The annual Cyprus Medical Tourism Conference at the Marriott Hotel in London will be a one- day trade event on February 5, 2009. The free conference is organised by three Cyprus government bodies. The conference aims to put medical professionals, travel companies and insurance providers from the UK in touch with medical professionals based in Cyprus working in fertility, obesity, orthopaedics, reconstruction, dentistry, cardiology and optometry. For the first time, the conference will also showcase spa and well-being services with the participation of Cyprus Spa Association. Participants include: Cyprus Dental Association, Ygia Polyclinic, Iasis Hospital, Picture Perfect Medical Coordinators, Blue Cross Polyclinic, American Heart Institute, St Raphael Private Hospital, Vorka Polyclinic, Nicosia Dental Polyclinic, Pedieos IVF Centre, M.D. Medical Centre, Apollonion Private Hospital and Chrysovalatou Clinic. The conference will include presentations, meetings, exhibitions and networking. Presentations include Dr Nicos Maroudias on the health system in Cyprus; Keith Pollard of Treatment Abroad on health tourism in Cyprus and the Cyprus Tourism Organisation on Cyprus as a medical tourism destination. The Cyprus Chamber of Commerce & Industry has a tight control on medical tourism providers in the country. Being a former British colony, the main market is the UK. Most Cyprus-based doctors and consultants have been trained in the UK, US, Switzerland, Sweden or Germany. The dental and medical personnel involved in health tourism speak good English.The small island has six public hospitals, more than 80 private hospitals and clinics, 2,500 beds, 2,250 doctors and 720 dentists. Some private clinics get half their business from medical tourists. The main source markets are the UK, Germany, the Netherlands, Russia, Greece and the Middle East. Cyprus is looking to further develop medical tourism by promotion of the medical, dental and spa services available. The Cyprus Health Service Promotion Board had been created to promote medical tourism. The number of people travelling to Cyprus for cosmetic, general surgery, IVF, Ophthalmic and dental treatment is said to increase year on year. This is mainly due to prices being significantly lower than at home, treatment can be received without delay, and alternative treatments are extensively accessible. Ironically, the only hospital or clinic with any form of international accreditation, The Princess Mary’s Hospital in Akrotiri, with CHSK accreditation, does not seek medical tourists as it is mainly for British service personnel and their families. This means that Cyprus has very little chance of selling itself to markets such as the US. But British and  European medical tourists have an almost total lack of interest in whether or not a hospital or clinic is accredited by JCI or any of the other essential accreditors, the question being nowhere on the list of things to check when deciding where to go.

The launch of yet another new American medical tourism agency, with a world network of hospitals, targeting companies who could be interested in medical tourism, is no longer news. There are scores of them, often using the same JCI-approved hospitals, the same countries and the same sales patter. Hidden away among the predictability is the launch of Satori World Medical’s new global hospital network offering high-quality healthcare and dramatic cost savings.  It has a genuinely innovative idea. Whether is works will be the acid test. Based in San Diego, Satori World Medical is concentrating on employer-sponsored medical tourism whether it is insured or self-insured, fully or partly paid for by the employer, or just an employee paid for service sponsored by the employer. It also targets insurance companies. The innovation is that the money saved will be shared between the employer, insurer and employee. The Health & Shared Wealth Program stipulates how the share is split for each company or insurer. For example, an employer could choose 20 percent as the level of sharing, so if a procedure cost US$20,000 using Satori, and the average cost for that procedure in the US is US$60,000, then the employee would receive US$8,000 (20 percent of the US$40,000 savings) deposit in the employee’s HRA. The contribution to the employee is tax-free and is tax deductible to the employer. An HRA is an employer-funded arrangement that reimburses employees for certain medical care expenses incurred by the employees. Unused amounts can be carried forward to future years. Satori ’s pricing model includes airfare (for the patient and a companion), hotel, doctor and hospital fees, personal accident insurance and all administrative services that delivers up to 50 percent of savings when compared to the same procedure performed domestically. The company also offers coordinated concierge medical travel services for all patients from a team of trained nurses. Satori’s network of JCI-accredited hospitals offers treatment in Costa Rica, India, Malaysia, Mexico, Panama, Philippines, Singapore, South Korea, Thailand, and Turkey. Not all details are finalized, but those already signed up are: Costa Rica Hospital Clinica Biblica India Asian Heart Institute Indraprastha Apollo Hospital Wockhardt Hospital Mexico Christus Muguerza Hospital San José Tec de Monterrey The Philippines The Medical City Singapore National University Hospital ParkwayHealth-Gleneagles Hospital ParkwayHealth-Mount Elizabeth Hospital Thailand Bangkok Hospital Medical Center Bumrungrad International Hospital Turkey Acibadem Healthcare Group Anadolu Medical Centre

Every week, we see an announcement of a new deal between medical tourism agencies, hospitals, businesses and insurers, offering overseas treatment to Americans. Persuading American employers and their insurers to send employees overseas has been a much more difficult struggle than many ever imagined. Terrorist attacks in India, Hamas rockets in Israel, kidnappings in Mexico these are not headlines that help sell employers on the idea of sending employees abroad for medical care, despite the potential for substantial costs savings. While the patient’s main concern is to save money, employers and their liability insurers are more concerned about safety, and the risk of being sued if an employee sent overseas is injured or killed in an accident or incident, kidnapped, or the treatment goes wrong. Agencies and others promoting medical tourism may play down these concerns, but with the US insurance industry in crisis, no employer can afford to run the risk of alienating their health and liability insurers. Agencies have often concentrated on selling on cost, and not understood the importance of getting risk managers and a company’s insurance brokers on board too. Medical tourism agency Planet Hospital has signed up five employers. But after the November terrorist attacks in Mumbai, Planet Hospital’s employer clients said they wanted to cross India off their list. Los Angeles-based clothing retailer American Apparel recently signed up for the service. But the company is restricting its options to Mexico. While an employer may be hesitant, employees are less so. As individuals, they often have a huge cost incentive. But unless employees are uninsured or underinsured, there is no financial incentive steering them overseas for care. Indus Health, a medical tourism agency specialising in India, is reported as having a corporate customer that has sent 15 employees overseas for care and during the terrorist attacks in Mumbai in November, had four clients in India, who were unaffected by events. Subsequent trips to India were not cancelled. Most employers now know what medical tourism is and most healthcare insurers and larger employers have looked at it. The cost saving is appealing, but no employee can be forced to travel overseas. Employees and their families must have incentives and perhaps even get a share of the savings.

Destination programmes is the new and more accurate term for domestic US medical tourism. Destination programmes are cropping up at more large medical centres and hospitals as evidence of further specialisation of healthcare delivery at the hospital level and also of an in-country variant of medical tourism. The basic idea behind these programmes is for hospitals to market themselves as being particularly skilled at treating certain conditions. There are two variants, one driven by quality and specialisation, the other driven by cost. As medical tourism is usually sold on a mixture of quality and cost, this makes for an interesting alternative that could alter forecasts for outbound US medical tourism, or skew it in the direction of cosmetic and dental, rather than surgical. Much may depend on what reforms to the health and insurance system the new US president drives through, and how far he cools down the climate of fear that makes many Americans cautious of travelling to foreign countries for care. Until now, most US hospitals have been quiet on seeking business from outside their local community. But this is slowly changing. This is how the University of Michigan Health System (UMHS) describes its new offering:  This is a way of attracting more patients from around the region, the country and the world to UMHS for advanced specialty care in specific areas. The first one, in skin cancer, launched late in 2008 attracted dozens of new patients from Michigan, around the country and even Japan. The six new ones deal with aortic diseases, congenital heart, endocrine oncology and three on cancer. One of the keys to developing destination programmes is the patient scheduling challenge, compressing care into the small number of days that the patient from afar will have allocated for the visit. This is no small feat for a hospital where departments tend to operate autonomously. The ability of hospitals to solve this problem is vital. Furthermore, hospitals must look into providing concierge services for patients and their families especially when they have to travel great distances for treatment. Concierge services involve attending to the lodging and transportation of family members as well as other services for extended stays. Hospitals still have much to learn from the hotel industry. Meanwhile, a number of locations in the US have created a competitive advantage in specialised healthcare for decades which draw patients from not only all over the US but from around the world. The Mayo Clinic is but one of many examples. Medical tourism agencies such as North American Surgery are connecting patients with US hospitals willing to compete on price with providers overseas and across town. Some US hospitals are giving big discounts to patients who pay up front in order to fill unused capacity. The North American Surgery network of US healthcare providers offers access to high-quality surgical procedures at prices that are often 50 percent below US hospital averages.

The Singapore government wants to grow its share of health tourists from the Gulf States as the Lion City’s Ministry of Health recently signed an agreement with Dubai’s Department of Health and Medical Services (DOHMS).   Our vision is to provide a complementary offering to healthcare systems across the Middle East, with a focus on advanced and innovative areas of medicine within Singapore, said Ke-Wei Peh, area director for the Middle East and Africa at the Singapore Tourism Board (STB). Singapore hosts an average of 200 patients from the Gulf every month. It hopes to draw one million foreign patients to the country by 2012. However, Health Minister Khaw Boon Wan has been quoted saying that it will be a challenge to meet this target under the current economic conditions. He pointed out that hospitals will have to work harder to attract medical travellers and that it may take longer for this target to be realised. While the numbers for 2008 are not available yet, latest but contested figures from the STB suggest that the number of medical tourists fell some 15 percent between 2006 and 2007. Based on exit surveys of international travellers at Changi airport, 348,000 medical tourists came to Singapore in 2007, compared with 410,000 in 2006.This drop came as a surprise as all Singapore hospitals registered higher patient admissions and patient days in 2007, compared with 2006. The figures clash with earlier STB numbers that said the city state attracted 571,000 medical tourists in 2007, up from 410,000 in 2006. The STB is urgently analysing the figures and survey methodology, as both sets cannot be correct. Industry professionals have predicted a 10 percent drop in 2008 because of the worsening global economy. Others in the industry have argued that the 2008  figures will be about the same as 2007. Singapore is confident that it will increase numbers in 2009. There is a debate between those who want to focus on Asia and the Gulf states, and those who also think that Europe and the US have potential. Singapore’s Parkway Health Group has three representative offices in North America but 17 in Indonesia. National Healthcare Group director Tyrone Goh said: "Jakarta is a one-hour flight to Singapore versus 20 hours from the US. Some in the trade feel that the potential of business from the US, particularly paid for by employers and insurers has been over-hyped. A case in point is when US company Hannaford and insurer Aetna allowed employees to go to Singapore for treatment. By the end of 2008, not a single employee had gone to Singapore. Early indications for 2009 show a slight flattening to no impact on the numbers of foreign patients coming to the city-state, depending on who you talk to. Singapore Medical Group, where up to 60 percent of patients hail from abroad, expects those from Germany, Japan and Australia to increase this year. ParkwayHealth has seen a short term 5 to 7 percent dip in medical tourists, particularly for elective or simple surgeries; but also reports a rising number of patients from non-traditional markets like Vietnam, Cambodia, the Middle East and Russia, and other less developed countries, where state-of-the-art medical facilities are hard to come by.

Specialist American travel insurance intermediary Seven Corners has signed US medical tourism agency Healthbase as the first preferred partner for the bordercross worldwide policy underwritten at Lloyds’ of London. The insurance is for any nationality, but the patient must be travelling outside the country they live in. Saroja Mohanasundaram, chief executive of Healthbase, said: "We are the only medical travel facilitator to provide a custom insurance programme to our clients as a further commitment to providing high-quality medical travel services at an affordable cost." The insurance plan provides Healthbase patients coverage for the treatment of common surgical complications such as adverse reactions to anesthesia, stroke, myocardial infarction, deep vein thrombosis and infections. Jim Krampen of Seven Corners said: "The medical complication benefits we designed for Healthbase clients will provide peace of mind and cover the cost to treat medical complications abroad and when they return home." Healthbase has a large number of internationally accredited hospitals in 14 countries, including India, Mexico, Costa Rica, Singapore, Thailand, Panama, Turkey, Belgium, South Korea, Malaysia, the Philippines, Hungary, Brazil and the US. Healthbase customers do not all live in the US. There are plans to add more destination countries soon - Canada, the UK, Jordan, Taiwan, New Zealand, Australia, El Salvador and Guatemala. Seven Corners originally planned to only sell via medical tourism agencies, but progress on this has been so slow that they are now also offering to quote direct to medical tourists.

A recently released research paper shows that US$14 billion is being spent across the Gulf on new hospital and healthcare facilities. Healthcare builds are continuing across Gulf countries with a mixture of public, private and joint-venture initiatives. The aim is to address the needs of patients, both local nationals and expatriates, and reduce the number of people who are going outside the region for medical treatment. With most states developing many new hospitals and clinics, the long-term aim is to promote medical tourism between Gulf States rather than overseas, and to also attract patients around the world. Figures show that Saudi Arabia is leading the way with a total spend on healthcare construction projects of more than US$6.6 billion, while the UAE and Qatar are closely matched at US$2.9 billion and US$2.8 billion respectively. Saudi Arabia has a total of 83 projects ranging from the US$400-million King Saud University Medical City in Riyadh to the US$5-million Qatif Central Hospital expansion. Kuwait has one major hospital project under construction the US$1.2 billion Jaber Al Ahmed Al Sabah Hospital. Bahrain is spending US$130 million on the 312-bed King Hamad General Hospital, which is running two years behind schedule. In the UAE, the biggest project is the US$1.9 billion first phase of the Cleveland Clinic Al Suwwa Island development in Abu Dhabi and the second is the Mohammed Bin Rashid Al Maktoum Academic Medical Centre in Dubai Healthcare City budgeted at US$572 million. Also in Dubai Healthcare City, the 400-bed University Hospital is under construction and will be completed in 2011. The UAE has a state-backed fund investing in healthcare. Mubadala Healthcare buys in global quality to overhaul the local healthcare system, encouraging Abu Dhabi residents to spend their healthcare dollars at home. The fund has only one shareholder, the government. Government figures show an estimated US$2 billion is spent annually ferrying UAE nationals abroad for treatment. Mubadala Healthcare ’s first two ventures,  the Imperial College London Diabetes Centre (ICLDC) in Abu Dhabi and the Abu Dhabi Knee & Sports Medicine Centre have been a success. The fund is a partner in Cleveland Clinic Abu Dhabi, a 360-bed hospital, scheduled to open for business in 2011. Cleveland Clinic Abu Dhabi will be an integrated clinic-hospital design that will serve local and international patients in an environment that combines excellent amenities with world-class medical care. One of the objectives is to address the needs of patients currently travelling abroad for treatment. Also in the pipeline is a spinal injury facility, on course to open in 2010, with a reference laboratory and a wellness and diagnostic centre planned for the same year. Once completed, the Abu Dhabi Spine Centre will be the first national unit of its kind. Parkway Health recently signed a deal to manage the upcoming Danat Al Emarat Women and Children’s Hospital in Abu Dhabi. Two of the government’s key partners, Johns Hopkins and Cleveland Clinic, also run the two largest UAE public hospitals.

Although health tourism is still new to Vietnam, it sees plenty of potential. Vietnam has an abundance of natural resources to provide natural health remedies to the health tourism industry, particularly hot springs and mineral springs. The Vietnam National Institute and Hospital of Acupuncture, alongside travel companies, are implementing a programme on combining travelling with acupuncture and acupressure. To date, thousands of people have joined the programme. Some of Vietnam’s most popular tourist sites offer added health benefits. Thap Ba Hot Springs in the central coastal city of Nha Trang, the Kim Boi Mineral Waters in the north-western province of Hoa Binh and the Vietnam National Institute and Hospital of Acupuncture are all places where visitors can enjoy traditional therapies. Also, the Vung Tau Medicoast in Ba Ria-Vung Tau province and Hoan My Dalat hospital in Da Lat provide health tourists with high-quality medical services. An increasing number of foreigners are arriving in Vietnam to embark on health tours, as the country is known worldwide for its traditional herbal medicine. The Vietnam National Institute and Hospital of Acupuncture is internationally recognised and more affordable than similar institutions in countries such as Thailand and Singapore. The Vietnam National Administration of Tourism (VNAT)’s development strategy aims to turn the country into one of the world’s top destinations by 2010. VNAT plans to advertise Vietnam on international television networks, as well as in newspapers in Singapore, Malaysia, Thailand and Cambodia.

During the campaign, US President Barack Obama promised Cuban Americans unlimited travel to their native land. Although this pledge does not apply to other American citizens, who are currently banned from or seriously restricted in travelling to Cuba, many in the US expect the country to be an emerging destination for medical travel. According to the US travel trade, two out of three Americans want an end to travel restrictions to Cuba. If President Obama grants general licenses that do not have to be applied for and does away with the cumbersome registration process of travel service providers, American travel agents and tour operators will receive an immediate business opportunity. Cuba has boasted a medical tourism programme for the past 40 years. Most people come from Caribbean and Central American countries. An increasing minority source of overseas-based patients is Canada, which unlike the US, has travel ban to Cuba. A handful of Canadian medical tourism agencies send Canadians to Cuba. One of these is Choice Self Directed Healthcare, which has launched a medical check-up service aimed at those already on or planning a vacation in Cuba. The agency also offers Canadian and American patients the option of going to Cuba for dental treatment, orthopaedics, cosmetic procedures, eye care and diagnostic services all at a significant cost savings. A hip replacement costs US$60,000 in the US, but in Cuba the cost is US$8,000, a savings of 86 percent. It even offers drug and alcohol rehabilitation treatment in Cuba. In Cuba, the public Cira Garcia Clinic in Havana provides the health check. It includes both an initial assessment and follow-up appointment with a specialist in internal medicine, laboratory investigations, electrocardiogram and simple radiography of the thorax. It costs international patients US$284, including a copy of all test results and recommendations. Daren Jorgenson, founder of Choice, said: Cira Garcia Clinic is a state-of-the-art facility staffed by fully licensed and well trained physicians, nurses and support staff, providing international patients with an outstanding quality of care comparable to that at leading Canadian healthcare facilities. According to Cubanacan Tourism and Health, the umbrella organisation charged with promoting Cuba’s health tourism facilities, the island attracts 3,500 health tourists a year. Cira Garcia Clinic claims 1,300 in-patient health tourists a year. However, both figures have been constant for at least three years, so their accuracy is doubtful.

When the UK’s most renowned medical journal, The Lancet, offers a thoughtful paper on health tourism, it shows that the medical profession takes the business of medical tourism very seriously. What is fascinating is that Dr Richard Smith of the London School of Hygiene and Tropical Medicine, and colleagues who helped him, have no connection with medical tourism. Unlike others, they are neither trying to promote medical tourism, nor protecting healthcare organisations from a threat to their income, nor promoting a medical tourism service or book. Much of what is written on medical tourism gives the impression that the vast majority of potential business comes from the US or the UK. As totally unbiased observers, they show that although these are important markets, they are far from being core to worldwide medical tourism. The paper pointed out: Social, cultural, and linguistic factors generate a strong regional dimension, with substantial intra-regional movement of patients, especially in bordering countries. For example, 70 percent of patients going to Singapore and Malaysia are from their neighbouring Asean member countries, while medical travellers going to Cuba are mainly from the Caribbean and Central America, and those going to Jordan are mostly from Yemen, Bahrain, Sudan, Syria, Libya, Palestine, and Saudi Arabia. The diaspora population is also an important source for foreign patients for countries such as India, The Lancet paper noted. This is a view that contradicts many writings on medical tourism, which do not view citizens living abroad are potential medical travellers. Diaspora is more then just expatriates living outside their own country, it extends to the second, third and subsequent generations. To those in the medical tourism business, the paper offers little that is new. But the analysis of the business is still interesting. Some of the findings are:     Health tourism accounts for an estimated four million patients a year     The market is worth US$20 billion to US$40 billion now     It could be worth US$100 billion by 2012.     Asia is the leader in attracting such patients. Thailand attracts one million a year, with India, Singapore, and Malaysia expected to reach that number by 2012.     The demand for services abroad is driven by domestic non-availability, often in specialised and niche or alternative treatment areas.     Low labour costs combined with high-quality medical professionals (many of whom are trained in the US or the UK) give many developing countries a huge cost advantage. The paper’s view is that active assistance from governments is what makes certain countries more successful than others. Many countries also engage in active policies, aggressive marketing and targeted initiatives to promote themselves as regional hubs for medical tourism. Governments offer special facilities and incentives for medical tourists, such as investing or helping with investment in multispecialty world-class hospitals; expedited visa procedures, including specific medical visas; integration of healthcare and tourist facilities; and funding higher medical education overseas to strengthen human resources, it said. It also illustrated why some hospital groups do better than others. Corporate hospital groups in India, such as Apollo Hospitals, Fortis Healthcare, and Wockhardt, have partnered international insurance and tourism companies and hospitals and practitioners abroad. Private healthcare groups in Singapore such as Raffles Hospital and Parkway Group Healthcare, have established marketing offices in China, south Asia, the Middle East, Indochina, and Russia. The paper also observed that while medical tourism is only one part of global healthcare, other factors are inextricably entwined within it, ie: the movement of health professionals and services across country boundaries, and the internationalisation of investment in and by hospitals and clinics. So increasingly, it is the hospital going to the patient rather than conventional medical tourism. The paper’s outsider view noted that while some governments and hospitals are extremely active and professional, those who passively support the business, and somehow expect customers to flock to them, are always going to be disappointed. One area seen as a constraint for the industry is the lack of portability of national and private health insurance. But they appear to suggest that even if all insurers were to pay for medical tourism, this would only result in a marginal increase in patient numbers travelling overseas.

Thailand’s leading private hospitals are gearing up for rapid growth in the medical tourism sector over the next three to five years. Two of the country’s biggest hospital operators Bangkok Hospital Medical Services (BHMS) and Piyavate Hospital have begun adding rooms and upgrading medical facilities to prepare for an expected increase in the number of foreigners in search of affordable medical treatment. BHMS is the largest hospital group in Thailand and the second biggest in Asia. It has 19 hospitals in the group. The flagship hospital, the 600-bed Bangkok Hospital Medical Center (BMC) in Bangkok, is actually comprised of four facilities: Wattanosoth Cancer Hospital, Bangkok International Hospital, Bangkok Heart Hospital and Bangkok Hospital (formerly Bangkok General Hospital). All of them have JCI status. Sixty percent of BMC’s patients are Thai nationals and the other forty percent are from other countries, foreign patients who are either visitors or expatriates living in Thai capital. BHMS has been preparing for the medical tourism boom for a couple of years. It has already increased the number of beds at Bangkok Hospital Pattaya, Bangkok Hospital Samui and International Clinic Koh Chang. The group is also renovating and adding beds at Bangkok Hospital Phuket. Furthermore, several hospitals in the group are gradually upgrading their operations to qualify for JCI accreditation. Specifically, Bangkok Hospital Pattaya and Bangkok Hospital Phuket are reported to be waiting for their accreditation to be formally announced. Bangkok Hospital Pattaya has 110,000 international patients annually from 136 countries. In another development, Piyavate Hospital, which is being renovated and expanding, said that 20 to 25 percent of its patients last year were foreigners, accounting for half or 50 percent of the hospital’s revenues in 2008. Foreign patients’ contribution to revenue is expected to reach 60 percent over the next five years. Piyavate Hospital chief executive Tanatip Supparit estimated that some 1.4 million foreigners received medical care in Thailand in 2008, with 800,000 receiving complicated treatment. The hospital plans to establish a medical centre in Oman, which supplies most of the hospital’s foreign clients, and is looking for locations for other overseas centres. "Southern and Eastern African countries are interesting targets for us, as some patients in those areas have begun seeking medical treatment in Asian countries like India and Thailand," said the hospital’s chief executive. Meanwhile, the Tourism Authority of Thailand (TAT) has said there are over 30 Thai hospitals ready for foreign patients. TAT expects two million visitors to take advantage of medical treatment services and facilities in Thailand in 2009. Majority of medical tourists come from the Islamic countries in the Persian Gulf: the United Arab Emirates, Oman, Qatar and Kuwait. Governments of these countries have contractual relationships with several hospitals. As a result of this, several thousand patients from the Middle East come to Thailand each year for care. Another large source of foreign patients are neighbouring Asia countries such as Cambodia, Laos, Vietnam, Myanmar and Bangladesh, where the quality of medical care is not as advanced as in Thailand. Also in recent years, patients from Europe, Australia and New Zealand, North Americans and, more recently, East Africans have been flying into the country for medical treatment.

A proposed EU directive would allow European citizens to have a procedure anywhere in the EU and be reimbursed in their home country, even if the treatment can be had at home. European citizens can already use medical services while on holiday or business using the European Health Insurance Card, and planned surgeries in other EU member states can be arranged if there is agreement between a patient’s own doctor and the doctor abroad who will treat the patient. This is commonly done in cases where a procedure is not available in the patient’s home country. However, the new plan would place power in the hands of patients who now have the option to seek treatment elsewhere in Europe, even if that procedure is available at home. For inpatient procedures, prior agreement may still be required but day-case patients could soon have the power to refer themselves to clinics anywhere in the EU and claim the costs back from their local health authority. The fine details of the plan are being thrashed out in Brussels this month. The move follows several rulings by the European Court of Justice, which supported patients’ rights to travel for medical procedures.   The new directive will guarantee entitlement to medical and dental care across the EU, and reduce waiting lists. There has been some concern that patients will have to pay upfront and cover their own travel expenses. It is also expected that patients will only be refunded the amount the operation would cost in their own country, rather than the fees they will actually pay out. For example, an Irish patient undergoing surgery in Sweden would only be reimbursed the cost of that procedure in Ireland, even if the price were higher in Swedish hospitals. If the price was lower, the patient could not pocket the difference, In a submission to the Department of Health, the Irish Patients’ Association warned against diluting the package of care currently available under the National Treatment Purchase Fund (NTPF). The NTPF pays for Irish patients who are waiting more than three months for an operation to be treated in private hospitals in Ireland and Britain. This can include travel expenses for the patient and a companion. Patient mobility between the Republic of Ireland and Northern Ireland is currently less than one percent of total treatments. The Department of Health said Ireland is not opposed in principle to the directive in this area, but acknowledged it was difficult to estimate how many Irish patients would travel overseas for treatment, and how many European citizens would seek medical care in the Irish system, which is quite expensive compared to other countries. Professor Charles Normand of Trinity College, Dublin, believes the numbers going for treatment outside their own countries will be small and will mostly be restricted to patients travelling for particular elective operations where there are long waiting lists. His view is contradicted by European Commission research that said 79 percent of Irish people would be willing to travel elsewhere in the EU for specialist care or to be treated more quickly. The European Commission has submitted the proposed directive to the Council and European Parliament.MEPs discussed the issue at committee level on January 21 and are expected to vote at the end of April. However, while the debate remains vigorous in Brussels, it is unlikely that the directive will come into effect until member states have been given time to prepare for its impact.

Medical tourism will remain robust and resilient despite the economic slowdown, according to the Malaysian investment and research group OSK Research. The majority of medical tourists to Malaysia seek curative medical treatment instead of aesthetic purposes, it said in its research note. Based on this fact, we believe demand for medical tourism in Malaysia will remain resilient as patients with a medical condition will seek treatment regardless of whether there is a recession or not, although those considering treatment for aesthetic reasons may defer their decision, the OSK study said. OSK Research predicted Malaysia could gain from the slowdown given the competitive advantage over the main competitors, namely Singapore and Thailand. Since Indonesians formed the biggest number of medical tourists to Singapore and Malaysia, the slowdown might result in some Indonesian patients seeking treatment in Malaysia rather than in Singapore because of the former has cheaper cost. We believe Malaysia will always have a price advantage over Singapore unless Singaporean players adjust their pricing drastically - which we believe is highly unlikely, due to the higher labour and operating costs, it noted. Also, it noted that the recent turmoils in Thailand provided an opening for Malaysia to raise its profile as an alternative destination for medical travel. Our discussions with the major players in Bangkok indicate that they have not seen any sign of recovery in the sector as a large number of its foreign markets such as the United Kingdom, the United States, Canada, New Zealand and Australia are still warning their citizens against travelling to Thailand due to high political risk, OSK Research said. Nevertheless, Thailand expects the recovery to come in the second half of 2009 once the political landscapestabilises, it added. This situation offers great opportunities for Malaysia to capture some of Thailand’s market share in medical tourism given that Malaysia offers comparable services at competitive prices," the OSK study stated. Malaysia is also eager to woo medical tourists from the Gulf.  Apart from the low cost of procedures in Malaysia, the government offers discounted tickets to family members of patients travelling to the country.   Syed Muhadzir Jamallulil, head of Tourism Malaysia in Dubai said: "There are a lot of facilities in Malaysia that can take care of the medical needs of travellers from the Middle East. They are much cheaper than the Gulf." Malaysia is fast emerging as a value-for-money destination for medical tourism, thanks to its world-class health and medical facilities, said Frost & Sullivan Asia-Pacific healthcare practice consultant Tham Lin Hui. The growing awareness about medical tourism in Malaysia will attract more foreign patients to seek treatment in the country, she added.