Iowa-based China Connection Global Healthcare (CCGH) is spearheading the new Fitness and Culture Experience for Teens, an eight-week summer camp in China for overweight American teenagers. Organised in coordination with China’s Aimin Weight Reduction Hospital, the programme will offer 40 US high school students and 10 of their Chinese peers an international wellness experience integrating diet, exercise and traditional Chinese medicine to achieve significant weight loss. The camp will be held in Tianjin, China from June 10 to August 10. The obesity-intervention plan designed to address the social, environmental and individual determinants of the disease. Based on reports from the Centers for Disease Control, one in six American children is overweight or obese, a rate that has tripled during the last 20 years. Children and adolescents are developing obesity-related diseases, such as type 2 diabetes, that were once only seen in adults. A new study by the World Cancer Research Fund also reports that 34 percent of all cancer cases in America can be prevented simply by eating better, exercising more and maintaining healthier weights. CCGH founder Ruth Lycke said: We are passionate about the Fitness and Culture Experience being a catalyst in changing the lives of these young people. This group will reshape their bodies and expand their awareness of the world and its people in a unique way." CCGH is a medical tourism agency specialises in sending American health tourists to China and the only company focused on addressing obesity in teens. Lycke herself went to the First Teaching Hospital in Tianjin years ago for traditional Chinese medicine treatment following a stroke. Organisers of the Fitness and Culture Experience for Teens hope to simulate the encouraging experience by teenager Alonzo Bland who last year lost over 300 pounds without the use of bariatric surgery during his nine-month stay in China. Teen participants in the programme this summer can expect to lose between 20 and 25 pounds per month under strict, medical supervision. CCGH has an office in China and is growing its teenage weight loss programme through a grassroots approach to local sponsorships and is hiring from the ranks of the highly skilled, unemployed in each city. Thirty field representatives in 30 cities across the US will assist CCGH in selecting participants and sponsors from the communities in which they live. The goal is to reach kids who need help the most and ensure no deserving teen is left behind as a result of his or her family’s financial situation. China Connection Global Healthcare enables its clients to receive Western and traditional Chinese medical care through a network of Chinese hospitals and clinics at rates far less than those charged in America. Since 2006, CCGH has assisted hundreds of people from the US, Canada, the UK, India, Australia and Japan in finding the care they needed.

The University of Pittsburgh Medical Center (UPMC) and Leptos Group, a leading property and hotel conglomerate in Cyprus, are developing a world-class hospital that will offer a wide range of medical services to both local residents and foreign visitors in the Mediterranean island. Under the 23-year partnership, UPMC will manage a new 100-bed hospital and the existing 36-bed Iasis Hospital in Paphos. With its global expertise in providing clinical, technological and hospital management services, UPMC will assist the new health complex in developing centres of excellence in the areas of oncology, transplantation, aesthetics, cardiology, orthopaedics and minimally invasive surgery. The new hospital called Neapolis, which will be completed in three to four years, is an integral part of a mixed-use development project that includes a university, research centre, office park and luxury lifestyle housing, as well as retail, entertainment, cultural and leisure facilities. The project is one of the largest landscaped parks on the island. Michael Leptos, chairman of the Leptos Group, said: Despite the economic climate, we are confident that the new Neapolis health centre will be a success, filling the need for more health care options in Cyprus and alleviating long-wait times for many patients seeking specialised care. In addition, these facilities will be well positioned to attract patients from throughout the Middle East and Europe as medical tourism grows throughout the region." UPMC’s services in Cyprus will include on-the-ground senior management for the hospitals, staff training, equipment procurement and implementation of sophisticated information systems. UPMC expects to develop medical services that are now in short supply on the island, including comprehensive cancer services at Iasis Hospital. UPMC already manages of two cancer centres in Ireland and it plans to develop at least 25 more cancer centres throughout Europe and the Middle East with partner General Electric Company. In addition to the Neapolis project, UPMC’s international portfolio includes management of the independent Beacon Hospital in Dublin, Ireland, and a leading transplant hospital in Palermo, Italy.

A 100-bed multispeciality hospital staffed by German doctors and nurses is being built in Khalifa City and is expected to be finished by the end of 2010. Its operator, German General Hospital, has also built a medical centre in Al Rowdah and brought in 80 percent of its staff from Germany and Western Europe. The US$50-million facility will focus on three main areas: cardiology, orthopaedics and vascular diseases. Markus Eulig, chief financial officer of the group, estimates that about 100,000 people travel from the UAE each year to receive medical treatment in Germany. For the first time in the Gulf, qualified German healthcare run by a team of medical experts from Germany will be available to the UAE and GCC residents. The hospital in Khalifa City will provide a service for those who feel an affinity for German medical care so they do not have to travel overseas, he explained. The Al Rowdah German Medical Centre is scheduled to open next month and will offer a broad range of services, with specialities in internal medicine, paediatrics, orthopaedics and radiology. Both facilities are being funded by Shedlin Middle East Health Care, which is regulated by the German financial authorities. The design and planning for both the medical centre and general hospital have also been carried out by German architects, Woernerundpartner, who specialise in hospital and health-care projects. The hospital and clinic will be operated by Klinikum Offenbach, whose main hospital in Germany has around 1,000 beds and treats 33,500 patients each year. The project’s UAE partner, Abdulla Abdul al Fahim, said the team did not want to close the market to Germany but simply give people in the UAE, and further afield, the option to receive treatment closer to home. He noted: If people prefer to receive German treatment and be cared for in the same way as they would be in Germany, they will be able to do that here. German medicine has an outstanding reputation worldwide. Quality of care, cleanliness, medical technology and innovation are all unsurpassed anywhere in the world. But there are three problems: high cost, need for a visa, and language difficulties. Some in Germany see inbound medical tourism from the Middle East as a short-term business only, and that longer-term it is better to invest in hospitals and clinics in the Middle East.

Local healthcare leaders are urging the government to give medical tourism more than a cursory glance. "Proper handling of medical tourism will bring to Israel much income and foreign currency, improve our status in the world, and especially in the region, contribute to the creation of new jobs, increase the satisfaction of doctors and contribute to their remaining in Israel. All this will raise the level of medicine in Israel," said Professor Shlomo Mor-Yosef, director-general of the Hadassah Medical Organization (HMO). Income from medical tourism will help finance hospitals, imaging institutes, labs and research. It would be a win-win situation, but no government, health or finance ministry has done anything significant to promote medical tourism to Israel. With a little investment in medical infrastructure, it could reduce the temptation among the most experienced and promising doctors to leave the country, boost the quality of "hotel services" in hospitals and help the tourist trade. The professor and his colleague Amitai Rotem, HMO marketing director, outlined the challenges of Israel’s medical tourism industry:     Without urgent state initiatives, Israel is leaving the field to other countries. In the meantime, a handful of Israeli hospitals are trying to develop their own medical tourism facilities.     Existing infrastructures in most local hospitals can’t compare with those now in the East. For Israeli hospitals to compete, the level of hotel services must be improved and the number of beds increased.     Current marketing and administrative systems, not built for the speedy responses needed for competition, must be upgraded. Prices are not flexible enough, and the quality of service offered today in most cases is suited to local needs rather than meeting international tourist standards. The government, Mor-Yosef and Rotem urge, must take an active role in promoting the field. Of the 16,000 foreign patients who came for treatment in 2006, public hospitals like Jerusalem’s Hadassah University Medical Centers cared for 7,000, and private hospitals for 3,500, with only a few going to government and health fund-owned facilities. Estimated annual revenue for these services total US$40 million. Mor-Yosef and Rotem said that major treatments such as surgery, organ transplants, dental care and plastic surgery are sought by medical tourists. Unlike ecotourism, in which the traveller chooses a destination and only then selects the elements of the vacation, Rotem noted that medical tourism begins with a defined medical need. To this is matched an appropriate destination in terms of medical specialisation, cost, service (such as a suitable language and culture) and in certain cases cultural availability (such as a Saudi Arabian tourist who wants to visit Jerusalem’s Dome of the Rock). From a desire to minimise cost and waiting time, the modern patient turns into a tourist, and tourism experts and health industry people supply the "merchandise." Mor-Yosef said while foreign tourists receive the same level of treatment as Israeli patients, profitability from foreigners is much greater. The Health Ministry’s rates for tourists are much higher than those for Israelis, and discounts for tourists are lower. Payment is made in advance, unlike the local market that pays with credit. He also stresses the need to upgrade facilities to meet the expectations of medical tourists by improving "hotel services" in hospitals.  The strong message from the pair is that government ministries need to work together; The Health Ministry must set a supportive policy, both in setting prices and allocating additional beds to hospitals that cater to medical tourists. The Interior Ministry needs to establish speedy and friendly processes for providing tourist visas to patients. The Tourism and Foreign ministries must market the State of Israel as a destination for medical tourism. The Finance Ministry has to allocate funds, both for marketing and for improving the infrastructure that will be needed as medical tourism increases.

The fate of a high profile international project indicates troubled times for Dubai’s healthcare building projects. Dubai’s third-largest property firm may cancel a proposed Formula 1 theme park if it fails to receive government cash or tap debt markets. The project timeline for the proposed theme park has already been postponed. The plan was to fund the park with the sale of houses, but UAE property markets have collapsed and banks are unwilling to lend to the property sector. Marriott International’s global expansion plans over the next five years of 30 new hotels in the Gulf region, including 17 new hotels in the UAE, nine in Saudi Arabia, three in Qatar and one in Bahrain. But construction is not going to be soon as the global economic slowdown hits, with the UAE’s hotel trade is suffering more than other Gulf countries. UAE hotels have slashed room rates in a bid to stimulate business. The medical tourism industry in UAE is not immune to the global financial crisis either. Indeed, Dubai’s attempt to take business from Asian medical destinations such as India by creating local brands to attract international patients maybe in jeopardy. DeveloperTatweer has apparently put some projects in its major project Dubai Healthcare City  (DHCC) on hold. The most well-known medical tourism project in the Middle East, DHCC is designed not only to attract medical tourists but also to reduce the need for residents to travel abroad to receive high quality treatment. Although the government-owned business is keeping quiet about what it is or is not doing, details of some future projects have vanished from the DHCC website, and the sole survivor no longer gives expected completion dates. The current debate is whether in tough times, medical tourism will accelerate in countries offering lower cost, or a lack of cash will reduce the demand for non life-threatening surgeries like cosmetic surgery, dentistry, and Lasik/laser procedures. Dubai’s problem is that by selling itself as a high-cost, high-quality destination, it loses out whichever argument is true. Healthcare tourism isn’t recession proof, and new destinations will find it harder than ever to break into the market.

Most Americans seeking medical services abroad are either uninsured or under-insured, so pay for treatment out of their own pocket. Most estimates of future demand by analysts, agencies and hospitals, assume that private and state healthcare insurance systems will follow the tiny handful now, where the insurers pay for medical tourism. Healthcare reform has been promised for the last two decades, but President Obama has pledged to cure Americans from "the crushing cost of health costs," saying the country cannot afford to put healthcare reform on hold.  This is a cost that now causes a bankruptcy in America every 30 seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes," Obama said in his speech to Congress. Obama’s plans include root-andbranch reform of healthcare. Hospitals, doctors and insurers have all done well in recent years, and have managed to prevent any serious healthcare reform. Now they are all seriously worried that Obama may actually succeed. His reforms would include lower prices from hospitals, salary cuts for doctors, payment to hospitals by government insurance schemes linked to quality of care not quantity of care, giving Americans a choice of a public health insurance plan to compete with private insurance, and forcing insurers and health plans to guarantee coverage with no exclusions for pre-existing conditions, accepting all comers and not price sections of the community out of the insurance market. Which of these are realistic and which are being used to scare hospitals, doctors and insurers into backing reform is unknown. Compulsory government health insurance for everyone with the government dictating the price that hospitals charge for healthcare is still a possibility. The medical and insurance establishment used lobbying and political allies to stop earlier attempts at reform. But Obama is in a much stronger political position than his predecessors. 45.7 million Americans are uninsured, and for those with insurance coverage health-care costs have been rising four times faster than wages. There is general agreement that healthcare has to be drastically reformed now. Anyone targeting American medical tourists could be affected by reform as it could change everything. The state cannot stop Americans going overseas for treatment, but by compulsory insurance and price-controls it could remove many of the reasons people go abroad. Health insurers that offer a private alternative to traditional Medicare will be affected by plans to make sharp cuts in their payments and open the programme to competitive bidding. The new administration plans to expand healthcare coverage for the uninsured. The expected cuts in budgets for programmes such as Medicare and Medicaid will reduce the amount doctors and hospitals get for treating patients whose care is paid for by the government; threats to stop accepting such patients could rebound harshly on hospitals. Central to the reform debate is whether healthcare providers should be able to set their own rates or whether the government should tell them who to treat and how much they will be paid. Hospitals and doctors are resigned to the fact that they will have to accept change. Insurers are threatening to fight the reforms, but with recent figures showing dramatic price increases for the ever-decreasing number of Americans who can afford private health insurance, they have no alternative solution to offer.  Obama wants the main features of healthcare reform to be in place by the end of 2009, which considering other changes he has pushed through in a few weeks, may not be as impossible as it sounds. Whatever the outcome, three things are clear. Americans have less money to spend on healthcare; major insurers will not rush into medical tourism deals until they know how drastically they may have to reform what they offer to patients and at what price; and the price-differential between US and other countries will fall. In these uncertain times, many American employers will wait to see how they are affected by healthcare reform, before changing their employee benefit packages to embrace employer-paid medical tourism. If Americans are a target market, you need to keep a very close eye on US healthcare reform as it could quickly impact your business. You may even have to change from marketing on price to marketing on quality alone.

The UK’s House of Lords EU Committee has published a report on the European Commission’s proposal for a Directive on Cross Border healthcare entitled Healthcare across EU borders: a safe framework. The commission’s directive aims to clarify EU citizens’ rights to seek medical treatment in member states other than their own, and have the costs reimbursed by their own national healthcare systems. These rights have been confirmed in numerous European Court of Justice Rulings but the proposed directive represents the first efforts by the EU to codify these rights in a single document. The directive not only covers in- and out-patient treatment, but also extends to dentistry. The report welcomes the European Commission for a Directive on patients’ rights to cross-border healthcare, but calls for improvements and warns that it must be carefully monitored upon implementation, suggesting a three-year review. The Committee agree with the Commission that, as the right of EU citizens to travel to another Member State to receive healthcare has been confirmed by the European Court of Justice over the last ten years, it is essential to put in place a legal framework to replace the current ad hoc arrangements. The Committee consider whether patients seeking healthcare in other Member States should pay the costs themselves in advance of treatment and then claim reimbursement later. They raise concerns that this would prevent those without adequate financial means from taking advantage of their right to cross-border healthcare. The report recommends that a patient’s own healthcare provider should pay the fees directly to the provider in the other member state, and suggests that this could be linked with the process of securing authorisation prior to travel, which the committee considers necessary to enable patients to make informed decisions about their treatment. The report also calls on member states to ensure that patients are aware of their rights under the directive and are informed about the quality of care that they can expect, and any potential language barriers. Member states should finance information for its own citizens about healthcare abroad and should draw up a description of its own health system to guide other member states. It accepts that in practice it will fall to medical practitioners, such as GPs and dentists, to actually provide the information to patients. The directive distinguishes between hospital care and non-hospital care. It defines hospital care as any treatment requiring an overnight stay. Non-hospital care is everything else. In the light of ECJ case law, the Directive provides that reimbursement for non-hospital care shall not be subject to prior authorisation, provided that if this care were carried out in the home member state, it would have been paid for by its social security system. However, the directive permits member states to implement a system of prior authorisation for reimbursement of the cost of hospital care provided in another member state. The directive proposes that patients pay for their cross-border treatment upfront and seek reimbursement at a later date. This would fit in with how several EU health systems already work for domestic care, where the hospital provider and social insurance are separate organisations. In the UK, the care and insurance are both provided by the NHS, so the patient gets free treatment. The House of Lords wants to replace the pay and reclaim system with one where the hospital is paid direct. Most EU countries favour a pay and reclaim basis. The Commission itself is prepared to consider direct payments, but only after treatment has been completed. This issue illustrates that most UK organisations that gave evidence have little understanding on how health systems work outside the UK.     The EU plan has an implementation target date of 2011.

US group Global Solutions, a leader in strategic and software consulting services, has acquired a majority holding in e-Medsol, based in India. Buying e-Medsol enables Global Solutions to expand into medical tourism. e-Medsol has a platform and a process to create an integrated solution for medical tourism. Anuja Agrawal of Global Solutions said: We feel e-Medsol has created an offering which is truly unique and has the potential to provide a cohesive structure to the medical tourism industry. We are firmly committed to enhancing e-Medsol’s offering to create a single point of service for any player in the medical tourism industry. Global has appointed a new chief executive and e-Medsol will continue to operate under the same name. Dr Benosh Haris, founder of e-Medsol, who will continue as chief operating officer, said: Global’s strong financial backing, global infrastructure, strategic consulting and product development expertise will bring the stimulus needed to grow our medical tourism offering. e-Medsol, based in Kochi, India, has a network of 50 hospitals and healthcare providers and healthcare facilitators across the globe. Over the next few months, e-Medsol wants to significantly grow that number and seeks to add insurance companies and corporate destination managers to the network. e-Medsol will be launching its consolidated platform for medical tourism in India, IndiaCares, in the next few months. Its global platform will be launched shortly under the iGlobal brand. There are more than 70 US medical tourism agencies that arrange medical travel for patients to Indian hospitals, and many more elsewhere in the world. Indiacares is an online platform so medical tourism agencies can tie up with hospitals in India and process everything online. Fifteen Indian hospitals are signed up as are 16 agencies; five in the US, three in Canada, three from UK, two from Middle East and three in Africa. e-Medsol is a software and service company focused on development of products and services for the medical tourism industry. Since its inception in 2004, it has focused on developing online models that can effectively connect hospitals to medical tourism agencies. It enables hospitals and agencies to network online and refer patients directly to these hospitals. Hospitals and agencies with existing working relationships often remain unconvinced that paying to add a third party into the mix will either increase their business or make their processes more efficient. Few agencies send more than a handful of patients to each particular hospital. New owners Global will need to add value to the offering to make it attractive to agencies and hospitals.

A Singapore company has launched a web-based medical service aimed at raising the number of visitors seeking medical care in the region. The FlyFreeForHealth platform is a medical concierge network, providing visitors medical advice via its portal. Nurses trained in hospitality, IT and tourism, dubbed iMedical Butlers, will offer medical advice through the site. The agency, which was established in August 2008, provides services designed for foreigners looking to receive medical care in the region. The new service is for treatment in Singapore and Thailand. The company hopes to add India and Malaysia soon. FlyFreeForHealth has just completed a review on hospitals in Korea and health packages in Korea are currently being developed. FlyFreeForHealth also has two new partners; the Tourism Authority of Thailand and Singapore travel agency, CTC Holidays. The new e-service aims to help patients make travel arrangements into the region, in addition to pairing them with the appropriate hospitals. FlyFreeForHealth currently employs six iMedical Butlers, and is looking to recruit more in the Philippines and India. The company is also looking at nurses fluent in Russian, to encourage visitors from Central Asia. Porntip Makornpan, a director at Tourism Authority of Thailand, said the country saw an inflow of some 1.5 million tourists seeking medical care last year, a decrease on earlier estimates of 1.69 million. Dr Wei Siang Yu, founder of FlyFreeForHealth said: The new business to consumer shift is seeing the behavioural pattern of medical travellers changing. They look for more options. They also want more interaction before selecting the doctor. Merely looking for information on the internet is no longer sufficient

East African country Uganda is planning to grab a market share of the medical tourism sector by attracting private investors to develop medical facilities. Medical tourism is a relatively new concept in Uganda and indeed the East Africa region, but has potential. Investment by both the private and public sectors in recent years have seen the establishment of specialist clinics, spas, improved hospital facilities, traditional medicine and better HIV/AIDS management. This has contributed to growth in the niche market. Professor Maggie Kigozi, executive director at the Uganda Investment Authority says, Medical tourism is opening a new frontier for revenue generation in the country. We are working to ensure Uganda is well positioned with facilities that meet the chief drivers of the growing medical tourism market: affordability, high quality and excellent service. Medical tourism, though still young in Uganda, is promising to drive forward both the health care and tourism sectors thanks to the partnership approach of both the private and public sectors. "The main attraction for clients visiting the country are the hot springs such as those at Ihimba, Sempaya, Kitagata, Buranga and Nyamasizi, that are said to have high mineral content. These are suitable locations for investors looking to build rehabilitation clinics and spas. The availability of women’s fertility services and advanced HIV/AIDS research and management programmes are other factors drawing patients to the country. But as the country only gets 70,000 visitors a year, the current number of medical tourists is tiny. Herbal medicine has also become an attractive option to patients who prefer to take the natural healing route. Uganda’s forests are a granary of herbal medicinal plants. The government plans to regulate the herbal medicine sub-sector to maintain quality and best practice." According to Bradford Ochieng of the Uganda Investment Authority, Uganda’s medical tourism sector offers the following: Internationally accredited medical facilities using the latest technologies (e.g. open heart surgery and fertility centre). The largest group of dedicated gynaecology and fertility specialists in East and Central Africa, supported by a team of experienced scientists, nurses and counsellors through its Women Hospital International. The fertility centre specializes in In-Vitro Fertilisation, intracytoplasmic sperm injection, laparoscopic surgery, and myomectomy operations. Medical treatment costs are lower than other countries in the region. Fluent English speaking staff. Options for private room, translator, private chef, dedicated staff during your stay and many other tailor made services. An international reference centre for AIDS research, prevention, care and treatment. Foreign investors require a minimum of US$100,000 in planned investment in order to secure an investment license from the Uganda Investment Authority, whereas for local investors, the minimum planned investment requirement is US$50,000. Local investors may proceed with their investment without licensing with the Uganda Investment Authority. The license is crucial to foreign investors as it is the instrument that legalizes their investment in Uganda.

Specialist research company Intelligent Spas has published the first-ever Global Spa Benchmark Report that presents a plethora of financial statistics for the global spa industry and includes breakdowns of key performance indicators by region for the Americas, Europe, Middle East/Africa and Asia Pacific. This statistical report contains over 1850 spa industry benchmarks relating to revenue, expenses, visits and employment, with many topics showing historical data available from 2005 to 2008, plus forecast data for 2009 and 2010. The benchmarks are comparable across the entire spa industry due to the consistent methodology implemented and the some of statistics and benchmark ratios featured in the report include: treatment room occupancy average treatment rate average revenue per visit revenue per available minute therapist productivity rate repeat visitation rate capture rate of hotel guests breakdown of total revenue including retail revenue breakdown of total expenses Of particular interest to medical tourism businesses is the comparison of visitor profiles by gender, age and residence The comprehensive report also presents a collection of other spa industry intelligence including: Spa business models describing ownership, business structure, management structures. Spa infrastructure covering spa size, space breakdown, treatment rooms and stations, standard support facilities versus water-based support facilities. Spa menus such as variety of hydrotherapy and water-based treatments offered and the range of treatments practised. Spa industry trends relating to clients and products. Other findings include: The average spa treatment rate achieved by spas globally in 2008 was $90. Europe achieved the highest rate of $111 and Asia-Pacific received the lowest average rate of U$77. The average size of a spa facility is 788 metres and spas contain nine treatment rooms on average. Employees per spa average 22.9, with the Americas averaging the most (33.8) and Europe the fewest (13.6). Across the globe, the day spa guest has become a critical target market for hotel and resort spas with 38% of total spa visits at hotel spas coming from local residents and other tourists not staying at that hotel. In Europe and the Middle East/Africa, just 53% percent of hotel spa visits are from in-house guests. All regions are expecting decreases in average annual revenue per spa during 2009, however the outlook for 2010 is brighter with all regions expecting growth between 8% and 32%. Julie Garrow of Intelligent Spas states, "After eight years conducting spa industry research within the greater Asia Pacific region, we are thrilled to provide global statistics for this very essential industry. This type of business intelligence is ideal for anyone interested to learn more about the spa industry and is a vital reference for those responsible for the operational or financial performance of their spa or spa-related organisation." The Global Spa Benchmark Report incorporates a selection of results from Intelligent Spas’ Global Spa Benchmark Program. An unprecedented response of over 1270 validated spa businesses contributed to this report. Intelligent Spas is the only independent researcher specialising in spas, and the Global Spa Benchmark Report is for sale.

Intuition Communications, which runs leading online medical travel portal Treatment Abroad, has appointed In Malta Online Group - its first overseas franchisee - to operate the Treatment in Malta website. The new site will be aimed at inbound medical tourists to Malta. The In Malta Online Group currently operates a number of online services and has invested in the franchise to expand its range of Malta-based web portals into the healthcare market. In Malta Group is the first franchisee that Intuition Communication has appointed. The new web site will follow the successful Intuition business model, and reflect the branding and content of Intuition’s other medical tourism. Intuition Communication will work closely with In Malta Online Group, and will provide web technology, business development, marketing and operational support to set up the website and ensure its success, once it goes live. Keith Pollard, who runs Intuition Communication, said: Franchising our business model and brand is a logical step for us in expanding our business, particularly into overseas markets. We see this as an opportunity to grow our revenues by licensing our technology and business model to web businesses and healthcare operators in other countries who wish to develop health information portals or medical tourism content. Franchising will enable us to benefit from the use of local sales and marketing partners/franchisees to achieve these revenues. We are looking for partners who, like In Malta Online Group want to extend existing web businesses or set up new web ventures, while minimising the investment required to develop and set up such a site. Our franchise will offer them the expertise, knowledge and ongoing support to build a successful portal within the health information sector of their own country. Aside from its main UK portal, Intuition Communication already has a local Treatment Abroad website in Cyprus, Spain, India and Hungary. These websites are owned by the company itself.

The International Medical Travel Association (IMTA), the world’s first ever not-for-profit medical tourism industry association, has elected Ruben Toral as its new president, succeeding Steven Tucker, who remains on the executive committee. Toral is a recognised authority in medical tourism and healthcare globalization. Formerly group marketing director for Bumrungrad International, Toral was instrumental in positioning Thailand and Bumrungrad International as a leading medical tourism destination. Toral has more than 15 years’ experience in building healthcare brands, businesses and physician networks in Asia and Latin America. As chief executive of Mednet Asia he works with international hospitals, insurers, employers and information technology companies to develop global healthcare delivery networks. Originally from the USA, he now lives in Bangkok, Thailand. Toral said: IMTA already has a solid membership base that includes many of the world’s leading medical tourism destinations. My mission is to expand our association by focusing on core issues that drive worldwide medical travel. Medical travel continues to generate headlines as a cost effective option. As an association, we must help healthcare buyers understand that medical travel is not only a significantly less expensive option, but also, in many cases, a better one. Toral’s appointment is part of a larger initiative to re-energise and expand the IMTA. A new executive committee includes vice-president Vishal Bali of Wockhardt Hospitals, secretary Jason Yap of Raffles Hospital, and treasurer Mack Banner of Bumrungrad International. IMTA is a global organization of stakeholders in the international medical travel industry, representing leading healthcare providers, medical travel agencies and related industry service providers worldwide. IMTA supports the development of international industry standards and best practices that promote and advance medical quality, safety, and transparency for the international patient, and that preserve and protect the doctor-patient relationship. IMTA was founded in 2006 and now has 40 full members who all have an active involvement in medical travel. Although seeking to expand membership, it is not prepared to offer membership to companies with little or no involvement in medical tourism, purely to generate income. Although it sponsors and takes an active role in conferences on global healthcare and medical tourism, it does not see a need to be a conference organiser with a proliferation of conferences to produce income, which it does not need as all the executive are unpaid volunteers. The association believes that with patient safety at stake, accreditation standards and processes must be vetted by internationally recognised accreditation organizations and government agencies. It has opposed trade groups and others seeking income by declaring themselves as accreditors or certification authorities as it creates market confusion. IMTA advocates that all international hospitals and other healthcare institutions be held to high standards, whether through a country’s own regulatory system or through internationally accepted standards set by recognised accreditation authorities.

Attracting more foreign patients has become of primary interest to the Korean medical community. Korea has advantages in high-quality medical services at relatively low prices. That is why the Korean government is allowing hospitals to market themselves to foreign patients. Foreign patients travel to countries with different cultures and languages and entrust not only their health, but also their lives to doctors in another country. But Korean hospitals are squeezing medical tourism into existing premises. The international patient centre is often in annex, staffed by doctors and nurses who can speak foreign languages. Foreign patients experience problems communicating at Korean hospitals, which lack foreign-language signs. There is a debate between those who want to spread the fruits of medical tourism around, and those who think that service quality can only be achieved by foreigner-only hospitals. The standard of medical care is high, but deficiencies in other service areas means there is a chance that Korea may end up losing foreign patients in the long term, despite some early successes. Reports suggest that some hospitals have not understood that while domestic patients may be content with delays and poor service, in medical tourism, the customer is king.   Last month, the Korean Medical Association conducted a survey of ten hospitals out of the 44 largest hospitals across the country, which are keen on attracting foreign patients. It showed that only four of them have assigned doctors to handle foreign patients, so nurses often have to act as translators. The Ministry for Health, Welfare, and Family Affairs (MIHWF) and the Korea Health Industry Development Institute (KHIDI) have established a foundation to attract foreign patients; the Global Healthcare Service Association (GHSA). The GHSA will become a private corporation, help with domestic and international advertising to promote Korean healthcare, train hospital staff to deal with foreign patients, and prepare brochures on treatment fees for foreign patients.

Medical tourism, one of the main sectors of the national economy, has not been negatively affected by the global economic crisis, says the PHA. Private Hospitals Association (PHA) President Fawzi Hammouri said Jordan is ranked by the World Bank as number one in the Arab world, and among the top 10 in the world, as a medical tourism destination. In order to maintain this ranking, we have to keep the current markets in the Arab world and find new ones in Africa, Europe and the US. New markets have already been opened in Chad, Nigeria, Russia, Azerbaijan and Kazakhstan, while plans are in place to open markets in Germany, the UK and the US. The high quality and competitive cost of healthcare in Jordan have made the country an attractive destination for foreigners seeking advanced treatments that are unavailable or unaffordable in their home countries. The medical tourism sector annually generates over US$1billion in revenues and the number of foreign patients seeking treatment in the Kingdom stands at over 200,000 per year, said Hammouri The PHA encourages hospitals to get Joint Commission International accreditation. There are 61 private hospitals, 48 of which are PHA members and four have JCI status. The PHA is working with hospitals to offer medical tourism packages to Americans and Europeans who come to the country for medical services with unprecedented packages. Hammouri explains, We will provide them with packages that are 25 per cent below market prices. This includes the plane ticket, accommodation and a visit to Petra to encourage tourism as well. Prime Minister Nader Dahabi wants the Health Care Accreditation Council (HCAC), and Ministry of Health, to enhance efforts to attract more patients, especially from Europe and the US. HCAC hospitals responded that it would help if the government made medical tourism exempt from sales tax. HCAC was established through a joint initiative between the Ministry of Health and USAID/Jordan as an independent national hospital accreditor; whereby HCAC hospital standards are accredited by an International accreditor of healthcare accreditation organisation ISqua.

Official figures for 2008 revealing that less than 1,000 medical tourists, rather than the 100,000 plus that the country has regularly claimed, shocked Philippine authorities and hospitals into a rethink. Existing marketing has been all talk, little action and a total failure; so new ideas are needed quickly. The Philippine Convention & Visitors Corporation (PCVC), a non-profit marketing division within the Department of Tourism, has appointed agency DM9 to develop a campaign to attract medical tourists. This could include road shows, videos for websites and brochures. Another agency, Campaigns & Grey has a project from Makati Medical Centre, the country’s premier hospital, to market the hospital ahead of its 40th anniversary. The brief includes promoting Makati’s improved facilities and boosting its standing among other medical centres. The Philippine Economic Zone Authority (PEZA) is helping develop medical tourism with incentives to health and wellness spas, and hotels; the latter being vital to places like Cebu, as there room shortages. PEZA has so far accredited two hospitals, St. Luke’s in Taguig and Cabrini in Cavite. St. Luke’s at the Fort is a 600-room, 1,000-doctor facility built at a cost of P9 billion and will open in October 2009. St. Luke’s Medical Centre promotes itself by pointing out that the cost of a heart surgery at $10,000,is just a tenth of the $100,000 in the United States, and a third of what hospitals in Thailand, Singapore and Malaysia charge. The problem with cut-price offerings is that medical tourists are wary of prices that appear too low. The country will struggle until individual and national marketing understands why offering ultra-low prices backfires and scares potential customers away, and how other approaches are vital. The Cebu city government here has given money to the Cebu Health and Wellness Council to help promote Cebu and its local health-and-wellness centres, hospitals and resorts as an international player in medical tourism and wellness. Hospitals, clinics, hotels and travel operators that are partners of Cebu Health and Wellness will soon launch special packages for tourists where tourists can combine an executive medical check-up with a holiday. Cebu Doctors University Hospital in January received 60 overseas patients, compared to an average of 10 a month in 2008. The hospital now aims for 100 foreigners a month for the rest of the year. It has rolled out a project to build suite rooms to accommodate foreigners. Most patients are Europeans in need of outpatient procedures, executive checkups, gastrointestinal procedures and heart surgery, not the Americans that everyone talks about.  Cebu Doctors has new partnerships with hotels, travel operators and spas. The group sees Cebu as a top destination for spa and wellness, as an adjunct to medical services. The Medical City has opened a satellite office in Tamuning to ease the paperwork for patients from Guam who want medical treatment at The Medical City. All these projects are good, but the individual impact is small. What the country needs is for all those officials and politicians who have spent the last four years talking up how much they want medical tourists to come to the country, and making bloated claims on numbers, to spend money on proper marketing campaigns with selected targets, measurable results; combined with ensuring there are sufficient good quality hotels and hospitals to deliver the goods. Also, if the country wants American medical tourists, having just two JCI status hospitals is not enough.

It is well documented that thousands of Britons leave the UK every year for dental and cosmetic surgery, with a minority going for medical treatment. But global medical tourism is a two way process: travel into the UK for healthcare has existed for many years, well before medical tourism became a business.In the UK, although numbers are unknown, anecdotal evidence suggests that it is concentrated on hospitals with an international reputation, almost all being in London. Some private and NHS hospitals actively seek out international patients, whether self-funded, insured or paid for by their governments. Others passively accept the business that has come to them for decades. The UK is more expensive than Asia but cheaper than the US or Middle East. Great Ormond Street Hospital for Children trust is also looking to grow its international business both from Europe and further afield over the next few years. In the UK, HCA International owns six leading London hospitals; The Harley Street Clinic, The Lister Hospital, London Bridge Hospital, The Portland Hospital for Women and Children, The Princess Grace Hospital and The Wellington Hospital. Since the 1970’s many international patients have travelled to London for specialist patient care. The International Patient Centre (IPC) caters to the needs of patients from abroad, across all the hospitals. With offices in Kuwait, United Arab Emirates, Pakistan, Nigeria, Greece, Cyprus, Libya, Egypt, HCA offers an extensive network of access points for the medical tourist. HCA will also look for expansion in countries where high quality specialised medical services at an affordable price are needed. Other hospitals have already taken opportunities abroad. Moorfields Eye Hospital has a clinic in Dubai; Moorfields Eye Hospital Dubai has seen over 2000 patients since opening in July 2007 in Dubai Healthcare City. Moorfields currently treats a significant number of patients in the UK from the Middle East.

Although Malaysia is an Islamic country, tourists from the Middle East make Thailand and Singapore their choice of destination over Malaysia when it comes to getting medical treatment, said a top Malaysian official. Making this statement, Secretary General of the National Chambers of Commerce and Industry Malaysia (NCCIM), Datuk Syed Hussien Al-Habshee said the lack of effective marketing strategy was the reason for Malaysia being left behind the two countries in medical tourism. Although we have the clear edge in terms of religion, Muslim hospital staff, halal food and other aspects, Middle East tourists prefer to go to Thailand and Singapore. Due to this, the country continues to be left far behind the two neighbouring countries in the sector which is growing annually.’ He says that in 2008 6,000 medical tourists from the Middle East went to Thailand for various forms of treatment in the country’s hospitals. Syed Hussien argues that there is an urgent need for more integrated strategies from government agencies. The three ministries involved, namely the Ministry of Health, Ministry of International Trade and Industry and Tourism Ministry should have a strategy to promote and market Malaysia as a premier medical tourism destination, rather than leaving it all to the private hospital sector, he said. A recent study by the National University of Singapore shows that the process of transforming Malaysian healthcare into a global commodity is well under way. This is underpinned by the Government’s effort in institutionalising various incentives such as tax support, accreditation, sales promotion and marketing activities to promote the country as a healthcare hub. The report echoes Syed Hussein as it says that the initiatives are fragmented and that the private healthcare sector has been tasked to be the driver of medical tourism in Malaysia. Among the factors working to Malaysia’s advantage, are its cost-competitiveness compared to the regional and international markets, the good infrastructure, and the fact that English is widely spoken. It has highly-trained and skilled medical personnel, state-of-the-art diagnostic equipment, modern facilities, accreditation based on international healthcare standards, competitive cost of treatment, and excellent hospitality. Malaysian hospitals are known for their resources and expertise in cardiology, orthopedics, cancer treatment, fertility treatment, and reconstructive surgery. What it is poor at is integrated marketing, promotion and advertising. The private sector has 230 private hospitals and 4000 medical and dental clinics. 35 private hospitals have been recognised by the Malaysian Ministry of Health for the promotion of health tourism. As a step to promoting itself in the Middle East, The Ministry of Health and the Association of Private Hospitals of Malaysia (APHM) recently took ten leading providers of medical care, wellness, health tourism and healthcare technology to MSE 2009, a trade exhibition in Dubai, with a forum on ’Malaysia - Your preferred healthcare destination’. After achieving JCI status, Prince Court Medical Centre (PCMC) in Kuala Lumpur wants to become a leading healthcare provider in Asia and promote medical tourism, says chief executive Stuart Rowley,  "We are targeting the Asian region, Middle East and there is a lot of existing demand coming from Australia and New Zealand for medical tourism."

A Medical Travel Facilitator’s Professional Certification is now in development.  Unlike any other programme offered in the industry, it denotes that an agent with this certification has successfully demonstrated skills and mastery of the body of knowledge needed to coordinate patient care and travel arrangements for people who travel for medical treatments. The new programme is being offered by the newly established Council on the Global Integration of Healthcare (CGIH), a global organisation incorporated for the development and advancement of global health policy in medical tourism Through exams, case studies and field demonstrations, CGIH certification denotes ability to use the body of knowledge on medical tourism for practical application. The council’s purpose is to provide the largest and most comprehensive body of knowledge for medical tourism without being distracted by commercial enterprise or personal ego trips. Its executive board, advisory board and membership represent a cross-section of industry, private business, government and academia.  It is now recruiting members. CGIH certification has a three-step process. These are:    1. An applicant must submit a portfolio of information about his business history, professional liability insurance and business establishment, and professional references to demonstrate that he/she is actively engaged in the profession of medical travel facilitation.    2. The applicant studies for a written examination covering all core areas of the Body of Knowledge.  A passing score of 92 percent is required for certification.    3. To continue to Advanced Status and Fellowship, a third step is to select one project that will serve as the applicant’s thesis. This project may be completed as part of the applicant’s job or as a result of their training/education.     A peer review panel has to approve the subject and methodology of the thesis project and will afterwards be tasked to evaluate the finished thesis and the required oral presentation to be presented at the Annual Institute of the council. The council is enlisting the assistance of psychometrists who will validate the testing and metrics to ensure that the programme meets its professional development objectives. CGIH is now working with specialists on business law, travel planning and clinical information to author study guides, pre-test and final exams for self-directed courses. Course         Description 0010      Basic travel planning for medical travellers 0200      Understanding travel service terminology 0020      Medical travel facilitators and travel agents: role differentiation 0030      World geography refresher 0100      Understanding customs and visa requirements 0110      Introduction to international airline reservations 0120      Introduction to international connections for medical travellers 0130      Introduction to hotel accommodation reservations 0140      Introduction to ground transfer arrangements 0150      Counseling clients about trip interruptions and lost baggage 0160      Introduction to destination management services 0170      The role of the medical concierge 0180      Travel planning for clients with special dietary restrictions 0190      Travel planning for clients with mobility impairments 0210      Travel planning for clients with visual impairments 0220      Travel planning for clients with hearing impairments

Healthcare providers are not recession-proof, as the two major players in Singapore illustrate. At Raffles Medical Group, revenue continued to grow but the speed of growth has dropped. Parkway Holdings, the city-state’s biggest private hospital operator, suffered a seven to eight percent decline in foreign patients in 2008 and the pace of growth slowing. It successfully achieved revenue growth by targeting foreign patients in new markets, such as Bangladesh, the Philippines, Vietnam, Cambodia, Pakistan and Russia. The result is double-digit growth in revenue and admissions from these foreign patients at the Singapore hospitals. Parkway and Raffles are the two biggest private hospital groups in Singapore. Both have robust operating margins, brand equity and a more diversified patient base than a decade ago. Both groups have been taking steps to deal with the downturn in business. Parkway has cut headcount and slashed senior management salaries. Raffles has been keeping its staff costs stable and with a new international marketing head - Singapore Tourism Board healthcare services director Jason Yap, it appears to favour tackling the situation by increasing demand, particularly for the complex cases which offer higher average revenue per patient. Neither is sitting back and waiting for business, they are marketing in targeted countries, promoting high- value medicine rather than the low-cost approach of most rivals, and if people overseas will not come to them, are taking healthcare provision to them.   Raffles Medical Group has hospitals in Hongkong and representative offices in Indonesia, Vietnam and Bangladesh. ParkwayHealth has 15 hospitals around the region, including in Brunei, India and Malaysia. plus 45 International Patient Assistance Centres across the globe including Bangladesh, Brunei, Canada, China, Hongkong, India, Indonesia, Malaysia, Myanmar, Pakistan, Philippines, Russia, Sri Lanka, Thailand, United Arab Emirates, United Kingdom and Vietnam.

Healthcare accreditation specialist CHKS Limted has been acquired by the Capita Group Plc for £11.6 million (US$15.17 million). Used to be owned by Healthcare Knowledge International, CHKS provides healthcare intelligence and quality improvement services to healthcare organisations. CHKS employs around 80 staff who are based mainly in Alcester, Cardiff and London. CHKS pioneered the UK healthcare intelligence market with hospital benchmarking in 1989. Capita is the UK’s leading outsourcing company and operates in nine key markets, ranging from financial services to local government, and has a strong and growing presence in the health sector. CHKS has developed a range of solutions for over 400 healthcare clients in 15 countries, offering online healthcare performance and governance tools. One of the attractions for Capita was CHKS contracts with the NHS and its development of on-line accreditation programmes. The international hospital accreditation programmes are internationally recognised by ISQua (International Society for Quality in Healthcare) and certificated by UKAS (UK Accreditation Services) to award ISO 9001:2008 certification. The CHKS international accreditation programme has been designed to be adaptable to the local cultural, legislative and professional framework of the host country. Individual hospitals or healthcare organisations or entire countries can implement the CHKS programme. CHKS has accredited one hospital in Cyprus, two in Denmark,various British forces medical centres in Germany which are only for British troops, one in Gibraltar, four in Ireland, and ten in Portugal. It also certifies another ten to ISO standard In Cyprus, Italy, Portugal and South Africa. In the UK, another 50 hospitals and care homes are accredited or certified.

Much of what is written about medical tourism in the US and the UK makes the assumption that worldwide medical tourism depends almost entirely on Americans and Britons. Figures from several countries over the past year have proved that this is not true, as the main sources of business are Continental Europe, Asia and the Middle East. The number of Americans leaving the country is debatable. Despite major reports, there are no real figures around. Those desperate to sell their services to overseas hospitals and government bodies have a vested interest in using the largest figure possible. The once regularly used 250,000 has mostly been replaced by either 500,000 or 750,000. These are all conveniently big and nicely rounded up numbers. The higher figure came from Deloitte which last year suggested that by 2010 a massive six million Americans would go overseas. The real truth is that these are wild guestimates with no statistical backing. No advocate of any version has ever cited a believable source. They have become medical tourism folk tales. There is some evidence that the number of Americans going overseas is growing slowly, but particularly with US healthcare reform, the giddy heights of six million is now pure fantasy. Deloitte’s report entitled Medical Tourism: Consumers in Search of Value also estimated that in 2008 over 400,000 people came into the US for medical treatment, and that numbers were growing. A much faster growing trend, but as yet with no statistics, is domestic or internal medical tourism where Americans travel within the US for medical treatment. For one, Healthplace America offers self-insured employers access to a specialty network of 31 US hospitals and clinics. It has signed contracts covering a total of 600,000 workers at companies since January 2008. Chief Executive Ken Erickson said he expects the contract total to hit US$1.3 million by the end of this month and 1,500 employees to use the network in 2009. Erickson said Healthplace America’s network can offer self-insured savings of 30 to 50 percent over rates negotiated by traditional insurers because the company pays the providers up front in cash based on fixed per-case rates. Typically, insurers pay providers after the surgery has been done. Other agencies now offer similar services, but individuals paying for their own treatment tend to deal direct with hospitals, which is why estimating numbers is so difficult. Uninsured Americans are shopping around for surgery in the US in record numbers, and using new services such as Healthbase, one of several medical tourism agencies that are either offering the US as an option, or see so much potential in inbound that they have followed Healthplace America in ceasing to offer treatment overseas. Meanwhile, Florida medical facilities actively, if quietly, market to attract overseas business. Many offer special services geared toward foreign customers with international services divisions that help patients with everything from applying for tourist visas to scheduling airline reservations and hotel stays. Miami Children’s Hospital, for example, has negotiated special hotel rates for its international patients and their families. In Jacksonville, Mayo Clinic Florida draws between 1,400 to 1,500 international patients each year with very little marketing. Much of the international patient traffic results from relationships that Mayo cultivates with physicians around the globe. Last October, the Mayo Clinic opened an information office in a large medical office building in Guatemala, a country from which it receives a large number of patient referrals. Baptist Health South Florida treats 12,000 foreigners each year, many from the Caribbean. The Laser Spine Institute in Tampa is aggressively marketing laser surgery, so now 70 percent of the facility’s customers come either from foreign countries or other US states, which would be 4,000 people in 2009. American hospitals, clinics, tourist boards and cities are all starting to actively market their service to patients from overseas or other states at a much faster pace than Deloitte envisaged last year. By the end of 2009, inbound and internal medical tourism in American could together outnumber outbound.

PROMED or the Council for the Promotion of International Medicine was recently created in Costa Rica with the aim of making the country into a medical centre of excellence within 10 years. The group, whose 21 members include hospitals, medical tourism agencies, was formed to raise the below-par country. Costa Rica is an increasingly popular destination, particularly for Americans. But there are only a few hospitals and clinics servicing medical tourists, and organisations marketing the country have not been working together. Reports from the Costa Rican Institute of Tourism ((ICT) say that the country’s cosmetic surgery maintains a 15 percent growth rate and that in 2007 Costa Rica helped 5,000 patients in search for the best healthcare solution. This means 2009 will see 6,500 medical tourists. The organisation does not say where they come from, but other industry sources suggest that the main source is not North America but Europe, Mexico and Central America. The ICT says that there are two niches; one is "health tourism" for people who want skin treatments, mud baths and other treatments in mountain hotels and spas. The other is medical tourism’ at private hospitals and clinics where the country has attractive prices. In the US, a heart bypass is US$100,000, but in Costa Rica is US$25,000. One problem that has restricted growth of medical travellers from the US is that few hospitals have international accreditation. Two have JCI status, Hospital Cima - San José and Hospital Clinica Biblica in San Jose. The only other one known to be seeking JCI is the third of the big San Jose hospitals, Hospital La Catolica. A new Cima hospital in Guanacaste for 2011 is also expected to join this small group. Cima is part of the International Hospital Corporation (IHC) with hospitals in Brazil and Mexico.

A website that offers information mainly to UK and Ireland residents seeking treatment in the UK, Ireland, Europe and elsewhere, suggests that fewer people are going abroad for treatment. RevaHealth.com is a healthcare search engine with information about 60,000 clinics in the UK and Ireland and thousands more in 50 countries around the world. It suggests that the number of Britons looking for health treatment abroad has dropped by over 40 percent in the past six months. But it also says that numbers leaving the UK for treatment has fallen by almost 20 percent between February and March. So if the six-month drop is 40 percent and the monthly drop under 20 percent, then this can either be read as a sign of a continuing fall, or that the fall has dropped by half, which suggests there is a recovery. A truer comparison would be March 2009 compared to March 2008. It is important to factor in that medical tourism does have seasons, that the site traffic for March is over 30 percent higher than February, and that half the site’s business is in domestic health care not medical tourism, so there is no way of knowing if the extra traffic is predominantly people seeking domestic healthcare or the same mix as before. Caelen King of RevaHealth comments, While putting off cosmetic dental and plastic surgery procedures might seem like the prudent thing to do in a bad economy, there are still lots of money saving options open to savvy customers. Due to the downturn in the economy, many clinics abroad are lowering their prices, making the potential savings even greater. Countries like Hungary, Turkey and even Thailand offer UK patients high-quality treatments like tooth whitening, breast implants and liposuction for less. Before getting carried away in an excess of gloom and doom or excitement about a recovery, it is vital to appreciate that the figures are purely the number of people looking for information on a website, not real figures of the numbers of people who are or have been or will actually go overseas for treatment Philip Boyle of RevaHealth adds: The number of enquiries we are getting for cosmetic surgery continues to grow faster than our traffic, with the number of enquiries from the UK jumping by over 58 percent from February to March.   Company figures for March 2009 are different from what other medical tourism sites may show as a large proportion of general searches and enquiries passed on to clinics are for people in the UK and Ireland looking for treatment at home The number of people in the Republic looking for dental treatment in Northern Ireland increased by nearly 75 percent in February. Tax relief in Ireland was recently lowered from the higher rate of 41 percent to the standard rate of 20 percent, making expensive work even more costly for many patients. Caelen King said: "Our research clearly shows that Irish patients are choosing to shop around for dental treatment, and going across the border to Northern Ireland is an increasingly popular option.’’

At the first Latin American Medical Tourism Congress in Monterrey, Mexico, the opening address to the audience was to announce its cancellation as a preventative measure to minimise the spread of swine flu.

Rigid rules on medical advertising have placed Malaysian doctors and hospitals at a disadvantage in global medical tourism. This is a stark contrast to doctors and medical institutions overseas, whose websites include virtual tours of hospitals or clinics and testimonials from their patients. Conservative local doctors argue that advertisements have nothing to do with medical skills or treatment but, in the real world, branding and promotion are inevitable. Health Minister Datuk Seri Liow Tiong Lai wants it both ways. While he claims his ministry will do its best to help promote medical tourism, he is firm that any form of advertisement should not breach the medical code of ethics. Less than three years ago, the Malaysian Medical Council (MMC) lifted the advertising ban imposed on registered medical practitioners. Unlike doctors in some foreign countries who can pose on their websites to promote their services, Malaysian doctors are only allowed to put up tiny photos with their names, qualifications, job titles, telephone numbers and places of practice in any form of advertisement. The Health Ministry’s Medicine Advertisements Board (MAB) must approve all medical advertisements, including websites, in advance. Over the years, there have been many complaints over the rigid guidelines on such advertisements. Advertising agencies too, are controlled, actual copies of advertisements must be submitted to the board for approval and no changes are allowed to the copy after approval. MAB’s control has also stopped the advertising industry offering foreign advertisements. Even healthcare facilities and medical tourism agencies wanting to advertise in the media in Malaysia, or use advertorials, are not allowed to actually name the healthcare facilities. No one will pay to advertise if they cannot name the hospitals, the types of treatment available or the list of medical specialists. Even advertisements on medical tourism in other countries must get approval, and only general information is allowed, not specific promotion on healthcare facilities or hospitals. Overseas healthcare facilities and tourism organisations are now advertising in foreign magazines which are on sale in Malaysia, and untouchable by the MAB, but Malaysian doctors and hospitals fear that if they advertise in these magazines, the MAB could bring charges of breaching the medical code of ethics. Malaysian Medical Association (MMA) president Dr Khoo Kah Lin would rather be a little conservative than over-advertise. He feels that the Malaysian Medical Council (MMC) and the healthcare industry can always discuss ways to make medical tourism more attractive, and that some doctors have a tendency to make excessive claims to boost medical tourism. Malaysia is not the only country to impose strict guidelines on medical advertisements. In China, advertisements on hospitals and doctors also need prior approval from the Ministry of Health and the State Administration of Industry and Commerce. Hospitals are discouraged from advertising and applications rarely get approved. Dental and cosmetic surgeries do openly advertise, while private hospitals opt for advertising on public transport such as buses and metro trains. The law in China has been tightened so only basic information on medical organisations like the name of the hospital, address, type of treatments and business hours are allowed. Many private hospitals want to highlight the types of treatment they offer, rate of success and rate of complications for each and every type of treatment. Putting up such information is a form of transparency that allows patients to choose. In Thailand, private hospitals advertise their range of services but avoid naming their doctors or specialists. To avoid any violations of rules, some even present their advertisements to the Thai medical council for review and approval. Like in Malaysia, medical practitioners are not allowed to stake claims, using superlatives like world-class, world-renowned or best in their advertisements. They can only list the types of services available. Syed Hussien of The National Chamber of Commerce and Industry of Malaysia (NCCIM) wants the Ministry of Health to set up a health tourism promotion council to promote and market Malaysia as a premier medical tourism destination. He argues that there are overlapping roles in promoting medical tourism by three ministries; health, international trade and industry and tourism. He argues that lack of effective marketing strategy means Malaysia has lagged behind Thailand and Singapore in this sector. A Medical Tourism Board will be set up in Penang to help promote its hospitals overseas, said Health Minister Datuk Seri Liow Tiong Lai.He added that hospitals in the state would contribute to support the board that would then run campaigns abroad to attract medical tourists. By avoiding detail on how this would work, he was saved from trying to explain how a campaign with rigid advertising restrictions would work. It appears that you can only advertise Malaysian medical tourism with adverts that are so bland as to be ineffective. The message from Malaysia is a clear warning to other countries. If you want a strong medical tourism industry, the various government bodies must work together, not against each other. With ever more countries and hospitals competing for foreign patients in a much tougher market than 2008, don’t blame the recession or hospitals if advertising controls, poor marketing, or other factors which governments have control over, cause your country to get fewer medical tourists than you expect.

With the growth in the number of medical tourism providers, quality standards become all the more important. To demonstrate their commitment towards quality some international healthcare organiSations choose to be accredited by the US based Joint Commission International (JCI). JCI accreditation has gained worldwide attention as an effective quality evaluation and management tool. A JCI hospital is an international hospital outside of the United States that has been accredited by the Joint Commission International. The year 2008 was another dynamic one for JCI accreditation. At the end of 2008, there were 242 JCIaccredited organisations in 35 countries, and some have already been added in 2009. JCI surveys were conducted in 24 different countries in 2008, including Austria, Brazil, China, Costa Rica, Czech Republic, Denmark, Egypt, Germany, India, Ireland, Italy, Israel, Jordan, Malaysia, Mexico, Portugal, Saudi Arabia, Singapore, Spain, Switzerland, Taiwan, Thailand, Turkey and the United Arab Emirates (UAE). Israel, Portugal, and Switzerland are new to JCI accreditation. The following organisations were awarded the status of accredited or certified following an initial or triennial survey during 2008: Al Essra Hospital, Amman, Jordan Al Noor Hospital, Khalifa Street, Abu Dhabi, UAE Alexandra Hospital, Singapore American British Cowdray Medical Center IAP Observatorio Campus, Mexico City, Mexico American British Cowdray Medical Center IAP Santa Fe, Campus, Mexico City, Mexico Antalya Hospital - Medical Park Healthcare Group, Antalya, Turkey Apollo International Hospital Bangalore, Bangalore, India Apollo Hospital Dhaka, Dhaka, Bangladesh Aut Even Hospital, Kilkenny, Kilkenny, Ireland Bahçelievler Hospital - Medical Park Heathcare Group, Istanbul, Turkey   Bangkok Hospital Medical Center, Bangkok, Thailand   Beacon Hospital Cancer Center, Sandyford/Dublin, Ireland   Bursa Hospital - Medical Park Healthcare Group, Bursa, Turkey   Centro Hospitalar do Alto Ave, EPE Unidade de Guimarães, Guimarães, Portugal   E-DA Hospital, Jiau-Shu Village, Taiwan   Göztepe Hospital - Medical Park Heathcare Group, Göztepe, Istanbul, Turkey   Ha EMEK Medical Center, Clalit Health Services, Afula, Israel   Hospital CIMA Hermosillo, Hermosillo, Sonora, Mexico   Hospital CIMA Monterrey, San Pedro Garza Garcia, Mexico   Hospital de Câncer II INCA, Rio de Janeiro, Brazil   Indraprastha Apollo Hospital, New Delhi, India   Institut für Medizinische und Chemische Labordiagnostik, Villach, Austria   International Medical Center, Jeddah, Saudi Arabia   King Faisal Specialist Hospital, Jeddah, Saudi Arabia   King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia   King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia   KK Women’s and Children’s Hospital Pte. Ltd, Singapore   Magrabi Eye and Ear Center, Dammam, Saudi Arabia   Mater Private Healthcare, Dublin, Ireland   Meir Medical Center, Clalit Health Services, Kefir-Saba, Israel   Min-Sheng General Hospital, Tao-Yuan, Taiwan   Mount Carmel Hospital, Dublin, Ireland   Mouwasat Hospital Qatif, Saudi Arabia   Prince Court Medical Centre, Kuala Lumpur, Malaysia   Raffles Private Hospital, Limited, Singapore   RAK Hospital, Ras Al Khaima, UAE   Riyadh Care Hospital, Riyadh, Saudi Arabia   Saad Specialist Hospital, Al Khobar, Saudi Arabia   Samitivej Sriracha Hospital, Sriracha/Chonburi, Thailand   Samitivej Sukhumvit Hospital, Bangkok, Thailand   Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia   Sema Hastanesi, Dragos/Maltepe, Istanbul, Turkey   Sheikh Khalifa Medical City, Abu Dhabi, UAE   Sonderkrankenanstalt für Rehabilitation, Thermenhof GmbH, Villach, Austria   Soroka University Medical Center, Clalit Health Services, Beer Sheva, Israel   Sports Surgery Clinic, Dublin, Ireland   Sultan bin Abdulaziz Humanitarian Center, Riyadh, Saudi Arabia   The Specialty Hospital, Amman, Jordan   Total Care AMIL Berrini, São Paulo, Brazil   Total Care AMIL Unidade Barra da Tijuca, Rio de Janeiro, Brazil   Tungs’ Taichung MetroHarbor Hospital Wuchi Campus, Taichung, Taiwan   UPMC Whitfield Cancer Centers, Waterford, Ireland   Wockhardt Hospital Bangalore, Bangalore, India JCI hosted two Executive Briefings in 2008. The first was held in Singapore, and the other in Berlin, Germany. Ninety-nine participants representing both accredited and non-accredited healthcare organisations attended. A new optional hospital tour activity was offered the day following each briefing at an accredited organization. The two participating organizations were Tan Tock Seng Hospital, Singapore and DRK Kliniken, Berlin. Each tour highlighted activities the hospital has used to implement the third edition of the International Accreditation Standards for Hospitals. The focus of the tour was patient safety as it pertains to medication use and infection prevention and control.

The International Association of Medical Tourism (IAMT) is a new non-profit organisation, based in New Jersey, USA, committed to offering wellness services to healthcare seekers worldwide. It is a coalition of hospitals, doctors, healthcare service providers and volunteers. It arranges care for patients, who are association members, but takes no fee as the patient pays the hospital direct. IAMT aims to offer a range of benefits to member healthcare providers, insurance companies and agencies. The founders have been long time volunteers in various international humanitarian activities. Volunteerism is the base of the organisation. A number of IAMT professionals and associates provide honorary services as volunteers. There are membership fees, a minimal part of which will go towards administrative expenses and the rest will be used for a ’Donate a Surgery’ programme. IAMT seeks to provide an unbiased source of information for patients, insurance companies and employers about top hospitals and their quality of care. The organization aims to offer medical guidance, treatment, and assistance to the uninsured, under-insured and anyone within the US in need of additional resources. A key aim is to offer international patients the power to choose by providing information about doctors and hospitals, enabling them to make informed decisions. Founder and president Naresh Jadeja said: We can help them. We will provide information about these facilities and detailed avenues from whom to seek help. No one should have to compromise with their health. You meet so many people and you hear so many stories about somebody who couldn’t pay for that knee-replacement surgery or a cancer patient who was denied treatment for some reason or the other. But there are several reputed hospitals even within the US and overseas which offer affordable treatment options to the uninsured and the under-insured. Jadeja told IMTJ: Our healthcare awareness campaign will provide information for all destinations including US, Europe, Canada, Latin America, and Asia-Pacific. There are medical tourism associations other than IAMT but every organisation has its own set of goals, values and mission. Our initial focus is Americans but we want to be worldwide.   It has already opened a regional office for the Asia Pacific region to provide information about US and Europe hospitals to patients in Asia Pacific countries. It will also oversee all logistic operations of IAMT in India, Singapore, Malaysia, Korea, Thailand, China, Hong Kong, UAE, and the Philippines. Businessman N.D Rana is the regional president. It plans to run conferences in 2010 in Mumbai, India and Newark, USA, both with a focus on Asia.

The Indian tourism ministry is finalising a scheme where a medical tourist visiting India will be offered an additional treatment free. It aims to launch in April and continue through the rest of 2009. The scheme will be part of the schemes implemented by the government to increase foreign tourist arrivals in the backdrop of the global slowdown, and the drop in visitor numbers following the terrorist attacks of 2008. The ministry is in advance discussion with major hospital chains including Apollo, Manipal, Moolchand, Fortis and Wockhardt to offer the complementary treatment. Now, foreign medical tourists will be offered one additional treatment for free. Almost all major hospitals have expressed their interest in partnering with us, said tourism secretary Sujit Banerjee. A patient coming for a bypass surgery could be offered a complementary skin treatment or something similar according to the patient’s preference. Foreign tourist and medical tourist numbers visiting India has been dropping since November. Arrivals picked up slightly in February, thanks to various promotional schemes launched by the government along with airlines, tour operators and hoteliers. Under the existing promotional scheme, a companion of a foreign tourist gets free air passage provided they fly with Jet Airways, Kingfisher or Air India. The tour package also provides extended stay in spas and hotels across the country. The measures are part of the government’s ’Visit India 2009’ plan. The bookings under the proposed scheme beginning this month will continue till the end of the year. The tourism ministry has set a target of doubling the number of foreign tourists arrivals to the country by the end of 2010. It has launched road shows in various source countries including US, UK, Canada and Australia to increase the number of visitors. Whether the measures will work is debatable. If having a heart operation, you are unlikely to care about a free cosmetic treatment. At a recent major health conference, Dr Naresh Trehan highlighted the importance of medical tourism, and India’s potential for it. He also mentioned problem areas that are more vital than a two-for-one promotion. Areas that restrict the growth of medical tourism to India include hygiene, visa procedures, pollution, medical regulation and political unrest. Dr Trehan painted a picture of the potential, but warned that India had a long way to go to achieve success.

Alpine Center and healthCare cybernetics (hCc) in Greece have joined forces to introduce a health-tourism study course to students from 30 different countries at the campus of this Swiss Business School for Hotel & Tourism Management Education. It groups medical tourism into eight segments: medical, dental, spa and thalassotherapy), wellness, sports, culinary, accessible, and assisted residential tourism. Dr. Constantine Constantinides, hCc’s owner, will teach the course. Constantine Constantinides informs us that a health tourism-related MBA will soon be launched. The school launched a new two-year course in spa management in 2008. Alpine Center has for two decades been a leading hotel and tourism management school in Europe and a leader in developing and offering quality, cutting-edge programmes of study. It will also host the International Health Tourism Research Institute whose mission includes conducting industry and market research by academic staff members and supervised students. Research results and findings will be published in both academic and industry journals. healthCare cybernetics (hCc) provides knowledge, analysis and strategic thought on healthcare.  Based in Athens, it plans to move to Dubai, but retain an Athens base for projects.

In July, American publisher Healthy Travel Media and the Association of Private Hospitals of Malaysia (APHM) will launch Patients Beyond Borders: Malaysia Edition, published in English for international distribution. Produced in collaboration with Malaysia’s Tourism Ministry and supported by hospitals and related private organisations, the 240-page guidebook will feature Malaysia’s 20 plus international hospitals, selected health travel agents, nearby recovery and guest accommodations, and area travel information. The majority of medical tourists come from Indonesia, Singapore and Bangladesh, but Malaysia also attracts medical travellers from the US, Canada, UK, and Australia. APHM members in the book include: Gleneagles Intan Medical Center Gleneagles Medical Center Penang National Heart Institute KPJ Healthcare Group NCI Cancer Hospital and Specialist Clinics Pantai Hospital Group. Penang Adventist Hospital Prince Court Medical Center Sime Darby Medical Center Subang Jaya Sunway Medical Center. APHM represents more than 100 private hospitals and medical clinics approved and licensed by Malaysia’s Ministry of Health. Of those, only around 30 private hospitals are directly involved in medical tourism. Healthy Travel Media and the Accredited Hospitals Association of Turkey (AHAT) will launch Patients Beyond Borders: Turkey Edition, to be published in English in late 2009. Supported by Turkey’s leading healthcare facilities, the 280-page guidebook will offer an in-depth overview of Turkey’s leading American-accredited hospitals, selected health travel agents, accommodation, and essential medical travel information. The book will include details of fully accredited Turkish hospitals catering to the international patient. The main nationalities going to Turkey are German, American, Dutch, British and Japanese. Turkey increasingly gets patients from Belgium, Azerbaijan, Russia, Bulgaria, Romania, Kosovo and Syria. Turkey also specialises in long-term care for elderly patients from Norway, Sweden and Denmark. The Accredited Hospitals Association of Turkey was established in January 2008 to coordinate the activities of hospitals throughout Turkey and deliver world-standard healthcare by creating collaboration among hospitals, patients, universities, and related organisations. It also encourages hospitals to maintain the highest standards of quality and attain international accreditations. AHAT members in the book include: Acibadem Healthcare Group Anadolu Medical Center Bayindir Hospital Florence Nightingale Hospitals Güven Hospital Hisar Intercontinental Hospital International Hospital Kent Hospital Memorial Hospital Mesa Hospital Yeditepe University Hospital Print and electronic versions will be available through retail outlets worldwide, Amazon and other online retailers, and through the relevant associations.

Polish private medical institutions have joined forces to jointly promote the medical services provided in Poland on the international market. Dozens of clinics have set up a medical organization called Medical Tourism Chamber of Commerce(IGTM), based in Gdansk. It seeks the support of the government and local governments, the tourism industry, the representatives of Poland abroad and foreign countries in Poland. IGTM seeks to target German, Scandinavian and British patients as dentistry and cosmetic surgery in Poland cost far less than in many older EU countries, around half the price. According to IGTM’s data there are dozens of Polish clinics specializing in services for foreigners and Polish clinics not only compete with their western counterparts in terms of prices, but also the quality of services, which has improved vastly in the past decade.

Taiwan has begun promoting its medical tourism industry to potential visitors from Mainland China. Taiwan Health, a high-end clinic funded by a Mainland China-based Taiwanese entrepreneur, will open an office in Guangzhou in June. It will serve as a centre for Mainland patients seeking health checkups or cosmetic surgery in Taiwan. The clinic has signed cooperation agreements with 10 private Taiwanese hospitals to act as a medical tourism agency to refer patients to them. Taiwan Health is working closely with the Taiwan External Trade Development Council (TAITRA). TAITRA has been tasked by the government with promoting Taiwan’s medical tourism industry. TAITRA wants Mainland Chinese travel agents to arrange for Mainland Chinese patients to see parts of Taiwan during their stay. Two market appraisal groups, each consisting of between 30 and 50 potential clients, will arrive in Taiwan before June. Compared to other Asian countries, TAITRA argues that Taiwan is geographically closer to China and enjoys several other advantages, including a common language and highly skilled medical personnel. Medical tourism is seen in Taiwan as more recession-proof than regular tourism, and it generates more revenue per visitor. So far, Taiwan’s efforts to attract medical tourists have focused on nearby markets, such as Japan, where the population is rapidly aging, and mainland China.

Texas-based US Risk Underwriters has launched a new professional liability product for the medical tourism industry called MedTour Pro for Employers. This and related MedTour products only cover treatment outside the US for US-based travellers, agencies and employers. MedTour Pro for Employers is designed for US companies that provide freedom of choice to their employees, including an option to obtain medical services abroad. The coverage is for damages caused by any actual or alleged negligent act, error or omission by the insured while providing options for medical tourism services. MedTour Pro for Employers is written by reputable insurance companies on a claims-made basis, with limits offered at US$1M, and a minimum premium of US$5,000. While MedTour for US-based medical tourism agencies offers a range of limits and a minimum premium of US$2,200. The cover is designed to respond to employers’ needs whenever they are sued for any wrong-doing that is involved with administration of medical travel benefits. MedTour Travel and Medical Complications is a travel policy plus non-negligent trigger coverage that pays out when there is a complication without having to assess negligence. This is not available for individual purchase and can only be bought by an employer or a medical tourism agency. The travel and medical complications package can either be automatically included in the agency fees, or offered as an option to customers. The first-known sale is to an American who went to Trinidad for cancer surgery, arranged by Mobile Surgery International (MSI).

Plans have been agreed to upgrade and develop health facilities in Ghana and make it the medical centre of excellence in the West Africa Sub Region. New equipment is being bought to refurbish all health facilities to help ensure quality healthcare delivery for people in the country and beyond. Dr George Sipa Yankey, Ghana Minister of Health, said the Central Regional Hospital on the Cape Coast will be developed into a medical tourism centre and further extend its quality services to neighbouring countries. Central Regional Hospital will soon be upgraded into a teaching hospital for the University of Cape Coast (UCC) Medical School to ensure excellent and quality healthcare is accessible for all people in the region. Meanwhile, Vision3, a strategic alliance formed between Gulf Finance House, Ithmaar Bank and Abu Dhabi Investment House, has signed a deal with the Moroccan government to develop a US$1.8 billion mixed-use health resort over a massive 270-hectare area in Essaouira. Mohammed Boussaid, Moroccan minister of tourism, said: The project will not only help develop the health and wellness sector in the Kingdom of Morocco, but also help promote health tourism.

In its second annual study on healthcare trends, Deloitte finds a favourable shift towards intra-bound medical tourism among Americans who would consider seeking treatment in another US city than going abroad. The results of the 2009 Deloitte Survey of Healthcare Consumers are vastly different from the previous year’s, which showed that Americans would consider travelling overseas for treatment - particularly if they can achieve 50 percent savings on international-standard healthcare. In this year’s results, 43 percent of the 4,000 Americans aged 18 and above say they are prepared to travel out of their local area to undergo a test, procedure, or treatment if it would cost 50 percent or less than when done in their home city. In fact, eight percent have travelled for care outside of their local community as medical tourists. However, out of local area does not automatically mean going overseas. Only one percent say they have gone abroad for treatment, a similar result to 2008. But while last year’s study said 40 percent would consider treatment abroad, the figure plummets to 10 percent for the 2009 survey. The results for 2009 also vary by category. Among uninsured patients, 20 percent would consider medical tourism. Receptivity to medical tourism is highest among younger adults at 10 percent to 12 percent, compared to only six percent for seniors. The most surprising low figure is from baby boomers at only seven percent, a figure that will disturb hospitals, agencies and self-appointed experts who have long argued that this generation is the key target American market for medical tourism. Other useful data from the Deloitte study are:     As healthcare reform heats up in the White House, nearly 40 percent of US consumers have expressed discontent with the status quo.     In addition to skipping or delaying care, the high cost of healthcare is prompting many consumers to switch physicians, prescriptions or health plans to save money.     Fifty-three percent would like employers to be required to provide health insurance for employees     Thirty-seven percent favour a mandate requiring every American to obtain health insurance either through direct purchase or through an employer or government programme. The findings suggest that a growing number of consumers wants to be actively engaged. They see variance in service, quality and costs. They are comparing doctors, hospitals, medications, devices, health plans and self remedies. They are exploring alternatives to conventional approaches and spending money to achieve their health goals. Paul Keckley, who oversaw the report for Deloitte Center for Health Solutions, said: The current economic climate is taking a toll on American consumers prompting them to increasingly make decisions about healthcare that are married to their pocketbooks. Consumers want a bigger say in their healthcare decisions. More than half believe that 50 percent or more of the dollars spent on healthcare in the US are wasted. The time for healthcare reform could not be more pressing. For the medical tourism industry there are clear messages. For every American who has gone overseas for treatment, eight have already become medical tourists within the US. The promise of healthcare reform has cut in half the number of patients who would consider going overseas. The key target market is not the baby-boomers with time on their hands who can combine overseas medical treatment with a holiday, but younger generations who are time and cost pressed by work and family commitments. Although one report is not conclusive in itself, it suggests what IMTJ has long-argued: that medical tourism combining holidays with treatment is only a small part of the global medical and health travel business - where people go abroad for a vast range of reasons from complex surgery down to spa treatment. Countries, agencies and hospitals promoting the beaches, safaris and tourism as equal to the medical treatment, may have to rethink their advertising and marketing if they want business. As cash gets tighter, people go for the treatment, not the tourism.

About 370,000 foreigners sought medical treatment in Malaysia in 2008, according to health minister Datuk Seri Liow Tiong Lai. Over the years, the country’s medical tourism industry has registered annual growth of 30 percent. The minister spoke at the awarding of the Joint Commission International’s (JCI) hospital accreditation to the Prince Court Medical Centre (PCMC) in Kuala Lumpur. "Being accredited, especially by an international body, would certainly help in benchmarking the quality services provided by the hospitals. The rapid uptake of accreditation activities by hospitals in Malaysia is testimony to the ministry’s commitment to ensure that healthcare is provided in a safe and effective manner to all our clients, local or from overseas. Our own home-grown hospital accreditation body, the Malaysian Society for Quality in Health (MSQH), has been awarded this coveted international accreditation by ISQua. Thus, the standards set by both JCI and MSQH are of international stature." Besides PCMC, the Penang Adventist Hospital and the International Eye Specialist Centre in Kuala Lumpur also have JCI accreditation. The Institut Jantung Negara is also working towards it. For the MSQH, 113 hospitals have been surveyed. Sixty five government and 18 private hospitals have received the accreditation. MSQH was formed by the Ministry of Health Malaysia (MOH), Association of Private Hospitals of Malaysia (APHM) and the Malaysian Medical Association (MMA). Only 35 of APHM’s 111 member hospitals are involved in medical tourism and they are the source of Malaysia’s medical tourism figures. APHM offers a range of medical tourism packages and sets recommended fees for medical tourism hospitals Rhe PCMC expects health tourism to contribute 30 percent of its revenue for the financial year ending March 31, 2010 Said PCMC chief executive Stuart Rowley: "Overseas patients can save up to 60 percent [in their medical cost]. We have 300 beds but only use 85.It does not make sense to use all, but we aim to do so within the next 12 months." Dr Mubbashir Iftikhar, chief executive of Malaysian medical tourism agency Wellness Visit, noted: Malaysia’s excellently maintained healthcare providers are certainly as good as their counterparts in Singapore and Thailand. Malaysia is as competitive in cost as Thailand and much superior in terms of healthcare providers, healthcare infrastructure, English-speaking staff, foreign trained specialist doctors, and strict government rulings on maintaining high standards of healthcare delivery systems. Malaysia is as competitive as Singapore in the quality of healthcare with its world-class hospitals and clinics, world-class renowned surgeons and doctors. Furthermore, Malaysia is offering services at costs less than Singapore. Singapore is no match to Malaysian costs for healthcare.

Cosmetic Harmony, one of the leading medical tourism agencies in Colombia, launched an affiliate marketing programme to boost the number of foreign patients coming into the country. When a customer arrives at our website via one of our affiliated websites and purchases any one of our cosmetic surgery procedures, the affiliate will get a US$100 commissions. All commissions are paid in every 30 days, said Anthony Giudice of Cosmetic Harmony. Based in Bogota, the company has offices in Miami, Florida and Panama City. Although Americans are the main market, it has served clients from all around the world, including the UK, Canada, New Zealand, Ecuador, Brazil, Netherlands, Panama and the Caiman Islands. Colombia is a country with great potential for health tourism. The professionalism of Colombian doctors and specialists is recognised around the world. In Pablo Tobón Uribe Hospital, 122 foreigners have been cared for in the past five years, patients who come seek treatment for illnesses related to orthopedics, urology, internal medicine and cancer. While the country is targeting medical tourists in certain medical specialties, including ophthalmology, orthopaedics, ear-throat-nose, and vascular surgeries, the main reason Americans and others go to Colombia is for cosmetic surgery which costs much lower than in the US. Meanwhile, the Government is about to close a tender with a design consulting firm that will allow the country to promote its health facilities to the international market. This is needed, as until now, marketing from local agencies and hospitals has been sporadic and of variable quality. Economic downturn and recession have caused many anxious Americans to put major purchases on hold. But they don’t wait for an economic upturn when looking for alternative medical treatments overseas. People who are putting financial decisions on hold until the economy recovers could be waiting a very long time," Guidice pointed out. Although Colombia is a much safer place than a few years ago, it still has problems. The UK’s Foreign and Commonwealth Office warned: Though the overall security situation in Colombia has improved considerably in recent years, the threat of terrorism is still high in many parts of the country.  A bomb attack in Bogotá last January 27 killed two people and injured at least 20 others.  Attacks can be indiscriminate, including in places frequented by expatriates and foreign travellers, and in the vicinity of government buildings and military establishments. Although Bogotá is much safer than outlying areas.

State-licensed clinics and hospitals are now allowed to directly seek foreign patients as part of South Korea’s efforts to become Asia’s new medical tourism hub. Hospitals were barred from directly advertising for patients or accepting them through dedicated referral services. Lee Young-ho, marketing director of the Global Healthcare Business Center, said: We expect about US$221 million in revenue this year in this sector, which will grow fast amid our aggressive overseas marketing. We expect more than 40 local travel agencies and hundreds of hospitals and clinics to apply for state licenses The country expects 50, 000 foreigners will seek treatment in its healthcare facilities this year compared to 27,480 overseas-based patients who arrived in 2008. By 2013, the number of medical travellers to South Korea will reach about 200,000. The Council for Korea Medicine Overseas Promotion, a government-sponsored institution that promotes medical tourism in Korea, said it hopes to raise the number to 140,000 by 2012, but the health ministry expects that figure not to be reached until 2015. On the other hand, critics argued there are still many obstacles to overcome. Questions remain about issues such as visa requirements and possible communication problems, most South Koreans are not fluent in English. Forty-four major hospitals, including the Big Four Seoul National University Hospital, Samsung Medical Center, Asan Medical Center and Yonsei Severance Hospital and some national and public hospitals will reserve 5 percent of their beds for foreigners. Asiana Airlines, Korea’s second-largest passenger carrier has a new agreement with Hanyang University Medical Center to support and promote medical tourism. American citizens accounted for 34 percent of the country’s total overseas patients last year, but it hopes to attract more patients from Russia, Mongolia and China this year. A group of Korean doctors, dermatologists, ophthalmologists, cosmetic surgeons and others recently visited Tokyo to promote the idea of Korea as a destination for Japanese seeking tummy tucks, corrective eye surgery and other medical procedures. If you come to Korea, dermatologists will provide treatment and medical counselling in Japanese. With advanced and safe dermatology laser treatments, you will become more beautiful while spending less money than you pay for the same treatment in Japan, Ahn Gun-young, president of Gowoon Sesang Clinic, told around 30 Japanese tour agents during the visit. Shinji Yamasaki, who runs Japan’s largest website for seniors, www.seniorcom.jp, said that 30 percent of the company’s members who are over 60 responded in a survey that they are interested in travelling overseas for medical reasons, particularly in getting cosmetic surgery. He explained: Since a large number of Japanese elderly are fond of Korean celebrities and as the price of Korean medical treatment is reasonable, Korean medical tourism has the competitive power to win Japanese customers. The Korea Tourism Organization has launched a trial tour for potential Chinese cosmetic surgery travellers with six Chinese travel agencies. From March to the end of this year, the package will offer Chinese travellers a five-day itinerary including massages, spa and special treatment programmes by dermatologists, along with a visit to popular destinations such as Jeju Island and Seoul. "Through these packages, we plan to make Korea a new destination for medical travel among the Chinese customers, and eventually expand it to the fields of dentistry, oriental medicine and health check-up," said Ahn Yong-hoon of the KTO`s Beijing office. The promotion is likely to remain limited as China currently bans promotion of medical services for serious illnesses. Meanwhile, South Korea is now 30 percent cheaper to visit than it was in the same period last year, revealed Baeho Kim, regional director of the South Korean Tourism Organization in Kuwait when leading a team of medical tourism delegates from three well-known South Korean hospitals, the KonKuk University Medical Center, Wooridul (Spinal) Health Care and the Kyung Hee University (East-West Neo Medical Center). South Korea is now more affordable than ever because of the fluctuation of our currency. So I expect more Kuwaiti citizens to visit Korea this summer. South Korea has made it easier for Kuwaitis to visit the country as a visa is not required for Kuwaiti citizens.

Kenya is taking initial steps to get a slice of Africa’s medical tourism business. The 320 bed Nairobi Hospital is eyeing medical tourism for new revenue, as local competition in private healthcare gets tougher. Nairobi Hospital chief executive Dr Cleopa Mailu, said Kenya has a high potential for medical tourism and the hospital has the facilities and manpower necessary to pull it off. The Government should liaise with the private sector in order to diversify our tourism products and services. Nairobi Hospital has invested heavily in diagnostic and treatment facilities and equipment, as well as on our professional human resources. What is lacking is a policy framework and marketing to tap into one of the world’s fastest growing services. The ball is now in the Government’s hands to take the initiative to tap the sector." At present, only a handful of tourists come to local hospitals, although the refurbishment of Kenyatta National Hospital has brought patients from nearby countries into Kenya as medical tourists. The wellness sector is another potential revenue earner for the country. Chale Island is popular among visitors who have their bodies covered with special mud as a form of skin rejuvenation therapy.

Dubai group MRI has filed a United States Patent & Trademark Office (USPTO) patent for technology that enables integration of medical tourism with health insurance. Called Offsurance, the medical tourism product claims to be a novel method of underwriting and implementing low premium health insurance incorporating medical tourism. It will take months for the patent to either be approved or denied, and more software patents are refused than accepted. Dr Fazal Raheman, CEO of MRI said: Offsurance is a path-breaking technology that can potentially reduce the US healthcare expense by over 50 percent. There is absolutely no intellectual property precedence in this exponentially growing segment of healthcare. Because Offsurance is the first and the only pending patent, we target the grant of the patent within the next six to nine months under the USPTO’s new accelerated examination programme. With the speed with which we have developed the technology, we are quite confident of achieving our targets not only of the timely grant of the US patent, but closing strategic alliance deals with corporate partners and investors for the product launch. Offsurance claims to resolve the geographical, organisational and logistic complexities involved in integrating medical tourism with health insurance. MRI is now seeking potential investors and corporate partners to develop the project. Offsurance.com is a venture of MRI Limited, a British company and MRI FZE, a Dubai-based technology development and consulting outfit.   The theory is that Offsurance can offer benefits to members of US health plans at reduced premium or credits. Offsurance offers a very low premium healthcare coverage for elective procedures as well as complex specialised surgeries. Offsurance increases the business of the speciality hospital engaging in medical tourism by assuring a steady flow of patients without having to spend on active marketing. There are some problems: nobody can patent medical tourism, insurance or insurance-linked to medical tourism. Convincing US health plans and health insurers - who are seeing dramatically falling customer numbers, struggling with proposed healthcare reform, fighting tougher insurance regulation, dealing with lower income or losses on investment income, and in some cases, deciding whether merger is the only way to survive - is going to be an uphill struggle. It is doubtful that they would get involved in technology that helps them use medical tourism to cannibalise their own customer base with reduced premiums. Medical tourism analysts have suggested that the patent is just a novel marketing approach when the crowd of companies offering medical tourism to America companies and businesses grows every week. One even mused that it appears to be the patent troll approach common in technology areas to making money based on having a generic IP that will obviously be utilised by other bigger companies. Dr Raheman told IMTJ: Patent trolls do not seek accelerated examination from USPTO in less than a year. If patent trolling was our intent, we would not have business plans and financial and marketing analysis for the potential investors. All of that and product development is a substantial investment on our part, which a patent troll would not make. The idea that my invention can extract millions from potential infringers of my patent is a huge compliment in itself, which brings so much confidence to my investors in my technology. It is not at all an insult, but evidence of how secure the investors’ money in Offsurance will be. He added: Our plan is to launch the product in October, if we are adequately funded. The reason we filed the patent is because we got our first letter of intent last month from a potential investor who is an insurance expert.  We had several meetings with other investors and they insist the patent filing should be as soon as possible as our product development continues.

The European Medical Tourism Alliance (EuMTA) is a recently formed not-for-profit organisation based in Hungary, which intends to represent the interests of agencies, clinics and hospitals in the European medical tourism industry. A Hungarian, Balázs Stumpf-Biró is the founder and executive director. It may change its name soon as the European Hospital and Healthcare Federation is keen to work with the organisation, but prefers healthcare travel to healthcare tourism. It is currently discussing membership with clinics, hospitals and operating in, or sending people to, Europe. (EuMTA) aims to: Represent the interests of stakeholders in the medical tourism industry. Harmonise industry activities. Provide compelling alternative solutions for shortcomings in the health care systems of the USA. Bring awareness to Europeans of the existence in Europe of high-quality medical alternatives. * Become an active industry forum. * Develop strong political and private sector lobbying capacity in the EU. * Improve patient mobility and promote free choice of medical provider.Balázs Stumpf-Biró told IMTJ: We are a Brussels-registered pan-European legal entity. For the first months of this year, we have been establishing connections with government and medical institutions as well as acknowledged professionals to gain legitimacy for the organisation. We have just opened up membership. There are some companies lined up and showed their interest to get involved. We are certainly not in a hurry as we believe in quality over quantity. With two existing global trade bodies, and a recent newcomer, IMTJ asked why a fourth was needed. An independent European trade association is necessary as this is how the majority of industry players feel. MTA is based in the United States, IMTA is in Singapore, how could we expect any of them to be a true representative of European interests? Or get along with the really specific EU legislation? We have shown our interest to both organisations for strong cooperation and working together, towards a transparent and safe global healthcare. No positive answer arrived yet from either. The organisation believes that while Europe has for many years been  active and attractive within Europe, the quality of medical care and healthcare facilities is less well-known elsewhere. Europe could become a bigger player if countries and organisations in it work together and promote the quality of care, significant saving within Europe compared to some EU countries or the USA, and that it is a much safer travel destination than many competitors. Once the key European participants in medical tourism are united in an entity that will represent and defend their interests in key markets, then it will be possible to promote Europe to people who now look elsewhere EuMTA is an European Economic Interest Grouping as defined by EU rules. So companies in different companies can work together in ways that do not breach strict rules on anti-competitive behaviour. There are three main categories of members; Founding (who bring capital), Full (from European Economic Area [EEA] countries) and Supporting (from inside or outside the EEA). To ensure European interests are foremost, only Full members have voting rights. It will be run by an executive director and four other board directors, with an advisory panel of experts. Membership projections are modest, with 60 in 2009, 80 in 2010 and 120 in 2011.

A Medical Tourism Chamber of Commerce formed late last year for clinics offering medical services to foreigners. The aim is to develop the Polish tourism and medical market and promote it throughout the world. The Chamber’s President Artur Gosk believes that medical tourism in Poland has a very good future. Today we can say with some certainty that the medical services market is a market that will be developing irrespective of world economic turbulence, and a product in the form of medical services that is price competitive and generally available will draw many patients. We are aware that it is a difficult task, but we have a good start. For the last few years, world medical tourism has been concentrated in such countries as Thailand, Turkey, Malta and India. New European Union countries such as Hungary, Czech Republic, Slovakia and Poland have also started to realise their potential. We know that the Polish medical market has a huge potential; we have many health centres specialising in rehabilitation and in the treatment of various diseases. Our private medical clinics are on a par with medical services offered abroad, and the medical staff in these centres is highly qualified. Seeing the potential in Polish health care, the Chamber wants to convert it into an export product. We talk to many institutions, both government and non-government institutions about the development of this field and we are often told that it is a niche product. The Medical Tourism Chamber of Commerce believes that a good climate exists to promote Polish medical tourism. Poland is in a good position to become a leader. Poland has two advantages. One is proximity of countries such as Britain, Germany and Ireland, Norway and Sweden, from which patients readily use medical tourism services and with which we have good transport links. Another is the value of the Polish currency, which means that Poland is very competitive in terms of sales of medical tourism services. Now is a good time to invest in promotion so that Polish medical centres and health resorts are able to develop a reputation and a brand name. The new organisation has developed a number of programmes to assist Polish medical centres in reaching the international market.

JCI’s new Middle East managing director Ashraf Ismail argues globalisation and the availability of information via the Internet, mean that improving healthcare quality and safety is no longer optional for hospitals. "If healthcare quality is not adequate in the hospital, patients will look around for better quality. If they do not improve quality and safety, they will lose their business. Accreditation is an excellent framework that helps organizations to achieve their quality goals in a systematic, measurable way. Achieving JCI accreditation also provides the international recognition to organisations for their commitment to quality and safety." Ismail admits that the healthcare industry in the Middle East has a long way to go and accredited facilities in the region still represent a very small percentage of all hospitals. There is no way to develop business in healthcare without improving quality and safety. Quality increases market share as hospitals build on their reputation. To build their reputation, hospitals must put customers first and consider patient safety and quality." Qatar’s health minister, Sheikha Ghalia bint Mohammed Al Thani, said the government is committed to launching one new hospital every year until 2011 at the Hamad Medical City, the state-backed medical complex being built on the site of the athlete’s village used during the 2006 Asian Games. The city will include a paediatric hospital and a neurology hospital. The Women’s Hospital will be shifted to the city. By 2011, Hamad Medical City will be a reality." Qatar’s Ministry of Health aims to boost the quality of health care on offer at public and private sector hospitals. It has launched the country’s first healthcare quality department that will assess the level of services provided by all healthcare providers. Qatar has created a new watchdog to look after health services provided by both the government and the private sector in the Gulf state. Known as the Supreme Council for Health, it has been empowered to fix the tariff of medical services provided by the state as well as private operators and decide on the pricing of medicines. This is in response to some hospitals overcharging patients in general and medical tourists in particular. The Saudi Arabian government has recognised that it cannot finance a sustainable healthcare sector. It seeks to restructure the management of the existing 218 government hospitals into private enterprises. Any additional hospitals or clinics built will be private. The Saudi Ministry of Health authorities are progressing toward regulating medical services instead of financing the provision of healthcare. It is believed that eventually, this will reverse the trend for patients to travel abroad for treatment, as privatisation will raise the quality of medical care offered. Several Middle East countries are now encouraging hospitals to achieve international accreditation with either JCI, Australian Council of Healthcare Standards International (ACHSI) or Accreditation Canada International. Accreditation Canada International has eight approved hospitals in the Middle East with two seeing approval. ACHSI has six accredited and three seeking approval, while JCI has 53 approved and at least one seeking approval. Middle East states have two reasons for wanting international accreditation, the main one is to convince doubting locals that they do not need to go abroad for quality care, the secondary one being to seek a share of the global medical tourism business.

Medical Group has contracted Knowledge Network to produce a feasibility study on developing the first centre for medical tourism in Croatia. The Centre is to provide health, education and hospitality services at a convenient urban location on the Dalmatian coast (less than one-hour drive from Split and Zadar international airports). It will consist of medical facilities and an accompanying 4-star hotel with spa and wellness facilities. The project is to be developed through two modules medical facilities (special hospital) and hotel facilities. Medical services to be provided within a special hospital will include dentistry, physical medicine, surgery, cosmetic surgery and diagnostics. The hotel will provide accommodation for tourists and patients, conferences spa and wellness centre and leasable area for shops, pharmacy etc. Medical Group is a Croatian firm that believes the country has excellent medical professionals and many attractive tourist destinations, so sees an opportunity in promoting and developing medical tourism in Croatia. It wants to attract patients and their families from all around the world by providing high quality medical services. The centre will be located in the city of Vodice, one of the most popular destinations in the Dalmatian coast. Vodice has a Mediterranean climate, exceptional natural beauty and good traffic connections with the rest of the country. Medical Group has also founded a Croatian association for the development of the medical tourism. The association is for existing providers of medical tourism services and those who are planning to do so. Main objectives are the development of medical tourism in Croatia, promotion of the association members in domestic and foreign markets and promotion of the need for medical tourism development in Croatia. The association is to promote services, connect all parties involved in the distribution chain (service providers, agents and hoteliers and transporters) and provide support in approach to foreign patients and development of medical tourism services standard. The association plans to be a business excellence centre that gathers medical and tourism experts. The idea is to facilitate knowledge and experience exchange between its members and organise conferences, symposiums, discussions and other gatherings. The two driving forces behind the new association and the centre are Dr Iljenko Bura, a surgeon at KBC Zagreb hospital and Goran Nedoklan, founder of the Matell Dental Centre in Vodice, and a pioneer of medical tourism in Croatia.

Aimed at attracting more Americans to Singapore for medical treatment, a new website helps users find specific specialists, review their credentials and request consultations. Singapore Tourism Board (STB) launched Singapore Destination Medicine in collaboration with MedicaView International to streamlines the process of searching, comparing and selecting Singapore healthcare services online. Targeting medical travellers, particularly from North America, the site offers a resource for those seeking high quality and affordable healthcare outside the US. The clean and user-friendly site features a simple form to select doctors or hospitals in Singapore, based on the required medical procedure. Users can call up accreditation information, doctors’ credentials and request cost estimates at selected medical institutions. John Linss of MedicaView International commented: "North American patients who have already travelled for healthcare to Singapore have discovered that high quality of care can be combined with affordable prices and the demand for such services is growing. There is no question that North American patients will be very comfortable visiting Singapore’s clean and modern city. The low incidence of crime, prevalent use of English and high level of service and hospitality will be very well received by them. Notable extras on the site include a continuity of care programme that can link stateside doctors with offshore surgeons to provide for electronic medical records to be stored in a secure collaborative environment where doctors from both sides can collaborate over the case. Surgical complications and travel insurance is also available to cover most eventualities related to travel and health care procedures. Travel options can be accessed directly from the site. Singapore Destination Medicine also provides for the syndication of Singapore healthcare services across other sites; DestinationMed, Global Patient Services, MedicaView.com and additional sites to be announced soon. Launched in 2003, SingaporeMedicine is a multi-agency government-industry partnership committed to strengthening Singapore’s position as a leading medical hub and international health care destination in Asia. Led by the Ministry of Health of Singapore, SingaporeMedicine is supported by three government agencies: the Economic Development Board, which develops industry capabilities, the International Enterprise Singapore, which fosters regionalism by Singapore-based health care players, and the Singapore Tourism Board, which markets Singapore as a healthcare destination to inbound international patients. MedicaView International (MVI) is a US company. Its Global Connect platform enables global and/or local online interaction and commerce between accredited healthcare providers, consumers and other healthcare related entities.

Astonishing new figures from researchers suggest that every year over a million Mexican and non-Mexican US residents travel from the US to Mexico for medical, dental, cosmetic and other treatment. Even on 2001 data, well before the establishment of a US/Mexico medical treatment industry with new clinics and hospitals, and before even more Mexicans settled in the US, it is reported that just under a million crossed the borders for healthcare. So..... if the research is accurate, it is reasonable to assume that 2008 figures are going to be over a million. It is believed that half of these medical tourists are Mexicans who are US residents and are coming home for treatment; this suggests that swine flu will have less effect on numbers than pessimists expect.  According to a new paper Heading South: Why Mexican Immigrants in California Seek Health Services in Mexico." published in the journal Medical Care, by researchers at the UCLA Center for Health Policy Research: Nearly one million Californians cross the border each year to seek medical care in Mexico. The figures do not include anybody travelling from other states such as Texas, Arizona or New Mexico. Cost was the primary factor in seeking health services. Lack of health insurance, cultural and linguistic barriers and immigration factors were also important motivators. Most come to Mexico for prescription drugs and dental care, and a smaller number go for surgery- but the latter may have risen since 2001. The researchers estimate that in 2001, 952,000 California adults sought medical, dental or prescription services in Mexico, and of these, 488,000 were legal Mexican immigrants. 13 percent of Mexican immigrants travel to Mexico for care, with the largest number visiting dentists. The paper is the first large-scale population-based research ever published on US residents who travel to Mexico for health services. It is based on an analysis of 2001 data from the California Health Interview Survey (CHIS), the nation’s largest state health survey.Lead author Steven P. Wallace comments, What the research shows is that many Californians, especially Mexican immigrants, go to Mexico for health services." Long-stay immigrants used Mexican health services the most, with 15 percent reporting crossing the border during a year’s time for health services. Half of these long-stay immigrants lived more than 120 miles from the border. Living within 15 miles of the border greatly increases the likelihood of someone obtaining health services in Mexico. Four percent of adult Californians travel to Mexico for some type of medical care. Immigrants who travel to Mexico for health services are not necessarily the poorest. One explanation: The cost of travel may offset any financial savings, creating a disincentive for the very poor to travel. The data that the researchers used is no longer collected, so updating the figures is going to be difficult. Assuming the figures are accurate, if you add those going to new Mexican hospitals and traffic from other states, a million medical tourists a year may be a reality. This has other implications, that people travel as much based on location and race, as on cost. If true, this makes Mexico the second largest medical tourism destination in the world, and perhaps even number one.

Licences of hospitals in the UAE will not be renewed by the Ministry of Health if they fail to upgrade their infrastructure. They must implement the latest systems and practices that meet international standards within three years. The accreditation rule will apply to both the private and government sectors. The ministry has signed a contract with an international accreditation body that will certify hospitals. Although not officially named, strong rumours suggest it is JCI. In the long run, clinics, medical professionals, nurses and technicians will also have to be accredited. The UAE authorities accept that unless it can convince local customers that hospitals offer a good standard of care at a reasonable price, and stop large numbers going overseas for medical treatment, any hopes of competing for a share of the growing medical tourism sector will fail. It wants to get business from other Gulf States, but to do that it has to build trust in local hospitals. It can never compete with Asian countries on price so has to promote other benefits.  The country is gearing up for the introduction of a compulsory medical insurance system that will require the accreditation of hospitals and medical professionals. The introduction of an integrated health information system will require hospitals to be more transparent about treatment costs and medical details, and all medical mistakes and errors will be recorded. Hospitals and other healthcare businesses will have to digitalise their patient records and billing systems so that a patient’s details will be accessible by all other hospitals in the network. Plans have been revealed to build two new world-class hospitals in the UAE by 2013. The new facilities will replace the existing Mafraq and Al Ain Hospitals.SEHA, the Abu Dhabi Health Services Company, will run both. The new Mafraq Hospital will have 690 beds, the examination and treatment rooms will be tripled from 19 to 60 and the outpatient clinic capacity will be increased by 70 percent to 147 rooms from the current 88.The new Al Ain Hospital will have 688 beds, of which 150 beds will be dedicated for rehabilitation. Once complete, the facility will serve as the regional Centre of excellence for rehabilitation with the first stroke unit in the UAE, and a centre of excellence in trauma, orthopaedics and sports medicine. The UAE now enjoys one of the world’s advanced and highly developed healthcare systems with Dubai Healthcare City, Shaikh Khalifa Medical City and other private healthcare providers. It accepts that it needs to bring other hospitals up to those standards. Dubai Healthcare City’s future projects include the Mohammed Bin Rashid Al Maktoum Academic Medical Center, The University Hospital, and Dubai Medical Suites. The Mohammed Bin Rashid Al Maktoum Academic Medical Center includes the 400-bed University Hospital, Harvard Medical School Dubai Center and Dubai Harvard Foundation for Medical Research. Shaikh Khalifa Medical City (SKMC) in Abu Dhabi aims to be the first hospital in the Middle East to receive Magnet accreditation, an internationally recognised award for nursing excellence and leadership.

Bulgaria, a fledgling member of the European Union, and a country with a seaside nestled at the crossroads between the East and the West, is increasingly becoming a popular tourism destination for visitors from the Gulf. The natural mineral springs and adjacent wellness therapy has turned Bulgaria into a preferred medical tourism spot. Medical tourism has potential for growth in Bulgaria as the country provides good conditions that meet the demands of Gulf travellers, says Hristo Barutchiev, manager of Rola Complex. On the southern Black Sea coastline, the Rola Complex in Pomorie combines a picturesque view and great climate, as well as mud and saline medical procedures that make it attractive to tourists. The first Kuwaiti visitors at the Rola Complex are scheduled to arrive in September, when the centre will open. Rola Complex is working with local partners, Kuwait International House, on the logistics for Kuwait’s travellers. There will be a direct charter flight from Kuwait to Bourgas International Airport, 8km from Pomorie. The complex offers a mild climate with cooler summer temperatures in the evenings soothed with a pleasant breeze. As well as the Gulf States, both the complex and hospital are specifically targeting Austrian, German and Israeli medical tourists.The Rola Complex boasts three different segments that cater to medical tourists - a medical centre, spa and anti-ageing centre, and balneology. Rola Medical Center will offer an IVF service with a proven success rate of up to 65 percent, as well as medical dermatology, including laser procedures for the removal of uneven pigmentation and acne, in addition to other various manipulations. Also, it will provide aesthetic dermatology applying a Brazilian anti-ageing patent, including fillers, surgical lifts, surgery-substitutes and rejuvenating therapies; as well as balneology, kinesiotherapy, and rehabilitation. Unusual specialities include mental health and help in giving up smoking. Rola Complex features 106 fully furnished apartments and studios in different sizes, half of which have already been sold. Each apartment is fitted with a kitchen, and a restaurant in the complex will offer Arabian cuisine. In addition, customers who own an apartment within the complex are entitled to discount prices in the medical centre. When completed, some two years from now, adjacent to the Rola Complex will be the most modern hospital in Bulgaria fitted with the latest medical equipment. Black Sea Hospital for Active Treatment will have five operation theatres for cardiovascular surgery, cardiology, transplants, aesthetic surgery and a modern and comprehensive diagnostic centre that will use the newest medical standards. Bulgarian doctor Professor Aleksander Chirkov, who has had extensive experience and practice in Europe and the United States, is now recruiting professionals from leading European medical universities and clinics. Once area it will focus on is a wide range of the latest stem cell treatments. Apartments and luxury villas will be constructed close to the sandy beach. When completed, the complex will include 4 swimming pools. private beach, bars and restaurants, sport facilities, children’s amusement playgrounds, and even water attractions at the yacht port, as well as yachts offering cruises in the Black Sea.

Declining tourism numbers are causing major problems for countries where the economy has become dependent on a continual rise in tourism numbers. Several countries in the Caribbean are desperately seeking a magic bullet to cure their tourism ills. They have seen the projections of 21 million American medical tourists going overseas for treatment every year. Some countries are being swayed by these magic numbers and are keen to capitalise on the anticipated hordes of medical tourists desperate to leave the US to come to their country for treatment. Should we be amused or saddened when we see another politician or tourism official planning to solve their tourism problems through medical tourism? The lack of infrastructure, medical tourism experience and accredited hospitals in some Caribbean countries has to be taken into consideration. The Bahamas wants medical tourists to replace lost holidaymakers. Their  target market is the 3 million Florida residents over 65. With the Jamaican economy suffering several recent setbacks, one financial analyst is calling for significant investments in health tourism to replace lost earnings. According to Keith Collister, purpose-built hospitals to attract foreign clients would more than make up for the earnings lost from bauxite and other ailing sectors, One such hospital based in Jamaica could replace the minimum likely damage to export earnings from the collapse of the bauxite industry whilst two such hospitals could generate enough revenues to replace the entire bauxite industry," he said at the launch of The Roxborough Institute, a new think tank. Another country where politicians are talking up the potential is the Bahamas, although more locals go to the US for treatment than come from the US. Antigua has made similar noises, despite the only attraction being one celebrity dominated recovery centre. The Barbados government has been talking for years of producing a health and tourism policy we are still waiting. At present, health spas and fertility treatment are available in Barbados. As an established holiday destination for the very rich, clinics and hospitals in Barbados targeting this sector may be a possibility. Trinidad and Tobago lacks medical facilities but is aiming to attract medical tourists. The Turks and Caicos Islands plan to enter the medical travel market when a new hospital is completed. Few of these countries have so far provided any detail on what they will offer. They face stiff competition from established medical tourism destinations who have spent time and money on promotion and accreditation.

A 2008 study by Deloitte identified Brazil, Costa Rica and Mexico, boasting professional costs ranging from 25 to 50 percent of the US average, as countries in Latin America with the greatest potential for inbound medical tourism. Other contenders were Argentina, Colombia, Brazil and Chile whose dental and cosmetic treatments are about 20 percent off prices in the US. With traditional tourism hit hard by the global recession, Costa Rica is seeking to draw foreign visitors by offering reasonably priced, high-quality healthcare. A combination of proximity to the US, excellent air connections, political and social stability and low crime stats make it an attractive proposition. Officials regularly quote the figure of 100,000 medical visitors to the country, but this may only be an estimate 20,000 a year is a much more realistic sum. To stimulate demand overseas, the government is enlisting the help of its tourism, health and trade ministries and planning a big publicity campaign. The Association for the Promotion of Costa Rican Medicine (PROMED) has also been established, consisting of six health consortiums, three private hospitals and several local universities and hotels. In Puerto Rico, medical tourism has become the hope for revenue resuscitation. Despite a dearth of healthcare facilities, tourism players talk of aiming for 120,000 visitors, but how this number will be reached is still the big question. Medical tourism to Panama for cosmetic and other surgery is increasing as the county boasts some of the most modern medical facilities in the region.   Many Panamanian doctors have studied in the US, Canada or Europe and speak English. However, lack of unity among the stakeholders such as the hospitals, clinics, tour operators and hotels is proving to be the obstacle to what could be a better growth picture. Brazil presents a deeply unregulated market. While local professionals do not lack for skills and do attempt to improve themselves, their community does not have a clear strategy to offer the global clientele. Few establishments can say they have international patient centres or staff trained to speak other languages and deal with the needs of foreigners. Marketing overseas has been known to be spotty, often done by word of mouth. Foreign patients do continue to seek treatment south of the border, but these have been mainly Americans and Canadians. Clientele from other parts of the world remain unconvinced that a cutprice proposition equals quality service.

About a million Indonesians go overseas annually seeking treatment, an exercise that amounts to well over US$1 billion, research by analysts Frost and Sullivan shows. The study, presented at a health forum in Singapore in April, indicates that despite the huge potential and spending power of Indonesia’s large population, the domestic healthcare industry has proven incapable of meeting their needs. Instead, countries such as Singapore, Australia, Malaysia and the US have been benefiting from the visits of wealthy local residents. Frost and Sullivan contend that Malaysia has been gaining over Singapore in attracting Indonesian patients. It said: Indonesian medical tourists going to Malaysia comprise around 70 percent of its total (inventory of) international patients, while those going to Singapore are only around 65 percent. Last year, Malaysian hospitals treated 288,000 Indonesian patients, up from  221,538 in 2007 and 170,414 in 2006. In 2007, Singapore hospitals treated 226,200 Indonesian patients, a drop from the 266,500 recorded in 2006. However, its revenue in 2007 from this market was recorded to have increased. Affordable pricing was Malaysia’s edge over Singapore, while political stability put it ahead of another rival Thailand. With Singapore’s healthcare infrastructure being world class, its treatment costs are higher than Malaysia’s as are accommodation and incidentals. This reality has led it emphasise quality, and focus on the highly affluent Middle East sector. A Muslim country, Malaysia has also decided to go for an Arab clientele, as well as those from destinations within the eight-hour flight range including China, Japan, Korea and the Asean.

Research group RNCOS says in its new report, Emerging Medical Tourism in Turkey, that despite the sluggish world economy, the industry witnessed impressive growth of around 40 percent in 2008 over the same period in 2007. Last year, the country received around 200,000 foreign medical tourists The study provides an in-depth analysis of the present and future prospects of the country in the medical travel arena, delving into the operations of key players such as The World Eye Hospital, Memorial Hospital, Anadolu Medical Center and Sanatolia Care. Growth has been fuelled by a cost advantage. In Turkey, fees for treatments range from one-half to as little as one-fifth the price in Europe and other developed countries. Its strategic location between Asia and Europe makes it accessible to travellers, and the capital Istanbul boasts good air connectivity. Turkey has proven especially attractive to European medical visitors, who are avid patrons of its spas. To promote these further, the tourism ministry has listed 17 registered thermal spa resorts with mud bath facilities, but there are an estimated thousand more unregistered. Istanbul Memorial Hospital was the first hospitals in the country to receive JCI accreditation.

A woman from Wales is suing a cosmetic surgery clinic in Belgium after she underwent cosmetic surgery a facelift. Mrs X, who is in her 40s, is taking the UK-based Elyzea Cosmetic Surgery Group to court for personal injury, following a botched facelift and upper and lower eye procedure in 2005. The woman is now too embarrassed to be seen in public, claiming that she has been left with prominent scarring around the eyes and the ears. She adds that she suffers numbness and a lack of symmetry on the left side of her face. To hide the scarring, she has had to grow her hair long. Although the surgery was performed in Belgium, she is pressing charges in the UK. If she succeeds, it could pave the way for other patients, who may have received below standard healthcare abroad, but want to go to court in the UK where they can expect bigger payouts. Elyzea, which has offices in London and Manchester, denies any liability, saying the procedure took place in Belgium, and thus, Belgian law should prevail. In that context, it is the attending surgeon who is legally responsible for any personal injury, not the firm he works for. A spokeswoman for Elyzea said they did not accept responsibility for the case, however, they did feel they had a moral responsibility to try to put things right. We are providing aftercare to correct errors. But generally patients are not reimbursed. Elyzea has offices in Paris, Utrecht, Manchester, London and Brussels. Europe lags behind the US in promoting insurance covering medical negligence. Many agencies, involved in arranging medical travel, don’t think they need protection or have the funds to buy a policy. Underwriters are reluctant to insure them because some are not licensed, appear to be new at the game or cannot present a professional way of selecting its roster of specialists.

A study by Jordan’s Private Hospital Association (PHA) reports that last year, 210,000 patients from 48 countries received treatment in local medical facilities. This was an increase compared with the 190,000 patients in the previous year. Most of the patients come from Iraq, Palestine, Sudan and Yemen. PHA president Fawzi Hammouri contends the World Bank places Jordan as first among the Arab countries and among the top 10 in the world when it concerns medical travel. In order to maintain this ranking, we have to keep the current markets in the Arab world and find new ones in Africa, Europe and the US, he said. We have already marketed in Chad, Nigeria, Russia, Azerbaijan and Kazakhstan. PHA is a private, voluntary, non-profit organisation established in1984 to represent the interests of 48 private hospitals in Jordan. It seeks to raise medical standards, supports national and international accreditation and promotes the Hashemite Kingdom as a medical tourism destination. To enable these ambitions to be fulfilled more quickly, it is planning to allow public and university hospitals to join its ranks. The new grouping will eventually be named Jordan Hospital Association. PHA is working with member hospitals to promote specially designed healthcare offers to Americans and Europeans. Hammouri explains: We will provide them with packages that are 25 percent below market prices. This includes the plane ticket, accommodation and a visit to Petra to encourage local tourism as well.

The European Parliament has approved plans to give EU (European Union) patients the right to seek healthcare within the bloc more easily and be reimbursed for the costs. MEPs (Members of the European Parliament) also want patients to be properly informed about their rights when they are treated outside their home member state. The draft directive on cross-border healthcare aims to eliminate obstacles for patients who seek treatment in an EU member state other than their own. It also clarifies patients’ right to be reimbursed after treatment in another member state rights that have been confirmed in European Court of Justice judgments but are not yet included in EU legislation. The directive does not change the right of member states to define the benefits that they choose to provide. If a member state does not include a particular treatment as part of the entitlement of their citizens at home, this EU cross-border healthcare directive does not create any new entitlement for its citizens to have such treatment abroad and be reimbursed. The new directive will not affect current patient rights, which are already codified under another EU regulation, or the regulations on the coordination of social security systems. Under the draft directive, European patients will have the right to seek healthcare within the bloc but member states may nonetheless introduce a system requiring prior authorisation for the reimbursement of hospital costs if the financial balance of the member state’s social security system could otherwise be seriously undermined. No state can do this unilaterally, it has to get at least majority approval from other states before it can include prior authorisation in national law. Meanwhile, MEPs want member states not the EU Commission as originally proposed - to define what hospital care is. They also stress that the prior authorisation requirement must not create an obstacle to patients’ freedom of movement. On the reimbursement of medical costs incurred, MEPs agree with the general rule that patients are to be reimbursed up to the level they would have received in their home country. They add that member states may decide to cover other related costs, such as therapeutic treatment and accommodation and travel costs. Since the proposed rules would in practice mean that patients needed to pay in advance and get reimbursed only later, MEPs added a provision that member states may offer their patients a system of voluntary prior notification. In return, reimbursement would be made directly by the member state to the hospital of treatment.  MEPs say member states must ensure that patients who have received prior authorisation will only be required to make direct payments to the extent that this would be required at home. The Commission is to examine whether a clearinghouse should be established to facilitate the reimbursement of costs. Parliament has added special rules for patients with rare diseases and disabilities that might need special treatment. Patients affected by rare diseases should have the right to reimbursement, say MEPs, even if the treatment in question is not provided for by the legislation of their member state and this shall not be subject to prior authorisation. Special costs for people with disabilities must also be reimbursed under certain conditions. Furthermore, all information must be published in formats accessible to disabled people. Parliament voted to exclude long-term care and organ transplants from the directive. To improve patients’ confidence in cross-border healthcare, they must receive appropriate information on all major aspects of such care, such as the level of reimbursement or the right of redress in the event of any harm arising from healthcare. MEPs back the idea that national contact points should be established but they also propose establishing a European Patients Ombudsman to deal with patients’ complaints regarding prior authorisation, refunds or any harm suffered, after all complaint options within the relevant member state have been explored. The legislation was prompted by a series of EU court rulings in the 1990s that established the right of patients to be reimbursed for treatment abroad. But the lack of legislation means there is still legal uncertainty for patients about under what conditions they are entitled to have their costs repaid. At the moment, just one percent of healthcare budgets are spent on cross-border healthcare. The law now goes back to the member states for consideration and will be only be taken up again in the parliament’s new legislature, beginning in September. This was the European Parliament’s first-reading position. This dossier is expected to require two readings and is unlikely to be concluded until the end of this year or possibly early 2010. Individual country legislation could be two to five years away. EU member states are still working to iron out a range of practical difficulties before the plan can be formally adopted. EU ambassadors will now discuss the proposal in early May as member states continue to wrangle over the practicalities of enhanced patient mobility. The plan has been discussed several times at meetings of EU governments this year, but Brussels insiders warn there is still much work to do before agreement is reached. Among the outstanding issues to be resolved are how much power member states will have to control the flow of patients to their health services from outside their jurisdiction. It is believed that the Czech EU presidency is now suggesting that countries should have greater freedom when demanding prior authorisation for treatment, particularly for "specialised and cost-intensive" care. The presidency is hoping for political agreement at a meeting in Luxembourg on June 8. Cooperation by member states on health issues is a thorny issue as healthcare is a matter for individual countries, and there are significant differences in funding models of health and social insurance systems across the EU. How this could affect medical tourism is not known. Those expecting a flood of state-paid patients to their hospital are likely to be disappointed. Much EU medical tourism is for cosmetic surgery, wellness, spas and dentistry-where there is limited provision in state healthcare. Some EU countries have an efficient state health system where patients do not feel the need to look overseas. But others suffer long waiting lists or poor provision. Much will depend on whether states are allowed to dilute the effect of the legislation by demanding that patients get advance authorisation, as countries where demand for overseas treatment is most likely are also those where health bureaucracy would make life difficult for those seeking state-paid overseas care. European medical tourism could benefit now from the proposals as opening people’s eyes to the idea of medical travel and that other countries may have better or cheaper private care than at home, will make more people aware of the benefits of medical tourism. What must not be forgotten is that the whole point of the legislation is to benefit patients -not states, politicians, hospitals or the medical tourism trade. UK Liberal Democrat MEP Liz Lynne reminds us that the legislation paves the way for European patients to access healthcare across the EU irrespective of income: Why should a patient have to lose their sight waiting for a cataract operation, or spend months in agony waiting for a hip replacement when they could get treatment sooner in another member state, sometimes at a lesser cost to the country of origin? If a clinician advises treatment and this cannot be provided at home, then we need a legal framework to ensure that they can seek it elsewhere."

Long-term problems in US healthcare have been a driving force in Americans going overseas for treatment. Many agencies and overseas hospitals have based business plans on this continuing and increasing. If President Obama succeeds in the most dramatic reform of the US healthcare system for forty years, things could change dramatically. Senator Edward Kennedy aims to push Obama’s main domestic priority through Congress. The goal is to provide insurance to most of the nation’s 50 million uninsured, and lower the soaring cost of care. The legislation would require all Americans to have health insurance, prohibit insurers from refusing to cover pre-existing conditions and place other restrictions on the industry including prohibiting insurers from denying coverage or charging more due to medical history. Insurers would be required to cover some preventive services. Annual or lifetime limits on coverage would be prohibited. There would be a sliding scale of federal subsidies for mid- to low-income families to help them purchase insurance. It would establish online exchanges, gateways where the uninsured and employees of small companies could shop for affordable insurance policies. Reinsurance funding would be provided for plans participating in the gateway. A new medical advisory council would establish minimum benefit levels for companies participating in the gateways. Millions of people would become eligible for state Medicaid health plans for the poor. People with incomes up to 150 percent of the poverty level would be able to get Medicaid. Incentives would be created for employers who automatically enrol workers into offered health plans. Kennedy has held back on two provisions that are being negotiated with Republicans, creation of a government-run program to compete with private insurers and a requirement that all employers provide health benefits to workers. Republicans continue to speak out against the idea of a public option. Democrats want the proposed new public plan to be an option offered in exchanges. Senator Conrad is circulating a proposal as middle ground on the public option issue. His plan would create non-profit cooperatives that would offer insurance policies to compete with private insurers. The cooperatives would be controlled by their members, not the government, and would be subjected to the same rules as private companies. Obama has called on Congress to pass legislation by October to overhaul the $2.5 trillion healthcare system, aiming to cut costs and ensure that millions of Americans now without health insurance get coverage. The goal is to have new measures from 2010. Democrats say a public plan that competes with private insurers is the only way to contain costs and keep premiums low. Republicans and insurers argue that it would drive insurance companies out of business and lead to an entirely government-run U.S. healthcare system. It is almost certain that the Democratic-controlled Congress will pass legislation, but nobody is betting what The American Health Choices Act will look like. The public plan is probably a dispensable stalking horse to force the insurance and health industries to accept change. Until this is all settled, few US insurers or businesses are going to consider adding insured or employer paid medical tourism to employee benefits.

While medical and health tourism within and to the Middle East is expanding, travel agents have been warned to be cautious. At a recent conference in the region, Dr Prem Jagyasi of Dubai medical tourism consultancy ExHealth, said travel agents looking to take advantage of the opportunity needed to be aware of the many challenges involved in healthcare travel. Healthcare providers are highly monitored; you have to ask how do you promote your services; what are patients’ needs and can you assure them on all pre-operation and post-operation needs? How do you identify the good healthcare providers? Do you charge the patient or the provider? According to UAE medical tourism agency Galavantor Middle East’s Rose Ann Shetty, there were other challenges for companies entering into the medical sector, Creating awareness among local insurance companies to cover overseas surgeries and advertising due to the MOH restrictions is our biggest challenge. Shetty also advised agencies looking to enter the medical tourism sector to be aware of the legal implications of sending a patient across borders. Hospitals are answerable to the law in their country and UAE laws will not apply. Due to the technical nature of so many aspects of medical tourism, both Shetty and Dr Jagyasi said it was important to be a specialist in the field, and it was dangerous to dabble in the sector. Shetty added, Specialist agencies spend considerable time undertaking due diligence and compliance audits on hospitals and surgeons to ensure their clients receive the highest standards of treatment and medical care. Dr Jagyasi suggests that the UAE has all the right elements in place for medical tourism, "The UAE has already the right infrastructure in place with the Dubai Healthcare City, Shaikh Khalifa Medical City and other private healthcare providers. There is an opportunity for medical tourism in the UAE with the GCC as the target market but the country has to build lots of trust in the healthcare system. For the UAE medical tourism to become a success, it is imperative to identify the hospitals that will promote medical tourism and what services they offer. In addition, promote services that are not covered by health insurance such as hair restoration, plastic surgery, dental treatment, cosmetic surgery, spa treatment, and where people can easily travel before and after the treatment." Dr Mehmet Hizarci of CFA International Consulting, takes up the theme, First and foremost, we should stop sending patients outside the UAE." Shetty sees potential for the UAE as an inbound medical tourism destination, with Galavantor offering inbound services by the end of the third quarter of 2009.However, Shetty added the inbound medical market to Dubai would not be anywhere near as big as the government envisioned, The two major hurdles are quality and high price. While facilities are excellent in the UAE, there is a serious lack of qualified and experienced medical workforce. It is not enough to have been educated in the West, specialists need to have experience and proven, successful track records.

Research group RNCOS says in its new report, Emerging Medical Tourism in Turkey, that despite the sluggish world economy, the industry witnessed impressive growth of around 40 percent in 2008 over the same period in 2007. Last year, the country received around 200,000 foreign medical tourists. The study provides an in-depth analysis of the present and future prospects of the country in the medical travel arena, delving into the operations of key players such as The World Eye Hospital, Memorial Hospital, Anadolu Medical Center and Sanatolia Care. Growth has been fuelled by a cost advantage. In Turkey, fees for treatments range from one-half to as little as one-fifth the price in Europe and other developed countries. Its strategic location between Asia and Europe makes it accessible to travellers, and the capital Istanbul boasts good air connectivity. Turkey has proven especially attractive to European medical visitors, who are avid patrons of its spas. To promote these further, the tourism ministry has listed 17 registered thermal spa resorts with mud bath facilities, but there are an estimated thousand more unregistered.

To save you rapidly looking for an atlas, Evia is the second largest island in Greece after Crete. The main gateway to the island from mainland Greece is at Halkida, only a ninety-minute drive from Athens. Though Evia is indeed an island, due to the close proximity it has with mainland Greece, as well as the connection available by   bridge and ferries, there is a sense that is part of Greece. Evia is famous for the natural spas that are found here. In the town of Edipsos there are a huge number of natural spas and waters, and the town is generally referred to as the spa capital of the island. Spa and therapeutic holidays are very popular on the island of Evia, and there are many hotels and companies offering a great selection of health and natural spa holidays, where visitors can enjoy the healing properties of these unique waters, which have been known about since ancient times. According to Constantine Constantinides of healthCare cybernetics, reporting back for on a recent health conference arranged by the Greek Ministry of Tourism Development on the island, at which he spoke on health tourism integration and development; Evia is not as well known to foreign visitors as some of the other Greek islands in the Aegean. The Ministry has set about to remedy this. The fact that the Minister is also the Member of Parliament for Evia is not going to hurt the effort. The Greek Ministry of Tourism Development is tasked with overseeing the development of special interest tourism, including health, wellness and medical tourism.Evia has been designated as one of the nine Greek ht8 Destinations (i.e., national Destinations offering or aiming to offer services in the 8 Health Tourism Segments. The leadership of the Ministry of Tourism Development clearly indicated its support for initiatives aimed at the further development of the health tourism industry in Greece. The Minister of Tourism Development, Dr. Konstantinos Markopoulos, is a surgeon. ht8 refers to the 8 Health Tourism Segments:    Medical Tourism    Dental Tourism    Spa and Thalassotherapy Tourism    Wellness and Fitness Tourism    Sports Tourism     Culinary Tourism    Accessible Tourism     Assisted Residential Tourism  ht8 is a concept introduced in 2008 by healthCare cyberneticsGreece is one of the top tourism destinations in the world with 17 million visitors in 2007, but we do not know how many came for health reasons. 85% of arrivals originate in Western Europe: 21.2% from the United Kingdom, 17.5% from Germany, 8.8% from Italy, 5.3% from France, 5.2% from Holland, and 7.5% from the Scandinavian countries. Increasingly, significant numbers of visitors from Eastern Europe and China are making Greece their preferred destination, creating a wider base of origin countries and new demands for services, facilities, and attractions. Among the targeted sectors for expansion include the development of wellness and health tourism, thermal spas and thalassotherapy centers. Greece boasts more than 700 hot springs, many of therapeutic value. The potential to develop wellness centres, spas, and integrated treatment facilities is significant. Greece’s Investment Incentives Law provides for grants of up to 60% for the establishment of, thalassotherapy centres.

The number of patients seeking medical and surgical care overseas has grown in recent years, prompting the American College of Surgeons (ACS) to study the issue and to develop an official Statement on Medical and Surgical Tourism. The ACS statement was developed with the patient’s interests in mind, and also offers guidelines for employers, agencies and insurers. Doctor James Unti of the ACS Nora Institute for Surgical Patient Safety says, It is important that individuals considering health care services outside the US become informed of the potential risks and complications as well as the medical, social, cultural, and legal implications of receiving such care. For those who chose to seek surgical care abroad, the ACS encourages patients to: * Seek care of the highest quality.* Select health care institutions that have met accreditation standards established by Joint Commission International, Trent International Accreditation Scheme, or a similar internationally recognized accrediting body. They should be aware that accreditation standards are not uniform and that standards set locally can vary from place to place around the world.* Seek care from surgeons and anaesthesiologists certified in their respective specialties through a process equivalent to that recognized by the American Board of Medical Specialities in the United States.* Prior to travel, make specific arrangements for continuity of care and follow-up care at home.* Obtain a complete set of medical records prior to returning home so that the details of their care are immediately available to their physicians and surgeons in the U.S.* Understand the special risks of combining long international flights and certain vacation activities with anaesthesia and surgical procedures.* Consider the medical, social, cultural, and legal implications of seeking medical treatment abroad prior to deciding on a venue of care. The ACS also* Supports their rights to select their surgeons and health care institutions without restriction.* Encourages its Fellows to assist all patients in reaching informed decisions concerning medical care, whether at home or abroad.* In the event of proven medical liability for injury, viable means for the recovery of damages should be in place.* Patients should be aware that many of the means for legal recourse available to citizens in the US are not universally accessible in other countries.* Opposes the imposition of provisions for mandatory referral of patients by insurers to health care institutions outside the US, unless such provisions are clearly and explicitly stated in the insurance contract and accepted by the subscriber.* Opposes the addition of provisions for mandatory referral abroad for patients with insurance contracts already in force, unless there is a fully informed consent from the patient. *  Supports the view that employers or insurers referring patients for mandatory treatment abroad should be responsible for the coordination and reimbursement of follow-up care in the US, including the management of postoperative complications, readmissions, rehabilitation, and long-term care. The American College of Surgeons is a scientific and educational organization of surgeons with more than 74,000 members and is the largest organization of surgeons in the world.

While agencies, hospitals, associations and experts continue their slow uphill struggle to try to convince European and American health and health plan insurers to allow customers to be treated overseas, there is another way. Across the world, some have concluded that adding medical tourism to existing insurance products is a back to front way of solving the problem. They argue that each country and customer niche has vastly different needs; so shoehorning medical tourism into existing health insurance is a non-starter. The collection of US/Mexican cross border plans are growing, while an Asian country uses captives to offer worldwide health insurance and treatment to multinational companies. In Oman and Canada, two new very different products have been launched that specifically deal with problems in each country.  BankMuscat has introduced a new product offering affordable medical insurance coverage against seven critical illnesses. The Hayatuna Medical Care Plan covers treatment of critical illnesses, including heart attack, cancer, kidney failure, major organ transplant, multiple sclerosis, stroke and coronary artery by-pass surgery. No medical check-up is required and customers can opt for critical illness treatment at any hospital anywhere in the world. The policy also does away with standard critical illness insurance requirements of having a post-diagnosis survival period, so encourages treatment at an early stage. Sulaiman al Harthy says, Through Hayatuna we seek to address the need for effective financial assistance for treatment of critical illnesses, not just in Oman. Every year, more than 50,000 people travel outside Oman for medical treatment.    In Canada, private health insurance has legal limitations. The problem that many Canadians have is that state care is good, but has long waiting lists. A new insurance offers Canadians private treatment either in Canada or the USA. It covers treatment and travel costs for patient and companion, including an instant second opinion and a private case coordinator who will oversee the diagnostic, treatment and recovery process. illnessPROTECTION.com Inc., an independent insurance advisor, has launched ELITE U.S. Healthcare insurance. Available to Canadians only, this provides timely access to medical centres of excellence in the US or Canada in the event of any illness or injury with a wait time for treatment in Canada. People are concerned about increasing wait times for medical treatments," says founder Mark Halpern, "Average wait times for treatment in Canada now range from a minimum of 13 to 28 weeks, so there is a need for affordable protection that eliminates unnecessary delays while funding treatments and travel costs."Halpern developed this product in a strategic alliance with Cleveland Clinic Canada. It is underwritten by Royal & Sun Alliance Insurance Company of Canada, and administered by Global Excel Management.

A new report, "Booming Medical Tourism in India, provides an insight into the Indian medical tourism market. It evaluates the past, present and future scenario of the Indian medical tourism market and discusses the key factors that are making India a favorable medical tourism destination. Both statistics and trends regarding market size, tourist arrivals, infrastructure, accreditations, drivers and restraints have been thoroughly discussed in the report. The research suggests that India represents the most potential medical tourism market in the world. Factors such as low cost, scale and range of treatments provided by India differentiate it from other medical tourism destinations. The growth in India’s medical tourism market is expected to serve as a boon for several associated industries including hotels, medical equipment and pharmaceuticals. Key Findings- India offers vast range of medical treatments from simple dental procedures to the complex cardiac surgeries.- Patients can save 60%-95% of their treatment costs by undergoing treatment in India.- Wellness tourism, spa, yoga and Ayurveda, has a very bright future in India as foreigners are increasingly flocking to India to seek physical and mental healing.- In 2007, around 272,000 medical tourists visited India for medical tourism and brought US$ 656 Million in revenues.- Lack of proper hospital accreditation system and inefficient laws against malpractice will be the biggest factor limiting the growth of India’s medical tourism Industry.- India enjoys a considerable superiority over both Singapore and Thailand as preferred medical destination. The report analyses the four most prominent hospital groups in Indian medical tourism - Apollo, Wockhardt, Fortis Healthcare and Max India. It costs$ 1300 printed and $ 1000 for a single user electronic copy. A UNI report circulating in India suggests that India, originally known for low cost surgery is becoming a destination for dental tourism for low cost treatment. Articles in the Indian press suggest that most dental tourists come from within Asia, but 28 per cent come from Europe and 21 per cent from North America. The Parthenon Group, a global strategic advisory firm set up its office in Mumbai last year. Parthenon is expanding its presence in India, including advising Indian hospitals on medical tourism opportunities. Alistair Stranack of the global healthcare practice, comments, If you look at cost comparison and facilities, Thailand is much ahead of India. India needs to establish itself as a true destination for medical tourism with facilities and quality, with more government support. India’s tourism ministry had a meeting with hospitals, travel and hotel associations, and government officials promoting medical tourism. The ministry has identified global medical exhibitions where India can participate and create awareness. Under the Visit India 2009 scheme, selected hospitals from major hospital groups have agreed to offer a full medical check up package at an affordable cost and one companion will be given free check up. The ministry has also created posters, literature, CDs and supporting articles to boost medical tourism.

Guam’s TakeCare Insurance Company has launched a new medical tourism company Veiovis to provide expertise, experience and service to the global medical tourism industry. The Guam-based subsidiary will operate internationally. Veiovis’s founder Joseph Husslein says, It is time to put the medical concerns of the patient on par with the tourist needs of the traveller in this industry.  Veiovis is designed to put the medical back into medical travel. Veiovis is an offshoot of TakeCare Insurance, with offices in Seattle, Washington, Guam, and Manila. Ed Fess, medical director for TakeCare and Veiovis explains, As I meet with both US and international doctors and hospitals, their common concern has been a severe lack among medical travel agents with experience in medical case management.  The industry is populated by agents with primarily travel and tourism backgrounds who have almost no developed infrastructure for managing the entire continuum of patient care.  By contrast, Veiovis leverages a model for overseas medicine anchored in health care management and real clinical resources that has been refined over the course of two decades through TakeCare. Grace Murphy for Veiovis adds, Three key patient responses need to be minimized as much as possible for the medical traveller:  stress, confusion and service irrelevance. Our patients rely on us to safely bridge the distance between their home-based doctor and their overseas hospital. A medical travel agency that can consistently meet that expectation is going to be more relevant to the consumer. TakeCare Insurance Company, Inc. is the sole Guam-based health insurance provider for the U.S. Federal Employee Health Benefit Program. Veiovis uses TakeCare’s health insurance and clinic operations, and success as a pioneer of medical travel, especially to the Philippines and other Asian medical destinations. Established in 1972, TakeCare is a privately held consumer health organization offering medical and dental insurance products covering 45,000 people and providing healthcare through full-service medical, dental, and optometry clinics. The largest insurer in Guam offers health plans to private businesses, the public sector and exclusively to the US Federal government. It uses a network of hospitals in The Philippines, Japan, Taiwan, Thailand, Hong Kong, Korea, Singapore, Hawaii and the United States.  Veiovis’ services for individuals and groups include:* An assessment of medical condition and needs* Connecting patients with the appropriate specialists in a particular type of medicine or a particular condition or disease.* Concierge services for such tasks as booking airlines, hotels, ground transport, laundry, cooking and courier service.*  Access to the hospital network The Veoivis hospital network; Philippines- St. Luke’s Medical Center- The Medical City Thailand- Bumrumgrad International Taiwan- Taiwan Adventist Medical Center Singapore- Raffles Hospital Hawaii- Straub Clinic and Hospital- Kapi’olani Medical Center at Pali Momi California- Anaheim Memorial Medical Center- Cedars-Sinai Medical Center- Good Samaritan Hospital- Long Beach Memorial Medical Center- Millers Children’s Hospital- UCLA Medical Center Oregon- Oregon Health and Science University

Joint Commission International (JCI) and the Korean Hospital Association (KHA) have agreed to establish programmes focused on improving the quality and safety of health care services in South Korea. JCI has worked with health care organizations, ministries of health, and global organizations in more than 80 countries. It focuses on improving the safety of patient care through the provision of accreditation and certification services as well as through advisory and educational services aimed at helping organizations implement practical and sustainable solutions. JCI is accredited by the International Society for Quality in Health Care (ISQua). KHA and JCI will assist hospitals in Korea as they strive to achieve a level of quality recognized worldwide. Together JCI and the KHA will: * Establish an ongoing series of educational programs for KHA member hospitals.* Translate and publish the Joint Commission International Accreditation Standards for Hospitals, Third Edition, into Korean.* Establish a help desk for KHA members to answer their questions about JCI standards, accreditation and service.* Distribute information on JCI standards for all accreditation programs via the KHA information network.* Develop and promote the use of patient safety solutions for the benefit of South Korean patients and health professionals. "Working with JCI will help the Korean Hospital Association raise the profile of health care in South Korea, and bring international recognition to the quality of care in South Korean hospitals. Improving the quality of health care and patient safety in South Korea is a strategic initiative of the KHA."says Hoon Sang Chi of the Korean Hospital Association. More than 246 public and private health care organizations in 36 countries have been accredited by JCI. Only one hospital in South Korea has achieved JCI accreditation-Severance Hospital, Yonsei University College of Medicine, Seoul. Others are working towards JCI accreditation. With strong government support, South Korea is on the way to become a leading medical tourism destination in Asia. The South Korean government has introduced a new category of visa for tourists who visit the country for medical reasons. The foreign medical tourist visa, M, is adopted in a bid to boost the nation’s medical tourism industry as local hospitals and medical institutes asked the government to simplify the visa issuance process. The new visa is issued in two forms, C3 (M), a 90-day visa for those with short-term treatment purposes, and G1 (M), a one-year visa for those who need long-term care. A law change allowing Korean hospitals to market services to foreigners and team up with travel agents has major Seoul medical institutions offering packages to two million gyopo, ethnic Koreans living overseas, promising them faster and more affordable service According to a new RNCOS research report, Emerging Medical Tourism in South Korea, government initiatives to promote the country as a medical tourism hub will fuel the growth in the South Korean medical tourism industry. Despite the gloomy outlook for the world economy, medical tourism industry in South Korea has witnessed an impressive growth of more than 55% in 2008 over the same period last year. Due to the global recession, South Korea is now 30% cheaper to visit than it was last year.

The Malaysian Health Ministry could be set to call for a review of the Medical Advertising Guidelines, if opponents of the current restrictions get their way. There is a growing concern from hospitals and agencies that the current restrictions have a very negative effect on the growth of Malaysia’s medical tourism market. If the ministry decides to review the guidelines, which were drafted to protect the importance of healthcare and medical services, it will call on all relevant stakeholders within the industry to be involved. The guidelines were last reviewed in December 2007 and only allow Malaysian doctors and hospitals to put up identity card sized pictures, qualifications, job titles, telephone numbers and places of practice. It disallows the use of superlatives for any healthcare centre, contrary to counterparts abroad that can include a virtual tour of their facilities and testimonials from patients. Advertising agencies, hospitals and medical practitioners need to submit the intended advertisement for approval by the Health Ministry’s Medicine Advertisements Board before ads are run. No changes are allowed after authorisation. Doctors who ignore the rules can be struck off. Suresh Ponnudurai of medical tourism portal Tropical Flow is eager to see changes made to the guidelines, The aim was so that advertising on health would not be the same as advertising a new TV or just a normal product. The guidelines also serve to create a level playing field for Malaysian healthcare centres and doctors. There should be changes to enable healthy competition in the industry. The irony is that while one part of the Health Ministry is handicapping medical tourism, other parts of it are promoting it. Health Minister Datuk Seri Liow Tiong Lai recently announced plans for a Medical Tourism Board to be set up in Penang. Hospitals in the state will contribute to support the board which will run campaigns abroad to attract medical tourists. Liow says that in 2008, 370,000 foreigners came to seek medical treatment, contributing RM300 million in revenue for the medical tourism industry. He adds that Malaysia’s medical tourism registered an annual growth of 30%, "We want to promote the industry for economic reason as we see it has so much potential that should be properly tapped. We expect the industry to continue to grow as Malaysia has the competitive edge compared with the neighbouring countries in terms of price and services provided. The Health Ministry is preparing a master plan to intensify promotion of health tourism in the country. It will work with the Tourism Ministry and Malaysian Society for Quality in Health (MSQH) to draw up a proper framework and guideline for the industry. Tourism Malaysia will embark on a three-year plan to collect data and market profile on health tourism, as part of its strategy to make Malaysia a premier health and wellness destination. Tourism Malaysia’s Zulkifly Said says the research is very important in order to identify potential markets that could be tapped. The organisation will also work on promotional activities such as familiarizaation trips and marketing support.

Ruben Toral, Chief Executive of Mednet Asiaand President of the IMTA, will launch a new medical tourism portal called Medeguide to provide doctors and hospitals a platform to market their products and services online. The site will go live on June 30, and when launched at the Healthcare Travel Congress in Singapore hopes to feature profiles of around 1,000 doctors from over 10 countries. By 2010 the site expects to have over 5,000 doctors in 20 different specialties. Toral was Marketing Director at Bumrungrad International in Bangkok, before becoming chief executive of Mednet Asia. He is also president of the International Medical Travel Association  (IMTA). Mednet Asia provides consulting, branding and marketing support to large US payer networks, international hospitals and information technology companies. Medeguide serves two audiences. For consumers, it is a one stop source of information on doctors and treatment packages, allowing patients to search, find and connect with hospitals and doctors based on location, specialty, procedures and board certification. For doctors and hospitals, it is an online platform to market their services and products to the millions who search for medical information daily. Top 10 doctors are specially selected based on their experience, qualifications and affiliations with leading hospitals. Ruben Toral says, "Globalization, the internet and consumerism are transforming healthcare. This is a tool to help patients make better healthcare choices by providing them with relevant information about doctors and treatment options globally." Already signed up are Bumrungrad International, Parkway, Christus Muguerza, Apollo Hospitals, Max Healthcare and Wockhardt Hospitals.Vishal Bali for Wockhardt Hospitals in India, says. "Our experience is that patients, particularly those from overseas, use the web as their primary source of information when researching hospitals, doctors and treatment packages." Theo Seiler for Asian Hospital in the Philippines adds. "It is an ideal platform for us because we can use it to promote our doctors locally and globally." Patients Beyond Borders, the medical tourism guidebook publisher, has agreed to develop content for the Destinations section, which includes information for prospective patients about popular medical travel destinations throughout Asia, Latin America, and Europe. Russell Conrad has joined as head of advertising and sponsorship, from Admax Networks, and agreed a deal with Admax Plus, a web based marketing firm that also uses social media marketing on Facebook and Twitter. With his IMTA hat on, Toral advises, IMTA is the only global association that brings together hospitals, providers and other medical travel stakeholders in a collective movement to develop and promote policies, best practices and best products around these issues. We expect to build membership by focusing on providers. the foundation of the medical travel industry, whose support is critical to IMTA’s credibility and financial health. Now more than ever, this nascent industry needs a unified voice that exemplifies integrity and works toward industry guidelines. It expects to play an even greater role in promoting patient safety and protecting individual well being by raising the bar on the development of globally recognized, quality standards, creating guidelines that advance industry self-regulation. We can accelerate the process and move the industry forward.

Highly collaborative annual surveys that don’t dictate policies and templates, but trigger the talent and know-how of hospital staff to find the absolute best way to do things is the message that a new rival to JCI is putting over, initially in the US. And it seems to be working. One problem is that many states only allow their own accreditation or JCI accreditation , but state laws are changing. While the hospitals the group picked up initially tended to be small and/or country ones, it is beginning to take major hospitals from JCI, the latest being Group Health Central Hospital in Seattle. So who is the newcomer? Houston based DNV Healthcare is part of the independent Norwegian foundation DNV that goes back to 1864. Their core competence is how to identify, assess, and advise on how to manage risk, with offices in a hundred countries. The initial focus is on the USA, but the longer-term aim is to make healthcare safer and more effective worldwide. Late last year, DNV’s innovative NIAHO accreditation program passed the rigorous evaluation process of the US Centers for Medicare & Medicaid Services (CMS); DNV Healthcare became the first new US hospital accreditation organization in more than 40 years. Underlying NIAHOSM standards are tightly coupled to the Medicare Conditions of Participation. DNV developed its NIAHO standards for hospital accreditation, building upon ISO 9001, a quality management standard that DNV says enables hospitals to most effectively address and avoid problem issues.  ISO 9001 is specifically designed to address service organizations and is proven as a basis for quality improvement. In essence, NIAHO requires hospitals to implement ISO 9001 as a means to achieving compliance. ISO 9001 is a vehicle to implement and maintain a quality management system that ensures compliance across all hospital processes. ISO 9001 is the "what," not the "how: giving hospitals much greater flexibility than the Joint Commission approach. In addition to the annual survey visits, each department in a hospital needs to be audited by another department on an annual basis. The worldwide potential is huge, as DNV has conducted ISO certifications of over 1200 health care facilities worldwide. DNV stresses that ISO 9001 compliance is not required on day one in order to obtain DNV accreditation, it can be completed later. It is a revolutionary approach that turns accreditation into a strategic business advantage by creating new standards of excellence from the skills, experience and ingenuity that already exist in a hospital. Yehuda Dror, president of DNV Healthcare says, The World Health Organization is actively promoting the concept of accreditation for all hospitals. The optimum solution will provide a clear foundation of best practices but also allow for local innovation. That is precisely the design of our NIAHOSM program. Now hospitals can choose to integrate proven quality systems into an annual accreditation process that is less complicated to administer. DNV offers risk-based certification as the standard way of conducting all management system certification, which evaluates how a management system handles risks, i.e. identifying strengths, weaknesses, and improvement opportunities.

A new report from Turkey’s top business association says the country should seek a bigger share of the fast developing medical tourism industry.  Doctor Erdal Karamercan of the Turkish Industrialists’ and Businessmen’s Association (TUSIAD), says Turkey should become a strong alternative for international medical tourism, one of the fastest developing sectors in the world. He argues that the Turkish private health sector is able to handle international competition in terms of hospital infrastructure, staff experience, and technology. Six authors wrote Medical Tourism-a new window of opportunity for Turkey, for TUSIAD. Private healthcare in Turkey is excellent, so much so that many people now visit purely for medical tourism; to take advantage of cosmetic, dental and major surgical treatments on offer at substantially lower costs. More than 30 Turkish hospitals and clinics have JCI accreditation. Karamercan adds, "In these times when the health sector is growing rapidly in our country, Turkey should become a strong alternative for international medical tourism. Transforming Turkey into a strong brand in medical tourism and receiving a maximum share from the global demand is essential. It is not only important in terms of economic gain but also for development of health services offered to our society. The state, private sector and civil society should prepare and act upon a realistic strategy toward this goal. We need a programme that can turn our qualities such as high technology, qualified health services, work force standards and accessibility into advantages in competition." The new report not only emphasises the importance of the subject but also offers suggestions on establishing collaborations and legal adjustments. Turkey is the 11th most visited tourism destination in the world. In 2008, 31 million foreigners visited Turkey and the number of tourists has increased 33 percent over the last two years. Meri Bahar, of Acibadem Healthcare, the head of the group that prepared the study says 30,000 to 40,000 people come to Turkey each year as medical tourists. This is a lot lower than previous guestimates of around 200,000. According to Bahar, Turkey’s goal should be 1 million patients by 2020. Investment has poured into Turkey’s private hospitals in recent years. But some groups see the best prospects for growth in tapping international markets. Russians account for about a third of leading health group Acibadem’s non-Turkish clients. Similar numbers come from the Middle East, Ukraine and Kazakhstan, and the group is actively marketing its services to doctors in Balkan and Central Asian countries that have cultural ties to Turkey, and easy flight connections. Foreign patients are expected eventually to fill 10 to 15 per cent of beds in Acibadem’s new hospital in Istanbul’s Maslak district. Between Europe and the Near East, Turkey has much to offer in terms of world-class health tourism treatment, state-of-the-art facilities, and highly skilled, western trained physicians. The cost of medical care in Turkey is competitive. One target market is the 5 million expatriate Turks living in the EU.

The Indian Medical Travel Association (IMTA), an association formed recently to promote India’s medical tourism industry is aggressively looking at this year promoting this high revenue-generating segment in the international markets of Middle East, Africa and Far East along with long haul markets Europe and USA. The association already has a membership of 40 hospitals, other service providers such as aruyveda, siddha and yoga clinics, wellness centres, and medical tourism agencies. It is targeting a membership of 100 in the coming months. It is also open to travel agents, tour operators and students. Most members are in India, but those who deal with it as a destination are also welcome. As a new association, IMTA’s immediate agenda is discussing with its members the best practices that can be adopted and bringing about uniformity by charting strategies to position India as a medical tourism destination. The association is a non-profit body and aims to be a unified voice for Indian healthcare (modern medicine as well as traditional Indian medicine) and travel industries. Pradeep Thukral, executive director, said, The medical tourism industry has a huge potential with state-of-the-art facilities, availability of doctors, technology, English speaking nation and the hospital capacity to cater to medical tourists. The fact is that prior to choosing a hospital, international patients first decide on the country. So we must join to aggressively promote India as a preferred global healthcare destination." IMTJ asked him about the possible confusion of the use of the initials IMTA, We might cooperate with IMTA Singapore or Israel and if tomorrow an IMTA comes up in Iceland or Indonesia. Our objective is India focused only, unlike others. The IMTA aims to Empower all the stakeholders in the Indian medical travel industry to work together to make India the leading global healthcare destination. Bring together the best providers in Indian healthcare and travel industries to help create a high quality, ethical and economically sustainable medical travel industry. Promote and provide a forum for communication on a regular basis for exchange of views, development of industry networks, creation and distribution of knowledge, establishment of standards and work on an agenda to make India the leading global healthcare destination. Promote and protect the safety and well-being of patients who choose India for their healthcare needs by creating channels for communication between patients, healthcare providers, overseas insurance and corporate referral groups, consultants and physicians from around the world. Serve as a strong voice of the medical travel industry to Indian and overseas media and raise awareness about the high level of quality healthcare and services available in India. Engage with the various arms of central and state government in India to influence public policy in national interest. Educate members on new technologies, marketing techniques and best practices to help participants to operate more efficiently. The original "IMTA" (the International Medical Travel Association) declined to comment on the potential for confusion now we have two IMTA’s both using IMTA on their websites and in their communications.

The Health Ministry of Malaysia has launched a "Malaysia Healthcare" logo and website as part of a concerted effort to promote medical tourism in Malaysia. Health Minister Datuk Seri Liow Tiong Lai who launched the branding exercise said the logo with its tagline ’Quality care for peace of mind’ was a part of collaborative efforts between the government and private sector, "The website will serve as a gateway for potential patients and visitors to explore what the Malaysian healthcare services sector has to offer in terms of medical treatment options, state-of-the-art health and medical facilities and general information on Malaysia. Thirty-six private hospitals in the country had been identified to promote the healthcare travel programme, and we hope more hospitals and dental clinics will participate. The ministry is proposing setting up the Malaysia Healthcare Travel Council to work with the economic planning unit, relevant government agencies and the Association of Private Hospitals of Malaysia, to promote the industry locally, champion the industry by consolidating the strengths of the government and private hospitals, and promote it overseas. According to the minister, the number of foreign patients has increased almost ten-fold from 39,114 patients in 1998 to 374,063 in 2008, while the revenue generated from their hospital bills had grown from RM14.1 million to RM299 million during the same period, which was a compound growth rate of 35.7%. The minister added, ""When the industry is gradually developed, we will be able to attract top medical practitioners from overseas to come to Malaysia, and this will be good for the healthcare industry. The multiplier effect of health tourism would be boost for other tourism-related industries such as hotel and transportation because foreign patients with accompanying family and friends would also use these services. Malaysia Healthcare promotes Malaysia as; Unprecedented value for money World-class practitioners Ease of entry Competitive prices Clinical competency Multi-ethnic, multi-cultural, multi-lingual The Health Ministry wants all hospitals in the country to be accredited by the Malaysian Society for Quality in Health (MSQH). Medical development division director, Datuk Dr Azmi Shapie said this was vital to ensure that the healthcare services offered by the hospitals nationwide would meet international standards, We will continue cooperating with the MSQH to ensure that each hospital and healthcare provider will meet the MSQH accreditation standard," MSQH is the national accreditation body for hospitals especially in terms of healthcare facilities, services and management. Of the total 137 government hospitals nationwide, 62 have been accreditation by the MSQH, while of 435 private hospitals, only 17 are MSQH-accredited, say the government. But that only totals 79, and the latest MSQH total is 82.As the MSQH accreditation is only valid between one and three years, MSQH-accredited hospitals need to continuously upgrade the standard and quality of their services.

Although rival JCI has accredited 2 hospitals in Lebanon, and they have accredited none in the country, Accreditation Canada International has been commissioned to carry out accreditation assessments for health care institutions in Lebanon on behalf of the Ministry of Public Health. The Lebanese Ministry has turned to Accreditation Canada for its expertise in assessing the quality and safety in health care facilities. Accreditation Canada has teamed up with a local firm, United Management Bureau (UMB) to meet the specialized needs of the Lebanese Health Care Accreditation Framework. The work will include the training of local surveyors and the assessing of hospitals that will lead to an understanding and plan for necessary improvements and recommendations. The partnership with UMB will maximize the benefit of shared extensive experience - UMB with their expertise in management systems coupled with Accreditation Canada’s excellent knowledge and understanding of principles of accreditation. The quality of hospital care in Lebanon has moved from a focus on physical structure and equipment to a multidimensional approach, emphasizing managerial processes, performance and output indicators. Mohamad Fawaz at UMB says "Quality improvement principles and hospital accreditation address issues of quality of care deficiencies and harmful or wasteful practices. Using Lebanese standards, the partnership between Accreditation Canada and UMB will play a key role in assisting in the objective of upgrading the quality and safety of care in Lebanon. Wendy Nicklin of Accreditation Canada adds, The breadth and reach of the focus on quality and safety in health care, continues to expand. Our experience and flexibility is a benefit which we bring to international markets with pride." Accreditation Canada International specializes in exporting health accreditation expertise to global frontiers. Accreditation Canada is a not-for-profit, independent organization that provides national and international health and social service organizations with a voluntary, external peer review to assess the quality of their services based on standards of excellence. It already works with The Bahrain Ministry of Health on an accreditation programme where local hospitals are in the process of international accreditation. In Kuwait it has accredited two hospitals, plus four in Saudi Arabia and one in the UAE. Recognizing that one standard approach does not work for everyone, Accreditation Canada International customizes its accreditation program to meet the client’s needs. Working collaboratively with clients, it provides continuous guidance without being prescriptive. The accreditation program is adaptable, culturally sensitive, and competitively priced. Accreditation Canada the institution and the accreditation program has been fully accredited three times since serving as a pilot for the International Society for Quality in Health Care (ISQua) in 1995. In 2007 a contract was signed between the Lebanese MOH and the Haute Autorité de Santé (HAS) to develop a hospital accreditation program. The new deal replaces this.

Canada has medical problems; there are long waiting lists, few Canadians can legally buy health insurance, the provision of private hospitals is poor, and many frustrated Canadians travel to the US or elsewhere for medical treatment. But some Canadian hospitals and agencies that send Canadians to the US or elsewhere, hope they can persuade Americans to go to Canada for treatment. Those seeing the potential in Canada say the corridor that includes Buffalo, Niagara, Hamilton and Toronto is the most likely destination as it has both hospitals and hotels. The trick will be convincing Americans that private healthcare is equal on quality to the US, and after taking accommodation and travel into account; the cost savings are worth the trip. Many US residents travel down to Central and Latin America for treatment due to close proximity. Although savings are much less for those near its border, private hospitals in Canada could become a lucrative market. Those promoting inbound medical tourism argue that in comparison to US health costs, medical tourism patients can save 30 to 60 percent on health costs in Canada. For Americans, a medical procedure done in Canada can be a good economical choice. There are no security concerns in travel to Canada, and no language barriers. Proponents point to Canada’s quality of health care as cited by the World Health Organization as equal to if not better than that of the US in most categories. The WHO does not differentiate between public and private care. A more recent survey says that the Canadian public health care system has flunked an international comparison test. According to Health Consumer Powerhouse (HCP), a research organization, Canada’s health care system ranks 23rd among 32 nations surveyed for quality, access and innovation. " Euro-Canada Health Consumer Index 2009," the second annual report, measures patients’ rights and information, waiting times for treatment, outcomes, the range and reach of services provided and access to pharmaceuticals.  Out of the 1000 points available, the Index ranked countries in the following manner: 1 The Netherlands  824 points 2 Austria                    813 points 3 Luxembourg          795 points 4 Denmark                794 points 5 Germany                769 points 23 Canada                549 points According to researchers, wait times to see a doctor and receive treatment dragged the Canadian ranking toward the bottom. Patients were waiting between 3-15 months for treatment, when they could have received the same quality of care in Germany, France or the Netherlands in two weeks. The Canadian system insures everyone, and all Canadians have access to basic and critical health care without ever seeing a doctor or hospital bill. But demands on the system have led to waiting lists for treatments such as MRI scans, cataract and artery bypass surgeries and hip replacements. Both American and Canadian health systems need urgent attention. How quickly one or both are fixed, will have a lot more influence on the medical tourism flows to and from Canada than anything else.

At a recent meeting in Phuket, Thailand, a new association was formed the Asian Association of Medical Tourism (AAMT). It has been formed because of the rapidly growing medical tourism industry in the Asia Pacific region. With the emerging trend of more people entering into the medical tourism industry in the region, the founders, SOS medical tourism, felt it important that the Asia-Pacific must have its own medical tourism association. Asian Medical Tourism Association (AAMT) was formed in mid 2009 as a non-profit trade body. At least for the first year, AAMT’s policy is to offer free membership for those involved in Asia-Pacific medical tourism. The association shall * Not show favouritism to any one member over another* Produce an information flow (online newsletter on a regular basis)* Network with other organizations with only the best interests of its members in mind.* Act as a database coordinator with research relevant to the medical tourism industry Aims and Goals- *To foster and grow the medical tourism industry in the Asia Pacific region*To act as an advocate for members to develop a better understanding of medical tourism* To help develop standards in line with the culture and economic needs of its members* To lend advice and provide information that may help our members further grow the interest in medical tourism industry* To provide a forum for our members to openly discuss issues relevant to all sectors of medical tourism industry* To act as a voice of medical tourism industry throughout all Asia AAMT will fully endorse and support the upcoming conference, The World Medical Health Tourism Conference to be held in Phuket in September 16-18, 2009. A 30% discount on the conference registration fee will be extended to certified members of the AAMT. All members are encouraged to attend the event, where the first ever meeting of members will take place to decide more detail on the future of the organisation. While rival bodies cover Asia, there is a mood in Asia-Pacific that they concentrate too much on potential American business, when countries see most growth from Asia, Pacific and Middle East regions.  A report on medical tourism by the Asian office of the Deloitte consulting group has had little attention.’ Medical Tourism-the Asian chapter compiled at the end of 2008, before the worst effects of the recession were known. While most others were still trotting out figures of up to 40% annual growth for individual Asian countries, the report suggested a more sober 20 percent annually across Asia. It highlights that the main fuel is the growing affluence of the middle class in Asia, allowing patients to travel for better quality medical care than in their own countries. Even before we knew that fewer patients from Europe and the US were travelling to Asia, it suggested that these areas were of much less importance to Asian medical tourism than many would like to admit.

With compulsory health insurance and offering probably the best healthcare in Europe, Germany is fast becoming a destination for specialist healthcare. Harley Street in London admits losing international business to Munich and other big German centres. German hospitals actively target Russians and the Middle East.So why will the number of Germans quitting the country for healthcare tourism rise dramatically? Germans are finding that dental treatment in former Eastern European countries is as much as 80% less expensive than at home, so it is cheaper to pay to go abroad than to have insured dental treatment at home and pay the self-insured portion of the bill, which can be up to 70% of the total. Germans also go abroad in large numbers for spa treatment. Although destination countries have talked about German patients, there has been no attempt to guess at numbers travelling for planned treatment, compared to those who have to get treatment when travelling.  A new survey suggests the number of outbound German healthcare tourists is already much higher than expected, and will increase. German health insurer Techniker Krankenkasse (TK) is pioneering insurance packages enabling its members to seek treatment abroad. A newly released survey done in 2008 found that around 1% of its members had care abroad in 2007, of whom 40% went for scheduled healthcare, rather than for acute and emergency care while travelling. It is the largest German health insurance fund with over five million members and 7.7 million insured persons. The insurer knows how many Germans have healthcare, so very conservatively, it has multiplied its sample to suggest that 272,000 booked ahead for care. This figure excludes spa visits and dental care not claimed back from insurers. TK leads the way in Germany in signing up foreign hospitals for members.TK European Service includes a special programme to use spas outside Germany - spa treatment is included in the list of benefits provided by statutory funds in the event of illness. The reason is that the survey found that, if ill, 33% of TK members surveyed said they would decisively take a service allowing them to use foreign spas, and a further 33% would probably make use of it. Dental treatment in Hungary, including hotel accommodation, is less than half the price of similar treatment in Germany.TK says that dental treatment is up to 80% cheaper in Eastern Europe. There are strong historic links that East Germans had before the fall of the wall with healthcare systems in Hungary and the Czech Republic. Other favoured destinations are Poland, and former Eastern European countries. Asian hospitals should note that neither the insurer nor members show any inclination or desire to go outside Europe for treatment. The health insurance reform of 2007 requires everyone living in Germany to be insured for at least hospital and outpatient medical treatment. 85% of the 70 million population are mandatory or voluntary members of one of the statutory health insurance schemes while the others have private health insurance.

The Pacific Asia Travel Association (PATA) has teamed up with the International Medical Travel Association (IMTA) to promote and develop healthcare travel and tourism across the region. The two associations have signed a memorandum of understanding that seeks to collaborate in such areas as data and trends analysis for the healthcare travel sector as well as exploring opportunities for joint membership. Medical tourism is recognised as one of the industry’s high value sectors, with medical tourists tending to stay for longer durations with the associated increase in local market spend. Ruben Toral of IMTA, says, "Asia is a well developed medical tourism region with excellent hospitals and tourism infrastructure. Working with PATA helps us to bring the healthcare and travel industries together in a more cohesive manner."IMTA is based in Singapore and the vast majority of members are based in Asia-Pacific. Formed 50 years ago with headquarters in Bangkok, PATA is a global organisation with 2500 members comprising 42 member destinations within the Asia-Pacific region, plus airlines, hotel groups, tour operators and travel agents. PATA is a membership association acting as a catalyst for the responsible development of the Asia Pacific travel and tourism industry. PATA member online booking service Agoda confirms the positive effect medical tourism has on the hotel industry. Michael Kenny of Agoda remarks, "We are definitely seeing a rise in medical tourism to Asia. For instance, our hotel partners in Bangkok such as the Ariyasomvilla and FuramaXclusive, which are both located very close to Bumrungrad Hospital, confirm that 30 - 40% of their guests are either medical tourists or their family members and friends. Following this trend, Agoda has made improvements to our site to make it easier to identify hotels which are near to popular hospitals, as well as negotiate long-stay discounts at a number of these hotels." Pomchai Chairungsinun of FuramaXclusive Sukhumvit adds, "Medical tourists make up about 30 to 35% of our clientele each year with June, July and August being our busiest months. The majority of patients usually have families visiting and will therefore request two to three rooms. Medical tourism is highly beneficial for us, as guests will generally stay for at least a week during their checkups and treatments. Our close proximity to Bumrungrad Hospital is a big bonus for visitors to the hospital." In Malaysia, G Hotel and Berjaya Georgetown Hotel in Penang have begun promoting themselves as medical tourist-friendly hotels, taking advantage of their close proximity to Gleneagles Medical Center and Penang Adventist Hospital.  In Singapore, many hospitals are located in districts with many nearby hotels. U.N. World Tourism Organisation (UNWTO) says the demand for international tourism has deteriorated, and continues to deteriorate, due to the economic recession. The impact is felt heavily in the Asia-Pacific region with tourist arrivals declining in Hong Kong, Japan, Thailand, Singapore, Macao and China. The only exception is South Korea, where tourism and medical tourism are both increasing. With tourism numbers expected to dip for the next three years, PATA and IMTA see medical tourism as one way of increasing visitor numbers.

The world’s first medical travel and medical tourism radio has launched on the internet. Executive producer and founder Julie Munro explains Medical Travel and Tourism Talk Radio is the voice of medical travel and a voice for patients. We want healthcare consumers around the world to know the advantages of global healthcare and how to access it. Existing information is often misleading or downright wrong, even from hospitals.  MT3Radio.com is a lively, impartial outlet for information about medical tourist options that goes to the source for facts, MT3Radio.com airs for a worldwide audience on the internet via wsRadio.com, worldwide leader in internet talk. It broadcasts live Wednesdays 9.00 am Pacific Daylight Time and is archived for listening 24/7. (9.00 am PDT is 12 noon New York, 5.00 pm London, and 2.00 am Sydney.)It seeks advertisers, sponsors and industry people who want to be guests. Show hosts take listener questions live on air, and talk with people who have been patients abroad or are planning to go, with some of the world’s leading doctors, and with industry leaders. Because the show is on the internet, listeners from any country can call in to ask questions or send emails. Show hosts are Julie Munro and television talk show host Sandra Millar. Curtis Schroeder of Bumrungrad Hospital Group in Thailand was the guest on the first show and he said, Medical tourism has staying power. It is not a flash in the pan. It appears to have fundamental economics that just make sense. It’s better faster, cheaper. Upcoming guests include: Jason Yap- Raffles Hospital, Singapore Angela Braly- WellPoint, USA Daniel Snyder, Parkway Group, Singapore Ori Karev, UnitedHealth International, USA Constantine Constantinides, Healthcare Cybernetics, Greece Peter Kovac, doctor, Hungary Ivan Lugo, Temple University School of Dentistry, USA Kitipan Arom, Bangkok Heart Hospital, Thailand Vishal Bali, Wockhardt Hospitals, India Mirko Jankov, surgeon, Serbia Marwan Ghosn, doctor, Lebanon Subjects planned to be covered include; Interviews and phone calls and questions for medical travellers during their medical trips and follow up at home Medical destinations country focus Medical travel agents answer questions about choosing a country, choosing a destination, preparing for the medical journey Quality and safety; reports on quality and patient safety issues, legal questions, risk, impact of cultural differences, electronic records, privacy, and more. Next live broadcast: Wednesday July 8 at 9.00 A.M. Pacific Daylight Time. The guest is Patrick Downing of Microsoft Healthcare Solutions Group discussing what the hospital of the future looks like. Julie Munro, founder of Cosmetic Surgery Travel, gives advice based to medical tourists preparing for treatment abroad, with do’s and don’ts to make the planning process better, smarter and safer.

Korea hopes to attract more than 200,000 medical tourists by 2013. Early signs are good, but problems are emerging that have to be solved to achieve that target. According to the Ministry for Health, Welfare and Family Affairs the number of foreigners visiting Korea for medical treatment jumped 32.1 percent to 9,075 in the first quarter of this year, up from 6,872 a year ago. 1,061 foreigners visited Korean hospitals in May, up from 751 last year. The government expects medical tourism to boom after the medical law was revised on May 1 allowing hospitals to launch marketing campaigns or pay commission to agencies to bring in more patients from overseas. Medical fees in Korea have been strictly controlled by the government and remain at a fraction of the prices in the United States.  But price controls do not apply to overseas patients. Initially, most hospitals charged the same to domestic and overseas patients. Most now or plan to, charge higher fees to overseas patients, as hospitals with an increasing number of medical tourists say it is inevitable for them to charge more to foreigners as it takes much more effort and time to handle non-Korean patients. According to the English Web site of the Council for Korea Medicine Overseas Promotion (CKMP), the overall price of medical services in Korea is 20 to 30 percent of that in the US. The latest statistics produced by CKMP suggest that Korea’s medical fees are 3 times lower than those of the US.A 2008 survey by the Tourism Ministry, reveals that American medical tourists do not feel fees in Korea are quite as cheap as KMOP has publicized. Those surveyed said they had an impression Korean medical services are only 20 to 30 percent less expensive than those in the US. They believed dental treatments are 30 percent cheaper, but cosmetic surgery is 30 percent more expensive. This suggests that tourists coming to Korea for cheap medical care may have problems as few hospitals are reluctant to give prices to patients or medical tourism agencies in advance. Most non-Korean websites of hospitals are long on explaining how good hospital is, but short on detail of what treatment is available and at what cost. Lee Young-ho at CKMP says that the focus of promoting Korea’s medical market should be on advanced medical technology, not price, We are seeing an increasing number of patients who come to Korea for high-quality treatment, instead of a cheaper alternative one. For Russians, the utmost importance is medical technology rather than the cost. I understand that if foreigners realize they have paid more, they will be disheartened. But what really matters is that foreign patients feel satisfied with our high quality medical service. It is not for the government to regulate the price. Hospitals have to make up for additional costs such as interpretation. Although top hospitals have people who are multi-lingual, in most there are few nurses and doctors that can speak the languages of foreign patients fluently, such as English, Russian, Japanese and Spanish.

While Russia, Georgia and the Ukraine are becoming known for IVF  and stem cell treatment, other former USSR states have plans for medical and wellness tourism. Their business comes from Ireland, the UK and a host of better off but more medically expensive Western European countries. Much less talked about is the increasing stream of well-off medical travellers coming from Russia and nearby former USSR satellites; not for cheaper care, but because of the scarcity of good facilities back home. Armenia is a small, mountainous, landlocked and relatively unknown state of 3 million people. With Turkey to the west and Georgia to the north, Armenia is not easily accessible by any means of transport, and there is poor availability of high standard accommodation. But Armenia has in recent years become a centre of medical tourism, providing visitors with the opportunity of excellent treatment such as laser surgery at a fraction of the price of the same operation in, for example, Germany.A wide range of surgical, cosmetic and dental procedures is on offer. Corrective laser eye surgery is widely available, while in central Yerevan two clinics offer laser hair removal. There is a world-class heart hospital in the Nork district of Yerevan, which performs open-heart surgery for $5000 and has one of the best success rates in the world. IVF treatment is offered, at the Yerevan Center couples from the USA, Holland, Russia and Germany have come to Armenia to get treatment. American company Stem Cells for Hope (SCFH) is a company engaged in the field of regenerative medicine. This includes ongoing research, development and the treatment of patients with stem cell transplantation therapy. SCFH has established license agreements with medical treatment facilities in Eastern Europe where stem cell transplantation therapy is approved by the appropriate local government agencies. It is a new company, but already offers treatment at facilities in the Ukraine and the Republic of Georgia; and also hopes to expand to other countries soon. A project in Turkmenistan is intended to become a centre for health tourism. This ecologically clean shore of the Turkmen sector of the Caspian Sea will open its doors to several health resorts, among them a fashionable 12-storey spa hotel, holiday homes and hotels. In the new health centres, foreign visitors will be to improve their health and undergo a course of rehabilitation and spa treatment. The project, with an investment of over $5 billion, offers a wide range of customs and tax privileges. Foreign investors are invited to erect modern houses, sanatoria, health centres, spas, hotels, as well as cultural and entertainment centres in the tourist zone. The seaside Turkmenbashi international airport is under construction and will be a key transit point for the air route from Europe to South and Southeast Asia. The seaport and marina will be fully redesigned. The number of medical tourists within the former Eastern bloc is not known, but local experts suggest that including numbers coming from Asia and Western Europe, it is more than in some countries widely regarded as important medical tourism destinations.

American medical tourism agency PlanetHospital and ABQAURP are both interested in healthcare quality on a worldwide basis. They have partnered to offer international physicians looking for quality approval and enhanced credentials. Established in 1977, ABQAURP, the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) is the US’s largest organization of interdisciplinary health care professionals. It has a Health Care Quality and Management (HCQM) examination for individuals. The certification process promotes professionalism in all health care professionals and ABQAURP is the only organization with an international certification developed, administered, and evaluated through the consultation of the National Board of Medical Examiners. International physician candidates will need to be credentialed through PlanetHospital. Once credentials are certified and the candidate has passed the HCQM examination, the ABQAURP Diplomate will have the opportunity to participate in the PlanetHospital network of hospitals and clinics. Those health care professionals already affiliated with the network will have the opportunity to be certified through ABQAURP’s HCQM certification. As an ABQAURP’s corporate partner providing products or services to the health care industry, individuals get greatly reduced prices for ABQAURP certification and continuing education programs, while the company gets exhibit space at live seminars, complimentary advertising in the Patient Safety and Quality Healthcare magazine as well as numerous other benefits. To be eligible to sit for the exam, international candidates must meet the same high eligibility and credentialing standards as US candidates, including a working knowledge of English. The ABQAURP Certification Exam is given in the English language at testing sites throughout the world. Non-US physicians and other health care professionals must meet eligibility and credentialing standards. Once eligibility requirements are met, candidates may proceed with the credentialing process. Sitting for the HCQM examination is permitted while the credentialing process is pending. Credentialing is provided through PlanetHospital using its own knowledge of the sector. There is a proliferation of accreditors, certificators and credentiallers offering, for a fee, to help individuals and organisations improve healthcare and medical tourism quality. There is confusion as some use the terms interchangeably, to confuse customers who do not know the ins and outs of the various processes. According to the 2009 edition of Mosby’s Medical Dictionary, credentialing means: Examination and review of the credentials of individuals meeting a set of educational or occupational criteria and therefore being licensed in their field. Accreditation means: A process whereby a professional association or nongovernmental agency grants recognition to a health care institution for demonstrated ability to meet predetermined criteria for established standards. Certication means: A process where an individual or an institution is evaluated and recognized as meeting certain predetermined standards. Certification is usually made by a nongovernmental agency. The purpose of certification is to ensure that the standards met are those necessary for safe and ethical practice of the profession or service. So: Individuals can be credentialed, but not accredited. Organisations can be accredited but not credentialed. Either can be certificated The new partnership does offer non-US professionals an acceptable examination based standard, a class above self-approved, non-examination, fee-based alternatives.

According to Coldwell Banker Peninsula Trading Co. there is a rapidly growing trend in Costa Rica in real estate investments in property developments planned for health care facilities, recovery centres, hospice homes and wellness retreats. As travel to foreign countries for both alternative and traditional medical care has grown in acceptance during the past decade, Costa Rica emerged as one of the most accessible, secure, innovative and price-competitive destinations for travellers from the US and Canada seeking  heath care. Costa Rica’s medical system is actually rated better than the United States’ by the World Health Organization. Costa Rica offers the climate and conditions for a healthy lifestyle, quality care and quick recovery. This also makes it attractive for those seeking holiday or retirement homes. Health care costs in the United States have exploded in the last few years, but the same procedures are very affordable in Costa Rica and can save people 30% to 70%. Several American medical tourism agencies see increasing opportunities in Costa Rica, while it is notable that the only three dental clinics in the Companion Global Dental network are all in Costa Rica. Costa Rica’s Nicoya Peninsula lies in the centre of one of the largest Blue Zones of the world. Blue Zones are those areas of the world where people live the longest and have the highest quality of life. In the Nicoya Blue Zone, adults have the longest life expectancy in the world due to water quality, a healthful diet and a slower pace. Wellness retreats on the Nicoya offer opportunities for meditation, yoga, massage etc. that contribute to a healthy lifestyle and recovery from major illnesses. While wellness, dentistry were the original draws, people now go to Costa for treatment on diabetes, cardiology, urology, fertility, orthopaedics and neurology. A main attraction for medical visitors continues to be cosmetic surgery. There are two major recovery centres, mostly used by wealthy Americans.     One of the benefits of seeking care in Costa Rica is its proximity to the U.S. All major carriers, as well as discount airlines Frontier, Spirit and JetBlue, have convenient direct service to San Jose, Costa Rica. The only two JCI accredited hospitals in the country are in San Jose; Hospital Clinica Biblica, and Hospital CIMA, as is one awaiting JCI status, Hospital La Católica.  Costa Rica is home to 30 hospitals and 250 clinics. Most of Costa Rica’s modern medical clinics are located in the Central Valley, either in the capital city of San Jose, or in nearby Heredia and Alejuela, near Juan Santamaria International Airport. Pharmacies in Costa Rica can deliver basic diagnostics and medications, including birth control and painkillers, without the doctor’s visits and prescriptions required in the US. Medical tourism has a very positive impact on the economy of this destination country. Highly skilled medical professionals, often U.S. trained and fluent in English, are moving there, as are major international pharmaceutical and medical supply companies. An estimated 20,000 health travellers sought treatment here last year, although no official count is available, says Dr. Alfredo Lopez, for the Council of International Promotion of Costa Rica Medicine, (Promed)

Pakistan wants to attract medical tourists, but any attempt to do so is being weakened by revelations that illegal organ transplant tourism is alive and kicking. Tourism minister Maulana Atta plans to introduce medical tourism in Pakistan by providing low cost state of the art medical facilities to the patients. A simple surgery can be under a tenth of the cost of Europe or the US. Pakistan has highly qualified doctors, the latest medical equipment and hospitals with all necessary arrangements, says the minister. Pakistan’s earlier entry into medical tourism was mostly based on cheap organ transplant tourism. Although the government outlawed the practice last year, there are disturbing reports that the trade is far from dead. The Transplantation of Human Organs and Tissues Ordinance in 2007 to check the commercialisation of organ transplantation in Pakistan is being flouted with impunity. Some hospitals that were leaders in organ transplant tourism continue to offer their services. On 23rd June 2009,The Supreme Court expressed concern that sale of human organs for transplantation is continuing despite a law prohibiting it. It seems the provisions of the ordinance are not adhered to strictly and despite prohibition of the sale of human organs in Pakistan, the trade is going on allegedly in two hospitals, the names of which have been mentioned in a letter sent by the Transplantation Society of Pakistan, said a three-judge bench. Summoned before the bench, one hospital told the court that it had decided not to carry out any future transplant, but the other made no such commitment. The court became involved when an eminent transplant surgeon who does legal transplants, received emails from fellow transplant surgeons in Saudi Arabia, Kuwait, Bahrain and India disclosing that their patients were still visiting Pakistan to obtain illegal kidney transplants. At a conference in India, his Indian hosts confronted him with a number of patients who had crossed the border to obtain illegal transplants in Lahore. The death of an Indian who had visited Lahore to sell his kidney and died of complications was widely reported. The BBC broadcast an interview with a Londoner, who had obtained a transplant in Pakistan that cost her £30,000. She was deceived into believing that no violation of the law was involved. The law specifically bans the sale of organs and prohibits organ transplantation from unrelated live donors. In cases where the latter are allowed the conditions stipulated by the ordinance are so stringent that no foreigner on a short visit to Pakistan can ever meet them. The Transplantation of Human Organs and Tissues Authority (Thota), the agency set up to regulate organ transplantation, was told of four cases of illegal transplantation surgery allegedly done in a Lahore hospital. The recipients came from Saudi Arabia, Kosovo, Turkey and Bulgaria. There are numerous institutions and persons involved in it, not just the hospitals and surgeons carrying out the surgery but visa officers in embassies who facilitate the issuance of visas, and the touts who procure the donors. In April, Thota reported that the number of foreigners being transplanted commercially with organs in Pakistan had dropped to nil from 1500 a year. But with cases of transplant tourism continuing, Thota is not working properly. The hospital that admitted several illegal operations, and the doctors involved, got no more than a mild telling off, with a promise not to do it again. Such ineffectiveness in controlling the illegal organ trade makes it difficult for Pakistan to be taken seriously as a medical tourism destination. Another problem for Pakistan is perceived hospital quality. Only one hospital has any international accreditation. Aga Khan University Hospitals in Karachi was first accredited by JCI in 2006, is due a re-accreditation survey, concentrates on charity work, and shows little interest in medical tourism.