health care universe.
The survey asked respondents their views about travel outside their local area for treatment. Other Deloitte surveys have referred to travel outside the USA, but this rather loosely describes medical tourism as travelling outside your own community.
The survey results were revealing. Many of the apparent differences in consumer attitudes and approach break down along lines of income, the extent and source of insurance coverage and the age of respondents. Wealthier respondents express greater interest in medical tourism, as do those enrolled in public health plans. Younger consumers are least interested in traveling for medical treatment, however in the past 12 months, consumers aged between 17 and 28 were more likely to have travelled outside their local area for medical services, than older working age consumers. Gender plays virtually no role in whether a patient considers medical travel. Those without medical coverage are least likely to travel for medical treatment. Individuals covered by Medicare are more likely to travel outside the area for treatment. Nearly half of consumers who say they earn upper-income annual salaries are willing to travel for treatment. Preparedness to travel is not the same as actually doing so. You may be prepared to go on holiday to the Arctic Circle, but whether you actually do so depends on a whole host of factors.
The survey only asked about preparedness to travel outside of their own community. This has been loosely reported as preparedness to travel outside the USA, but that is an incorrect interpretation of the survey. The question refers to preparedness to travel outside people’s own town or city for health care. That could be within their own state. It could be to another state, it may even be to another country.
The number reported as actually travelling outside their own community is 7%, down on 8% last year. This does not, as some have wrongly reported, equate to 7% who travelled to another country or even 7% who travelled outside their own state. Compared with 49% in 2009, 41% say that they would travel outside their local area to seek medical services.
The concern for medical travel businesses is that despite health care being top of the political agenda for the last year, and medical tourism receiving increased coverage in the US media, the survey shows a fall in the numbers who did or who are prepared to travel for treatment.

The European medical travel industry has issued the “Declaration of Venice” supporting the rights of European Union citizens to travel for health care services. The declaration was one of the key outcomes of the European Medical Travel Conference 2010 in Monastier, near Venice, Italy.
Drafted by a group of medical travel experts, the Venice Declaration calls for public tourism organizations to encourage greater cooperation and synergies between the tourism and health sectors. Medical travel services should be assisted through the provision of additional health services for tourists. The declaration stresses the need for stakeholders to collaborate more effectively in integrating elements of the health and travel sectors by investing greater resources to improve quality, customer orientation and the healing competency of health services.
The Declaration of Venice also calls for improved quality of medical travel agencies and service providers, as well as greater emphasis on patient safety; follow up care in their home countries; cross-border case management executed by medical professionals; patient referral and re-referral systems to guarantee continuity of care; economic models that protect patients from fraud and corruption; and the availability of inexpensive no-fault medical malpractice coverage.
The main points of the declaration;• The right of citizens to travel to receive access to better health care services.• The need for global health systems to respond better to the needs of increasingly mobile citizens seeking the best quality, most timely, most cost-effective, and convenient medical treatment and healing capacity in Europe and throughout the world.• The need to integrate better health and tourism services by investing more resources to improve quality, customer orientation, and healing competency of health services.• The need for controllable patient safety.
Attendees at the Venice conference signed the declaration in a bid to affirm the rights of citizens of European Union states to travel and request and receive medical care and treatment. Key statements by the signees:• Recognise the need for health systems worldwide to provide improved responses to the health care needs of increasingly mobile citizens who look to obtain the best quality, most timely, most cost-effective, and most conveniently located medical treatment and healing capacity available in Europe and throughout the world.• Stress the need to encourage stakeholders to collaborate more effectively in integrating elements of the health and travel sectors together.• Agree the need for a combination of a sound infrastructure, high quality medical facilities, and a healthy environment to provide to citizens high standard destinations for medical reasons.• Want the quality of tourist attractions to be balanced by high quality medical facilities.• Recognize that the main motivating factor for citizens looking abroad for medical treatment is access to health care, value; and outcomes for healing.• Aagree that access to medical travel services should be encouraged through the provision of additional health services for tourists.• Believe that public tourism organizations should encourage greater cooperation and synergies between the tourism and health sectors.• Want equal access for tourists, whether in good or poor health.• See the need for patient safety to be made a top priority.• Agree that patients’ rights must be recognized.• Want patients to have neutral medical professional guidance for the selection of their services.• Agree that for patient safety there is a need for:- effective medical follow-up of patients on their return to the home country;- cross-border case management executed by medical professionals;- patient referral and re-referral systems that guarantee continuity of care;• Countries and regions should invest greater resources to improve the quality, customer orientation, and healing competency of hospital and tourism services.
More important than the detailed wording, is that key players in the European medical travel industry are in agreement on the way forward. This may encourage European politicians to take the medical tourism industry seriously, as they may listen to a concerted lobby; they have not listened to individual countries or organizations that they see as promoting national interests.

Currently, there’s confusion around exactly what EC health ministers have or have not agreed for the future, and when, and we have Spain, France and the UK all seeking to show how they are clamping down on “ health tourists abusing local health services for free’. So, it is no surprise that NHS hospitals and UK expatriates are unable to separate fact from political rhetoric. Spain and France are still at the “waving sticks at foreigners ’ stage. It should be emphasized that this has nothing to do with commercial medical tourism where people pay to travel to the UK, France and Spain for private treatment, but where EU citizens and others use free health services. Separating real abuse from political cant, is almost impossible as while all three nations are happy to accept the considerable amounts of money they get from millions of tourists, they seem reluctant to allow these same tourists to have treatment for illnesses and accidents they have when in their country. Particularly in off-peak times a large number of these short term and long holiday tourists are retired, so tend to have a higher number of falls and heart attacks than younger visitors. One in four of the EU adult population is now over 65.When pressed, the three countries have found it impossible to give any accurate figures for the number of people who travel to their country as deliberate medical tourists, and get free treatment or leave bills unpaid.
It is no wonder that NHS hospitals are thoroughly confused as to what treatment they can give even to their own UK nationals who live or work abroad on a full or part –time basis. The Department of Health privately admits that much will depend on who wins the UK election, as to what rules will stay, which will change, and which hospitals will be instructed to ignore or strictly enforce.
Meanwhile, the current rules on NHS treatment of UK expatriates are-• Entitlement to NHS hospital treatment is based on ordinary residence’ in the UK, not nationality, having property in the UK or the payment of UK taxes or national insurance contributions- as has often been suggested in the press.• Anyone not ordinarily resident in the UK is deemed an overseas visitor and is subject to the NHS (Charges to Overseas Visitors) Regulations 1989, as amended. These regulations place a responsibility on NHS hospitals to establish whether a person is ordinarily resident, or exempt from charges under one of a number of exemption categories, or liable for charges. • New guidance has been issued to the NHS on how best to implement the charging regulations and most hospitals have an overseas visitors manager to oversee this. It is for hospitals to decide what evidence is acceptable in each individual case.• Anyone who lives outside the UK for more than three months is no longer automatically entitled to free NHS hospital treatment. If the person is away on a one-off extended holiday, then they will continue to be fully entitled to free hospital treatment as soon as they return to live permanently in the UK. They will then be ordinarily resident again.• Members of the Armed Forces and Crown Servants, together with their dependants, retain full eligibility. • UK state pensioners who live for six months or more each year in the UK and six months or less in another EEA member state, without registering as resident in that other member state, are exempt from charges for all hospital treatment during the time they reside in the UK. Other UK state pensioners who are not considered ordinarily resident in the UK are entitled free of charge to treatment the need for which arises during visits here, but not pre-planned treatment, as long as they have lived for ten years or more in the UK in past. • UK ex-pats who have previously lived in the UK for ten years or more and who are now working overseas are exempt from charges for all hospital treatment during visits back to the UK for a period of five years.• An ex-pat who is not considered exempt from charges under the charging regulations will be charged for any treatment they receive during a visit to the UK. • An ex-pat who resumes their permanent residence in the UK is exempt from charges immediately.• The rules are enforced by trusts. Hospitals are advised in the guidance to ask baseline questions to all patients to establish if they have lived lawfully in the UK for the previous year or not, which can then be probed at interview if necessary.• *Proof of simply owning property in the UK is not sufficient evidence of entitlement. Examples of residence in the UK might include bank transaction details, utility bills in the name of the person (not the tenant) or immigration stamps. It is down to the hospital to make a judgement on what evidence is acceptable in each case.
What has confused hospitals is a proposal to extend the period of absence allowed for expatriates from three months to up to six, as politicians announced it as if it was a certain change. The proposal is currently only a consultation called Access to the NHS by Foreign Nationals, and this also covers some treatment for NHS expatriates. What happens will depend on the results of the UK election. The political nature of the proposals and why any new government could change or scrap them are that the proposals concentrate on the rights of failed asylum seekers and a proposal to refuse entry to the UK to those who have significant outstanding debts for previous NHS treatment, both of which are insignificant in real terms.
NHS hospitals are required under European law and official instructions to provide free treatment to EEA nationals. The NHS does not offer cosmetic surgery or cosmetic dentistry, and the provision of dental care is not at hospitals- so the reasons that EU nationals mainly travel across Europe are not covered either by the NHS or other country’s health systems. The “ abuse” that some EU politicians claim is costing their hospitals lots of money is for non-emergency surgery only, and none of the countries can provide anything more than a few word-of-mouth sample cases. Perhaps most telling that this is all political is a sentence in the official consultation, “ The NHS does not collect detailed data on the overseas visitors it treats or charges so the precise scale of health tourism is difficult to quantify. “

About four million people in the United States could be fined for failing to buy health insurance when the health overhaul law is fully in force in 2016, the Congressional Budget Office forecasts.
Starting in 2014, individuals must maintain minimum essential coverage or pay a penalty. The penalty will equal the greater of (1) 1 percent of modified adjusted gross income (AGI) or $95 per person in 2014, (2) 2 percent of AGI or $325 per person in 2015, and (3) 2.5 percent of AGI or $695 per person in 2016, indexed for inflation in later years. Minimum essential coverage includes cover under a qualifying or grandfathered insurance company or employer-sponsored plan, government-sponsored program such as Medicare or Medicaid or a state-based exchange. The penalty for dependents under the age of 18 will be capped at 50 percent of the adult individual’s penalty. The penalty for each family will be capped at 300 percent of the adult individual’s penalty. The maximum penalty will also be capped at an amount equal to the average national premium for exchange coverage.
There are a number of exceptions to the individual mandate, including exceptions for individuals who have income below the tax filing threshold, incur hardships, have religious objections, are not lawfully present in the United States, are incarcerated or are overseas. The new law waives insurance premiums for those with very low incomes as well as some other groups, while subsidies are provided to help poorer people buy coverage.
Most individuals must buy health insurance under the landmark legislation passed by Congress last month, or face fines that will be phased in. By 2016, those without coverage may be fined up to 2.5 percent of their income.
Of the estimated 4 million who will, some 9 percent will be under the poverty line — $11,800 in annual income for an individual and $24,000 for a family of four, said the CBO, which analyzed expected compliance rates. The U.S. population is about 309 million, according to the Census Bureau. The CBO also forecast the government would collect about $4 billion annually from related penalties between 2017 and 2019.The number predicted to pay tax penalties amount to less than 1.5 percent of the population.
To put the number of uninsured into perspective and to indicate that the deliberately uninsured are neither a real medical tourism target, nor indicate that health care reform can never work- 1.5 % pales into insignificance compared to the latest figures for the number of Americans driving without car insurance- between 15 and 20% – the figures vary by state; this suggests that whatever government does there is going to be a part of the population with a total disregard for any laws.

Thailand’s political crisis has been ongoing for almost two months. Some hospitals and medical tourism agencies are making the point that trouble is occurring in only a few places. Some are claiming that Bangkok is safe.
Many countries are now advising their citizens not to travel to Bangkok. Some are advising against all but essential travel to anywhere in Thailand. Some are advising against any travel to Thailand. Some have even flown their citizens, some of whom are medical tourists home.
How damaging the political troubles are to medical tourism is something local hospitals and clinics may not know for months or even years to come. Persuading insurers or employers that it is safe to send people to Thailand is not going to be easy.
Overseas governments are updating advice on a daily basis and at the time of writing-• The State Department alerts U.S. citizens traveling to Thailand of ongoing demonstrations in Bangkok.” Due to escalating violence in central Bangkok, all U.S. citizens should avoid nonessential travel to Bangkok. Those traveling outside of Bangkok in Thailand should be aware of the possibility of disturbances elsewhere and should exercise caution and good judgment.”• The UK’s Foreign and Commonwealth office warns there is a high threat from terrorism throughout Thailand; “ Attacks could be indiscriminate, including in places frequented by expatriates and foreign travellers. You should exercise caution at all times. We advise against all but essential travel to the whole of Thailand.”• The Australian Department of Foreign Affairs and Trade warns, " We advise you to reconsider your need to travel to Thailand due to the recent deterioration in the security environment caused by widening political unrest and civil disorder occurring in Bangkok and other parts of the country. There is a high threat of terrorist attack in Thailand. We continue to receive reports that terrorists may be planning attacks against a range of targets, including tourist areas and other places frequented by foreigners. " • Over 30 other governments have issued warnings against travel to Bangkok, some warning against all travel to Thailand.
The increasing violence has taken its toll on tourism, Thailand’s main foreign exchange earner. Tourism accounts for 6 percent of the country’s economy and has steeply declined since the protests started. Cancellations are pouring in from tourists and medical travelers. The situation is serious, and it really depends now how events will turn. The longer protests go on, the more aware will be travellers around the world about Bangkok’s situation. It will then become harder to convince them to come back. Thailand has faced many crises in the last few years and Bangkok and Thailand have always bounced back more rapidly than expected.
With concerns growing around the world, the Tourism Authority of Thailand (TAT) encourages visitors not to cancel travel plans, and merely warns travelers to be vigilant. TAT encourages passengers to travel to Thailand and has been seeking support from trade partners to discourage cancellations and encourage people to travel to Thailand, amending itineraries to avoid the city of Bangkok.
Even by the middle of April, medical tourism had begun to feel the pinch of prolonged political strife. Bangkok Dusit Medical Services (BGH), the country’s largest private hospital operator, said foreign patient visits decreased by 20% compared with the same period of 2009. Phyathai Hospital saw a 7-10% decline of international patients arriving compared with last April.
The most severe impact has been from Europe and the Middle East as some appointments were cancelled and others postponed. Some countries from the Middle East instructed their citizens not to go to Thailand or even hosted charter flights to take them back home.

From an assistance company based in Thailand – Asian Assistance (Thailand) Large scale political demonstrations have been occurring in Bangkok since March 12, 2010, and currently large parts of Bangkok’s central business district are occupied by anti-government protestors. A number of violent clashes with security forces and dozens of attacks involving explosives have occurred, resulting in deaths and injuries. The Thai government continues to deploy significant numbers of police and military forces and future violent clashes remain a real possibility. A state of emergency is in effect in Bangkok, Nonthaburi, and some areas in the provinces of Samut Prakan, Ayutthaya, Pathum Thani, and Nakhon Pathom. The situation is volatile and it is unclear for how long these protests will continue and which areas may be affected. Public transportation, including the SkyTrain (BTS), Metro (MRT), and bus routes, has been disrupted. Bangkok’s airports and train station are operating normally. The medical facilities located in the areas where the demonstrations are centered are: • Bangkok Christian hospital• Bangkok Nursing Home• St. Louis Hospital• Lerdsin hospital• Chulalongkorn hospital• The Police hospital The Chulalongkorn hospital, which is located near the epicentre of the red shirts anti-government protests, is considering moving patients for further treatment to another public hospital, The Siriraj hospital for further treatment after protesters forced their way into the hospital yesterday, Thursday, night searching for troops. From “ The New York Times”
“ A major Thai hospital evacuated hundreds of patients and suspended all but emergency surgery after anti-government protesters stormed in to hunt for security forces they suspected were taking positions there overlooking their barricaded enclave. A group of the so-called Red Shirts barged into Chulalongkorn Hospital late Thursday despite pleas from its director, then withdrew after not finding soldiers or police within the sprawling compound.
Hospital director Adisorn Patradul said all but two of the hospital’s 500 patients were either discharged or sent to other facilities Friday in the wake of the raid.’ The incident yesterday clearly showed that it was longer safe in the hospital. They could come in anywhere they want,’’ Adisorn said.”

Mexican president Felipe Calderón hopes to convince U.S. officials that retirement benefits and medical tourism to Mexico is beneficial, when he goes to Washington on an official visit on May 19.The country wants to attract millions more American retirees to live in Mexico by allowing the healthcare benefits they receive under Medicare to be used in Mexican hospitals. The argument is that for US retirees living in Mexico and those in border states, they and Medicare would save money by getting treated in Mexican hospitals.
The subject has been brought up several times in recent years, the main excuse for inaction being “ wait till after US healthcare reform. It is not known if President Obama and his officials will just listen politely and quietly ignore the proposition as too much to take on at the same time as reforms on health care, or whether they will seriously consider it as another way of reducing costs. Calderón is expected to suggest Medicare pay benefits to U.S. retirees in Mexico. Under current rules, Medicare only covers healthcare services in the United States.
Essentially, all Americans are eligible for Medicare when they turn 65. There is an initial enrollment period for seven months after their 65th birthday, when they can enroll in Medicare for free. The senior citizen must decide whether to enroll in Medicare Part A only, which offers basic Medicare coverage, or also in Part B, which offers supplemental coverage. Some seniors who are covered by their company’s group health insurance, or their spouse’s, may decline to enroll at all, or may just decide to enroll in Part A as it is cheaper. Some Medicare coverage is administered by private companies paid by the federal government to administer Medicare. Each state has a different way of dealing with Medicare. It is not a "one-plan-fits-all" system. Medicare is complicated, with many exceptions, provisions, rules, limitations, and providers, making it difficult to negotiate a deal around . This complexity is why all previous attempts to get Medicare to pay for treatment outside the US have failed.
But there are already an estimated 1 million Americans living in Mexico. And according to Mexican government estimates based on U.S. Census figures, that number is likely to soar to 5 million by 2025 as the U.S. population grows older and more Americans look for sunny, cheaper places to retire. The U.S. Census projects that the number of U.S. retirees will soar from 40 million now to nearly 90 million by 2050. Already, 5 million American retirees live abroad; 2.2 million are in Mexico, the Dominican Republic and Brazil. Another 1.5 million live in Europe and 850,000 in Asia.
Some people believe that the key to attracting more U.S. medical tourists and retirees to Mexico is getting hospitals in the region to be certified by JCI. There are already eight Mexican hospitals certified and several others awaiting certification. According to Mexican government estimates, healthcare costs in Mexico are about 70 percent lower than in the United States.
But there are two huge snags, the first being that until healthcare reform is fully completed, amending Medicare may not be workable. The second is the drug-related violence in northern Mexico and the damage that may cause to the country’s reputation as a safe destination. Mid April saw six people die in the border city of Acapulco during one of several gun battles in broad daylight on the main thoroughfare in Acapulco’s tourist district. Fears of drug violence spreading to beaches and colonial towns are affecting Mexico’s tourism and medical tourism industries. The number of international tourists flying into Acapulco fell by almost a quarter in the first three months of this year. Almost 20,000 people have died in the fight between cartels and Mexican security forces. Violence has worsened dramatically since the start of the year, with 1,000 deaths across Mexico in March. The U.S. State Department has warned against nonessential travel along the U.S.-Mexico border, especially in the violent cities of Ciudad Juarez and Tijuana.
The Mexican medical tourism sector may feel that the media is exaggerating the risk, but the killing of three people linked to the U.S. consulate in Ciudad Juarez provoked outrage from U.S. President Barack Obama and put new pressure on Mexico. Mexico’s tourism industry is still likely to grow in 2010 compared to last year, but businesses worry a perception of danger hangs over Mexico that could continue to undermine the industry. Until Mexico can control the drug gangs, Calderon’s overtures to Obama may fall on deaf ears, as the safety of its citizens at home and abroad is high on any US government’s agenda.

The Iranian health ministry has agreed to a health tourism office being set up. Tehran University of Medical Sciences (TUMS) suggested establishment of the office for health tourism, initially to promote the medical tourism potential at the university’s hospitals, and perhaps later to be extended to a wider national role. TUMS has 16 hospitals with 4000 beds.
The chancellor of the Tehran University of Medical Sciences (TUMS), Dr. Bagher Larijani suggested setting up the office for health tourism and the health minister, Dr. Vahid-dastjerdi has given TUMS the green light to do so. The chancellor justified his suggestion on the basis that health tourism not only could tap the health resources of the university, it but also can play a constructive role in the state’s health economy. He also mentioned the need for a more effective coordination among the state’s universities on medical tourism. The health minister Dr. Vahid-dastjerdi, welcoming the move, gave her approval and has asked the chancellor to take on the responsibility for establishing the office and a network between medical sciences universities throughout Iran.
Iran’s health tourism sector has a promising future, says the head of Majlis Health Commission, Shahabeddin Sadr, “Many Iranians used to go abroad for treatment, but few now do. Today, due to the knowledge of Iranian doctors, which is well known in the world, and hospital facilities, many tourists arrive in the country for inexpensive and high quality health services. In the near future, Iran’s health tourism will turn into a promising industry that Iranians will be proud of. Many medical advances have been made by Iranian researchers recently and Iran is one of the most progressive countries in the region. There is no need for foreign doctors as Iranian doctors are among the most qualified ones in the world.
Iran has suffered from political violence in recent months, selling Iran as a safe destination for medical tourists is going to be a challenge.

One take on the US healthcare reforms is that that high US health insurance premiums could prevent people buying insurance, risk the tax fine, and make them consider medical tourism. Healthcare, banking and insurance reforms contain many future measures to control what insurers can do on premium, co-pays, deductibles and acceptance. But, while reform is being implemented in the next two to four years, those with or considering health insurance have limited price protection.
Most states can prevent insurers of health plans from applying excessive insurance premium increases, but whether they take a hard or soft line depends on the political climate in the state, the stance of the insurance commissioner, and whether a state with limited finance is faced with many small local insurers, or bigger nationals who can afford the legal costs of fighting tooth and nail against any attempts at price control. Much of the problem is because, unlike almost every other country, insurance regulation and authorization in the USA is not on a national basis, but on a state-by-state basis.
Concerned that health insurance premiums may shoot up in the next few years, Senate Democrats have laid a foundation for federal regulation of rates legislation that would give the secretary of health and human services the power to review premiums and block any rate increase found to be unreasonable .The federal government could regulate rates in states where state officials did not have “sufficient authority and capability” to do so. A similar proposal was in the original healthcare bill, but was omitted from the final measure for procedural reasons.
Reviving the proposal, Senator Tom Harkin said: “Rate review authority is needed to protect consumers from insurance companies’ jacking up premiums simply because they can. Protections must be in place to ensure that companies do not take advantage of current market conditions before health reform fundamentally changes the way they do business in 2014.Currently 22 states in the individual market and 27 states in the small group market do not require a review of premiums before they go into effect. This is a gaping hole in our regulatory system, and it is unacceptable.”
Under the new health care law, starting in 2014, most Americans will be required to have insurance. Insurers will have to offer coverage to all applicants and cannot charge higher premiums because of a person’s medical condition or history, and there will be other controls affecting price and cover.
Responsibility for regulating insurers has traditionally fallen to the states, but insurance commissioners’ ability to control rate increases varies widely from state to state. Harkin says that the aim is not to put artificial caps on premiums or impose price controls, but rather consumer protection “from insurance companies’ jacking up premiums simply because they can. Protections must be in place to ensure that insurance companies do not take advantage of current market conditions before health reform fundamentally changes the way they do business in 2014.”
Should this bill become law, it may encourage those seeking US business of the need to move away from the negative marketing that concentrates on the failings of US healthcare and insurance, and towards more positive incentives and promotion of why an American medical tourist should come to their country/hospital.

The Philippines Department of Tourism (DoT) is urging British businessmen to invest in Philippine tourism, citing the many advantages offered by the country, such as increased government incentives and the opportunities arising from medical tourism. The DoT has pitched to property developers, and travel and tourism companies. Tourism Secretary, Ace Durano says, “With a long established mutual relation with the British stakeholders, we are now focusing on expansion and exploration into other forays of tourism investment which is a priority category for foreign investments in the Philippines.”
DoT expressed optimism about the prospects for foreign investment in Philippine tourism, citing the comparative advantages enjoyed by the country. The presentation highlighted Central Philippines, which accounts for more than half of tourists visiting the islands, with Cebu leading the main destinations in the area, the others being Boracay, Bohol, Camarines Sur, Camiguin, Mindoro, Palawan, Romblon, Siargao, and the provinces of Western and Eastern Visayas.
The government is committed to promote investment for tourism by relaxing investment regulations and providing incentives, investing in infrastructure development and marketing activities; and easy access to and from major international cities in the region. The Tourism Act of 2009 is a measure designed to make the Philippines more globally competitive by making tourism one of the country’s engines of investment and employment, of growth and national development, in particular the provision for tourism enterprise zones to be established in strategic areas throughout the country to attract foreign investors. The DoT highlighted Philippine medical tourism for combined health, wellness and leisure vacation packages.
The Joint Foreign Chambers (JFC) has unveiled recommendations for the government on how to increase inbound medical travel-• Eliminate taxes on foreign airlines.• Implement 24/7 operations in international airports and seaports.• Develop and implement national and destination plans.• Promotional resources should highlight international medical travel and promote transparency of medical packages.• Develop and implement national policy on wellness and medical travel.• Offer seamless travel of medical travellers by issuing longer medical tourism visas for patients and their companions and streamlining procedures.
The Philippines, while having had foreign patients for more than three decades, has only recently launched a concerted effort at medical tourism marketing. Medical tourism continues to grow, with the number of patients rising from 60,000 foreign patients in 2007 to about 100,000 foreign patients in 2008 and 2009.The DOT expects 200,000 foreign patients arriving annually by 2015.
The Medical City (TMC), one of the local pioneers of medical tourism, has assumed the management and operations of the Great Saviour International Hospital (GSIH) and the Global Medical Network (GMN) in Iloilo, and in anticipation of a full purchase of these facilities planned before year’s end. At the same time, TMC has acquired existing sister sites in Luzon, including the Mercedes Medical Center (MMC) in Pampanga and a network of outpatient clinics in Dagupan, Olongapo and Cavite.TMC is increasing its presence in Luzon and Visayas as part of a national expansion strategy, aimed at offering its distinct brand of health care to a broader patient base.

Korea is hoping to show employers and insurers that they can save money on healthcare, by flying a patient to Korea for medical treatment, rather than to pay for a comparable procedure in the United States.
One Korean health insurance provider is piloting a plan for around 350 employees of three American subsidiaries of Korean companies – Woori America Bank, Daewoo Electronics America and Daewoo International America. The Korean insurance package will send American workers to South Korea for medical treatment for serious illnesses, according to the Health Ministry and the Korea Health Industry Development (KHIDI).
Woori America Bank, a wholly owned US subsidiary of Woori Bank, Korea, is a community bank offering financial services to the ethnic Korean community. It employs around 230 people in 18 branches in New York, New Jersey, California, Pennsylvania, Virginia and Maryland. Daewoo Electronics America is an importer of electronics products made by parent Daewoo Electronics in Korea. It only has a handful of employees in Miami and New Jersey. Daewoo International America is a subsidiary of multi-faceted Daewoo International, and operates in New Jersey, Detroit, Houston and Los Angeles.
All three companies combined have some 350 employees in the USA, so the number expected to travel will be very small, if any do. But it is the concept that is being piloted; even taking in to account travel expenses to get to Korea the cost is expected to be half as much U.S. hospital treatment. The pilot hopes to test the concept, and the willingness of American workers, to travel to Korea for serious surgery. Although some of the employees are Korean or of Korean ancestry, it is believed that most of the 350 are American.
It is the first time a health insurance company has offered a package specifically designed to bring foreigners into Korea for treatment. The package covers major medical costs associated with 14 illnesses including cancer, heart disease and spinal deficiencies. The companies will pay about 30 to 40 percent less for the Korean coverage than they would pay to American insurance companies offering coverage for fewer surgeries. The insurer says that upon enrolling in the plan, workers can chose between Korean and local medical treatment; those who pick the Korean option will pay 30 to 40 percent less in monthly premiums. The Korean option covers not just medical costs, but all associated travel expenses. The package is being offered through an American health-insurance agency.
The insurance plan is seen as giving a boost to medical tourism in Korea, which is competing against other Asian nations, including Thailand, Malaysia and Singapore, in offering affordable medical care to Americans. In development is a similar health insurance plan from an American insurer that will probably offer Asians temporarily working in the United States the same option of flying to Korea for major medical care.

New dates for the Destination Health event which was due to be held in London last weekend have now been confirmed. Destination Health, is a consumer event for the growing numbers of people planning on and interested in travelling abroad for health and medical treatments. The event was originally due to be held last weekend at London’s Olympia but the organisers had no choice but to reschedule the event for the weekend of 26th and 27th June as over 90% of the exhibitors were unable to get to London as a consequence of the Europe wide flight ban. All the original exhibitors will be attending the event, which will give potential medical tourists the opportunity to meet doctors and personnel from around the world, compare treatment options and attend seminars on a wide range of subjects. Apart from featuring over 60 exhibitors from all over the world there will also be a mini trade conference featuring a wide range of speakers talking about all aspects of the business of medical tourism including marketing, sales, the law and medical tourism, the EU directive, working with facilitators and more.Event organiser, Nav Mann, of Bluewater Events remains positive that; “despite this huge upset caused by the flight ban exhibitors remain upbeat and are understanding of the situation. The interest from exhibitors and consumers in the event indicates that we expect a high turnout and hope that Destination Health will become a popular annual event for the medical tourism businesses and consumers alike”. www.destinationhealht.co.uk

What may surprise the medical tourism industry is that the British national health system, the NHS, has a new initiative that could eventually see it using spare NHS capacity to attract medical tourists. Much may depend on whether or not the initiative survives after the general election on May 6th, as whoever wins will have to implement substantial public spending cuts.
Health Secretary Andy Burnham says the NHS could generate additional funding from other countries and organisations using its knowledge. As the largest publicly funded health system in the world, the NHS is home to groundbreaking treatments, cutting edge research and a hub of innovation. It is now looking to explore new international opportunities to export its knowledge, skills and services.
There is increasing demand from Governments and organisations abroad to share knowledge, provide services, or even replicate parts of the NHS. A new organisation, NHS Global, will help NHS organisations to make the most of the global opportunities on offer. NHS Global will build on the success of NHS organisations already sharing their expertise internationally, such as the NHS Institute for Innovation and Improvement, and Moorfields Eye Hospital.
The Department of Health has begun preliminary work with NHS organisations and will launch a call across the system for further ideas to be submitted for consideration by NHS Global. It will also consult with NHS staff and stakeholders on how to ensure that NHS Global maximises benefit for patients in the UK.
Andy Burnham said,” Every year we invest over £100 billion in our NHS. The NHS uses that money to provide high quality healthcare at home, but there is great potential to benefit from the exceptional knowledge and intelligence within the NHS. NHS Global demonstrates that the NHS now has the confidence and capacity to play a greater role on the world stage. However, there is still much more that we can do and demand for NHS knowledge far outstrips supply. The NHS must make the most of these international opportunities. A key part of responding to the economic challenge that the NHS faces will be realising the full potential of innovation, not only making effective use of our knowledge and skills at home, but also making money abroad that can be reinvested back into the NHS.”
Sir David Nicholson of the NHS added,’ The NHS provides high quality health services to patients every day. International demand for knowledge, skills and services developed in the NHS is growing. What we need is a more systematic approach to supporting NHS organisations in making the most of these opportunities and bringing benefits back to the NHS and the taxpayer. NHS Global provides us with the opportunity to take a significant step forward in making this happen.”
NHS Global will be able to remove barriers, provide technical and commercial support and help the NHS to get best value for the knowledge and skills it holds in a way that does not affect frontline services at home, by acting as a central contact point for countries interested in doing business with the NHS. It will support the NHS in a range of business functions, including:• Identifying commercial opportunities in the NHS;• Generating demand in international markets;• Brokering partnerships between NHS organisations and overseas customers;• Identifying potential legal issues and risks;• Marketing and communications.
The Department of Health will consult on an operating model for NHS Global in the coming months and subject to the outcome of this consultation, expects to launch NHS Global in the summer.

The Cayman Islands Government has entered into an agreement with Indian surgeon, Dr Devi Shetty to build a major medical facility there.
Dr Shetty, Chairman of the Narayana Hrudayalaya group of hospitals in Bangalore, India, revolutionised medical care in that country by implementing business practices that resulted in high-quality, yet cost-effective care at state-of-the-art facilities. Over the next decade, he plans to recreate a similar health city and medical university that also will revolutionize tertiary health care on the islands, providing medical procedures at half the cost of US facilities.
Shetty has responded to criticisms that high local labour costs means he could not offer Indian prices on the islands, by arguing that the cost-effectiveness of his methods is from increasing the output of each doctor, which also increases their skills. The outcomes from his hospitals, therefore, are superior to many US hospitals, which also bear artificially inflated costs. The cardiac surgeon expects, as a result, to draw the majority of his patients to Cayman from the US.
The first phase of the project, expected to begin in January 2011, will be to construct a 200-bed hospital and open during 2012. As the project develops, eventually to a 2000-bed hospital, doctors will be trained in the Cayman Islands at the medical university that also will be built there. Dr Shetty argues that the Cayman Islands is a good location with its political stability and proximity to the US. It also is a pleasant place to live, which will make it easier to attract highly qualified surgeons, he hopes.
Concessions made by the Cayman government to attract the hospital include waivers of certain work permit fees and duties imposed on the medical equipment, but not on the construction of the hospital. Dr Shetty and his partner investors, including local business partner Gene Thompson, have personally inspected several potential sites, but the final location of the proposed facility has not yet been decided. Although the government hopes to smooth the path, it has not promised to automatically give planning permission to any site chosen for Cayman’s biggest ever development. While the venture is a completely private partnership, it still requires government approval.
Narayana Hrudayalaya heart-hospital in Bangalore performs 32 open heart surgeries a day, almost eight times the average at other Indian hospitals, and the highest in the world. It is the centre of the rapidly developing Narayana Health City in Bangalore. This campus will consist of eight other hospitals and research institutes, ranging from a 1000-bed cancer hospital to a 500-bed eye hospital to institutes for neuroscience and thrombosis. Other health cities in India are in the planning stage.
Premier McKeeva Bush wants the hospital, as it would be a significant boost to the local economy that has suffered from a drop in the two key economic activities of tourism and offshore financial services. Not everyone on the islands is sold on the huge new medical tourism project. Some doubt that costs can be kept low enough in a high-wage economy to attract enough Americans. Others are concerned that Shetty’s high-throughput conveyor belt business model that was developed for poor Indians, will not work on medical tourists who want a high standard of care and personal doctor time.

Overseas tour operators have urged the Indian authorities to provide long-duration multiple-entry ayurveda visas for tourists who seek wellness and curative packages, requiring longer stays.
Gerard Bogrand of France-based Ayurvedic Voyages, argues that the current form of single-entry two-month tourist visas actively discourage medical tourists seeking traditional medicine, and would instead go to other destinations in Asia, “ In view of the increasing clientele for ayurveda and the country’s efforts to put the traditional system on the international circuit, the federal government should remove all hassles and proactively introduce long-duration multiple entry visas.” Other foreign tour operators back the demand, saying this would lead to a quantum jump in the arrival of medical tourists.
The federal government is pursuing an international cooperation scheme to propagate the country’s traditional systems of medicine, including yoga, siddha and unani-but on the question of visas, is not prepared to promise any help.
In Bangalore, the state government is planning to develop the hub near the Bengaluru International Airport (BIA) in Devanahalli, as part of its initiative to make the city one of the preferred destinations for medical tourism in the world. The Karnataka State Tourism Development Corporation (KSTDC) will develop the hub, as per its 10-year tourism master plan, in coordination with city-based private hospitals, and syurvedic and naturopathy centres. The government is acquiring 12,000 acres of land to develop the area near the airport, and the medical hub will occupy 300 acres of this land. Private hospitals, diagnostic centres, ayurvedic resorts and centres offering alternative systems of medicine including naturopathy and yoga will all be included. Ayurvedic resorts would be set up to attract tourists heading for Kerala for naturopathy and ayurvedic treatment. Many private hospitals are already involved in projects in the area. Some plan new hospitals for three years time, but progress will depend on how fast the hub and transport links are developed.
Karnataka State Tourism Development Corporation was set up by the government of Karnataka state in India to promote tourism within the state. The aim of KSTDC is to provide infrastructure, transport and other facilities to tourists visiting Karnataka. Part of mission is also to promote unknown tourist spots in Karnataka. The KSTDC owns hotels, guesthouses and a taxi fleet, and is the largest tour operator in the state.

With the recent changes to the way that Irish patients can claim money back on dental treatment, the cost of treatment for many is rising. Government budget cuts at the end of last year effectively removed access to subsidised and free dental treatment
Philip Boyle from RevaHealth looks at what treatments Irish patients have been enquiring about over the last year. Statistics about the different types of treatment that Irish dental patients are interested in, are based on where they are having the treatment performed.
Irish people having dental care in the Republic of Ireland -• Braces and orthodontics top the list, with new treatments like Invisalign helping to increase their share of the market. Optional cosmetic treatments including teeth whitening and veneers are still prominent despite the downturn. It will be interesting to see if they remain so prominent over the coming year.
Patients from the Republic who consider dental treatment in Northern Ireland-• An even greater proportion of patients looking for treatment in Northern Ireland are interested in braces, not surprising given that it is one of the more expensive treatments available – starting prices for treatment in Dublin are close to €4000.• Root canal treatment also accounts for a far greater share of the market in Northern Ireland than with Irish dentists. It is a necessary precursor to many other treatments, but can be quite costly, especially as it is done as needed per tooth.
Patients from the Republic who consider dental treatment abroad-• *Dental implants jump to the top of the list. Price is their primary concern, and with implants starting around €1500 at home and around €600 in Hungary it is no wonder that they are asking about treatment abroad. Surprisingly the relatively inexpensive teeth whitening is also very popular, as is the other cosmetic favourite, dental veneers. Even more surprising though is that braces abroad are so popular. With regular visits needed to tighten and adjust most braces, travelling abroad each time can prove to be very expensive.
A recent study showed that operating costs for Irish dentists are much higher than their equivalents in Northern Ireland. The Irish Dental Association says that dentists have frozen or reduced their professional fees in recent months, but cannot absorb all the costs of the reduced payment from the government. Fintan Hourihan of the IDA said, “ It is a disgrace that people are being made pay the same level of social insurance from their wages but are receiving less in benefits. If a regular insurance company tried it, they would be run out of town but the Government has got away with yet another stealth tax, which is set to cause serious damage to the dental health of the nation. Dentists are trying to keep costs as low as possible but inevitably some of the costs previously borne by government will end up being borne by patients.”
Ireland was one of the first EU countries to take tough economic action with wage and health benefit cuts. Greece needs to dramatically cut government spending and the Spanish government, having already cut government spending and raised taxes, has promised even more austerity. Health spending by government is not immune to these cuts, and people will be forced to rely on their own resources when they have less to spend. European health tourism may benefit in the long term, but in the short term people are less likely to spend on health at home or abroad.

Recognizing that medical tourism is here to stay, the American Society of Anesthesiologists (ASA) has produced consumer guidance. It urges American patients to ask the right questions when considering traveling internationally for surgery
Dr.Amrik Singh at the University of California Davis Health System advises, “Patients who have decided to go abroad must be vigilant in considering all the variables of their medical care abroad. They must carefully consider their preoperative and postoperative treatment. They must be comfortable with the physicians and facility administering the procedure, as well as feel secure in the urgent hospital care available if complications occur. Patients must ask tough questions, check accreditations and success rates and work closely with their health care provider at home.”
Professor Joseph Antognini of the University of California Davis Health System adds, “Patients should know and research the potential risks of traveling abroad for medical treatment. These risks include exposure to infectious diseases prevalent in the host country, possible substandard quality of care at certain facilities and travel-related health complications.”
The ASA offers the following checklist –
• Have I involved my local doctor in my decision-making?
o You should work with your local medical provider when preparing for the procedure, as he/she will likely play an important role in both your preoperative and postoperative care.
• Are the physicians who will be performing the procedure licensed specifically for the procedure, and is the hospital accredited by a reputable organization?
o Find out what professional memberships, training and qualifications the physicians Choosing an accredited facility ensures the hospital proved it met certain standards of care intended to keep patients safe. You should also research mortality rates, infection rates and other performance measurements.
• What is the pain culture of the country?
o Different cultures have different views on what are acceptable and unacceptable levels of pain. Find out specifically whether the anesthesiologists will take into account your wishes, providing it is safe to do so. Make sure the anesthesiologist will provide pain evaluations before and after surgery.
• Is the facility performing my procedure at the same facility that would care for me if I needed extended care as a result of complications?
o If not, where would I stay, and what is my comfort level with that facility? Understand the potential complications associated with the procedure, and be prepared for an unexpected hospital stay.
• What access will I have to preoperative and postoperative medications with the physician performing the procedure? Are the medications safe?
o Have a list of existing medications you are taking and find out which ones you will be given before, during and after the procedure. It is also important to find out what the procedures are in order to gain access to those medications you will need before and after the procedure, as well as where they are made.
• Have I considered working with a medical tourism company?
o Medical tourism service providers can guide you through the process by doing everything from transferring your medical records to coordinating your travel logistics. It is critical that you research them carefully because, as is the case with hospitals, they can vary in quality of service.
• Have I spoken with patients who have had similar surgeries conducted at the hospital chosen for my procedure?
o Ask to talk to other patients who have had similar surgeries conducted at that hospital. In addition to asking if the surgery was a success, ask about the care received before and after surgery, and what experiences they had accessing medications.
• Who will be traveling with me for this procedure?
o A companion can play a significant role in the overall outcome and experience associated with having a medical procedure abroad. If possible, identify a family member or friend who can accompany you. In addition to ensuring that you are receiving the best care possible, they can also play a motivational role, which can make the experience more comfortable and decrease recovery times.
Founded in 1905, the American Society of Anesthesiologists is an educational, research and scientific association with 44,000 members organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.

Following on last year’s survey of American health customers, the Deloitte 2010 Survey of Global Health Care Consumers from the Deloitte Center for Health Solutions looks at similarities and differences in health care behaviors, attitudes and unmet needs among consumers in the United States, Canada, France, Germany, Switzerland and the United Kingdom. The US report is the one from last year. There is one new global report and five new reports, one for each of the other countries. Paul Keckley of the Center for Health Solutions comments, “We found that consumers across Europe, in Canada and United States shared common ground in assessing their health care. Many don’t really understand how their systems of care work.” Deloitte researchers contacted 1,000 consumers each in Germany, Switzerland, France and the United Kingdom, and 2,300 people in Canada. In the global report, one conclusion is that proximity and reputation are the most important factors in choosing hospitals. The Switzerland report is not yet available.
The Canada report says-• 2% have traveled outside Canada for health care in the last two years.• 23% would travel outside Canada for any treatment if they had to pay 100% of expenses.• 17% would travel outside Canada for elective treatment if they had to pay 100% of expenses.• 23% would travel outside Canada for necessary treatment if they had to pay 100% of expenses.
The German report says-• 1% have traveled outside Germany for health care in the last two years.• 10% would travel outside Germany to have a necessary medical or surgical procedure if the health insurance provider paid the cost of standard treatment.• 3% would travel outside Germany for necessary treatment if they had to pay 100% of out of pocket expenses.• 89% are fully insured with a health fund and 14% have private health insurance.
The France report says-• 2 % have traveled outside France to consult a physician, take a test or receive treatment in the last two years.• 17% would travel outside France for treatment if the public health insurance provider paid the cost.• There is no figure for the % if private health insurance paid for treatment.• 10% would travel outside France for necessary treatment if they had to pay 100% of out of pocket expenses.• 86% have top-up private health insurance as well as public health insurance.
The UK report says- • 3 % have traveled outside the UK for healthcare in the last two years.• 24% would travel outside the UK for treatment if the NHS paid the cost.• There is no figure for the percentage if private health insurance paid for treatment.• There is no figure for the percentage that would travel outside the UK for necessary treatment if they had to pay 100% of out of pocket expenses.• 35% have private health insurance as well as public health insurance. (This figure does cast some doubt on the accuracy of the sample. The true figure is around 13%.)
For European countries, the main reason that people travel from the UK, France and Germany is for dental treatment. Most of those who travel for dental treatment are happy to repeat the experience. So when 1, 2 or 3 % travel abroad in the last two years, repeat travel means that it is likely to be less than 1, 2 or 3 % a year.
Using the same questions and categories for the UK as for France and Germany causes problems, as the NHS in the UK is a public healthcare system; it is not state insurance as in other EU countries. The British do not have to pay for care and seek refunds, as the NHS is free to use. In their global report, Deloitte correctly say that only about one in ten Brits has private health insurance, so suggesting in the UK report that one in three have private insurance seems to have escaped the eagle eye of the report writers. Much more misleading is the suggestion that one in four Brits would want the NHS to pay for care outside the UK. For the British public, they have more chance of winning a major prize on the national lottery, than getting the NHS to pay for treatment overseas! There is a double missed opportunity of not asking those with private health insurance if they would go overseas if the health insurer paid or asking how many people would go overseas if they paid 100% of the costs themselves. Minor quibbles aside, the reports show that there are major differences between Europe and the Americas on medical tourism. It suggests that Europeans may consider medical tourism if someone else pays for it, but their keenness drops dramatically if they have to pay all or some of the costs.

The planned medical tourism exhibition at London’s Olympia on 17th and 18th April has been postponed following an historic event.
For the first time ever, European air traffic has been badly disrupted by volcanic ash spreading from Iceland. It is moving east and airspace over Belgium, Germany and Scandinavia have been closed. Airports in Denmark, Norway, Sweden, Finland, Belgium, France, Switzerland, Ireland, Russia and the Netherlands have all been closed.
UK airports have been brought to an almost complete standstill in the biggest shutdown in history. The grounding of nearly all non-emergency flights – which began on Thursday morning – will stay in place until at least 1300 on Saturday, with further delays probable.
The air traffic control body National Air Traffic Service (NATS) imposed the restriction because of the danger the ash poses to aircraft Planes cannot fly through it because it contains tiny particles of rock and glass that can wreck jet engines, choke ventilation systems and sandblast windscreens. Ash can cripple jet engines and does not show up on radar. Flying into an ash cloud can stop all four jet engines instantly.
Exhibition organizers say,“ Destination Health has been postponed due to the closure of UK airports. As 90% of the exhibitors are coming from overseas, we are unable hold the exhibition without their participation. New dates for the exhibition will be announced shortly and all tickets issued will be valid for those dates. We apologise for any inconvenience caused. Tens of thousands of passengers have been stranded in one of the most disruptive events to hit air travel in years.”
Eruption of the volcano beneath Iceland’s Eyjafjallajokull glacier has resulted in six-mile high clouds of toxic ash rolling toward Northern Europe.

The Health & Medical Tourism Business Conference

Olympia, London Saturday 17th April 2010

Book your free place now for the Destination Health business conference at London’s Olympia this Saturday. The event is a forum for medical tourism professionals to attend seminars, meet, network and hear some of the industry’s leading business experts talk about the opportunities in today’s rapidly growing international medical tourism market.
Entrance to the conference is free and seminars will be held on a wide range of subjects including, the future of medical tourism, marketing, the EU Directive on Cross Border Healthcare, Legal issues in medical tourism, how to promote your business online and working with medical tourism facilitators. To book your free place go to www.destinationhealth.co.uk.
Speakers at the conference will include:

Rob Dickman: Senior Policy Manager Department of Health who will discuss the impact of the ratification on the EU Directive and how it may affect medical tourism.

Keith Pollard: Managing Director of Intuition Communication will talk about the future of medical tourism. Intuition Communication publishes a number of leading health information portals which include; Treatment Abroad, Private Healthcare UK, Harley Street Guide and the International Medical Travel Journal. Keith will talk about the future of medical tourism.

Philip Archbold: Sales Director, Treatment Abroad will talk about how to effective market your medical tourism company.

Zahid Hamid: Chief Executive Euromedical Tours, talking about working with medical tourism facilitators.

Laurence Vick: Head of Clinical Negligence Team, Michelmores Solicitors LLP will discuss medical tourism and legal issues.

Alison Hope: MD of Visit Poland Ltd will discuss how to raise your clinic’s profile in the UK.
Destination Health, www.destinationhealth.co.uk, the medical tourism show running alongside Destination London has attracted more than 60 healthcare providers from overseas who are targeting UK patients and patients from London’s traditional markets such as the Middle East.
Confirm your place at www.destinationhealth.co.uk

Medical Tourism Training Inc, a Massachusetts based company, delivered its specially created two session training program, “Caring for the Medical Tourist: Training for Hotel and Resort Employees” to more than 250 staff at the Ramada Plaza Herradura, San Jose, Costa Rica. The customer service oriented program addresses the unique demands of international health travelers who are at the crossroads of hospitality and hospitals.
“To be a leader in the medical tourism sector, our employees must be ready to deliver top quality customer service that meets the needs of our guests receiving dental and medical care in Costa Rica”, according to Gustavo Araya, President of the hotel. “This training program sensitized our staff to the physical appearances and many of the specific requirements of our medical tourism guests. Our trained staff gives our hotel the competitive edge over other hotels and resorts vying for business in this increasingly dynamic sector”.
Medical Tourism Training offers a series of customer service training programs that address the various issues that are crucial to achieving success in the medical tourism sector. “Our research shows that health care providers are losing customers every day because the customer service expectations of international health travelers are not being met. Prompt and polite communications are essential to success in this sector that is relationship driven”, says company President, Elizabeth Ziemba. “Every phone call or email that goes unanswered or employees that react poorly to foreign customers lose business. Our programs train staff, instilling effective, proven skills that can transform relationships with medical tourists”.
Created specifically to address the obstacles and opportunities faced by medical tourism businesses and organizations, Medical Tourism Training’s team of experts from the health, travel, hospitality, training and business sectors understand what is needed to succeed in this nascent industry. The company is dedicated to tackling the unique needs of medical tourism organizations by providing specialized programs based on best practices and real-life situations.

Health tourism has been a strong selling point for Thailand, focusing not only on Bangkok but also other areas with a high concentration of foreign tourists, such as Pattaya, Hua Hin, Chiang Mai, Samui and Phuket.
Zadok Lempert of Medico Management & Travel Services International says, “The good exchange rates between the Thai baht and the US dollar or euro make medical treatment an outstanding value-for-money service for foreign patients. For example, average treatment costs in Singapore are 5-20% higher than in Thailand. Cheaper medical costs mean family members and friends will have more money to accompany the patient. They can find accommodation near the hospital."
However, Dr Lempert argues that Thai medical tourism lacks good marketing and promotion as co-operation between hospitals and travel agents is limited,” Travel agents view the 3-6% commission rates offered by hospitals as too low while hospitals are confident that they already have their own markets and need not depend much on medical tourism agents. Only six to eight hospitals in Thailand are serious about medical tourism but the number should increase in the future. Language skills of hospital staff are another obstacle.”
Some in Thailand forecast that 1.4 million medical tourists will visit Thailand for treatment this year, up from 1.2 million in 2009. Popular treatments are hip and knee operations, cosmetic surgery and dental services. Other local figures suggest the number of foreign patients in Thai hospitals has grown from 500,000 in 2001 to 1.4 million in 2006. Some websites promoting Thailand argue that it had 750,000 American medical tourists in 2009 and Thailand will have 6 million medical tourists in 2010.There are significant doubts surrounding these claims by those who argue that hospitals counting visits rather than actual patients, and other distorting factors, artificially inflate the figures. Either way, these are not official figures, just widely used estimates.
Many countries have two separate figures, one for medical tourism, and one for health and wellness tourism. Including the latter is a nightmare for statisticians: do you count a tourist who goes to a spa-hotel as a medical tourist or a holidaymaker? Thailand has 743 spas, half of which are hotel/destination spas.
The health tourism figures include those going to:• Hospitals – conventional medicine, invasive treatments, state-of-the-art technology• Wellness and Spa – complementary medicine, traditional natural preventive medicine, organic additives addressing the mind, body and soul• Destination spas – body and mind treatment backed with medical knowledge and hydrotherapy tubs, wet-rooms, steam baths, sauna, therapeutic message, etc.
The Tourism Authority of Thailand says that Thailand attracts 14 million visitors a year. The majority are leisure and business travellers. The current country distribution of visitors coming to Thailand with the primary motive of healthcare, according to the Tourism Authority is:• U.A.E – 43.6%• Qatar – 8.9%• Oman – 6.0%• Japan – 5.3%• Myanmar – 5.0%• Bangladesh – 3.6%• U.S.A – 2.5%• U.K – 2.5%• Germany 1.2%• France 1.1%• Australia – 1.0%• Canada – 0.8%• Others 18.5%
Thai tourism bodies have recently been heavily promoting the potential in the Middle East, and their own figures suggest Americans and Europeans are increasingly nervous of the continuing political unrest and violence. The latest recommendation from the UK’s Foreign and Commonwealth Office is: “We currently advise against all travel to some specific areas of Thailand and all but essential travel to other specific areas of Thailand. The situation in Thailand remains volatile. British Nationals should exercise extreme caution throughout the country.”
The Thai Government invoked the Internal Security Act and implemented additional security measures, but the situation worsened. Thailand declared a state of emergency in the capital, Bangkok, after protesters stormed the grounds of parliament, forcing government ministers to flee by helicopter. Agencies sending patients to Thailand need to check what is happening daily.

American citizens living full time outside the USA will not be required to purchase health insurance. While health care reform will affect many expatriates, the mandate to obtain insurance coverage, and the penalties imposed upon people who do not insure– will apply primarily to US citizens who live within the 50 states. The law adds a new provision to the tax code, which mandates that every US citizen obtain minimum essential coverage, or be fined. The complex legislation has some specific exclusions.
In the new Section 5000A (f)(4) of the Internal Revenue Code, expatriates shall be treated as having minimum essential coverage. So if you are an American expat, it doesn’t matter whether you actually have health insurance or not. The law says you do.
But of course, life is never that simple. Only full-time expatriates are excluded. To avoid the insurance coverage mandate, an expat must qualify for the IRS’ foreign earned income exclusion that says that expats do not have to pay federal income taxes on up to a set amount of overseas income. The IRS has tight rules for who qualifies: an expatriate must establish a tax home in the new country and must either be a bona fide resident of the adopted country for an entire tax year or spend a minimum of 330 days per 12-month period outside of the United States. The actual tax limit will vary in every tax year and the limit is most likely to go up, but could come down. This year’s limit is around $91000, so as it stands any American employee earning more than that overseas could be required to buy US health care. If the person runs a business, it gets much more complex and there could be various tax and insurance requirements on the business. What is of particular uncertainty is that as the plan to tax companies offering high value health insurance plans has already been amended since the original healthcare reform bill, lawyers and tax specialists are unclear as to whether it does or does not apply to employees and subsidiaries overseas.
As some of the new rules do not apply until 2014 and some until 2015, companies employing American expatriates have time to take legal and tax advice. It is a foolish company that does not have extensive international health insurance that will include many types of treatment including preventative, dental and check up care. But unless an agreement can be made on ensuring that any long spells of medical treatment and recuperation back home in the USA, will not count as days spent in the county for tax purposes, than employers and insurers will have to devise alternatives to repatriating injured, sick or recuperating American expats back home to the USA.
For residents of the United States’ Asian territories -in order to avoid the health insurance requirements, residents of Guam, American Samoa and the Northern Mariana Islands (as well as Puerto Rico and the US Virgin Islands) need reside in those territories for only 183 days per tax year while having no other tax home.

The largest German health insurance fund Techniker Krankenkasse (TK) is a pioneer in enabling its members to seek treatment abroad. A 2008 survey found that around 1% of its members had care abroad in 2007, of which 7% went for scheduled healthcare, rather than for acute and emergency care while travelling. The insurer multiplied its sample to suggest that 272,000 booked ahead for care. This figure excludes spa visits and dental care not claimed back from insurers. A survey of those who had treatment abroad in 2009 suggests that 40% planned to do so, and of these 90% went for dentistry or spa treatment. For as spas and dentistry, the German customer has to pay a high proportion of the cost out of pocket. For those getting dental treatment abroad, the insurer pays out the same amount, so the balance paid by the customer when the cost is lower, is much less. As the overall cost of treatment is much lower, their own share of the costs will be much lower. Grossing up a small survey is statistically hazardous, so the insurer merely suggests that 1% of the TK’s 7.2m customers, or 72,000, had treatment abroad, but only 30,000 went for planned treatment. Multiplying this to the total population is dangerous, as TK tends to insure technicians who are generally wealthier, but with a population of 82million, a third of a million Germans had planned treatment abroad.
Before hospitals and agencies rush to seek deals with TK and other German health funds, or their customers, it is worth pointing out that no insurer shows any inclination of allowing treatment outside the EU, and the customer can only get treatment within the EU in a facility within TK’s network.
TK and the customer also share the costs of treatment at an accredited health spa, including room and board as well as travel to and from the health spa. TK members can choose a health resort outside Germany, but only one in TK’s network of 26 partners in Italy, Austria, Poland, Czech Republic, Slovakia and Hungary that TK pay on a direct basis. All facilities are inspected on site by TK for their compliance with quality standards.
The health insurance reform of 2007 requires everyone living in Germany to be insured for at least hospital and outpatient medical treatment. 85% of the 70 million population are mandatory or voluntary members of one of the statutory health insurance schemes while the others have private health insurance. And since 2009, everyone in every health fund gets charged the same premium.
TK also pays for certain costs of benefits when received in an EEA country, but only if the treatment would have been paid for in Germany e.g. no cosmetic surgery or cosmetic dentistry. And for planned treatment abroad, to get reimbursement after treatment and after they have paid the hospital/clinic themselves; the customer has to supply detailed bills/medical prescriptions. TK reimburses those costs that would have resulted from that treatment in Germany, limited to the amount of the bill, minus the additional contribution/co-payments stipulated by German law, and with other deductions. TK does not pay for travel or accommodation costs for non-emergency treatment.
TK and fellow insurer AOK also have a small network of 70 private hospitals and clinics in Austria, Belgium, Italy and The Netherlands, and others in the process of joining, where the insurer pays the bills on a direct billing basis. A key requirement to being in the Europa Service network is that the hospital must have German speaking medical and non-medical staff. The network was set up in 2004 just for AOK Rheinland/Hamburg, and in 2009, the AOKs of Berlin, Brandenburg, Sachsen-Anhalt, Schleswig-Holstein and Westphalia-Lippe joined this EuropaService.
AOK has contracts with clinics on the North Sea coast of Belgium and the Netherlands and in Austria to guarantee good medical care, simple procedures and expert service to customers in additional EU member states. It also collaborates with partners in Austria, the Czech Republic and Italy, and is developing partnerships in Poland, Spain and Turkey.

Healthcare will soon become more patient-friendly and tailored in an attempt to encourage more people to take responsibility for managing their health and as new tools, technology and health information give consumers power to take charge, according to the latest in the HealthCast series of reports on health industry trends from the Health Research Institute of PricewaterhouseCoopers (PwC).
The trend will be reflected in significant healthcare business model changes, regulatory health reforms and realignment of financial incentives over the next five years. In response to the global recession and pressure to reduce rising national health costs associated with chronic diseases, government and health leaders recognize that individuals must play a bigger role in managing their health and overall health spending.
• 86 % believe the prevailing attitude in their country is that government will continue to be responsible for basic healthcare.• The consensus is that individuals have the greatest influence over their own health and outcomes.• 97 % agree that patients should have some responsibility for managing their chronic conditions such as obesity, asthma, diabetes and heart disease.• Patients’ lack of willpower is the biggest barrier to individuals actively managing their health.• 74 % believe that unhealthy behaviour will become increasingly unacceptable in their country.• 76% agree that lack of knowledge and access to health information keeps individuals from managing their health. • 74% believe that patients do not understand the health information and choices available to them. • 84 % agree that compensation to hospitals, physicians and other providers should be based on quality health outcomes.• 74 % expect that health funding and financing in their countries will be redistributed from treating sickness in acute care settings to keeping people well and outside of hospitals, nursing homes and doctors’ offices.• 49 % expect medical tourism to increase by 2015, as health systems compete for consumers by offering personalised care, access to medical innovation and the greatest value for consumers.
Current health systems are difficult for consumers to understand or influence. These systems typically are based on an acute care model focused on the treatment of illness after a patient becomes sick or injured, with care usually taking place in a hospital or physician’s office. This model is heavily dependent on hospital infrastructure and the availability of an appropriate medical workforce. These factors lead to inefficiencies, waste in health spending, poor outcomes, long wait times and patient dissatisfaction.
PwC says health leaders can work together to achieve solutions for customised diagnosis, care and cure by:• Developing incentives that encourage partnership.• Working on regulatory reforms that reward competition and innovation.• Planning for redistribution of funding from sickness to wellness.• Providing individuals with better information to understand their options and share in decision-making with their providers.
David Levy of PwC says, “There is growing recognition that if the patient is left out of the equation, it is impossible to adequately manage care, consumption and spending. Transforming the internal focus of the health system will mean re-engineering virtually all components of the health infrastructure – communication systems, doctor-patient roles and responsibilities, and perhaps even the most challenging aspect of care, habits and traditions.”
PwC surveyed 590 leaders of health plans, providers, government, employers, physician groups and pharmaceutical/life science firms in 20 countries and conducted more than 200 in-depth interviews in 25 countries with thought leaders and executives representing government, hospitals, pharmaceutical companies, insurance companies, clinicians, academics and the business community. 3,500 consumers in seven countries were researched to identify preferences and attitudes about the health system.

The European Union (EU) has been exploring how best to legally protect and educate their citizens on cross-border healthcare. After extensive external surveys and analysis, they drafted a directive in 2008, outlining proposals for cross-border healthcare. This draft directive aims to ensure a clear and transparent framework with the goal of safe, high quality, and efficient medical care for Europeans travelling within the 27 countries in the EU.
There are social and political issues surrounding the implementation of the Directive, including the right of the EU to intervene in health matters, the dangers of enhanced patient mobility, and the additional cost to the public health system. Some of the proposals in the directive including a legal framework for the reimbursement of medical treatment when it takes place outside of the EU are not universally popular. To become policy, the proposed directive on patients’ rights in cross-border healthcare must be approved by the EU’s legislative bodies – the Council of Europe (the 27 health ministers) and the European Parliament.
A series of rulings by the European Court of Justice, beginning in 1998, found that healthcare could be sought in any member state, with patients entitled to have their costs covered by their own health systems. The proposals would allow citizens to seek treatment anywhere in the EU and claim reimbursement in their home countries under certain circumstances. Patients can seek non-hospital care, such as dental treatment and medical consultations, without prior authorisation. However, prior authorisation is required for in-patient procedures, such as surgery. Organ transplantation and long-term care are not in the directive. For anyone covered by a national social security scheme, if planned surgery is the reason for travel to another European country, the law already says that these costs can be met if they obtain prior authorisation. The dispute is about which country pays for what and about the rules for pre-authorisation.
Although very few state-funded Europeans travel outside their country borders for treatment, and most pay out of their own pockets with a small number paid for by their private insurance company, often forgotten are the millions of EU citizens who work in or retire to a different country and wish to use the health care system of the country where they are living.
Although the vast majority of patients receive healthcare in their own country, sometimes the care is best provided abroad. This can be the case for example for highly specialised care or in border areas where the nearest appropriate facility is abroad. A new generation of Europeans, accustomed to crossing borders with ease and able to purchase goods and services from any part of the European Union, are proving less willing to accept constraints on where their healthcare may be obtained. This is often due to perceived advantages relating to quality or favourable cost, the availability of different treatments or where patients have close cultural, family or linguistic links in another country. Rules for receiving cross-border healthcare and for reimbursement of costs are now not always completely clear or easy to understand. That is why the EU has developed the proposal for a legal instrument that will provide more clarity about possibilities to seek healthcare in another EU country. The proposal will also make clear who is responsible for quality and safety of care in cross-border settings.
Hopes that the directive would be agreed in 2009 were dashed – the directive was delayed and nine countries (including Spain and Hungary) voted against the draft directive in December 2009. The debate over this directive continues, and only time will tell if the issue will be resolved by the summer. But as Europeans continue to seek healthcare in other EU countries, the EU must continue to assess how responsible they are for cross-border healthcare and what measures they will take to protect EU citizens. Opinions differ, but the consensus seems to be that 2011 is more likely a start date now than 2010

The Mediterranean island of Malta has launched a new initiative to coordinate the way in which the island is promoted to the world. Incorporating public and private organisations across the country, Malta is seeking to alter its position as it seeks future inward investment, tourism revenue and international business talent.
18 leading business, financial and tourism organizations back the initiative, “Creating the Malta Story”. It aims to create a compelling identity based on Malta’s unique characteristics. London based consultants, The Communication Group, were appointed to undertake the initiative and have spent several months researching and evaluating the Malta story including interviews with Malta’s business, finance and tourism chiefs.
Initiative leader Michael Refalo says, “A unified, authentic identity for Malta will help us to stand out in an increasingly competitive market. The Malta Story capitalizes on our rich and diverse 7000 year history, passionate, well educated people, internationally recognised centres of excellence and its position at the most southerly point of Europe. With this initiative, we are securing Malta’s place as a destination where people want to live, work, and invest. All participants are in agreement that Malta needs a collective message to promote itself in the future, to complement the government of Malta’s vision for 2015 and further develop Malta’s competitive position in the world.”
Texas based consultancy firm Angelou Economics has recommended that Malta should target seven industry sectors as it charts its course towards Vision 2015 and Beyond. To identify economic development opportunities towards higher value economic growth, job creation and wealth creation.
Tourism is one of the seven industry sectors, as is life sciences. Tourism includes educational, health, and eco-tourism, short duration travel, high end tourism and arts and culture. Life sciences includes rehabilitative care and high-end health services. The seven industry sectors are the same as laid down in the government’s original Vision 2015 in 2007. The country is suffering badly from unemployment and recession. In health, Malta’s private hospitals will serve as the basis for healthcare tourism.
Malta has undertaken various national promotions on health tourism, but has yet to make significant progress in the market. Plans and initiatives have to be backed by money and resources from the state. So far, Malta has outlined what it wants to focus on, but has provided little information about what it actually plans to do and how it intends to fund those plans.

Turkey could earn $8 billion from health tourism annually starting from 2015 provided the government introduces tax incentives for the sector, a report by the Foreign Economic Relations Board (DE?K) has said. The government has not yet made any response.
DE?K’s health tourism report says the sector needs a value-added tax incentive for a sustainable rejuvenation in the years to come. It argues that Turkey is among the few countries that offer vast opportunities in health tourism, and could attract one million patients a year if the necessary infrastructure is established. The introduction of a tax refund on health tourism services would boost this promising industry, and would ensure sustainable growth in the long-term, injecting new life into the sector.
DE?K argues that Turkey, India, Israel and Singapore will be the global health tourism market leaders by offering affordable prices in health care services. Turkey currently attracts 30,000 to 40,000 international patients. According to the report, India, Turkey, Thailand, Singapore and Taiwan lead the current global health tourism industry, based on price comparisons rather than numbers of medical tourists. The report suggests that a unit must be formed within the Ministry of Health to promote health tourism.
According to the Turkish Health Tourism Organization (TUHETO), of the 27 million tourists who visited Turkey in 2009, some 871,000 where nationals of Kazakhstan, Azerbaijan, Kyrgyzstan, Uzbekistan and Turkmenistan. Ibrahim Artukarslan of TUHETO hopes health tourism in the future will attract as many tourists as normal tourism attracts to Turkey,” Our message is that Turkey is not only about sun, sea and sand, but it is also a health destination, which has the facilities to receive many more patients from overseas.” At present the share of health tourism of all arrivals to Turkey is small. However, there are numerous travel agencies in the United States, Germany and Central Asia that market health tours to Turkey, including laser eye operations and IVF treatment.
TUHETO held a workshop in Almaty, Kazakhstan, and plans to organize workshops in several other locations overseas, including Brussels, Frankfurt, Dubai, Azerbaijan, Russia, Croatia, Ukraine and Libya. TUHETO was founded in 2009 and has some 60 members, including private hospitals, thermal resorts and spa hotels as well as four and five star hotel chains.
There is a revival in health tourism activities in Turkey’s southeastern cities, according to Dr. Azmi of the Universal Hospitals Group. Wealthy Middle Easterners, who might face trouble getting visas for Western countries, are choosing Turkey as a health care services destination, he says. For health care tourism, Turkey has all the appropriate facilities. Antalya, Ankara and Istanbul have many health care tourism attractions and destinations. Afyonkarahisar city also has many thermal springs.
DEIK argues that the factors that make Turkey attractive in terms of health care tourism are:• Large-scale private sector investment in health care. • Rapid increase in number and variety of hospitals, medical centres, clinics and thermal spas. • Trained qualified medical staff. • The latest technology.• Substantial price advantage.
It also lists factors that restrict growth:• Legal regulations prevent the use of foreign doctors in Turkey. • International accreditation is essential.• Professionals and auxiliary staff need to speak foreign languages.• There is a need for more hospital beds.• Overseas Middle Eastern investors need incentives to develop thermal tourism.• There should be organized overseas marketing, with hospitals working together.• Greeks find it very difficult to get visas to go to Turkey

The Health Care Accreditation Council (HCAC) of Jordan’s comprehensive accreditation programme has been granted accreditation by the International Society for Quality in Health Care (ISQua). HCAC has become the third health care accreditation organization in the world to gain all three international accreditations set by ISQua. The only other two countries that have received this prestigious international recognition are Australia and Netherlands.
ISQua, the world’s only accrediting agency for health care accreditation bodies, acknowledged HCAC’s accreditation program as a formally benchmarked, internationally recognized accreditation body, ranking among the world’s top-tier health care accreditation bodies. ISQua launched its International Accreditation Programme (IAP) in 1999. It is the only international programme that accredits the accreditors.
The ISQua international accreditation standards are intended to verify that the accrediting organization is able to measure the quality of its services and performance against internationally recognized standards. The ISQua accreditation process involved self-assessment by HCAC, as well as a thorough review by the ISQua’s expert surveyors, who themselves have extensive experience in the health care accreditation field as well as meetings with HCAC accredited hospitals and the HCAC certified surveyors.
HCAC staff spent a year preparing the detailed self-assessment report required for submission prior to the arrival of the survey team. In January ISQua surveyors from Australia, Canada and South Africa conducted an intensive on-site survey at HCAC, evaluating every department and its function within the organization based on HCAC’s accreditation programme and the HCAC mission.
May Abu Hamdia of HCAC explains,” Obtaining ISQua accreditation is a lengthy, but worthwhile process, and we are proud of everyone in our organization, who worked diligently to fulfill the complex requirements set by ISQua."Triona Fortune of ISQua adds, "Three accreditation awards for such a young organization is an incredible achievement."
Said Darwazah of HCAC stated that this international accreditation signaled a new era, "ISQua’s international accreditation is recognized as the highest standard of achievement for health care accreditation bodies worldwide, and accredited agencies such as HCAC are committed to quality and continuous improvement through rigorous and comprehensive peer review. International accreditation by ISQua is a symbol to our stakeholders and clients that HCAC has committed to providing high-quality services. It sends signals of confidence to the community it serves and increases an organization’s competitive edge in the marketplace."

The number of people in Europe looking to receive dental health care outside their own country has grown significantly in the last two years and the global economic crisis has only strengthened this tendency. The difference between dental care prices in the UK and Eastern European countries is as much as 70 per cent.
A recent conference on dental tourism in Bulgaria aimed to popularize the experience and good practice of dental tourism in Europe both among Bulgarian dentists and among Bulgarian tourism organisations. There are 8000 dentists and 3000 travel agents in the country. Ventsislav Stoev, chairman of the Bulgarian association for health tourism said, "Bulgaria can become the Mecca of dental tourism, if we manage to develop attractive holiday packages with included dental services. Latest statistical data show that the prices of these services in Bulgaria are seven times lower than in England." Some tour operators in the coastal city of Varna offer one week or fortnight packages that included premium-class dental services. Travel agencies in Bulgaria have joined forces with the dental clinics to attract more tourists to the crisis-hit country.
Romanian development and tourism minister Elena Udrea says she will grant support and campaign for the development of the country’s health tourism by extending easy terms to access European grants. At a meeting with local travel agents of the Dornele region, the agents raised the problem of co-financing for European projects, indicating that bank interest rates are high and the ministry should find solutions to allow for special loans to health tourism on easy terms.
Udrea toured the Vatra Dornei spa complex and said she was pleasantly surprised by the equipment and facilities of the resort that meet the existing European health tourism standards. Vatra Dornei is a famous spa for all ages, recommended for healthy people who want to fortify their bodies through mountain climbing or winter sports, and those who want to repose in a tonic bio-climate that has a soothing influence on the nervous system.
In the Balkans, Turkey has already won a position as a destination for medical, spa and wellness tourism. Other Balkan countries see it as a role model to emulate and help counter local economic problems. Bulgaria and Romania have taken steps in the last few years to attract tourists with offers for affordable quality dental care. Croatia and Serbia have developed a network of health services that they offer to medical tourists. Bulgaria is already seeing more Greek medical tourists who cannot afford treatment at home due to salary cuts and a collapsing economy.

Moves to combat transplant tourism, in which patients from rich countries pay large sums to have organ transplants in poor ones, are gaining pace, said experts at the Madrid international conference on organ donations and transplants.
The European Union is to approve a law to control organ transplants throughout the 27-nation bloc by June. Spanish health minister Trinidad Jimenez said,” The aim is to save 20,000 lives a year and encourage cooperation between European countries.” The EU directive could be approved by the European Parliament as early as May. The directive will clearly establish the free and voluntary nature of organ donation, a principle on which there is unanimity throughout Europe. The measure also aims to fight organ trafficking and transplant tourism.
The aim of the European Directive on the quality and safety of human organs intended for transplant, is to double the number of donations and to ensure that all transplants carried out in the EU are done to the same quality and safety standards. An Action Plan has also been drawn up in addition to the directive, which sets out 10 actions to be carried out between 2009 and 2015, including the exchange of information and good practices between countries.
The World Health Organisation and the European Union have led the way in tackling the problem. Spanish health minister Trinidad Jimenez said, "Stopping the illegal trafficking of organs and ending transplant tourism is an objective shared by all countries. The European Union has a harmonised model in which no one puts a price on an organ, and the WHO is making a great effort to spread this model."
Rafael Matesanz, the head of the Spain’s national transplant organisation, said efforts to curb transplant tourism began in 2005 with the very decisive action of the World Health Organisation and the international Transplantation Society to establish laws in the countries where it does not exist. Spain has included the illegal trading of organs as a crime in the current reform of its Criminal Code.
Dr Luc Noel, a coordinator of the WTO on the subject, said a common front was now emerging in the battle against the practice. Laws against the trafficking of organs had been adopted in five countries considered among the worst offenders: China, the Philippines, Pakistan, Egypt and Colombia. In all these countries, many poor people sell their livers or kidneys to patients in rich countries in need of them. Although organ transplant tourism continued in China, legislation passed there in 2007 had already led to the arrest of a gang of traffickers.
China’s deputy health minister Dr Huang Jiefu attended the Madrid conference to emphasise his country’s efforts in this regard, "Since the beginning of this century, organ transplantation has become a booming health industry in a country where over 90 per cent of the organs still come from executed prisoners. The trading of human organs emerged in China in an under-regulated environment, forming a tremendous profit chain that is against the principles of equality and the goal of building harmonious society in China."
The Spanish newspaper El Pais recently reported the case of a Spaniard, Oscar Garay, who paid €135,000 ($198,000) to receive a new liver in a hospital in the Chinese city of Tianjin in 2008.Huang Jiefu admitted that since the 2007 law, "We still have some hospitals trading with illegal organ agencies and selling organs to foreigners for profit.But seven hospitals have had their licences withdrawn for carrying out transplants.”
The head of the Transplantation Society, Professor Jeremy Chapman, said, "China is working very hard to stop the trade" in organs. But such work must go hand in hand with efforts in the countries of origin of the tourists. To stop the trade you must stop the need."

India’s leading hospital chains Fortis, Apollo and Max Healthcare have each agreed health deals with American companies. All three companies decline to reveal the numbers or identities of the partners, citing confidentiality agreements. However, this does not necessarily mean that more Americans will be travelling to India from the USA for low cost surgery. The deals may well relate to the treatment of American expatriate workers who are based in India or other nearby countries, where India is an appropriate choice of healthcare provider for the expatriate American. It raises the question of how any country defines a medical tourist. India is not alone in counting heads by nationality and claiming X number of medical tourists from Y. An American medical tourist does not have to come from the USA. Thousands of Americans work and live outside the USA. India is not alone in being faced with the question of how you classify medical tourists. For example, do you count an American working in say Pakistan who comes to India for treatment, as an American medical tourist or a Pakistan one? Do you count an American living in India as a medical tourist if they have elective treatment while in India?
The argument may sound pedantic, but is crucial to the debate as to whether or not US businesses will in future send people overseas for treatment, or only consider non US treatment for Americans who are already expatriates. The American tax definition of an expatriate is much tougher than most countries, as the main qualification is that they have to spend a minimum of 330 days a year outside the USA. Someone who is a tax expatriate will not have to buy insurance under US healthcare reform. The rules can also mean that if an expatriate has already been home during the year, they could face a tax bill if they have to then return for surgery and recuperation. The need for local care and the complex tax rules, are why US companies with American employees often have a mixture of insurance and deals with hospital groups overseas, and this is completely different from arranging medical tourism for American employees living in the USA.
Pervez Ahmed of Max Healthcare says,” India is still at a disadvantage when it comes to receiving patients from the West, largely due to the distance factor. So patients from the US are eying destinations closer to home such as Canada or even South America. Despite the direct deals with corporates, we expect most patients will come from their subsidiaries in Asia and other nearby locations.”
According to several Indian newspapers, Fortis says it has already treated 20 patients after entering into the partnerships. Half of its international patients are American, and in total it gets 2,000 international patients from developed countries. Vishal Bali of Fortis explains, “ We have been getting 2 to 3 such patients every month for six months now. The corporate healthcare market in the US is the largest contributor to healthcare spending there. If opportunities open up there, then it will significantly contribute to the entire phenomenon of medical tourism.” Apollo says its deals have triggered a near 100% growth in the flow of US patients, that a large percentage of its 4,000 overseas patients, including corporate executives, were Americans; while half of its international patient base comes from developed markets.
Indian hospitals say the tie-ups will build their credibility in the developed markets and ensure a bigger penetration in the lucrative US market. The deals may help India compete against other South-East Asian nations such as Singapore and Thailand. Although the tourism ministry still insists that India’s medical tourism market will be worth $2 billion a year by 2012, Vishar Bali of Fortis argues that recession means that the target will not be reached before 2015.

The Deloitte Center for Health Solutions has teams of people studying US healthcare reform. Deloitte has yet to provide a view on how the reforms will affect medical tourism, but has offered an independent and balanced view of the overall impact of healthcare reform in the USA.
Paul Keckley of Deloitte’s Center for Health Solutions comments;” Health reform—HR3590 and HR4872—is now the law of the land. It features expansion of coverage to 32 million currently uninsured, regulatory changes to control premiums and competition for insurance plans, delivery system reforms to coordinate care and reward value instead of volume, and mechanisms to bridge gaps between human services programs and health care especially for underserved populations.”
“ The impact of insurance reforms combined with new industry taxes will likely increase premiums above the underlying cost of health for most Americans. And the physician fix is not fixed even as economic recovery is slower than hoped. Curve-bending resulting from delivery system reforms—integrated health systems, evidence-based medicine, the medical homes, pay for performance, primary and preventive health—combined with a dose of personal accountability for healthier living and adherence to recommended treatments—are delayed in the bill so we’ll likely not know until after the decade is past. Though promising and logical, unknowns prevail.”
“ Will quality of care improve? Conceivably the deployment of health care information technology, implementation of comparative effectiveness, transparency of outcomes and satisfaction will increase its likelihood. And the promise of widespread use of electronic health records with personal health records is worth serious pursuit.”
“ Health reform requires finding middle ground on complex issues for which trade-offs are necessary. It means changes for everyone including regulators, industry leaders, and consumers.’
“The events of the past year hopefully will lead us on a path to fundamental improvements in the U.S. health system that improve quality, rein in unsustainable costs, and eliminate disparities in access. The health care industry will thrive because it’s too important to fail.”
The 2010-2011 changes most noticeable to consumers include:• Medicaid expansion: States may increase eligibility threshold to 133 percent of the federal poverty level (mandated by 2014)• Tax credits for small businesses: Businesses with 25 or fewer employees and average wages of less than $50,000 can qualify for a tax credit of up to 35 percent of the cost of their premiums• Dependent coverage: Parents are allowed to keep children on their health insurance until age 26 if the child is ineligible for coverage through an employer• High-risk pools: In the next 90 days, individuals with pre-existing conditions that left them uninsurable for the last six months may enroll in a new high-risk insurance program subsidized by the federal government and administered by the states• Risk assessments and preventive health plans for seniors: Effective 2011, Medicare enrollees will be provided a comprehensive risk assessments and personalized prevention plans as part of the program• Insurance industry regulatory changes: Lifetime caps eliminated, rescission of coverage for other than fraud eliminated, mandatory reporting of medical loss ratios, and elimination of pre-existing condition as a basis for coverage for children under two years of age (begins for adults in 2014)

Indian hospital operator Fortis Healthcare’s purchase of a stake in Singapore-based Parkway Holdings is a clever move as it combines two distinct competitors in medical tourism, the cut-price surgery of India and the more expensive high-tech approach of Singapore. Also the deal means Fortis now owns or has a share in hospitals in many countries. Fortis Healthcare has completed the acquisition of a 23.9 per cent strategic stake in Parkway Holdings from American investment group TPG Capital, for $685.3 million. Parkway, with a network of 16 hospitals and 3400 beds spread over six countries, including India, is one of Asia’s premium healthcare providers. The acquisition of Parkway gives Fortis a springboard for international expansion. This is the company’s fourth acquisition after Malar Hospitals, Escorts Heart Institute and Wockhardt Hospitals. Though it is not acquiring a majority stake, being the largest shareholder in Parkway will help Fortis to take management control.
ParkwayHealth offers healthcare services through its chain of 16 hospitals in Singapore with 1022 beds, Malaysia (1900 beds), Brunei (20 beds), India (425 beds in a joint venture with Apollo Hospitals), UAE (260 beds) and China (14 beds).
The Fortis management believes that the Indian operations will benefit from the skill sets, technology and capability of Parkway in addition to the opportunity of healthcare tourism market in the region. Fortis could exchange patients based on complexity of healthcare needed as well as affordability. The deal makes Fortis a leading player in Asia, with a network of 62 hospitals and 10,000-plus beds, giving them a Pan-Asia platform.
Fortis chairman Malvinder Singh is relocating to Singapore, as it plans to use the acquisition of hospital chain Parkway Holdings as its vehicle for global expansion, “Parkway is a reputed brand and its size is three times of Fortis Healthcare. The next phase of our growth will be beyond Asia .Our ambition is to strengthen our brand at a global level. First step in this strategy was to penetrate the Indian market, which we have done through Fortis Healthcare and Fortis Hospitals. The next step is to establish a footprint in Asia that will be done through our acquisition of Parkway. This gives us a strong platform to leverage our partnership to position ourselves for the next phase of growth outside Asia. We are evaluating a bunch of international acquisition opportunities.”
Malvinder Singh said, “Singapore is renowned as an international medical hub for high-quality healthcare services, with access to a ready pool of experienced nursing staff, specialist medical practitioners and the latest medical technologies and treatments. Parkway’s strong presence in Malaysia with the Pantai Group of Hospitals gives us great confidence. This acquisition will significantly expand our footprint across the region and place us strategically for geographical and clinical leadership in Asia, a big step closer to our vision of establishing a global healthcare delivery network. We are long-term players in the healthcare business and we understand this business. We will support the management of Parkway in achieving their growth objectives and work together to enhance shareholder value.”
The deal transforms Fortis to a strong leadership position in Asia. The plan is to use this capability to deepen businesses in the existing market, get into new markets in Asia and then go beyond Asia. This is a well thought out global play, and recognition that domestic health and/or medical tourism is a simplistic notion that is only part of the wider global healthcare opportunity.

Riga is the capital of Latvia, and hoping to attract tourisms that want cosmetic surgery. Cosmetic surgery can be 40 per cent cheaper in the Baltic state than in Western Europe. The authorities see encouraging the industry as a quick way of getting a new image for the city, which has suffered heavily from Latvia’s economic collapse. Nils Usakovs, the mayor of Riga says, “We want more tourists, more British, coming here for cosmetic surgery or for dental services, and the prices will be considerably lower.”
The drive for medical tourists is being led by Dr Janis Zarzeckis, one of Latvia’s leading cosmetic surgeons, who says that the move has the extra bonus of keeping doctors and nurses in the country, rather than seeing them follow those who have left to earn more. Wages in Latvia have been dramatically cut and taxes raised as the country struggles to reduce spending and repay its national debt. Cosmetic surgeons are now getting fewer local patients, so badly need foreign ones. Dr Zarzeckis specialises in facelifts, eye surgery and breast implants.; from treating one foreign patient a month five years ago, he now has one a week, one in three from Britain.
Whether cut-price cosmetic surgery and dental treatment is enough fot Latvia to compete with established medical tourism destinations,and the host of newcomers and hopefuls, is an open question. There is nothing wrong with the price, or the qualifications and expertise of the health professions. But the U.S. Department of State reports that medical care in Latvia continues to improve, but falls short of Western standards. According to the Department of State, it is not lack of trained medical professionals, but that economic problems mean clinics lack state of the art equipment and facilities. It does say that dental care is good in Riga.
Funding from the Riga city authorities has enabled a group of eight medical companies to join together and form Baltic Care that has opened an office for consultations in London, and plans another in Stockholm. Baltic Care is an alliance of leading private healthcare clinics, which will effectively and professionally create individual healthcare programmes in Riga. The alliance consists of top specialists from Latvia and the other Baltic States using state-of-the-art diagnostic and treatment methods that comply with European Union standards. It uses a local travel company and the national airline to offer travel and accommodation packages.

The government of Barbados wants to encourage health and wellness tourism, but with the money coming from the private sector. The government role should be to provide the legal and regulatory framework for expansion and private investment. Establishing a National Health Care Quality Council will help to ensure that growth is from a secure base.
This basis, says the Ministry of Health, is among several recommendations made last year to the government by an inter-sectoral task force that examined the development of that segment of tourism on the island. It sees opportunities to target the US and Europe with a range of wellness offers. The target market is seen as “ An aging population with increasing demands for cosmetic surgery, spas and retirement communities. There is also growing affluence amongst the younger population, particularly in the US who rate vacations that offer spa facilities, fitness and addiction treatment as highly desirable."
The island’s established tourism infrastructure with good transport and hotels is seen as a platform on which a health and wellness tourism market could be built. It has a good climate, low labour costs, reliable communications and transport infrastructure, first class hotel and tourism services, an educated population, and well-trained practitioners in an established health and medical service in both public and private sectors.
The task force recommends that the government seeks technical assistance to undertake a study and development plan; draft a Health and Wellness Tourism Development Incentives Act; develop new legislation to address this aspect of tourism; and establish coordinating bodies to manage the six sectors of wellness promotion, complementary and alternative medicine, healthy food alternatives, assisted living, universal access to tourism products and services, and conventional medicine. One recommendation, a wellness council to act as the regulating body for wellness professionals such as Reiki experts, reflexologists and massage therapists- has already been acted on.
Barbados wants to create a health and wellness tourism product that is distinct from others in the Caribbean. The establishment of a National Health Care Quality Council is needed as in order to attract health and wellness tourists, high quality standards are paramount and there is a need to ensure that health care standards are at world-class levels. It will be established to be the national co-coordinating agency for quality management in the health sector. The council will provide annual reports on the quality of the sector, set benchmarks by which performance can be measured and establish performance standards and protocols. It will have measurable indicators and evidence-based tools that should be applied in every aspect of the health services, as well as audit the performance of institutions and develop links with reputable international agencies to help with benchmarking, peer review and accreditation.
Wellness tourism needs to be expanded within Barbados. Across the island, there are numerous hotels that offer spa packages, but there is a lack of other well-being facilities that package accommodation and treatment together to attract long-stay visitors. Ministry of Health

President Barack Obama has signed the most sweeping U.S. health policy legislation in five decades into law. Although details are to be finalized, Obama says that local state opposition will not be able to stop it. The Republicans will fight the detail, but have accepted it will be impossible to untangle even if they win future presidential elections.
The law will extend health insurance to 32 million Americans who currently have none. It will bar practices including insurance companies refusing coverage or renewal to people with pre-existing medical conditions, expand the Medicaid government health insurance program for the poor, and will require employers and individuals to obtain health coverage. There will be tax rebates for those who obey, heavy tax fines for those who refuse, and help for the poor and low paid.
Health reform will offer major changes in the arena of dental care with a lasting effect on the type of dental care that people receive. Millions more will have dental insurance- and this could have an impact on dental tourism. There promises to be a huge expansion of coverage for individuals in need of dental care. The healthcare reform bill looks very promising for people who have long awaited adequate coverage for their dental needs.
The passage of President Obama’s health care reform will make a difference in the lives of tens of millions of people. The subsidies will make insurance affordable to millions of families who could not pay the unsubsidized rate. By prohibiting insurers from discriminating against people with serious health conditions, people will no longer have to worry that a serious illness will cause them to lose their job and then their insurance.
The effect on medical tourism will not be immediate, as the major measures only take effect in 2014. But overseas governments, promotional bodies, agencies and overseas hospitals whose business model is based on attracting some of the 47 million uninsured Americans, and based on the belief that US healthcare reform would fail just as it has in the last 40 years will need a dramatic rethink. It will certainly not be the end of US outbound medical tourism, but it is worth noting that even the latest scaled down medical tourism forecasts from Deloitte had the very important qualification that these figures assumed healthcare reform would not happen.
Using figures produced for the legislation illustrating where the US will be in 2019:• 159 million covered by employer health insurance plans• 44 million on state programs• 25 million covered by individual or small business insurance • 24 million covered in the exchanges• 22 million left uninsured.
The uninsured category has gone from the second largest to the smallest, and as the fines by 2019 will be around $800 for each person in the family, the numbers may be far smaller. This uninsured segment will not be a medical tourism target as it includes 8 million illegal immigrants. The rest will mostly be those excluded from cover as they earn too little, or opted out, so have no money for any medical treatment anywhere.
Insurance exchanges will be created in which small businesses and individuals without employer-sponsored coverage can shop for coverage. Plans offered on the exchange have to meet minimum benefit requirements. There are already guidelines on the pre-agreed range of insurances on offer, with no mention of allowing overseas treatment.
The reforms do not solve the basic problem that health care in the United States is expensive. Suggestions that reform will fail as demand will outstrip available resources are just ridiculous. There will be strict controls on what insurers can exclude and new minimum standards on cover and benefit levels. These in turn will drastically reduce the number of uninsured and underinsured Americans.
Initial optimistic reactions from the medical tourism market have been on the basis of the headlines, rather than detailed proposals that are still emerging. There are many views on how reform will affect medical tourism. Some argue it will increase medical tourism, others that it will decrease medical tourism. A few even suggest it will increase the volume of medical tourism from Europe to the USA.
Reform will change the ground rules for those targeting Americans, and anyone looking for US business will have to study the reforms in detail and show that they understand the implications. The American insurance industry will become more powerful with an extra 32 million customers by 2019. Anyone hoping to convince insurers that they should pay for medical tourism will have to be armed with detailed figures, quality outcomes, employer and employee incentives, aftercare proposals and answers on how insurers can avoid medical malpractice suits. A simplistic approach based on cost savings overseas will achieve very little.

Malaysia is keen on promoting medical tourism in Brunei. Ooi Say Chuan of the Malaysia Healthcare Travel Council advises, “In 2008, we had 370,000 foreign medical tourists so this actually speaks a lot of the number of tourists who placed their trust in Malaysian healthcare services. We want to discuss with the Bruneian government the use of Malaysian hospitals as an option. I think it is more than just the price. The patients who come want to feel at home and in Malaysia we are multilingual. Our staff speak Bahasa Malaysia, English, Chinese or Tamil so people in the region are actually quite comfortable staying in Malaysia hospitals. Also, being an Islamic country you can have halal food. All hospitals can accept international patients but the government has taken a stand to promote 35 hospitals whom we feel will be able to meet the demands of international patients well. We want them to have accreditation under the Malaysian standard for quality in health, so when they market to our clients abroad they can be assured that these hospitals are accredited.”
The aim is to establish an understanding between the two countries similar to the one that Brunei shares with Singapore. Recently, the Singapore government made an announcement allowing Singaporeans to use their national insurance to pay for healthcare. This allows them to go to Malaysian hospitals that are referred through Singaporean facilities. It is an initiative taken by the Singaporean government.
Bruneians who go to Malaysia often seek treatment for cancer, heart bypass and orthopaedic according to hospitals. Pantai Hospitals recorded 100 Bruneian patients seeking treatment in 2009 all its 10 hospitals. TMC Fertility Centre had eight Bruneian patients and is looking to increase the figure

Gleneagles Intan Medical Center in Kuala Lumpur is among the 12 Malaysian private healthcare providers to benefit from Singapore’s Ministry of Health (MOH) move to allow its citizens to use their compulsory medical savings or MediSave, to pay for private care aboard from March. Previously, Singaporeans, permanent residents and their immediate families could only use the MediSave for emergency hospitalisation. But it can now be used for hospitalisation and day surgeries but not for outpatient treatment.
The MediSave scheme will start off with two healthcare providers, Health Management International (HMI) and Parkway Holdings.HMI has set up its local MediSave accredited referral centre at its Balestier Clinic and Health Screening Centre. It will work with its two overseas subsidiaries, Regency Specialist Hospital in Johor Bahru and Mahkota Medical Centre in Malacca. Parkway Holdings has established a MediSave accredited referral centre at East Shore Hospital. It will partner nine hospitals of Pantai Holdings in various Malaysian states, as well as the Gleneagles Intan Medical Center. Gleneagles will tie up with FireFly and Holiday Tours and Travel, to provide further cost savings and coordinated medical travel for Singaporeans seeking treatment at the hospital. Patients interested in making use of the scheme can approach the two healthcare providers direct. Currently, Singaporeans makes up to 10 percent of health tourism for all hospitals in Malaysia.

Despite the world’s financial crisis, which had a severe effect on the international tourism sector, the number of Gulf states tourists selecting Turkey as a destination has increased in 2009 by 16.45%. 27m tourists from around the world visited Turkey during 2009. Out of the entire world, Arab tourists have made the biggest increases, led by Kuwait, and followed in order by United Arab Emirates, Bahrain, Saudi Arabia and Qatar. Turkish tourist authorities are running advertising and promotional campaigns in the Arab world for 2010.These will focus on introducing and marketing Turkey as a health and medical tourism destination. Turkey has a reputation of being one of the countries that has advanced medical services with relatively reasonable rates and the ability to carry out complex medical operations such as open-heart surgery.
The Turkish Government has recently offered a number of investment opportunities and facilities to invest in the medical and health tourism sector for both Turkish and foreign investors where they can build health and spas near natural and thermal springs. According to official statistics, over 200 health and spa centers will be built as per this plan. Afyon City has five resorts by mineral springs and has been selected as a model city and future capital for mineral springs’ tourism.
A new government long-term plan from 2010 to 2023, aims to sustain health and medical tourism in order to make best use of the unique natural wealth that the country has. The government wants to attract more Arab tourists, particularly as a health and medical destination. The cultural and geographical closeness to these countries means these tourists prefer to come to a country that appreciates the Islamic culture. Favourite cities are Istanbul, Yalova, Bursa, Bodrum, and Antalya.
Turkey is also seeing more outbound health tourism in a special niche sector. With more Turkish parents wanting their child to be born in the USA, tourism companies are starting to offer birth tourism packages to US cities. Many women say giving birth in the USA has benefits including cheaper education and fewer visa worries. Some Americans want to restrict the practice, citing fears of illegal migration.12, 000 Turkish children have been born in the USA since 2003.The numbers are significant enough to draw the attention of tourism companies and inspire them to pursue birth tourism. The Turkish-owned Marmara Hotels group has a new birth tourism package that includes accommodation at their Manhattan hotel. Levent Ba? of Gurib Tourism says, “We have been involved in medical tourism since 2002, but we were also receiving so many demands about this issue that we decided to sell birth packages. We first started our research in New York City, Los Angeles, Chicago and Orlando and we only contacted Turkish doctors. We are preparing a package that covers everything from the flight and city tours to accommodation for several months and hospital expenses.” The minimum cost is $25,000, which rises to $40,000 if the destination is New York.
Many women abroad wish to give birth in the USA, as according to the U.S.’s 14th Amendment, the country grants citizenship to anyone born on its soil. But right-wing politicians want to change the law. Republican Congressman Gary Miller is co-sponsoring a bill that seeks to abolish birthright citizenship for children born in the country to illegal immigrant parents,” They come to this country and have babies. The children are citizens. The children are eligible to go to school. They receive food stamps and social programmes. The American taxpayers are paying for it,"
While it can be controversial, birth tourism is legal in the U.S. and not just popular in Turkey but also in Asian countries such as South Korea, Hong Kong and Taiwan. Many South Korean parents-to-be have chosen to give birth in the U.S. for many reasons, ranging from a desire to enroll their children in American schools to enabling them to avoid South Korean military service.
The birthright citizenship formerly applied in other countries such as the United Kingdom and Australia but both countries modified their law in the mid-1980s. India maintained a birthright law until 2004, but ended the right to prevent continued illegal immigration from neighbors Pakistan and Bangladesh.

In less than six months, an America online health pricing service has grown from a small local pilot to a national system that allows American consumers to compare prices in every state. It is encouraging US domestic medical tourism. The map of locations covered includes hospitals on the borders of Canada and Mexico. It plans to add Canada very soon as Canadian consumers are already using it to compare hospitals across the border. Mexico is likely to be next on the list.
PriceDoc, a free transparent health care pricing service, says that US patients have performed over one million searches for medical and dental procedures listed on the website. It empowers health care consumers to negotiate the cash price of quality medical procedures. Both patients and providers are integrating transparent pricing into their health care exchange, as over 2,500 providers from across the country have become subscribers and posted more than 50,000 medical and dental procedures available for cash prices.
With more than 47 million Americans without health insurance and an additional 100 million without dental insurance, there is an obvious need for greater access to affordable health care. PriceDoc launched nationally in November 2009, empowers consumers who are uninsured, underinsured or seeking elective procedures to view and reserve prices with qualified providers for cash or credit card payments. More patients are participating in health savings accounts and other flexible spending plans that allow patients to choose which doctor to go to, and how much to pay for their care. In February 2010, PriceDoc received a patent for its online bidding system for health services, rendering it the only online site where patients can make an offer for health care services at their desired price with verified providers.
Patrick Bradley of PriceDoc says, “U.S. healthcare consumers have sent a clear message. They want an easy way to access transparent and negotiable pricing for quality affordable health care. Based on our record market growth over the five months since our national launch, it is evident that both patients and providers believe in transparent medical pricing." By listing their services and prices, health care providers gain access to cash-paying patients who optimize their office scheduling, secure fees-for-service and offer cash payments that reduce paperwork and overhead costs. Consumers can identify local providers and review provider experience, credentials and patient referrals, ensuring they receive high-quality health care. Community members can also identify other users with similar health care concerns and ask questions, share experiences and provide support.
A powerful option on the website is the name your price feature. If the patient is not able to find a price within their budget, he or she is then able to post the price that they can afford. PriceDoc then searches for a provider that will accept their offered price and notifies the consumer.

The Indian Medical Travel Association (IMTA) has welcomed the government of India’s recently announced Tourist Visa-on-Arrival for citizens of five countries – Finland, Japan, Luxembourg, New Zealand and Singapore, in an effort to promote tourism. This will help some of the foreign patients who now find it convenient to plan a visit to leading Indian hospitals for advanced health check up and medical treatment, and use a normal tourism visa rather than the complicated medical visa system. Pradeep Thukral of IMTA said, “IMTA welcomes the Indian government’s new guidelines on visa on arrival and we have strongly recommended to the government to open up the facility to citizens of a larger number of countries. Most of our member hospitals have reported higher volumes of patient arrivals and also enquiries from potential patients who wish to use the visa on arrival facility.”
Medical tourists spend more money and their time of stay is longer than regular tourists. Each visiting medical traveller to India spends an average of US$ 5000, which makes this segment a special target for India’s medical and tourism service providers. Until the recent recession, terrorist attacks and tourist visa clampdowns, the volume of foreign patient arrivals at Indian hospitals had been estimated at growing at a healthy pace of over 40 per cent every year –although these are purely trade estimates rather than actual figures.
The new tourist visa on arrival scheme for citizens of New Zealand, Japan, Finland, Luxembourg and Singapore costs US$60 on arrival at the country’s main airports: Delhi, Mumbai, Chennai and Kolkata. The scheme, according to home affairs minister Shri Mullappally Ramachandran, has the objective of promoting tourism.
But many of the markets that India targets, including the USA and UK, still face problems in getting entry visas. Thousands of prospective UK visitors to India have had their plans upset by the sudden change to visa rules and subsequent delays in the system, recently outsourced in the UK to VFS.The change in rules affects holders of multi-entry visas. The Indian Ministry of Home Affairs has decreed that anyone who intends to enter the country twice in less than two months must seek additional permission from the High Commission of India in London or the Indian Consulates at Birmingham and Edinburgh. To get permission to visit more than once in two months, travellers must take a full itinerary with hotel and flight bookings.
The Indian government claims that the extra red tape can take three or four working days, but VF Services recommends a minimum of one month to ensure a visa will arrive before departure. The 2010 Commonwealth Games will be held in Delhi in October, which is likely to add pressure to the system.

RevaHealth is looking for help from clinics, hospitals and agencies that receive dental tourists from the Republic of Ireland.
Philip Boyle explains the background, “Dental tourism is a very divisive topic. On the one hand the advocates of dental tourism espouse the financial savings that can be made, while on the other hand its opponents often talk about poor quality work being carried out abroad. Unfortunately for everyone involved hard facts are very difficult to come by. Last August the Irish Times reported on a Consumer Choice magazine report that said “Dentists were found to be 29 per cent more expensive in Dublin compared to Belfast“. A couple of weeks later the Irish Dental Association released the results of their own survey, which said that “More than three out of four dentists have had to treat patients for problems linked to treatment received abroad”. A previous dental tourism survey carried out by us here at RevaHealth.com showed high levels of satisfaction with the treatment received, but worrying levels of education when it came knowing in advance exactly what treatment was needed.”
He continues, “Ideally we would like to see everyone involved in dentistry in Ireland, whether at home or abroad, publish information and minimise spin. Putting the facts in the public domain should help everyone involved; patients will be able to make better informed decisions on where to be treated, and dentists will be able to make better informed decisions based on what patients want and need. Luckily, we are in the position of being able to ask thousands of patients both before and after their treatment about their expectations and their experiences. We already ask patients on an ongoing basis about their post treatment satisfaction levels. We intend to expand this into other areas of questioning and share the results as soon as we can.”
The results of surveying all RevaHealth users from Ireland who had dental treatment outside of the Republic in 2009 on levels of satisfaction with Irish dental outbound tourism;
• Satisfaction levels (%)• 80.9% communication • 84.5% friendliness• 79.6% price • 80.0% location • 81.3% overall
The company admits that there is a natural tendency for people who have travelled abroad to slightly inflate their satisfaction scores as a means of self-justification. In future surveys they intend to add a question on quality of work.
So what does Philip Boyle want from you? “Satisfaction levels are one thing, but what questions would you like to see answered by Irish dental patients? Over the coming months we intend to publish the results of our survey of Irish patients who were treated in Ireland, as well as continuing to publish more information from Irish, British and overseas patients in general. If you have questions that you think would add to the overall quality of information available about the Irish and British dental industries, or another international market, please contact RevaHealth.“
One reply makes the excellent point that customers want far greater transparency when it comes to dental fees. So if dental professionals in the Republic feel that their prices are justified for the service they provide, they should publish their rates for standard procedures to allow customers to make true comparisons.

While the government of Pakistan seeks to improve hospital quality in the hope of attracting medical tourists, a leading local expert warns that it may all be in vain.
Terrorism in Pakistan is scaring away potential health tourists despite the fact that the country has great scope for becoming a health tourism destination, says Professor Tipu Sultan of Bahria University Medical and Dental College. He argues that Pakistan could offer services to foreigners, especially Americans and Europeans of Pakistani origin, in orthopedic, eye, ENT, heart, and urology treatments besides providing them with investigation facilities in endoscopies, X-rays, MRI, CT scan, cardiology and arthroscopy.” Americans of Pakistani origin usually cannot get a visa for India and staying in India is more expensive."
Sultan says that expert manpower, including surgeons and doctors, is available in Pakistan. The availability of airline tickets and large number of incoming and outgoing flights and affordable expenses could attract foreign nationals to visit the country for treatment purposes; “ Pakistan excels in non-emergency orthopedic surgery, including its diagnosis and treatment. Treatment in Pakistan is cheaper than in India because of the downward slide of the rupee in terms of the dollar.”
However, the professor points out that national initiatives are needed to attract health tourists. Health tourism packages should be introduced that include investigation, expert opinion, treatment and post-operative rehabilitation, as well as accommodation for the patient and any traveling companions. Sultan says there are good national hospitals that could be used in Karachi, Lahore and Rawalpindi, rather than the small private clinics currently on offer, but at present these hospitals show not the slightest interest in medical tourism. The professor blames investors in Pakistan who want to get returns within a year’s time and therefore they opt for investment in sectors other than health tourism.
The Federal Ministry of Health has a working party developing national standards for delivery of health services by public and private hospitals across Pakistan and that plans to grant accreditation to hospitals in line with their respective service levels. The ministry will be responsible for nationwide monitoring of the performance of hospitals as a prelude to improved service delivery and provision of optimal care to patients in both federal and provincial hospitals. Legislation will be needed to create a unit empowered to grant accreditation to hospitals in accordance to their service levels.

A team of local healthcare workers in Hong Kong has been appointed by the Australian Council on Healthcare Standards (ACHS) as qualified hospital accreditation surveyors for assessing the quality and safety of local hospitals. Appointees will have the same professional status as their counterparts in Australia and worldwide. ACHS is an Australian-based, international accrediting agency designated by the pilot scheme on hospital accreditation in Hong Kong as the accreditor. The 21 newly qualified local surveyors will conduct organisation-wide accreditation surveys of pilot hospitals together with other surveyors from the ACHS.
Dr Gloria Tam comments, "Hospital accreditation is adopted worldwide as a measure to enhance service quality in hospitals and patient safety. The aim of the pilot scheme is to derive a common quality assurance system that will find international recognition for introduction to public and private hospitals in Hong Kong. The participation of public and private hospitals in the scheme will ensure a level playing field for both sectors.” Five public hospitals and three private hospitals have joined the three-year pilot scheme, which is expected to complete by 2011, Hong Kong Sanatorium and Hospital has become the first Hong Kong hospital to receive accreditation from the ACHS.
Four Philippine medical institutions have signed up with Accreditation Canada International to raise the bar in health care services making health care delivery safer and more effective for Filipinos and foreign patients. Philippine Heart Center, Manila Doctors Hospital, Asian Eye Institute and Clinica Manila have all signed contracts with the organization that specializes in exporting health accreditation expertise worldwide, to participate in the organization’s pilot implementation program in the Philippines.
Working with Accreditation Canada allows the four medical institutions to participate in Qmentum International; the new programme that establishes the highest international healthcare accreditation standards that benefit from more than 50 years of Canadian and international expertise. Wendy Nicklin of Accreditation Canada comments, “The challenge today is that many internationally recognized accreditation bodies exist around the world. While their standards are generally high, their processes are all quite different. The Philippines is a great opportunity to share ideas and develop clear, sustainable benchmarks regarding quality improvement and measurement.”
Accreditation Canada has been active all over the world, and is a partner in current quality improvement initiatives in the Middle East, South America, Europe and the Caribbean. The organization continues to increase its presence in the Americas, North Asia, and Southeast Asia. These two organizations and others are successfully competing with the biggest international accreditor JCI that has no accredited hospitals in Hong Kong and only three in the Philippines. Hospitals argue that smaller competitors are more flexible in adapting standards to local conditions, while JCI has a tendency to impose US standards. This is significant for some US medical tourism agencies that will only offer JCI hospitals, as they are not offering customers the option of treatment in hundreds of hospitals that are accredited by other reputable international accreditors.

GHAN, an online professional network only for hospital and clinic executives, continues its membership growth around the world with expansion into Canada and the USA.
Hank Kearney of Florida based health consultants PHM International that owns GHAN, says, “GHAN’s growth is due to the open exchange of ideas and information necessary to help meet the unique challenges faced by healthcare executives The challenges faced by these executives, administrators, and managers range from financing and regulatory issues, to information technology expansion planning, the critical shortage of workers, and everything in between. It empowers hospital and clinic executives to stay connected to other thought leaders. In doing so, they are better positioned to establish the thriving, well-managed facilities that attract patients, qualified talent, and investors. "
As a member only network, GHAN helps hospital and clinic executives to stay current of new trends and developments around the world. In addition, select members have the opportunity to earn money by participating in one-on-one briefings with business clients in medical device manufacturing, finance, IT, insurance and pharmaceutical sectors.
GHAN has its foundations in Global Health Access an online system of referrals for hospitals, patients, insurance companies, and medical tourism. Founded in 2000, Global Health Access evolved into GHAN, with a focus on emerging markets.
Hospitals in emerging markets face unique challenges as they strive to improve healthcare, often with limited resources. Despite the challenges, many of these healthcare facilities offer medical services and expertise to rival that found in developed countries. Many are, or want to be, involved in medical tourism.
The online community already has 3000 members from private hospitals and clinics in emerging markets such as Russia, Brazil, India, China, Africa, and Eastern Europe. Offering an interactive, confidential environment, the system allows healthcare leaders to network with other executives, participate in teleconferences and online chats with industry experts, search an extensive online research library, and find job openings.
PHM International offers GHAN members direct access to PHM International advisors who specialize in a variety of relevant areas, including hospital expansion, finance, business development, and medical tourism- at a price. Membership is available to executives, administrators, and managers at the world’s emerging market hospitals and clinics-for an unlimited number of members for each hospital or clinic.Annual charges:• Clinics and hospitals will 50 beds or less: Free.• Hospitals with 51 to 100 beds: $250• Hospitals with 101+ beds: $1,000
The network charges business customers for access to targeted hospital executives for online focus groups, conducting surveys, other market research, product testing and other opportunities.
There are now many associations and organizations offering membership to hospitals and clinics interested in medical tourisms. All offer networking. Some are genuinely member focused, while others are more concerned with selling members a range of services. Like the rest, GHAN offers an annual conference. Whether GHAN is primarily a hospital driven information network, or mainly a device for PHM to market consultancy services to hospitals and health related businesses across the globe, is an interesting question.

A new health care medical tourism project by the Kadeco group and Iceland Healthcare is finally set to get underway in the second quarter of 2010 at the Asbru Enterprise Park in Keflavik, Iceland. The location for the health care facility was chosen mainly because of the area’s knowledge and experience of tourism.
The Asbru Enterprise Park, located next to Keflavik International Airport, includes a former military hospital on the campus that is being renovated. The hospital will be run by Iceland Healthcare and specialise in medical treatment including cosmetic surgery, fat-removal and joint replacements. It will have three operating theatres, 35 hospital beds and the ability to treat up to 4000 patients per year. Initially patients are expected to number 2000 a year, and the first clients are likely to arrive in the second quarter of 2011. Initially the company will focus on marketing in Norway and Sweden, and soon afterwards in the United Kingdom. Future plans include service offering in the United States.
The rise in health care and medical tourism will be a precious source of income for Iceland, having suffered crashing banks and a collapsing economy in 2008 and 2009, and put a hold on all projects. 2010 sees travellers from the UK flocking to Iceland due to the favourable currency exchange rate. Iceland’s leading airline, Icelandair, has seen an increase in UK sales over the past year since the Icelandic economic situation, where voter refusal to allow the government to compensate British investors in failed Icelandic banks has ironically brought increased attention to the country. World travel guide Lonely Planet has chosen Iceland as the best value destination for 2010. UK customers are seen as a key market for medical tourism.
Ásbrú is a new name to a former Nato military base near Keflavik airport. After Nato evacuation in 2006, the base was re-invented as a community of entrepreneurs, students and business. Housing facilities on the former military base will be used to accommodate patients and their families. Kjartan Thor Eiriksson of Kadeco says, “The project is definitely one of the most exciting innovative ventures in Iceland at the present time. It will constitute an important aspect of the build-up and development at Asbru. The cluster of health related services at Asbru will be strengthened through the operations of the hospital, and this will attract even more diverse companies involved in medicine, treatment, health promotion, research, education and the production of various health related products.”
Kadeco manages the renovation venture. The real estate company Seltun, of which Kadeco is majority owner, will own the hospital, lease it out to Icelandic Healthcare, and oversee the financing of that aspect of the venture. Salt Health, which holds an 85% share in the company, owns Iceland Healthcare; Otto Nordhus holds an 8% share, and various other parties with a combined total of 5%. Robert Wessman and Otto Nordhus hold majority ownership in Salt Health. They own the operating company but are not directly involved in financing or investment of the reconstructed hospital.

The government of Seoul, the capital city of South Korea, has introduced an enhanced plan for its medical tourism offering, as part of its effort to increase tourism revenue through its advanced medical services.
Under the plan, the city government will focus on developing five medical areas, including health checks, skin care, cosmetic surgery, herbal medicine, and dental services, while partnering with local clinics and hospitals to establish one-stop services where the patient can receive comprehensive medical services. The official statement says, "In order to develop Seoul as Asia’s leading medical tourism city, we are planning to enhance measures in both quality and quantity while strategizing ways to effectively promote our services overseas. Medical tourists spend more money and their time of stay is longer than regular tourists, which make them a very special target audience. Each person spends US$3,250 per visits” The government of Seoul will finalize the list of partners for this plan, by the end of March after an extensive evaluation process. These partners will be responsible for promoting the service to overseas markets.
Other parts of Korea see the opportunities for medical tourism: Busan, the southern port city, and Gangnam, south of Seoul. Both areas have proved that they are capable of becoming leaders in a local market. Busan has long been visited by Japanese tourists arriving by ferry and flights for overnight shopping sprees and aesthetic therapies. As well as hair transplants, manicures and pedicures, the city is expanding into cosmetic surgery and other medical services. Cosmetic surgery clinics are receiving Japanese medical tourists who want to look like Korean celebrities. Local cosmetic surgeons and medical tourism agencies are now attracting Russian health tourists. The local government is supporting the industry.
Gangnam, one of the most affluent areas in the country, contains one in three hospitals and two in three cosmetic surgery clinics in Seoul. Top-class hotels such as the Ritz Carlton, Intercontinental, Park Hyatt, Marriott, fashionable restaurants, shopping districts and tourist attractions are all popular with medical tourists. According to the district office, the area saw a 25 percent jump in the number of foreign visitors to its clinics in 2009. Seoul’s Incheon International airport now has a medical tourism information centre with a rest area, information on local hospitals and clinics, and free internet access.
One blot on the horizon is a report that Korea’s major hospitals charge medical tourists, 2.5 to 3 times more than locals. The hospitals say the pricing is globally competitive but critics argue that dual and discriminatory pricing policy will ultimately scare away foreign patients, jeopardizing the plan to make the medical tourism industry one of the nation’s main growth engines. Some hospitals counter that the restrictions they have on pricing to Koreans means that they are under pricing to locals. Another counter argument is that medical tourists are charged more to cover the cost of international patient centres, the longer consultation periods, the costs of marketing, and the need for interpreters.
Pricing is subject to local medical laws, but the majority of hospitals claim that foreigners are not subject to medical law. If their argument is correct, foreigners cannot be protected from malpractice and other legal risks. Another problem is that two-tier pricing may also violate the Fair Trade Law, which stipulates that unfair or discriminatory deals can be punished by a fine of up to 2 percent of the gross sales.
Jung Eun-Young at the Ministry for Health says that legislators revised the medical laws last May with the clear intent to introduce a two-tier system. Under the revised law, hospitals are allowed to directly market medical services to foreign patients, and are obliged to notify the list of fees for medical treatments not covered by insurance through a booklet and website. Although the deadline for the new pricing rules was the end of January, most of the 1500 hospitals licensed to treat medical tourists have not made a price list available to foreigners.
While the pricing debate has raged in the local and national press in the country, the various bodies promoting medical tourism to South Korea have been noticeable by their silence on the issue.

The Mexican federal government’s Tourism Secretariat has a new initiative to rejuvenate medical tourism in the country, expecting 650,000 visitors, who will spend $US50 million by 2020.
Secretary of tourism Rodolfo Elizondo explained that the project sought to enlist all private hospitals of international status and create a specific offer that will be primarily promoted within Hispanic communities in Texas and California. Most of this community has no health insurance; so several thousand people living over the border could be interested in the services that Mexico has to offer.
Ricardo Haneine, a private consultant who helped the government develop this project, explained that in the first five years of the programme, elective services such as cosmetic surgery, ophthalmology and odontology, as well as basic cardiology and chemotherapy treatments, would be offered. From the sixth year on, more specialized services will be provided in order to attract a higher number of people looking for medical treatment.
40 hospitals have been listed as quality hospitals by national and international standards, eight of which are already certified by JCI. The federal government is currently looking for an agreement with international institutions to enable hospitals in Mexico to be certified nationally and internationally at the same time. The Tourism Secretariat intends to integrate another 50 hospitals into its programme in the next ten years, projecting to invest US$1025 million.
The Secretary of Tourism stated that although a few hospitals already welcome foreigners and do their own promotion by themselves, it is the first time that the government has got behind them with plans for a more integrated and targeted marketing campaign.
Mexico’s Health Ministry plans to build up the country’s medical tourism infrastructure during the next two years. The initiative includes training a group of bilingual Spanish-English nurses, a pilot programme is being organized. Very popular with Americans are low cost dental procedures in the border towns. Clinics estimate that 40 percent of their patients are foreigners during the tourist high season that spans the months from October to March. Figures would be higher if the epidemic of drug and gang related violence in some border towns could be eradicated.
Health tourism is also a main priority for the new Governor of Sonora as Sonora is very close to large populations in Arizona and California, and Hospital CIMA Hermosillo in Hermosillo sees American medical tourists as a lucrative opportunity. Regional initiatives to promote medical tourism are underway in the northern border states of Chihuahua, Baja California and Nuevo Leon.
What the government has yet to do to encourage the recovery of the tourism industry after the recession of 2009 is amend and update laws on tourism as a matter of urgency and ensure that the Tourism Secretariat both continues to exist and is supplied with the funds it needs to make the project work. The plan can be seen as a late attempt by the organisation to survive, as late last year the government announced plans to close it and merge it into a new department of tourism and trade .The future is still uncertain as many politicians oppose the merger, so it is still la matter of discussion, lobbying and political maneuvering. Mexican Health Minister Jose Angel Cordova Villalobos wants greater coordination at the federal level. Ultimately, whether or not federal assistance actually happens, is dependent on national and local politicians working together, and putting their individual ambitions and party politics aside- but as we have seen in the US over health reform, this rarely happens.

Jamaica, Fiji and The Bahamas are all islands and have three other things in common. They all rely heavily on the tourist trade, have all suffered in the last year, and see medical tourism as a way of replacing lost revenue and jobs. Whether they are island dreamers or interesting new locations, only time will tell.
The Grand Bahama Port Authority’s (GBPA) bid to attract medical tourism to the island will be supported by the government, said Minister of Health Hubert Minnis, but only when the plan is properly organized and there are guidelines in place, “The idea of medical tourism is an excellent one." GBPA has identified two areas –cardiovascular medicine and orthopaedic medicine – for specialized hospitals for Grand Bahama and a developer investor kit has targeted the top 10 or 15 hospitals in the United States for the island. The intention is to attract only certain types of medical procedures and to start off with those with a relatively low risk to avoid any accidents that could potentially ruin the business. GBPA chairman Hannes Babak said last year, “We want to lead medical tourism and that will help local practitioners and give them a great facility in terms of a hospital." The GBPA chairman had talked of securing a deal for a $100 million 100-room hospital. It is now unclear if that plan is still on the drawing board as he has not been at the GBPA since his work permit expired on December 31st 2009.
Tourism Fiji sees medical tourism as a promising and emerging market for attracting more tourists. Patrick Wong of Tourism Fiji says much needed investment in the area in partnership with an international brand is also important, "Medical tourism would be a boost developing our tourism industry. It would require a very high standard of medical villages investing in the likes of retirement villages, cosmetic surgery, health institutions, health farms and other specialized medically related establishments. Cosmetic surgery as seen on the television series Make Over will encourage people to come to Fiji for this.” Tourism Fiji sees medical tourism as a niche market it would like to pursue in partnership with international hospital groups. Indian group Apollo has, according to Tourism Fiji, shown interest in a site at Lautoka. Indian investors toured the country in 2006 during an attempt by the Health Ministry to attract investment, but none pursued any projects.
In Jamaica, health and wellness tourism is now high on the agenda of tourism minister Edmund Bartlett who says he will be pushing that industry full force with the expectation that it will yield large revenues. He says the industry is yet to be fully explored despite all the basic fundamentals being in place. The minister says Jamaica has a major advantage in its dental care based on expertise available and cost of the service. He says the country compares well with developed countries and would fit well with an ideal vacation spot, "We are working with the ministries of health and industry to review and create legalization and regulations. I have been getting a number on inquires about health and wellness tourism, followed by proposals, two of which we have taken on board and are working with."

Lebanon is now seeking to become a centre for medical tourism. Making Lebanon the hospital of the East is the ambition of the Tourism Council. With 11,505 physicians and 177 hospitals, the country wants to attract overseas customers. According to a report published by the Agency for Investment Development in Lebanon (IDAL), the growth of medical tourism is expected to be around 30% on average between 2009 and 2011. DAL’s mission is to promote Lebanon as a viable investment destination.
Le Royal Beirut Hotel is an example of a hotel that has made partnerships with clinics, travel agencies and airlines to offer packages for medical tourism. It wants to be at the forefront of the business. Wellness refers to the spa with holistic treatments from mud baths to facials, a concept that has been operating successfully at the hotel for several years. Two years ago the hotel introduced sophisticated slimming equipment and an in-house dietician, designing programmes for travellers who wished to lose weight, change their lifestyle and regain their health. Recently it went a step further and launched a complete health tourism package with a range of partners. Joyce Mouawad explains. “The programme was launched in February and Middle East Airlines will be responsible for the airline ticket, Nakhal will take care of transportation inside Lebanon and the hotel will host the client/patient before and after treatment. The patient will be treated at the Bellevue Medical Centre, a general hospital with advanced equipment, which excels in diagnosis and different types of surgery, including cosmetic surgery. With the country having hit a record number of tourists last year, there is no doubt that non-seasonal medical tourism is set to increase and boost the hospitality industry.”
The package is aimed initially at Arab travellers who visit Lebanon for anything from cosmetic surgery and dental care to intestinal bypass operations, but also wants to attract European tourists, particularly from Cyprus and Greece. . There are also partnerships with other specialised medical centres that will be launched soon. The new package has met with official approval from the country’s Ministry of Tourism as an initiative that is set to help Lebanon’s reputation as a wellness and health destination improve even further.
Attracting European medical tourists is difficult. Although the situation overall in Lebanon is calm, it is fragile. On several occasions in recent years, the security situation has deteriorated quickly. Several European governments, including the UK –whose lead on travel advice most follow- currently advises against all travel to some areas of Lebanon and all but essential travel to other areas of Lebanon.

The promotion of health tourism to Cyprus could have a knock-on effect in the quality and cost of private healthcare provided on the island, operators said at the Heathcare Business Conference in Nicosia.
One problem identified is the lack of international accreditation. Currently the accreditation position is lagging considerably in Cyprus, a situation that has been ongoing for two years despite the Health Ministry promising to co-sponsor the accreditation applications of a number of private health institutions. So far, only the Bank of Cyprus Oncology Centre in Nicosia has been accredited by CHKS and Near East University Faculty of Dentistry in Lefkosahas been accredited by JCI’ although the latter is not interested in medical tourism.
The conference was told that the country is owed money from EU countries that it cannot reclaim as private healthcare institutions in Cyprus which treat foreign citizens resident in Cyprus under reciprocal treatment schemes cannot secure payment for the treatment from the national governments or insurance companies in question. Nikos Maroudias of the Cyprus Health Service Promotion Board argues, “The increase in the quality standards which comes with health tourism will also benefit local patients.”
The standards, service and perhaps, above all, cost of healthcare in Cyprus is deemed sufficiently competitive in the European market for the Cyprus Chamber of Commerce and Industry (CCCI) to have held a conference to promote and examine the industry. Dental treatment in Cyprus, for example, is on average about 40-50 per cent cheaper than the UK.
Manthos Mavromatis of the CCCI comments,” Cyprus is in line with European standards and in a harmonised position regarding the healthcare industry, so it is useful for Europeans who wish to undergo treatment. The Health Ministry has engaged in an unforgivable delay in certifying some private healthcare institutes. We call on the ministry to certify them, so that they can get on with doing their job.” The Cyprus Tourism Organisation (CTO) says there are 11 health centres yet to receive Health Ministry accreditation, where private investors have expressed an interest filed with the CTO under the Motivational Plan for the Improvement of the Tourist Product. The Cyprus Health Service Promotion Board is also pushing for accreditation.
With the economic crisis a drop in foreign custom as high as 30 per cent has been experienced by private healthcare providers on the island. This is a trend that has also been affected by cheaper alternative destinations being available for the medical tourist, such as Hungary, Bulgaria and Syria. Cyprus remains very competitive in terms of the costs involved but does need to work on remaining competitive and on lowering its prices.
After being hit by the recession and a fall in tourism numbers, one of the main hospitals in Nicosia was badly damaged by the recent storms that caused death and destruction across Europe.

The Taiwanese government has approved a package of amendments that pave the way for foreign investors to open hospitals in Taiwan, although a decision has yet to be made whether or not Chinese investors will be eligible for the new measures. The law amendments must be approved by the legislature before they can be implemented, but that is only a formality. In line with the amended provisions, which provide tax incentives, investors in international medical services can establish hospitals in an exclusive biomedical park in northern Taiwan’s Hsinchu County in the form of a corporation. They can also issue shares. Health minister Yaung Chih-liang said, “ This will help lay a foundation for Taiwan to develop international medical services and medical tourism.
The DOH has agreed to allow foreign investors or joint ventures to set up the hospitals based on the build-operate-transfer model on a 7.85 hectare plot within the planned 38-hectare biomedical park in Hsinchu. It is estimated that foreign capital will be attracted to Taiwan as a result of the plan. The DOH does not restrict international investors from setting up medical facilities in appointed zones, nor does it limit the number of such facilities, so Kinmen Island would also be an acceptable location.”
The government has been criticized for promoting medical tourism at the expanse of caring for the local population. So it argues that such international hospitals add to rather than take away from Taiwan’s medical resources, as they are profit-making establishments that target only the better off customer who must pay for all of their own expenses, with no subsidy from the government. Taiwan’s medical level is on par with international standards and can compete with Singapore, Hong Kong and Dubai, but the country has not attracted as many patients as it expected.
With the relaxation of rules on Chinese traveling to Taiwan, Taiwan Institute of Economic Research (TIER) says Taiwan had 40,000 medical tourists in 2009, and estimates for 2010 are at least that. But this is nowhere near the government’s target of 100,000 by 2012. The Taiwanese government is focusing on health examinations, cosmetic surgery, dentistry, laser eye surgery and Chinese herbal medication in order to attract Chinese from around the world to Taiwan. Although other nations are targeted, the country has found it almost impossible to attract Europeans and Americans not of Chinese origin. Scores of local hospitals have joined the top ones in targeting medical tourists, while entrepreneurs have set up clinics just to offer health checks.

As Japan encourages Chinese medical tourists, the government warns hospitals against assisting Japanese patients to get transplants in China.
The Japan Tourism Agency (JTA) is looking to boost the number of medical tourists coming from China. The JTA hopes to boost the number of medical tourists to Japan to 100 a year. The agency set up a study panel on medical tourism targeting China’s wealthy class last year and has been looking into ways to secure interpreters and responses to medical accidents. The agency is also planning to conduct a survey on Chinese tourists and medical institutions in Japan. They will ask what medical treatment they want, their preferred payment methods and what kind of tourism information they are interested in.
So far, 30 Chinese have joined medical tours to Japan organized by Nippon Travel Agency. The Tokyo-based company launched package tours in April last year, incorporating cancer-detecting PET (positron emission tomography) checks along with the usual sightseeing.
The Japanese government recently warned hospitals from assisting with transplant tourism to China after an investigation of over two hundred hospitals uncovered several doctors who had provided such assistance. The Japanese Society disallows transplant tourism to China for Transplantation because of China’s lack of transparency and use of prison inmates in obtaining organs.
The Japanese Ministry of Health, Labour and Welfare conducted investigations of 247 hospitals in Japan, finding that doctors in five of the hospitals, including several in Tokyo, were found to have aided patients by providing their medical histories to agencies who could arrange organ transplants overseas for them. The Ministry of Health warned the hospitals not to assist in illegal organ trafficking, “Organ transplants that are not approved by the government are not only illegal but are organs for sale. Please contact the ministry if suspected agencies attempt to obtain or breach patient information.” The ministry warns medical personnel in large hospitals as well as small clinics not to assist with illegal, commercialized organ transplants and to handle patient information with caution.
The Japanese hospital system is in a state of crisis. There is not only a shortage of doctors and nurses, but also a growing shortage of beds as well, due to the poor financial condition of many hospitals. The Japanese public medical system currently allows for 5400 procedures, each of which is strictly regulated in terms of price and method in order to qualify for government reimbursement. The financial crisis for many hospitals has come about as the government continues to seek ways to cut its annual health spending.
JTA is cooperating with ten hospitals in Japan (mainly in Tokyo). The idea is to offer l treatment to Chinese medical tourists, concentrating on brain surgery, cosmetic surgery, and oncology. The JTA has admitted that it has a number of challenges, including language and payment methods. A survey will question Japanese medical institutions over whether they can provide care in foreign languages and how they will provide treatment information to their clients.
There are many problems with bringing Chinese patients into Japan, the least of which is the simple matter of getting cooperation from the immigration authorities that can take three months or more to issue visas, and require lots of detailed documentation. Other problems include• Logistics –specialized transportation may be needed from the airport • Language — Chinese-Japanese interpreters are few and expensive• Legal — Informed consents for operations must be in Chinese• Fees — How much to charge? • Payment methods — Bank transfers?• Culture – Getting Japanese hospitals tend to treat their patients as customers and not as people who do as the hospital orders them • Amenities – Few Japanese hospitals have quality rooms for wealthy patients• Post-operative follow-up — Who will do this?• Accompanying family — Do they also get visas?

German based international hospital accreditor Temos has been quietly expanding the range of services it offers, the partners it works with and the number of international hospitals accredited by it. Late in 2009 it launched Temos Dental.
Dental tourism is one of the most developing fields in medical tourism. The competition is high and the quality of dental treatment is very different, and not always as it should be. In the dental tourism market the assessment of quality, patient safety as well as patient satisfaction, guaranteed pre- and after-treatment and cost-effectiveness are important issues for all involved parties.
Dr. Claudia Mika of Temos explains. “ We developed the system together with several German medical services, health insurers, dentists and experts in quality management. The system is ready and we have started negotiating with several dentists/dental clinics about an accreditation. Temos Dental is not a standard or a norm like ISO 9001 or JCI which has to be implemented 1:1 and ignoring own- often even better because developed over years- internal QM approaches. It is an assessment and validation of the existing quality and supports optimization individually for the clinic/practice in the frame of the on-site visit and the reporting. If the existing system is an ISO or JCI, this is OK and we do accept but will of course check that. Our experience shows that there is in 100 % of the hospitals we visited, and which are accredited by others, potential for optimization. Our philosophy is that you need to include different cultures, different mentalities and national norms and laws that result in different realization of quality management. We developed the system with German experts but due to the international focus with some space for flexibility for our partners. That means, there is no negotiation with the hospitals and clinics about our quality criteria to be met to pass and to receive the certificate. But our experience is that the compliance is much higher when we work together with the staff and management on existing quality approaches than to force people into implementing a completely new system. For me it has been important to develop a practical approach which is of use for the assessed facility and which is lived after we have left the facility and not remembered again shortly before the next assessment. What is unique for Temos Dental is that we are also checking the pre- and after-treatment processes, billing, and innovative approaches like telemedicine. “
TEMOS and Trent Accreditation Scheme, the UK based international accreditation organization, have agreed to partner on various projects. The first project is focusing on the certification and validation of dental facilities. Elizabeth Brownhill from Trents explains, “We have reached an agreement with Temos that we will do some joint work on dental clinic accreditation. We have standards for dental clinics. Temos has a similar developmental philosophy to us, so will test out joint working using our standards and joint survey.”
Trent is preparing to undertake the next round of surveys of private hospitals in Hong Kong and welcome a new member to the scheme, the Hong Kong Anti-cancer Society Jockey Club Cancer Rehabilitation Centre. The other hospitals in the scheme in Hong Kong are Canossa, Evangel, Hong Kong Adventist, Hong Kong Baptist, Hong Kong Sanatorium, Matilda, Precious Blood, St. Paul’s, St. Teresa’s, Tsuen Wan Adventist, and Union. Hospitals in Cyprus, Malta and the Philippines are also undergoing accreditation.

16 Canadian spas have received “Quality Assurance Approved” status, a national designation recognizing consistent safety and hygiene standards in the spa industry, offering reassurance and uncompromising quality for spa guests.
They are;
* 100 Fountain Spa at the Pillar and Post, Niagara-on-the-Lake,* Ambiance Day Spa, Saint John* Brentwood Bay Lodge & Spa, Victoria* Haven Spa at Sidney Pier Hotel & Spa, Sidney* Holtz Spa, Ottawa* Riverstone Spa, Inn at the Forks, Winnipeg* Rosewater Spa of Oakville, Oakville,* Santé Spa Calgary, Calgary* Santé Spa Victoria, Bear Mountain Resort, Victoria* Secret Garden Spa at The Prince of Wales, Niagara-on-the-Lake* Shear Elegance Salon & Spa, London* Sun Tree Spa, Temple Gardens Mineral Spa Resort, Moose Jaw* Ten Spa, Winnipeg* The Grotto Spa at Tigh-na-Mara Resort, Parksville* The Spa Ritual, Calgary* Vida Wellness Spa, Wall Centre, Vancouver
Following several years developing the criteria, Leading Spas of Canada introduced an extensive Quality Assurance program as a pilot project last year. Diane Sparrow explains, “Safety and hygiene standards have been a key concern over the past few years, as the popularity of spa treatments has grown. Spa offerings and amenities vary dramatically. This programme is not designed to measure the value of amenities, such as steam room or sauna, nor to credit them for the size of their spa, and grade them on a scale. The spas are all examined by the same criteria and must meet all essential safety, hygiene and operational standards. Receiving QAA status identifies them as dedicated to safety, hygiene and operating practices, offering confidence and comfort to the spa management, employees and the guest.”
To receive recognition as a “Quality Assurance Approved” spa, on-site assessments were conducted, examining each spa’s standards regarding sterilization of instruments, hygiene standards in treatment protocols, equipment and facility safety, cleanliness, proper safety and security procedures, staff certification and education, proper signage and customer service standards. To ensure proper standards for the staff, human resource processes were examined as well, in addition to the spas marketing materials being reviewed to confirm required information including cancellation and gratuity policies, rates and menu of services were clearly presented. The assessments were conducted by specially trained third-party evaluators, to maintain the integrity of the program, and culminate in a strict pass or fail result. All of the criteria must be met or exceeded before the spa receives their Quality Assurance Approved (QAA) status. The spas that successfully achieved QAA status during the pilot program were recently awarded a certificate for display and seal of approval to incorporate into their marketing materials, valid for the next two years before another assessment will be conducted.
Since 1998, Leading Spas of Canada (LSC) has been Canada’s only national spa association, setting rigorous standards of safety, hygiene and service. For the past decade, these standards were supported through voluntary adherence by all member spas, which remains for all member spas. The new Quality Assurance program is a step beyond, incorporating the on-site assessments to physically verify all requirements are met or exceeded. Leading Spas of Canada say the initiative is the only national comprehensive assessment program for spas in the world.

Malta’s main international links are with the UK, due to history and tourism, and Italy, its main trading partner in Europe. Maltese patients who cannot get treatment at home now have a choice of government paid treatment in the UK or Italy.
The UK link is a long standing one and now the Ministry for Health has entered into an agreement with Air Malta to extend the national highly specialized referral programme to provide cost reduced flight tickets to persons who require medical assistance abroad. Air Malta will reduce airfares for those requiring medical treatment in the UK, and waive most of the ticketing conditions usually applicable for public travel, giving patients and the government flexibility in booking air tickets.
In 2009, there were 477 cases who required assisted travelling, 174 of whom were aged under 18 years. The government pays for all children under 18 years who require treatment in the UK and for one accompanying adult. In 2009 Air Malta carried four incubator cases, 26 stretcher cases and 81 oxygen cases. The new agreement supersedes another concluded 30 years ago.
The government has a new similar agreement with Italy from 2010, enabling Maltese patients to receive treatment in Italy, if this is not available in Malta. Patients can now go to Italy for emergency and high-intensive care, neoplastic and cardiovascular disease, organ donation and transplantation. In these and other sectors of healthcare, Italy boasts reputable institutes in health and advanced research.
The signing of the Italo-Maltese agreement has now given patients a choice between going to the UK or to Italy. The agreement will also create links between experts and facilities in both countries for the provision of medical care to their populations. This agreement includes other areas of cooperation; exchange of research material and epidemiological information, exchange of information on assessments of new medicines and emerging health technologies and policies on their use in the health sector, collaboration between professional organisations and non-governmental health sector organisations and the development of mechanisms to combat emerging health threats and communicable diseases with a focus in the Euro-Mediterranean region.
The new arrangement is for a period of four years and can be renewed for further periods of time. Italy is by far Malta’s biggest trading partner and has not only maintained the numbers of Italian tourists visiting it but has actually increased them well as the number of air/sea routes operating between our two countries.

Indonesian hospitals claiming to be international should change their name unless they can prove they have accreditation from a recognized international accreditor, said a Ministry of Health official after reports of such hospitals turning away low-income patients.
Farid W. Husein said any hospital with the tag international added on to the end of the name should have international accreditation, “ There is only one hospital in Indonesia with such accreditation, and that hospital does not have international in its name.” He said there were 10 known hospitals using the word international in their names, adding they had been given until August to obtain international accreditation, or else would have to drop the word from their names, “We will consider it an act of willful deceit if they continue to use the word without having obtained the requisite accreditation.” As it is impossible to get international accreditation from a reputable accreditor within that time scale, the ministry is effectively telling these hospitals to change their names – something that is possible within months.
Such hospitals in major cities nationwide are popular among patients. More affluent Indonesians tend to seek healthcare abroad, particularly in Singapore and Malaysia, citing the poor services available at home. International hospitals are considered a compromise between prohibitively expensive overseas trips and substandard treatment at other local hospitals.
A new law on hospitals, passed last year, aims to address complaints of hospital services. Although the law does not specify the punishment for hospitals making false claims about their qualifications, the ministry has wide enough powers to make up their own punishment. The Indonesian government has its own accreditation system for hospitals, but it is not of international quality. So even the government says hospitals can only get international accreditation after being examined by an international organization.
Siloam Hospitals Lippo Village in Tangerang is the only hospital in the country with international accreditation, from JCI.Omni International Hospital has defended itself by saying that it brands itself “international” because “it excels in human resources and facilities”; but the Tangerang hospital accepts it is on shaky ground, and has rapidly emphasized that it intends to obtain international JCI accreditation within a year, as does Santosa Bandung International Hospital.
If the hospitals believe Husein’s threats are empty, a recent case may change their mind. The Health Ministry has issued a warning to Mayapada Hospital in Tangerang for hiring foreign unregistered oncology consultants who did not have a practice license. Farid W Husein asked the hospital to announce to the public that they had terminated the service. Mayapada had placed an advertisement in a national newspaper about the foreign oncologists. The hospital removed the advertisement and published an apology. The government will also apply penalties to foreign doctors who practice in Indonesia without registration and a practice permit. The penalty will also apply to the institution that hired them.

The Colombian government is promoting the South American country as a medical tourism destination, where visitors can receive high quality-low cost treatments such as cosmetic surgery and dentistry.
Tourism minister Luis Guillermo Plata says that the government expects to see a rise in medical tourism visitors because the quality of Colombian medicine is high but far cheaper than treatments in Europe and the U.S.The government estimates that twenty foreigners travel to Colombia every month for cosmetic surgery procedures such as liposuction, rhinoplasty and breast augmentation. The majority of patients come from the USA, Spain, Panama and Mexico, according to the government. Approximately 2.2 per cent of visitors to Colombia in 2008 came to receive medical treatment, around 27000 people. The government estimates that the majority of these patients were Colombians residing in other countries. One problem for Colombia is that several hospitals are still only in the middle of their international accreditation process. Colombia is projecting itself as one of Latin America’s main destinations in terms of health tourism. Expectations concerning the increase in the number of health tourists in the coming years are high due to the excellent quality of medical care and the high cost of treatment in the United States and Europe, where the ratio to Colombia is seven to one.
In view of the increasing strength of the sector and in the process of waiting for health organizations to obtain their certification, the government is planning alliances between the health and tourism sectors to create packages that will include medical treatment, lodging, food, transfers, and tours according to the complexity of treatment.
Colombia has expectations for health and wellness tourism with spas and spa-hotels planning to offer services on a par with five-star hotels. Cosmetic and weight-loss surgery both offer potential. Former Argentinean soccer star Diego Armando Maradona, recently had weight-loss and cosmetic surgery in the country.
The development of health and medical tourism in Colombia depends on getting referrals, international accreditation hospitals, alliances with international clinics and hospitals, as well as the implementation of an infrastructure for bringing together the health and tourism sectors.
The Ministry of Trade, Industry, and Tourism sees health services as one of the categories for providing increasing income for the country, and is helping investments in the construction and outfitting of spas and clinics. The main locations will be the cities of Bogota, Cali, and Medellin.
While only 541,000 foreigners went to Colombia in 2002, 1.22 million tourists chose this country as a travel destination in 2008. Bogota is the most visited city. Second place is Cartagena, followed by Medellin, Cali and Barranquilla.
As yet it is slow progress, with a lot of work to do to get facilities up to the standard that international health and medical tourists now expect. Only when that is achieved, can the country begin to market itself as a serious destination.

The organisers of Destination Health – The Health & Medical Tourism Show have published the list of exhibitors who will be taking part in the show.
Nav Mann, Event Director says “With less than 2 months to go to Destination Health, we are very pleased with the wide variety of healthcare providers who will be taking part in the event. From dentistry to cosmetic surgery to fertility treatments and medical procedures, we have gathered together the very best clinics and hospitals from around the world to meet with UK patients who are planning to travel overseas for treatment”
According to the organisers, healthcare providers will be coming from all over the world to exhibit at Destination Health. Countries represented so far include; Barbados, Denmark, Germany, Croatia, Turkey, Iran, Iraq, India, Thailand, Singapore, Spain, Czech Republic , Italy, Greece, Antigua, Hungary, Poland, Egypt, Cyprus, Portugal, Lebanon and Malta.
Anand Chaudhary from Medical First Health & Wellbeing, “The decision to exhibit at Destination Health was easy. We realise that our participation at this event places us firmly on the map for medical treatment abroad and with the opportunity to meet people we are saying ’we are here and we can treat you’. What better show of confidence and trust is there?”
Destination Health is supported by media partners Treatment Abroad the Europe’s number one medical tourism website and the International Medical Tourism Journal (IMTJ), Destination Health will take place on the 17th & 18th April 2010 at the Olympia Exhibition & Conference Centre.

Private clinics and hospitals in Georgia are trying to break into the international medical tourism market by offering inexpensive procedures and taking advantage of lenient legislation, but the government has no interest in helping them.
Healthcare Agency International (HIA) in Tbilisi has been bringing patients to Georgia – and sending Georgians abroad for treatment – for the past three years. The company says that Georgia is an attractive medical treatment destination for infertility treatment and surrogate mother selection. This is because Georgia permits procedures that are banned in Europe and elsewhere, including surrogacy egg donation. HIA offers customers a database of surrogate mothers with photographs – a practice that has largely been discontinued in other countries due to privacy issues. HIA also offers background information and details about the women egg donors. The agency charges $20,000 for the entire surrogate package, including the fee for the mother, medicines and delivery, a fraction of the cost for the entire procedure in the United States. International patients account for 50 to 60 % of the clinic’s total business, and it is anticipated that the percentage and total numbers will grow.
Georgia is also offering international patients hair transplants and dentistry. Existing problems include the lack of direct flights and absence of international accreditation of clinics or hospitals. Few hospital and clinic websites are in English or other non-Georgian languages.
Another problem is the government’s total lack of interest promoting Georgia as a medical treatment destination. Less than 1 percent of the 1.3 million visitors to Georgia in 2007 came for medical or spa treatments, according to the latest figures available from the Department of Tourism and Resorts. The government is doing nothing to promote or develop the field either domestically or internationally. The Ministry of Health argues that medical tourism is the sole responsibility of the Department of Tourism and Resorts in the Ministry of Economic Development; and in turn that department says it the government is looking into the country’s potential for medical tourism, and its priority is to recapture the country’s Soviet-era legacy as a regional spa destination. There are 100 spa resorts in Georgia. Local travel agencies argue that the authorities are not marketing the country and relying on a historic spa reputation to get visitors is not enough.

Jupiter Hospitals that runs a 200-bed hospital in Thane will launch its first hotel, Fortune Park Lakecity, very soon. The group has signed Fortune Park Hotels to manage and market of the hotel. Jupiter Hospital is looking for similar hospital/hotel projects in Southern India. The ten-storey Fortune Park Lakecity will have 94 rooms, 58 in the first phase. It will have four categories of rooms including standard, fortune clubroom, executive suite and deluxe suite, a multi-cuisine vegetarian restaurant ’Rainbow’, banquet, boardroom and a private dining room. In the second phase Fortune Deli, a lounge; health club; swimming pool; gymnasium and health super market will be operational. The hotel will also have a spa, which will be developed as phase three.
Dr Ajay Thakker of Jupiter Hospitals says, “Everybody speaks about promoting health tourism in India but hardly any one thinks about the infrastructure to support it. India has the best of medical services but it has to be backed up by good infrastructure and accommodation for patients. So we thought of building a hotel within the hospital premises.” The hospital will account for 25-30 per cent of the hotel’s business. Apart from the hospital clientele, the hotel will cater to business and corporate client since this area is surrounded by many businesses. It will also introduce a new concept, Health Super Market, selling health and sports equipment and drinks.
As part of its expansion plans, Wockhardt Hospitals (WHL) is planning to open four new super speciality hospitals in the next three years after clearing its debt by selling ten hospitals with 1900 beds to Fortis Healthcare. WHL still has ten super speciality hospitals with 1200 beds. It is planning to open four new hospitals with a total of 1000 beds in the next three years in Mumbai, Bhopal, Jabalpur and Patana. Fortis now has 39 hospitals across India, including 6 in Bangalore, 4 in Mumbai and 3 in Kolkatta.
Following the terrorist bomb blast that killed nine people at the German Bakery in Pune, a restaurant frequented by overseas tourists, tourists have been advised to take maximum precautions, while travelling from, to or in any Indian city. Pune is a medical tourism destination for surgery, cosmetic surgery and dentistry. The US, the UK and Australia have issued travel advisories to their citizens to maintain a high level of vigilance, be aware of local events, and take the appropriate steps to bolster their personal security, as no city in India can now be regarded as safe.
Euthenic Group wants to promote medical tourism in Orissa and set up a 1000 bed-super speciality hospital in the state. After completion of the private-public project in 2013, the American group will hand over the hospital to the state government. The company argues that the state can earn foreign exchange through medical tourism. The health ministry has asked the company to submit a detailed project report to the state government as early as possible.

Predictions that American corporate and insurer paid medical tourism would be substantial, have been dealt a body blow by one large national employer agreeing to send all those needing heart surgery to one Cleveland hospital.
For four years, some agencies and experts have been predicting that it is only a matter of time before businesses and insurers send thousands of Americans overseas for surgery. Hannaford Brothers, often mentioned at conferences as a prime example of a company that has agreed to pay for employees going overseas, has in three years sent nobody overseas. A handful of smaller firms have agreed deals and sent the occasional person overseas, but most of the deals are when a company is close to the Mexican or Canadian border or mainly employs immigrants who want to combine treatment with a trip home to families in countries such as India.
Whilst corporate medical tourism evangelists continue to sing the same song, those who have arranged actual deals advise that only a small minority of companies will take up the offer, and while some employees will accept overseas treatment, other companies are finding nobody taking the option. Companion Global Healthcare has increased the number of companies contracted to provide medical travel benefits, but few employees are taking advantage of the benefit. WorldMedAssist is reported as seeing a similar trend.
Lowe’s Companies Inc. decided to shop nationally for the best deal in heart surgery for its employees. The USA’s second-largest home improvement retailer reached a three-year agreement with the Cleveland Clinic. The move could spur others to shop far and wide for medical treatment. This is the first time a multistate national company has chosen one specialist hospital and made it available to employees.
Lowe’s is offering incentives to employees in the form of reduced out-of-pocket costs to go to Cleveland for heart procedures. Lowe’s chose Cleveland Clinic from five hospitals nationwide in an effort to improve the quality of medical care for its workers and to lower costs, with a package price for doctor and hospital services. Based on past claims, Lowe’s estimates that some 125 patients a year could take advantage of the programme. Patients must be approved for surgery in advance. The arrangement is attractive enough that Lowe’s will pay travel and lodging expenses for patients and a companion, and waive a $500 deductible and other out-of-pocket costs.
Last year the hospital performed a record 4,128 heart surgeries and 44% of heart and chest surgeries patients were from outside Ohio. Michael McMillan of Cleveland Clinic comments, "The thing we will want to demonstrate together is that by an employee traveling to a place with better outcomes, fewer re-operations and lower complication rates, over time it will lead to lower costs."
Over the last two years there have been hundreds of articles looking at the potential of insurer paid employer arranged medical tourism for US businesses. Most have used the case of Hannaford Brothers to illustrate the potential for overseas hospitals. Hannaford has indeed encouraged medical tourism, but not outside the US. Three years ago, the Hannaford Brothers grocery chain became one of the first employers in the USA to encourage workers insured under the company health insurances to go abroad for medical care. Their insurer is Aetna, who used this as a pilot exercise. Aetna is now rather dismissive of the potential of insurance paid overseas medical tourism, and has no plans for more pilots or to offer it to any of their millions of insured. The original offer was that employees who flew to Singapore to have joint replacements did not have to pay any out-of-pocket expenses. Plus the company would cover travel costs for both the employee and a companion. Aetna agreed that if hospitals locally wanted to be able to match the quality that could be provided at the Singapore facility, and the cost-effective care that could be rendered there, that they also should be eligible to participate. St. Mary’s Hospital in Lewiston agreed a package rate comparable to what Hannaford would have to pay in Singapore, when major travel expenses are factored into the equation. So far, 10 people covered by Hannaford have taken the grocery chain up on its offer. A hospital in the Boston area is also participating. Nobody has gone to Singapore. St. Mary’s is in talks with other major employers who are interested in making an arrangement similar to the one it has with Hannaford.
The conclusion is that US domestic corporate medical travel is expanding quickly, but the reality of sending employees overseas remains a stagnant backwater in the flow of medical tourism.

Growth returned to global tourism in the last quarter of 2009 contributing to better than expected full-year results, according to the latest edition of the UNWTO World Tourism Barometer. International tourist arrivals fell by an estimated 4% in 2009. Prospects have also improved with arrivals now forecast to grow between 3% and 4% in 2010.Although any direct statistical link between medical tourism and other travel is yet unknown, both are driven by economic forces. Spa and wellness tourism are closely linked to holiday travel trends. Suggestions that medical tourism numbers globally fell by 20 to 25% in 2009 are unproven, but it is conceivable that elective medical tourism may be hit harder by recession than other types of tourism.
International tourist arrivals for business, leisure and other purposes declined worldwide by 4% in 2009 to 880 million. This represents a slight improvement on the previous estimate as a result of the 2% upswing in the last quarter of 2009. In contrast, international tourist arrivals shrank by 10%, 7% and 2% in the first three quarters respectively. Asia and the Pacific and the Middle East led the recovery with growth already turning positive in both regions in the second half of 2009.
Taleb Rifai of the World Tourism Organisation (UNWTO) commented, “The global economic crisis aggravated by the uncertainty around the flu pandemic turned 2009 into one of the toughest years for the tourism sector. Recent months suggest that recovery is underway, and even somewhat earlier and at a stronger pace than initially expected.”
Experience shows that tourism earnings generally follow the trend in arrivals quite closely, even if they suffer somewhat more in difficult times. Based on the trends through the first three quarters, receipts for 2009 are estimated to have decreased by around 6%. While this is unquestionably a disappointing result for an industry accustomed to continuous growth, it can also be interpreted as a sign of comparative resilience given the extremely difficult economic environment.
Similarly to the situation in previous crisis, consumers tended to travel closer to home during 2009. Several destinations have seen domestic tourism endure the crisis better and even grow significantly, often with the support of specific government measures aimed at leveraging this trend. This was the case among many other countries, of China, Brazil and Spain, where the domestic market, representing a large share of the total demand, contributed to partially offsetting the decline in international tourism.
Except for Africa, which bucked the global trend, all world regions show negative results in 2009:• Europe ended 2009 down 6%. Destinations in Central, Eastern and Northern Europe were particularly badly hit, while results in Western, Southern and Mediterranean Europe were relatively better.• Asia and the Pacific showed an extraordinary rebound with only a 2% drop. While arrivals declined by 7% between January and June, the second half of 2009 saw 3% growth reflecting improved regional economic results and prospects.• With a drop of 5% in the Americas .the Caribbean returned to growth in the last four months of 2009. The performance was more sluggish elsewhere.• The Middle East fall of 6% came after high growth levels of previous years, with a positive second half in 2009.• Africa was a robust performer with a 5% increase.
Against the backdrop of both the upturn in international tourism figures and overall economic indicators in recent months, UNWTO forecasts a growth in international tourist arrivals of between 3% and 4% in 2010. The International Monetary Fund (IMF) has just recently stated that the global recovery is occurring significantly faster than expected. Asia is expected to continue showing the strongest rebound, while Europe and the Americas are likely to recover at a more moderate pace. Growth is expected to return to the Middle East while Africa will continue its positive trend.
Upside opportunities:• Business and consumer confidence has picked up.• A slump is generally followed by a rebound due to pent-up demand and destinations are expected to actively leverage this opportunity.• There is scope for a revival among source markets that were hard hit in 2009 such as the Russian Federation and the UK.
Downside risks:• Unemployment is the key challenge. The jobs crisis is not over yet, particularly in major advanced economies.• Economic growth in major source markets of Europe and the USA is still fragile.• Stimulus measures are likely to be phased out due to increasing public deficits while a number of advanced economies may see increases in taxation, putting extra pressure on household and company budgets.• Oil prices remain volatile.• Terrorist and political security threats provide increased related hassle for travellers and will affect some countries badly.• Revenues are expected to recover at a slower pace than travel volumes.

Na’ama Moran, entrepreneur, believes medical tourism on cruise ships is the next big thing and a logical mixing of the three increasingly popular areas of medical tourism, health and wellness and cruising.
She gave a presentation on the business of medical tourism on ships, at the recent 2009 Seasteading Conference. Seasteading was originally an idea for a floating island for business or accommodation using an anchored platform. But cruise ships are floating cities already. So seasteading has extended into refurbishing a cargo or cruise ship, for business or residential purposes. Long-term habitation in a cruise or cargo ship may not be as easy as buying an apartment building, but the floating luxury condominium residence The World has been housing jet-setters since March of 2002.The main advantage of a shipstead is cost: both up-front purchase and maintenance are far cheaper than that of any platform ever designed.
Questions remain about the length of time a cruise or cargo ship could sit in the ocean before needing to come back to shore. Fresh water capacity, wastewater capacity, and other supply / maintenance concerns will likely be resolved differently per ship. Unresolved is whether large vessels, which are designed for movement and delivery rather than continuous occupation, could be relied upon to sit at all. Safety and/or regulatory standards may mean they have to keep moving, come to dry dock, and get an annual survey and inspection. A shipstead would be able to rely on the time-tested strength of its construction, spending its efforts on developing solutions to those external problems without the additional challenges of managing an experimental platform.
Moran argues that using the existing hospitality afforded by modern cruise ships, the political advantages of location outside of any government’s EEZ (Exclusive Economic Zone), and the growing trend of medical tourism around the world, she can build a business to provide revolutionary levels of hospital care to patients of all kinds. Operating in offshore waters outside of US jurisdiction, a medical cruise ship can offer equivalent cost savings to the services offered by foreign health care providers, but at increased levels of comfort and accommodation one would expect of a modern cruise vessel. As for the acquisition of a vessel, Moran notes, "This is the best time to get a cruise ship as there are many second hand ones around.’
Moran seeks to assemble a team of business builders, seed funders, and analysts, particularly those with specific experience in medicine, hospitality, insurance, and cruise industries, to kick start her vision of MediCruise. Many medical practitioners will be familiar with cruise ships, as they are a favoured location for medical conferences.
The original business idea for a medical tourism cruise ship is moving slowly forwards. SurgiCruise is a new business dedicated to bringing high quality medical treatment to patients at a reasonable cost by bringing care closer to them. SurgiCruise cruise ships will be specially retrofitted to provide a state-of-the-art facility to deliver medical care close to the United States. It has decided to start with orthopaedic surgery, as it is difficult for these patients to travel many hours in a plane and to stay in an unfamiliar country. The company says it is in the process of retrofitting a ship and hiring medical staff.

The Indian Medical Travel Association (IMTA) has announced their plans to attend Destination Health – The Health & Medical Tourism Show due to take place on 17-18 April 2010 at Olympia London.
Nav Mann, Event Director says “As one of the leading healthcare destinations, visitors to Destination Health are keen to see a good representation of Indian healthcare providers at the show. We are delighted to support the IMTA in its endeavors to promote India’s growing medical tourism industry ”
Amongst all global medical tourism destinations, India undoubtedly offers the best to the world in terms of quality, cost and care. Reputed Indian hospitals now have the latest cutting edge technology and world class doctors. The flow of overseas patients to India is growing every year at a healthy pace. Modern medicine combined with India’s five thousand year old traditional therapies can offer to the whole world an unbeatable healing package.
The IMTA – a unified voice of the Indian healthcare (modern medicine as well as traditional Indian medicine) and travel industry is aimed at preparing India for facing the challenges of global competition in Medical Tourism space and actualise the tremendous opportunity for India to become a leading global healthcare destination.
Destination Health is supported by media partners Treatment Abroad the Europe’s number one medical tourism website and the International Medical Tourism Journal (IMTJ), Destination Health will take place on the 17th & 18th April 2010 at the Olympia Exhibition & Conference Centre.
For information please visit www.destinationhealth.co.uk or call +44 208 230 0066 / +44 1420 849210 or email navmann@destinationhealth.co.uk / Twitter: medtourismshow

Medical tourism is increasing in Saudi Arabia, says the Supreme Commission for Tourism and Antiquities (SCTA), in a recent report, Health and medical tourism achieved more than 800 million Saudi riyals out of the total spending by both citizens and expatriates for domestic tourism in 2007. At the same time, foreign tourists spent over 400 million riyals to undergo treatment in the Kingdom during the period.” The SCTA report says that there are an increasing number of hospitals, clinics and promoting medical tourism in the kingdom, mainly in Riyadh and Jeddah. Unfortunately SCTA has no figures on numbers of medical tourists or revenue for 2008 and 2009.
Jeddah’s Dr. Soliman Fakeeh Hospital (DFSH), one of the leading hospitals in the region, has unveiled first-of-its-kind healthcare Corporate Social Responsibility (CSR) report in the Middle East. This unique sustainability report covers patient care, workplace relationships, community wellbeing and the environment.
DSFH says the report is aimed at reinforcing its commitment to sustainability and responsibility to the social environment it operates in. The DSFH report is also the first non-financial report to be developed by a hospital in the region. The report looks at steps to raise standards of patient treatment and care. Across the world, hotels and spas are increasingly promoting their environmentally friendly attitudes, as part of the global increase in eco-tourism and specially built eco-friendly hotels. As yet hospitals have ignored this trend that takes hotels away from competing on price and targeting a consumer sector that pays high prices for eco-friendly accommodation.
DSFH has implemented a series of initiatives such as cutting down on energy and water consumption, switching to eco-friendly technology and programmes aimed at cutting down on its carbon footprint. The philosophy is that sustainable businesses can cut costs, drive innovation, reduce risk and motivate employees.
Dr. Mazen Fakeeh at DSFH, said: “The hospital has always believed in practices built around the principles of honesty, responsibility and ethics. Over the last few years, we have established our mandate as a socially responsible hospital by cutting down on energy and water use, switched to digital x-rays, started recycling campaigns, and tracks our carbon emissions. Our objective is to raise the patient satisfaction rate by at least five per cent annually. These are the first steps towards a cleaner, greener future for Saudi Arabia. As part of the steps in this direction, we have fixed nearly 540 water saving installations that helped reduce our water consumption in 2008 by more than 50 per cent compared to the previous year. We also put in place a number of energy saving measures that have reduced our energy consumption by 5 per cent compared to the previous year. Our efforts are primarily aimed at embedding sustainability into every aspect of our strategy and decision-making; on patient care, workplace relationships, community wellbeing and environment.”
Dr Soliman Fakeeh Hospital (DSFH), founded in Jeddah in 1978, is a leading referral hospital. It is a regional pioneer in the field of organ-transplantation, including kidney, bone marrow, liver, and heart transplantation. Its open-heart surgery centre claims the highest number of operations done in the private sector in the kingdom with a success rate comparable to any international center of excellence.

Following the recent abolishment of visa requirements between Turkey and Syria, the southern province of Hatay has seen a remarkable increase in the number of patients from Syria, as well as from Lebanon, Iraq and Iran, who seek to benefit from better health services in Turkey. Private and public hospitals and clinics are getting an increase in the number of foreign patients. One private specializing in laser eye surgery is now getting 100 Syrian patients each month, in addition to patients from Lebanon, Iraq and Iran who cannot get such treatment at home.
Turkey is also attracting international private equity, as the country possesses all the positive traits for such investment – a young and growing population, a deep pool of managerial expertise, expanding trade links, an economy that is opening up, and fast developing capital markets. One sector attracting private equity is healthcare, and the buyers mostly want minority stakes and o leave the existing management in place.
In December, US private equity firm Carlyle Group took a 40% stake in healthcare group Medical Park and is looking to buy stakes in two other Turkish companies. Medical Park was established in 2005 with two existing hospitals based in Istanbul dating from the mid-1990s. Through the development of new hospital projects in leading cities in Western Turkey, and the acquisition of single hospitals based in North and East Anatolia, Medical Park now owns and operates 13 hospitals with 2000 beds. It is now the second largest healthcare services group in the country, but rapid expansion funded by loans, caught it out in the economic crash of 2009. Carlyle’s equity investment will be used primarily to finance the hospital company’s continued expansion and reduce debt. Can Delgag of Carlyle commented,” The Turkish healthcare services sector shows great promise as patient demand for services has been high and is expected to grow steadily."Walid Musallam of Carlyle added, "As the global financial crisis eases, we see increased investment opportunities in the MENA region in general and Turkey in particular. We will give all the necessary support to make Medical Park a successful regional player."
Universal Hospitals Group is another heavily indebted private Turkish hospital group looking for new private equity, and may sell its Ege Saglik hospital in Izmir, plus other Black Sea hospitals, to an un-named fund. Universal’s hospitals on the Black Sea coast attract many Russians. Universal is the largest healthcare services group in Turkey with 80 hospitals and clinics in Turkey. It has just opened its first overseas new 120-bed hospital in Albania’s capital city Tirana, as a way of targeting those Albanians unable or unwilling to go to Turkey for treatment. Plans include new hospitals in Sudan, Macedonia, Azerbaijan and Russia.
Turkey’s Ministry of Health oversees more than 1000 public hospitals throughout the country and there are also 375 private hospitals. The ministry has teamed up with JCI to transform Turkey’s health care system by developing its own set of standards to measure hospital quality. To that end, JCI helped the ministry develop a road map highlighting key areas of focus: hospital design, medication management, infection control, medical transport, patient safety and quality improvement, care continuum, and primary care. There are now 70 trained local surveyors ready to evaluate hospitals as it relates to patient safety. The ministry’s next goal is to develop primary health care standards. Turkey pursues its desire to have its own hospital accreditation system and has been tightening the rules on cosmetic surgery clinics.

The government should actively attract tourists from overseas with advanced cosmetic surgery and health examination services, say those involved locally in medical tourism.
Ben Tsao of Kaohsiung Aesthetic Medical Tourism Promotion Association cites a report from Taiwan Institute of Economic Research (TIER) showing that foreign patients accounted for less than 1 percent of total medical service users in 2008. He points out that the most popular services among foreign patients are health examinations and cosmetic surgery; and not the five physical surgeries promoted by the government of joint replacement, cardiovascular operations, in-vitro fertilization, facial rejuvenation and liver transplants, “Those surgeries normally have to be performed at large teaching hospitals, which may use resources that should be reserved for citizens. It is difficult for the patients to travel after the surgery. Cosmetic surgery and health examinations, on the other hand, can be conducted at mid-sized hospitals and private clinics, where patients generally are not required to stay in the hospital.” Taiwan has an average of 40,000 medical tourists a year, with revenue under US$10 million; both figures well below rival Asian countries.
Kaohsiung Aesthetic Medical Tourism Promotion Association, with the local tourism industry and medical associations, is launching a series of events this year to promote medical tourism. This extra promotion is needed as the Department of Health has only a small marketing budget for medical tourism, although it has asked the government for more money. As well as a need to promote services that medical tourists will actually buy, rather than services that the government thinks they ought to buy as it would be good revenue for hospitals, local specialists argue that the country has to establish a good reputation in medical tourism, package tours and market them overseas.
Min Sheng General Hospital is one local hospital that has been embracing medical fir the last two years. As well as a range of other services for international patients, it now offers a range of international healthcare packages from surgery to VIP health examination.
The hospital has a list of why American medical tourists should go to Taiwan;1 English friendly country.2 Same electrical power outlet (110 volt).3 Safe to walk alone and low crime rate.4 Drive on the same side of the street.5 Bilingual signage to find your way around.6 Great and inexpensive public transportation.7 Great exchange rate; more value for your money.8 Great shopping.9 Politically safe country.10 Non-stop flights from the west coast and you can have a stop over in Japan before coming to Taiwan.11 Delicious and safe food to eat.12 Advanced technology and highly trained physicians.13 Religion tolerance.14 Americans are well liked in Taiwan.15 Taiwan is small enough not to waste a lot of time traveling around.16 Great variety of scenery.17 Culturally interesting.18 Conveniently located as a jumping off place for any further travel to another Asian destination.19 The average standard of living is comparable to the one in Western countries (no social shock).20 Taiwan is malaria free.

The International Society for Quality in Health Care (ISQua) launched its International Accreditation Programme (IAP) in 1999. This is the only international programme that accredits the accreditors. As of December 2009 ISQua has accredited 16 organisations, 19 sets of standards and 5 surveyor training programmes.
All IAP products include:• A set of internationally validated standards. • A self-assessment process.• Evaluation findings and written report.• Formal recommendations.• An accreditation award from ISQua.• Ongoing monitoring and improvement.
Principles underlying all ISQua Standards;• Leadership through effective planning, governance and management.• Customer focus to meet the needs of internal and external customers, both existing and potential.• Organisational performance through the management of processes and outcomes and the transparency of decision-making.• Continuous quality improvement based on innovation, evidence, best practice and evaluation to better meet the needs of customers.• Valuing people by appropriately selecting, training and appraising personnel and maintaining good relationships.• Safety by providing safe work environments and complying with statutory requirements.
ISQua is now offering three products for health care external evaluation and standards setting bodies. These are:
• Organisation Accreditation
This involves self-assessment validated by an on-site peer review evaluation. These standards have incorporated the International Standards Organisation (ISO) requirements for certification bodies, the Baldrige criteria for performance excellence as contained in the EFQM (European Foundation for Quality Management) Excellence Model, and criteria for organisational excellence from the standards of a number of national accreditation bodies. The standards have been grouped into functions that logically reflect the business functions of external evaluation organisations.
• Accreditation of Standards
This involves self-assessment validated by a desktop peer review evaluation. The ISQua International Principles have been developed for the assessment and accreditation of health care standards of external evaluation organisations, including accreditation, certification, inspection and standards setting bodies. All external evaluation of healthcare services should begin with a well established and tested set of standards. These standards contain 6 principles.
• Accreditation of surveyor training programmes
This involves self-assessment validated by a desktop peer review evaluation. Many governments and funding agencies are now requiring external evaluation bodies to have a form of external approval for their surveyor training programmes. There are 6 standards with 29 criteria.
Some hospitals and medical tourism agencies still advertise that a facility is “ ISQua accredited’; the organization does not, never has and never will, accredit any hospital, clinic, agency or doctor directly -it only accredits organisations that do that, and no organization that is not a national or international accreditation body directly accredited by ISQua, has the right to advertise that it is “ISQua accredited”.
Accredited bodies include;
• Accreditation Canada, Canada
• The Australian Council on Healthcare Standard – ACHS, Australia
• Council for Health Service Accreditation of Southern Africa – COHSASA, South Africa
• Global-Mark, Healthcare Certification Programme, Australia
• Health and Disability Auditing New Zealand – HDANZ, New Zealand
• Health Accreditation System of Instituto Colombiano de Normas Técnicas y Certificación, Co – ICONTEC, Colombia
• Healthcare Accreditation Quality Unit, UK – CHKS-HAQU, UK
• The Irish Health Service Accreditation Board – IHSAB, Ireland
• Joint Commission International, USA – JCI, USA
• Malaysian Society for Quality in Health – MSQH, Malaysia
• Netherlands Institute for Accreditation in Healthcare – NIAZ, Netherlands
• Quality Improvement Council and the QIC Accreditation Program, Australia – QIC, Australia
• Taiwan Joint Commission on Healthcare Accreditation – TJCHA, Taiwan

The organisers of Destination Health, the forthcoming Health & Medical Tourism Show have announced the launch of the Patient Meeting Request System.
Designed to facilitate pre- arranged meetings between visitors and exhibitors attending the show, the organisers are expecting the system to generate up to 10,000 meeting requests in the run up to the show.
Commenting on the development, Event Director, Nav Mann said “The PMRS system will enable potential patients visiting Destination Health to pre-select the healthcare providers they wish to meet and set up meetings prior to the event. It’s an excellent method of allowing potential patients to carefully select relevant providers in advance of the show and be better prepared during their visit.”
“From the exhibitor’s perspective the system will allow them to plan their participation in a more focused manner and be better pre-prepared for the enquiries they will gather during the event”
The organisers are offering free use of the system to exhibitors who confirm their participation before 20th February 2010, after which date a fee of £295 + VAT is to be charged for use of the facility.
Supported by media partners Treatment Abroad the Europe’s number one medical tourism website and the International Medical Tourism Journal (IMTJ), Destination Health will take place on the 17th & 18th April 2010 at the Olympia Exhibition & Conference Centre.

Homewatch CareGivers, the largest and most experienced international franchise provider of full-service home care, founded in 1980, has opened its newest international location in Guatemala, joining the 180 locations in the United States, Canada, New Zealand, Costa Rica, Ireland and Panama. Each office is locally owned.
The new office, located in Guatemala City and owned by Juan Carlos and Patricia Lavidalie, will offer home care services, personalized for each client and focused on services that allow a family and their loved one to have the comfort and security of home while receiving the supporting care they need. Caregiver services are carefully documented for each client in a customized care plan. Every care plan is administered by well-trained, compassionate caregiver dedicated to helping families with the care they need, such as 24-hour, around-the-clock care for a loved one who is dealing with a chronic illness, assisting an individual with the support needed at home to recover from a recent hospital stay or medical procedure, providing safe and convenient transportation to and from appointments, or stepping in to help with emergency childcare when the unexpected happens.

Leann Reynolds says, “Guatemala is part of our global growth plan. This positions our company to serve the needs of the domestic population, and also those clients who choose to have medical procedures overseas in destination countries such as Panama, Costa Rica, and Guatemala, as part of the growing trend in medical tourism.”
Homewatch CareGivers has operations worldwide and is constantly expanding the offering of their successful business franchise opportunity to new countries. The company is actively seeking local and country master franchisees in Singapore, Thailand, Australia, Denmark, Finland, France, Germany, Iceland, Norway, United Kingdom, Egypt, Kuwait, United Arab Emirates, Canada, Brazil and Mexico
Homewatch CareGivers responded to the growing demands for services for people travelling for medical treatment and procedures both domestically and abroad by developing a comprehensive aftercare programme. This is designed to educate the medical tourism community and patients worldwide on the benefits of working with a medically trained home care company. Jean Forbes comments, “Our goal is to work effectively with the agencies and hospitals involved in care to ensure the most successful treatment outcome.” The Homewatch CareGivers aftercare programme is designed to work with patients who fit into two specific categories depending on their medical needs. A typical short-term client might be travelling for a cosmetic or orthopaedic procedure. Long-term clients might be travelling more frequently for ongoing treatments several times a year. The programme recognizes the different needs of the different clients in all stages of care, and works for a seamless and coordinated plan of care for each client.
The company splits medical tourism clients into outbound, inbound and intra-bound clients. With outbound clients, it mostly works with medical tourists from the US who are having procedures done in Costa Rica, Canada and Panama. The logic is that a significant number of Americans leaving the country for procedures are travelling to Latin America. Intra-bound (domestic USA) client care is provided by a network of US offices and caregivers. The aftercare programme helps customers, in conjunction with their agency/ doctor/ hospital; work to establish the best care plan for healing and rehabilitation from treatments or procedures. For medical tourism aftercare, the company is targeting Mexico, Brazil, South Africa, India, and several other undisclosed countries around the world.

Legislator Shim Jae-chul has submitted a bill to the National Assembly that calls for setting up a single international hospital accreditation system for Korean hospitals, "Korea needs an accreditation system that patients at home and abroad can trust, which can be used to find the most suitable hospital for their illness. Under the current law, general hospitals and clinics with 300 beds or more are required to participate in hospital evaluation programs as part of plans to improve the quality of the country’s medical services. However, they have not been much use as they lack credibility and their assessment reports have been too ambiguous and general. Even an accreditation system supervised by the Ministry for Health, Welfare and Family Affairs and run by the Korean Hospital Association, has turned out to be good for nothing as it failed to show which hospital offers the best treatment for a particular disease. An excessive number of accreditation bodies, run by the government, associations, as well as academies, have been established, resulting only in a financial burden on the government and a work overload at hospitals.”
Shim wants a new patient-friendly system to be launched this year to replace or integrate the numerous domestic accreditation programmes, “Only the hospitals that want to certify their medical skills will participate in the accreditation program, which, will be run by the government for the first few years. Hospitals will also be allowed to receive accreditations in certain areas that they are proficient in. An independent organization will eventually take over the state-initiated program once it gains trust among patients. This will help local hospitals promote medical skills without having to pay a hefty amount of money to gain international accreditation from organizations such as the JCI is that is only suitable for large hospitals. The JCI might be a must to those hospitals targeting Americans, but it is not widely recognized in countries, such as Japan, Europe, Middle Eastern nations and Russia."
Shim’s aim is to help hospitals and clinics wanting to increase their medical tourism business, “ The new indigenous accreditation system will contribute to providing accurate information about Korean hospitals in the future. Korea’s advanced medical technologies and outstanding human resources are undervalued abroad. Perhaps Korea has focused too much on telling the world how good our medical industry is without properly providing the information that foreigners want to look at before making a decision."
The Korean medical tourism industry saw 27,480 foreign patients in 2008, and 50000 in 2009, with the number expected to jump to 200,000 by 2012. The government’s goal is one million foreign patients a year by 2020.Korea’s state tourism is aiming to attract 70,000 health tourists this year. The state- owned Korea Tourism Organization (KTO) will promote the country’s medical tourism using foreign media. The KTO will also expand its one-stop service centre for medical tours located in Incheon, Korea’s main gateway, by setting up a branch in Busan, located on the southern tip of the Korean Peninsula. The organization is actively trying to attract more health tourists through its 27 overseas branches. Hospitals have launched strong marketing campaigns since they were allowed to advertise for foreign patients under a law that took effect last year. Last year, KTO attracted health tourists from Japan, China, Russia and Kazakhstan. It is now also targeting the United States and wealthy Middle East countries. The Chinese market is an important target, with an estimated growth of 20-30 percent every year. In 2009 5 % of the 50,000 overseas medical tourists to South Korea were from China. For the Chinese, the short distance and frequent flights from China to South Korea, as well as the food and mild climate are advantages. In order to attract more Chinese travellers, some hospitals in Seoul have begun to employ interpreters and nurses who can speak Chinese.
Samsung Medical Center in Seoul has launched a new international executive health programme, a top-of-the-range all-encompassing medical check-up service designed for high-end customers from overseas markets. Jaseng Hospital of Oriental Medicine recently opened a totally separate building, exclusively for foreign patients.
Organizing the medical treatment needs to be done privately, as many travel agencies shy away from being involved in what can be complicated and risky surgery. It is illegal for Chinese travel agents to operate cosmetic surgery tours. They can however organize visas, tickets and hotels and trips that include one-day facial experiences in cosmetic clinics in South Korea. KTO has launched promotions with six Chinese tourism agencies.

As part of its expanding role in the global marketplace, Accreditation Canada International has launched Qmentum International, a new accreditation product tailored to its international clients.
Qmentum International builds on more than 50 years of Canadian accreditation expertise. This rigorous programme will challenge performance-oriented, client-focused health services organizations at all levels, while recognizing their achievements at different stages of their quality management. It focuses on quality improvement, patient safety, risk assessment and mitigation, performance measurement, and accountability. It provides a sustainable quality improvement approach through step-by-step implementation. Internal reviews are now completely automated. It is based on ongoing support and capacity building, involving the entire staff of the participating institution, including frontline staff.
It is founded on Accreditation Canada’s widely recognized national accreditation programme, as well as the successes of previous international programmes. Fulfilling the requirements of the International Society for Quality in Health Care (ISQua), the development was guided and supported by the expertise of an international advisory committee, with members representing the Middle East, the Caribbean, Europe, and South America.
Wendy Nicklin of Accreditation Canada says, “We have been involved in international health accreditation since the 1960s. Based on this experience and our ability to tap into the expertise of our partners worldwide, we launch this invigorated and dynamic accreditation programme tailored to international markets. We look forward to continuing to help health organizations around the world reach their quality improvement goals through the application of the most comprehensive, rigorous standards available. We recognize that one approach does not work for everyone and that accreditation must to take into account the needs of the entire organization being reviewed. Accreditation should not be looked at as a pass or fail test, but a means of achieving institutional excellence.”
Accreditation Canada International specializes in exporting accreditation expertise to health services organizations worldwide. International clients include the United Arab Emirates, Saudi Arabia, Bahrain, Ireland, France, Serbia, Costa Rica, Brazil, and Italy.
Accreditation Canada International has a new partnership with the Environment and Quality Assurance International Certification Center (EQAICC). The EQAICC is an international certification body with head offices in South Korea and Japan, and branch offices in China, Taiwan, and the United Kingdom. This new partnership will permit the EQAICC to implement Accreditation Canada’s international accreditation program in health care organizations in South Korea. Jason Moon of EQAICC says, "The high quality of Accreditation Canada’s services will be welcomed in Korea. These services will soon be expanded to Japan and China."
Accreditation Canada International will provide education and training to EQAICC professionals and their extensive network of surveyors. In partnership with EQAICC, several pilot projects with South Korean hospitals will be carried out to identify areas of the program that must be tailored to the South Korean health care system and environment. The hospitals will receive an accreditation recognition decision from Accreditation Canada.

With the threat of terrorism causing the Indian government to suddenly impose new restrictions on normal tourist visas, Indian hospitals see their overseas business under threat. The problem is that almost all medical tourists have been using the standard tourism visas, rather then the special medical visas that were intended for them.
“M Visa – Medical Visa” the Indian government’s pioneering initiative to encourage growth of medical value travel to India was introduced in 2005, but in the last five years very few overseas patients have chosen to apply for medical visas as the scheme has inherent flaws that cause problems for foreign patients who choose to use the scheme.
The majority of foreigners coming to India for medical treatment have been applying for a tourist visa and not opting for M visa, because medical visa rules make it mandatory for them to register with the Foreigner Registration Office (FRRO) within 14 days of the arrival in India. This is very awkward, if not impossible, as patients may not be able to leave the hospital once their treatment starts to go and register at the nearest FRRO.
The Foreigner Registration Office is the primary agency that regulates the registration, movement, stay, departure, and extension of stay in India. It has foreigner regional registration offices in New Delhi, Mumbai, Kolkata, Amritsar and a national immigration office in Mumbai. In other places, the local superintendents of police of the districts are registration officers for foreigners. Like all local bureaucracies, the FRRO is not known for speed in handling documents or requests.
Patients who come on M Visa have to seek the Indian hospital’s help to find and get to the nearest FRRO office and comply with the procedures. This puts strain on hospital resources, so most hospitals have been advising potential patients not to apply for M visa and opt for a tourist visa. But this has defeated the very reason why the government of India introduced the medical visa scheme.
The Indian Medical Travel Association (IMTA) wants a simplified medical visa that can be applied for online, without the hassle of physically presenting at an office. Pradeep Thukral says, “ IMTA has apprised the relevant ministries of the Indian Government of the issues with the medical visa and we have requested them to modify the system to make it an enabler for the growth of medical value travel to India. An early action to address the issues with medical visa would surely enhance the volume of international patients coming to India, it will also help to track the numbers of medical tourists arrival to India more accurately. "
Whether the politicians will take any notice of a polite request for change is debatable, as IMTA has yet to gain any public support from any leading politician. Presenting the government with a vague appeal without suggesting how many tourists or how much revenue the country could lose, may not be enough to sway politicians panicking about terror and the political situation between India and Pakistan.

To many Europeans, it is not news that Belgium is a favoured destination for medical tourists. Until recently, the country has left promotion to a handful of individual clinics and hospitals, and not thought it worthwhile to promote Belgium outside of Europe. That is now changing.
A recent seminar in Brussels “International Promotion of Belgian Medical Solutions” organized by Healthcare Belgium and UNAMEC with the support of the Federation of Enterprises in Belgium, presented Unamec and Healthcare Belgium solutions for companies in the medical sector wishing to be active internationally and shared some success stories.
Healthcare Belgium is a non-profit organisation established in 2007 by 11 top Belgian hospital groups. The organisation receives substantial support from Agfa Healthcare, Dexia Bank, the Federation of Enterprises in Belgium (VBO-FEB), the Virtual Colonoscopy Teaching Centre (VCTC) and Ion Beam Applications (IBA). The concept of Healthcare Belgium resulted from a study published by the VBO-FEB under the title "Dare & Care". The initiative focuses on a unique Belgian blend of advanced technology and medical excellence available for patients and healthcare professionals.
Healthcare Belgium’s objectives are to:• Provide information on Belgian medical services to foreign patients and healthcare providers in an ethical and coordinated way.• Ensure that patients from abroad can rely on high-quality services at a fair price and that they are taken care of in a professional manner from the moment of their first contact until they return home.• Foster the international development of Belgian telemedicine.
It guarantees that foreign patients will receive the same high-quality treatment and excellent service as Belgian patients at every stage. All patients are treated with courtesy and dignity and their privacy guaranteed.
The hospitals involved;• Antwerp Hospital Network ZNA• Antwerp University Hospital• Brussels Europe Hospitals• Brussels Saint-Luc University Hospital• Brussels University Hospital• CHIREC• Ghent University Hospital• Imelda Hospital• Leuven University Hospitals• Monica General Hospital Antwerp• Onze-Lieve-Vrouwziekenhuis Aalst

For Healthcare Belgium, Mondial Assistance operates an international call centre staffed by healthcare professionals. This answers any questions medical tourists may have concerning treatment in any of Healthcare Belgium’s hospitals and can make appointments with doctors .The call centre takes care of many of the practical aspects of a trip to Belgium, such as accommodation and medical or personal assistance.
Healthcare Belgium patients and/or family benefit from preferred rates in a large number of hotels all over Belgium including-• Hotel Amigo, Brussels• B-Aparthotels:Luxury Apartments Brussels• Hilton: Brussels & Antwerp• Hotel Le Plaza Brussels• Hotel Sofitel Brussels Europe• Manos Hotels Brussels• Marriott: Brussels & Ghent• Martin’s Hotels• Radisson: Brussels, Antwerp & Spa• The Dominican Brussels
Belgian hospitals are equipped with advanced technology and run by highly qualified staff. The Belgian healthcare system is well developed with a large number of specialised centres and internationally renowned doctors.
Patients from countries and regions including the Netherlands, France, Germany, the United Kingdom and the Middle East have been coming to Belgium for many years to receive medical treatment.
NOTE-individual hospitals not listed for websites as are all on the above website

The developing healthcare and medical tourism sector in the United Arab Emirates faces challenges to its long-term sustainability due to the relatively high cost of medical provision in the country, according to Grant Thornton; one of the world’s leading independently owned accounting and consulting firms.
Competitor countries, particularly in Southeast Asia, have already established a strong reputation for quality, low-cost healthcare provision, and therefore have significant first-mover advantages compared to the UAE, according to "Transforming the Middle East’s healthcare model," a new research report by Grant Thornton.
Farouk Mohamed of Grant Thornton UAE points out that the average cost of heart bypass surgery in the UAE is US$44,000, compared with an average of US$18,500 in Singapore, US$11,000 in Thailand, US$10,000 in India and US$9,000 in Malaysia. He adds,” While the cost of healthcare provision in the UAE compares very favourably with most Western markets, the long-term development of the country’s medical tourism sector remains extremely price-dependent.” Grant Thornton argues that development of the medical tourism sector in the UAE is dependent upon more competitive costs, as the existing infrastructure in the UAE, and especially Dubai Healthcare City (DHCC), is already well developed.
But DHCC has problems. Time stops on the website in 2008, while details of what hospitals and clinics are still there, and when new ones will open, have vanished. IMTJ has been unable to get any response from DHCC. DHCC’s flagship hospital will not hit its original 2011 completion target, as like many building sites in the state, work has stopped. So far, only the hospital’s foundations are finished, with exposed steel protruding from the ground. The 400-bed University Hospital, the jewel in the crown of the healthcare city, now has no firm opening date. DHCC was launched in 2002, in a bid to stem the tide of local patients seeking medical care abroad and houses 80 outpatient clinics. Dubai Holding, Dubai Healthcare City’s state-owned parent company, has struggled to finish many of its grand projects, which include the sprawling leisure and entertainment development Dubailand.The Dubai government has serious debt problems that credit experts say exceeds $150 billion, raising questions over how or if projects such as Dubai Healthcare City will be financed to completion.
For DHCC, the news just gets worse. One of DHCC’s most prestigious healthcare brands, the US-based Mayo Clinic, has closed its clinical practice due to a lack of patients. Dr. Taysir Khatib, the Mayo Clinic’s regional office manager for the Middle East, reports that there were too few patients for even one cardiologist in Dubai, and were barely able to break even. The Mayo Clinic has reverted to a regional office that attracts local patients to its US hospital.
The Emirates’ plans to attract international medical institutions such as Mayo to Dubai Healthcare City were drawn up to reverse a long-lasting trend of patients seeking medical care abroad. The U.A.E. spends nearly $3 billion annually on sending its citizens to clinics in the U.S., Europe and elsewhere for specialist health care.
In 2009, outpatient care centre, Dubai Medical Suites (DMS), closed less than six months after its launch. Unveiled in January 2009, DMS was intended to attract foreign hospitals, which would offer visiting specialists and share the costs of funding the 20-clinic centre. But it failed to spark the interest of US and European hospitals facing a recession in their home markets. DHCC has seen 200,000 patients, mostly locals or expatriates, in three years of operation. It has offered financial breaks, such as reduced rents, to a number of clinics in a bid to help them through the economic crisis but lack of patients, high rents, and regulatory requirements have seen a number close.
On another part of the medical tourism equation, the cost of hotel accommodation for patients and families, Dubai has been accused of not understanding that to compete with other tourism areas, they must follow the market in offering lower prices and better packages, as the boom time of the last decade will not happen even if global recession ends. One of the UK’s biggest tour operators has warned Dubai hoteliers that unless they become more flexible with their pricing, they will continue to lose out. Glenn McCool of Tui, says,” “My message to hoteliers is reduce rates more, make your food prices cheaper and offer all-inclusive packages. Dubai is a stopover or short-break market with a lack of all-inclusive deals, high room rates and expensive food. Dubai room rates have come down by around 25-35 % compared to peak 2008 prices, but need to come down a further 50-60 %.”

Local and national politicians recently inaugurated what they claim is the most advanced hospital in Indonesia.
Zainoel Abidin State Hospital (RSUZA is equipped with several state-of-the-art medical instruments, including a CT Scan, MRI machine and radio-diagnostic devices, and was rebuilt with aid from the German government. The facility has been receiving patients since last August, but only fully opened in 2010.
Aceh Governor Irwandi Yusuf commented, “ RSUZA is the most advanced hospital in Indonesia, and its facilities can match prominent hospitals in Penang and Singapore. I hope the new hospital will put an end to the practice of thousands of Acehnese going to Penang, Malaysia, or Singapore each month for medical treatment. Including myself, who had to opt for Singapore as a place to have medical treatment because the facilities there were far more advanced than what we have had in Banda Aceh. But with this new hospital, I am certain that the equipment we have now can rival hospitals abroad.” He also encouraged the staff to prove to the public that the hospital personnel could master the hospital’s advanced machines. “A strong building and advanced equipment are not enough to make RSUZA the best hospital in terms of services for the people of Aceh,” he said.
German Ambassador to Indonesia Norbert Baas added, “ RSUZA is equipped with advanced infrastructure and eco-friendly integrated waste management technology. The employees of RSUZA have been intensively trained to ensure the patients and staff can reap maximum benefits from its new facilities and equipment. The hospital is also designed to weather flooding and earthquakes.”
The hospital’s reconstruction was part of German aid for Indonesia, after the 2004 tsunami in Aceh that killed 170,000 people. The development of the two-storey hospital began in March 2006, funded by a 31 million euro grant from the German government through state-owned bank KfW. The bank will continue to guide the hospital management for the next two years and arrange collaborations between the hospital and universities in Germany for paramedic training courses. The German Agency for Technical Cooperation provided an additional 10.2 million euros worth of technical assistance. The director of the hospital, Taufik Mahdi, said the facility had 350 beds, and would add 150 more this year. Since the hospital opened, an average of 600 people a day have come to receive medical treatment.

Lilia de Lima of the Philippine Economic Zone Authority (PEZA) has applauded Bacolod City’s success in developing economic zones and stressed its potential for medical tourism. PEZA’s thrust is to push development outside Cebu and Metro Manila; Bacolod City offers a close partnership between the local government and the private sector, with the new Bacolod Silay Airport. “Bacolod is ideal for medical tourism, as it has very good doctors and nurses”, claims De Lima.
PEZA has 207 special economic zones all over the country, 127 of which are IT ecozones, 69 manufacturing zones, nine tourism economic zones, one medical tourism park and one medical tourism centre. PEZA stresses the need to keep investors happy, and to free them of red tape. The Bacolod City Sanggunian has amended the city ordinance that encouraged the development of special economic zone for information technology parks and buildings to now include retirement villages and medical tourism. Bacolod Councilor Jocelle Batapa-Sigue and principal author of the change, says that the availability of economic zones under PEZA is one of the requisites to attract investors to the city. The ordinance also defines medical tourism as travel to the Philippines for the purpose of availing quality but affordable healthcare services or treatment of illnesses and health problems in order to maintain one’s health and well-being.
PEZA has three official definitions-
• A medical tourism special economic zone is a selected area which is highly developed or which has the potential to be developed in accordance with the standards of the Department of Health (DOH) to have support facilities and services required for health and wellness.
• A medical tourism park is an area which has been developed into a complex capable of providing medical infrastructures and other support facilities, in compliance with DOH and Department of Trade (DOT) requirements, such as but not limited to medical accommodations, wellness centers, spa, health farms, sports and recreational facilities, and rehabilitation facilities required by medical tourism enterprises, as well as amenities required by foreign patients including professional and workers involved in medical tourism activities.
• A medical tourism centre is either a medical hospital or a stand-alone building that hosts specialized medical clinics and other specialized medical related activities, in compliance with DOH requirements, the whole of part of which has been developed to provide infrastructures and other support facilities required by medical tourism enterprises, and which may also provide amenities required by foreign patients including professionals and workers involved in medical tourism activities.
A meeting of local hospitals active in medical tourism reported that medical tourism in the Philippines has huge potential but it is growing rather slowly. Jun Amistoso of Asian Hospital reported 80 foreign patients every month. They come mostly from Micronesia, Taipan, Marianas islands, and Guam, all American territories. A few come from California. 70 percent of foreign patients are between 40 and 60 years old. It has a new procedure called minimally invasive surgery that attracts foreign patients. The Makati Medical Center plans to run a full campaign for medical tourism soon. Evelyn Yumolt said the hospital has made it a policy not do any transplant on a foreign or local patient unless the donor is a relative. Yumol and Amistoso argue that a real problem is the few direct flights from the country of the patient to the Philippines, and ill people cannot be expected to make two or three flight changes.
HEAL Philippines is a new partnership between the government and the private sector for the promotion and development of the country’s medical tourism industry. Health and Wellness Alliance of the Philippines (HEAL Philippines) is an organization of hospitals, clinics, spas and other medical tourism providers seeking to promote and develop the Philippines as a prime destination for global healthcare and retirement. Joyce Alumno of HEAL Philippines says, “The Philippines is quickly gaining ground in being a leading hub of health and wellness in the world. Our hospitals are better equipped than many hospitals of developed countries, complemented with the unique Filipino hospitality.”

Amor Dehissy has been running Estetika Tour International, offering medical tourism to Tunisia, since March 2004.This makes him one of the most experienced agents in the business, and increasingly concerned about the recent influx of new intermediaries, often attracted by over-optimistic predictions of future business volumes, and seeking profits in a sector that needs no qualifications or experience to enter.
In discussions with fellow medical tourism agents, he found his views mirrored. So a group from ten countries as diverse as Austria, UAE, France, Germany, Hungary, India, Romania, Turkey, Tunisia, and Ukraine, has begun an ambitious project to build a medical tourism agencies network around the world. The network has no name yet, just a working one of Alliance. The aim is to have a minimum of 50 network members by the end of 2010.
Amor Dehissy, the founder of the network, wants to talk to anyone interested in becoming a member, and argues,“ Agencies are now growing at an exponential rate fuelling the medical tourism bubble. This anarchy and lack of professionalism damages the world medical tourism industry,instead of serving it. If we want to serve the medical tourism industry we should offer services that cannot be offered by hospitals or doctors, such as building up an international network of doctors that agree to follow up patients once they return home, or building up an international agency network brand name that international patients can trust. It is a very difficult project but very exciting one as it aims to restructure the medical tourism industry and bring more added value to it.”
Dehissy lists the potential benefits
For patients:• They will benefit from post surgery follow-up in a large number of cities in the world (lack of post op follow up is the main obstacle to medical tourism development)• An international brand name trusted by international clients (individuals or organisations)For the agency:• Enjoy the benefit of a worldwide brand name and continue to develop your own one and preserve your financial and legal autonomy.• Solve the crucial problem of post-operative follow up and better serve your international patients.• Be in a stronger position to better negotiate with your service providers (airlines, international hotels chains, hospitals and doctors)• Credibility with insurers and large companies • Generate business, information and experience exchange between agencies• Political lobbying • Mutual support between agencies
The next steps are to discuss strategy, agree details of the project and timetable, agree a name and any other ideas that potential members can suggest to help advance the project. The action plan includes appointing ten board members, each in a separate part of the world.

The Medical Travel Quality Alliance (MTQUA) has issued its first list of the top ten world’s best hospitals for medical tourists and has named Fortis Hospital in Bangalore as number one hospital in the world. Six of the top 10 world’s best hospitals are in Asia, two in Europe and two in North America.
MTQUA founder Julie Munro says, "Fortis is exemplary in nearly all the criteria we used. The medical traveler’s journey is a complex one and this list helps patients look beyond hospital websites where they can get the full spectrum of care management they need for a successful medical trip. If you cannot get as good or better care abroad than you can at home, you may as well stay home.”
This list is issued to help patients, hospitals, and medical travel agents better understand the important factors that create an outstanding medical experience for a medical tourist.Some patients now consider accreditation status and word of mouth recommendations before they make their choice of hospital, and that’s a definite improvement over relying only on the internet for information or choosing the lowest cost. There are other significant, factors including patient safety and security, international patient operations and protocols, marketing integrity, and transparency.

Top ten recognition was given to the hospitals based on MTQUA’s strict assessment criteria of-
1. Medical quality and outcomes2. International patient management3. International patient marketing4. Value for service5. Patient safety and security6. Transparency7. Attention to the unique needs of the medical traveler
The top ten hospitals-
1. Fortis Hospital, Bangalore, India2. Gleneagles Hospital, Singapore3. Prince Court Medical Centre, Kuala Lumpur, Malaysia 4. Shouldice Hospital, Toronto, Canada 5. Schoen-Kliniken, Munich, Germany 6. Bumrungrad International, Bangkok, Thailand 7. Bangkok Hospital Medical Center, Bangkok, Thailand 8. Wooridul Spine Hospital, Seoul, Korea 9. Clemenceau Medical Center, Beirut, Lebanon 10. Christus Muguerza Super Specialty Hospital, Monterrey, Mexico
Why Fortis Hospital Bangalore is number one –
Medical quality-It has an excellent surgery option for medical travelers seeking joint replacement, particularly hip resurfacing and replacement. It’s also strong in cardiac surgery and neurosurgery.
International patient management-The hospital has a transparent process sensitive to the needs of patients and families for their cultural, language, and religious requirements, their medical needs and emotional support.
International patient marketing-It actively supports web-based social networks, including Youtube, Facebook, and Twitter. It has its own blog.
Value for services-It has a competitive cost structure.
Patient safety and security-The hospital assigns dedicated staff representatives to the patient throughout their hospital stay and a treating physician who directly discusses procedures and outcomes before the patient leaves their home country. Communication with the patient’s family physician is encouraged. Patients may stay in the hospital for their full recovery period to avoid moving to a hotel.
Transparency-Every effort is extended to ensure transparency of care, from cost to outcomes data. Patients receive a portfolio of their medical file and surgery documents including CT scans, MRI and X-rays, and operative notes to take back to their home country.
Attention to the needs of the medical traveler-It offers prompt scheduling of pre-surgery preparation and provides exemplary follow up care and services to monitor medical travellers once they return home.

Health experts at the London School of Hygiene and Tropical Medicine (LSHTM) and the Indian Institute of Management in Bangalore have been exploring the potential for bilateral agreements on health services between the UK and India. Their findings from the year-long study suggest a two-way agreement would benefit both countries.
They claim that at least £120m could be saved if thousands of NHS patients currently waiting for just five different operations went to India, with a companion, for treatment in an accredited hospital. This is according to health economists’ calculations, and the basis of the calculation is strongly disputed by the NHS.
The report suggests that a two-way agreement could make it easier to guarantee high-quality treatment, good follow-up care and deal with malpractice or clinical negligence. English is universally spoken among educated Indians and the health and education systems share many similarities. Britons are used to Indian doctors. These factors could make India an acceptable destination for some people awaiting NHS treatment, says the report. It alleges that thousands of patients waiting for operations such as hip replacements and hernia repairs could be treated more cheaply and quickly if the government set up formal agreements with countries such as India.
But government and NHS officials say that the logic and calculations used by LSHTM researchers are wrong as -* There is no need to consider non-European alternatives because NHS waiting lists are so short.* The numbers are based on historic figures, not the numbers waiting in 2010.* The cost comparisons do not take all factors into account such as fixed NHS costs. * The Department of Health believes the majority of Britons are unwilling to travel abroad for treatment.* India is too far away as the NHS can only pay if the flight is under three hours* The government rules for the NHS are that local trusts can only pay for overseas treatment if patients fit a detailed list of strict criteria.* Under a thousand NHS patients were treated overseas in 2009, most of these being mothers who wanted their babies born in their home country to get dual nationality.
Richard Smith at the LSHTM, said: "After the next election the NHS will have to think about how to save money. This could benefit patients and save millions. People would never be forced to go anywhere, but it’s worth considering giving patients the choice. If you pick a country we have ties to, like India, and start exploring the mutual benefits of a partnership, a lot of the envisaged problems could be resolved."
A Department of Health spokesman retorted that India was not an option: "There is high-quality spare capacity readily available in northern Europe for the NHS to purchase within the specified air travel time. Therefore, the NHS is not looking to contract for treatment for NHS patients outside the maximum air travel time limit."
A new independent study by Nuffield Trust rather undermines the report findings, as it has found that in the NHS in England, waiting times have dropped dramatically so hospitals now see all patients within 18 weeks, The amount of business that the NHS pays for in the private hospital sector has reduced so much, that most leading UK hospital chains no longer actively seek such business.

A leading finance and insurance group from China has visited Min-Sheng Hospital, Yi-Der Long Term Care Center, and other health facilities. China Ping An Trust & Investment Co. in Shenzhen was on a fact-finding visit of Taiwan health care institutions. The delegation was very interested in topics ranging from JCI accreditation to executive health checks and long-term care.
China Ping An is to invest heavily in health care and long term care facilities in China, and are currently looking to gather expertise and partnerships in Taiwan, Hong Kong and Singapore.
NeoStem is an American innovator and leader in the pre-disease collection, processing and long-term storage of adult stem cells for the general population to use in future medical applications that is expanding into research, medical tourism, and China for the commercialization of regenerative medicine and other stem cell applications.
NeoStem (China) has strong support from the Chinese government for commercialization of cosmetic / regenerative medicine applications which will also expedite the process of US development as the company becomes a vertically integrated stem cell operation in a permissive regulatory environment that includes strong government support.
NeoStem has embarked upon several stem cell initiatives in China, including the creation of a separate stem cell operation in China, the construction of a stem cell research facility in Beijing, the establishment of relationships with hospitals to provide stem cell therapies, and the licensing of stem cell therapeutics focused on regenerative medicine applications. During 2010, NeoStem plans to begin offering stem cell banking services and therapies in China, in addition to medical tourism initiatives that will offer these services to those living in developed countries such as the US where such treatments are either unavailable or unaffordable.
NeoStem is targeting the introduction of highly mature U.S.based therapies that lack FDA approval that is necessary for widespread use in the domestic market. NBS China intends to commercialize its first stem cell therapy for orthopedic indications in 2009 while developing a pipeline of additional therapies for central nervous system disease, wound healing, and heart disease. The initial orthopedic market will target 80-100 million arthritis sufferers in China.
NeoStem will also offer medical tourism service centres to serve patients from affluent countries that have more restrictive regulatory processes such as US and Europe. The Company’s medical tourism initiatives in China will offer world-class standard operating procedures, standards of care, and facilities. An estimated 7000 patients have been treated in China’s medical tourism industry since 2001, but the company says that current offerings do not include the world-class standard of care that NeoStem can offer.

The Indian Medical Travel Association (IMTA) partnered with FICCI – India’s leading business federation to promote medical tourism to India from the African Continent. Namaskar Africa was an Indian business expedition to Africa organised by FICCI from 14-16 January 2010 at Lagos in Nigeria. The Indian delegation included top hospitals groups from India – Fortis Hospitals, Apollo Hospitals, and Columbia Asia Hospitals. Doctors from leading Indian Hospitals gave presentations. The symposium was attended by a large number of local doctors as well as healthcare delegates from 15 African countries.
The volume of international patients coming to India for medical treatment from West Africa – particularly Nigeria is growing very fast and more than ten thousand visas were issued by Indian High Commission in Nigeria alone during 2009 to patients who wanted to travel to various Indian hospitals for medical treatment.
According to Pradeep Thukral of IMTA, “Africa is a prime market for promoting medical travel to India and Namaskar Africa provided an excellent opportunity for our members to promote their services and also explore business opportunities for setting up diagnostic and clinical facilities in the African region. This event was an excellent networking opportunity between Indian African healthcare professionals and will help to further boost the flow of international patients referrals from Africa to Indian hospitals.’
IMTA will also attend Medical Tourism Destination 2010, to be held in Kenya during May 10-11, 2010 at Kenyatta International Conference Centre, Nairobi and in Uganda during May 15-16, 2010 at Uma Exhibition Centre, Kampala to showcase the best of Indian healthcare in these East African countries.
The government of Mauritius aims to position the island as one of the leading medical travel destinations in the region, by attracting investors. Mauritius is seeking India’s help to boost its medical tourism industry and has invited Indian healthcare majors to invest in the island nation. Indian hospital group Fortis recently acquired a 140 bed /hospital clinic in Mauritius in partnership with a local group. Apollo has the new Apollo Bramwell Hospital of Mauritius. Investment bodies are in talks with a few more hospital chains in India. At least two more including an eye care hospital chain, are set to invest in the country.
The island now gets fewer than 4,000 foreigners a year coming for medical treatment and wants India’s help to increase its revenue from this sector. The logic is that Africans reluctant to go to Asia will go to Mauritius and get treated by Indian hospitals. Apollo Bramwell Hospital has been designed to serve both Mauritius and the international community; the target market for international services includes the continent of Africa and the eastern Indian Ocean rim.

Bahamian healthcare facilities are likely to enter into joint ventures and partnerships with overseas providers in a bid to develop a medical tourism sector, says the minister of tourism, with the industry targeting profitable niche markets seen as having long-term sustainability. Rather than overseas companies entering the Bahamas on their own, they are more likely to link up with established Bahamian-owned companies in joint ventures, partnerships and re-brandings.
Vernice Walkine of the Ministry of Tourism said, "Our desire is to partner with a premier medical provider that would be compatible with our Bahamian destination brand, and also with our Ministry of Health’s standards for providing recognised, reputable and proven procedures in treatment." Developing medical tourism could help to diversify the Bahamian tourism industry and the wider economy. The Ministry of Tourism is seeking to develop an investment incentives policy for the healthcare industry, similar to that presently enjoyed by the hotel industry.
The authorities feel that to establish the Bahamas as a medical tourism destination, it is not sufficient just to open and let the world know. They believe that people who travel overseas for medical care are looking for specific treatment in specific areas, and a specific level of confidence. So it is a matter of specializing in something that will be of great interest to those markets and are trying to define those areas precisely, and see what needs to be done to become effective in those areas.
The Bahamas has a small amount of medical tourism business, including high intensity focused ultrasound prostate cancer treatment where 15 patients a month travel to the Bahamas for treatment, staying for five days, and bringing along family members.
American medical institutions are being targeted by the Grand Bahamas Port Authority (GBPA) for its proposed $100 million hospital for Freeport. The GBPA has enlisted consultants to develop framework proposals for how medical tourism could work in Freeport.
Dr. Marcus C. Bethel, a former Minister of Health says that the proposal for Grand Bahamas is deserving of critical analysis,” The rationale is the high cost of health care in the USA, and its proximity to The Bahamas. The benefits to be derived might include creation of specialized health services such as kidney transplants, cardiac surgery, orthopedic surgery, pediatric surgery and cancer therapy. Also, the introduction of such services means expansion of support services, including housing and food services for the medical personnel, patients and families. The introduction of medical tourism would require the investment of millions of dollars to build a modern hospital and support facilities, and the importation of medical doctors, nurses and allied health personnel to staff such a facility.’
Dr Bethel asks questions that anywhere seeking to offer medical tourism should decide- 1. What medical services are anticipated in its business model?2. What are the details of the proposed hospital facility and its location?3. Where will the staffing (administrative, medical, nursing and allied health) of such a hospital be sourced?4. What qualifications will they possess?5. What work permits are required and for what period?6. Who are the principals funding such a venture?7. What are their qualifications in such a venture?8. What role is the local medical community expected to play, if any?9. What oversight of the practice and ethics of the industry are to be implemented and by what agency?

Seoul City intends to boost tourism as one of its top priority tasks for 2010, and the metropolitan government is ambitiously seeking to attract 10 million foreign tourists this year.
The city will try to attract more Chinese tourists as their number is expected to rise due to a loosening of visa regulations. It is seeking to boost the medical tourism industry, and hopes to increase the number of medical tourists to 52,000 from 37,000 recorded in 2009, out of a total of 50,000 for all South Korea.
The city plans to offer a range of support programs for foreign medical tourists and improve related rules and regulations to reinvigorate medical tourism. It will also seek to intensify publicity efforts to attract more foreign patients.
The city plans to develop a set of special tourism products targeting Chinese tourists, which will enable them to visit major tourist attractions where they can experience Korean food, culture and advanced technology. For 2010, it seeks to attract 1.8 million Chinese tourists. Last year, 1.34 million Chinese people visited Seoul.
In 2010, Korea is expecting to attract around 60,000 medical tourists and the target is to attract 140,000 in 2015.Korea’s cosmetic surgery clinics are packed with foreign patients. In the past, the patients were largely from China, Hong Kong and Singapore, but recently they have diversified and now they come from Indonesia, Saudi Arabia, the UK and the USA.
Foreign visitors spent more than US$60 million in Korea for medical treatment during the first nine months of 2009.The Bank of Korea says healthcare travel revenue between January and September jumped 29 percent from the same period last year while health-related outbound travel expenditures recorded a 35 percent drop at $69 million. Medical tourism has increased rapidly as the quality of medical treatment in the country improved and the Korean won weakened against other currencies in early 2009. Foreign patients in Korea reportedly spend twice as much money as regular Japanese tourists.
Cosmetic surgery among Asians reflects the “Korean Wave.” Cost is not an issue, as they are willing to pay up to three times more for surgery in Korea. Asian women from China, Taiwan, Vietnam, Singapore and Hong Kong are flocking to Korea for facial bone contouring and cosmetic surgery on their eyes and noses. Asians from other territories want to look more like popular Korean actors and musicians. And they are willing to travel and pay up to three times more than they would in China.

Tunisian towns and resorts are transforming into prominent therapy centres, making the country a health tourism destination that attracts people who seek relaxation, treatment or cosmetic surgery from around the world. Estimates indicate that the number of health tourists was 250,000 in 2009.
The government is seeking to place Tunisia on the world’s health tourism map, and has made the export of health services a goal for 2016. Hospitals and clinics market themselves as health tourism destinations, and Tunisia is now ranked second after France in mineral spring water treatment, and second among African nations in seawater treatment.
The country is implementing a strategy aimed at developing different aspects of tourism and to promote the health and wellness services on offer. The quality of medical services and internet technology have opened up new horizons for Tunisia, and the country is now attracting large numbers of visitors from the region and Europe.
According to statistics from the Ministry of Tourism, 150,000 people visited Tunisia for treatment and relaxation in 2008, compared to 111, 000 in 2007 and 42,000 in 2003. 3000 Britons go there every year for surgery; organ transplants, kidney and heart conditions, cosmetic surgery, vision correction, cornea transplants, etc.
The government’s strategy is encouraging the construction of comprehensive health cities – complete with specialized centres, hospitals, pharmacies, pharmaceutical production, and labs – as well as the diversification of services. In partnership with the private sector, some 17 centers will be constructed. The strategy also incorporates expanding beyond the regional and European markets to Canada, the US, Russia, China and the Gulf.
The climate in Tunisia is sunny and moderate around the year, and the scenic, natural landscape and the good value for money encourages people from Europe to go there, especially those who required long treatment periods. Tunisian cities are rich in water springs running from the north to the south, with more than 51 therapeutic mineral water centers that help people relieve back and joint pain, ENT conditions and eye problems. Rheumatism, bronchial diseases and skin conditions are also successful treated here, alongside the relieving of tension and fatigue. The springs can be either cold (with water at less than 25 degrees C) or hot. Health and therapeutic tourism is based on the concept of helping the mind and body together, where body ailments are treated in a relaxing atmosphere that takes away the stress of daily life. Natural elements – mineral water, sea, sand and the sun – are used in such treatments.
Tunisia also offers cosmetic surgery at moderate prices, in well-equipped, modern hospitals. Most of the patients come from France, Belgium and Switzerland.

According to the latest figures issued by the Jordan Enterprise Development Corporation (JEDCO), Jordan’s revenues from medical tourism sector in 2009 reached US$1.4 billion from more than 220,000 medical tourists who visited the Kingdom. The increase in the number of medical tourists was 10% higher than in 2008. Jordan’s Private Hospitals Association says that Jordan has managed to attract medical tourists from the U.S., Eastern Europe and Asia, due to the high quality of medical services in Jordan. The goal in the next five years is to receive 300,000 medical tourists per year, and boost annual revenue to $1.5bn.
After establishing itself as a popular destination for medical care among Arabs in the Middle East, Jordan is now looking to attract more patients from outside the region. A study conducted by Jordan’s Private Hospitals Association (PHA) found that 210,100 patients from 48 countries received treatment in the kingdom in 2008, compared to 190,000 in 2007. Figures for both income and numbers for the first nine months of 2009 were 5 to 10% higher than in 2008.
There are 60 private health institutions in the kingdom. Most doctors are English-speaking and many have been trained or are affiliated with top US hospitals. While the kingdom’s medical care quality is high, its costs are relatively low compared to the rest of the world. Healthcare procedures in Jordan typically are just one-tenth of the price of treatments in the USA, and less than a third of the cost of medical services in the UK.
The marketing campaign includes a web campaign and package deals from hospitals that include air travel. Traditional markets that provide nearly all medical tourists are the Arab countries in the region. It is now working on many countries in Africa and the ex-Soviet Union, and the American market. The private sector traditionally has not had much help from the government in promoting medical tourism in the country, but the Jordan Tourism Board is now taking a more active role in boosting the industry as it has seen the growth and potential that medical tourism offers. There are a lot of people in countries such as Nigeria, Ethiopia, and Zambia who want to get treatment in Jordan, but it is very difficult for them to get a visa.
Jordan Hospital in Amman saw a 10% boost in medical tourists in 2009. Most foreign patients at the JCI-accredited hospital are Arabs from the Middle East, but overall the 10th highest total of medical tourists at the hospital comes from the USA, while the UK ranks 13th. The most common procedures requested by patients from the USA and UK at the hospital are plastic surgery, in-vitro fertilization, and orthopedic care. Patients travelling to Jordan from within the region most often seek cardiac surgery, neurosurgery, and cancer-related procedures.

The Tourism Authority of Thailand (TAT) will boost medical tourism in earnest in 2010. Thailand has high potential and marketing opportunities for medical tourism, and most foreign visitors using the service are those with high purchasing power. One reason for the new campaign is that latest estimates for visitor numbers have dropped to 1.2 million for 2009, from 1.3 million in 2008, and signs of falling numbers. This makes TAT’s target of 2 million medical tourists in 2010, and 10 million by 2015, very ambitious. The majority of Thailand’s medical tourist business now comes from Middle East countries
TAT is in the process of gathering information relating to health service providers, accommodation, rehabilitation facilities and tourism programs for companions, to be displayed on its website. Road shows will be later scheduled to target countries, as part of the marketing strategy, and the countries will include Vietnam. The Ministry of Tourism and Sports (MOTS) has been meeting businesses involved in medical tourism to discuss the business potential and cooperation for the best absolute outcome. The ministry is seeking approval for a visa fee waiver for medical tourists until the end of 2010 to help the industry.
Leading private hospital chains playing a key role in boosting Thailand as a medical-care service destination remain cautious over new investment this year, despite the authorities’ assurance of a better outlook. The chains saw declining business in 2009 due to the global economic crisis, the airport shutdown and type-A (H1N1) influenza.
Hospitals have been active in investing in buildings and personnel to accommodate more foreign patients in the past years. Now they are more cautious. Phya Thai Hospital and Bangkok Dusit Medical Services (BDMS) are among those with investment plans to expand capacity on hold. Vibhavadi General Hospital is going ahead with its plan to construct a nine-storey building adjacent to the existing hospital, with work expected to be completed in 2010. The construction cost is Bt300 million, of which Bt200 million will be spent next year. After the building is completed, Vibhavadi will be able to serve 3000 outpatients per day, up from the current 1100.
BDMS may construct a second hospital in Abu Dhabi when the economy improves, but not in 2010. Phya Thai Hospital had planned to expand the existing hospitals in 2010 so as to increase capacity to serve both inpatients and outpatients, but has had to put the investment plan on hold after the fourth quarter’s performance was not so good. Phya Thai operates three hospitals in Bangkok under the Phya Thai and Phya Thai Sriracha brands. It saw a decline in patient numbers after September, and although total numbers in the fourth quarter of 2009 were still above the same period in 2008, they were below the hospital’s expectation.

Medical tourism is seen as a key element of Pakistan’s new National Tourism Policy 2010, so a new task force has been formed to work out proposals to promote and develop medical, health, spiritual and wellness tourism in Pakistan. The Federal Minister for Tourism Moulana Atta-ur-Rehaman believes that Pakistan is missing out on medical tourism opportunities by failing to promote it properly. The task force will seek suggestions from provinces and other stakeholders concerned to implement medical tourism in Pakistan.
Tourism officials claim that Pakistan can compete with other countries, and could even be less than half the price of India, although as Pakistan and India are bitterly opposed to each other, such claims have to be taken in context. They also want to take advantage of India’s problems, ironically partly caused by Pakistan.
Pakistan may have potential to develop medial tourism, but needs co-ordination and all parties working together. Individual hospitals and agencies have acted on their own, but with very limited success. This is the reasoning behind setting up the task force that seeks to get all stakeholders of the country on board, including hospitals, hotels and the travel trade. The Punjab government is already working on developing a 150 bed hospital for kidney transplantation and heart surgery, two specialties that Pakistan wants to develop, to target medical tourists. The new National Tourism Policy 2010 seeks to offer local and foreign investors improved fiscal incentives and soft loans so that the terrorism affected tourism industry infrastructure can be rehabilitated across the country. The federal government aims to assist tourism promotion, and wants the four provincial governments to do the same. The State Bank of Pakistan has been approached to approve the creation of a revolving credit facility based on soft terms and low interest rates. To encourage local and foreign investors, improvement in tax and duty incentives is being worked out so that new tourist facilities are created with new investment in all parts of the country.
Pakistan’s tourism industry has suffered falls in numbers and revenue in the last two years, and the existing tourism policy dates back to 1991.Despite privatization of three big hotels owned by the Pakistan Tourism development Corporation (PTDC) no new further investment have been made in these facilities, so plans to privatize other state owned hotels and motels has been put on hold. The Tourism Training Institute, was occupied by the Taliban, but has now been brought under control of Pakistan forces; however, these forces want to turn it in to jail. Tourism ministers want it back so that tourism training can be revived. This points to the main problem that Pakistan has. However good any tourism or medical tourism initiative is, until the problems of terrorism in general, the Taliban in particular, and the powder-keg relationship between India and Pakistan are solved, travellers will be wary of the country.

The organisers of the forthcoming London based medical tourism exhibition, Destination Health, have signed a tentative agreement with the Turkish Healthcare Tourism Development (THDTC) to bring Turkey’s leading healthcare providers to exhibit at the event.
Housed within the ’Turkish Healthcare Providers Pavilion’ Turkey will be represented by hospitals, clinics, medical spa and wellness hotels and resorts. Speaking on the most recent show development Nav Mann, “As one of the most popular medical tourism destinations we are delighted the THTDC, the official body promoting healthcare in Turkey, has chosen Destination Health to reach UK medical tourists.”
“Turkey has much to offer in terms of world-class health tourism treatment, state-of-the-art facilities, and highly skilled, western trained physicians. We are confident the Turkish Healthcare Providers Pavilion will be a big hit with our visitors and prove to be a profitable investment for the individual companies taking part”
Supported by Europe’s number one medical tourism website Treatment Abroad and International Medial Tourism Journal, Destination Health will take place on the 17th & 18th April 2010 at the Olympia Exhibition & Conference Centre.
The show is expected to attract people from all walks of life who are actively planning to travel abroad for treatment. In addition, visitors will include health and medical professionals who are looking to establish business partnerships with healthcare providers around the world.
Exhibitors will be promoting a wide range of health and medical services including dental treatments, cosmetic surgery, breast augmentation, IVF and other medical procedures. Exhibitors will also include medical spas, health resorts, insurance companies, travel agencies, intermediaries and medical tour operators.
Visitors to the show will be offered free seminars, presentations and all the help and information they need to make their decision to travel abroad for treatment.Entry to the show is free if visitors register in advance.

For further information on exhibiting or attending the event, please contact:
Nav MannEvent Director, Destination HealthTel: +44 (0)20 8230 0066Fax: +44(0)20 8230 0067
navmann@destinationhealth.co.uk
www.destinationhealth.co.uk

As well as seeing medical tourists to Turkey as good potential, Medicana Hospitals Group is looking to expand overseas. Having established a reputation for quality care as one of the leading private health care provider networks in Turkey, the Medicana Hospitals Group is looking to expand overseas. It is investigating the potential of running hospitals and providing management and hospitality services in countries from the Balkans to the Middle East, from Central Asia to North Africa. Active projects are underway in Romania and Bulgaria, while the group is also looking into potential opportunities in Libya, Egypt, Syria and Albania. Executives are talking to both private providers as well as public health managers to custom-tailor programs, including turnkey projects for setting up hospitals.
Medicana, along with other private health providers in Turkey, wants to grab a share of health tourism by expanding to countries in Turkey’s immediate neighborhood. Medicana operates in other countries mainly by the transfer of technology and expertise rather than direct investment. This includes running hospitals, designing the building and equipping them with state-of-the-art medical technology, managing hospital staff and providing hospitality services to patient’s relatives.
Medicana has secured contracts with health providers in other countries in which simple operations are conducted in domestic hospitals while high-risk surgery is referred to Medicana branches in either Istanbul or Ankara. Some of Medicana’s doctors and staff travel to these countries to perform surgery at hospitals there.
The group has recently started to receive patients from Iraq. Most cases are young children with heart problems, paid for by The Iraqi Health Ministry.Medicana offers very competitive rates for high-risk surgery. For many operations, the cost is one-tenth what is charged in the US and a third of European Union prices. For example, laser surgery on both eyes costs 3,000-5,000 euros in Europe, whereas it costs 1,500 euros in Turkey, including flights and a three-night hotel accommodation.
The group provides health and wellness services for heart surgery, advanced cancer treatment, cosmetic surgery, a fertility clinic, brain surgery and organ transplantation in its hospitals. Medicana’s surgery success record is well above the world average. To expand its health network, Medicana plans to establish a medical school and a nursing school.
The group established the Medicana International in December 2007 to cater especially to foreign diplomats and professionals working there. The hospital offers everything from family medical services to comprehensive surgery in one building. All doctors speak English, and the staff is specially trained to respond to the needs of foreign visitors. The hospital reached 80 percent of its operation capacity within its first year. With seven state-of-the-art hospitals in Istanbul and Ankara and more planned in other cities, the group is expanding both in the domestic market and abroad.
With state of the art facilities, equipment and expertise, Turkey is building a medical tourism industry that attracts patients to Turkish clinics and hospitals. Although some business is from Western Europe, the majority comes from the Middle East, Russia, Turkmenistan, Uzbekistan, Kazakhstan, Albania, Armenia and Georgia.

Using a technique that has worked very well internationally in other sectors, a new US based website aims to connect hospitals and doctors around the world direct with patients, cutting out all ’middle men’; whether they call themselves agents, brokers, advisors or facilitators.
Delaware based MediBid.com connects physicians to patients anywhere in the world. The MediBid portal connects patients directly to doctors. Participating physicians can expand their practice by offering medical services to cash paying patients without what the company calls ’’ interference from the medical middlemen who drive costs skyward without improving care.”
Ralph Weber, MediBid founder says,” The costs of running a healthcare practice have skyrocketed in recent years. This poses a significant challenge to physicians who simply want to provide quality care to their patients. The medical middleman has driven up costs for both patients and physicians without regard for quality of care. Medical bureaucracy interferes with the practice of medicine. This is bad for doctors and patients.”
MediBid helps cash paying patients connect with medical practitioners. MediBid allows doctors to set their own prices based on the patients’ needs and gives patients a choice. Physicians tailor bids on a case-by-case basis, which empowers them to find new patients and enhance their practice. MediBid does not regulate prices. Patients pay doctors or facilities direct.
MediBid is much more than a medical directory or medical tourism facilitator; it allows doctors and patients to work through the issue of cost on everything from primary care to the most critical of care. Physicians respond to requests for care from patients with a special bid, not a pre-arranged tariff.
Ralph Weber explains,“MediBid helps physicians to expand their fee for service practice through private contracting. By removing the middleman from medical care, MediBid makes it possible for the uninsured, the underinsured, Canadians on a waiting list, people using a high deductible health care plan, and people seeking experimental procedures, elective surgery or a non covered procedure to be able to afford the care they want and need. MediBid was founded on a belief that universal access can be accomplished by reviving the free-market healthcare system. Interest from patients during the testing phase was strong and the response by physicians has been overwhelmingly supportive. This is truly an idea whose time has come.”
MediBid is an interactive marketplace to allow cash paying patients to seek medical care from doctors, hospitals, and facilities both locally and around the world. More than a physician directory, it is a resource where medical consumers can find a doctor, then actively seek bids for the care they need. It gives physicians a direct connection to their patients. Physicians and hospitals are charged an annual registration fee, with no transaction or bid charges.

The Japanese healthcare industry is focused on the domestic market and has let the world of medical tourism pass by. Few hospitals in Japan are foreigner-friendly with only a handful of doctors and hardly any other staff who speak foreign languages. Traditional practices such as making patients wait around for hours and then giving them a very short consultation, are not patient friendly. But the majority of hospitals in Japan are struggling financially, so an interest in medical tourism is emerging. To get anywhere, hospitals would have to become more international and accommodative toward foreign patients’ needs. with multilingual staff and international patient centres.
Medical tourism is very much in its infancy in Japan and there are no official statistics on how many foreigners go there for treatment. There are signs the government is getting serious about attracting medical tourists so that hospitals become more internationally competitive. The Ministry of Economy, Trade and Industry (METI) has new guidelines for hospitals on how to attract medical tourists, emphasizing cost-effective health care and advanced medical technology.
METI will soon launch a pilot program under which two consortiums, made up of hospitals, tour operators, translators and other businesses, start accepting patients from abroad. 20 overseas travelers will be brought to Japan by early March for health checkups or medical treatment at hospitals. Patients are expected from Russia, China, Hong Kong, Taiwan and Singapore.
The Japan Tourism Agency will soon be interviewing hospital officials in Japan and their foreign patients, as well as researching the practices in other parts of Asia, as it wants to develop medical tourism as a way of helping the country achieve a total tourism target of 20 million visitors a year.
Tokyo-based trading company PJL started bringing Russians, especially those living on Sakhalin Island, to Japanese hospitals four years ago. 60 people have visited Japanese hospitals through PJL introductions since November 2005. They have come for treatments ranging from heart bypass surgery to removal of brain tumors to gynecological screenings. PJL receives fees from patients for translating documents and interpreting on site for them.
Hospitals who have been involved in medical tourism say that the key to success in building up the medical tourism industry is finding enough skilled interpreters and translators who can communicate patients’ needs to hospitals before they arrive.Japanese hospitals are restricted in what they can charge at home by Japan’s universal health care system. But hospitals are free to set whatever fees they like for medical tourists. Japan’s health care is relatively cheap, but reports of patients from abroad being charged more than double what Japanese patients are charged, is not the way to build a medical tourism industry. Hospitals dealing with Russian patients are charging about the same as Japanese patients.
Another problem for Japanese hospitals is the lack of any international accreditation.Kameda Medical Center, a 965-bed hospital group in Kamogawa, recently became the first hospital in Japan to get approval from the Joint Commission International.Kameda now gets three to six patients per month from China, mainly for preventive and comprehensive health checkups) and post surgery chemotherapy that uses drugs patients cannot get in China. The hospital has signed an agreement with a major Chinese insurer that covers 3,000 affluent Chinese and expatriates.
For medical tourism to grow in Japan, the government needs to do more than just say encouraging words. Rivals such as Malaysia and South Korea, have invested in incentives and marketing support, and are stepping up their levels of assistance.

The Indian government has failed to deliver promised help to the medical tourism industry and in late December it reacted to a terrorism panic by immediate changes to visa rules that will damage medical tourism. In the rush to get the measures through, no thought appears to have been given to the impact on medical tourism, health tourism or general tourism.
New visa requirements oblige travelers on tourist visas for more than 90 days to take a mandatory two-month "time-out" before returning to the country. The unexpected visa rule changes were prompted by revelations that Pakistani-American terrorist David Coleman Headley and his associate Tahawwur Rana had visited India on fake multiple-entry visas. The duo were arraigned in October in Chicago on charges of plotting an attack on India that killed 160 people in Mumbai. Foreign governments have protested at the new rules. The US issued an advisory asking its citizens to review their travel plans to India. Permission to re-enter without a 2-month gap may be granted on the submission of a detailed itinerary and supporting documents such as ticket bookings, but it may take most of the gap period to process the documentation. The new visa rules will apply to anyone needing a visa to come to India, even to people of Indian origin. Although there is a system of medical visas, the process is complex and off-putting, so most medical tourists come on normal tourist visas.
The new rules will also have an impact on medical tourism, as many medical procedures that people go to India for require time, often with treatment over several months, so will affect those needing several visits.
Ironically, the clampdown comes as the Indian tourism industry had begun showing definite signs of revitalization after last year’s Mumbai attack and a bruising economic crisis. But the new visa regulations could kill the recovery.
The denial of a visa to a potential terrorist may be the instinctive reaction of any government fighting international terrorism; it is a fundamentally flawed one as terrorists use false visas. What the government is doing is trying to limit the number of trips a foreign visitor makes to India. The new rules also risk strengthening any perception of India as an uncomfortable or unfriendly tourist destination. As travel experts point out, the new visa rules make considerable paperwork and excessive paperwork will just make medical tourists go elsewhere.
A final draft of the visa regulations is expected to be issued later this month but a number of embassies in India and some Indian embassies overseas are advising "a minimum gap of two months is mandatory between visits as tourists to India”. Even if the Indian medical tourism lobby, which so far has been silent, manages to change or the rules on medical tourists, months of uncertainty will have taken their toll.

The Malaysian government has identified healthcare travel as one of the potential services sub-sectors to generate national economic growth. Malaysia is fast-gaining recognition as a preferred destination for healthcare travellers. The competitive cost of treatment, along with excellent service, has enabled Malaysia to provide quality healthcare services. Malaysia’s top 35 private hospitals have seen growth from 103,000 medical tourists in 2003 to 375,000 in 2008. In terms of growth, medical tourists grew at an average of 30% per annum while revenue grew at an average of 35%. During the first half of 2009, the promoted hospitals recorded 165,095 foreign patients. Estimates for 2010 are 625,000 medical tourists.
The establishment of the Malaysia Healthcare Travel Council (MHTC) will bring together the efforts of significant players in the Malaysian healthcare travel industry, both in government and in the private sector, to drive growth of this industry to a higher level. MHTC is tasked with the responsibility to formulate strategic plans for promotion of healthcare travel services and to spearhead the promotional activities for the Malaysian healthcare travel industry. MHTC will also provide a focal point for industry players to collaborate and resolve issues that may hamper the development of the industry as well as be the focal point for enquiries on healthcare travel. The 2010 Budget includes an enhanced tax incentive for healthcare service providers who offer services to foreign health tourists. Income tax exemption of 50 % on the value of increased exports is increased to 100 %. This enables healthcare service providers to offer high quality health services and attract more health tourists. To encourage private hospitals to expand their capacity, the Government will provide tax exemption equivalent to 100% of qualifying capital expenditure incurred for a period of 5 years for the construction of new hospitals or for expansion/modernisation/ refurbishment of existing hospitals. This tax incentive is for applications received from 1 January 2010 until 31 December 2014. Setting up an International Patients Unit in these hospitals will also qualify for this incentive. To be eligible for this incentive, hospitals must be registered with the Ministry of Health for the promotion of healthcare travel. In line with the Government’s desire to promote healthcare travel, the Ministry of Health, Malaysian Medical Council and Association of Private Hospitals Malaysia will review existing advertising regulations and guidelines to see how to meet the changing role of private hospitals in promoting medical tourism. To encourage private hospitals to attain high quality of healthcare services, expenses incurred by private hospitals to obtain domestic or internationally recognised accreditation such as the Malaysian Society for Quality in Health (MSQH) or Joint Commission International (JCI), are eligible for double deduction incentive under the Income Tax Act 1967. To allow smooth arrival, stay and departure of medical tourists: The Commercial Vehicle Licensing Board (CVLB) will issue relevant permits to hospitals/ medical facilities registered under the Ministry of Health for the promotion of healthcare travel. The permits will allow hospital vehicles to ferry patients and accompanying persons from and to airport/ port and hospital/ hotel. Foreign patients entering Malaysia for medical treatment on emergency via ’Visa-On-Arrival’ will be allowed to convert their VOA status to social visit pass upon recommendation of private hospitals registered under the Ministry of Health for promotion of healthcare travel; and approval of extension of stay for medical tourist at the state level will be expedited.

Jordan is famous for The Dead Sea with its healing powers. The country promotes the Dead Sea as both a medical destination and a leisure destination. What makes the Dead Sea unique is that it is the largest natural spa on earth. It is known for the medical properties of its waters and mud and the curative powers of its salty water. The high concentration level of oxygen in the Dead Sea area makes it an ideal cure for patients with asthma or chest problems] Dead Sea products are known worldwide and are used for beauty and cosmetics. Close by is Main Hot Springs, is known for its thermal powers. King Herod and Queen Cleopatra discovered the secrets of the Dead Sea and the Main Hot Springs centuries ago.
Jordan has a large number of Germans who come to Jordan for for treatment, often lasting between 4 to 6 weeks. Some insurance companies in Germany and Austria send their clients to Jordan for treatment at the Dead Sea, as they find it more reasonably priced and more effective than chemical treatments that might have some side effects. Jordan has a lot to offer in terms of special prices and packages.
The Jordan Investment Board says that there is a particular interest from international investors in the development of hotels in Aqaba and the Dead Sea, with a lower interest in projects in Amman and Petra. The Jordanian government has a commitment to privatization in the health industry, paving the way for additional modernization and development in the industry. Growing joint venture partnerships between the public and private sectors are a major stimulant to new investment in healthcare services and infrastructure. The organistion also has an investment map listing potential projects that welcome partners. In health care that list includes a specialist childrens hospital, a cardiac surgery hospital, a surgical transplant centre, and a cosmetic eye surgery clinic.
There is a growing demand for medical care due to the young and growing population, incoming immigrants seeking Jordan’s comparatively higher standard of living, and medical tourism. The national economy is receiving massive injections in developmental capacity and revenue due to the medical tourism sector. The growth in the sector is due to the correct publicly held perception of Jordan as a supplier of high quality healthcare services at competitive prices.
Jordan is increasingly becoming a more popular destination for medical tourists with several medium to large hospitals encouraging business. Hospitals in Jordan are conduct complicated and expensive surgeries at a low cost compared to more developed countries with similar success rates and customer satisfaction ratings.
The Jordanian government commitment to reform of the health sector aims to improve healthcare services and assurance of facility use, health delivery systems, and health information systems. The target for 2010 is 140,000 medical tourists.

There are signs that the medical tourism industry in Singapore is becoming healthy again. Things are looking up after the recession, which hit at the end of 2008 and continued for much of 2009, caused some reduction in business. As many economies have stabilized or recovered, the industry is upbeat for 2010.The general view is that late 2008 and early 2009 were both quiet, but mid to late 2009 has seen a steady recovery and a return of confidence. ParkwayHealth reports that it has seen a steady recovery since the middle of 2009 and prospects for 2010 are encouraging enough for it to continue with plans for a new hospital in Novena.
For Singapore, Indonesia is a key market. ParkwayHealth saw figures down in all three hospitals of around 8% from Indonesia in late 2008, but 2009 has seen a gradual return to normal. Pacific Healthcare runs specialist centres and clinics, and suffered a 10 per cent fall in medical tourists in 2008.Indonesians form the largest group of medical tourists for them, and the financial crisis last year weakened the rupiah, and there were also uncertainties about the economy and when it would recover. Rather than just relaying on Asian business, more medical groups are targeting patients from Russia, Germany and Sweden.
Malaysian private hospital Sime Darby Medical Centre Subang Jaya (SDMCSJ) has agreed with the National Cancer Centre Singapore (NCCS) a patient referral partnership to treat cancer. Both will make referrals to consenting patients on a need basis, from time to time, for second medical consultations and follow-up treatment. SDMCSJ’s Elaine Cheong said this paves the way for a smooth and hassle- free process for patients who travel to both countries for management and treatment, "Our cancer centre and NCCS will also cooperate to provide financial counselling to patients regarding the referrals."
Singapore Tourism Board reports that the medical travel sector is fairly resilient, given that health-care treatments are often a matter of necessity, and it continues to work towards the target of one million patients by 2012.
Figures from SingaporeMedicine show that in 2008, 646,000 ’ medical travelers’ came, up from 571,000 in 2007. But these numbers are misleading as they patients and those who accompanied them here, as well as tourists who received incidental health care. SingaporeMedicine is a government-industry partnership to promote the country as a world-class health-care destination.
Dr Wei Siang Yu founded medical tourism portal Fly Free For Health, has seen more traffic in the last months of 2009. Users can get opinions from doctors and nurses online so that they feel reassured about travelling to Singapore.

The government of the Cayman Islands and Dr Devi Shetty, a leading Indian cardiac surgeon, are exploring an initiative to bring medical tourism to the Cayman Islands.Dr Shetty is the founder of the Narayana Hrudayalaya Group of hospitals in Bangalore, India. He is planning to set up a new medical complex in the Cayman Islands that will include a 500 bed hospital, that would later be expanded to 2000 beds and include a medical university.
McKeeva Bush, the Cayman premier confirmed, “ I am talking to Dr Shetty and our government has some interest his proposed medical facility in terms of our medical tourism plan. We are very supportive of the proposed hospital and we are continuing our discussions.Medical tourism will assist the Cayman Islands and it is a serious plan that Caymanians will benefit from, as it will enhance the services that are currently available.”
While government fully supports the medical project it is a completely private initiative by private investors and the government have denied reports they have offered land or any other form of partnership. Cayman Airlines is prepared to offer discounted airfare for early morning flights so people could fly in the morning, get their CT/MRI or other tests done and return in the evening.
The Health Practice Commission’s Dr Steve Tomlinson is not convinced, “I would reserve my opinion as for medical tourism to work it has requirements; it has to be quality service; needs to be less expensive than what the cost is wherever those patients are coming from, and/ or must offer treatment not available in the places where those patients are coming from.Cayman law says that we cannot offer healthcare services that are not already available in Canada, the United States and the UK. I believe that most patients would be coming from those countries.Medical tourism works in some places where people are paid very little for the work that they do because the cost of living in places like Bangalore, India, is much lower than it is here in the Cayman Islands.If you are going to use high-grade medical equipment and supplies it becomes very expensive.”
Dr Shetty says the hospital in the Cayman Islands would primarily serve Americans in search of lower-cost medical care. The plan is to build and run a general hospital where procedures, both elective and necessary, will be priced at least 50% lower than what they cost in the US.The financial model would only work if it can do volume operations.
Cayman is close to the United States , just 52 minutes from Florida, so it could be easy to bring medical professionals and patients to it.A replica of the health city in Bangalore could offer low-cost healthcare to American patients, but Cayman is not a low cost economy like India, and it would have to pay medical staff at American rates.The islands are small with a population of about 60,000 people, so would have to import medical and support staff.
Some local medical professionals do not believe the model would work as; local hospitals and private practices would have to close because they wouldn’t be able to compete; support staff could not survive in one of the world’s most expensive places to live; there is no spare housing for the 2000-3000 staff members needed; and importing a low cost model only works in a low cost country.

The French healthcare system is good so would anyone living in France even think about going abroad for treatment? The answer lies in the high cost of some treatments such as dental treatment in France. Customers have to pay for treatment and then attempt to get partial payment from their healthcare insurer.
In France a good-quality porcelain crown could cost up to €800, of which only €75 would be reimbursed by insurance; the same crown might cost only €300 in Budapest, so the attraction of going abroad for treatment suddenly becomes more obvious. And for dental implants these are expensive, up to €2,000 to €3,000 for one tooth, and no reimbursement from the healthcare provider.
Treatment in France tends to be stretched out over a long period. The wait between preparing a tooth to receive a crown and having the crown fitted may often be as long as 10 days. Treatment abroad means people can have lots of work done over a short period. Some people needing major amounts of reconstructive surgery even opt for two trips, each lasting a fortnight, in order to get their treatment completed quickly rather than spend the afternoon in a French dentist’s waiting room every fortnight for a year. Another area where foreign prices are attractive to people in the French system is eye care because treatments, even simple eye tests, are poorly reimbursed.
State health insurance systems do not cover cosmetic treatment. Eastern European countries, especially Hungary, Bulgaria and the Czech Republic, have overtaken Spain as favourites for dental work because standards are high and prices are attractive. Tunisia is also a developing destination for medical tourism for French visitors because many there speak excellent French. Getting reimbursed for medical treatment received abroad but within Switzerland and the EU is theoretically straightforward as French consumers have the law on their side. However, you have to fill in forms and hope you do not fall foul of bureaucracy. For those who have had the treatment and returned to France, they can claim reimbursement by filling in yet another form (declaration of treatment received abroad). This must be sent with all bills, travel tickets, a pay slip from the month before you travelled abroad for treatment, plus prescriptions and other paperwork that justifies your trip. You must keep photocopies of everything, one copy for you and one for your insurance company, or more often two sets, one for the main insurer and one for the top-up insurer.
Every insurer has a different policy and reimbursement tariff for elective medical treatment abroad, but in theory there are no barriers to the French buying medical care wherever they like. Costs such as travel, accommodation and living expenses during the stay abroad are not reimbursed. Most people get paid eventually, but the fact of having to pay for treatment first, and having to navigate the hazards of paperwork and the administrators that handle it, limits the number of French people going abroad for treatment.

The Centers for Medicare and Medicaid Services (CMS) has awarded continuing accrediting authority to the Healthcare Facilities Accreditation Program (HFAP) until September 2013. This is only one of three CMS-approved accrediting programs in the country; HFAP has expanded to provide accreditation for a range of facilities, including ambulatory surgery centres. An organization with deeming authority can accredit hospitals to comply with Medicare’s conditions of participation. Hospitals seeking Medicare approval may choose to be surveyed either by an accrediting body or by state surveyors on behalf of CMS.
The continued recognition of HFAP is the culmination of a rigorous process of reviews of policies and procedures, an onsite visit by federal officials, and scrutiny of actual hospital inspection records. Michael Zarski of HFAP says, "What this means to patients and healthcare consumers is the assurance that any facility accredited by HFAP meets or exceeds quality and safety standards set by CMS." A non-profit, nationally recognized accreditation organization, HFAP has been accrediting healthcare facilities for more than 60 years and its mission is to advance high-quality patient care and safety through objective application of recognized standards.
The CMS has also approved the continuation of deeming authority for The Joint Commission’s hospital accreditation programme until July 2014. Mark Pelletier at The Joint Commission comments, "Accreditation is a proven method for improving the care of Medicare beneficiaries." The Joint Commission’s hospital accreditation programme has held deeming authority since the inception of the Medicare program in 1965.In addition to hospitals; it has federal deeming authority for ambulatory surgery centres and critical access hospitals. The Joint Commission, a private non-profit organization, accredits the overwhelming majority of hospitals in the United States. This is the first time that it had to submit for re-accreditation, as until 2008 it automatically had continual deeming status.
DNV Healthcare attained Medicare deeming authority in September 2008. It is part of a Norway-based foundation that offers third-party assessment, verification, and certification of compliance with standards. It is the first and only CMS approved accreditation program to offer annual surveys, and to integrate ISO 9001 continual quality with the Medicare conditions of participation. It is a revolutionary approach that turns accreditation into a strategic business advantage – by creating new standards of excellence from the skills, experience and ingenuity that already exist in your hospital. DNV argues that NIAHO is designed from the ground up to drive quality transformation into the core processes of running a hospital; and helps healthcare organizations meet their national accreditation obligations and achieve ISO 9001 compliance in the same seamless programme.
Just over a year since CMS granted hospital deeming authority, hospitals across the USA that are embracing a totally new approach to accreditation and almost 100 have been accredited or are being processed. As well as regional hospitals, they include teaching hospitals and new builds. In 2010, DNV is introducing a range of specialist accreditation services, including for primary stroke centres and critical access hospitals. Dave Griggs of St Elizabeth Medical Centre in New York says, “ DNV helps staff focus on what matters, the patients.”
Having competition has forced the existing two accreditors to improve their offering and not take their hospital customers for granted.

A rebounding medical tourism industry emerging from global recession may benefit the Philippines. At the opening of cosmetic surgery clinic, Shimmian Manila Surgicenter, Dr. Levi John Lansangan commented, “We are seeing a recovery from the global recession. Scandinavian visitors really want to go to South East Asia. And the Philippines has an advantage because people can enjoy a low price and an excellent service with us. I have clients from Sweden, Denmark, and Finland. Our government, particularly the tourism department, has been very supportive. But we also have to improve our peace and order situation because people think it is dangerous to come here.”
The Philippines is on its way to becoming a global health and wellness destination, claim the Department of Tourism (DOT) and Department of Health (DOH). Sixty representatives from the DOT, DOH and the private sector gathered at a Health and Wellness conference where they mapped out various strategies to improve the health and wellness industry. Those in attendance included representatives from the health and wellness, retirement and tourism sectors. DOT director Cynthia Lazo says, “We are one of the leading countries in terms of wellness tourism. If we are to really get ourselves on top, we need to get our act together to make our country a destination for medical and wellness.”
The future of medical tourism in the Philippines will not solely depend on the volume of foreign clients coming to the country to seek medical help, but its growth is largely reliant on the Filipinos working abroad. Dr. Anthony Calibo of the DOH’s Philippine Medical Tourism programme commented, “Solidifying the organization of all the stakeholders involved in health and wellness services, retirement and tourism will provide the necessary drive for the Philippines to become a major player in the global healthcare industry. Unlike other countries, the Philippines has its natural market. It is not relying on foreign patients, because the source of constant and sustainable growth for the industry is Filipinos residing and working abroad. Regardless if foreigners come in the Philippines or not to seek medical help, the medical tourism industry will still grow because many of these prefer to get medical attention in their homeland.”
Calibo admitted that the Philippines’ positioning as a premier medical tourism destination, has been overshadowed by other countries including Thailand, and India because of negative publicity brought about by calamities like typhoon Ondoy and Pepeng, and the recent Maguindanao massacre, among others. Calibo says the Philippines will be assured of the dollar-earning Filipinos who go back to their home country for medical services, including vanity, dental, and executive check-ups
He pointed out world-sought-after Filipino nurses and good English speaking medical professionals, as one of the advantages of the Philippines, “There are still challenges that the medical institutions in the country should address seriously. This is in providing world-class medical services and technology, as the Philippines is already on top in terms of human-touch. We need to work together in addressing issues that hamper growth in attracting medical tourists, and the foreign retiree market. The Philippines will only succeed if more medical institutions will get international accreditation and improve medical services.

The organisers of Destination Health, the forthcoming Health & Medical Tourism Show have reported an unprecedented level of interest from UK patients planning to travel abroad for treatment. With just over four months to go, the organisers have already received a significant number of advance registrations from medical tourists keen to attend the exhibition on 17th & 18th April 2010 at the Olympia Exhibition Centre in London.
Commenting on the visitor registrations, Event Director, Nav Mann said Although our visitor marketing programme is not scheduled until January 2010, we are delighted with the level of interest from UK patients which confirms UK demand for medical treatment abroad
Analysis of visitor registrations has revealed the type of treatment providers patients are actively seeking to meet at Destination Health. Over 66% are looking for dental treatment, followed by 43% for cosmetic surgery and 27% for fertility treatment. There is also significant interest in medical spas with over 22% of the visitors keen to learn more about this type of treatment for skin conditions and arthritis.  Over 34% are looking to make contact with hospitals and clinics specializing in a range of general treatments.
When asked why they want to attend the event an overwhelming number (88%) indicated they wanted to meet providers face to face before making any commitment to travel for treatment.
Mr R Mill from London, who recently registered When I heard about this exhibition, I jumped at the chance to register for my free entry. For a few months I’ve been thinking about traveling abroad for dental treatment and having done some research on the internet it’s frustrating not being able to meet the people who might operate on me. Destination Health is a godsend as it gives me the opportunity to meet the clinics and see first hand what they have to offer.
Supported by media partners Treatment Abroad the Europe’s number one medical tourism website and the International Medical Tourism Journal (IMTJ), Destination Health will take place on the 17th & 18th April 2010 at the  Olympia Exhibition & Conference Centre.
For information please visit www.destinationhealth.co.uk or call +44 208 230 0066 / +44 1420 849210 or email julian.fisher@destinationhealth.co.uk  / Twitter: medtourismshow

DNV, the German based provider of risk management and sustainability solutions, has signed an agreement for joint research with China Health Economics Institute (CHEI), the research body under the direct leadership of Ministry of Health. The DNV-CHEI joint research institute, Healthcare Risk Management Research Centre, will focus on China national healthcare reform strategy and hospital management from a risk management perspective. DNV has well-established theories and tools in risk analysis with proven international experience.
Per Marius Berrefjord of DNV says The Chinese healthcare reform is one of the largest undertakings in human history, directly impacting the entirety of China’s 1.3 billion population. We look forward to working hand in hand with CHEI to find appropriate risk analysis methodologies for both the national strategy and also at the hospital level. The Chinese development model has gained increasingly international recognition and China’s adoption of sustainable practices creates stronger Chinese enterprises and contributes to a balanced and harmonious economic progress at the national level.
China now is carrying out a reform, aiming to build a basic health-care system that can provide safe, effective, convenient and affordable health services to all its urban and rural residents by 2010. It is now implementing the three-year action plan (2009-2011) that will enable all Chinese people to enjoy the universal medical services, by taking efforts in five aspects: expanding medical insurance coverage, building a basic medicine system, improving medical service system especially those at the grassroots level, providing equal public health services in both rural and urban areas and reforming public hospitals. In addition to developing a national policy, there will be 100 pilot programmes at state-run hospitals and an effort to resolve healthcare delivery to the 800 million people living in rural areas.
The Healthcare Risk Management Research Centre, will contribute to China’s healthcare reform that now tops the agenda of the government, with three primary targets:1. To create a think-tank in the field of risk management in healthcare system advising the national and provincial governments.2. To provide advisory services for Chinese healthcare policy making and management practices.3. To contribute to the development of Chinese healthcare accreditation standards.
DNV is working around the world to make healthcare safer and more effective. DNV is helping American hospitals transform accreditation into a strategic business advantage and is now the No.2 hospital accreditor in the US. DNV serves as the major external advisor to the government of the United Kingdom on its healthcare system, is the top hospital accreditation body in Brazil and the fastest growing accreditation body in India.
If China’s healthcare reform works, it could drastically reduce the number of Chinese travelling overseas for treatment, and in the long run, offer a powerful inexpensive medical tourism destination.

A scheme to market Cornwall, in the South West corner of England, as a destination for health tourism has taken another step forward with collaboration between accommodation providers and the county’s private hospital.
Under the partnership, a list of Cornish hotels, guesthouses and self-catering accommodation suited to convalescing patients has been drawn up by the Duchy Hospital in Truro for patients who wish to recuperate in the county. The accommodation will be promoted to the growing number of patients from outside Cornwall who choose the hospital for procedures such as cosmetic surgery, orthopaedics, eye operations and vascular surgery. The list will also be available to people looking to recover in Cornwall after a procedure elsewhere in the country. The accommodation details will be provided by the hospital’s Freephone enquiry line, on its website and in packs sent to patients prior to their operations.
Chris Sealey of Duchy Hospital comments, This partnership will make it far easier for people to recover in Cornwall’s fantastic environment. Our out-of-county patients will be able to plan their recuperation in advance, while patients elsewhere in the UK will be able to choose accommodation providers who welcome convalescing patients and are prepared for their needs.
Currently, the majority of non-Cornish patients at the Duchy Hospital are there because the hi-tech nature of their procedure means it is not offered at their local hospital. It is the busiest treatment centre outside London for certain types of varicose vein procedure and, last year, the hospital was one of the first in the country to offer a treatment for the previously incurable eye condition, dry AMD. Duchy Hospital is Cornwall’s only private hospital with 33 single rooms and 2 double bedrooms, all with en suite facilities to ensure complete privacy. In addition a two-bed high dependency unit is available for patients requiring particularly close monitoring.

Pat Smith from the four-star Bosinver Farm holiday cottages, one of the self-catering locations included in the scheme, says: People have always come on holiday to Cornwall for their general wellbeing. Our collaboration with the Duchy Hospital takes that a stage further. If you have particular medical needs, why not have those tended to in Cornwall, and recover in one of the most beautiful locations in the country. Another participant in the partnership scheme is the Stonesthrow apartment in Porthtowan, developed to accommodate people recovering from eye and ear operations. Stonesthrow’s owner, Priscilla Davis comments, We offer features such as a talking clock, large print notices and audio books. I worked in the health service for a number of years and understand the importance of relaxation for a speedy recovery. That is exactly what the county offers, and why we are so keen to take part in this scheme.
As well as medical reasons, other factors can determine where patients choose to have their operations carried out. Some out-of-county cosmetic surgery patients choose to have a procedure carried out discreetly in Cornwall, and use an extended break in the county to explain their changed appearance.

SpaFinder’s 2010 Spa Trends Forecast, suggests global spa trends that will influence spa experiences for both consumers and the industry in 2010 and for years to come. The annual report is based on analysis from a team of experts who visit thousands of spas, interviews with top industry analysts and research organizations, and ongoing consumer and industry research in the spa, travel, wellness, and beauty sectors. Those relevant to health tourism include;
Prevention
Prevention as the new in word of the spa industry in 2010 and beyond.
Germany’s Brenner’s Park-Hotel Medical Spa’s PREVENT program, combines comprehensive examinations with personalized therapies, nutrition, and fitness.
Hammam
With spa-goers increasingly seeking authenticity, tradition, and that magical spa experience that also offers true results, the Middle Eastern hammam (hamam in Turkey) represents one of the hottest trends for 2010.  They are elaborate facilities where you get a full-body scrub, soaping, and often a massage inside a heated steam room. This is the year when people who have never heard the term hammam will learn its meaning, and those already familiar with it will discover new places to experience it. Travel to hammams like the 16th-century Çemberlita in Istanbul will increase, while brand-new spas will unveil distinctly modern incarnations.
Hybrid
The modern spa is increasingly a hybrid, with spas incorporating far more fitness, fitness centres incorporating more spas, hospitals incorporating spa elements, and spas bringing in more medical doctors and specialists. The era of the spa/fitness/integrated-health-center/hospital/spiritual-retreat/wellness-center/beauty-clinic is on a serious upswing. Many more hotels are being built with spas.

Wellness tourism
People seeking spas for wellness will increasingly travel across borders for preventive services, diagnostics, spa and well-being vacations, even stem cell banking. The concept dramatically broadens the appeal of medical tourism away from surgery.
Examples include stem cell banking at The Medical City in the Philippines, executive physicals at Lanserhof in Austria or Kurotel in Brazil. Traveling across borders to destination spas such as Champneys in the UK, Rancho La Puerta in Mexico or Chiva-Som in Thailand for a life/health turnaround are examples of core, established wellness tourism.
Many global consumers opt for these journeys because another country/region offers significantly lower costs or greater procedure/treatment availability. But the upswing is also part of a wider trend toward mindful, not mindless, travel. Given the economic and moral climate, people are increasingly embracing travel with a higher benefit to themselves and their bodies.
Diversity
For years analysts have discussed how the spa industry has been attracting new demographics (men, teens, seniors, new ethnic groups). But in 2010 diversity has reached a tipping point: It has fully arrived, and here to stay. Spa going has become so mainstream that the face of the spa-goer will now continue to reflect the wider global population. Every spa region has its unique diversity story, and around the globe far more men, younger and older generations, and ethnic groups are hitting the spa. And spas are taking note, with offerings that cater to these diverse groups’ needs and wants.

Spas will now be classified as wellness clinics, the Quality Council of India (QCI) has said. In a bid to put an end to unethical practices in spas and other healthcare clinics, QCI will launch the final edition of wellness and health care clinic standards during December.
According to the QCI, experienced doctors using standard ayurvedic products should be appointed by all spas. Unethical practices such as using several non-standard techniques for therapy and massaging should be discarded. At present, there is no check on activities at healthcare clinics and spas.
Preliminary standards for wellness and healthcare were launched during 2008, but overlapping with the standards of other bodies led to confusion. To solve this issue, QCI will now launch the final edition soon.
Schools, hospitals, laboratories, blood banks, and spas will be accredited from 2010. The repackaging of ancient healing practices for a modern consumer base is best typified by spa resorts. The concept of a spa is wellness in its purest form. But spas have mushroomed everywhere. The QCI standard will at first not be mandatory, but customers should understand to choose those spas that are accredited. QCI has many examples of unethical claims made by spas and related consumer and trade complaints. With huge growth in the wellness market, QCI feels it is important to develop a mechanism where spas are accredited.
Responsible spa and clinic owners are delighted that QCI is taking this initiative. It is very important for healthcare clinics and spas to have qualified ayurvedic doctors. Proper hygiene should be maintained, which is not the case at present in some spas.
It is not always feasible and economically viable for small Indian wellness operators to obtain accreditation from international agencies. Therefore, QCI felt a strong need to frame an Indian standard on par with international standards, which could be implemented by all in the industry.
In order to improve healthcare, at least one state government is considering a proposal asking all hospitals and private nursing homes to acquire accreditation from National Accreditation Board for Hospitals & Healthcare Providers (NABH). NABH is a constituent board of Quality Council of India, set up to establish and operate accreditation programme for healthcare organizations.
With the mushrooming of private hospitals, clinics and other health/wellness centres, authorities and state governments are concerned about quality of care. Most of the medical tourism industry also welcomes these initiatives as a way of proving to potential customers that very cheap does not equate to poor quality.
Hospitals, large and small, have in the past three months been scrambling for an accreditation by NABH, with 320 applications in the last three months. The sudden increase is because in May, the Ministry of Health and Family Welfare made it mandatory for hospitals to have an NABH certification by December 2010 if they want to treat the large pool of Central Government employees under the CGHS (Central Government Health Scheme). An NABH tag has become attractive to big healthcare brands such as Apollo or Wockhardt Hospitals, even when they already sport an international certification. A national certification costs a quarter of an international one. National and international insurers prefer hospitals with an NABH accreditation.

The Accreditation Association for Ambulatory Health Care (AAAHC) has received board approval to extend its accreditation services internationally, beginning with Costa Rica in early 2010.
John Burke of AAAHC explains, With the advent of medical tourism and the significant number of Americans living abroad, we feel it is important to offer assurances that ambulatory medical services in other countries operate at a level consistent with U.S. ambulatory organizations that are AAAHC accredited. Our unique approach to ambulatory healthcare accreditation, which includes a peerbased survey process, comprehensive education programs and internationally recognized standards, will enable us to work closely with these health centres to assure they are providing high-quality care.  As the US’s leading ambulatory healthcare accrediting organization with more than 4500 ambulatory healthcare organizations accredited nationwide, the AAAHC will work initially with outpatient health centers in Costa Rica that voluntarily wish to pursue accreditation to assure access to quality healthcare services.  Accreditation for ambulatory organizations in other countries will be added later.
The Accreditation Association for Ambulatory Health Care, also known as AAAHC or the Accreditation Association, is a private, non-profit organization formed in 1979. It develops standards to advance and promote patient safety, quality and value for ambulatory health care through peer-based accreditation processes, education and research. Accreditation is ultimately awarded to organizations that are found to be in compliance with the Accreditation Association standards.
The Accreditation Association currently accredits over 4,600 organizations in a wide variety of ambulatory health care settings, including ambulatory and office based surgery centers, managed care organizations, as well as Indian and student health centers, among others. With a single focus on the ambulatory care community, the Accreditation Association offers organizations a cost-effective, flexible and collaborative approach to accreditation.
Accreditation is a voluntary process through which an ambulatory health care organization is able to measure the quality of its services and performance against nationally recognized standards. The accreditation process involves self-assessment by the organization, as well as a thorough review by the Accreditation Association’s expert surveyors, who themselves have extensive experience in the ambulatory environment. It is this self-analysis; peer review and consultation that ultimately helps an organization improve its care and services.
The Certificate of Accreditation is a symbol to others that an organization has committed to providing high-quality care and that it has demonstrated its commitment by measuring up to the Accreditation Association’s high standards. It sends signals of confidence to the community it serves and increases an organization’s competitive edge in the marketplace. In addition, accreditation may satisfy certain regulatory requirements for licensure or certification.

Although some patients can be safely transported by normal air or private road ambulance services, some need special facilities. In the Ukraine, Kharkove hospital needed to transfer a patient to Germany’s Leipzig University Hospital. The 51- year old man had acute respiratory disease syndrome, and to survive he needed facilities not available at Kharkov.Normal transport methods could have killed him. ADAC-AirAmbulance had a solution. Using a Dornier 328 jet, there was enough space for the Leipzig hospital team and their intensive care equipment. A mobile ECMO unit, being used for the first ever time by the company, allowed the patient to be successfully transferred with a three-hour flight. All the time, he was under permanent manned intensive care, a new level of care in air medical transport. Germany’s ADAC-AmbulanceService is a subsidiary of the German car club ADAC, and a market leader in European medical assistance. It transports 16,000 patients each year with its own fleet of air ambulance aircraft equipped with the most up-to-date equipment.
International Air Charter (IAC) is offering the services of dedicated medical evacuation (medevac) aircraft to meet the growing demand in the UAE and the Middle East region. The regional demand for medevac services is forecast to rise even as huge investments in healthcare infrastructure and services continue to be made across the Arab world. The medevac market there offers considerable potential as the service providers are currently responding to 30 to 40 requests a month. While international missions used to involve mostly transports to medical facilities in Europe and the USA, the rise in the number of available high standard medical facilities in the Middle East has increased patient options and the frequency of medevac enquiries in the region.
IAC has 24-hour access to a fleet of dedicated medevac aircraft around the world and can respond to medical emergencies in a matter of a few hours via its network, while always adhering to the highest international safety standards. Elie Abdo of IAC says, Medevac has become a more viable option for the UAE thanks to the influx of modern medical facilities within the UAE and throughout the region.
American air ambulance group Sky Doctors has launched a corporate website after a lengthy legal struggle to acquire the company domain Skydoctors.com.An established air ambulance company for over 17 years, the team has flown over 75,000 air ambulance transports. Sky Doctors offers ambulance services via medical jets that cover long distances quickly while keeping the patient under medical supervision.
Acquiring the domain Skydoctors.com took considerable effort, as its previous owner was unwilling to sell the rights to the trademarked name. Eventually, a legal suit was avoided, as the company was able to secure the domain after a lengthy negotiation that lasted several years. The company says that recent US internet regulations and prominent legal battles over domain rights have shifted towards protecting businesses and reducing the effectiveness of domain squatters. The growing list of recent legal victories protecting corporations was a major factor in Sky Doctors successful acquisition of the domain.

Taiwan’s new economic development vision for 2015 includes a three-year programme on inbound medical tourism .The government recognizes a global trend toward internationalization and industrialization of medical care services. The Medical Service Internationalization Flagship Project is a key development priority.
In October 2007, the Department of Health (DOH) began planning distribution channels and marketing campaigns on medical tourism. The objective is to integrate the resources of industry government and academia into a medical care service network and jointly build a brand image of Taiwan as the home of first-rate medical care services. The Medical Service Internationalization Flagship Project focuses on enhancing the basic operating environment of the industry and building distribution channels.
The DOH’s Taiwan Task Force for Medical Travel (TTFMT) has helped partner Taiwan hospitals with the Guangzhou-based Zion Health Club, Formosa Health Business Company, and Pacific Rim Medical Overseas Consortium to collaborate in transferring patients to receive medical care. TTFMT is also actively putting together international cooperation channels. It has signed memoranda of understanding with Guardian Healthcare Co., the Taiwan subsidiary of the Harvest Medical Investment and Operation Group, and Canada’s Allied Development Services International whereby patients of foreign nationality requiring multinational medical treatment will have priority referral to hospitals cooperating with the TTFMT.
Taiwan is still in the early stages of developing medical care services for the international market. Strategic planning is to be undertaken in five areas:
1. International marketing: The principal task will be to boost Taiwan’s international profile, build an overall medical care reputation, actively develop overseas Chinese and Chinese mainland markets and promote service models and the development of cooperative channels.
2. Medical care service quality: With medical care services as the core competency of this industry, quality control monitoring and improvement will continue so as to enhance Taiwan’s overall medical care image.
3. Tourism resource integration: Strategic cooperation between Taiwan’s leisure and tourism industry and the medical care industry will be intensified to enhance the added value of medical care service alliances and upgrade the basic tourism infrastructure and information technology services for higher tourism quality.
4. Policy coordination: Border entry procedures for non-nationals will be simplified to enhance the attractiveness of traveling to Taiwan for medical treatment. Pertinent laws, regulations and controls will be reviewed and relaxed to create even more favorable conditions for the industry.
5. Cross-industry alliances: Efforts will be made to establish cross-industry cooperation models involving members of the tourism, hotel, airline and both domestic and overseas insurance industries to expand the medical care services value chain, boost added value, provide complete services and establish industry-oriented operating models.
Formosa Medical Travel, an American medical tourism agency, has entered into agreements with three of Taiwan’s major hospitals; Tungs’ Taichung Metro Harbor Hospital, Show Chwan Memorial Hospital, and Changhua Christian Hospital.
Taiwan is well-positioned to compete with other Asian countries in promoting medical services to foreigners, especially overseas Chinese, because of the country’s advanced medical technology and highly qualified doctors, says Hwang Kung-chang of the DOH,Although Taiwan got a late start in the field compared with other Asian countries such as Singapore, Thailand and India, it still has enormous potential given that we have first-class doctors and medical expenses are much cheaper than they are in Western countries.
The DOH has brokered a deal to develop medical referral services between an insurance firm based in California and nine private hospitals in Taiwan. The partnership will allow Central Health Plan of California, the third-largest medical service management company in southern California, to represent Taiwanese hospitals in the US and refer its clients, or the clients of other US health insurers, to the health care institutions to receive care in Taiwan.

The Medical Travel and Health Tourism Quality Alliance (MTQuA), has launched the first certification programme in the world to train and qualify international patient advisors for the medical tourism industry.
Julie Munro, MTQuA founder, who runs medical travel agency Cosmetic Surgery Travel, says, Medical tourists looking for medical treatment abroad need trusted professional advisors to ensure they get excellent and safe care in another country. Patients going abroad are often advised to check doctor credentials and hospital safety records on their own. This is almost impossible to do, but now with the help of a professional who is a certified international patient advisor, it can be done. Certification is a major step in the medical tourism industry progress toward becoming an acceptable alternative for patients seeking choices in medical care.
For doctors, having professionals to manage their travelling patients lessens the worry that their patients may be left stranded without proper care management during the course of treatment at a medical destination or after they return home and lack needed follow up care.
MTQuA’s advisory panel includes medical and hospital representatives from Wockhardt Hospital in India, Clemenceau in Lebanon, Surgeon and Safari of South Africa and Nazounki of France.
Individuals who provide assistance, care and management for medical travelers can qualify for the professional designation Certified International Patient Adviser (CIPA). Individuals in the travel and hospitality industry can qualify as a Certified Medical Travel Concierge (CMTC).
Workshops and training for 2010 include:
Kuala Lumpur, Malaysia – January 2010
Singapore – January 2010
San Antonio, USA – January 2010
Vancouver, Canada – February 2010
Seoul, Korea – February 2010
Istanbul, Turkey – March 2010
Chicago, USA – April 2010
Venice, Italy – May 2010
The Medical Travel and Health Tourism Quality Alliance was launched in April 2009 .The mission of this alliance is to advance patient safety and medical excellence for travelling patients by encouraging, developing and promoting professionalism in medical travel. It is committed to raising industry standards, to put quality first and to partner with hospitals and other providers as equals in the care of the medical traveller. It promotes the development of standards and practices to advance the medical travel and health tourism industries, and provides training and workshops to all partners in the international patient’s continuum of care.
The MTQuA Seal of Quality 2010 identifies medical travel agencies, advisors, and support services that have put or are putting processes in place that prioritize medical quality and safety outcomes for the travelling patient. This annual seal assures medical tourists their medical care, safety and quality outcome always comes first. It is available to companies worldwide that have attained a standard of professional and caring service and support to the medical traveller. Only a handful of agencies currently have the 2010 seal; Cosmetic Surgery Travel, Euromedical Tours, Hygieia Turkey, MedNet Brazil, Nazounki and Surgeon and Safari.

UK management and engineering firm Mott MacDonald has been appointed by Ithmaar Development Company to provide infrastructure design and supervision services for Dilmunia Health Island. The first of its kind, this new health island, is set to be an international health and wellness facility in a resort-style environment based on a 125 hectares man-made island off the north-east coast of Bahrain. The project is expected to cost $ 69 million Designs for the health island were developed last year. The health island is expected to house a state-of-the-art diagnostic centre along with centres for nutrition and diabetes, cosmetic surgery, aesthetic medicine, women and children’s health, alternative medicine as well as a sports medicine centre. Deluxe spas, boutique hotels, residential clusters, commercial facilities and recreational amenities are also included in the concept design.
Mott MacDonald’s team in Bahrain will design and supervise the construction of all infrastructure services from roads, bridges, power network, water, sewerage and treatment services to a district cooling plant with associated distribution services and a canal which is all due for completion by mid 2013.
Mott MacDonald’s Alan Worley says, "This follows successful completion of design work on Al Seef Tower in Manama for Ithmaar Development Company and is an endorsement of what we hope will be a productive on-going relationship backed by Mott MacDonald’s local knowledge of Bahrain and world-class engineering design and management skills."
DP Architects from Singapore is the master planner. In early June, reclamation works were completed. In March 2008, site mobilization and reclamation works started. Ithmaar Development Company (IDC) was set up by Bahrain’s Ithmaar Bank in 2006 to manage major development projects.
The name Dilmunia derives from the ancient name Dilmu, often believed to be the original Garden of Eden. The island will be a lush green oasis offering physical, mental and spiritual equilibrium. The aim is to combine a balanced lifestyle with secure comfortable accommodation and expert medical help nearby. The experience of the various themed hotels reflects the alternative remedies such as Chinese medicine, Thai herbalist beliefs, French-inspired hydro remedies, as well as traditional health and wellness. Up market homes will be combined with top of the range entertainment, retail and leisure. Nature will be presented in a variety of themed gardens, waterways, wetlands, and parks. Dilmunia will be managed and operated by a core group of medical professionals with access to visiting world-renowned specialists. World-class medical facilities will be attracted to invest and locate there.
This concept goes against the current trend of (low) cost driven medical tourism. If the concept were to be launched today, it might face problems in the current market and economic climate. But we are talking about several years ahead, when hopefully global recession will be a distant memory. It may have advantages over land-based Middle East medical tourism, providing a contrast to soulless hospitals in characterless modern cities. Anyone doubting the potential should look at the many eco-hotels and spas that are successfully attracting upmarket consumers in the worst possible financial climate, in locations where conventional cheaper hotels struggle to survive.

The Spanish Island of Gran Canaria, just off the coast of Morocco, is fast establishing itself as a wellness and health tourism destination, offering facilities and technology at an affordable cost. The doctors and nurses in all hospitals and clinics are well qualified as well as speaking fluent English. The cost of treatment is up to 40% less than other UK and European medical tourism destinations even with the current exchange rate. Famed for its healthy microclimate averaging 24 degrees all year round and its purifying natural mineral waters and Aloe Vera, Gran Canaria offers perfect conditions in which to recuperate and rejuvenate. It has long attracted holidaymakers in search of blue skies and beaches. Being just a short flight from many EU countries and with some of Europe’s best spa and thalassotherpy facilities makes it an ideal destination to combine surgery, post operative recuperation and holiday relaxation.
Gran Canaria boasts some of the best-rated spa and thalasso facilities in Europe including the Lopesan Costa Meloneras Resort Spa & Casino which has a spa set in an area reminiscent of a volcanic cave, The Lopesan Villa del Conde Resort & Corallium Thalasso with private seawater pools, jacuzzis, sun terraces and treatment rooms, and The Gloria Palace San Agustín Thalasso and Hotel with its four high tech sea water pools.
The Gran Canaria Spa, Wellness & Health Association (GCSW&H Association) has persuaded several of the top spas, medical and recuperation facilities on the island to offer bespoke wellness and medical holiday packages to suit individual needs of medical tourists, particularly from France, Germany, Spain and the UK.It has also persuaded fourteen of the top spa hotels to offer packages. These all provide guests with a choice of three to five star accommodation offering outstanding spa facilities and comfort, and close to: Hospital San Roque Maspalomas, Clinica San Roque Las Palmas, Eurocanarias Oftalmologica Eye Clinic and Branemark Center.Clinica San Roque Las Palmas specialises in cosmetic surgery. Eurocanarias Oftalmológica is a top specialist eye clinic. Hospital San Roque Maspalomas is a cosmetic surgery specialist. Branemark Center is a specialist dental clinic.
What is particularly interesting about what the association is doing is that they are not wasting time with politics or lobbying, but devoting limited resources to persuading all in the related medical, health, wellness and accommodation sectors, not only to work together, but to provide packages for targeted markets. José Maria Manaricua, the association president comments, Over the years, Gran Canaria has promoted tourism devoted to relaxation and personal care through constant improvement and the gradual development of the necessary tourist services and infrastructure to turn the island into a European exponent of health and wellness services.
The Gran Canaria Tourist Board, Federación de Empresarios de Hostelería y Turismo de Las Palmas, and entrepreneurs from the medical and tourist sectors formed the association in 2004.  The public and private sectors work together to market and promote Gran Canaria as a health and wellness destination through a single organization that represents each and every associated centre.

Africa is a continent that has a few well-off countries with good medical facilities, such as South Africa, but many more where facilities are less than adequate, often due to lack of  funding by governments. Recent years have seen more private companies moving in to fill the gaps. Any new hospital or clinic in Africa must have a first priority of serving the country it is in. Secondly it has to deal with international travelers and expatriates there for work or retirement. Thirdly it has to deal with medical tourists. Unlike many other continents, in Africa, medical tourism is more driven by need rather than want, due to lack of local facilities. It is often easier to travel to a clinic across a border, than it is to go to one in their home country. Also there is a growing middle-class who can afford to travel for treatment, and increasingly they prefer to stay within Africa rather than go to Europe or Asia. African Medical Investments is providing healthcare in niche areas, particularly to the expanding African middle classes and expatriates. It is looking to capitalise on the growing demand for quality medical services in Africa with recently secured funding from US based hedge fund Harbinger Capital. Progress with negotiating new facilities in new target cities and increasing the number of patients has been good. African Medical’s Vivek Solanki says, We are being approached by foreign governments with requests for medical facilities in their cities.
Earlier this year it opened the first of a number of planned clinics and well women centres aimed at meeting the demand for dedicated healthcare services across Africa. The first development was a 30-bed boutique hospital and well-woman clinic in Dar-es-Salaam, Tanzania. As with other clinics, it is managed and operated by African Medical’s wholly owned subsidiary, VIP Healthcare Solutions Limited (VIP).
It currently has five facilities, and the company is evaluating additional cities that meet its investment criteria. Since then it has opened a similar hospital in Cape Town. The Maputo Trauma Centre & Well Woman Clinic will open in March next year in Mozambique. Accra in Ghana and Nairobi have been identified as suitable for a Well Woman and Well Man clinic. African Medical is also in discussions with the authorities to establish boutique hospitals, trauma centres and Well Woman clinics in Kampala in Uganda and Kigali in Rwanda, which display the vital criteria including high number of expatriates and members of the African middle class. When the company bought VIP in November 2008, it already managed the Airport Medical & Travel Vaccination Centre at Johannesburg International Airport and The Trauma Centre in Harare.
The target of 10 facilities in total by 2012 and 15 by 2015 remains unchanged, with this goal looking yet more achievable now with the new funding agreement with Harbinger. More patients are expected to fall into the company’s target audience as more international investment is directed towards Africa.

Organisers of Destination Health, the forthcoming health & medical tourism show in London have announced the addition of three new exhibitors. Founded by famous musician Eric Clapton on the island of Antigua, Crossroads Centre is a non-profit, International Centre of Excellence for the treatment of alcohol and other drug addictions will be at the show to promote their services.
Destination Health has also been chosen by the Danubius Hotels Group to promote their medical spa and wellness hotels. They are Europe’s largest and most-experienced spa hotel operator specialising in Medical and Wellness will be showcasing their 14 health spa resorts in 4 European countries.

London based consultation practice and now exhibitor, Dentist Abroad, launched its Harley Street practice in 2006. With their dental experts travelling weekly to meet with patients prior to treatment in Hungary they are once again on hand in London after treatment. As the first to offer this service Dentist Abroad have become renowned for introducing new and revolutionary services to the UK medical tourist market.
Commenting on the new exhibitors Event Director Nav Mann said We are delighted to have Crossroads Centre, Danubius Hotels and Dentist Abroad exhibit at Destination Health. This truly demonstrates the variety of treatment providers coming to the show.

Supported by media partners Treatment Abroad the Europe’s number one medical tourism website and IMTJ the leading journal for the medical tourism industry, Destination Health will take place on the 17th & 18th April 2010 at the Olympia Exhibition & Conference Centre.

As Europe’s largest buyers of medical tourism services, demand from UK patients who are planning to travel abroad for treatment is growing every year. The show, which is expected to attract thousands of people actively planning to travel abroad for treatment, but will also include health and medical professionals looking to establish business partnerships.

The organisers of Destination Health have announced the addition of several new fertility clinics, who will be promoting their services at the Health & Medical Tourism Show due to be held on 17 18 April 2010 in London
With over a third of the exhibition dedicated to Fertility & Conception, the organisers are looking to create one of the biggest showcases for fertility clinics around the world. Exhibitors already booked into this area include top clinics from Spain, Barbados, Czech Republic and Denmark.
Destination Health Event Director, Nav Mann commented There is strong desire and an ever increasing number of UK infertility patients in the UK contemplating travelling abroad for fertility treatment. As a consequence there is a substantial opportunity to meet and provide information in the area of fertility treatment.
Supported by media partners Treatment Abroad the Europe’s number one medical tourism website and the International Medical Tourism Journal (IMTJ), Destination Health will take place on the 17th & 18th April 2010 at the  Olympia Exhibition & Conference Centre.
As Europe’s largest buyers of medical tourism services, demand from UK patients who are planning to travel abroad for treatment is growing every year. The show, which is expected to attract thousands of people actively planning to travel abroad for treatment, but will also include health and medical professionals looking to establish business partnerships.

World Eye Hospital is the world’s largest private eye hospital group with nine clinics in Turkey, and four foreign ones (Berlin, Cologne, Amsterdam, and Heusden-Zolder in Belgium). It draws patients from all over through their extensive health-tourism packages and experienced medical staff. In 2008 the group cared for 25,000 foreign patients, and this is expected to reach 30,000 for 2009. Most overseas patients are from Germany, The Netherlands, Austria, Switzerland, Scandinavia and the Middle East.
The international marketing and operation department cares about international patients and prepares special medical tourism packages. These packages include flight, hotel accommodation, guide service, Bosporus trip or Grand bazaar trip, examinations, surgery and post operative controls. The most important reasons why foreign patients choose World Eye are the advanced technology, VIP service and special health treatment packages. The iLASIK procedure is now available in Istanbul Hospitals. iLASIK treatment packages include flight tickets and accommodation. World Eye boasts hospitals offering five star hotel comfort, and is able to provide health services at world-class standards to foreign patients. From coming to Turkey, to returning home, transport, transfer, accommodation, city tours, guidance, treatment and medications, all are covered. Foreign patients experience both life in Istanbul and have their eye operation at the world’s largest private eye hospital group. For religious ceremonies a mosque, a chapel and a synagogue are present.
To be close to international patients and so they can have pre- and post operative examinations, clinics have been established in Amsterdam, Berlin, Cologne and Belgium. During the next 6 months, additional new clinics will be opened in London, Bahrain, Kiev, Baku, Tirana, Bucharest and Moscow.

It has seven eye hospitals in Istanbul, one in Ankara and one in Izmi.It will open a new one in Tirana this month, and a very large one in Antalya in 2010. The Antalya hospital will be oriented on health tourism and patients will be able to stay at 5 star hotels with health packages for 1 week. More than ten Russian agencies have already begun to sell packages for the summer of 2010 for Antalya, as there will be a direct air route. As well as offering Lasik surgery, the company handles cataracts and glaucomas. Within Turkey, it runs mobile clinics and works for the public health service. World Eye is the first and only JCI accredited eye hospital in Turkey. It claims to be the pioneer of health tourism in Turkey. It offers special eye surgery and golf packages to overseas golf enthusiasts.
LASIK eye surgery rates have been cut by the recession in most countries. All this expansion costs money. Turkish group Dunya Goz Hastenasi, which trades as World Eye Centers, has an offer to sell a 25% stake to the National Bank of Kuwait that it is considering.

Australian external accreditors who will assess public and private hospitals will mostly be based in Hong Kong under a HK$10 million pilot project to enhance patient safety. Five public hospitals and three private ones are joining the pilot program to be administered by the Australian Council on Healthcare Standards that has just begun. The Australian agency won the bid in competition against several accreditation agencies from the United States and Britain.
Hospital Authority’s Pang Fei-chau says, "With rising public expectations and globalization of health-care standards, the Hospital Authority will adopt a transparent approach in driving quality improvement and patient safety. It lays down the foundation for pursuing hospital accreditation."
The public hospitals in the pilot scheme are Caritas Medical Center, Pamela Youde Nethersole Eastern, Queen Elizabeth, Queen Mary and Tuen Mun. From the private sector are Hong Kong Sanatorium and Hospital, Union and Baptist. Hong Kong Sanatorium and Hospital has been using the Australian council for three years and Trent system for longer. A hospital will only be awarded accreditation after having achieved "moderate achievement" for all 14 mandatory criteria and having demonstrated no major risk. Forty surveyors from the pilot scheme hospitals will be trained to help with transfer of knowledge, techniques and understanding.
Alan Lau Kwok-lam of the Hong Kong Private Hospitals Association, explains why the Australian council was chosen; Its biggest advantage is continued quality improvement as they have a team in Hong Kong most of the time. By basing the team in Hong Kong, their presence will help us to understand the process of accreditation much better. The city’s 13 private hospitals will still maintain the UK’s Trent Accreditation Scheme. You can be marked by one agency, you can be marked by another. We have been working with Trent for almost 12 years now and we feel comfortable with it. It is something that we feel can help us with our standards."

The government continues to promote the development of Chinese medicine by funding research projects. There is no uniform set of criteria internationally for the setting of standards for Chinese medicine, so Hong Kong is leading the way. The Hong Kong Accreditation Service (HKAS) provides accreditation for laboratories, certification bodies and inspection bodies in Hong Kong. Under the mutual recognition arrangements made with international accreditation authorities, the accreditation given to testing and certification agencies by HKAS is recognised by 72 accreditation authorities (including the China National Accreditation Service for Conformity Assessment) in 54 economies.
There are 6120 registered Chinese medicine practitioners. Patients who need to be hospitalised or suffer from severe illnesses are treated by Western medical practitioners with Chinese medicine a supplementary role. There is increasing demand for Chinese medicine services from members of the public. The Hospital Authority is trying out different models of Chinese and Western medicines shared care services in various hospitals.

Joint Commission International (JCI) is marking the tenth anniversary of the first health care organization to be awarded accreditation under its globally developed international standards for hospitals.
Established to respond to a growing demand around the world for standards-based evaluation of quality in health care, JCI accredits or certifies more than 300 health care organizations and clinical care programs in 39 countries. JCI offers accreditation programmes for hospitals, clinical laboratories, continuum of care (non-acute care settings such as home care), medical transport, ambulatory care, and primary care. JCI also offers a certification programme for disease- or condition-specific clinical care programs. JCI’s accreditation standards are international ones that apply to healthcare organizations worldwide while still accommodating cultural differences.
In December 1999, Hospital Israelita Albert Einstein, a private, non-profit, non-governmental facility in Sao Paulo, Brazil, was the first hospital accredited by JCI under the international standards. The hospital has also since achieved JCI Disease- or Condition-Specific Care Certification for its stroke program.
JCI’s thorough accreditation process focuses on determining whether a health care facility has the right systems and processes in place to support high quality and safe patient care and has the culture and capacity to continuously improve patient care. JCI’s expert surveyors examine crucial issues such as the safe use of medications, infection prevention and control, and patient assessment and patient rights. This rigorous process requires hospitals and other health care organizations to demonstrate a track record of standards compliance and relies on candid interviews with patients, families and staff about care practices. JCI’s accreditation process addresses health care organization management and incorporates standards related to quality improvement and patient safety, governance, leadership and direction, facility management and safety, staff qualifications and education, and management of information. The on-site accreditation process focuses on each organization’s range of specialties and services.
Karen Timmons of JCI says, Quality and safety challenges know no borders, and health care organizations around the world want to create environments that focus on quality, safety and continuous improvement. Accreditation meets this demand by stimulating continuous, systematic improvements in a hospital’s performance and the outcomes of patient care. Health care organizations that have achieved JCI accreditation have made a public commitment to quality and patient safety. Claudio Luiz Lottenberg of Hospital Israelita Albert Einstein adds, JCI is the barometer for quality and safety as we meet patient needs."
JCI is the international arm of The Joint Commission in the United States.JCI is accredited by The International Society for Quality in Health Care (ISQua). To help spread accreditation worldwide; JCI has recently translated its handbook into Japanese, so removing a key problem preventing Japanese hospitals from considering international accreditation.
The World Health Organization recently redesign Ted the Joint Commission and Joint Commission International as the world’s first WHO Collaborating Centre for Patient Safety Solutions, dedicated solely to patient safety. The Collaborating Centre focuses worldwide attention on patient safety and best practices that can reduce safety risks to patients, and coordinates efforts to spread these solutions as broadly as possible internationally through its work with ministries of health, patient safety experts, national agencies on patient safety, health care professional associations, and consumer organizations.

The Malaysian government aims to support the health tourism industry to accelerate the growth of Malaysia’s market share from 0.29% now to 2% by 2012.The aim is to increase revenue from RM4.0bil currently to RM4.04bil in 2012. Healthcare travel has been identified as one of the new sources of growth within the economy, said Nor Mohamed of the economic planning unit at the opening of the Association of Private Hospitals of Malaysia (APHM) International Healthcare Travel Conference 2009.
Malaysia’s healthcare had a reputation for high quality and value-for-money services.APHM president Dr Jacob Thomas says that the private healthcare industry has the necessary infrastructure and tools to accommodate further development, especially the ones brought about by the growth in healthcare tourism. Private hospitals in the country have no shortage of doctors and have enough to care for patients, both local and foreign.
At present, the growth targets are little more than a wish list, as the government has yet to formulate specific policies to help the growth of healthcare tourism, APHM wants private hospitals to be given tax incentives to refurbish their wards and rooms, but this too is just part of the wish list.
In order to expand medical tourism, irritants such as restrictions on advertising, impeding its growth must be removed and concrete measures taken to stem the brain drain of highly skilled doctors, a senior minister has acknowledged. The establishment of the Malaysia Health Travel Council seeks to advance the sector by acting as a one-stop centre and serving as a platform for the private sector and government to iron out problems. To promote medical tourism, the income tax exemption on the value of increased exports was raised to 100 per cent from 50 per cent in the last budget. Nor Mohamed promises that more incentives will be revealed later.
Despite having the ingredients to be a big player in medical tourism, Malaysia has been slow to leverage on the advantages, with a lack of focus over the past decade. A range of initiatives submitted has vanished in a tangle of competing government agencies. APHM delegates hope the new agency will solve this, but their frustration at talk rather than action, is increasingly evident. Malaysia has to compete against more established markets such as India, Singapore and Thailand. A medical procedure in Malaysia would cost about one-tenth of that in the United States, and often less than in Thailand or Singapore, but not usually less than in India.
Penang and Malacca are the leading states in the country. Johor seeks to be a medical hub for both locals and foreigners with the building of a new hospital and the proposal for a wellness centre in Nusajaya, both within the planned Medical City in Nusajaya.The proposed wellness centre would be built with the cooperation of the Singaporean government. The hope is that the additional facilities will boost the state’s medical tourism. Johor’s strategic location and comparable costs for healthcare could draw more foreign patients, especially from Singapore and Indonesia.

Later this month, you could be misled into thinking that the Salvare (Watch the Youtube video) is a real cruise ship offering medical tourism. The advertising with images and even a video looks authentic, but it is only fiction.
Universal Coverage, a novel by Daniel Putowski,  comes out on December 15th and is based on the premise that the US healthcare system has succumbed to fraud, greed, long waits, and uncertain outcomes. In the book, Bob Smith believes that the only affordable solution to save his dying son is a medical tourism cruise on the Salvare. As it is in international waters, the Salvare falls outside any national or international regulation or licensing of health care providers. It is an unlicensed hospital ship providing treatment to anyone with money. The Salvare cruises off New Jersey. It is a 120,000-ton ocean liner with private staterooms for every patient, chef prepared meals and nightly entertainment. Fully staffed by doctors and nurses, although with dubious medical credentials, it is a fully functioning hospital and recovery centre, even offering open-heart surgery and chemotherapy  
The plot of Universal Coverage is of little interest to us. But the cruise ship medical tourism concept is similar to an American proposal that due to lack of funding has yet to make progress. Cruise ship owners want real money to turn normal cruise ships into hospital ships, in advance, not just promises of payment. With healthcare reform a hot news item in the US, few investors are willing to consider investment at this stage.
Cruise ship medical tourism may offer potential for investors, but also raises concerns for patients. A medical facility in international waters is unregulated; it could employ unqualified or struck off doctors, use new untested techniques, buy organs from the poor and charge whatever it liked, with no possibility of unhappy customers being able to do anything about it. 
But..cruise ship medical tourism offers real possibilities for the ethical medical tourism businesses. 
Several new cruise ships have state of the art spas offering treatment that extends to medical spas offering facial aesthetic treatments. Holidays spent entirely on a cruise ship are becoming increasingly popular and appealing. The competition is fierce among the cruise line operators .The single most important objective for many guests on board is to relax, calm themselves and get rid of stress. Adding spa facilities and treatments makes perfect sense. 
Samsara Spa is featured on all the latest Costa Cruises ships, including the Costa Luminosa, Costa Pacifica, Costa Serena and Costa Concordia. The spa will also be featured on the Costa Deliziosa (January 2010), the Costa Favolosa (Summer 2011) and Costa Fascinosa (Spring 2012).
Extending over two decks and boasting panoramic views of the ocean, the 23,000 square-foot Samsara Spa offers travelers the ultimate wellness experience at sea. Spa amenities include a thalassotherapy bath, a rock sauna (a hotter version of classic saunas) and a Turkish bath (either traditional or scented with gently-fragrant rosemary, eucalyptus and lavender) a warm thermal bath called a tepidarium, a solarium, and tearoom. VIP treatment suites are also available. A fitness center and wide variety of wellness classes complete the spa’s facilities. Exclusive spa cabins and suites (average 100 per ship) provide an extension of the experience at all times with direct access to the spa via elevator and stairs. In 2008, 1.2 million guests chose to cruise with Costa.

There is a need for greater professionalism and ethical behaviour to develop the medical tourism industry, particularly among agents and facilitators. You expect your regular travel agent or tourism consultant to have professional qualifications, so why not your medical tourism agent?
The Council on the Global Integration of Healthcare is developing professional certification for agents.
Certification through CGIH will denote that an agent has successfully demonstrated skills and mastery of the body of knowledge established as a minimum requirement to coordinate patient care and travel arrangements for patients seeking internationally and domestically integrated medical care from outside their home communities. Through exams, case studies and field demonstrations, certification denotes ability to utilize knowledge for practical application.
The certification is a three-step process:1. First an applicant must submit a portfolio of information about their business history, professional liability insurance and business establishment, and professional references to demonstrate that he/she is actively engaged in the profession.2. The second step is an examination covering all core areas of the knowledge. A score of 92% is required to meet certification requirements.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 must approve the subject and methodology of the thesis project. A peer review panel will also evaluate the finished thesis and a required oral presentation to be presented at the Annual Institute of the Council.
The Council will enlist the assistance of psychometrists who will validate the testing and metrics to ensure that the program meets its professional development objectives.
Medical agency training course classes should be available from 2010. They will help agents meet the course work requirements for certification through the Council’s Certificate Program
There will be over twenty courses/ modules with online study materials, a pre- and post-test, and a completion certificate. CGIH is looking for expertise within the membership to assist with the development of these courses. The goal is excellence in patient safety and customer service. CGIH aims to certify the individual agent, not the company they work for, as knowledge is for the individual. Agents from all over the world are invited to become certified by CGIH.

One problem faced by all cosmetic surgeons and agencies is the perfectly performed procedure where the customer ends up with a look they do not like. Although launched as a ’plastic surgery game, a new iPhone app could be of use in distant communication between customers, agencies and clinics.
Technology has revolutionized the way people act, and one recent innovation is image modification. Photo editing programmes offer an instant makeover so people can see how they would look with new hair, larger breasts, or an improved nose.
American cosmetic surgeon Dr. Michael Salzhauer, owner of Miami cosmetic surgery clinic Bal Harbour Plastic Surgery, has designed an advanced beauty makeover app for iTunes: iSurgeon. iSurgeon is for the iPhone/iPod Touch, and combines personal image modification with high tech gaming features.
iSurgeon has two modes: Game Mode and Advanced Surgery Mode. Both include procedures Dr. Salzhauer offers in his own Miami practice including: nose jobs, breast augmentations, cheek implants, tummy tucks, liposuctions, face lifts, lip enhancements, and ear reshaping. The iSurgeon App costs only a few cents.
Dr. Salzhauer comments, the iTunes app store was lacking a truly useful and well-designed beauty makeover app. iSurgeon delivers on the promise of realistic photo alterations while also allowing users to play cosmetic surgery games in the role of a surgeon.iSurgeon provides those interested in cosmetic surgery treatments with a clear visual of what they would look like post-surgery.
In Advanced Surgery Mode, you can modify images taken with your iPhone/iPod Touch or images already stored in your phone. Within seconds, you can see what you would look like after various cosmetic surgeries. The results can be easily shared as both Facebook and email are conveniently built into the app. What may be of great use to medical tourism is that you can do the same procedure on someone else. So as long as you have an accurate picture of the person, you can use it to show them what they would look like after surgery.
More scarily, Game Mode gives you the opportunity to be a surgeon operating on any of the four pre-programmed images to enhance their cosmetic appearance. Before each surgery procedure, users can tap the hint button on their screen to view an image of their patients desired results. The aim of the game is to emulate the desired look as closely as possible. Using the iPhone/iPod Touch’s touch screen capabilities, the user can modify the subject’s physical appearance, scoring points for each successful enhancement. Game Mode is complete with realistic sound effects.
iSurgeon’s creator Dr. Michael Salzhauer is not afraid of controversy, already being well known for writing the book "My Beautiful Mommy" to help children deal with their mother’s surgery.
The launch comes weeks after the first plastic surgery app, The Shafer Plastic Surgery app, created by Dr. David Shafer of New York, that has more than 1,000 questions and answers about specific cosmetic procedures.

Medical spas in the US and elsewhere have increased in numbers and are popular as medical tourism destinations. Several countries have reported problems of medical spas undertaking medical procedures that neither the spa nor the staff are qualified to do. Unfortunately, this reflects badly on the majority who are professional. They have tended to fall between the gaps in legislation, but one of the first countries seeking to remedy that is the USA. Nationally, the number of medical spas around the country has grown from 500 in 2004 to 2,500 today. If this growth rate continues, more states will follow the four who are preparing regulations, and almost every sate has discussed the idea.
According to the International Medical Spa Association, the official definition for medical spa is a facility that operates under the full-time on-site supervision of a licensed health care professional. The facility operates within the scope of practice of its staff, and offers traditional, complementary, and alternative health practices and treatments in a spa-like setting. Practitioners working within a medical spa will be governed by their appropriate licensing board, if licensure is required.
The death of a nurse, who had a liposuction procedure performed, has raised concerns over the safety of medical spas to the level that several states are progressing legislation. The proposed legislation is now travelling through several state medical boards in Massachusetts, New York, Florida, and Utah. Proposed legislation would require owners of medical spas to have certain credentials, dictate which procedures can be performed, and set a minimum level of training for those performing particular procedures. Legislation does not want to stop consumers having medical procedures in spas, but to ensure that the procedures are performed safely and by someone with the correct training.
The concern of cosmetic surgeons is the lack of training or experience of some employees at medical spas. An employee of a medical spa may start out performing one procedure and move to another more difficult procedure without much experience. Indeed, lack of experience with certain medical procedures has resulted in serious consequences for some customers, but more common is minor problems such as second-or third-degree burns from improperly conducted laser hair removal procedures.
Medical spas in the US offer treatments including laser hair removal and liposuction, as well as massages and other traditional spa treatments. The types of procedures performed in medical spas have expanded to include chemosurgery for skin cancer and reconstructive surgery.
Massachusetts health officials want to crack down on medical spas, following the lead of Florida, which has been preparing legislation for three years. In Massachusetts a medical spa task force has been set up to advise the state legislature on how best to regulate the facilities. It would prefer a system of federal regulation of medical spas as it would be more cohesive than a state-by-state model but believes that is unlikely to happen, as medical and other professional boards, like nursing, electrology and aestheticians boards, are regulated and licensed by individual states. But the government has just decided to take insurance regulation away from states into a national body, so national regulation is a possibility. The task force has proposed that spas be required to get licenses from the Massachusetts Department of Public Health, and recruit a physician or nurse with special training to remove age spots or tattoos with a laser. Non medical practitioners – cosmetologists, electrologists, and aestheticians – will be allowed to remove body hair using a laser, but only after special training and certification. The task force reported that doctors and other professionals not specifically trained in dermatology have begun offering laser skin procedures, presenting an unacceptable risk to patients.
Regulating medical spas is complicated because they combine many different professionals under one roof, including cosmetologists, electrologists, aestheticians, nurses, and physicians. In most US states each of these professions is licensed by its own board, and each has its own standards. There are no overall regulations governing who can do certain cosmetic procedures and what type of training is required, and there is no requirement that medical spas be licensed.

The Health Professions Council of South Africa (HPCSA) has raised concerns about the training of some doctors who undertake cosmetic surgery and treatments in South Africa. According to the HPCSA, a doctor can go for two-day weekend courses abroad, return with a certificate and open a plastic surgery practice. In reality, a doctor needs an additional four years of study to become a specialist. The HPCSA does not recognise these weekend qualifications from abroad. The HPCSA was investigating three GPs who have been performing cosmetic surgery. The council has already found two doctors guilty.
Qualified surgeons around the world are also complaining of beauticians and general practitioners that are not trained to perform cosmetic surgeries. At a recent conference, the consensus was that although qualified surgeons are seeing a rise in the number of women seeking aesthetic breast surgery, they are also concerned with the increasing number of corrective surgeries needed after operations by unqualified surgeons go wrong.
Swedish surgeon Dr Charles Randquist raised this concern at the Asian Breast Aesthetic Symposium. He was speaking on behalf of 60 surgeons from Brazil, Singapore, South Korea, China, Japan, the United States, Canada and Malaysia who attended the inaugural symposium, ’’ Many women think cosmetic surgery, including the double eye-lid operation, can be done by beauticians. But beauticians and general practitioners are not trained to perform such surgeries as liposuction, breast augmentation and other cosmetic or reconstructive surgeries. Surgeons have a responsibility to advise women on whether they need or don’t need it and the risks involved."
Consultant surgeon Dr Lim Kim Siea from Malaysia added that he had seen a rise in the number of women, especially Chinese women, seeking aesthetic breast surgery, "I also see quite a number of botched surgeries and have to re-do the procedure. Many women are lured by beauticians into having such surgeries by unqualified doctors from China, who fly in and charge low prices. Many women find that these doctors have done a shoddy job and seek repairs which cost them another big sum."
The International Society of Aesthetic Plastic Surgery (ISAPS), representing over 1600 of the world’s leading board certified aesthetic plastic surgeons in 84 countries provides comprehensive international guidelines for consumers traveling for cosmetic surgery procedures
 What is the surgeon’s training?
 A gynaecologist performing a breast augmentation or a dermatologist doing a face-lift is not an appropriate choice.
 Is the plastic surgeon certified?
 Ask for certification information and who the certifying body is. The ISAPS website lists the names and addresses of over 1,600 certified plastic surgeons in 84 countries.
 What about aftercare?
 Patients should stay in the area where the surgery was performed for at least one week, depending on the procedure. Find out in advance where you will stay and if this facility is prepared to care for your post operative needs.
 What about complications?
 What doctor will care for you at home if you have complications and who will pay for secondary or revision procedures?
 Do the key personnel at the surgeon’s office speak your language fluently?
 If you cannot be easily understood, be prepared for complications.
 With whom are you communicating?
 You should be talking directly with the doctor’s staff and the doctor. An agent should only make travel and accommodation arrangements.
 Is the surgeon a member of recognized national and international societies?
 ISAPS membership is by invitation and is granted to applicants only after extensive screening.
 Have you checked for references?
 Ask for names and contact information of patients who have recently had a similar procedure and contact them about their experience with the surgeon, their staff, aftercare facilities and post-operative follow up.
Although aimed at consumers, the logic also applies to all agencies.

Medical tourism has often been berated for being unregulated, uncontrolled and dangerous. Any treatment has an element of risk. A rush of stories on the dangers of cosmetic surgery, the need to regulate medical spas, proposals for controlling ayurvedic hospitals, are all concerned with domestic treatment, not medical tourism. Any media scares or discussion of regulation also effects medical tourism, as does a new app for the Iphone that scarily turns cosmetic surgery into a game, and American proposals to tax all cosmetic surgery.
Some problems on alleged risk can arise from differences in interpretation in differing countries, and problems in translation particularly when Asian and South American clinics and agencies refer to plastic surgery that in Europe and elsewhere would be called cosmetic surgery. In the US, some surgeons make the distinction; others refer to everything as plastic surgery. Cosmetic surgery, sometimes called aesthetic surgery is purely elective, a lifestyle choice undertaken to enhance physical appearance, improve self-esteem and boost confidence. It is a treatment for want rather than for need. Cosmetic surgery differs from plastic surgery, which is generally surgery to repair or reconstruct tissue or skin damaged by congenital (inherited) disease, injuries or burns. The primary role of plastic surgery is to restore function, and aesthetic improvement is secondary.
Governments are rarely enthusiastic about any legislation on cosmetic surgery, unless they see income. $5.8 billion over ten years is what a new tax that has suddenly appeared within US healthcare reform proposals, expects to generate. The White House-backed plan would impose a five-percent tax on all elective cosmetic surgery in the US. The measure exempts plastic surgery done to remedy a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease.
Individuals who seek purely elective procedures, typically paid for directly out of patients’ pockets, would have to pay the new tax from January 2010. Recession has not dented US demand for cosmetic surgery procedures, up three percent in 2008 to 12.1 million procedures, according to the American Society of Plastic Surgeons. But breast augmentations were down 12 percent from 2007, to 307,230, while botox injections were up eight percent to just over five million procedures.
The tax would be paid by the patient receiving the cosmetic procedure and collected by the doctor. If the patient fails to pay the tax, the medical professional who performed the procedure would be liable. The tax would apply to all, including medical tourists to the US.
Alternative health is rarely regulated, but in India, the Department of Ayush is preparing a voluntary scheme in collaboration with the Quality Council of India (QCI) on accreditation of AYUSH hospitals similar to the highly successful hospital accreditation programme under its National Accreditation Board for Hospitals and Health Care Providers (NABH).
Medical tourism agencies need to keep up with new and proposed legislation in countries where they send patients. Although hospitals and larger clinics may have national and international accreditations, many smaller clinics, and much of the health and wellness industry remains unregulated with no real international benchmark to judge by.

Politicians and officials in the Philippines have boasted about the influx of medical tourists, quoting barely believable figures of 600,000 plus. This bravado may have made them sound good, but has been counter-productive to organised development of the industry.
New legislation designed to boost tourism and medical tourism takes a more realistic view of the situation, and accepts talk must be replaced by action. The Implementing Rules and Regulation of the new Tourism Act or Republic Act 9593 is key to the attainment of the $3 billion revenue target from medical tourism by 2012.Ruy Moreno of the National Competitiveness Council (NCC), says that medical, health and wellness tourism could account for 20 to 25 percent of the $1 trillion tourism business, But to attain our target, we just have to compete in terms of policy framework to support our competitiveness.
The NCC estimates that medical and health tourism revenue in the country is between $200 and $300 million with no more than 100,000 medical tourists. NCC has an ambition to attract 200,000 medical tourists by 2012.Moreno stresses the need to come up with an IRR to the Tourism Act that will address all the issues that hamper competitiveness in the industry, by being able to provide the vision and the continuity in terms of policies and implementation. The country has suffered a drop in tourism revenue. Moreno comments, We cannot be competitive in other sectors of tourism but we are in the medical tourism sector. This is our real advantage because we have good medical institutions and facilities coupled with good medical practitioners and professionals. Medical procedures are 20 to 30 percent cheaper than in other countries.Cebu has been positioning itself as a medical tourism hub in the country in the last two years, but although this bid still has to take off, it is at last showing some promise. Cebu hospitals offer advanced technology in performing laparoscopic surgery, laser eye surgery, dermatology and cosmetic surgery, dental implants and cosmetic dentistry. They also charge a lesser fee for these operations than other countries. Cebu Doctors’ University Hospital (CDUH) has a laser surgery centre offering at less than $1000 for both eyes, while abroad, it would cost about $2,500 for each eye. 25 percent of the centre’s patients are Europeans, 15 percent are Australian, five percent are Americans and another five percent are Asians.Seeing the potential of Cebu to attract more foreign direct investments, the Cebu Investments Promotions Center (CIPC) will in 2010 spearhead a collaborative effort with private and public stakeholders to promote the province as the world’s second home destination for the wealthy. The promotional programme will combine tourism and investment opportunities in Cebu, targeting foreign tourists and investors in the high-end market. Cebu’s long-term vision is to make it a second home destination for foreigners whether they come as a medical tourist, to do business, or invest in properties.

The world recession is damaging the tourism business in many Caribbean islands. They are all looking at ways to replace lost tourist income. Medical tourism shines like a beacon offering hope and income. That few have any medical facilities for medical tourism does not seem to dim their enthusiasm. They have advantages for Americans, in being quick and easy to reach, and speaking English. The timescale involved in getting investors to build hospitals and then attract medical tourists may be longer than they realise. Despite this, Barbados and the Bahamas are both keen on becoming major health tourism destinations.
Barbadian doctors trained in an innovative, minimally invasive gynaecological surgery are providing the service in Barbados for the first time and training other local doctors. The Ministry of Health is hailing the move as an example of the expanded health services available in the country, noting that Barbados is poised and ready to take advantage of the health tourism sector.
Minister of Health, Donville Inniss reflects that Barbados could be the place of choice for health and medical tourism. The Ministry of Health is about to enter into negotiations with potential consultants on conducting a feasibility study on the construction of a new hospital on a greenfield site, to conduct appraisals of alternative sites and make recommendations on the most suitable location for a new general hospital.
A new independent National Health Care Quality Council will be the national coordinating agency for quality management in the health sector. The council will provide annual reports on the quality of the sector; set benchmarks by which performance can be measured, and establish performance standards and protocols, measurable indicator and evidence-based tools that should be applied in evaluating every aspect of the health services and to audit the performance of institutions and providers; license health care institutions and develop links with reputable international agencies to help with benchmarking, peer review and accreditation.
Grand Bahama Port Authority (GBPA) chairman Hannes Babak is aggressively pushing the idea of using medical tourism to help boost Grand Bahama’s ailing economy, " People will spend money on the island. They have to fly in here, use the facilities, the airport, so there is a huge effect on medical tourism. One side is the medical and one side is tourism. Medical tourism is the perfect business that we can bring and create here in Freeport where we can be the leader in this area of the world and not a follower. We can attract one of the leading hospitals from the United States."
GPBA, the organization that runs Freeport harbour and economic zone, has targeted 10 to 15 hospitals in the United States with a developer/investor kit to see if they are willing to branch out into Grand Bahama. No US hospitals have admitted to being in talks or having any interest in medical tourism in the Bahamas. GBPA aims to attract only certain types of medical procedures and to start off with those that are relatively low risk to avoid any accidents that could potentially ruin the business.

Serbia has hundreds of health spas that offer treatment for health problems ranging from thyroid malfunctions to backache. The hot springs became medieval pilgrimage centers, administered by monasteries where monks and nuns tended to the needs of the sick. In the Communist era, the state took them over, even if Orthodox religious bodies often continued to run them. Now government privatization efforts aimed at drawing in investors and tourists are meeting opposition, from the Orthodox authorities wanting to protect local interests and from spa workers seeking to preserve the medical role of thermal treatment centers.
In 2008, the government approved the privatization of 13 of the country’s main spa facilities, which are increasingly being used for leisure and health tourism. About 37 percent of all tourism in Serbia is spa-related, according to the Serbian Spas Association. While the clientele is still almost exclusively domestic, out of 366,000 visitors in 2008, only 23,000 were from abroad, the government sees the sector as a potential magnet for foreign visitors.
According to the Serbian Chamber of Commerce, British investors have expressed an interest in developing thermal tourism. But developments are slow. The sale by public auction of one of the country’s best-known spas, Gornja Trepca, in central Serbia, provoked an uproar in September last year. Although the buyer, a Serbian company, paid five times the minimum set price, $96,500, the Orthodox diocesan authorities reportedly demanded that the deal be annulled on the grounds that the land on which the spa facilities were built belonged to the local monastery. Sorting out property rights often stands as one of the biggest obstacles to progress.
The Union of Serbian Spas, which represents spa workers and patients, insists that all medical activities should remain the property of the state. Related facilities should be excluded from privatization, and the priority for adding beds should be to expand treatment capacity. The union is now demanding that the legislation governing privatization be amended to protect local patients’ rights and limit privatization to spa hotels, excluding treatment facilities.
The privatization of spas has started, but is awaiting a special law on spas, and a definition of privatization for each one, and the publication of tenders for the most appealing ones to attract investors. No more than half the existing beds will be privatized. At least half will stay in the national health system.
Serbia has 360 thermal springs and 36 spas. High quality and affordable medical care is found throughout Serbia. Many of the medical spas that offer treatments also offer guests top medical care, accommodation and peaceful surroundings to heal and enjoy. With over 50 health resorts and 1300 mineral baths, Serbia is growing as a popular medical destination for a variety of medical treatments, procedures, health spas and services.

Emaar Healthcare Group, the healthcare subsidiary of Emaar Properties, has opened its flagship medical facility, The Dubai Mall Medical Centre. At 60,000 sq ft, this is the largest outpatient facility in the region, offering a full range of specialties. Located at the Dubai Mall, the multi-specialty medical centre is focused on offering an integrated healthcare experience, with emphasis on evidence-based medicine and commitment to international best practices.
Emaar Healthcare has partnered with Methodist International, the international arm of US-based Methodist Hospital, to develop its flagship medical centre that will work towards constantly improving clinical outcomes and effectiveness.
Omar Al Shunnar of Emaar Healthcare Group says, "The Dubai Mall Medical Centre embodies the vision of Emaar Healthcare Group to serve as a true vehicle of change by redefining healthcare delivery in the region. Every aspect of the medical centre has been carefully planned to ensure that patients have a comforting experience. The differentiating features start with the spacious, elegant reception area and extend to the various specialties and supporting facilities. These are complemented by the service of internationally qualified doctors and staff aimed at setting best practice standards in Dubai’s healthcare sector."
The centre also offers advanced services in diagnostic imaging with on-site laboratory facilities and fully equipped procedure suites. Other on-site clinical services include an onsite pharmacy; advanced paperless patient administration and electronic medical records; modern consulting suites; and a dedicated wellness centre.
Methodist International has a partnership with Emaar Healthcare to promote best practice standards and develop and manage hospitals and clinics throughout the Middle East, North Africa and Turkey.Emaar aims to become a world class healthcare provider network by integrating a network of primary health clinics in communities with associated specialised clinics, secondary and tertiary hospitals. Emaar Healthcare Group will soon open two further healthcare facilities in the UAE.
The Middle East’s inbound travel market has a golden opportunity in attracting more medical tourists, claimed Dr Prem Jagyasi of ExHealth at the recent Middle East Tourism Marketing Summit (METMS) in Dubai, Demand is increasing day by day and cost is not the only factor, patients are looking for immediate care. He added that despite the higher cost of treatment in Dubai, compared to established medical tourism markets in Singapore, Thailand and India, locals seeking medical procedures were looking for immediate treatment in the Middle East.
Jagyasi warned, The major problem is that the Middle East is not promoting medical tourism yet. We need government bodies to come onboard to help solve this. Dubai is very keen to promote medical tourism and the government is looking at developing the required services, but there is a lack of trust in medical services here and this is something we need to overcome. Dubai should consider setting up a medical tourism board.
Healthcare City in Dubai has 80 clinics and the emirate hosts thousands of medical tourists each year, although there are no official data. A second phase of the healthcare complex is under construction, and will include nutrition centres, spas, resorts and sport medicine centres.

An increasing number of US employers are embracing the medical tourism concept. However, the pace of change is slow. The case study most mentioned is Hannaford Brothers, a supermarket chain based in Maine, with 27,000 employees in five states. Two years ago, the company offered to send its employees needing knee or hip replacements to Singapore. The medical costs would be so low that the company would pay the employee’s insurance co-payment of about $2,500 and the travel expenses for the employee and a spouse or companion.
The move attracted the attention of hospitals in Maine and Boston, and they offered to match the Singapore price. Hannaford recently said that in the last two years, ten employees have had operations. The twist is that none of the employees went overseas; all 10 had the surgery performed in the United States. A flight from Boston to Singapore takes between 24 and 30 hours hardly ideal for a person recovering from major surgery.
So, for many Americans the distances involved in travelling to Asia for treatment deter them from opting for surgery overseas. But the threat of Americans seeking care abroad is prodding some domestic providers to offer discounts much larger than they would under typical third-party reimbursement. Employers are embracing medical tourism, but only within the US.
In March, Mobile Surgery International celebrated the first case of an American patient and his American surgeon both travelling to another country in order to carry out a successful, high quality, surgical procedure of the patient’s choice at a cost the patient could afford. The rise of domestic medical tourism was shown when October saw the first domestic US mobile surgery case involving a patient from South Carolina, a surgical team from Florida and an operating room in Kansas.MSI identified excess operating room capacity in Kansas to which it sent the surgical team and the patient. The patient had uneventful surgery at a location he could reach more easily than a foreign country and at a price he could afford. As with foreign cases, domestic mobile surgery overcame economic and geographic barriers to treatment choice and quality. Galichia Heart Hospital expects more business from out of state patients through a facilities agreement with Florida surgeon Arnon Krongrad of Mobile Surgery International.
The Kansas hospital Galichia Heart Hospital is cutting rates for uninsured patients and those with high deductibles. The moves are an extension of the domestic medical tourism programme that it is now promoting online with a video. Stephen Harris of Galichia says the U.S. hospital pricing system makes it economically feasible to discount rates and still make money. For decades, he adds, hospitals typically have collected 35 to 40 percent of their charges from insurers. And they’ve billed uninsured patients for 100 percent of the charges. Discounted prices for those without insurance will be about half of what has been charged. Galichia hopes to pick up more medical tourism traffic from January through a contract it has with AWAC, a medical management company based in Georgia.AWAC works with 20 third-party administrators of self-insured health plans, acting as their medical directors. As part of its contract, it will promote Galichia’s medical tourism program.
Several U.S. medical facilities have started medical tourism programmes of their own, hoping to draw foreign patients as well as Americans who are uninsured or who have high-deductible insurance plans or health savings accounts. The Surgery Center of Oklahoma in Oklahoma City, advertises flat-rate discounted fees for outpatient procedures.

The world economy has made the travel and tourism industry of every country suffer with an appreciable downturn in medical tourism. London’s World Travel Market has long been the most important travel trade show in the world, and figures launched at the show are depressing for 2009, but offer hope for 2010 and beyond. 2009 has seen the worst recession since the 1930s. While there are tentative signs that the economic cycle is now turning, recovery is expected to be gradual, and a second dip into recession early next year cannot yet be ruled out.
Jean-Claude Baumgarten of the World Travel & Tourism Council (WTTC) reports, "Travel and tourism is forecast to decline by 5.5% in 2009.Activity in 2010 is likely to be flat at best." Updated forecasts from WTTC show that there has been no change in the projected long-term trend growth of 4% per annum forecast for travel and tourism over the coming decade. International air passenger traffic contracted by 6% year on year in the first eight months of 2009; Monthly data for 68 countries covering 80% of global tourist trips showing overnight visitor arrivals on a similar path (January to September growth is estimated at 6% year on year
There are tentative recovery signs for travel with the most recent data indicating that the worst has passed. Given the deeper-than-expected global recession and tourism indicators for the year so far, the contraction in activity is now expected to be larger than anticipated in January. Corporate travel cuts, household curtailment of leisure travel (especially international trips) and the postponement of investment plans for tourism infrastructure have all been as bad as expected.
The UNWTO World Tourism Barometer suggests that the decline in international tourism may have started to bottom out. International tourist arrivals declined by 7% between January and August 2009, but the rate of decline has eased in the past few months. This confirms UNWTO’s initial forecast of a 5% decline in international tourist arrivals for the full year 2009.International tourist arrivals worldwide are estimated to have declined by 7% between January and August 2009. Destinations worldwide recorded a total of 600 million arrivals, down from 643 million in the same period of 2008. But the downward trend that started in September last year may have begun to bottom out. Arrivals in the two high-season months of July and August declined by 3% compared with a decrease of 8% in the first half of the year, and data available for September points to a continuation of this upward trend. Tourism earnings, with a 10% drop, have suffered more than arrivals as consumers tend to trade down, stay closer to home and travel for shorter periods of time.
For 2010, UNWTO expects a moderate growth of up to 5%. Asia will show the strongest rebound, while Europe and the Americas will probably take longer to recover. Growth is also expected to return to Africa and the Middle East.2010 will still be a difficult year. The risks associated with the influenza virus remain on the horizon and the pace of economic recovery is expected to be modest. On the positive side, consumer confidence is giving signs of picking up.

Medical Tourism to Central and Eastern Europe is believed to be increasing. The region as a whole offers a variety of affordable treatments and procedures within easy reach of most European and Asian travellers. Many states are former communist bloc countries that are new to advertising, marketing and private healthcare. To them, medical tourism is a growth industry. Getting information on numbers is difficult.
Croatia is slowly but surely establishing a name for itself as a medical tourist centre, with low-cost treatment and high standard of care. Medical travel is based on dentistry and cosmetic surgery, spas and health resorts, not hospital treatment.
Miljenko Bura, who recently formed Medical Group to bring together 36 private clinics, dentists and surgeons keen to cater to foreign patients and promote medical tourism in Croatia, says, Croatia has excellent medical staff and a long tradition. We can be competitive in every respect when it comes to dentistry, surgery and aesthetic surgery, which are well developed here."
Medical Group plans to build a state-of-the-art medical centre on the coast and has already attracted strong interest from foreign investors keen to invest in medical tourism in Croatia. The recession is also playing into Croatia’s hands because prices will become an increasingly important factor. DentVitalis owner Sime Zivkovic reports a steadily growing number of foreigners coming to Croatia as prices are sometimes up to a third of those in Western Europe.
There are also many medical tourists from Russia because it is problematic to receive some kinds of treatment back home. Armenia offers cosmetic or dental procedures. Laser surgery is also available in this former soviet country. Clinics in Yerevan perform laser hair removal and corrective laser eye surgery is also available. Doctors in Armenia perform even more complex surgeries than the cosmetic ones, including open-heart surgery.
The Central and Eastern Medical Tourism Summit (CEEMTHS) is a medical tourism conference that will focus on the region and showcase agencies and providers from countries that include Croatia, Bosnia and Herzegovina, Macedonia, Serbia, Bulgaria, Romania, Hungary, Slovakia, Slovenia, Czech Republic, Poland, Lithuania, Latvia, Ukraine, Estonia, Armenia and Turkmenistan to a global audience.
The two-day conference in Zagreb, Croatia on 17th – 18th May 2010 includes a general medical tourism agenda plus a further conference dedicated to dental medical tourism.

Accreditation Canada International is progressing the national accreditation program for the Kuwait Ministry of Health. The Ministry intends to implement an accreditation program for healthcare quality and to ensure national standards developed specifically for Kuwait are followed.
Earlier this year, three hospitals began piloting the accreditation programme, process and standards. They are two acute care hospitals and one specialist orthopedic clinic. The pilot hospitals established self-assessment teams and are completing the assessment against the relevant standards for their programme area. They need to show that they comply with five patient safety standards.
January 2010 will see Accreditation Canada provide on-site training to 40 surveyors. The surveyors will be selected by the Ministry of Health according to a surveyor system appropriate to the Kuwait accreditation programme structure and the Kuwait context. Accreditation Canada surveyors will mentor the Kuwaiti surveyors and support them in conducting their pilot surveys in February 2010.From March to June 2010, Accreditation Canada will work with the MOH to complete the survey reports for the three pilot surveys, evaluate them, adjust the standards and accreditation process if required, and finalize the programme and process. There are already two local hospitals with international accreditation from Accreditation Canada; Dar Al Shifa Hospital in Safat and New Mowasat Hospital in Salmiya.The New Mowasat Hospital has launched its first Certified Professional in Health Care Quality (CPHQ) review and study program.  According to Dr Ghada Welwel, a certified professional in health care quality, the program is part of the hospital’s objective to enhance the performance of its staff from the executive level to the bottom. She said New Mowasat Hospital is the first hospital in Kuwait to adopt the service quality standards applied by the Canadian board, Through New Mowasat, the private and public hospitals in Kuwait are working hard to adopt these international standards. In a hospital setting, quality takes on a variety of meanings. It encompasses technical excellence. It is also about patient-centered approach to care delivered by the dedicated professionals in the hospital. In addition to having the technical and clinical expertise to provide safe and high quality care, it is also critical that the hospital focuses on other factors in a patient’s hospital experience. For us to develop high quality services we have to educate the staff on how to provide health care quality.
Dr,Welwel plans to hold an international conference in February 2010 on the quality of patient care and the legal responsibility concerning the health and safety of patients, Professionals from Europe and the United States are expected to attend this conference. It will be the first of its kind in the Middle East and hopefully it will take place in collaboration with New Mowasat.

South Africa and Tunisia, two of the most important medical tourism destinations in Africa, are changing their healthcare systems, while Ghana is making an entry into health tourism.
South Africans are willing to pay for national health insurance, but only if they are guaranteed quality services, says a new survey from the Department of Health. A committee is drafting a policy for national health insurance that the government intends to bring it into effect by April 2010.The plan is a single health system to which all who can afford it contribute through payroll deductions and general taxes. Although the majority of respondents (62%) supported a progressive financing system where the proportion of income paid for healthcare increases with wealth, there were significant variations across the socioeconomic spectrum: the richest preferred proportional contributions, while the poorest preferred progressive contributions. The survey was based on interviews with 4800 households. It found the public health service was often not as bad as people feared, suggesting the government had some work to do to improve impressions about its facilities. Less than half (45%) of respondents said patients at public hospitals were treated with respect and dignity, basing their opinions on media reports and the experience of friends and family. But of those who had been admitted to a public hospital in the past year, more than half (57%) said they had been treated with respect and dignity.
The Health Minister of South Africa says that the country is in a favourable position to develop medical tourism industry. This has provoked a debate on serious underlying issues with respect to the management of its public healthcare system, and whether or not expansion of the private sector through medical tourism is a diversion from core concerns that deters foreign direct investment.
In Tunisia, health as a fundamental right for all citizens is in President Ben Ali’s electoral programme that focuses on Health: a basic right and an essential foundation for quality of life. Tunisia will focus on establishing a modern healthcare system, and achieving greater performance of hospitals and healthcare institutions, by establishing a code of public health and setting up a higher health council.
Promoting health tourism in line with international standards will be achieved through developing a plan to promote the health-spa sector and endeavoring to make sure Tunisia holds top rank in the world in thalasso-therapy. All this will be consolidated through establishing a national centre for documentation on medical research.
The West African country of Ghana is now targeting health tourists. Medical tourism is flourishing in Ghana because the country is embracing modern medical care and is trying to become a beacon for Africa in terms of development. Cosmetic surgery, massages and detox are popular among visitors from other African countries. Holy Trinity Health Spa on the banks of Ghana’s River Volta offers massage, hydrotherapy and beauty treatments, as well as cosmetic surgery. It is attracting hundreds of foreign visitors a year, with the offer of cut-price treatment administered by doctors mostly trained in Western medical schools. The clinic is attracting customers from all over West Africa and beyond.

Two areas that give medical tourism a bad name, and most medical tourism hospitals and clinics avoid, are suicide tourism and organ transplant trafficking. Authorities want to end both.
According to a joint study by the United Nations and the Council of Europe, a new international convention is needed to prevent trafficking in kidneys and other organs and potentially life-saving tissues and cells. The study calls for international experts to agree on a definition that is recognized worldwide on what constitutes trafficking in organs, tissues and cells. To have an effect, the U.N. General Assembly would put the issue of organ trafficking on its agenda and start debating the issue, then draft and approve a new convention binding on all countries.
Carmen Prior, the public prosecutor of Austria and a co-author of the study, says the definition should be incorporated into an international convention that would include measures to prevent the crime, to protect and assist donors, and to prosecute the traffickers, "especially intermediaries and brokers and doctors and medical staff involved in such activities."
The study stresses that trafficking in human beings for the purpose of removing an organ is a small part of the wider problem of organ trafficking. It says that exploiting a living person to get an organ is already a crime under a United Nations protocol and a Council of Europe convention against human trafficking, but there is currently no international legal instrument against trafficking in organs, tissues and cells.
Arthur Caplan, a co-author of the study, who chairs the University of Pennsylvania’s Department of Medical Ethics and directs its Center for Bioethics, says the report reinforces the belief by many "that the basis for obtaining organs and tissues for transplant should be voluntary altruism. It reaffirms as a primary principal that there should be no financial gain involved in obtaining organs and tissues for transplant. All national and international laws should incorporate this principal and prohibit the sale or payment for organs. The problem that leads to trafficking is basically shortage. The good news is many nations are starting to take steps to reduce or attack the problem of trafficking of organs.
In an attempt to prevent suicide tourism, The Swiss Justice Ministry is reviewing draft legislation to restrict the number of patients allowed to undergo euthanasia to a minimum. The authorities have taken this initiative following a sharp increase in the influx of foreigners. Switzerland is one of the few countries where euthanasia is legal. The government aims to do everything possible to prevent people from crossing the Swiss border only to commit suicide a few hours later in a clinic or warehouse. The draft bill proposes for euthanasia to be allowed only for terminally ill patients and only if they provide at least two independent diagnoses of their illness. The draft aims to overrule the Swiss Supreme Court’s ruling of 2006 that says that every person has the right to decide when and how to die. Hundreds of foreigners, mainly Europeans, travel to Switzerland every year to receive a lethal injection of coma-inducing drugs and pay several thousand euros making it a profitable business for Swiss medical clinics and entrepreneurs. The draft bill has to be approved by the Swiss parliament before taking effect as early as May 2010.

Malaysia has been promoting medical and health tourism for several years but the reality is that this is unlikely to become a major contribution to the nation’s coffers for foreign exchange earnings.
Some private hospitals and clinics are good enough to be recognised as suitable, safe, and cost-effective choices for foreign patients. As healthcare costs in some other countries escalate, this drives people to look elsewhere. Most international patients come from nearby countries with less developed medical infrastructure e.g. Indonesia, Bangladesh, Burma and Russia. Other medical tourists come mainly from Europe, Australasia, and the Middle East. To promote medical tourism, the government will enhance tax incentives for healthcare service providers who offer services to foreign health tourists. There is an incentive for income tax exemption of 50 per cent on the value of these increased exports. Most doctors are not really aware as to the exact mechanisms of tax rebates under such circumstances. With the 2010 budget, this rebate will be increased to 100 per cent to encourage private hospitals and healthcare facilities to promote their services more aggressively overseas. Thus, essentially all earnings from foreign health tourists will be tax exempt. Whether this extends to earnings from the professional aspects/fees of individual doctors and specialists is still unclear. This incentive is expected to enable healthcare service providers to offer high quality health services, to continually raise standards and to promote more assertively overseas to attract greater numbers of health tourists.
According to a new research report from RNCOS,Malaysia Medical Tourism Outlook 2012 infrastructure development and low cost treatment will boost the Malaysian medical tourism market with annual growth of 23% a year between 2009 and 2012.The report provides information of a whole range of topics from key competitors to new market trends.
The Malaysia Healthcare Travel Council will launch in December to position the country as the healthcare hub in the region. The council will initially be set up as a department in the ministry and be answerable to an advisory committee. To ensure its success the government is working closely with the private sector.
According to the government, in the first nine months of 2008, 282,000 foreigners visited Malaysia for medical treatment worth RM222.25 million, a 16% increase from the previous year. According to statistics, the number of medical tourists in Malaysia has more than tripled since 2003 to hit 341,288 in 2007. Medical tourism receipts have risen four times to RM253.84 million during the same period.
On a familiarization tour sponsored by the Ministry of Health (MOH) agencies and others in medical tourism, mostly from the USA, visited top international hospitals and clinics. The Immigration Department has implemented the Green Lane System at main entry points that speeds up customs clearance for medical travellers.

Turkish Airlines has prepared a support programme for health care establishments who invest in medical tourism. It offers special discounts and incentives for those who come to Turkey for medical treatment. The airline has signed a deal with the majority of the 32 JCI accredited health care establishments in Turkey. Turkish Airlines wants Turkey to be among one of the leading destinations for medical tourism
Turkey has a higher number of JCI accredited hospitals than most countries, and offers substantial cost advantages with savings up to 75 to 90% on treatment costs in the USA.
The airline offer to patients and companions who travel to Turkey for medical treatment purposes:Travel from the USA to Turkey: Up to 25% discounts on some first, business and economy class system fares.Travel from other countries to Turkey: 20% discount on some first, business and economy class system fares.10kg excess luggage allowance for the patient and each companions. Up to two companions get the discounts
Passengers travelling for medical purposes are required to present an acceptance letter from the receiving healthcare establishment. Patients travelling from the USA are also allowed the discount by presenting a referral letter from a hospital or clinic in the USA. Discounts cannot be combined with other discounts. No discounts on promotional fares. No discount for stretcher. Turkey has a lot of catching up to do when it comes to health tourism. The country has a lot of potential, but has not been able to effectively harness it. Despite having many advantages over its competitors, including high-quality tourism facilities, thermal baths and experienced medical staff, Turkey still lags behind many countries, says Dr. Dursun Ayd?n of the Health Tourism Development Association. Turkey is home to more than 200 private hospitals, most of which are equipped with the latest technology.
Authorities agree that among the reasons for Turkey lagging behind its health tourism rivals is the divided structure of its marketing strategies. The sector lacks a hub that would take on the responsibility of coordinating the inflow of tourists and patients from various countries by directing them to the most suitable health centers. This hub would also serve to keep track of patients’ treatment and post-treatment, Turkey needs a proper marketing and promotional strategy.
Unique is the health village project developed by Turkey and Norway for the elderly. Since health services are rather expensive in Scandinavian countries, the governments are in search of new opportunities to give their citizens the highest-quality service possible at a reasonable cost. That’s where Turkey has great advantages, including its proximity to European countries, wide transportation networks, favorable climate conditions and Turkish hospitality. Antalya Flavius Beauty Hospital has begun to collaborate with the Norway Health Ministry and local municipalities to help Norwegian patients over the age of 60 in their treatment process. If a pilot is successful, the project is expected to be expanded.
Turkey is the pioneer of health tourism that involves health care for the elderly, for which the highest demand comes from Denmark, Norway and Sweden. To avoid the worst ravages of a Scandinavian winter, healthcare organisations send a party of care home residents, with staff, for several weeks or months to the warm climate of Turkey.

Healthy Travel Media, publisher of the Patients Beyond Borders series, and Medeguide, an online international doctor directory, have jointly launched the Patients Beyond Borders FOCUS ON: series.
Produced by Patients Beyond Borders editors and marketed by Medeguide, FOCUS ON: is an easy-to-distribute digital publication with search capability, enabling hospitals to showcase their centers of excellence, signature services, facilities, doctors, leading-edge technology, and international patient resources.
FOCUS ON: also provides a direct connection to Medeguide’s doctor and treatment-package search engine, allowing users to access hospitals directly to request appointments and information.
The Patients Beyond Borders team of independent editors will work closely with selected hospitals to highlight information important to medical travelers, including the hospitals’ vital information and statistics, images of the facilities, patients’ stories, noted specialties, international awards and accreditation, along with destination-specific travel tips.
Josef Woodman, author and creator of the popular Patients Beyond Borders series says, " This gives medical travelers unique, concise insight into what makes a particular hospital special. Medical travelers typically use multiple sources of data before selecting a particular hospital or doctor, and it consolidates all that information in one easy-to-read document that can be shared, emailed, and printed."
Medeguide founder, Ruben Toral, describes the service as A Swiss army knife–one simple tool that does many things. Consumers want relevant information in a format that can be shared easily with family and friends."
Through direct connections to Medeguide’s online doctor directory, FOCUS ON: users can review and share profiles of doctors and packages with the click of a mouse. Woodman and Toral continue to look at new opportunities in the medical travel industry through an approach called destinations to doctors. By coordinating and combining information on destinations, hospitals, treatment packages, and doctors, they believe patients will have better tools to make informed healthcare decisions.
Medeguide is an online doctor directory featuring medical and surgical specialists from leading medical centres around the world. Using Medeguide, consumers can search, find, and connect with doctors and hospitals directly for appointments and information.
Patients Beyond Borders is the series of bestselling consumer guides to medical tourism. Its imprint, Healthy Travel Media, publishes books, eBooks, and web-based consumer reference information on medical and wellness travel.
Healthy Travel Media and the Tourism Authority of Thailand (TAT) have launched Patients Beyond Borders: Thailand Edition. Produced in collaboration with TAT, the 244-page guidebook features 32 pages of colour and offers an in-depth overview of Thailand’s international hospitals, selected health travel agents, nearby recovery and guest accommodations, spas, and area travel information.

The New Zealand government is concerned that medical tourism could damage the limited healthcare offering to residents, and has spotted a tax revenue raising opportunity.
According to the government, 1,000 foreign visitors a year choose to have medical treatment in New Zealand because it is cheaper than their own country. This is especially the case for US residents, where a hip replacement operation costs $US50,000 compared with $US15,000 in New Zealand and heart bypass surgery costs $US125,000 in the US against $US25,000 in New Zealand.
The government says that they have been told, and they are not saying where the information comes from, that the number of overseas patients choosing to have surgery in New Zealand was expected to reach 20,000 by 2020, when the industry would be worth $1 billion a year. Hospitals suggest 20,000 is a number dreamt up to justify taxation.
The government idea is that all private hospitals, or all those treating overseas visitors, will have to pay a per head ACC levy to cover risks associated with New Zealand’s growing medical tourism industry.
The Accident Compensation Corporation (ACC) provides comprehensive, no-fault personal injury cover for all New Zealand residents and visitors to New Zealand. All workers and motorists pay a range of levies. A clue to the reason for the sudden tax idea is that the government has a $4.8 billion shortfall and 2010 will see substantial levy increases to counter the rising cost of providing ACC, but costs are rising faster than income.
Minister Nick Smith argues, New Zealand taxpayers are paying ACC levies that provide insurance against medical misadventure for wealthy Americans who choose to have elective surgery in New Zealand. There is a real concern around medical tourism and the risks for New Zealand around the ACC scheme. It is not right that levy payers are subsidising misadventure insurance for private hospital operations in New Zealand. I have asked ACC to look at the design of a specific levy on private hospitals so that the costs of the risks from medical treatment in New Zealand is met by the industry and not other New Zealanders. If New Zealand can genuinely earn foreign exchange from efficient health services, that is a good thing, but it should not be being subsidised by New Zealand levy payers. The problem here is about fairness and also about the longer-term risks if this industry grows, as some are speculating."
The NZ Private Surgical Hospitals Association, representing the country’s 37 private hospitals, suggest that the minister’s argument is inconsistent and unfairly singles out one group of visitors. They insist any new levy should be imposed only on those hospitals in the business of medical tourism. The association’s president Terry Moore says ACC should cover all overseas visitors or none. Moore doubts the 1000 figure, I would be very surprised if as many as 1000 overseas patients were coming to New Zealand every year for surgery, but there is no question that some hospitals were wanting to get into the market. It is a good thing for the economy. But no one knows just how big that market can be because it is no small thing to fly all the way from the US to have that treatment. If ACC chose to apply a levy I think it is quite important that the levy is only levied on hospitals that actually treat overseas patients."

For a number of months, Accreditation Canada has been working on the development of a new international accreditation programme .To ensure it addresses the diverse cultures and societies of the international target markets, there is an international advisory committee representing countries from the Middle East, Europe, Caribbean and South America. Pilot testing has begun and the new programme will be launched in 2010.
It has been developed from Qmentum, and includes novel features such as an emphasis on risk prevention planning, patient safety, performance measurement, governance and health system performance. It will help ensure that international clients have the right tools to better serve their customers.
The most valuable innovation for international hospitals is that it has built in customization and flexibility. It recognizes individual readiness for accreditation by streaming into one of three typical evolutionary steps for quality improvement and safety; putting in place basic structures and processes; developing standardized processes; monitoring and measuring outcomes. This step-by-step approach is a strong competitive advantage and will enable the accreditor to meet the needs of many diverse international target markets. The programme can be adapted to meet the individual needs of each organization, no matter how advanced they already are on quality improvement .The aim is to encourage all client organizations, both individual hospitals and countries, to aspire to higher levels of quality and patient safety by demonstrating compliance with ever more demanding standards of excellence. Since 1958, Accreditation Canada has been committed to improving quality and safety in health services through accreditation. In keeping with this mandate, it introduced a new accreditation program called Qmentum in 2008 just in Canada. Based on the latest research and evidence and extensive feedback from clients, surveyors, board members and staff, Qmentum emphasizes health system performance, risk prevention planning, client safety, performance measurement, and governance.
Qmentum fosters an increased awareness of accreditation as a powerful tool for accountability, and enables health care organizations to use accreditation effectively and easily as a roadmap for quality. Some of Qmentum’s features include updated and new standards, a quality performance roadmap, a customized survey plan, a revised self-assessment and on-site survey process, performance measures, and new accreditation reports. It also incorporates automated measurement tools for greater and faster data exchange, improved standardization and objectivity, and less paperwork, and allows Accreditation Canada to quickly capture information from both large multi-site and smaller single-site organizations.
Accreditation Canada’s international department, Accreditation Canada International, promotes accreditation around the world. Recognizing that one standard approach does not work for everyone, it customizes its accreditation program to meet the client’s needs. Working collaboratively with clients, it provides continuous guidance without being prescriptive. Accreditation is not a pass or fail. Accreditation means helping organizations prepare for success.
The organisation works with international governments, helping them achieve independence in accreditation by establishing accreditation agencies and customizing accreditation programs. Accreditation Canada’s first international hospital accreditation took place in the early 1980s. Currently, its international clients are located in the Middle East, Europe, the Caribbean, and Latin America.

Hungarian dental clinics that have many years of experience and treat thousands of medical tourists a year, have got together to keep Hungary as a leading dental tourism destination, as newer and less qualified locations seek to take their business away. They want to work with and get more support from their country’s government departments and tourism organizations.
The Association of Leading Hungarian Dental Clinics (ALHDC) seeks to promote Hungarian dental tourism while committed to providing a high standard of ethics and professional conduct of dentists. They strive to foster patient relationships based on mutual trust, excellent customer service, and the best patient care available. ALHDC promote the profession of dentistry by enhancing the integrity and ethics of the profession, strengthening the patient/dentist relationship and helping members run a successful dental tourism practice.
There is a 12-point code of practice that members must obey;1 To provide the possible highest standard of remedy a team of specialized dentists is essential. The practice must employs a minimum of ten dentists / oral surgeons with specialist diplomas.2 For patient safety practices must have at least 5 modern dental medical operating units and prepare at least 1500 units of aesthetic tooth replacements a year.3 Modern dental technology demands an adequate medical experience so practices must do a minimum of 1000 implants a year.4 Computer technology is vital for patient safety and satisfaction so practices must use cutting edge technology and pre-implantation surgery planning methods on a daily basis.5 The quality of treatment depends on the quality of equipment; so all materials and instruments must be of the highest quality and only sourced from reputable6 Practices must work within industry recognized protocols, including clinical governance and undergo regular internal clinical audits and assessments. This includes ongoing dental and hygienist clinical education and professional development courses.7 The precision of diagnosis is the key factor to enhance prevention, therapy and rehabilitation, so practices must use digital intra-oral and panoramic X-ray equipment.8 Patient safety and accountability are essential so practices must have professional indemnity/liability insurance.9 The quality of patient care must be accredited by external experts and practices should seek to introduce an audited quality assurance system. 10 Up-to-date knowledge is not possible without excellent international communication, so practices must employ multilingual staff.11 Good administration is the foundation of high quality patient care, and this includes post-treatment follow-ups. Practices must have a team of patient co-coordinators and customer care staff.12 It is very important to create a safe environment for foreign patients during their stay, so there should be a transfer service to airports and hotels.
Hungary was one of the first countries to encourage patients to cross borders for treatment.  Many German and Austrian patients travelled to Hungary for dental treatment, before many countries had ever heard of dental tourism. Hungarian clinics have successfully marketed themselves to the UK, Ireland, Scandinavia and The Netherlands New opportunities are developing in other European countries including France, Italy, Switzerland, Russia, and the USA.
60% of the business of the founding members comes from dental tourism.ALHDC and founding members are based in Budapest-
* Bátorfi Dental Implant Clinic* Implant Center* Kreativ Dental* Madenta* Solydent* Vital Point Clinic