The Malaysia Healthcare Travel Council is working hard to promote Malaysia as a medical tourism destination for people from Oman. Kavitha Mathuvay from MHTC explains, "There is encouraging market growth in Oman. It has grown 50% since 2010. In 2012, 1,000 Omani patients went to Malaysian hospitals, increasing to 1,300 in 2013. Among the GCC countries, Omanis are ranked third among medical travellers to Malaysia." MHTC is also working with Oman’s Ministry of Health to promote Malaysia as a destination for medical referrals. It has to compete with India, Thailand and European countries for referrals. One attraction for people from Oman is that many features appeal to Muslims, such as the availability of halal food, access to prayer rooms in hospitals, and services in Arabic. Omanis seek treatment in Malaysia for cardiology, orthopaedics, oncology, ophthalmology, IVF and neurology. The potential market is limited as nearly half of those living in Oman are expatriate workers; mostly low paid domestic and manual workers .The need to go overseas may only last until new free public hospitals are built. Healthcare for Omani citizens is free; they get free treatment in public hospitals, while expatriates do not. The healthcare sector in Oman is set to undergo a major expansion, with both the government and the private sector investing in new medical cities as well as developing a number of smaller hospitals.

UAE hotel group, TIME Hotels Management, plans to build a new five-star hotel located just a few minutes from Dubai Healthcare City. The 277-room TIME Royal Hotel will occupy a prime position with a 10-minute drive from Dubai International Airport. The hotel is set to open in 2016 and will offer guests a choice of two restaurants, a coffee shop, fully equipped gymnasium, swimming pool, and spa. While there are many modern hotels in Dubai, there are few near to Dubai Healthcare City. Dubai has some of the most expensive room rates in the world. Mohamed Awadalla of TIME Hotels comments, "Dubai plans to position the emirate as a global medical tourism destination. To support this ambitious strategy it is imperative that in the nearby Oud Metha area where we are building the new hotel, that there are many more hotel rooms. We will add more value to the market with two rooms per floor designed to be handicap-accessible; which is a first for the city. The hotel will also be wheelchair friendly with ramps sited throughout its major public areas and with adapted elevator access." DHCC’s medical tourism agency Salamatak is expanding its focus across Africa, Middle East and East Europe. Ibrahim Abu Gharbieh of Salamatak says, “Not all medical tourists want to stay close to the hospitals. Some want to stay next to shopping and stations, some prefer to stay in beach hotels, and some are price conscious.”

The Dominican Republic aims to become an international health destination, particularly for people from Caribbean countries. Rescue RD group offers medical services in Puerto Plata, La Romana, Bavaro and Sosua-Cabarete.It has seen a gradual increase in cases referred to the Dominican Republic from other Caribbean islands in the last four years. But these are mostly travellers who become ill or injured during their holiday and need to be airlifted from islands that have inadequate medical care, and are mostly covered by travel insurance, Developing medical tourism is a priority for the country; say the Tourism Ministry, the Exports and Investment Center (CEI-RD), Congress, Free Zones Council for Export and Public Health. These government organisations claim that the growth of public and private healthcare nationwide, including in tourist resorts, would be a good base for targeting medical tourists from the Caribbean and USA. These arguments are often boosted by numbers claimed for existing medical tourists. RDD Rescue points out that the numbers are actually of international patients and in 2013 alone, this included 36,000 tourists assisted with emergencies. There are four types of hospital in the Dominican Republic. The first is the public hospital. There is one in every reasonable sized town and the medical treatment is free, but all medicines and x-rays, stitches etc have to be paid for. The standard of care is average at best and they should only be used in dire emergencies. The in patient has to provide their own sheets, pillows, toilet paper, food etc, and they are basically looked after by members of their family. It is very unlikely that English will be spoken here. The second type of hospital is the major international hospitals only in the capital, Santo Domingo and Santiago. These hospitals have the latest equipment and top medical professionals. They have private facilities, but even the public facilities will be two bedded rooms with a bathroom. The health care is not free and payment is needed for the room and medical help. These hospitals carry out everything including organ transplants and some, although not all of the staff will speak English. The third type of hospital is the high quality hospitals and clinics in the tourist areas. Whilst not as large as the major hospitals in Santo Domingo or Santiago, these are high quality clinics with a high standard of in-patient care and all will speak English. The fourth type is local clinics for local people. There are usually 3 to 5 in each town. They will be of a higher standard than the public hospital, but not as high as those in tourist areas. There are single in-patient rooms with bathrooms and televisions, and are fine for basic operations or broken bones, but anything more complex will need to be referred to a larger hospital. Costs are significantly lower than the tourist clinics or the major hospitals and they are unlikely to speak English. In practical terms, the only places capable of handling medical tourism are the handful of international hospitals and the small private clinics in tourist areas. The public hospitals are places that medical tourists should avoid, and the local clinics do not have facilities. In DR there are two worlds, the haves and those of the have-nots. It is a land of extremes and stark contrasts. There is extreme poverty side by side with extreme wealth. While public bodies claim to want medical tourism, none are yet prepared to spent time or money in promoting the concept. This is left to individual hospitals and a small medical tourism association with three members.

For the first time, private hospitals in England will have independent inspections where hotel style ratings will be made public, so helping domestic and international patients in making choices. The independent Care Quality Commission is running a pilot to test a new inspection approach. Eight independent hospitals will be inspected around the country. These vary in size and in the number and type of services they provide, including both NHS-funded care and solely private care. The first new style inspections will allow it to test out the new model in different independent hospital settings. CQC will expect to receive equivalent information about performance to that it receives from NHS hospitals. CQC’s new regulatory approach for the independent healthcare sector signals the first time that these providers will be awarded ratings (from April 2015). There will also be a significant increase in access to information that will help people who use the services to make decisions about their care. The first inspections will take place from October to December 2014. They will include announced and unannounced elements and may include inspections in the evenings and weekends when CQC suspects people can experience poor care. These pilots will help it refine the way it inspects this sector and help it develop a rating system. It will begin to issue ratings for private hospitals in 2015. The core services being inspected will follow the same approach as in the NHS to include: surgery; including cosmetic surgery, urgent care services, medical care, children and young people’s care and outpatients. The eight pilot hospitals are:• Baddow Hospital, Essex• BMI Mount Alvernia, Surrey• The Lister Hospital, London• The London Welbeck Hospital, London• Nuffield Health Tees Hospital, County Durham• Oaklands Hospital, Salford• Peninsula NHS Treatment Centre, Devon• Spire Southampton Hospital, Hampshire Professor Sir Mike Richards, chief inspector of hospitals, says: “We need to hold the independent sector to the same standard as the NHS.As we have seen in the NHS, these new-style inspections will allow us to get under the skin of the organisation to give us a much more detailed picture of independent hospital care in England than ever before. We are significantly increasing public access to information on independent healthcare, which is good news for people who use services, as it will help people to make informed decisions about their care.” Each inspection seeks to answer five questions about services: are they safe, caring, effective, well led and responsive to people’s needs? All independent healthcare providers will receive full ratings from April 2015. The ratings are: outstanding, good, requires improvement and inadequate.Where there are failures in care, the inspection team will highlight what needs to be addressed and the hospitals must put in place a clear programme to deal with any problems quickly. The independent sector covers large hospitals that operate under a single corporation with multiple locations to single specialties (for example, cosmetic surgery clinics or dialysis centres) and individuals delivering single speciality services. There are 276 independent acute hospitals and 47 independent treatment centres registered with CQC. The inspections will be at individual hospital level. CQC is developing its approach to inspecting at corporate headquarters level for large corporate providers that own many hospitals and/or clinics.

The Tourism Observatory for Health Wellness and Spa has issued a case study of the Hungarian spa town of Hévíz, “Hot springs, tourism and economic impacts’ Health tourism is the one and only industry in Hévíz. The thermal lake of Hévíz is the world’s largest biologically active natural thermal lake. It is in a unique setting, 6 km from the Lake Balaton, 198 km from Vienna and 193 km from Budapest. The heat coming from the deeper layers of the earth’s crust heats the waters locked inside the underground deposits, which means that the lake is also heated by geometric energies. Guests can bathe even in the winter months. The steady and constant water flow has a beneficial effect on the body as it keeps bathers lightly massaged during the whole time they spend in the lake. The therapeutic effect has many uses in health prevention and cure., and the basis of balneotherapy is thermal water. It is claimed that the therapy has beneficial effects on rheumatic diseases, osteoporosis, degenerative spinal/joint diseases, chronic and gynaecological conditions. The healing city of Hévíz attracts some 225,000 guests every year who spend a million guest nights at the destination. There are 23 hotels, many of which are either wellness or medical hotels .In Hungary there is special legislation for medical hotels by law and industry self-regulation is for wellness hotels. The study estimates that the 225,000 tourists have a significant impact on the local economy with direct and indirect spending .The study report includes details on methodology, economics and healthcare; too detailed to explain fully here.

The Russian annexation of Crimea from Ukraine has almost destroyed local health and wellness tourism. As some Western countries do not accept that the vast majority of the people of Crimea are happy to once again be part of Russia, politics and sanctions mean that health tourist numbers from Europe and Ukraine have fallen to almost zero. As many of the people who have traditionally gone to Crimea for health and wellness breaks, or recuperation, come from Russia and other CIS countries, Russia has a simple solution which may or may not work. The intent is to rebuild tourism and health tourism with an almost exclusive focus on people from Russia and the other CIS countries including Kazakhstan, Latvia, Estonia, Moldova, Georgia and Belarus. The logic is simple, facilities are rarely modern and few speak any language other than Russian- so trying to target Europeans who want luxury facilities or do not speak Russian, when the majority of the European press voice anti-Russian sentiments, is pointless. The Russian government has allocated $58 million for health, wellness and medical tourism to Crimea in a bid to salvage the tourism industry in the annexed Ukrainian territory. The money, assigned to the state Social Insurance Fund, will make it possible to send 75,000 Russian people to the Black Sea resort’s sanatoriums. Crimea, a popular resort in Soviet times that had been part of Ukraine since 1954, was annexed by Russia in March 2014.In addition to triggering sanctions against Moscow and the Crimean peninsula, the annexation has crippled Crimea’s tourism industry, previously heavily dependent on Ukrainians. Official Crimea estimates forecast 3 million tourists in Crimea this year, compared to 6 million in 2013. The Crimean tourism industry stands to lose up to $2.3 billion this year. Giving money will not be enough as in practical terms Russians cannot easily reach the Crimean peninsula, which has no land connection to Russia, leaving the local airport and ferry line sorely overloaded. Additional airline and ferry services will be needed to cope with 75,000 Russians.

Sri Lanka plans to promote medical tourism to support a 20 billion dollars export target in year 2020. Sujatha Weerakoone of the Export Development Board explains, “Professional service exports present a tremendous opportunity and can speed up government’s ’20 billion dollars exports by 2020’ goal. Medical tourism is one of the most promising sub-sectors in this. We are ready to work with any and all stakeholders to get this off the ground. With only a per capita healthcare expenditure of 175 dollars, at first, Sri Lanka does not appear to have an advanced healthcare infrastructure similar to developed countries. But due to the support of well trained, high quality healthcare professionals, availability of treatment centres as well as pharmaceuticals, we are witnessing the emergence of a new sector that is medical tourism contributing to our service exports. Studies show that around 15% of patients in Sri Lanka are foreign patients, such as from the Maldives.” Sri Lanka has over a thousand government hospitals including teaching hospitals, district hospitals, special hospitals, divisional hospitals and medical care units. The island also has number of private hospitals. The government neither has the money, experience nor wish to promote medical tourism on its own. So it wants to develop private public partnership to develop medical tourism. The EDB has made the first national initiative to rally healthcare providers as well as stakeholders and formulate a common voice. It wants to build a 2015-20 National Masterplan Initiative on Medical Tourism. This would map out such factors as availability of hospital facilities, accreditation, specialisations, centre of excellence areas, post-surgery and wellness packages, medical tourism packages and tie-ups with global medical travel agents. The EDB is establishing a formal link between the Medical Tourism Committee of Sri Lanka and Private Health Association (PHA). The EDB is ready to allocate prominent space in its web portal’s service exports section for this initiative. The Private Health Association includes the majority of Sri Lanka’s private hospitals, nursing homes and private healthcare providers as members. Members of PHA treat 55 % of the country’s outpatients and 15 % of the country’s in-house patients, while the rest are treated by state sector hospitals and healthcare facilities. Dr Lalith Peiris of Lanka Hospital of Sri Lanka comments, “This initiative can also help bring high net worth tourists instead of budget tourists and wellness medical tourism is a huge growth area. Through EDB we can help stakeholders understand how important medical tourism cold be.”

India’s Apollo Hospitals group is getting more patients from the UAE, Qatar and Oman. It sees huge potential in the GCC and the greater Middle Eastern region, despite the huge number of new hospitals being built in various countries there. Dr Hariprasad of Apollo Hospitals explains, "The proven Indian clinical competencies give India a huge competitive advantage. We have seen the number of patients visiting us from GCC region growing at a rapid pace. In the last few quarters we have seen a remarkable increase from UAE, Qatar and Oman. Comparing global prices for medical treatment, India leads in the race for providing quality healthcare services at affordable prices. This is a huge, untapped market, not just for therapeutic medical tourism like Ayurveda, but also for curative treatment." Emirates, one of the world’s fastest growing airlines, has teamed up with Apollo Hospitals, to connect international patients with quality healthcare services in India. As part of the joint venture with Emirates Airlines, patients and their companions from 19 countries across Middle East and Africa can visit the hospital group’s flagship locations in Chennai, Hyderabad, New Delhi, Kolkata, Ahmadabad and Bangalore with special fares for round-trip flights on Emirates. Apollo Hospital, Chennai caters to many patients from the Middle East with various speciality services it is recognized for. It performs a large number of bone marrow transplants and has a very high success rate. The Chennai unit also specializes in oncology as it was the first to introduce CyberKnife treatment and will be introducing Proton Beam therapy in the near future. Other speciality services include Mazor robotic spine surgery, plus heart, liver, lung and kidney transplants. Dr. Hariprasad adds, “Apollo Hospitals Group is at the forefront of medical tourism and will make India a global healthcare destination. Our mission is to bring healthcare of international standards within the reach of every individual. Providing quality healthcare of the best grade at affordable prices is important as we project ourselves as the leading institution in medical tourism."