A sudden government interest in health tourism to prop up a national tourism industry with problems is an increasingly familiar refrain. The latest in this growing list of countries with little existing inbound medical tourism is Pakistan. More than 2,000 people have been killed in Taliban-linked attacks across Pakistan in the last two years, scaring away all but the most intrepid foreign tourists. Pakistan earned $200 million from 800,000 visitors in 2007. Fewer than 400,000 visitors came in 2008, and the numbers are expected to be even lower this year. Terrorism has really affected us a great deal, admits Tourism Minister Ataur Rehman.The Pakistan government hopes that medical tourists can help revive the country’s troubled tourism industry in a big way, which is why the main focus of their new tourism policy will be on health tourism. Rehman says that his ministry is in consultation with the provincial tourism departments, travel agencies, airlines, businessmen, and other stakeholders on the new policy of providing foreigners with quality healthcare at a price far less than what they pay in Western countries, The introduction of health tourism will not only bring in foreign tourists but will also help develop health infrastructure on modern lines, create job opportunities, generate greater revenues and most importantly, cast off the country’s negative image of being an unsafe destination. He argues that the country has internationally acclaimed doctors and world-class medical facilities, with Pakistani hospitals and doctors being at par with their Western counterparts in specialising in the fields of heart surgery, eye care, cancer therapy, dentistry and diagnostics, at a fifteenth of the cost overseas. Rehman says a new plan to revive the tourism industry is essential as there has not been a fully new one for two decades. The aim is engage the private sector in developing the tourism infrastructure to attract locals and foreigners. The minister criticises international newspapers and TV channels, for inflicting considerable damage on the country’s tourism industry and substantially reducing numbers, by generalising a bad law and order situation At present, most Pakistan medical tourism is outbound to countries including India, Thailand and the UK.Hospitals in Pakistan have problems with international credibility, as only one has JCI status and no others have any other international accreditation. While the Pakistan Tourism Development Corporation seems to promote dentistry, cosmetic surgery and open-heart surgery, the only medical tourism page on its website that works is one promoting a small clinic offering hair transplants. Only a small handful of medical tourism agencies outside Pakistan will offer treatment in the country, mostly cosmetic surgery and dental. The main market is still Pakistani expatriates based in the US and UK, but others are trying out what is on offer. A few medical tourism agencies specializing in treatment in Pakistan, some based in Pakistan, some not, are beginning to appear. Medipassion Healing is a new Canadian agency with an office in Pakistan. Medical Travel Pakistan is a new agency based in Karachi that will soon offer heart surgery, dentistry, knee and hip replacements and cosmetic surgery.

The Asian Medical Tourism Association (AAMT) is offering potential members involved in medical tourism in the Asia-Pacific region free membership for the first year. Details of the organization and a venue for an initial meeting are still being worked on. Medical Tourism Facilitators Association is a new international non profit group created by a medical tourism agency for medical travel agencies, with the common goal of increasing awareness towards liability risks, practicing standards, guidelines and help towards pricing, investments. Founder Raj Joseph Raj of US agency Medvoy has recruited members in the USA and Argentina. The European Health and Medical Travel Association was a Lithuanian based trade organization that began in late 2007.The aim was to unite agencies and hospitals in Europe. After three years of never having more than two members, both agencies owned by the founder of the organization, it has ceased to exist. UK based International Medical Facilitators Association was founded in 2007 by Jagdish K. Jethwa, owner of UK agency Taj Medical.TIHFA aimed to initiate regulation and standards for a growing industry. But with standards agreed when the sole member was the agency owned by the founder, and the requirement for agencies to be bonded, nobody joined and it too has now closed. Another well-intentioned body that has closed after failing to get much if any interest is The Society for International Healthcare Accreditation (SOFIHA). It was set up in 2008 in the UK as an international organization devoted towards the development and promulgation of high-quality accreditation of hospitals and healthcare facilities across international borders. Few organizations or people joined up and it has now ceased to exist. The International Association of Medical Tourism has changed its name to International Wellness and Healthcare Travel Association (IWHTA) to avoid any confusion with others with similar initials. The new name is accompanied by a re-branding initiative to present a unified approach to the wellness and healthcare travel Industry. The association’s name change is a result of its desire to broaden its services, further distinguish itself in the industry and to avoid any confusion with other organizations and their activities. The name change reflects the organization’s long-term strategy to advance its international presence, and more closely aligns and strengthens the identity of its core programs: helping hospitals to achieve accreditation and higher standards of safety and quality, involve more resources for its ’donate a surgery’ programme and truly assist people to have access to better, more affordable care and get better value for their health care dollars. It offers membership to doctors, hospitals, clinics, insurers, travel and medical tourism agencies, manufacturers and individuals. There are no details yet of any organizations that have signed up. Healthcare Tourism International/HTI launched the world’s first accreditation system for health tourism agencies in October 2007;HTI compliance. After a sluggish take up, there are now eight signed up agencies. The latest three to join the HTI programme are MedTravel Costa Rica of Costa Rica, Universal Air Travel Tours of India, and MT Bulgaria of Bulgaria.

The Surgery Center of Oklahoma is a state-of-the-art multispecialty hospital in Oklahoma City, owned and operated by 40 top surgeons and anesthesiologists in central Oklahoma. Being doctor owned, it can offer lower prices than others. A recent decision to list prices upfront on the website is already attracting medical tourists from across the US and resulted in a five-fold increase in people coming from over the border in Canada. The message to Americans is that if they are considering going overseas for surgery, get quotes from this American hospital first. The hospital says, It is no secret to anyone that the pricing of surgical services is at the top of the list of problems in our dysfunctional healthcare system. Bureaucracy at the insurance and hospital levels, cost shifting and the absence of free market principles are among the culprits for what has caused surgical care in the United States to be cost prohibitive. As more and more patients find themselves paying more and more out of pocket, it is clear that something must change. We believe that a very different approach is necessary, one involving transparent and direct pricing. Transparent, direct, package pricing means the patient knows exactly what the cost of the service will be upfront. Fees for the surgeon, anesthesiologist and facility are all included in one low price. There are no hidden costs, charges or surprises. The pricing outlined on this website is not a teaser, it is the actual price you will pay. We can offer these prices because we are completely physician-owned and managed. We control every aspect of the facility from real estate costs, to the most efficient use of staff, to the elimination of wasteful operating room practices that non-profit hospitals have no incentive to curb. This powerful message that prices are comparable with costs in countries competing for medical tourists and are a fraction of what large US hospitals charge, is not limited to individuals; insurers and businesses are being targeted too. In an ambitious move, the hospital is soliciting business from large, self-insured companies; brochures have been sent to all the Fortune 500 companies in the US. The hospital says it can do deals with self-insured companies that are better then they can make through a third-party administrator. India based international medical tourism web network Kosansh now has more than 20 US hospitals signed up, many seeking domestic US tourists rather than international patients. Patients can search on price and other factors. Roshan Shah comments on the Oklahoma initiative, This is exactly what is needed. Clear transparent pricing is what patients love. According to a story in a major American insurance trade magazine, Best’s Review, some health plans are now countering the appeal of international medical tourism by offering discounts for medical care performed at US facilities.

Until recently, legal restrictions on investment by overseas companies, taxation on medical tourists and limited facilities, meant that Tunisia was limited to a few, mostly local visitors, seeking cosmetic and dental surgery at small clinics. That is about to change. All the restrictions have now been swept away, and the long-planned private hospital targeting medical tourists, will start being built in 2010. Tunisia aims at becoming a destination for medical tourism and spa procedures. A new large international airport is expected to completed and operational by the end of 2009.  Tunisia is soon to boast its first private hospital, built by the Japanese group Tokushukai Medical Corporation, in order to improve the local offer in the field of medical tourism to attract European and Arab patients. The hospital will have an initial capacity of 400 beds. Target countries will include those across Africa, particularly from Chad, Nigeria and Mali. The Japanese TMC group, with 260 private hospitals, is the third biggest hospital group in the world, and the largest in Japan. In December 2006, Tokushukai ’s first overseas hospital, Tokushukai Sofia Hospital (1,016 beds) opened in the Bulgarian capital Sofia. For Bulgaria, this was the first new general hospital that has been built in 30 years. The group hopes that the new one in Tunisia has the same appeal and impact as the one in Bulgaria has had. According to the Tunisian Health Ministry, some 72,000 foreign patients were registered in 2006 mainly from the Maghreb region and Europe. Trade estimates for 2009 vary, but are around 75000.Higher figures you may have seen quoted, include spa visits and other wellness tourism. Most Europeans come for cosmetic surgery or dental treatment, while Africans come for surgery. Tunisia has 80 private clinics with an accommodation capacity of 2500 beds, and most of these clinics are well developed and with the latest technologies. Tunisia attracts more and more Brits, Germans, Italians, French, Belgians, Swiss, Portuguese, and Spaniards. The number of foreign patients having been treated in private Tunisian clinics has grown rapidly in the last five years. Medical tourism in Tunisia has become the countries second highest foreign currency earner, and the second largest employer. Most of the 8000 doctors were trained in Europe or America, so they meet Western standards. Prices are 40% to 60% less expensive than those in Western Europe, even allowing for a stay of one week. Its proximity to Europe makes Tunisia an attractive alternative to India and Thailand, for those who want to avoid long-haul flights. Another new investment, again believed to be with overseas money, is a planned health tourism complex that will soon be built in the El Khabayat region near Gabes; a coastal town located some 400 kilometres south of the capital. Covering an area of 140 hectares, the complex will comprise several health cure centres using essentially thermal waters for which the area is known. The complex will include hotels, leisure facilities, including a golf course as well as a congress centre.

Medical tourism is one of the few bright spots in the gloomy Philippine economic landscape. Government officials are hoping the medical tourism sector will help alleviate the poor investment climate, fall in tourism revenue and the depressed overseas employment market that has traditionally provided jobs to millions of Filipinos who send money home. Since 2006, the Department of Tourism (DOT), in conjunction with the Department of Health (DOH), has been heavily promoting the country as Asia’s premier medical and wellness hub. The attraction is that officials say each medical and wellness tourist that comes to the Philippines spends $3500 during his or her stay. The DOT will hold the biggest medical tourism and wellness summit in the Southeast Asian region at the end of October. Joyce Alumno, Philippine Health and Wellness Tourism Summit project director, says We hope to showcase the Philippines as a provider of world-class, globalized health care, with excellent quality, patient safety and the uniquely Filipino culture of caring, kindness and compassion. Philippine medical tourism has some problems to solve. The Department of Health recently suspended kidney transplantations on foreign patients in the country after human rights groups expressed alarm over the increasing number of medical tourists who came to buy kidneys from poor Filipinos. In launching the summit, Alumno said one aim is to address the misconception that the Philippines has third world health care, This conjures up images of decrepit medical facilities, insufficiently trained doctors, nurses and medical professionals and an overall backward state of affairs, such a picture is false. Dr. Anthony Calibo, Medical Tourism Program manager of the DOH, notes that the Philippines established some of the earliest specialty hospitals in Asia; the Philippine Heart Center, the National Kidney Transplant Institute, the Lung Center of the Philippines and the Philippine Children’s Medical Center.Calibo believes the Philippines, should concentrate on medical; hospital- surgical clinic services, and wellness; spa facilities, corporate wellness programs, and alternative lifestyles. DOT Undersecretary Cynthia Carrion is in charge of wellness tourism and Wellness.She argues that the main attraction for foreigners to come to the Philippines is affordability of quality medical care in the country, at only a fraction of what they would pay in their home countries, The price comparison is really big. Cheap is not the word. It’s just that we do good value for the money. For example a rhinoplasty that would cost $8000 in the US would only be $1200 in the Philippines. Carrion stresses that medical tourism is not only for foreigners. She is appealing to the millions of Filipinos living and working abroad to come home for their healthcare needs. A dental clinic in Cebu wants to attract more tourists as the province tries to position itself as a preferred medical and wellness tourism destination. Bright Smiles Oral Care Center (BSOCC) has just begun offering dental packages to tourists, plans to partner with travel agencies, and intends to open another clinic in Cebu.The Cebu Health and Wellness Council (CHWC) is working on a marketing blueprint for growth of the health and wellness sector in Cebu in the next few years.

Why are countries so keen on medical tourists? The answer, according to the health subcommittee of the Turkish Industrialists and Businessmans Association (TUSIAD), is that a health tourist spends 12 times what a normal tourist does. The same organization reports that 30,000 to 40,000 health tourists go to Turkey each year for treatment, spending $ 150 million, and that by 2020 that figure could increase to a million people. The cost of medical care in Turkey is competitive with the rates of South America and Southeast Asia, and is a fraction of the cost of similar treatment in the US. Turkey is a candidate for membership to the European Union. This has prompted private clinics and government hospitals to shore up their standards in order to meet and surpass rigorous international requirements, ultimately boosting the country’s image. As a result, much of the healthcare available in Turkey is sophisticated and modern. It has one of the largest number of JCI accredited hospitals and clinics in Europe. Turkey has always been popular with Europeans, as a closer low-price high-quality alternative to Asian countries. Slowly it is gaining popularity with Americans. According to Health Tourism Turkey, the arriving patient profile has changed with the number of American patients increasing faster than the number of Europeans, although there are no records of either total numbers or numbers from individual countries. Most of the Americans are self-paying with no health insurance. Selin Yıldırım, deputy-managing director of the World Eye Centers, although accepting American numbers will probably increase, is not convinced that the American invasion is as great as claimed, as the  majority of patients coming to Turkey for eye treatment are still EU citizens. Many of Turkey’s leading health care organizations participated in the U.S.-Turkey Medical Health Tourism Conference held by the Health Tourism Council in Chicago in May 2009, and although there is some increase in individuals traveling, the optimistic expectations of people being sent by insurers and businesses, seems to have produced no results so far. Turkey has advantages in terms of prices, but it is also much ahead of Europe with its investments in technology. Its technology is used in some advanced hospitals in Germany and the US. It claims to be ahead of Scandinavia, the Balkans and Central Europe. Medical standards are monitored through independent accountability watchdogs built into the system. The ministry of health lays out regulations with which every hospital and clinic must comply. There’s also an independent Turkish Medical Association and several other societies that promote high standards and learning among the medical community. As well as Europe, an increasing number of Middle Eastern patients are coming to Turkey for dental treatment, particularly from Iran and Kazakhstan.

Over 60 delegates from tourism, health, medical and government sectors, at the first Health and Wellbeing Conference in Cairns heard international experts discuss the opportunities available in health and wellness tourism to Australia. At the end of the conference delegates issued the Cairns Declaration; a document outlining Australia’s planned entry into the growing medical tourism sector. Australia’s traditional tourism sector is suffering, so looks to health and wellness tourists who often stay for long periods, bring family members, and are a higher spend traveller. According to conference organiser and fervent advocate of Australia as a new destination, Australian Tourism Export Council (ATEC) managing director Matt Hingerty The Cairns Declaration is a landmark document for the Australian inbound tourism industry. For the first time we have a formal statement from tourism and health professionals agreeing to work together to build a viable new tourism sector for Australia. Countries such as Singapore and Dubai are already investing billions in building new hospitals and other facilities to cater for the forecasted boom in medical travel in the decades to come. It’s time Australia did the same. A collection of medical tourism entrepreneurs told the conference that Australian healthcare’s strong reputation would attract South-East Asians and Americans. Wei Siang Yu of medical tourism agency Fly Free for Health, argues that Australia could become the largest second opinion destination for medical tourists, as doctor shopping, where people seek up to six medical opinions ahead of treatment from diseases like cancer and pediatric services, is a standard practice in South-East Asian countries. Matthew Hingerty says medical tourism would provide a big boost to the tourism sector and would not impact on health services in Australia, "This is not about the public health system at all. There’s spare capacity in our private health system. There is also some promise down the track that if the industry does develop there will be further investment into our private system, so this is about building capacity and not taking away from it." Not everyone has bought into the fervour of the conference. The Australian Medical Association (AMA) argues that a health tourism push could raise prices for Australians. AMA’s Steve Hambleton says," Everyone is entitled to a second opinion, but multiple doctor shopping is not appropriate for the individual or the health system." Others have voiced concerns about agencies promoting Australia and New Zealand as English-speaking and more culturally close to America than Asian countries, with worries that this could be interpreted as racism; a touchy topic in the country after the recent comments from the United Nations special rapporteur on indigenous rights that there is entrenched racism in Australia. The current value of inbound Australian health tourism is unknown, but believed to be much smaller than outbound Australian medical tourism, which is mainly cosmetic and dental, but surgery too. A colonoscopy, for example, might cost $1,600 in Australia, but only $440 in Thailand. According to the Australian-based medical tourism agency My Medical Choices, the most common destinations are India, Thailand, Malaysia and Singapore.

India’s Ministry of Tourism (MoT) will organise medical tourism road shows in the Middle East this October, in a bid to increase medical tourism traffic from countries in the region to India. The road shows will be held in UAE (Dubai), Saudi Arabia (Riyadh), Kuwait (Kuwait city), and Qatar (Doha) from October 2 - 10, 2009. MoT is expecting a total of 15-20 medical service suppliers from India, primarily hospitals to participate in the road shows to spread awareness about the high-class services available in India. The focus will be on medical tourism rather than health/wellness tourism. Pradeep Thukral of the Indian Medical Tourism Association (IMTA) comments, The medical tourism industry in India is growing at the rate of 30 to 40 per cent year-on-year. Conducting road shows will definitely help the destination to promote the services aggressively. IMTA has 55 members as of now and there are a few members who have shown keen interest in being a part of the road shows. Middle East outbound healthcare travel is experiencing growth despite large number of new hospitals being built in the region. The Healthcare Travel Exhibition & Congress is taking place from 15 to 17 November 2009 in Dubai. High on the agenda are discussions on how to attract medical tourists. Dr Prem Jagyasi, chairman of the conference, who runs healthcare management consultancy ExHealth in Dubai HealthCare City, comments, The Middle East has a unique dual position in the medical tourism Industry. On the one hand, the region’s well-developed hospitals are preparing to capture the international market for elective procedures while on the other, international healthcare organizations are tapping into GCC’s affluent society in search of highly sophisticated and advanced healthcare services unavailable within the GCC. A leading sponsor of the conference is the Association of Private Hospitals Malaysia (APHM), as Malaysia feels it can compete with local hospitals on service and better them on price. Dr Jacob Thomas of APHM adds, This conference is an excellent platform to inform healthcare buyers about what we have to offer in Malaysia. The United Arab Emirates currently has an outbound annual medical travel bill of US$2 billion. The UAE in general, and Dubai Healthcare City in particular, are attempting to turn the tide by reducing outbound medical tourism and increase inbound, but with little success so far. Dubai Healthcare City once had a flood of new projects planned, but the only major one now is the new 400-bed University Hospital that will not open before 2011. All of the Middle East will have to fight to attract medical tourists from within the region, and from other countries. This is as well as seeking to reduce the outbound flow, when several Asian countries that see this region as a prime target for high-paying medical tourists, are becoming increasingly sophisticated at marketing their offerings.