The news that three Costa Rican clinics have just received accreditation from the AAAASF may lead you to ask, who?
The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) was established in 1980 to develop an accreditation program to standardize and improve the quality of medical and surgical care in US ambulatory surgery facilities while assuring the public of high standards for patient care and safety in an accredited facility.
Today more than 1,100 outpatient surgery facilities are accredited by AAAASF, the largest not-for-profit accrediting organization in the United States. Many more facilities are in process for accreditation. These numbers have increased dramatically over the last two years.
The vast majority of ambulatory surgery facilities in the world are unaccredited by AAAASF or anyone else, operating independent of any peer review and inspection process.
In 1996, California became the US state to mandate accreditation for all outpatient facilities that administer sedation or general anesthesia. AAAASF was instrumental in the development of the California legislation as well as subsequent laws and regulations in Florida, Georgia, New Jersey, Pennsylvania, Texas and many other states.

AAAASF conducts an accreditation program that certifies that an accredited facility meets nationally recognized standards. Physicians, podiatrists and oral and maxillofacial surgeons conduct the accreditation program. The AAAASF strives for the highest standards of excellence for its facilities by regularly revising and updating its requirements for patient safety and quality of care.
AAAASF has designed an accrediting program to help provide patients with the assurance of safety and quality in all aspects of their outpatient surgery experience. To achieve this goal, every AAAASF-accredited ambulatory surgery facility must meet stringent national standards for equipment, operating room safety, personnel and surgeon credentials.
AAAASF’s Harlan Pollock says; The business of AAAASF is accreditation. It is the high quality of our standards that have made AAAASF the ambulatory facility accreditation choice of governmental agencies, professional organizations and individual facilities. AAAASF core principles and philosophy concerning patient safety is a constant that is unwavering regardless of political or economic pressures that impact on healthcare, and therefore on the accreditation agencies.  Our standards are continually upgraded in order to eliminate any ambiguity, as well as, to meet constantly changing practices and technology. This flexibility allows us to address the needs of our facilities, while still providing for patient safety. The agency was founded by a group of plastic surgeons who had high professional standards related to surgery, sterile technique, anesthesia and a strong opinion that office surgery needed oversight. Through the years, the leadership has been expanded to include physicians in other surgical and medical specialties. Recent expansion of AAAASF accreditation to include procedural and other medical facilities has been both challenging and rewarding.  Applying our surgical philosophy and high standards on non-surgical specialties has contributed greatly to patient safety.
Until recently, the organisation limited itself to the USA.It is now expanding into countries where the majority of medical tourists are Americans requiring outpatient treatment. This may be very attractive to small hospitals and clinics for which international accreditation by JCI or others is not cost-effective compared to the volume of Americans treated.

Dubai has been promoting Dubai Health Care City (DHCC) as a world centre for medical tourism. Tourism officials have attempted to talk up the potential by quoting numbers of inbound medical tourists in the millions. But there are no official figures on current inbound and outbound medical tourists.
Phase I of DHCC is going to be completed in 2010, but there still seems no cohesive marketing strategy to promote the location. Listing how many new hospitals and clinics you have, what connections you have to prestigious US and European hospitals, what new equipment you have bought is not a marketing strategy.
Medical tourism is an increasingly competitive marketplace, with over 300 countries targeting international patients. The myths of millions of high-spending American medical tourists, and thousands of Britons seeking ways of jumping NHS queues, have both been shattered. There is a huge international move away from long-trip to short-trip air travel, or travel by road and sea rather than by air.
No longer is Dubai just competing with Asia. It is competing with domestic US medical tourism, South and Central America, Africa, Europe and lots of places previously uninterested in medical tourism. Several competitors are in the Middle East region itself with both Jordan and Lebanon both very active, and Abu Dhabi close behind Dubai in developing its healthcare offerings.
On quality of care, DHCC can promise new buildings, comfort and the latest equipment. The quality of doctors may depend on the number of home and overseas patients a hospital attracts. Leading specialists only remain leading specialists if they can regularly operate, so if they can only rarely use their expertise, they will neither go to nor stay in Dubai. Patient care is about much more than clinical excellence, and on the softer elements of customer care, Dubai has a steep learning curve to climb. A key attraction for medical tourists is financial savings. Compared to top Asian hospitals, Dubai has a serious cost disadvantage.
Dubai has partnered with Harvard Medical International (HMI) to provide a trusted name as its strategic collaborator. But, HMI operates in more than 30 countries including many medical tourism locations, so there is no longer any uniqueness of the partnership in Dubai.
Many other governments are working with health and tourism bodies to promote their country as a medical tourism destination. Some are now expert in marketing and advertising to target countries and individuals. As yet, the Dubai government strategy seems to be limited to a very broad We have lots of new hospitals, come to us. 
Thousands of UAE citizens traditionally went to the US for medical treatment. Now fewer patients from the Middle East and Gulf states seek treatment in the US. This does not mean they stay at home. 200,000 UAE citizens a year go to Asian countries including 90,000 to Thailand.
Targeting and capturing the UAE citizens who now go overseas should be the first priority for DHCC. Only when it can convince its own citizens to get treated there can DHCC be regarded seriously as a destination for overseas medical tourists.
DHCC includes scores of international health businesses, but 2009 has not yet seen a single press release from DHCC, and there is no sign of any marketing strategy.

The Socialist ex President of Extremadura, Juan Carlos Rodríguez Ibarra, has attacked medical tourism in a radio interview, and written an article published in El País on gatecrash health tourism, where thousands of Europeans take advantage of the Spanish Health Service for their operations.
He is not attacking medical tourism where people pay to go to Spain for treatment in a private clinic, but cross border healthcare where some holidaymakers, and foreign part or full-time expatriates are accessing free treatment in Spain. Ibarra’s argument is that health tourism is increasingly common with thousands of Europeans taking advantage of the free Spanish system for procedures which are free there but charged for in the countries of origin, describing replacement hips and knees, and heart and cataract operations the most in demand. He claims the practice has reached such dimensions that some travel agents have added the health service to the list of attractions. Ironically, the nation most blamed is the British, the irony being that only weeks ago British politicians were blaming foreigners going to Britain just for free treatment as a reason the NHS is not delivering as well as they would like.
It would be easy to dismiss Ibarra as yet another politician ranting at foreigners, but he gives some data to back up his argument. He may be using old data, but anyone who has ever tried to get Spanish figures on anything will know that they are usually several years old before they reach daylight. He quotes the Malaga division of the Andalucian Health Service as saying in June 2004 that some 400,000 EU residents live in the province and get health cover and the ensuing financial black hole is enough to pay for the Malaga Metro or build 25 hospitals. He says that every EU citizen not on the census but receiving health care is costing Spain 686 euros a year.
Key points from his article;

Surgery tourism is becoming an increasingly common practice among visitors to the Costa del Sol on holiday or long stays in their second homes.
Thousands of Europeans exploit the benefits of the Spanish public health to undergo surgery and get free hip and knee, cataract and coronary operations that they would either have to pay for or wait a long time for in their home country.
In 2004 Spain received 44.7 million tourists. This included 183,000 paying health tourists in all of Spain. But for Malaga province alone 400,000 EU citizens had free health care, only 5 % being registered as resident expatriates.
Of the registered foreign residents in the various municipalities of Spain, only 114,000 had done the paperwork that allows Spain to get 2000 euros per person per year from the countries from where these people come. The remaining resident expatriates are neither registered nor legally resident in Spain. Each foreign EU citizen not registered in Spain and receiving health care, costs the Spanish health system 686 euros a year.
45 million tourists go to Spain annually, far exceeding the number of Spanish going on holiday to other EU countries. 
23% of patients treated in emergency Costa del Sol Hospital in Marbella were foreigners, mostly from the European Union.
It is increasingly common for foreign citizens, who have a home in the Costa del Sol and in their home countries decide to go to a Spanish public hospital for surgery or benefit from treatments they need, primarily hip and oncology.

Ancient remedies and treatments are often referred to as alternative medicine. But as they predate modern medicine by many centuries, many would argue that modern medicine is the alternative to centuries old natural treatment that is frequently more holistic and long lasting than modern medicine.
Traditional medical, dental and cosmetic medical tourism in India relies heavily on being able to offer prices much lower than in other countries. But as scores of other countries go down the; come to us as we are cheaper road, some agencies and tourist bodies are concerned that selling on price advantage alone could be short-lived. Traditional remedies have survived the test of time, but people realise that they now have to be marketed with good accommodation, transport and food; the number of health tourists prepared to be treated in wooden huts and travel by yak is limited.
Following in the footsteps of the Kerala tourism industry, Himachal Pradesh is integrating tourism with ayurvedic treatment by setting up a hub of health tourism in north India. The state has introduced ayurvedic treatment packages at three of its premium hotels- Holiday Home Shimla, Tea Bud Palampur and Chail Palace, that offer rejuvenating panchkarma therapy massage to tourists, besides treatment for aliments such as chronic conjunctivitis, corneal ulcer, dry eye syndrome, osteo and rheumatoid arthritis and mental disorders. The panchkarma therapies for these ailments will be provided under expert guidance of doctors and trained staff of special ayurveda centres being set up in the hotels.
Hotel Tea Bud at Palampur has been equipped to provide treatment for more serious aliments through therapies like abhyangam for improving concentration and mind power and netra-tarpan for eye and mental disorders. Special techniques developed and mastered by ayurveda experts of Kerala, pizhichil and the ancient classical therapy kayadhara have also been introduced for curing rheumatic diseases like arthritis, paralysis, hemiplegia and nervous disorders. Sarvakaya abhyangam, shiro dhara and skin treatments such as triposha, nalikerodakm and kartatika kepam are being offered at Shimla and Chail hotels.
Alternative medicine is based on completely natural methods; there is no usage of any chemicals, and there is no danger of any interference with the organic system. It uses a holistic approach as opposed to looking at a set of symptoms and just treating them.
Alternative medicine holds out immense potential in attracting medical tourists to India where medical tourism in alternative medicine has its ancestry in South India and North-Eastern India. Internationally famed for its natural remedies and therapies, Kerala’s schools of medicine have embraced siddha, naturopathy and ayurveda in treating their patients.
These traditional medical practices are expected to attract high-spending medical tourists from Europe, Australasia and the Middle East, particularly in the summer months. These tourists stay longer than those jetting in for a cheap surgical operation, and more importantly are likely to be regular returners, while conventional medical tourists stop coming one they have been cured.
Ayurveda, the Indian wisdom of medical knowledge, has boosted medical tourism in Kerala and helped draw a large number of tourists to the state, says the state’s health minister.

Baja California Medical Tourism Association (BCMTA) is a State of California non-profit mutual benefit association. It is the only association outside the Republic of Mexico totally dedicated to advocating and promoting medical services for the entire state of Baja California. BCMTA will represent all of Baja California not just one location or cluster
BCMTA aims to help provide medical service seekers access to Baja California’s highest quality, affordable and compassionate medical services. It has offices in Tijuana, Mexico and San Diego, USA.From the Mexico border north through the Greater Los Angeles Region there are 24 million residents.
The huge number of Americans travelling to Mexico has seen many agencies; hospitals and clinics open to medical tourists, or set up specifically for them. While many offer excellent care at reasonable prices, some are taking advantage of the modern equivalent of the California gold rush.
Choosing a clinic or hospital is a lottery, and incompetent or dishonest surgeons and agencies cheat a few unlucky medical tourists. BCMTA wants to offer a Seal of Approval to people seeking medical services, information and referrals in the Western United States, with emphasis in California’s vast Hispanic and non-Hispanic population. BCMTA wants to make available a network of highly accredited health care providers dedicated to the practice of providing treatment with healing in mind and dedicated to wellness programmes. The organization believes that the practice of medicine requires of its practitioners an advanced level of competence and above reproach moral values. BCMTA considers for membership only those who meet this code of values.
The chairman is Judith Wilson, managing partner of the Tijuana law office of Bryan, Gonzalez Vargas & Gonzalez Baz. The secretary is another lawyer, R. Anthony Moya, a partner in the San Diego office of Lewis, Brisbois, Bisgaard & Smith. The other board members are: Mauricio Monroy, who runs investment advisors Mauricio Monroy Contadores in Tijuana; Carlos Rosette and Carolina Rosette, owners of Hi-Tek Mexico web designers; Hank Morton and Geoff Hill of Baja Bound, a major seller of Mexico auto insurance on the internet; Patrick Osio and Hector Molina, of media and marketing agency TransBorder Communications; Melissa McKeith, of attorneys Lewis Brisbois Bisgaard & Smith; Alfonso Hernandez of travel and medical tourism agency Five Star Tours based in San Diego; and Al Delino, who runs his own graphic design firm.
BCMTA will go direct to the California consumer with attendance at health expos, television and radio spot advertisements, news releases, commentary articles, networking with other organizations, and as guests on television and radio programmes, as well as reviving The Baja Connection radio program over the Internet. And an important element is the organizing of medical tours, several of which are already in the works.
BCMTA is actively inviting for membership medical institutions and practitioners who have a proven track record, and are accredited. By having only those with full accreditation the California non-profit will sustain a high degree of credibility with the U.S. public. It will work with other organizations in promoting and lobbying for Medicare payment approval for services in Mexico; and with local authorities to expedite border crossings.

ACHS has been awarded a contract by the Hong Kong Hospital Authority (HKHA) to assist with the development and implementation of a pilot scheme of hospital accreditation.     The project will run over the next three years. Initially, five public hospitals will participate in a pilot project to be prepared for accreditation. These hospitals will first undergo a mock survey by early 2010, followed by formal assessments for accreditation within two years. The assessments will look at patient safety, services outcomes, patient records, handling of medical incidents and training, using the EQuIP 4 standards. Following the assessment of the project’s outcomes, it is intended that a common accreditation programme will be developed that is applicable to all hospitals, public and private, in Hong Kong. The Hospital Authority is a statutory body that manages 41 public hospitals, 48 specialist outpatient clinics and 74 general outpatient clinics.
JCI is continuing to add to the number of hospitals it has accredited, with new ones being added every month. It has recently accredited its first hospital in Japan, first in Colombia and second in Egypt.Kameda Medical Center in Kamogawa City, Chiba became the first hospital in Japan to be accredited by Joint Commission International.Kameda Medical Center includes Kameda General Hospital and Kameda Clinic. In addition to treating patients from Japan, Kameda Medical Center frequently sees patients from all corners of the globe. Fundación Cardiovascular de Colombia inSantander is the first JCI hospital in Colombia. Despite recent claims by the Colombian president to have 11 medical clinics with international accreditation, the other international agencies have no Colombian hospitals or clinics listed. Magrabi Eye Hospital in Cairo is only the second Egyptian hospital with JCI status, the first being originally accredited back in 2005.
JCI is holding two seminars on quality improvement and accreditation, in Seoul in November and in Amman in December. The interactive seminars are for healthcare professionals who are preparing for JCI accreditation or are interested in improving quality and safety in their organization. Participants will learn from global experts, share experiences, and observe a simulated accreditation survey at a local health care organization.
The World Health Organization recently redesignated 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. The Collaborating Centre 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.
Hospitals across the US are switching to new accreditor DNV Healthcare for accreditation. A new video illustrates some experiences of hospitals using DNV.

A new show aimed at people looking to travel abroad for medical treatment is set to take place next spring in London.
Supported by The Independent newspaper and online media partner Treatment Abroad, Destination Health will take place on the 17th & 18th April 2010 at the Olympia Exhibition & Conference Centre. The show is expected to attract up to 5,000 people from all walks of life who are actively planning to travel abroad for treatment. In addition, visitors will also include health and medical professionals who are looking to establish business partnerships with healthcare providers from around the world. Destination Health is the ultimate event for people who are planning to travel abroad for health and medical treatments. With just one visit they will have an opportunity to meet and discuss their medical requirements with a host of hospitals, clinics and consultants representing the world’s leading medical tourism destinations right on their door step said Event Director Nav Mann.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. The price at the door is £12.To register for free tickets visit www.destinationhealth.co.uk

For further information on the event contact:Nav MannEvent DirectorDestination HealthTel: +44 (0)20 8230 0066Fax: +44(0)20 8230 0067
navmann@destinationhealth.co..uk
www.destinationhealth.co.uk

In the Netherlands there is a system of obligatory health insurance, for everyone including expatriates, with private health insurance companies. These insurance companies are obliged to provide a package with a defined set of insured treatments. Five large mutuals control the market. Insurance companies must offer a core universal insurance package for the universal primary curative care. They must do this at a fixed price for all. The same premium is paid whether young or old, healthy or sick. People are free to purchase optional packages from the insurance companies to cover additional treatments such as dental procedures and physiotherapy.
Healthcare in the Netherlands is generally very good, but is more expensive even than countries previously thought to charge more for equivalent care. When taking into account cost, quality and easy access, the only country that qualifies is Germany.
The two biggest Dutch insurers have agreed to send a small number of patients to private hospitals and clinics in Germany. Agis, a subsidiary of Achmea, the largest Dutch insurer with 5.3 million policyholders, is sending a few patients to Germany for procedures that are cheaper. Medical tourism agency Holland InterCare arranges the treatment and travel for its parent Agis. For the last decade the company has arranged medical treatment in the Netherlands for patients from Surinam, the Dutch Antilles and Aruba. It also has service centers in Turkey, Morocco and Surinam, as many policyholders of Agis have their roots in these countries. The service centers help Agis clients visit these countries for the purpose of planned and organized treatment. The agency recently began arranging healthcare overseas for Dutch nationals on a self-pay basis, and has extended this to insurer paid patients. The agency is negotiating to extend the operation from just Agis policyholders to the other Achmea group insurers; Zilveren Kruis, Avero Achmea, Centraal Beheer Achmea, FBTO and Interpolis.
Large insurance group UVIT is using two German healthcare groups, MEDIAN and Helios; the former for hip and knee replacements with a five-week stay in a rehabilitation unit with intensive physiotherapy and coaching. This is for those, mostly older retired patients, who prefer aftercare in a home, compared to the Dutch practice where the patient goes home and then gets outpatient treatment. Numbers are expected to be small, 100 patients a year. Helios covers all types of operation, and there is no set numbers.
Helios Healthcare International arranges treatment for international patients in hospitals within the Helios group. In Germany, Helios owns 57 hospitals with 17,300 beds, including five maximum care hospitals in Erfurt, Berlin-Buch, Wuppertal, Schwerin and Krefeld. MEDIAN operates 27 rehabilitation and acute care clinics. In August, the company was sold to Advent International, the US private equity firm, and Marcol, London based real estate private equity investor.
The Health Insurance College of the Netherlands suggests, with no supporting numbers, that 1% of medical care for Dutch people takes place abroad. Much of this is dental tourism, as dental care is not within the compulsory health package, and private dental treatment in the country is expensive. Another group is expatriates who go home for treatment. Very few go overseas for major medical treatment.

A criticism of medical tourism to less-developed countries is that it takes doctors and nurses away from caring for the citizens of that country, particularly the poor. A new United Nations initiative will enable medical tourists to donate every time they travel. This will only work if medical and other tourism agencies, organisations, and hospitals/ clinics dealing direct with overseas patients, grasp this opportunity to show the medical tourism business as more than about profit.
The United Nations and the World Travel & Tourism Council have launched an ambitious global health initiative, MassiveGood. The project was created by the Millennium Foundation for Innovative Finance for Health and will allow travellers to give a voluntary contribution every time they purchase travel services. The innovative travel related fundraising initiative will help finance healthcare for the world’s poor.
The money will go towards fighting life-threatening contagious diseases including HIV/AIDS, malaria and tuberculosis, in developing countries. Managed by The Millennium Foundation for Innovative Finance for Health, it will allow travellers to give a small donation ($2/€2/£2) every time they purchase travel services. Funds will be distributed by UNITAID, hosted by the World Health Organization.The Millennium Foundation is an independent, non-profit foundation, established in November 2008 under the auspices of the United Nations.
MassiveGood is in testing phase. The technology solution was developed by Amadeus and can be integrated into all global distribution systems and embedded in the regular booking system for tickets and other travel reservations. As a result, it will make it easy for everyone who travels to make their micro-contributions through a simple click each time they book their reservation, whether online or through an agent.
It is on track for launch in early 2010 in USA, UK, Spain, Germany and Austria, followed by Australia and New Zealand. It has the potential to raise up to $1 billion in additional funding for global health during its first four years of operation.
Major global distributions systems including Amadeus, Sabre and Travelport have signed on, as have online travel agent Opodo, American Express Business Travel, Carlson Wagonlit Travel, Voyageurs du Monde and Mondial Assistance. No organizations connected with medical tourism are known to have signed up yet.
Dr. Philippe Douste-Blazy of the Millennium Foundation says, "The biggest crisis the world is facing is the glaring inequalities in access to health care between the rich and the poor.Unitaid was launched 3 years ago as an innovative mechanism for scaling up access to treatment for HIV/AIDS, tuberculosis and malaria. Founded by Brazil, Chile, France, Norway and the UK, it now has the support of 29 countries and supports partner programmes in 93 countries worldwide, addressing HIV/AIDS in 49 countries; malaria in 29; and tuberculosis in 72 countries.

Malaria kills 1 child every 30 seconds – $2 can treat 2 children against malaria.
Tuberculosis kills 1 person every 15 seconds – $24 can cure 1 adult of TB.
HIV/AIDS kills 1 person every 13 seconds – 40€ can treat 1 child for a year.
Every 3 seconds, a child under the age of 5 dies in low-income countries.
Every minute, a woman dies in pregnancy or childbirth.
Any medical tourism organisations interested in helping this excellent project should contact the Millennium Foundation.

Iceland’s business centre Asbru is nearer to developing a medical tourism destination targeting Scandinavian and British medical and dental tourists.
Asbru, on a former NATO airbase next to Iceland’s Keflavik International Airport, will become home to a new international health services centre. A contract has been signed by the Keflavik Airport Development Corporation (Kadeco) and Iceland Health.
Kadeco aims to develop a health village concept where businesses working in health related industries are clustering together to exploit synergies. It is Iceland Health’s goal to increase specialised health services and begin substantial medical tourism in Iceland. Iceland Health’s initial product offering will include joint surgery and obesity surgery, including important post-surgery rehabilitation. Obesity services will include a range of behavioural treatments against obesity.
Iceland Health’s Asbru health centre has a professional advisory council. The council has confirmed members including: Otto Nordhus, chest wall surgeon; Bjarni Sem, heart surgeon and Leif Ryd, orthopaedic surgeon. The council will also include obesity and rehabilitation experts.
The Iceland Health project will catapult Asbru to the position of the premier medical tourism facility in Iceland. Asbru is already home to several innovative companies in the health and wellness sector. The majority of tourists who go to Iceland travel through Keflavik Airport. Icelanders enjoy the longest life expectancy and highest healthy life expectancy in Europe.
The facilities at Ásbrú will include a health and fitness village with an international centre for health and relaxation. A Reykjanes Health Association has been founded to promote Reykjanes in the as a destination for health and relaxation. The goals are to market Iceland as the land of strength, fortitude, beauty and health.

In May 2009, Icelandic entrepreneur Jonina Benediktsdottir opened a 50 room detox health center in Asbru.She is now getting large numbers of Norwegian customers, and has been profiled on Norwegian television. Jónína’s connection with Norway began when Norwegians began going to the detox treatments she offers in Poland. Norwegians prefer going to Iceland rather than Poland. Also booked in are health tourists from Sweden, Finland, the Czech Republic and Canada.
After Nato evacuation in 2006, the base was re-invented as a community of entrepreneurs, students and business. Ásbrú has the largest university campus in Iceland, one of the largest business incubators in Iceland, as well as other projects including a green energy research centre.

While media attention may be on US healthcare reform, over the border in Canada, an equally bitter fight is taking place on the future of state and private healthcare. The outcome will affect medical tourism into, out of and within Canada.
Although this is a highly political fight, it is not being fought by politicians, but in the courts. In British Columbia, private clinics and surgery centres are catering for patients who would normally look to pay privately for faster treatment across the border in the USA. The courts will consider their legality within weeks.
Healthcare in Canada is a government-funded health system where all Canadians get free care. It is not national, but controlled by each province. It was only in 2005 that a Quebec court ruled that private health insurance was legal, and only in that state. This ruling paved the way for private care.
Facing long waits and substandard care, private clinics are proving that Canadians are willing to pay for treatment. Private for-profit clinics are permitted in some provinces but not allowed in others. Under the Canada Health Act, privately run facilities cannot charge citizens for services covered by government insurance. A network of technically illegal private clinics and surgery centres has opened in British Columbia, copying what happened in Quebec. In October, the courts will be asked to decide whether these clinics are legal, illegal, or can operate in a restricted way. More than 70 private health providers in British Columbia schedule simple surgeries and tests with waits as short as a week, compared with the months it takes under the public system.
Brian Day runs a private surgical centre in Vancouver, "You cannot force a citizen in a free and democratic society to simply wait for healthcare, and outlaw their ability to extricate themselves from a wait list." Opponents say that allowing private care will drive the best medical staff and well-off patients into the private sector; leaving the public sector to slowly crumble. The lawsuit is to determine whether the Canadian Constitution guarantees citizens the right to choose their own care.
Separately, an investment group backed by Arizona businessman Melvin J. Howard has filed a legal challenge under the North American Free Trade Agreement, demanding that US healthcare companies gain access into Canada. The consortium hopes to build Canada’s largest private health centre in Vancouver, offering orthopedics, cosmetic surgery, general surgery and other services.
Private health insurance is allowed in Canada, but the provincial governments allow it only for services that the public health plans do not cover; for example, semi-private or private rooms in hospitals and prescription drug plans. Several provinces have legislation that financially discourages but does not forbid private health insurance in areas covered by the public plans. Canadians are free to use private insurance for elective medical services such as laser vision correction surgery, cosmetic surgery, and other non-basic medical procedures.
The Canadian government has invested a large amount of money nationwide in a successful effort to reduce wait times, especially for life-threatening conditions such as cardiac disease and tumours, and for procedures such as knee replacements and cataract surgery. Under Canada’s system, most doctors run private practices but are paid uniform rates by a government-funded network. Many Canadians have private or employer-paid insurance that covers things such as dental and eye care, which are not part of the larger plan.
The outcome of the legal case will probably determine the future of private healthcare in Canada. While a few Canadians travel to South America, Cuba and China, most go to the USA. If private treatment is allowed in Canada, then the rationale for most Canadians becoming medical tourists may vanish.

The Netherlands has come top in the 2009 Euro Health Consumer Index (EHCI), for the second year in a row. Denmark keeps its runner-up position from last year. Besides the Dutch and Danish system there is a small group of strong performers: Iceland, Austria and Switzerland.
There are general improvement trends among most of the measured healthcare systems, with examples of reform making impact not only in Netherlands but in Ireland and the Czech Republic as well. There is continuous decline in the Spanish, Portuguese and Greek healthcare systems and improvement in the Netherlands, Denmark and Iceland. Large parts of Eastern and Central Europe are affected by the financial crisis.
Research director, Dr. Arne Bjornberg, comments "The Netherlands is the best performing country by combining competition for funding and provision within a regulated framework. There are information tools to support active choice among consumers.
The EHCI is a measurement standard for European healthcare. It ranks 33 national European health care systems across 38 indicators, covering six areas that are key to the health consumer: patients’ rights and information, e-Health, waiting times for treatment, treatment outcomes, range and reach of services provided and access to medication. The Index is compiled from a combination of public statistics, patient polls and independent research conducted by Brussels-based think tank Health Consumer Powerhouse
Johan Hjertqvist of Health Consumer Powerhouse, comments, "With patient mobility growing around Europe there is a strong need for transparency exposing the pros and cons of the national healthcare systems. The EU intends to introduce a cross border care scheme that requires significantly better information to patients. "
The individual category leaders:* Patient rights and information: Denmark* Waiting time for treatment: Albania, Belgium, Germany, and Switzerland* Outcomes: Sweden* Range and reach of services: Belgium, Luxembourg, and Sweden
While dental and cosmetic surgery tourism are driven by other factors, outbound medical tourism from European countries is driven by cost, waiting times and how good a national healthcare system is. This shows to any agency or hospital targeting Europeans that the likelihood of people travelling and what may make them become a medical tourist differs hugely between countries. 
Germany probably has the most restriction-free and consumer oriented healthcare system in Europe, with patients allowed to seek almost any type of care they wish whenever they want it. The report debunks the myth that German healthcare is excellent but expensive, German healthcare costs are in the middle of the Western European countries.
The report includes all 27 European Union member states, plus Norway and Switzerland, the EU candidate countries of Croatia and Macedonia, plus Albania and Iceland. The Netherlands has a consumer-friendly healthcare system. In Denmark, a determined political effort to improve delivery and transparency of healthcare is paying off.  Germany is improving, as are Ireland, Hungary, the Czech Republic and Lithuania.
Long waiting times are a reason for surgical tourism. In the 31 countries, the worst two are Portugal and the UK. The NHS in the UK recently spent millions on reducing waiting and introduced a target maximum of 18 weeks to definitive treatment after diagnosis. The patient survey shows it has got worse since 2008. The UK in 2009 has showed surprisingly negative feedback from patient organizations on the waiting time situation, particularly after government spending on the NHS has been increasing heavily, states Dr. Arne Bjornberg
After the spring 2009 EU directive on cross-border care, the indicator on cross-border mobility was reintroduced. The only three countries scoring well are Denmark, Luxembourg and the Netherlands. Denmark had its 2007 law on free mobility in the EU temporarily suspended between November 2008 and June 2009, but that has now come back into effect. Luxembourg does not have a healthcare services, it lets citizens seek care in neighbouring countries.
There are only three countries Germany, Denmark and the UK where the public can go online and compare outcomes at hospitals. Patients may soon be able to travel across European borders for treatment, in line with a new directive on patient mobility. This option, suggests Bjornberg, will only be used by between 3% and 5% of patients, but It is important to have access to data showing which hospitals are best for particular operations. Once Croatia joins the EU it could become a destination for health tourism because it is relatively inexpensive and has a record of good results. There are no reasons for restrictions on cross-border care. Patient mobility seems to scare healthcare administrators but that’s because they are control freaks.

AirMed Asia, a subsidiary of leading U.S. air ambulance company AirMed International, has entered into a joint venture agreement with China-based Asia Air Medical (AAM) in which the two companies will cooperate in the Greater China region (China, Hong Kong, Macau and Taiwan) to expand air medical transport operations.
The joint operation will feature Beechjet air ambulances, with initial operations in Beijing and Shanghai. The aircraft will be Chinese registered, providing access to most domestic airports in China. AirMed Asia will staff the aircraft with medical teams and use its 24/7 dispatch and medical coordination system to guarantee the highest quality of patient care and transportation. Wilson Kao of Asia Air Medical says, Our plan is to establish a new Chinese communication center as well as more bases in the western region of China. Asia Air Medical (AAM) is the first dedicated air ambulance service in China.  AAM will take on the role of air medical transportation service provider in partnership with AirMed to expand operations into domestic airports within China. AirMed Asia is the first and only USA air ambulance company with a base in Asia. It operates a state-of-the-art Hawker 800 medical jet from Hong Kong. In April, AirMed Asia was awarded full accreditation from the Commission on Accreditation of Medical Transport Systems (CAMTS), the highest standard possible for an air medical transport service. AirMed Asia, the only accredited program in Asia, is one of only four international programs to achieve this status. US based AirMed International is the parent company of AirMed Asia and operates a fleet of medical aircraft from multiple worldwide bases. AirMed has flown more than 15,000 global transport missions.
Shemer Medical Centre, a leading medical tourism hospital in Israel, is promoting its International Flying Doctor service. This offers emergency evacuation by air transfer to Israel from any location in the world; non-emergency medical flights to Israel from anywhere in the world; hospitalization in Israel; urgently flying-in a leading senior specialist physician from Israel to provide consultation and treatment at the patient’s bedside in his/her country; and bedside to bedside medical escorts that accompany patients on commercial flights.
US based Foundation for Air-Medical Research and Education (FARE) has become MedEvac Foundation International; a name change to reflect its growing international focus. The Foundation was established in 2000 by the Association of Air Medical Services (AAMS) to support research and education for the air-medical and critical-care medical-transport community. MedEvac’s Kevin Hutton says The MedEvac Foundation International is the first organization of its kind to engage, mobilize, and empower people and organizations to make a difference in medical transport across the globe. The vision of is to ensure that every patient in need has access to safe, quality air-medical and critical-care ground transport. We hope to achieve these goals for medical transport patients everywhere. It is funding a soon-to-be-available online database containing an annotated bibliography of critical-care-transport safety literature, as well as a monthly On the Fly newsletter featuring issues specific to aviation and patient safety.