India’s growing medical tourism industry will be adversely impacted in the short-term as a result of the Mumbai terror attacks, a leading healthcare industry official has said. Vishal Bali, chief executive of Wockhardt Hospitals, said: "While foreigners still fear to visit the country there will be a short-term impact on medical tourism. A day after the terrorists attacks in Mumbai, we got calls from US patients asking whether it was safe to travel to Bangalore. We assured them of safety and many came in. Though there is some fear in the minds of foreigners, they also have a lot of confidence in our country. I expect only a short-term impact." The terrorist carnage began on November 26 and lasted for over three days resulting in nearly 200 dead and massive damages to two of the city’s leading five-star hotels. Wockhardt Hospitals, a leading player in medical tourism, is considering raising funds through the private equity route after scrapping plans to raise funds from the capital market for expansion because of a poor response. But world recession has made investors including private equity funds to think twice before investing. Wockhardt want to invest substantially in the next three years by expanding its healthcare infrastructure. The company has 15 hospitals in the country with a combined capacity of 1,500 beds and the plan is to increase it to 4,000 beds in the next three years. Another leading Indian medical tourism player, Fortis Healthcare has earmarked a fund of around $500 million for acquisitions, is in talks with more than two players in southern and western India. Fortis currently has 2,600 beds in 22 hospitals, mostly in northern India. It will add 150 beds in Mumbai and another 400 through acquisitions by March. Ideally, it seeks those with 150 to 200 beds, with a target of 40 hospitals by 2012. Delhi-based Panacea Biotec is to set up a super-specialty hospital in Gurgaon. The company has entered into collaboration with Dr Umesh Gupta of Umkal Group to set-up a multi super-specialty hospital.

Spa Resources International (SRI), the Dubai-based specialised spa management and consultancy company, has entered into a new agreement with United Eastern Medical (UEM), one of Abu Dhabi’s leading healthcare development and investment companies. The joint venture aims to address the acute increase in interest for integrative health, beauty and wellness services in and around the UAE. Both parties will bring their unique strengths and leadership positions in the medical and spa industries to facilitate the creation of a holistic healthcare environment in the region, which integrates spa and wellness services. Daniella Russell, director of Wafi Health & Leisure Group, the parent company of SRI, said: "UEM has a focused and strong vision for the future of the medical sector in the region, and as a home-grown company Spa Resources International is very happy to be an integral part of that vision. Our extensive experience in the development, management and operation of spa, leisure and wellness facilities in the region will stand us in good stead in our joint venture with UEM, with whom we share common ideals, values and goals as to where we want to take the healthcare industry."" UEM aims to develop and manage an integrated health delivery system that comprises world-class specialty hospitals and premium healthcare facilities throughout the Middle East. Mohammed Ali Al Shorafa, managing director of United Eastern Medical commented: "Our partnership with Spa Resources International, forming Spa Resources United Eastern LLC (SRUE), is very exciting for UEM as it perfectly mirrors our strong ambitions and vision to transform the regional healthcare system. The new centres that we will develop together will create an ideal synergy offering a combination of spa treatments alongside unique health and medical programs, and will bridge the large gap between healthcare and wellness." Among the upcoming projects in this joint venture is the expansive spa and wellness centre that will be located within UEM’s flagship project, Danat Al Emarat Hospital, a 300-bed women and children’s hospital currently being developed in Abu Dhabi and due to open in 2011. It targets both the UAE and nearby states.

Tuanku Fauziah Hospital (TFH) has received accreditation from the Malaysian Society for Quality in Health (MSQH) for its healthcare services. It was presented by Perlis Health director Dr Mahani Yusof to TFH director Datuk Dr Faiz Ahmad Khan. "The accreditation is indeed our proudest achievement as it is like the accreditation given to hospitals in developed countries. It also proves that we are able to be on par with the best hospitals, not only in Malaysia but also in the world," said Dr Faiz. The hospital also announced a major project to build a block of multi-discipline wards for TFH with the state-of-the-art facilities and equipment. THF is 100 years old and the new area is expected to be ready by November 2011. The new building will include an obstetrics and gynaecology patient evaluation centre and ward, a paediatrics ward and a royal ward for royalty. The Health Ministry is considering linking Malaysian Society for Quality in Health (MSQH) accreditation as a criterion for renewal of hospital licenses. The ministry’s deputy director-general Datuk Dr Noor Hisham Abdullah said the move would help steer the country toward creating a safer Malaysian healthcare system and provide better outcome for facilities and services. He said the ministry had set a 2010 deadline for all public hospitals to be MSQH surveyed, with some 64 per cent having been assessed and accredited by MSQH. "I advise all private hospitals to do the same to embark on the process of MSQH accreditation. The accreditation will provide a competitive edge, particularly to hospitals keen on health tourism," said Dr Noor Hisham. There are now 77 MSQH accredited hospitals.

New Malaysian medical tourism agency Perfect Enhancement expects to capture 10 per cent of the cosmetic surgery market share within five years, and two to three percent by the end of 2008. Aside from having confidence in its marketing strategy and services, the firm attributes its optimism to the industry’s rapid but stable growth. "We are geared towards penetrating the cosmetic surgery market by offering our services to international and local patients. We are proud to be the only agency that has a visiting medical consultant who is a qualified doctor, performing screening interviews and post-procedure care," said PESB managing director Lenny Irana Zahari. PESB believes its strict business practice of working only with the best surgeons, private hospitals and hotels in the country will make them the preferred medical tourism agency in three years. The business has tied up with four major private hospitals and clinics and is looking at the possibility of expanding into other medical tourism services in the future. While not promoting cosmetic surgery alone, the firm feels that it is part of its responsibility to educate the public about the proper channels and the importance of understanding the procedures and its risks as well as knowing the best people to do the job. The four local hospitals and clinics used are: The Prince Court Medical Center (PCMC), a prestige new five star 330-bed international hospital in Kuala Lumpur. It is one of the largest private hospitals. Owned by Petronas, it is managed by The Medical University of Vienna in cooperation with Vamed. The Columbia Asia Hospital in Puchong, Selangor is one of the 21st century "model hospitals", run by the Columbia Asia company which is the result of a ten-year development effort that combines best care with best technology practices all under one roof. Nicanor Clinic is a modern, sophisticated and fully accredited Day-Surgery centre, using state-of-the-art technology. Imperial Medical Centre (IMC) is a one-stop personalised cosmetic medical centre that provides total solutions in the field of plastic & cosmetic surgery, cosmetic dermatology and laser treatments. Being the first aesthetic and cosmetic surgery medical centre in Malaysia to obtain a license from The Ministry of Health of Malaysia, IMC started operation in May 2008, and is owned by a group of cosmetic surgeons.

Anantara Hotels, Resorts & Spas, a leading developer and operator of luxury resorts and spas has signed a new management contract for its first Anantara Resort in the Sultanate of Oman. Anantara will partner with Blue City Company 1 (BCC1) to develop the 100-room luxury resort and spa that will be located on a natural peninsula some 60 minutes from the historical city of Muscat. Guests staying at the resort can also indulge in a rejuvenating and relaxing spa experience at the Anantara Spa. Roger Kacou, vice-president of hotels and leisure, BCC1 said: "The alliance combines the strength of Anantara’s experience in designing, developing and managing luxury hotel developments with Al Madina A’Zarqa’s commitment to building a city of the future and placing Oman on the map as a premier tourist and business destination in the Middle East." The group is set to open Anantara Qasr Al Sarab in late 2009 in the Liwa desert in Arabia’s Rub Al-Khali. In October, it opened Desert Islands Resort & Spa as the centrepiece of the unique Sir Bani Yas island experience in the UAE. The exclusive resort offers 64 luxuriously designed rooms. Safaa Spa has four treatment rooms offering an array of natural treatments Äì Thai massage, aromatherapy, and Ayurvedic therapies. Prior to Desert Islands Resort & Spa, Anantara had planted its presence in the region with standalone spas located in the Emirates Palace, Abu Dhabi and the 10,0000 sq foot Anantara Spa at Kempinski Hotel Ishtar Dead Sea in Jordan.

Singapore’s first mediplex and a new alliance with a US company to send employees to Singapore for medical treatment, have positioned Singapore as an industry innovator and a top destination for medical travel. Singapore’s first fully integrated mediplex, Connections at Farrer Park will open in 2010 to patients both foreign and local. The 19-storey Farrer Park mediplex will be one of the largest and most advanced of its kind in Asia and will feature a hospital, private medical suites and a full-service hotel for. The mediplex will offer a full spectrum of patient-oriented facilities and services, with some of the region’s best physicians. PlanetHospital, a US-based health tourism agency, arranged a learning trip to Singapore in November for key executives of California-based corporation, Snow Summit Ski Resorts. Snow Summit is looking to offer high quality, reliable and affordable care in Singapore for its employees. Darla Hanft of Snow Summit, said: "Safety, cleanliness and food remain obstacles for many when presented with alternative healthcare destinations. This is where Singapore has a clear advantage over other destinations." Earlier this year, supermarket chain Hannaford Bros., with Aetna’s help, offered its 27,000 employees a deal where employees can receive a hip replacement in Singapore’s National University Hospital, with the entire US$8,000 tab covered, including travel for the patient and spouse. American agency, Companion Global Healthcare, included Singapore’s ParkwayHealth as part of its global provider network where patients have access to pre-negotiated, in-network rates at ParkwayHealth’s facilities, with dramatically lower costs than those typically charged in the US. The World Health Organization currently ranks Singapore the best country in Asia, and sixth in the world. Singapore’s hospitals and medical centres have achieved high marks in clinical indicators that equal and even surpass most in the developed West. Singapore is proving to be an attractive medical destination, especially because medical treatments such as a heart bypass could cost upward of US$130,000 in the US but would only cost US$18,500 in Singapore. In 2007, over 500,000 patients travelled to Singapore specifically for health care, and this number will be higher in 2008.

Medical tourism in Israel will total NIS 160 million in 2008, compared with NIS 100-110 million in 2007, according to a study by The Center for Academic Studies at Or Yehuda. The survey claims that 48 percent of the patients came from Eastern Europe, mostly Russia and Ukraine; 37 percent came from Jordan, Cyprus, Turkey, the Palestinian Authority, and other neighbouring countries; and, 14 percent came from the United States and Western Europe. Sixty-five percent of the patients came to Israel for complex or risky surgical treatments and 35 percent came for various cosmetic treatments. This contradicts long-standing figures from the country’s tourist board that the main market is Germany. The economic crisis is expected to reduce the number of cosmetic surgical treatments of foreign patients in 2009. Recent attacks on Gaza will make Westerners wary of planning trips in a country at war. Widely circulated press reports on the study omitted certain crucial information that throws serious doubt on the study’s accuracy. Although there are over forty medical tourism and travel agencies promoting medical and health tourism, and scores of hospitals and clinics seeking business, the study only interviewed 100 patients in three centres;  Hadassah Medical Organization in Jerusalem, Tel Aviv Sourasky Medical Center (Ichilov Hospital), and Tel Hashomer Medical Center.This very unscientific sampling technique shows yet again why you have to be very wary of widely circulated reports on country statistics. Russia is increasingly becoming the major source of tourists to Israel. Tourism from Russia has grown steadily since September, when Israel waived its visa requirement under a reciprocity agreement with Moscow. The two countries launched direct charter flights from Eilat to Moscow and St Petersburg just last month. To date, the Israeli government has taken no action to promote or to curb medical tourism and has allowed the industry to develop undeterred and unregulated. According to government spokespeople, 15,000 foreigners came to Israel’s hospitals for treatment in 2006. The number of foreign patients grew to 20,000 in 2007. The figure for 2008 is expected to be 30,000.

Treatment Abroad, the leading information portal for medical tourism, has launched a Perfect English copywriting and editing service for healthcare providers who want to improve the quality of the English used on their websites. The company’s team of native English-speaking copywriters will review the English language version of an overseas website and re-write its content in grammatically correct, properly translated and easy to understand. A well-written site is an important factor in patient choice and most English-speaking medical tourists expect and want potential healthcare providers to be able to communicate in good English.   This new service is a particularly valuable tool for clinics, doctors and hospitals targeting medical tourists from the US, the UK and other English-language speakers whose first impression of a provider is often formed by the standard of English used on its website.   A site that has been badly written or translated can give a poor impression or inaccurate view of the services offered and an incorrect view of the capabilities of the medical staff to understand its patients. This can discourage potential patients from making further enquiries, while a well written website, with clear and correctly worded information, instils confidence in potential medical travellers when researching treatment options. The introduction of this service is part of Treatment Abroad’s commitment to supporting its clients and it is part of a wider service of providing clients with a range of sales and marketing tools to help them reach as many potential medical tourists as possible. Keith Pollard, Treatment Abroad managing director said: We know from our survey of 650 medical tourists that a well written website is an important marketing tool and plays an essential role in attracting patients. A poorly worded site can reflect badly on a clinic or hospital and good communication between healthcare providers and potential patients is a crucial part of attracting English speaking medical tourists.  This new copywriting service is part our commitment to providing a comprehensive after-sales support service to our clients.

Despite the global economic downturn, Malaysia expects to see a 28 percent rise in foreign patients seeking medical treatment in the country. Among the reasons cited is the establishment of a one-stop medical and tourism online portal that facilitate all needs of overseas-based patients be it consultation, treatment, accommodation or tours. MalaysiaHealthCare.com (MHC) chief executive officer Suresh Ponnudurai said the country would continue to attract health tourists from countries such as Indonesia, Singapore, Bangladesh and Japan and those from the Middle East and Europe. Malaysia is one of the region’s centres of medical excellence owing to its quality and affordable facilities and services. About 360,000 health tourists visited Malaysia in 2007, a 20 percent increase from 2006. The use of technology and the internet has positioned the healthcare industry as one of the best in the region. Malacca received more than 64,000 medical tourists last year, mostly Indonesians, and was ahead of Penang, Federal Territory, Johor and Selangor. The numbers are expected to increase after the upgraded Batu Berendam Airport opens to bring in tourists from neighbouring countries. Also, a 300-bed private hospital Straits of Melaka Specialist Centre will be developed in Klebang within the next two years. MHC acts as a channel to network, integrate, facilitate and manage all aspects of health and medical tourism for health tourists and service providers such as hospitals, travel and insurance agents, airlines and hotels. Medical tourists can schedule their treatment and holidays by making online bookings for services. The country’s Health Ministry will be launching a special website on health tourism next month to disseminate information worldwide on the Malaysia’s medical tourism industry. Health minister Datuk Liow Tiong Lai said the website will include information on the medical facilities and specialist services available, as well as the payment rates, to make it easy for those interested to seek treatment in Malaysia. He added the ministry will indirectly help private hospitals in the country attract tourists who wanted quality medical treatment and healthcare. In line with the government’s aim of developing the medical and health-based tourism sector, the ministry held a promotion drive and briefing in Indonesia and Vietnam last year. These promotional efforts will be extended in 2009 to several other countries including Australia.

The Associated Chambers of Commerce and Industry of India (ASSOCHAM) has predicted that medical tourism will grow between 22 and 25 percent in 2009 and will start to have an annual growth rate of 30 percent from 2010 to reach the size valued at about Rs95 billion by 2015. Currently, the size of medical tourism in India is measured at Rs15bn. ASSOCHAM estimates that India is poised to become an epicentre for medical tourism from throughout the world. ASSOCHAM says that at least a six -fold increase is anticipated in the size of medical tourism by 2015, and worldwide patients will make India as a preferred choice for medical treatment because of cost. Projected market value for the Indian medical tourism market is as follows: Rs15 billion in 2008, Rs19.5 billion in 2009, Rs25.35 billion in 2010, Rs32.95 billion in 2011, Rs42.84 billion in 2012, Rs55.69 billion in 2013, Rs72.40 billion in 2014 and Rs94.12 billion in 2010. ASSOCHAM estimates that the cost of surgery in India can be one tenth of what it is in the US and Western Europe and sometimes even less. A heart-valve replacement that would cost US$200,000 or more in the US for example, goes for US$10,000 in India and that includes round-trip air travel. Similarly, a metal-free dental bridge worth US$5,500 in the US costs US$500 in India. The Chamber has estimated that 180,000 foreigners visited India for treatment from various parts of the world in the eight and half months since April 2008. It expects the number will increase between 22 to 25 percent this year. If ASSOCHAM is correct, this would put the current number of medical tourists to India at 270,000 a year from now, 670,000 by 2012, and 1.3 million by 2015.

The US healthcare market does not work like other markets.  Because health care costs are usually paid for by a third party either by the insurance provider or by the government, patients are not price-sensitive and providers don’t feel the need to compete for their business.  Lack of competition results in a highly artificial market plagued by problems of high costs, inconsistent quality and poor access, said Devon Herrick, senior fellow with the National Center for Policy Analysis (NCPA). Herrick is the author of the report entitled Health Care Entrepreneurs: The Changing Nature of Providers published by the NCPA last month. But in healthcare markets where patients pay directly for all or most of their care, providers almost always compete on the basis of price and quality. Herrick cited the following:     Cosmetic surgery: Since it is rarely covered by insurance, patients pay out of pocket and are sensitive to prices. They typically compare prices before surgery and pay a price that has been falling over time in real terms.     Laser eye surgery: Competition is holding prices in check and improving quality in vision correction surgery, including accurate correction, faster healing, fewer side effects and an expanded range of conditions that can be treated.     Medical tourism provides cash-paying patients healthcare outside of the US in high-quality facilities that rival domestic facilities. Patients can save 30 to 50 percent by going abroad. What lessons can be learned from these examples of entrepreneurship in healthcare?  The most important is that entrepreneurs can solve many of the healthcare problems that critics condemn, said Herrick, adding that   Public policy should encourage, not discourage, these efforts. NCPA is a non-profit, non-partisan public policy research organization established in 1983. The NCPA’s goal is to develop and promote private alternatives to government regulation and control, solving problems by relying on the strength of the competitive, entrepreneurial private sector. According to the latest official statistics, 7 million Americans have their own annual individual health insurance, four million more buy short-term cover, 83 million are covered by government schemes and 45.7 million have no health insurance at all. The figures for employer health insurance are confusing as they integrate policies paid fully by the employer with policies paid for only by the employee under a group offering.

The USAID Jordan Economic Development Program SABEQ, a five-year development initiative aiming to build the private sector in Jordan, recently conducted two workshops on Joint Commission International (JCI) standards for hospitals. The workshops were held in cooperation with the Private Hospitals Association (PHA). The first workshop provided a JCI overview, targeted at an audience from the Royal Scientific Society, University of Jordan Hospital and others. It detailed JCI standards and conducted a general discussion of the process of preparing for an international accreditation. The longer second workshop targeted Jordan’s private hospitals, enabling private hospital representatives to discuss actual JCI accreditation standards and how they can be applied in Jordan. Discussions covered each chapter of the JCI accreditation manual separately. Methods towards hospitals’ compliance with JCI standardisations were also freely discussed in interactive sessions between presenter and audience. USAID’s Economic Development Program SABEQ involvement aims to enhance productivity and revenues by achieving international hospital standards and creating jobs for Jordanians. The medical services sector in Jordan is an important and vibrant sector. Medical tourism derives upon the Kingdom’s reputable performance in health services and the latest PHA estimates say that foreign patients generating around $650 to $700 million in revenue to more than 120,000 incoming patients per year. This figure is much less than estimates made in 2008 of 250,000 foreign patients; the lower figure does not mean less people coming to Jordan, but by taking out resident expatriates and making other adjustments, the figure is now much nearer reality. One of the main objectives of the national strategy for the medical services sector in Jordan is to target and increase the number of incoming patients and revenues generated from their treatment and stay in Jordan. By ensuring the standards of Jordanian hospitals through accreditation programmes, Jordan can become more competitive on an international level, in the medical tourism sector. Dr Fawzi Al-Hammouri, chairman of PHA, commented: Four Jordanian hospitals have now acquired JCI accreditation. Highly qualified Jordanian physicians have secured an outstanding reputation for Jordan in the region and beyond. Jordan has a total of 101 hospitals, of which 58 are privately run. Forty-eight are PHA members including the four, all in Amman, who have JCI accreditation Al-Essra Hospital, Jordan Hospital & Medical Center, King Hussein Cancer Center (KHCC) and The Specialty Hospital.

In the looks-conscious, affluent society of South Korea, cosmetic surgery is the way to go. Imperfections in appearance are corrected through cosmetic surgery to achieve the wider eyes, whiter skin and high nose bridges that many South Koreans deem as beautiful. The financial meltdown has, however, affected cosmetic surgery business, forcing some among those in search of beautiful looks to say no to the knife. Clinics report the number of patient visits each month has been down 40 percent since September last year. But plastic surgeons have been quoted saying that the country’s economic decline has brought a silver lining. A cheap Korean won has encouraged more and more Japanese, Chinese and Korean-Americans to come to Seoul for cosmetic procedures. Some clinics report that by the end of 2008, 20 to 30 percent of patients were foreigners, up from 10 percent a year earlier. A few larger clinics are capitalising on the downturn at home to open branches in China, seen as the industry’s next big growth market. A recent survey of medical tourists by the Korea Tourism Organization (KTO) shows that beauty care and cosmetic surgery, along with oriental medicine and general health check-ups, are the most popular reasons to come to Korea. The number of foreign visitors coming to Korea for medical purposes has been steadfastly growing, from 16,000 in 2007 to over 40,000 in 2008, according to the Korea Health Industry Development Institute. The Council for Korea Medicine Overseas Promotion reported that 37,000 foreigners visited the country in 2008 to receive medical treatment, more than double the 15,000 who came in 2007. Korea’s key target markets are Japan, China, the United States and the Russian Far East. The KTO believes that for Japan, marketing activities should focus on beauty care, cosmetic surgery and oriental treatment, while China shows the most potential for inbound travellers. Other markets as the US, Thailand, Singapore and India show relatively low interest toward Korea than other popular medical travel destinations, so the KTO wants to concentrate on promoting Korea’s price competitiveness, rather than on quality. As for Russia, KTO suggests that the marketing should revolve around improving Korea’s overall recognition in the region, and developing total tourism packages linked to medical treatment. KTO is building a one-stop information centre, to open this year, with the aim of attracting 100,000 medical tourists by 2012 .The KTO also plans to use its 27 overseas offices and to participate as many exhibitions and shows abroad as possible. Until now, it had been illegal for hospitals, clinics or agencies in Korea to recommend the services of a hospital or mediate between a patient and a medical institution for profit. Lawmakers passed a bill in early January that allows Korean hospitals and other medical institutions to market their services to foreigners. Korea’s medical industry is racing to meet the demand. Hospitals are hiring interpreters, while some are planning to place ads on newspapers catering to Korean communities overseas. The Ministry for Health, Welfare and Family Affairs projects 80,000 people will visit Korea for medical treatment this year.

A health tourism complex will soon be built in the El Khabayat region near Gabes, a coastal town located some 400km south of the capital. The 140-hectare complex will comprise several health cure centres using essentially thermal waters for which the area is known. Hotels, leisure facilities, a golf course and a conference centre will also be part of the development. Work is expected to start during the second part of 2009. Tunisia is increasingly becoming a hub for medical tourism, having treated some 102,000 patients in various cosmetic clinics. The Tunisian Central Bank’s latest figures show that health tourism revenues reached 60 million dinars (US$43.14 million) in 2007. Most of the revenues are generated by cosmetic surgery, orthopaedic interventions, eye surgery, heart surgery and dentistry. Tunisia is also the world’s second largest destination for thalasso therapy. In 2007, 151,000 visitors, mostly from France and Switzerland, stayed in Tunisia’s 41 thalasso therapy units authorised by the Public Health Ministry.

Thailand expects to welcome about two million medical tourists this year, according to the Tourism Authority of Thailand and the Department of Export Promotion. A 38 percent increase from the 2006 figures of 1.45 million was recorded. The combined revenue from the foreign patients of THB40 billion (US$1.15 billion) in 2006 is expected to rise to THB45 billion (US$1.3 billion). Figures have been rising in recent years. In 2002, there were 630,000 medical travellers with a combined spending of THB18 billion (US$519.7 million). In 2003, the number was 973,532 with a spending of THB26 billion (US$750.68 million). In 2004, the number rose to 1.1 million with THB30 billion (US$866.17 million) in revenue. In 2005, the number reached 1.25 million with over THB30 billion (US$866.17 million) in revenue. The figures may be correct, but critics argue that the practice of some Thai hospitals of counting one patient staying in the country going to hospital on three days, as three medical tourists, and including non-Thai outpatients (and there is a large population of resident expatriates as well a huge numbers of visitors) who only go to hospitals for prescription drugs, as medical tourists, hugely inflate the figure to as much as three times the real numbers. The political problems of late 2008 caused a temporary hiccup. Curiously, the figures above ignore the loss of medical travellers due to political unrest. No one knows how many medical travellers were lost, but the Bank of Thailand estimates that it deterred 3.4 million tourists from visiting the country. Assuming the political problems are solved, the trend will be year-on-year increases in medical tourists going to Thailand - the disagreement is about how many. Hospitals involved in medical tourism report some slowdown. But, despite a triple hit of political unrest, increased airfares and recession, they claim to suffer less than expected. Phyathai Hospital weathered the rough times through its focus on Persian Gulf customers. Currently, Westerners account for 5 percent of overseas patients at Samitivej Hospital, but sees more potential in the East than the West. Some Bangkok hospitals have contracts with Gulf state governments.

You would not dream of going to or sending customers to Iraq or Afghanistan for medical treatment. As much as hospitals, clinics and agencies protest that politics and war is not their concern, customers watch television and read newspapers. If a country seems at war or in crisis, then it is human nature to think twice and consider an alternative destination. Thailand and India found that political unrest and terrorism did affect medical tourism numbers, and that business as usual only returns months after the end of the problem. Other countries with unstable governments or lawless areas, suffer, despite their denials, from visitors being scared away. With hundreds of countries now to choose from, and many thousands of hospitals,clinics, spas and centres actively seeking medical tourists, it is easy to find an alternative to a troubled country. Tourism crisis expert David Beirman, reported in eTurboNews, made some very interesting points on the Gaza crisis, which apply to tourism and medical tourism: In 2008, Israel, the Palestinian territories, Jordan and Egypt all enjoyed record year for tourism arrivals. One of the key reasons that these four destinations enjoyed such strong tourism inflows was because there was a general perception that they all experienced relative stability during 2008. However, the picture for 2009 is far less optimistic, at least for the short to medium term. In 2008, the interplay of tourism between Israel, Jordan and the Palestinian territories and Egypt was positively influenced by the relatively benign security environment. Israel, the Palestinian Authority, Jordan and Egypt face a challenging 2009. The eruption in Gaza has created a whole range of perceptual and security concerns about the safety of travelling to Israel and these concerns will also apply to Palestine, Jordan and Egypt. To add further intensity to the challenges the global economic downturn will mean that the four destinations will switch from being the highly affordable destinations they were in mid 2008 to relatively expensive destinations. The fact that many hoteliers in the four destinations have significantly increased their prices in recent months has exacerbated this problem. A recession usually means that travel does not stop but tourists tend to gravitate to destinations closer to home or those that are very affordable. Israel, Egypt, Jordan and Palestine have all enjoyed positive growth from the discretionary travel market and will find that their longer haul markets may look elsewhere on both security and economic grounds. Haifa University’s Dr Yoel Mansfeld wrote some years ago that surges of conflict and terrorism had a negative impact on tourism to Israel and the immediate region. And in his analysis, peaks and troughs in international tourism arrivals to Israel were heavily influenced by the perceived security environment. Many agencies and hospitals promote their services as medical treatment with a cheap holiday. So when the holiday trade gets hit, so will the medical tourism trade. Hospitals and agencies in regions hit by war, terrorism and political unrest have mostly failed to connect with consumers on their concerns. Websites remain unchanged. In a period when medical tourists are less certain of their ability to pay for treatment, political problems can be the tipping point that makes them change destinations or even stay at home. Medical tourism needs to find ways of satisfying real or imagined customer concerns. Your hospital may be hundreds of kilometres away from troubled areas, but customers’ geography is very hazy.

Washington-based The Icon Group is actively seeking medical tourism providers from around the world, who want American venture capital. Philip Slaton of Icon speaks to IMTJ Q: Is it your money? A: We are agents of venture capital companies. We are not the actual venture capitalists. What we do is find the medical tourism company, have it prepare submission documents, and submit them to the VC investor company. We bring the parties together.    Venture capital is not lending money. It is making equity investment in the infrastructure of a business with the idea of making it a huge financial success. Q: What areas are you targeting? A: Central and South America, the Caribbean, Southeast and Southwest Asia, South and North Africa and Eastern Europe. Q: What types of business? A: Of primary interest are hospitals, clinics and medical tourism agencies. Q: What level of finance? A: Our VC investors are only interested in investment projects requiring a minimum of US$3 million invested per year for a minimum of three years. Q: What do you look for in a prospect? A: Business stability, proper accounts and good standing with governments. True sustainable growth opportunities that need investor capital. Q: Who are the venture capitalists? A: Venture capital is funded from private investors that place money with hedge fund managers. Investors are usually formed into limited partnership investor pools or limited liability corporations with the hedge fund manager as the managing officer or partner. This partnership invests in the company and takes a very substantial ownership position in the company including voting seats on the board of directors. Venture capitalist are owners of the company along with the original owners, according to an owners’ agreement that all parties agree to before money is funded. There is no investment to be returned and this is not a loan. It is an equity investment, in return for ownership in the business. Q: Can you expand on your role? A: The level of scrutiny of the VC investors is breathtaking. The challenge that I face daily is getting books of companies cleaned up enough so that standard accounting methods are implemented and an independent audit is done. Q: What interest have you had so far? A: I have interest from 35 medical tourism providers. I expect four to six at the most to pass muster for VC investment consideration.Venture capital is not long-term money. It is an investment in a business to help it reach sufficient size that it can be sold or floated on a stock market. Medical tourism is a new business that banks are often wary of, so entrepreneurs need to turn to private markets for capital. Venture capitalists as co-owners will fire owners or managers who fail to perform; they keep a tight rein on their investment and ensure it is not used for personal gain.

The managements of Israel’s hospitals see medical tourism as a source of income, but the sector is its infancy, although efforts are being made to encourage it. The Israeli government has begun to understand the potential. Tourism bodies are starting to promote the country. Last year, Israel received 35,000 medical tourists, bringing hospitals revenue of $100 million. Most of the patients are from Eastern Europe, Russia and the former Soviet states, as well as the Balkans. Like many other countries, Israel wants the American medical tourists. There are strong links between the US and Israel. But, in the short-term, the chances of getting much US business are remote. Most Americans regard Israel as being an integral part of the Middle East. The simple fact is that Americans do not want to go to places regarded as politically unstable. Much depends on whether President Obama can help restore peace in the Middle East. There are other problems as well prices are higher than Thailand. Singapore or India, few websites are in English, and marketing leaves a lot to be desired. A leading local business, Israel Scientific Instruments (ISI), has recently set up a medical tourism agency. It wants to promote Israel a destination of choice for American medical tourists, but is concerned that all agencies and hospitals are going their own way, and that without coordinated marketing, it will be an uphill struggle. The other problem for Israel is that the US medical tourism industry has spent the last three years educating Americans that they should only go to JCI-accredited hospitals. Many US medical tourism agencies, employers and insurers have got themselves into a situation that they disregard other reputable accreditation agencies, and will only send people to JCI hospitals. Almost every other country is more flexible and international, seeing JCI as just one of many factors to consider when seeking treatment. The big drawback to getting American business is that only three hospitals have JCI status. Three others are in the two-year process of getting that status, but many hospitals see no point in spending money on JCI, as, compared to Europe, they see little potential from US sources. All three hospitals with JCI status are part of Clalit Health Services. These are the Ha EMEK Medical Center in Afula, Meir Medical Center  inKefar-Saba and Soroka University Medical Center in Beer Sheva, Three more hospitals are in the process of obtaining accreditation:   Kaplan Medical Center in Rehovot, and two owned by Clalit; Carmel Medical Center in Haifa and Beilinson Medical Center in Petah Tikve.