IHHR 3 - April 2018

The magic of telemedicine Could insurance companies help build traction?

Q&A The US Cooperative for International Patient Programs (USCIPP)

Destination spotlight Healthcare and health insurance in India

Issue 3 ¡ April 2018

Attack of the cyber villains How can hospitals protect themselves against cyberattacks?

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10. Attack of the cyber villains How can hospitals protect themselves against cyberattacks?

18. Destination spotlight

22. Trouble in paradise

Healthcare and health insurance in India

Hospital billing in Mexico

14. The cost of safe dialysis The difficulty of accessing renal services abroad

26. The magic of telemedicine Could insurance companies help build traction?

32. ProďŹ le The US Cooperative for International Patient Programs (USCIPP)

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Welcome! Step inside the third issue of IHHR, where you can find features spanning telemedicine, kidney dialysis, cyberattacks, and high hospital bills in Mexico; a profile on healthcare in India; and an interview with the US Cooperative for International Patient Programs (USCIPP).

with Australia that allows for free health services including dialysis, and citizens of Belgium and Holland are usually able to pay for their dialysis via their national insurance, citizens of other countries are reliant on different agreements that may not cover all private renal care available.

Also in this issue, our destination spotlight looks

Every connection, every device, and every piece of data moved across and between networks in the connected healthcare ecosystem is potentially at risk in a cyberattack Jacquie Schwoerke, Director of Global Patient Services at Sharp HealthCare, Gigi Galen Grobstein, President and Founder of Star Healthcare Network, and Richard Nicholas, Principal Consultant at TPA Network lend their expert opinions on the contentious issue of hospital billing in Mexico – a nuanced topic involving mutual distrust and financial irregularities.

In our telemedicine feature, we explore how insurance companies are utilising such services, and ask whether telemedicine can ever replace in-person interactions with doctors. Elsewhere, we look at how hospitals might protect themselves against potential future cyberattacks: “Every connection, every device, and every piece of data moved across and between networks in the connected healthcare ecosystem is potentially at risk in a cyberattack,” warns Kaspersky researcher, Denis Makrushkin.

Our kidney dialysis feature explores the difficulty of accessing and covering renal services abroad: while the UK has a reciprocal health agreement

at healthcare and health insurance in India, where private enterprises are blossoming due to a growing need for high-quality medical care, and we speak to USCIPP about its work to help meet the challenges presented by rapidly expanding health innovation and healthcare. “While US hospitals grapple with cost containment, hospitals in other countries now offer viable and affordable substitutes closer to home,” says USCIPP founding member Pamela Frank.

Enjoy the issue and please drop me a line if you would like to contribute to IHHR. I’d love to hear from you.

Happy reading and stay well!

Online: www.ihhr.global, @IHHRonline

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NEWS BDMS Alarm

Apple to let customers

Center celebrates

see medical records

successful first year

on their phones

Bangkok Dusit Medical Services Co. Ltd (BDMS) set up its Alarm Center in 2017 to ‘provide timely and personalised’ assistance services to customers, which it says is ‘integral for providing effective, quality medical care’. Since its opening, it has dealt with complex medical, logistical and insurance cases involving patients from around the world and handled emergency calls throughout Thailand and neighbouring countries.

It now operates 24/7 with English-speaking staff and oncall interpreters, including a response team made up of medical evacuation and repatriation specialists selected from BDMS’s Emergency/CCU teams, who are also specially trained in aviation medicine and aeromedical transport. The Alarm Centre team manages issues such as onlocation patient assessments; evacuations via air, land and sea; hospitalisation and treatment; and worldwide repatriation.

The company’s hospital network consists of 45 medial centres across Thailand – led by the flagship Bangkok Hospital in the capital – which includes 14 JCI and 11 CCPC accreditations.

Tech giant Apple has announced that users of its iPhone in the US will now be able to automatically download and see parts of their medical records on their mobile device.

The update will be available via iOS 11.3 beta, and will feature on the company’s Health app.

The records are based on Fast Healthcare Interoperability Resources (FHIR), a standard electronic medical records transferral system. Customers will be able to view allergies, conditions, immunisations, lab results, medications, procedures and vitals on one screen, and will receive notifications if data changes. The Health app data is encrypted and can be protected with a user’s password. A number of facilities have signed up for the beta programme including: Johns Hopkins Medicine in Baltimore, Maryland; CedarsSinai in Los Angeles, California; Penn Medicine in Philadelphia, Pennsylvania; Geisinger Health System in Danville, Pennsylvania; UC San Diego Health in San Diego, California; UNC Health Care in Chapel Hill, North Carolina; Rush University Medical Center in Chicago, Illinois; Dignity Health in Arizona, California and Nevada; Ochsner Health System in Jefferson Parish, Louisiana MedStar Health in Washington, D.C., Maryland and Virginia; OhioHealth in Columbus, Ohio; Cerner Healthe Clinic in Kansas City, Missouri.

“Our goal is to help consumers live a better day. We’ve worked closely with the health community to create an experience everyone has wanted for years – to view medical records easily and securely right on your iPhone,” said Jeff Williams, Apple’s COO. “By empowering customers to see their overall health, we hope to help consumers better understand their health and help them lead healthier lives.”

Apple hopes that more hospitals will join the programme after the beta phase.

Kern Medical adopting new health management technology Trauma centre Kern Medical has selected Cerner, which assists clinicians in making care decisions and organisations in managing the health of their populations, to implement the Cerner Millennium integrated electronic health record (EHR) and Cerner HealtheIntent big data and insights platform for population health management. This is expected to support improved health outcomes through an integrated platform and actionable health data.

Kern Medical decided to transition to Cerner Millennium, a healthcare IT platform that is designed to support an individual’s care journey across the continuum – from the doctor’s office to the hospital and outpatient clinics – with consistent patient engagement, based on its goal to have one, integrated and efficient platform

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to allow for seamless care.

“Kern Medical is committed to delivering safe, compassionate, high-quality care to our community and Cerner’s health IT solutions will help us continue to do so,” said Dr Glenn Goldis, Chief Medical Officer, Kern Medical. “Through this transformation, we will strive to provide an integrated approach toward improving the health and wellbeing of our community.”

Cerner HealtheIntent is designed to aggregate data in near realtime from multiple sources to create a single, comprehensive view of an individual’s healthcare experiences, as well as the healthcare organisation’s patient population, to inform clinical decision making. Kern Medical clinicians will receive support through meaningful data to help engage people beyond the hospital setting and manage health outcomes.

“Cerner HealtheIntent will help Kern Medical physicians have deeper insights into their patient population, so they can engage patients and the extended care team to take action,” said Ryan Hamilton, Senior Vice President, Population Health, Cerner. “A population health approach will assist Kern Medical in managing the health of its community one person at a time, empowering patients in their healthcare and enhancing the patient experience.”

NEWS New financing to improve patient outcomes Diagnostic commercialisation company Diaceutics, which works to improve patient outcomes via better diagnostic testing, has announced that is has raised £3.75 million in new mezzanine financing from two partners, WhiteRock Capital Partners and Silicon Valley Bank, which will be used to support the company’s continued global expansion.

The funding will be used to invest in the data analytics services that it provides to pharmaceutical clients and continue to expand its global laboratory network. It also plans to grow its internal team of experts to deliver data-driven insights designed to improve diagnostic testing that benefits patients.

“We need to continually broaden

our global data capabilities and insights; this mezzanine financing allows us to keep pace with our data collection and protection infrastructure while expanding globally,” said Peter Keeling, CEO, Diaceutics. “Furthermore, we are eager to continue diversifying beyond our expertise in oncology into general medicine areas and provide our pharmaceutical clients with invaluable insights that help them ensure patients who can benefit from these precision drugs are indeed receiving them.”

Andrew Gowdy, Senior Portfolio Manager, WhiteRock Capital Partners, commented: “Diaceutics is paving the way when it comes to precision medicine, transforming how patients are diagnosed and treated. Partnering with a company that is revolutionising healthcare and expanding at an incredible rate is very exciting.”

“Our aim is to work with innovators

who are solving real-world problems and Diaceutics certainly delivers those solutions,” said Clive Lennox, Director of Irish Business Development, Silicon Valley Bank.

“We’re committed to supporting the burgeoning Irish technology market and we are thrilled to be involved with such a dynamic organisation, as it takes the next step in its journey and expands out into a wider range of markets.”

The benefits of short-term health plans Provider and manager of specialty health insurance products Pivot Health has defined ways short-term health plans can benefit consumers who would otherwise be uninsured or lack sufficient coverage due to changes in their life situation.

“An Affordable Care Act (ACA) plan is a fine solution for individuals and families who qualify for financial subsidies to lower their health insurance costs. But for the eight million Americans who don’t qualify for an ACA plan subsidy and for those in a variety of life events, they should know there are other affordable options,” said Jeff Smedsrud, CEO of Pivot Health.

“When life throws a curveball, shortterm health plans can be a low-cost insurance solution while covering doctor office visits, hospitalisation and more. It is a niche, temporary solution, but a large overall market.”

According to Smedsrud, the first life situation when short-term health insurance could make the most sense for a healthcare consumer is

‘joining the ‘gig’ economy’. “For new business owners or solopreneurs, being able to obtain immediate and affordable health insurance coverage is a key component to their personal success. Short-term medical insurance can start in just 24 hours and costs about 50-per-cent less than traditional health insurance,” he said.

Another life situation is ‘stuck in employer waiting period’. “[Some] employers have a 90-day waiting period before health insurance benefits begin,” said Smedsrud. “A temporary short-term health plan helps bridge the gap for workers who are between jobs or stuck in a new employee waiting period.”

A third life situation is ‘moving to a new state’. According to Smedsrud, when an individual with an ACA plan moves, their insurance certificate is no longer valid in their new state of residence.

“They can certainly enrol in another ACA plan once they have settled in their new home, but time and paperwork can delay coverage,” he said. “In addition, the deductible starts over, which is a big disadvantage to those who move late in the year. Short term medical [insurance] with a lower deductible can serve as a temporary solution to provide immediate coverage for an unexpected illness or accident that occurs.”

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NEWS Advancing kidney disease research Following an extensive nationwide search, Joshua M. Tarnoff has been named CEO of NephCure Kidney International, a not-for-profit patient advocacy group committed to eradicating glomerular (kidney) diseases by advancing research,

educating patients, their families and healthcare professionals and providing emotional support for all who are affected by these diseases.

Joshua was most recently CEO and President of biopharmaceutical company Complexa, Inc. for seven years and has also held executive positions at Viropharma Inc. and AstraZeneca. He brings more than 30 years of

pharmaceutical and biotechnology experience to NephCure.

“Josh’s experience and passion for helping others will be a great asset to our organisation,” said Dr Irv Smokler, NephCure’s Board President and founder. “We look forward to Josh’s leadership and innovation as we approach our 20th year of helping FSGS (focal segmental glomerulosclerosis) patients.”

Best in healthcare Dr Shervin Naderi has been recognised for his exemplary work by the American Health Council.

The Naderi Center, which is located in Chevy Chase, Maryland and Herndon, Virginia, has been awarded ‘Best in Healthcare’ by the American Health Council, which has also donated to the American Cancer Society on the Centre’s behalf.

The American Cancer Society encourages patients to seek anticancer breakthroughs using the very best in technology with experienced physicians, such as leading reconstructive specialist Dr Erica Anderson, who is known for her outstanding breast reconstruction skills.

Dr Naderi is a double boardcertified facial plastic surgeon who has significant experience in reconstructive surgery of the face and neck. He is a member of the American Academy of Facial Plastic and Reconstructive Surger, and others. He regularly trains other doctors, is cutting edge in his field and is listed in The Global Directory of Who’s Who.

Blue Cross introduces health solutions platform Boston, US-based not-for-profit health plan Blue Cross Blue Shield of Massachusetts (Blue Cross) is introducing the Emerging Solutions platform with the goal of curating market-leading health solutions and providing advice to employer customers on which solutions could best help improve their employees’ health.

“Through the Emerging Solutions platform, we serve as a trusted advisor to our employer customers, working closely with them to identify the health solutions that can best address the specific needs of their

America’s Health Insurance Plans appoints new CEO Matt Eyles has been named President and CEO of America’s Health Insurance Plans (AHIP), an advocacy group for health insurance providers in the US. He will succeed Marilyn Tavenner, who is retiring on 1 June and continue to lead the vision and mission established under her leadership. Matt has led AHIP’s policy work as Executive Vice-President since

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employees,” said Blue Cross Chief Marketing Officer Kathy Klingler. “We are focused on advancements that matter to our employer customers. Our decades of experience, commitment to innovation, and strong partnerships with digital health companies allow us to curate solutions that can best improve employees’ health and lower overall healthcare costs.”

Debbie Williams, Senior Vice-President of Sales and Account Services, said that the company has heard from many of its employer customers that they are looking for new ways to help their employees with specific challenges including diabetes, pre-diabetes, and maternity wellness. “Emerging Solutions can address these needs. One of the feeders into our Emerging Solutions is the work done by Zaffre Investments, our health-focused investment arm. We have a unique opportunity to continuously see the newest technological advancements in health and select those that will best benefit our members,” she said.

2015 and was promoted to Chief Operating Officer in 2017.

He has been an advocate for insurance providers and a partner to policy makers, working on areas such as healthcare reform in Washington, lowering prescription drug prices, strengthening employer-provided coverage and long-range strategic planning.

“It is an honour to represent insurance providers and the members they serve,” Matt said.

“We will continue to focus on solutions that deliver more affordable choices and higher quality for every American. It’s also an honour to have worked

with and learned from Marilyn.

For more than 40 years, she has driven important changes that have directly improved the lives of patients, consumers, and hardworking taxpayers.”

Marilyn described Matt as one of the most experienced leaders in Washington. “We have partnered together on real solutions that allow health insurance providers to better serve the millions of Americans they work for every day,” she said.

“We worked closely with the Board to plan an effective transition to ensure that under Matt’s leadership, AHIP will continue to be the industry leader for years to come.”

NEWS Cigna enters voice control space via Amazon Alexa Global health service company Cigna Corporation has announced that it is entering the voice control space with the launch of the ‘Answers by Cigna’ skill for Amazon Alexa.

The aim of the new skill is to demystify

language about healthcare by providing instant and easy-to-understand answers to more than 150 commonly asked healthcare questions.

Cigna is the first global health service company to offer a skill aimed at personalising and simplifying health benefits information.

“Voice control offers an exciting and innovative way for Cigna to educate and engage people about healthcare in a way that is convenient for

them,” said Rowena Track, Vice-President of Digital Marketing at Cigna. “The applications for voice control are expanding every day and we see great potential as we continue to simplify and personalise our customers’ healthcare journeys. Our work with Amazon Alexa provides us with experience and expertise as we evolve our voice platform and introduce new personalised services throughout the year.”

Breakthrough in leukaemia treatment A new treatment for a chronic form of leukaemia may help improve the quality of life of people with the disease.

A Phase 2 clinical trial conducted by Australian researchers and published in Annals of Internal Medicine

has shown that treatment-free remission (TFR) can be achieved in patients with chronic myeloid leukaemia (CML) who were treated with a new drug called nilotinib.

The lead investigator of the trial, Professor Tim Hughes of the South Australian Health and Medical Research Institute, said that the results will impact on how doctors treat the disease.

Dr Peter Doss, Director of Interventional Radiology at Bayshore Medical Center, now offers an image-guided, non-surgical procedure used to treat malignant lesions in the liver

Bayshore Medical Center offers minimally invasive cancer procedure Bayshore Medical Center in the US has announced that it now offers a minimally invasive procedure to deliver chemotherapy directly to a tumour.

Transcatheter arterial chemoembolisation, also known as transarterial chemoembolisation, or TACE, is an image-guided, nonsurgical procedure used to treat malignant lesions in the liver.

Chemotherapy medication and embolisation materials are delivered into the blood vessels in the liver that lead to the tumour using an X-ray guided catheter.

“The liver is unique because it has

two blood supplies,” said Dr Peter Doss, Director of Interventional Radiology at Bayshore Medical Center. “Normal liver cells are most often fed by branches of the portal vein, however cancer cells in the liver are usually fed by branches of the hepatic artery. Blocking the branch of the hepatic artery feeding the tumour helps to kill off cancer cells but leaves most of the healthy liver cells unharmed.”

The procedure lasts for around one to two hours and is eligible to patients with good liver function, without fluid in the abdomen or problems with the portal vein.

Following the procedure, most patients spend one night in the hospital for monitoring and to control any nausea they may experience. Once released, they are advised to avoid strenuous activity for 10 days and can return to a normal level of activity in one to three weeks.

“This procedure is another tool in the ever-expanding fight against cancer and has been shown to improve survival rates and quality of life,” said Dr Doss.

“Unfortunately, TACE isn’t a cure for cancer, but it can be a very beneficial procedure for our community members living with liver cancer. I am privileged to be able to offer it to those in need, close to their homes.”

Building oncology programmes Integrated commercial stage biotech company Partner Therapeutics, Inc. (PTx), which focuses on the development and commercialisation of therapeutics that improve health and economic outcomes in the treatment of cancer, has closed a Series A financing (the first round of financing given to a new business once seed capital has already been provided) to support the company’s launch and growth.

The company raised financing of US$60 million. This was led by a group of biopharma investors,

including Perceptive Advisors, Adams St. Partners and MidCap Financial. The funds will support the company’s efforts to build oncology programmes, and also help with the development and commercial operations of the business.

“We are excited to work with the team at PTx, a group with proven capabilities to build strong portfolios, execute development, and lead the commercialisation of meaningful cancer therapies,” said Adam Stone, Chief Investment Officer at Perceptive Advisors.

“We share the team’s enthusiasm for the opportunity to build a new cancer company and look forward to our partnership.”

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FEATURE

Attack of the cyber villains Security experts warn that more major cyber attacks like the WannaCry ransomware attack of May 2017 are inevitable. How will hospitals be affected and what steps must they take to protect themselves and their patients? Robin Gauldie investigates

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FEATURE

T

he Chief Executive of the UK’s National Cyber Security Centre, Ciaran Martin, has warned that a major cyber attack on the UK is a matter of ‘when, not if ’, raising the prospect of devastating disruption to British elections and critical infrastructure.

In remarks underlining newly released figures showing the number of cyber attacks on the UK in the last 15 months, Martin said the UK had been fortunate to avoid a so-called category one (C1) attack, broadly defined as one that might cripple infrastructure such as energy supplies and the financial services sector.

The US, France and other parts of Europe have already faced such attacks. Some are launched by profit-motivated criminal groups using ‘ransomware’ to lock victims out of their own computer systems until the hackers are paid off. Some are originated by governments, or deniable non-state actors operating on their behalf. And others are the work of politically motivated networks such as the shadowy Anonymous, or of individual hackers ‘showing off’ their skills.

STATE ACTORS In 2009, Israel and the US allegedly used a computer ‘worm’ called Stuxnet to damage the infrastructure of Iran’s nuclear programme – possibly the first instance of a cyber attack by a state actor on another power. Since then, Russia has been accused of backing thousands of attacks on state infrastructure in countries including Estonia and, more recently, Ukraine – a charge that it denies.

hospitals, like other vulnerable corporate institutions, have been slow to react and are tempting targets. In addition, they are at risk of becoming collateral damage from attacks not directly aimed at them, such as the cyber warfare being waged against Ukraine and earlier such attacks on Estonia attributed to Russian sources.

North Korea was blamed for the worldwide release in 2017 of the WannaCry ransomware virus, which posed a serious challenge to Britain’s National Health Service (NHS).

Many hospitals in the UK and elsewhere relied on computers using Windows XP, introduced by Microsoft in 2001. In April 2014, Microsoft ended support, including security upgrades, for Windows XP and

worm. Kaspersky’s numerous healthcare sector clients include the Dutch hospital and clinic group ZGT, the Belgian AZ Sint Jan hospitals with 1,238 beds in Bruges and Ostend, and the Illinoisbased Riverside Healthcare group.

“Most of these devices have a communication channel to the internet, external networks and different types of custom cloud base servers. These devices are full of technologies made for one goal – to help doctors treat their patients at the highest level,” he said.

Security, Lozhkin says, is often given a lower priority. Program design architecture vulnerabilities, unsecured authorisation, unencrypted communication channels and critical bugs in software can all

Hospitals, like other vulnerable corporate institutions, have been slow to react and are tempting targets warned users that computers running the system would thereafter be insecure and at risk from infection. In 2014, the UK Government signed a £5.5 million contract with Microsoft for the extended support of Windows XP until 2015 but did not renew it. Instead, individual hospital trusts still using XP were left to choose for themselves whether to continue with support. Many failed to recognise the security risks.

“Modern medical devices are fullyfunctional computers that have an operating system and applications installed on them,” said Sergey Lozhkin, Senior Security Researcher at the global research and analysis team at Kaspersky Lab, a global cyber security company which, in 2010, detected the Stuxnet

compromise security, he warns.

Despite warnings, many NHS hospitals neglected to migrate to more up-todate versions of Windows, or at least to patch their systems against ransomware.

When WannaCry hit, this proved to have been an expensive false economy.

EXTORTION AND THEFT When organised cyber crooks attack hospital systems, their motives are to demand ransom and/or to steal data that they can either use fraudulently or sell on to other criminals.

Hospitals using proprietary software and outmoded operating systems are sitting ducks for hackers looking to >>

The motives for such statesponsored attacks are political, not financial, but although hospitals have not (so far) been directly targeted, they are at risk of becoming collateral damage when vital public infrastructure such as power supplies and telecommunications is attacked.

Wherever such attacks originate, the problem is now a fact of life – but

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steal confidential patient information that can be sold on to other criminals, wrote Dr Krishna Chinthapalli, a neurology registrar at the National Hospital for Neurology and Neurosurgery in London, in the British Medical Journal (January 2018). Hospitals are probably more willing than other organisations to pay for quick recovery of their data, he said.

US hospitals, most of which are also commercial operators with a need

the digital currency favoured by hacker gangs, and denied rumours that the first ransom demand had been for $3.4 million.

Security experts have pointed out that the criminals behind such attacks often demand a relatively small ransom in order to make paying seem a more affordable option.

Allen Stefanek, the hospital’s President and Chief Executive, said paying the ransom was ‘the quickest and most

Cyber villains increasingly understand the value of health information, its ready availability, and the willingness of medical facilities to pay to get it back to protect their bottom line, are arguably even more tempting targets for criminals (though not necessarily for political players or exploit-seekers) than non-profit healthcare providers such as NHS hospitals in the UK. According to some estimates, as many as half of all US hospitals have been hit by ransomware attacks. In February 2016, Hollywood Presbyterian Medical Centre in Los Angeles became the first US hospital to admit it had paid a ransom to hackers to regain access to its computer systems.

Hollywood Presbyterian reportedly paid the equivalent of US$17,000 in Bitcoins,

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efficient way to restore our systems and administrative functions,’ adding that it had been done ‘in the best interest of restoring normal operations’.

However, just as with old-school extortion, there is no guarantee that paying ransom will end the problem, cautioned the US Federal Bureau of Investigation.

THREATS WILL INCREASE The threats to healthcare will increase as ever more connected devices and vulnerable web applications are deployed by healthcare facilities, according to another Kaspersky researcher, Denis Makrushkin.

“Every connection, every device, and every piece of data moved across and between networks in the connected healthcare ecosystem is potentially at risk in a cyber attack,” Makrushkin said.

“Health data is extremely valuable on the black market, and medical systems can be life critical, so organisations are easy targets for extortion.”

Kaspersky’s research reveals the extent to which medical information and patient data is left vulnerable to any motivated cyber criminal, he said.

“The risk is heightened because cyber villains increasingly understand the value of health information, its ready availability, and the willingness of medical facilities to pay to get it back.”

Speaking at the European Cyber Security Weekend in Dubin in November, Makrushkin warned that, in 2018, the healthcare sector will face more attacks aimed at extortion, data theft and disruption.

“The concept of a clearly-defined corporate perimeter will continue to erode in medical institutions as evermore workstations, servers and mobile devices go online. Keeping defences and endpoints secure will be a growing challenge for healthcare security teams as every new device will open up a new entry point into the corporate infrastructure.”

CASE STUDY: WANNACRY AND NHS ENGLAND, MAY 2017 WannaCry was the largest cyber attack to affect the NHS in England, although there had been previous

FEATURE

attacks on individual NHS trusts. In the investigation that followed, the National Audit Office (NAO) highlighted shortcomings in the NHS’s defences. “It was a relatively unsophisticated attack and could have been prevented by the NHS following basic IT security best practice,” said Amyas Morse, Head of the UK NAO. “The Department (of Health and Social Care - DHSC) and the NHS need to get their act together to ensure the NHS is better protected against future attacks.”

As early as 2014, the UK Government had urged NHS trusts to migrate away from the obsolescent but widely used Windows XP operating system by April 2015. Two years later, NHS Digital (the NHS’s IT service) warned organisations to patch systems against WannaCry, but the DHSC had no way of ensuring that local NHS organisations complied.

At least 81 out of 236 trusts and a further 603 primary care and other NHS organisations were infected by WannaCry, according to the NAO, but NHS Digital believes no patient data was compromised or stolen. NHS England estimated more than 19,000 appointments were cancelled. According to DHSC, NHS England and the UK National Crime Agency no ransom was paid, but the cost of 19,000 cancelled appointments, additional IT support and restoring affected data and systems is not known.

The NAO’s report of the investigation, issued 27 October 2017, said the cyber attack could have caused more disruption had a cyber researcher not activated a ‘kill switch’ so that WannaCry stopped locking devices. DHSC had developed

Keeping defences and endpoints secure will be a growing challenge for healthcare security teams as every new device will open up a new entry point into the corporate infrastructure a plan for responding to such an attack but had not tested it at local level.

“As the NHS had not rehearsed for a national cyber attack it was not immediately clear who should lead the response and there were problems with communications,” the report said. Email systems had been infected by WannaCry or were shut down as a precaution, and NHS staff had to fall back on using landline phones and personal mobile devices – some of which had also been encrypted by WannaCry. “NHS Digital told us that all organisations infected by WannaCry could have taken relatively simple action to protect themselves,” the NAO report states. “Infected organisations had unpatched, or unsupported Windows operating systems so were susceptible to the ransomware. However, whether organisations had patched their systems or not, taking action to manage their firewalls facing the internet would have guarded organisations against infection.”

The NAO has acknowledged that, since then, the NHS has accepted that there are lessons to learn from the incident and has taken action, including writing to every

major health board asking them to ensure that they have implemented all NHS Digital’s earlier alerts and taken action to secure local firewalls. A case of closing the stable door after the horse has bolted, perhaps – but better late than never. ■

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FEATURE

The cost of safe dialysis Tatum Anderson explores the difficulty of accessing renal services abroad and investigates the largest problem: cost

D

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example, many younger people don’t work as a result of their illness, and can’t afford holidays. However, Gleadell says it’s also about confidence that they will be guaranteed dialysis at their destination.

That’s why there are a number of providers of holiday dialysis, in a market that has been going for around 30 years.

FINDING DIALYSIS Organisations have sprung up to help people find dialysis; from Freedom Dialysis to IDO in France, which offers packages from New York to Barbados, and information on proximity of dialysis services to hotels.

The market has changed quite a bit. For instance, the resorts that had dialysis suites included, in locations such as Croatia, have disappeared. Instead, holidaymakers must choose holiday cottages, hotels or even resorts within easy reach of a local hospital that has renal services. There are renal services available, for example, from Tenerife and

$ $$

ialysis, the most common treatment for kidney failure, is one of the most all-consuming healthcare procedures there is. Most patients have three sessions a week, each lasting three to four hours.

Patients must plan their life around these sessions. And, things get more complicated when a patient wants to travel abroad, because they must arrange to have guaranteed access to a dialysis unit at the destination.

The number of people on dialysis is huge.

In the US alone, this number stands at 468,000, according to US charity the National Kidney Foundation. It estimates two million people worldwide are currently receive treatment with dialysis or a kidney transplant to stay alive. And the numbers are rising.

Laura Gleadell, Managing Director of Freedom Dialysis, which organises holidays for people on dialysis, says it’s difficult to deal with many of the restrictions in life, such as those related to diet. “You have an illness where you are going to have such a harsh regime of four to five hours a session, so it pretty much takes up your holiday,” she said.

Many don’t chance travelling because of the logistics of organising dialysis.

“A lot of people weren’t travelling with dialysis because they didn’t think it was possible,” she said. “We get people who haven’t been away for 15 years.”

Of course, there are other reasons. For

FEATURE

Majorca to the Costa del Sol and Egypt.

But holidaymakers can’t just turn up.

Renal services must be pre-planned and pre-booked before they leave home. The problem is, it is not so easy to find a regular slot for up to five hours every few days in many of these renal units. That’s because, certainly in Europe, they are usually part of an overstretched health system, and most slots are booked on a regular basis for local patients. Therefore, there is very little extra capacity for visiting holiday patients. And if there is capacity, it’s usually booked well in advance by the more organised holiday patients. That applies as much to patients who holiday within their own country as it does to foreign visitors.

So stretched is provision in some areas,

that it’s near impossible to get a slot at all.

London, is pretty impossible, for example, say experts. And the Scottish Renal Registry, for example, says most renal units in Scotland are still heavily over-subscribed and while treatment is available for all residents who can benefit from it, that’s not necessarily the case for holidaymakers.

“There is no spare capacity and haemodialysis for visitors must be arranged well in advance,” it said in a statement.

FLEXIBILITY IS KEY

$$

Because it’s so difficult to find renal slots, dialysis patients are often advised to be more flexible about their destinations.

Some official NHS guidance recommends those looking for Dialysis Away From Base (DAFB) must book a minimum of four weeks in advance for trips within the UK and three months if outside of the UK. Those who don’t organise holiday dialysis may be forced to travel to hospitals far away from their base, and to be dialysed as an emergency patient.

There are numerous alternatives for holiday dialysis patients.

There are public hospitals that provide dedicated machines for holidaymakers in popular holiday destinations.

Malta and Ibiza, for example, have done this. The problem is, there may just be a couple of machines available for holidaymakers.

And given that only one person can be dialysed at a time, these machines can only manage a couple of people per day. That means they get booked up extremely quickly.

Within the UK, there is a swap database that enables holidaying patients to use spare slots, left by people who live in the area they want to holiday in, who have also gone on holiday.

Then there are private hospitals that have dialysis units – in big cities, for example. In London, the Royal Free Hospital has a separate dialysis unit called the Mary Rankin.

And, finally, some of these private renal units have been specially set up for holiday use. Perhaps they have a dedicated machine, for holiday patients, or even a dedicated floor.

They are usually located specifically near popular tourist destinations.

HOLIDAY DIALYSIS UNITS One company, Da Vita, has renal centres in the Nevada desert, close to Las Vegas, 14 DaVita dialysis centres in Orlando near Walt Disney World, Universal Studios Orlando and SeaWorld Orlando, from LA to Atlanta.

In Greece, for example, the Mesogeios chain has units all over the country, including Herakleio Crete, and treats

Those who don’t organise holiday dialysis may be forced to travel to hospitals far away from their base, and to be dialysed as an emergency patient local patients as well as the large number of foreign renal patients. It’s a big unit, boasting a capacity of 160 patients and 40 machines. The company says every year it provides renal services to at least 700 visitors (Greek and foreign) with two dialysis rooms.

One company, Renal Services, offers holiday dialysis at Skegness and other destinations in the UK – from Newcastle to Salisbury. Another, Lakeland Dialysis, has a holiday unit in Cumbria in close proximity to the beautiful Lake District area. There are many of these organisations sprinkled throughout the UK, Germany and other countries.

Both rely on people to put themselves up in accommodation nearby.

Some holiday dialysis units even provide free cottage accommodation – as is the case in Hampshire St Anne’s. Others opt for dialysis cruises, where they can access dialysis units onboard ships.

Here, patients can have dialysis onboard cruise ships. There are a number of cruise ships that provide this kind of service; Dialysis at Sea Cruises claims it is the largest provider of dialysis >>

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FEATURE

services aboard cruise ships in the world.

It was founded in 1977. Cruise Dialysis, a UK firm, works with a number of cruise providers, including Celebrity, Royal Caribbean, Norwegian Cruise Lines, MSC ships and the Europa2. It would not say which dialysis providers it works with.

“The benefit of a cruise is that we can guarantee the standards of the dialysis unit and, unlike a land holiday, there is no travel to and from the unit,” said Lisa Parnell, Director of Cruise Dialysis, a UK firm. “There is no need for the patient’s travelling companion to accompany the patient to the dialysis unit, ensuring both the patient and companion make the most of their holiday.”

As might be expected, different units have different levels of service. Most are nurse led, stretched and busy. Others, in contrast, may feature a 24-hour nephrologist, or send a bus around the hotels to collect patients with dialysis appointments. Some provide menus and drinks. IMED Levante hospital, which has a dialysis centre in Benidorm, Spain, even provides access to Wi-Fi access, tablets and private TVs. Many of the cruises also feature on-board nephrologists.

AN EXPENSIVE BUSINESS But even if a patient is able to find spare capacity, the largest problem is cost.

“It’s not the dialysis that’s the problem.

It’s the funding,” said Yolanda Pickett Fernandez, Director of External Relations at IMED Hospitals, the chain of hospitals to which IMED Levante belongs.

That’s because if someone cannot find a space at the public renal service, the option is to go private. Some renal services are paid for by insurance schemes, reciprocal arrangements between countries, and via the European Health Insurance Card (EHIC), which helps patients to access state provided healthcare in all European Economic Area countries.

So, for example, the UK has a reciprocal health agreement with Australia which allows for free health services, including dialysis. And citizens of Belgium and Holland are usually able to pay for their dialysis via their national insurance, which covers dialysis in private units like IMED’s, said Fernandez. But citizens of other countries are reliant on different agreements that may not cover all of the private facilities. Some areas of Scotland will pay for a fixed number of dialysis sessions abroad per year, public or private, Fernandez said. But that is unusual for English NHS commissions, unless there is a specific agreement with

16 IHHR

a private hospital abroad. Some patients are entitled to a partial or full refund via the European Cross Border Healthcare under a European directive known as Article 56. It may only be a partial refund because many countries have set a renal tariff and will only reimburse to that amount if the cost of renal services abroad exceeds tariff. The reimbursement amount is about £150-£170 per dialysis session in the UK. “Not all patients get treated the same. Some hospitals pay and others don’t – if they come to a private unit they’d have to pay for it,” said Fernandez.

Of course, if a public health system tenders out some of their services to private hospitals then those patients can go to private hospitals providing dialysis using their EHIC (EHIC also reimburses to a lower rate than that which is charged usually by the private hospital, so often other services such as private transfer from hotels are not included).

Things are similarly complex onboard ships. “With regard to payment for dialysis sessions, providing the majority of ports visited are within the European Economic Area and the patient is from England, then NHS England will reimburse part of the cost. Different criteria apply for patients from Scotland, Ireland, Wales and overseas,” said Cruise Dialysis’ Parnell.

IDENTIFYING GAPS The gaps between reimbursement levels and the cost of treatment are also varied, but can be wide onboard cruise ships too, according to experts. “Providing dialysis onboard cruise ships is expensive due to staffing, logistics, supplies and insurance,” Fernandez said. “The cost of each dialysis session onboard ranges from around £250 to £480. Unfortunately, the EHIC is not accepted for dialysis treatments onboard.”

And even with space and funding arranged, patients also have to ensure dialysis is done safely. There is a risk of contamination from blood-borne viruses (BBVs) such as HIV, hepatitis C or hepatitis B and so it’s essential that units operate under specific protocols and safety procedures.

For example, there are several lines and other tubes that must be replaced between patients. Reusing of lines is totally unacceptable, said Gleadell of Freedom Dialysis. Her organisation vets units in order to determine whether they are observing such protocols. They often inspect units, and will not send patients to those they suspect may be reusing lines.

There’s also the issue of segregation.

Some units segregate patients with these conditions so that they are using entirely

different machines, rooms and even nurses.

Of course, there are national guidelines that units must stick to, but there is also an international standard, called universal precautions, that places certain conditions on renal units; they must isolate patients with hepatitis B. Segregating

If patients are able to organise safe dialysis abroad well in advance, there’s no reason why they shouldn’t be able to travel patients with hepatitis C and HIV is not mandatory, but many units do it anyway.

It’s hard to make generalisations about the quality of units by country. But, according to Gleadell, there are countries with exceptionally high rates of hepatitis – from Egypt to India – and patients should be extremely cautious about which units to select. For its part, the UK’s Department of Health suggests that the risk is low in Northern Europe, the US, Canada, Australia, New Zealand and Japan. It believes there is an increased risk of getting a BBV outside these areas.

Going on holiday with dialysis is down to good planning in the end, experts say. If patients are able to organise safe dialysis abroad well in advance, there’s no reason why they shouldn’t be able to travel. “Obviously people can live a very long and healthy life on dialysis, but it comes with a lot of restrictions.

It shouldn’t be that difficult to go on holiday or to want to visit family and that’s what we try to make better,” Gleadell concluded. ■

FEATURE

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DESTINATION SPOTLIGHT

Rising demand Tatum Anderson explores healthcare and health insurance in India, where a growing need for high-quality medical care has prompted the growth of private enterprises

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DESTINATION SPOTLIGHT

I

ndia is predicted to become the most populous country on the planet in the next decade, and is an emerging economic powerhouse that is witnessing rising prosperity and a rapid growing middle-class population (estimated to increase by seven per cent for the five-year period 201621). Not surprisingly, there is growing demand for high-quality medical care.

But, according to the World Health Organization, the Indian Government spent just 1.46 per cent of GDP on healthcare in 2014, one of the lowest in the world.

So, into the breach has mushroomed a private sector. It’s been largely unregulated, according to experts, and has traditionally operated in cash. That means India has one of the highest rates of out-of-pocket spending on healthcare in the world, at over 62 per cent of all spending (beating only Afghanistan, Sudan, Yemen and Nigeria). Just 20 per cent of Indians have health insurance, for example, and most of them are concentrated in the bigger cities – nicknamed the Metros.

But, things are changing. A growing number of top-tier hospitals are providing world-class services that attract a growing number of paying customers from around the world. There appears to be a trickle-down effect, with thousands of other hospitals around the country now upping their game, according to Jijo John, Director of Dart Consulting, an India-based management consultancy.

John believes improvements to these hospitals has contributed to a corresponding rise in hospital costs.

Exclusive maternity hospitals are now charging US$2,500 for a delivery – when these used to be available for $250. Better services are appealing to more middle-class Indians. “You get better treatment, ambulances to pick you up. That’s happening in the biggest cities,” he said. “This will encourage people to go for insurance.

In the last five to 10 years, people have felt the need for insurance, because medical costs have been increasing.”

REACTIVE HEALTHCARE At the very top of the enormous healthcare sector are some of the most famous hospitals in the world amongst domestic and international patients, including Columbia Asia, Fortis and Apollo Hospitals group.

The latter is Asia’s largest healthcare group with 9,215 beds across 64 hospitals, 2,200 pharmacies, over 90 primary vare and diagnostic clinics.

Jithu Jose runs the International Business Division of Apollo for Middle East & South Asia for the group. He explains that services the hospital group provides reflect the changes in disease patterns around the world. For instance, in India, the proportion of the population aged 65 and above is expected to grow from 4.3 per cent of the population in 2000 to 6.7 per cent in 2021, according to Oxford Economics. In three years, 95 million Indian citizens will be aged over 65. Along with the rising aspirations and economic vitality of a growing middle class, this increasing share of an aged population should impose additional demands for healthcare services. It’s a trend seen in countries across the globe. “We are in a world of ever-increasing disease burden and everchanging disease patterns,” Jose said.

That means the Group is focused on innovations in non-communicable diseases (NCDs), from cancer to heart disease, according to Jose. “A notable aspect is the substantial rise in oncology demand,” he said. “At Apollo, we can confidently state that we handle the highest oncology inflow

the sheer scale of the domestic market actually dwarfs the international market.

That’s why there is an interest in covering health spending, according to Dart Consulting’s John. He said: “Insurance will be a booming industry in India. It has already started and will speed up in the coming years.” Certainly, healthcare spending is expected to rise from 2.5 billion in 2010 to US$3.370bn by 2021, according to Oxford Economics.

Luckily, a plethora of government, public-private and entirely private

We are in a world of ever-increasing disease burden and ever-changing disease patterns of medical travellers to South Asia.”

The Group is set to open a Proton Care Centre in Chennai later this year.

International patients, in particular, opt for solid organ transplants among other high-end specialities, including the use of shape memory alloy for spine surgery, combined heart and liver transplants and paediatric triple abdominal bypass operations. “Organisations like ours are skewing towards absolute super speciality space,” Jose said. “The case mix has changed, and today we have evolved to a very strong position in the medical travel segment covering everything from a US$100 comprehensive preventive check up to heart and lung transplants.”

But although most international patients to India come from Bangladesh, Afghanistan, Iraq, Nigeria and Kenya,

insurance schemes have launched since the government liberalised the health insurance market in 1999.

Government schemes tend to aim at the poorest, as part of a bid to provide universal health services to millions of Indians below the poverty line (BPL). Such initiatives have sparked an insurance revolution. Between 2007 and 2010, the proportion of the Indian population with some kind of health insurance roughly tripled to 25 per cent or 302 million people. Health insurance became the second largest business in the non-life insurance sector.

However, the government contribution is still small, which has prompted the growth of private enterprises. In 2010, there were 40 private health insurance providers, although only two per cent of the population >>

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19

INTERVIEW

had private insurance that year.

DE-RISKING HEALTH INSURANCE Many of the private providers are tieups between Indian and international insurance firms. Apollo combined with the health arm of Munich Re to form Apollo Munich Health Insurance in 2009. Bajaj Allianz General Insurance Company is a joint venture between Bajaj Finserv Limited and Allianz. CignaTTK Health Insurance Company, between Cigna Corporation and Indian conglomerate TTK Group.

It launched in February 2014.

But the insurance plans and corresponding hospitals payment systems are in their infancy. So, they end up skewing demand in strange directions say experts.

For example, a typical health insurer has a provider network of around ,000 hospitals, of which only around 60 are in the upmarket tier-1 category, (with accreditation from Joint Commission International or the National Accreditation Board for Hospital & Healthcare Providers). So, patients tend to wait for long periods or travel for treatment at these upmarket tier-1 hospitals. That means 10 per cent of the hospitals submit 80 per cent of the claims.

And policies tend to cover hospitalisation only. That has not only led to a boom in new-build commercial hospitals in rural areas. It has resulted in many hospitals encouraging patients to be admitted for a day, regardless of need, in order to be eligible for insurance coverage.

Some hospitals even charge patients without health insurance less than those patients with health insurance.

These activities have had a knock-on effect on costs said Thomas K. Thomas, writing in The American Journal of Managed Care in 2011. “Instead of lowering the costs, the indemnity nature of health insurance has actually led to cost inflation,” he said. “Over the long term, health insurers have to evolve toward the more complex capitation and pay-for-performance models of provider reimbursement.”

Dart Consulting’s John said insurancebased, or so-called cashless services, almost guarantee higher costs in some hospitals. “The moment you say you get reimbursement for a cashless policy, they will do all kinds of tests and issue an inflated bill,” he said. “I don’t want to tell them I get reimbursement.”

20 IHHR

That’s why although take-up is increasing, there is still a ‘missing middle’ or a large number of middleclass Indians who are not insured according to Ernst & Young (EY).

New insurance policies will be key, it suggests. One strategy to ‘de-risk’ the health insurance pool and develop a deeper base of customers is to insure an entire extended family, from infant children to aunts and uncles suggests EY. Insurer Max Bupa has introduced cover for an extended Indian family that can encompass 40 or 50 people, for example.

Others are looking at wellness and preventing hospital admissions altogether. They have linked health

insurance programmes to smartphone applications (a totally underused resource according to EY) that monitor physical activity or visits to the gym. Aditya Birla’s new insurance programme offers a 30 per cent monthly premium reimbursement to clients who work out regularly or who record a certain number of steps in their daily activity.

But the most successful, according to EY, will be the organisations that create integrated networks. Apollo Munich, for example, has created a network of pharmacies, clinics and hospitals, and even a call centre to help prospective customers manage their diabetes risk and prevent hospitalisation altogether. ■

INTERVIEW

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21

FEATURE

Trouble in parad Tatum Anderson investigates the contentious issue of hospital billing in Mexico, and how this is straining the relationship between providers and payers

I

n recent years, the US Consulate General in Tijuana, Mexico, has reportedly received numerous complaints from US citizens about some of the healthcare facilities in Los Cabos, Mexico’s popular beach vacation region, located at the tip of Baja California. A statement from the US Consuls and Embassies in Mexico said: “Complaints documented by the Consulate include allegations that some Los Cabos-area hospitals have withheld care for payment, engaged in price gouging, failed to itemise charges, withheld US passports, obstructed needed medical evacuations, gave monetary incentives to ambulances for delivering patients to specific facilities, and held patients at hospitals

22 IHHR

against their will pending payment.”

A number of cases have been reported and recorded in Los Cabos, including one US citizen who was reportedly hospitalised with a fractured ankle and declined the recommended operation.

The facility allegedly told the family of the injured person that the airline would not clear the citizen to fly without the operation, which was apparently untrue.

Another citizen was hospitalised due to an apparent drug overdose. The medical evacuation company was not able to secure the patient’s release until the patient’s family payed US$36,000. There are plenty more stories like these. However, the issues are not confined to Los Cabos, with other regions of Mexico affected.

Indeed, TPA Network, which works with both small and large-scale health insurers, third-party administrators, health maintenance organisations and other health plan administration entities in the US and offshore, said that some of the treatment is ‘aggressive, unethical and potentially harmful … to patients who have become seriously ill or injured while in Mexico’. Its Medical Bill Review Services for Care Delivery in Mexico documents allegations that hospitals are committing a number of serious offences such as withholding care or holding patients at hospitals against their will, pending payment, withholding passports until payment is made, obstructing medical evacuations, and positioning

FEATURE

adise

employees as in-house resort doctors to direct care to their facilities.

The list of accusations is serious, and includes many Jacquie Schwoerke,

There are some hospitals that are great in Mexico but like anywhere worldwide these days we find a lot of inflation of charges, or unbundling of codes"

Director, Global Patient Services at Sharp HealthCare, has also come across. Her hospital in San Diego accepts patients who have been evacuated from Mexico, she explained. “The number of times I’ve had to contact the US Consulate representative down there [Mexico] and get them up in the night as the air ambulance is there, I was trying to get them out of the hospital, but the [hospital] won’t give them their passport,” she said.

“It’s awful. The US Consulate will step in because, by law, they really cannot hold anybody in a hospital even if they can’t afford to pay the bill. That is a fact.”

Schwoerke says she’s come across many other situations where patients may be intimidated. “What happens is, the

hospital administration then threatens their family that they will call the ‘Federales’, who will detain them until the bill is paid,” she explained. “That’s not true. Once you get the consulate, representing the foreign traveller, they will come in and protect them.”

The perpetrators in Mexico are limited but seem to be making life very difficult for international hospital patients. “It is a small group of private hospitals, but they are tainting the reputation of the quality providers and hospitals throughout the rest of Mexico,” added Schwoerke.

She would not name the hospitals in question, but said they are recognisable.

To their credit, experts say Mexico’s authorities have acted quickly >>

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FEATURE

against hospitals whenever the US Consulate has taken up the problems for individuals. The problem is, it’s easy for hospitals and doctors to set up operations again, sometimes under different names.

Separately from the physical intimidation, Schwoerke believes there can be significant financial irregularities from these hospitals. Some are price gouging and profiteering by charging highly inflated tourist rates to foreigners, she said. For instance, she has noticed that sometimes the price for services will exactly match whatever the credit limit is on a tourist’s credit card.

with the hospitals are doing just this.

Gigi Galen Grobstein, President and Founder of Star Healthcare Network in the US, a cost containment firm that works closely with Sharp HealthCare, agrees that there is a problem with the kinds of billing they are seeing out of Mexico, but she said this is similar to her experiences all around the world. “There are some hospitals that are great in Mexico, but like anywhere worldwide these days we find a lot of inflation of charges, or unbundling of codes,” she said.

She recounted a particular case in

It is up to insurers to inform customers which hospitals to avoid when they visit Mexico FOLLOW THE MONEY But, more worryingly, Schwoerke says, some of the hospitals have drastically increased the charges for services rendered in Mexico. Also, it’s very difficult to know how things are being coded, and she suspects that sometimes services are being unbundled. This phenomenon has also been spotted by TPA Network.

Unbundling is when a hospital does not charge the price attached to an entire procedure – represented by a single code. Instead, the procedure is broken down into its component parts – such as including charges for individual surgical items – which each have individual codes and prices. But, when added up, these individual codes and prices may surpass the price of the code of the original procedure. Schwoerke also suggests some unscrupulous billing companies working

24 IHHR

Mexico, which was investigated together with Sharp HealthCare. She said: “Charges from the hospital were inappropriate, and we found a physician billing for services even though the doctor had no affiliation with the hospital. It was a fabricated claim.”

But, some of the US billing companies working for Mexican hospitals actually help companies like Grobstein’s. “There are a lot of American firms that are billing for Mexico, which I find helpful,” she said. “Sometimes in Mexico, with billing, you are not clearly understanding whether things are in US dollars or in pesos. Sometimes, the coding is unclear and not in the right format, which is how we clearly review a claim.”

Things can be very complicated when dealing with some of the hospitals there, she also said. “A lot of times, I prefer an American firm helping out a hospital in

Mexico because it’s easier to differentiate the services,” she said. “When we get bills from Mexico providers, they sometimes don’t have very much information, the bills are unclear, such as what happened with the patient, so we spend a lot more time with the Mexican bills or any bills outside the US. And we have to check that the bill comes from the hospital.”

For its part, the US Department of State has issued advice for patients to ensure proper billing for hospital services: “Obtain the estimated cost of any proposed treatments; request an itemised bill every day; express any concerns about billing with hospital administration immediately; if uncomfortable with costs, check with other hospitals and if medically possible, change hospitals; immediately work with your insurance company – do not assume the hospital will; and if it appears that the dispute will be unresolvable, contact the Embassy/Consulate/ Consular Agency for additional advice.”

Tellingly, it suggests: “Additionally, patients have the right to consent to treatment and where they will receive treatment. Finally, hospitals may not retain or attempt to detain a patient, his/her passport, or body to guarantee

FEATURE

domestically and abroad. “There are certain elements of the problem that will likely persist,” he said. “Unfortunately, there will continue to be innocent people that will fall through the cracks as there will always be a small hospital facility in a tourist location that will seize the opportunity to take advantage of the situation. That’s one of the reasons we started our service.”

But, new technologies should help somewhat, Nicholas says. “With the advent of social media and utilities such as YELP, those hospital facilities that continue to cause problems in the future will be called out,” he explained.

“It is likely that the various hospital associations in Mexico will try to police their own a little better as tourism is a major revenue source in Mexico.”

AN EXERCISE IN TRUST Scott J. Rosen, President and CEO of MDabroad, says the picture is slightly more nuanced than it may at first seem. For example, healthcare is a lot more expensive in Mexico than many assume. The country has suffered from a volatile economic situation that has contributed to costs too. “There is an expectation by payers that healthcare payment of medical services provided.”

WHAT TO DO? Experts say the industry must work together if it is to solve the problem, but only if there are more formal complaints made. Schwoerke suggests that it is up to insurers to inform customers which hospitals to avoid when they visit Mexico.

After all, they always know where customers are travelling to and are able to list hospitals to avoid. “They should have a flyer or a letter saying welcome to your policy, please avoid these hospitals in the area you are going to. Please notify the embassies where you are travelling,” she advised. “These companies need to engage the consumers when there is a hostage situation. They need to advise the traveller never to give up their passport, because once you’ve given your passport you have no way out of the country,” she said.

Certainly, the US Consulate in Mexico has issued a list of preferred hospitals and tells visitors to restrict visits to these only.

Richard Nicholas, Principal Consultant at TPA Network says he has dealt with health insurance in the US and Mexico for nearly 40 years and there has always been an issue with fraud both

Rogue billing companies are known to contract with hospitals and overbill claims, thereby perpetuating the acrimony and further straining the relationship between providers and payers should be inexpensive in Mexico.

While the cost of labour and some locally manufactured products are less expensive than in Europe, and certainly in the US, there are several factors that contribute to a higher price tag on private care in Mexico,” he said.

And, says Rosen, international insurance companies can sometimes

add to the problem. “Getting paid from international insurers is difficult, the revenue cycle is unpredictable and there is a higher default rate than the lower market,” he said. “This all contributes to a higher cost of care.”

Rosen believes there is plenty of mutual distrust. “It is true that insurers or assistance companies typically come from a place of cynicism when it comes to the integrity of the billing practices of medical organisations,” he said.

But unscrupulous companies make everything worse. “There are definitely some nefarious players in the market,” he explained. “Rogue billing companies are known to contract with hospitals and overbill claims, thereby perpetuating the acrimony and further straining the relationship between providers and payers. In response, payers audit every bill, negotiate hard and really have no choice but to treat every claim from these areas as if they lack the proper clinical and pricing support.”

Rosen also said that providers have a different perspective to insurers. “An insurer is sometimes a black hole that receives claims and then fights to pay as little as possible. For payers, the provider is an entity that sees any chance to treat a patient as a license to bill an insurance company with deep pockets for anything and everything it can,” he said. “If each of the parties would become familiar with the people, the inner-workings and even the facilities of the other respective entity, the relationship would cease to work under the veil of anonymity.” When there is anonymity, he said, there is a tendency to act in a more brazen and emboldened manner. “When a relationship exists and there is a real human relationship, a face, a name and memory, people tend to conduct themselves in a more human manner,” he explained.

A solution might be found in creating an initiative within the industry to re- introduce trust amongst all the players. That organisation of providers and payers could jointly agree upon certain guidelines, such as billing practices, claims submission guidelines, clinical expectations, verification of benefits/guarantee of payment language and payment timeframes.

“They could create a trusted network of industry players with the imposition of these guidelines as a precondition to working together,” said Rosen.

Of course, it would cost money and time, and require a third party to manage, he said. “MDabroad would be glad to be the arbiter of good faith and put this together!” ■

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FEATURE

The magic of telemedicine Telemedicine is no longer a revolutionary concept. However, there are barriers to its implementation. Could insurance companies help build traction? Tatum Anderson investigates

P

atients who need to see a doctor but can’t manage a face-toface appointment are doing so via their PCs or mobile phones. They are prepared to consult on all sorts of complaints too. From cardiology to dermatology, gynaecology and even psychiatry and pathology, there are emerging telemedicine services.

Expatriates are using virtual healthcare services provided by physicians located at home, and home-based citizens are

26 IHHR

seeking less expensive care via telemedicine from healthcare providers located abroad.

Doctors are even using telemedicine to talk to other doctors, as is the case at US hospital Cedars-Sinai Medical Center.

With 350 million smartphone users in India, many of whom live far from health services, telemedicine has found a natural space. Jithu Jose, Head of International Business Division of the Apollo Middle East Consultancy, UAE, said: “Our telehealth service is one of the largest

such service in Asia and we cover some 30 countries on it.� Patients can book appointments, have online consultations and health checks, and there are online health records and homecare services too.

Likewise, Pakistan-based DoctHERS matches patients and their families with the vast pool of female doctors who are unable to practise outside the home, for cultural or childcare reasons. The platform is being offered to corporates to plug the massive gap in healthcare

FEATURE

services for employees within their supply chains in Pakistan, according to Asher Hasan CEO of DoctHERS. So prevalent is telemedicine, that research firm Mordor Intelligence estimates the market will grow from $US23.2 million in 2015 to a massive $66.6 million by 2021.

And, the world’s largest insurance companies are offering telemedicine services to their customers. Cai Glushak, a Clinical Professor of Medicine and International Medical Director at AXA Partners, which is considered one of the early adopters, said: “In our industry, telemedicine can serve two functions: cost-savings and convenience.

Depending on your target client, it will have different attractiveness. Telemedicine really maximises its cost-effectiveness for payers responsible for medical costs. So, this applies to traditional health insurers, certain expat benefit programs and travel insurance that covers medical expenditure,” he explained.

“Beneficiaries will be well-served when it avoids the need to find a doctor, especially in unfamiliar and remote locations. Where access is a problem it is a truly valuable service. In this case, a typical 10- or 15-minute teleconsultation may avoid a costly and protracted emergency room or doctor’s office visit – along with all the potentially unnecessary testing that would follow.”

them money when dealing with both tourists and expatriates who would like access to the level of healthcare that they are used to at home. “Essentially, we are the policyholder’s ‘custodian’ when they need medical attention in a foreign country. In most travel scenarios, an ill patient either goes to the concierge to get the hotel Doctor or to a local doctor,” he said. “This disjointed experience ends up costing two to three times the price of a virtual consult and is all-too-often a scary experience for the patient. We are the safe and familiar ‘first port of call’ for the patient and take over directional care responsibility from the patient’s first contact through to managing that patient’s journey within the insurer’s network.”

There are many flavours of telemedicine.

Often called virtual health or virtual doctors, a market of online GP services has flourished over the last five years.

GPs may work for a number of different platforms, depending on when they are free. Some services provide a 10-minute consultation as standard, and then if patients require longer consults, they pay for extra time. Others do not see children. Some services like his own, said Miller, only take on highly

qualified doctors – such as those who are registered with the UK’s General Medical Council, have worked between five and 10 years after graduation, have been trained in telemedicine and commit to a minimum of 15 hours per fortnight to stay on the platform.

A doctor can diagnose an ear infection via video chat, but they won’t notice the skin discoloration on a patient’s arm that could be something more serious He believes that’s vital for maintaining quality. “Our intention was never to be an uber-type provider, where patients are matched with random doctors that have spare time. We wanted to make sure the doctors were ours and our clinical governance meant that patients received the highest >>

WORLDWIDE CONNECTIONS Doctor Care Anywhere provides telemedicine services for some of the world’s biggest insurance companies.

The platform enables patients around the world to consult with general practitioners (GPs) for AXA PPP, Nuffield Health and Aon to name a few. So far, the platform has been accessed from 108 different countries in the last 18 months, said Dr Eric Miller, Global Head of Corporate at the company.

When a customer or patient requests an appointment, the doctor service works something like this: the patient is asked to fill in an online form, which asks for pertinent information. That is sent to a doctor’s panel, which decides whether this is an emergency case, or whether to offer a GP appointment via videoconferencing, or if not convenient, by phone. Around 60 per cent of the patients opt for videoconferencing appointments (the others, who prefer a phone consultation, are usually calling from work or are at a location where broadband is limited).

Miller believes insurance companies are offering this service because it saves

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FEATURE

often dissuade implementation.”

Legal issues are a major barrier to the use of telemedicine as well. Some countries and states may actually require videoconferencing as a condition of performing telemedicine, for example (whereas many platforms offer the ability to provide telemedicine via phone as well as videoconferencing).

In addition, some countries ban healthcare providers from providing services unless they hold a valid license or registration in the country or local jurisdiction where they are providing such services.

quality care wherever in the world they happened to be,” he said.

PICKING UP ON PATIENT CUES But are there limitations to the kinds of treatments that can be diagnosed or managed online? Miller says 65 to 75 per cent of GP consultations can be resolved in one sitting. The rest are referrals and repeat appointments (and no emergency cases are taken). He believes it is possible to see to most complaints, given the appropriate training is provided. “A great doctor is able to diagnose based on history, presenting complaint and clinical signs,” he explained.

“Our training, for this new technical edge, requires doctors to pick up on subtle patient cues within the videoconference – by what the patient is saying, and how they are saying it. There are nuances doctors must be very sensitive to through video rather than being there in person. It’s more ‘web-side’ manner than ‘bed-side’ manner.”

What with advances in smart phone, video and broadband technologies, telemedicine has come on leaps and bounds. Remote patient monitoring devices and apps that are able to feed data into the services are all helping to improve the use of the technology too. Any restraints in using telemedicine services are now unlikely to be down to the quality of the technology itself, but attitudes to the technology in patients and doctors, experts say.

For example, many of the target populations are still not tech savvy enough and may have difficulty handling a video-interface, which requires proper browser and webcam functionality (many users, especially older patients, prefer a simple telephone conversation).

Bandwidth is often a problem in many locations – and not just developing countries. So, transmitting complicated

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data and video requires bandwidth – may vary at the customer end.

The age of the doctors is relevant too, said Christine Carrillo, CEO and co-Founder of JOANY, a healthcare concierge service that allows consumers to submit online questions about anything from doctor’s appointments to medical bills and what’s covered by their plans – and therefore has a view of the entire healthcare market. “Telemedicine is a costly venture and requires a proper network, infrastructure and training to implement. While newer physicians are often trained to diagnose remotely, it is a skill often lost on physicians who started practising before telemedicine existed or while it was in its infancy,” she said. “It’s a concept all medical providers should consider, but available resources

A typical 10- or 15-minute teleconsultation may avoid a costly and protracted emergency room or doctor’s office visit AXA Partner’s Glushak said issues of licensing have a knock-on effect when it comes to prescriptions. “The challenge is pairing the service with the ability to fill a prescription,” he explained. “Country restrictions may limit the authority of the telemedicine physician to arrange a prescription in the country where the patient is located.”

Many providers get around this by partnering with local doctors to produce prescriptions, or if volume demands it, opening an independent

FEATURE

unit within the country. AXA Assistance calls its combination of approaches a prescription solution, where it collaborates within a growing number of countries in combination with providing telemedicine from abroad.

Luckily, gradually the rules are being changed. A European Union (EU) physician registered in one EU country can provide virtual care services to patients in another EU member state, even if that physician is not registered in the member state in which the patient is located. That is part of the EU Cross-Border Healthcare directive.

IRONING OUT CHALLENGES Some countries have been ahead of the game. Mutual recognition and related rules laws reduce some of the burden – Australia and New Zealand as far back as 1992 created a mutual recognition model permitting physicians in Australia and New Zealand to practise in certain territories in Australia and New Zealand where they are not registered.

Even in the US, over the last few years, there have been efforts to streamline and simplify physician licensing across state lines because so many prevent one doctor from providing services to telemedicine patients who may be located in a different state. Indeed, some states have even begun to enact laws requiring commercial health plans to cover medical services provided via telehealth to the same extent they cover

If a doctor fails to diagnose a serious disease and does not also have a longstanding provider-patient relationship, that could spell trouble medical services provided in-person.

Gallagher Healthcare Practice, a US-based insurance broker and risk management provider, warns of future legal problems, however. If a doctor fails to diagnose a serious disease and does not also have a longstanding provider-patient relationship, that could spell trouble. “That could lead to increased liability losses,” said a report carried out by Gallagher Healthcare Practice, in conjunction with a Washington DC law firm. Such problems may be more prevalent in a number of chronic diseases – such as cardiovascular disease – where without good management, high severity cases have very bad patient outcomes, it reckons. “Coupled with the relative novelty of virtual care, telemedicine related to these conditions may lead to increased liability losses. One thing seems certain, negligible malpractice activity in telehealth is unlikely to continue,” according to the report.

As legal challenges are ironed out, it may be up to organisations like insurance companies to help overcome the reluctance to adopt technology. Insurance companies

could do their part to build up traction for such services, said Miller of Doctor Care Anywhere. He reckons that people are starting to renew policies with insurers who offer telemedicine services. He says net promoter scores (NPS), which measure how willing customers are to stay with a service, prove this. “We have consistently scored higher above 85 on our NPS. This is really ‘sticky’ and provides a ‘halo effect’ for our insurance partners ... sometimes raising their NPS by 50 per cent.”

How successful a telemedicine service is depends on whether the insurer wants to be the gatekeeper, and controls the advertising, he said. “If it’s a service that’s just advertised as, ‘Yes, we have telemedicine’, it won’t get used much,” he said. “If we have access to the patient, by email, text or bespoke messaging, there is a much higher utilisation rate.”

But JOANY’s Carrillo says, as convenient as telemedicine is, nothing can replace inperson interactions with doctors. “Sure, a doctor can diagnose an ear infection via video chat, but they won’t notice the skin discoloration on a patient’s arm that could be something more serious,” she said.

“A patient can only rely on telemedicine to address the concern at hand, not to proactively identify other areas of concern.”

Telemedicine also relies more heavily on patients to maintain a proper treatment regimen. “Patients can misreport the severity of an issue to avoid a higher medical bill or skirt tough conversations about medical problems,” she concluded. ■

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INTERVIEW

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INTERVIEW

Packing a punch Pamela Frank, Director, International Services, Children’s Mercy Hospital; Founding member of The US Cooperative for International Patient Programs (USCIPP); and current USCIPP Premium Member, and Jarrett Fowler, Senior Manager, USCIPP, discuss their work to meet the needs presented by rapidly expanding health innovation and healthcare

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INTERVIEW

What aspects of your role as Director of an international programme at Children’s Mercy Hospital do you find most fulfilling?

PF: International programmes are still relatively new to most hospitals, creating a start-up/entrepreneurial environment (as much as that can exist within the constraints of academia).

As such, there is a lot of opportunity to generate enthusiasm among many departments. I love energising others and helping them to engage in new ideas.

Children’s Mercy has opted to create a decentralised international programme, so I get to involve colleagues (both internally and abroad) in the building and expansion of the programme.

Have you always aspired to forge a career in this line of work?

PF: Not at all. My first jobs were in telecoms and then medical equipment, with a regional focus on Latin America.

My introduction to healthcare happened when I was job searching and ended up temping at a hospital. It was during that time, 1995-97, that I first learned of a new trend at hospitals to target foreign patient referrals. My then boss and continued mentor encouraged me to pursue that path, and two years later I landed a job that launched my career as the first Director of International Services at Tufts Medical Center. I was fortunate to have two strong female mentors to help direct my career, Dr Pat Recupero who first encouraged me to bushwhack this path, and Carol Sayles who was an earlier pioneer in the field of medical travel.

Carol grew MD Anderson’s international revenue tenfold before coming to Boston Children’s to launch their programme, where I eventually landed.

Who inspires you in your day-to-day work?

PF: The families of our patients.

Supporting them during what is likely the most difficult time in their lives is a privilege and a reminder of the tenacity of the human spirit. Often those that are hardest hit will have the most grace. I get to experience firsthand what Isabel Allende meant when she wrote ‘We all have an unsuspected reserve of strength inside that emerges when life puts us to the test’.

Can you highlight the importance of expanding global access to US expertise in high-quality healthcare?

What is the present situation and what is your long-term vision?

PF: US sub-speciality care is still considered to have the most breadth and depth in the world. People who can afford advanced technology and quality care want access to it. But there are other ways to export our expertise. We help train foreign clinicians and researchers.

We offer advisory services to hospitals and governments seeking to expand their medical infrastructures. Some hospitals even have overseas satellites. Quality and advanced care, access (short waiting periods) and affordability are key variables for deciding to travel for medical care.

As a country we don’t do well on the latter. And while US hospitals grapple with cost containment, hospitals in other countries now offer viable and affordable substitutes closer to home. Since 2009, the Joint Commission International (JCI) has accredited more than 1,000 hospitals in over 100 countries.

The US needs to not only lead this global transformation but also learn from it. We have a lot to gain in doing so, especially in the field of genomic medicine, which will be a major global unifier for healthcare systems worldwide.

Why do you think that global access to US expertise in high-quality healthcare is lacking and what can be done to improve the situation?

PF: There are a number of variables as to why people can’t access US healthcare, but the ones we have a shot at influencing include: uniform telemedicine regulations; packaged pricing (which one can argue goes hand in hand with cost containment); and on-demand billing.

Countries are developing their individual telemedicine laws. As a result, it’s cost prohibitive for a hospital to understand and comply with the laws in each country in order to help a handful of individuals who could benefit from our physician’s remote expertise.

Similarly, packaged pricing is commonly offered by our international competition to self-pay patients. We know this is a growing market segment, but we can’t meet their needs by telling them the price will be US$200,000 but with a margin of error upwards of 30 per cent, and we might need to collect an additional $60,000. That just doesn’t fly unless they’re very wealthy, and the majority of our patients aren’t.

Finally, our hospitals’ billing >>

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INTERVIEW

systems aren’t helpful to the international patient. It takes upwards of seven days from date of service to generate the bills and often there are late charges. Our international competition offers a final bill in the same format as you would receive when you check out from a hotel.

Can you discuss some of USCIPP’s key partnerships and explain why they are so important?

PF: Without a number of key partners and individuals USCIPP would not exist.

When I was still at Boston Children’s, we hosted an international forum at which Professors Tricia Johnson and Andy Garman from Rush University presented their research on medical travel. Ultimately, Tricia and Andy became USCIPP’s executive leadership and the driving forces behind the initial $500,000 seed funding from the Market Development Cooperative Program (MDCP) under the US Department of Commerce (DoC). Since then, USCIPP has gone on to win a second MDCP grant for $300,000.

Boston Children’s played a key role as well in those early days. It was during a visit to the DoC in my former role as their Director of International Services that I first learned of the MDCP grant. Obama had just been elected and we arrived on the first day of his newly appointed head of their service sector. There was a palpable excitement as you walked the halls. So when we were unexpectedly introduced to him in passing he spontaneously invited us to participate in an impromptu roundtable discussion about our nascent industry.

34 IHHR

During that meeting, he turned to my student intern and asked what our industry needed. She immediately responded, ‘transparency and data,’ and from that single answer, the seed of USCIPP was planted. The first grant application was denied because we couldn’t apply as a single hospital and the non-profit I had established for the purpose of the grant was still pending approval. Furthermore, less than half of the original group of hospitals submitted letters of support.

The following year, however, Rush University’s Department of Health Systems Management, in collaboration with the University Health Systems Consortium revised and resubmitted the grant and won.

As health innovation and healthcare needs continue to expand globally, successes need to travel across borders much more quickly USCIPP’s continued success has been because of its hospital members and dedicated staff. A number of the founding institutions with strong brands like Johns Hopkins, Brigham and Women’s Hospital, UCSF Health, Cleveland Clinic and UCLA Health have played an important role as premium members. Their leadership has been key in growing the base

and advising on best practices.

On a personal level, are there any particular goals you would like to achieve?

PF: USCIPP’s continued success is personal for me so of course I’d like to see it gain additional funding to expand its staff and services. I worry about staffing burn out as members who weren’t around pre-USCIPP take it for granted and increase their expectations and demands, despite limited funding.

On a hospital level, I’d like to help Children’s Mercy gain global recognition for its many world-stage endeavours and innovations. Our decentralised model for international operations can serve as an example to other hospitals wondering if they have what it takes to jump on the international bandwagon.

How does USCIPP go about supporting the efforts of its members in expanding global access to US expertise in high-quality healthcare?

JF: While it is still a small nonprofit organisation, USCIPP definitely punches above its weight when you look at our current portfolio of activities. We conduct ongoing research and business intelligence for our Premium members to help them understand new markets and how geopolitical changes may affect the delivery of international healthcare services; we engage in advocacy and awareness building activities with important stakeholders around the world; we work with the International Trade Administration of

INTERVIEW

the US Department of Commerce to maintain the ChooseUSHealth brand and connect the hospitals with potential partner organisations at trade events in the US and abroad; we facilitate member-tomember networking and the sharing of best practices through ongoing educational initiatives, including an in-person annual meeting for our members; and we’re currently piloting a patient experience survey initiative that is exclusively focused on international medical travellers.

There are a number of variables as to why people can’t get access to US healthcare, but the ones we have a shot at influencing include: uniform telemedicine regulations, packaged pricing … and on-demand billing.

Can you discuss USCIPP’s memberdriven approach to pushing forward an agenda of research, benchmarking, education, and awareness building?

JF: Everything that USCIPP does – research, benchmarking, education, building awareness – is ultimately driven by our members. We have a number of committees and working groups to advance our initiatives. These are composed of representatives from our member institutions and include an Advisory Council, a Benchmarking and Analytics Subcommittee, a Membership

and Partnership Subcommittee, an Education and Conference Subcommittee, a ChooseUSHealth Strategy and Design Committee, and an advocacy and awareness working group.

Can you tell us about USCIPP’s international patient experience survey initiative and the importance of involving patients?

JF: USCIPP members have expressed an interest in the collaborative development of a common set of international patient experience-of-care metrics that would allow for cross-organisational comparisons and the identification and dissemination of evidence-driven best practices. USCIPP members identified this as a collaborative goal in April 2016, which saw the creation of the Patient Experience Initiative Committee and the selection of the Rush University Center for the Advancement of Healthcare Value (CAHV) to provide survey development and pilot testing services. The Patient Experience Initiative Committee has designed a 34-question survey that accounts for different touchpoints unique to the international patient experience that may not otherwise be identified by traditional surveys designed for domestic patients. The survey is to be given to patients in a standardised format and allows benchmarking capabilities once aggregated scores come in from all participating institutions. The pilot survey is available in English, Spanish, and Arabic. Preliminary data will be presented to members in May during the USCIPP 2018 annual meeting at Cleveland Clinic.

Can you talk a little about ChooseUSHealth and how the resource works?

JF: ChooseUSHealth is a federally supported, collective branding initiative that aims to globally communicate the value of American healthcare. It is the result of a multi-year collaboration between USCIPP and its members, experts at the Chicago-based branding agency Health Brand Group, and the International Trade Administration of the US Department of Commerce.

ChooseUSHealth helps international patients connect to American medical institutions that can both treat a specific illness and address issues around travel, interpreters, cultural sensitivities, and financing. ChooseUSHealth also encourages collaboration with potential international partners by highlighting USCIPP’s members’ educational, advisory, and management services capabilities. The ChooseUSHealth website features individual hospital profiles and is currently available in both English (www.chooseushealth.org) and Chinese (www.chooseushealth.cn). We expect a Portuguese-language version of the site to go live later this year.

Looking ahead to the next five to 10 years, what will be your key foci?

JF: My ideal five-to-10-year plan for USCIPP is to continue to broaden our focus on encouraging international healthcare collaborations and to more fully and intelligently integrate our activities with global health. As health innovation and healthcare needs continue to expand globally, successes need to travel across borders much quicker. I think USCIPP is uniquely positioned to help our members make important contributions to these goals, as well as to help the US learn from advances abroad. ■

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HOSPITALS DIRECTORY Your essential guide to global medical providers

To be listed contact sales@ihhr.global +44 (0)117 922 6600 ext. 1

INTERNATIONAL HOSPITALS DIRECTORY

A

B

Buenos Aires – Hospital Italiano Buenos Aires

B

Belo Horizonte – Hospital Mater Dei Contorno

Buenos Aires – Hospital Universitario Austral

Belo Horizonte – Oncocentro Oncologia Clinica e Medicina Inte...

AltmŸnster – Neurological Therapy Center Gmundnerberg GmbH

Brasilla – CliniCassi Brasilia Norte

Kapfenberg – NTK GmbH (Neurologisches Therapiezentrum Kapfenb...

Curitiba – Hospital Marcelino Champagnat

Schruns – Rehabilitationsklinik im Montafon Betriebs-GmbH

Joinville – Hospital Dona Helena

Villach – Landeskrankenanstalten-Betriebsgesellschaft - KABEG...

Lauro de Freitas – Nucleo de Oncologia da Bahia

Villach – Thermenhof Warmbad GmbH, Sonderkrankenanstalt fur R...

North Taguatinga – Acreditar Oncologia S.A. - Unidade Anchieta

Baku – Republican Treatment and Diagnostics Centre

Porto Alegre – Hospital de Cl’nicas de Porto Alegre

Ganja – Ganja International Hospital

Porto Alegre – Hospital Mae de Deus

Nassau – Doctors Hospital

Porto Alegre – Hospital Moinhos de Vento

Al Hunayniyah – Al Hilal Multi Specialty Medical Center-Riffa

Recife – Hospital Memorial Sao Jose Ltda

Al Muharraq – Al Hilal Hospital

Recife – Hospital Santa Joana Recife

Manama – Bahrain Specialist Hospital

Recife – Real Hospital Portugues de Beneficencia em Pernambuco

Manama – Dr. Tariq Hospital

Recife – Serviço de Referência Nacional em Filarioses - SRNF ...

Bashundhara – Apollo Hospital, Dhaka

Rio de Janeiro – Acreditar Oncologia S.A

Christ Church – Barbados Fertility Centre

Rio de Janeiro – Americas Centro de Oncologia Integrado

Aalst – Onze Lieve Vrouw Ziekenhuis

Rio de Janeiro – Centro de Estudos da Saude do Trabalhador e Ecologi...

Antwerp – GZA Ziekenhuizen - GZA Hospitals campus Saint Augus...

Rio de Janeiro – Hospital Copa DÕOR

Antwerpen – AZ Monica

Rio de Janeiro – Hospital Pro-Cardiaco

Brasschaat – AZ KLINA vzw

Rio de Janeiro – Hospital Rios D’OR

Brussels – Universitair Ziekenhuis Brussel

Rio de Janeiro – Hospital Sao Vicente de Paulo

Dendermonde – Algemeen Ziekenhuis Sint-Blasius VZW Onze-Lieve...

Rio de Janeiro – Intensive Care Serviços M_dicos Hospitalares

Edegem – Antwerp University Hospital (UZA)

Rio de Janeiro – Laborat—rio de Hansen’ase Ambulat—rio Souza Araœjo ...

Gentbrugge – AZ Maria Middelares

Rio de Janeiro – Pronep Lar Internaç‹o Domiciliar LTDA

Izegem – sint-Jozefskliniek Izegem

Rio de Janeiro – Samaritano Botafogo Hospital

Kortrijk – AZ Groeninge

Rio de Janeiro – Total Care AMIL - Botafogo

Leper – Jan Yperman Hospital

Rio de Janeiro – Total Care AMIL Unidade Barra da Tijuca

Leuven – UPC KU Leuven (University Psychiatry Hospitals Leuven)

S‹o Paulo – Aeromil Taxi Aereo LTDA

Melsbroek – National Multiple Sclerosis Center

S‹o Paulo – Amil Resgate Saude - Alphaville

Oostende – vzw Az Damiaan

S‹o Paulo – Amil Total Care Cincinato Braga

Ronse – AZ Glorieux

S‹o Paulo – Associacao do Sanatorio Sirio - Hospital do Coracao

HM DX – Bermuda Hospitals Board - Pathology Department

S‹o Paulo – CCC Centro de Combate ao Cancer

Bahai – S.O.S. Vida - Inovando em Saude

S‹o Paulo – Clinica Odontologica Omint >>

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INTERNATIONAL HOSPITALS DIRECTORY

B

C

S‹o Paulo – Grupo de Apoio ao Adolescente e Crianca com Cancer - GRAACC

C

Santiago – Clinica Alemana de Santiago S. A.

Sao Paulo – Hospital 9 de Julho

Santiago – Clinica Las Condes

Sao Paulo – Hospital Alem‹o Oswaldo Cruz

Beijing – Beijing Harmonicare Women & Children’s Hospital

Sao Paulo – Hospital Alvorada

Beijing – Beijing Jian Gong Hospital (Health Palace Hospital)

Sao Paulo – Hospital BP Mirante

Beijing – Beijing Jing Cheng Skin Diseases Hospital

Sao Paulo – Hospital e Maternidade Santa Joana

Beijing – Beijing Smile Angel Children’s Hospital

Sao Paulo – Hospital Geral de Itapecerica da Serra - Seconci - SP OSS

Beijing – Beijing United Family Hospital Co., Ltd.

Sao Paulo – Hospital Infantil Sabar‡

Beijing – Beijing United Family Rehabilitation Hospital Co., Ltd.

Sao Paulo – Hospital Paulistano

Beijing – Beijing Yanhua Hospital

Sao Paulo – Hospital Pro Matre Paulista

Beijing – Mary’s Orthopedic Hospital

Sao Paulo – Hospital Samaritano

Beijing – Oasis International Hospital

Sao Paulo – Hospital Santa Catarina

Beijing – Sino-Kor(Beijing) Medical Aesthetic Hospital

Sao Paulo – Hospital Santa Paula

Beijing – The Second Hospital of Beijing

Sao Paulo – Hospital Sao Camilo Pompeia

Changsha – Xiangya International Medical Center

Sao Paulo – Hospital TotalCor

Chengdu – Better and Better Medical Cosmetology Hospital

Sao Paulo – Instituto do Cancer do Estado de Sao Paulo

Chengdu – Chengdu Angel Women’s and Children’s Hospital

Sao Paulo – Pronep S‹o Paulo Serviços Especializados Domiciliores Ho...

Chengdu – Chengdu Maria Women and Children’s Hospital

Sao Paulo – Rede D’OR Hospital e Maternidade Sao Luiz

Chengdu – Chengdu West Angel Women’s & Children’s Hospital

Sao Paulo – SBIBAE - Programa Einstein na Comunidade de Paraisopolis

Dalian – Dalian Melinda Women and Children’s Hospital

Sao Paulo – Sociedade Beneficente de Senhoras Hospital Sirio-Libanes

Dalian City – Dalian Baijia Maternity Hospital

Sao Paulo – Total Care Unidade Jardins

Dongguan City – Dongguan Maternal And Child Health Care Hospital

Salvador – CEHON - Centro de Hematologia e Oncologia da Bahia

Guangdong Province – Clifford Hospital

Salvador – Hospital Cardio Pulmonar

Guangdong Province – Shenzhen HarMoniCare Women’s and Children’s Hos...

– Acreditar Oncologia S.A. - Unidade PIO X

Guangzhou – Fuda Cancer Hospital

– CliniCassi Brasilia Sul

Guangzhou – Guangzhou United Family Yuexiu Clinic Co. Ltd

– Instituto Nacional de Traumatologia e Ortopedia - Unidade Hospita...

Guangzhou – Guangzhou Women and Children’s Medical Center

– Sociedade Beneficente Israelita Brasileira Albert Einstein - SBIBAE

Guangzhou – Modern Hospital Guangzhou

Jerudong – Jerudong Park Medical Centre

Hainan – Hainan Modern Women and Children’s Hospital

Pengkalan Hulu – Pengkalan Batu Health Centre

Hangzhou – Hangzhou Women’s Hospital

Sofia – ACIBADEM City Clinic Tokuda Hospital EAD

Hangzhou – Shulan (Hangzhou) Hospital

Phnom Penh – Royal Phnom Penh Hospital

Hangzhou – Sir Run Run Shaw Hospital, College of Medicine Zhejiang U...

Grand Cayman – Cayman Island Health Services Authority Pathology Lab...

Hangzhou – The First Peoples Hospital Of Jiande

Grand Cayman – Health City Cayman Islands

Hangzhou – The Second Affiliated Hospital Zhejiang University School...

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INTERNATIONAL HOSPITALS DIRECTORY

C

Hefei – The Second Hospital of Anhui Medical University

C

Shenyang – The People’s Hospital of Liaoning Province

Huangshi – Huangshi Central Hospital

Shenzhen – Hainan Modern Women & Infants Hospital

Huangshi – Huangshi Maternity and Children’s Health Hospital

Shenzhen – Reher Cosmetic Hospital

Hunan – Hunan Cancer Hospital

Shenzhen – Shenzhen Shekou People’s Hospital

Hunan Sheng – Hunan Want Want Hospital

Suzhou – Dental Doctor Suzhou Guru Oral Clinic

Jiangsu – Affiliated Aoyang Hospital of Jiangsu University

Tianjin – Amcare Women’s and Children’s Hospital-TianJin

Jiangsu – Wuxi No.2 People’s Hospital

Tianjin – TEDA International Cardiovascular Hospital

Jiangsu Province – Changshu NO.1 People’s Hospital

Tianjin – Tianjin Aiwei Hospital

Jiangsu Province – Wuxi Baijia Maternity Hospital

Tianjin – Tianjin United Family Hospital

Jinan – Jinan Aima Maternity Hospital

Wenzhou – Cangnan People’s Hospital

Jining City – Affiliated Hospital of Jining Medical University

WuhaiÊ – Wuhai Maternity and Child Health Care Hospital

Jinjiang City – Jinjiang Municipal Hospital Jinnan Branch

Xi’an – Xi’an Angel Women’s & Children’s Hospital

Kunming – Kunming Angel Women’s & Children’s Hospital

Xi’an – Xi’an Qujiang Obstetrics & Gynecology Hospital

Kunming – Kunming Children’s Hospital

Xiamen – The First Affiliated Hospital of Xiamen University

Kunming – Yunnan Maria Hospital

Yan Helu 23 – Tianjin Ninghe Hospital

Kunming – Yunnan Richland Hospital

Yuhong District – Chongqing Angel Women’s & Children’s Hospital

Luoyang Shi – Luoyang Peony Maternity Hospital

Yuyao City – YuYao People’s Hospital of Zhe Jiang Province

Nanchang – Nanchang Renai Maternity Hospital

Zhangzhou – Zhangzhou Zhengxing Hospital

Nanjing – Nanjing Medical University Friendship Plastic Surgery Hosp...

Zhejiang – Ruian People’s Hospital

Ningbo – Ningbo Fourth Hospital

Zhejiang – The First Affiliated Hospital of Zhejiang University, Sch...

Ningbo – Ningbo No.2 Hospital

Zhejiang Sheng – YinZhou People’s Hospital, Ningbo, China

Qingdao – Qingdao Lianchi Maternity and Infant Hospital

Zhenjiang – Zhenjiang First People’s Hospital

Qinghai Sheng – QingHai Red Cross Hospital

Zhiushan – Zhoushan Hospital

Quzhou – Quzhou Kecheng People’s Hospital

Bogota – Fundacion Cardioinfantil - Instituto de Cardiologia

Shandong Province – Zibo First Hospital

Bogota – Hospital Universitario Fundacion Santa Fe de Bogota

Shanghai – Children’s Hospital of Fudan University

Floridablanca – Fundacion Cardiovascular de Colombia

Shanghai – Shanghai Baijia Maternity Hospital

Medell’n – Hospital Pablo Tobon Uribe

Shanghai – Shanghai Children’s Medical Center

Cali – Centro Medico Imbanaco

Shanghai – Shanghai Proton and Heavy Ion Center

San Jose – Hospital Clinica Biblica

Shanghai – Shanghai Pudong Hospital

San Jos_ – Hospital CIMA San Jose

Shanghai – Shanghai United Family Hospital Inc.

Ostrava – Fakultn’ nemocnice Ostrava

Shanhai – Changning Maternity & Infant Health Hospital

Prague – Na Homolce Hospital

Shanhai – Huashan Hospital, Fudan University

PragueÊ – Institute of Hematology and Blood Transfusion >>

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Quito – Hospital Metropolitano Quito

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Kerala – Rajagiri Hospital

6th of October City – Dar Al Fouad Hospital

Maharashtra – Asian Heart Institute and Research Center Pvt Ltd

Cairo – As-Salam International Hospital

Maharashtra – Fortis Hospital Limited, Mulund

Cairo – Dr. Faris Medical Center

Maharashtra – National Institute of Ophthalmology

Cairo – International Medical Center

Maharashtra – Wockhardt Hospitals Ltd Unit: Adams Wylie Memorial

Cairo – Magrabi Eye Hospital _ Cairo

Mohali – Fortis Hospital, Mohali

Cairo – Wadi El-Neel Hospital

Mumbai – Kokilaben Dhirubhai Ambani Hospital & Medical Research Inst...

El Knater El Khaireya – ElAraby Hospital

Mumbai – SevenHills Healthcare Private Limited

El-Saida – Children Cancer Hospital Egypt (CCHE) 57357

Mumbai – Shroff Eye Hospital

Giza – Dar Al Oyoun Eye Hospital

Navi Mumbai – Apollo Hospitals Enterprise Limited, Navi Mumbai

Giza – International Eye Hospital

New Delhi – Fortis Escorts Heart Institute

Addis Ababa – International Clinical Laboratories

New Delhi – Indraprastha Apollo Hospitals

Tbilisi – Medical Center MediClub Georgia

New Delhi – Maharaja Agrasen Hospital, Punjabi Bagh

Koblenz – Bundeswehrzentralkrankenhaus

New Delhi – Moolchand Hospital

Thuringen – Kreiskrankenhaus Greiz GmbH

Palakad – Ahalia Foundation Eye Hospital

Athens – Diagnostic and Therapeutic Center of Athens HYGEIA S.A.

Pune – Aditya Birla Health Services Ltd.

– Asia Medical Specialists Ltd

Punjab – Satguru Partap Singh Hospital

Budapest – Saint James Eye Clinic Hungary

Rajasthan – Narayana Multispeciality Hospital, Jaipur

Bangalore – Columbia Asia Referral Hospital, Yeshwanthupur

Telangana State – Apollo Hospital, Hyderabad

Chandigarh – Grewal Eye Institute Private Limited

West Bengal – Apollo Gleneagles Hospitals, Kolkata

Chennai – Apollo Hospital, Chennai

Bali – Siloam Hospital Bali

Chennai – Sri Ramachandra Medical Centre

Bantam – Awal Bros Hospital Batam

Delhi – Max Super Speciality Hospital (A Unit of Devki Devi Foundation)

Banten – Eka Hospital

Gachibowli, Hyderabad – Continental Hospitals Limited, Hyderabad

Bekasi – Awal Bros Hospital Bekasi

Gujarat – Apollo Hospitals International Limited

Denpasar – RSUP Sanglah

Gujarat – Care Institute of Medical Sciences

Jakarta – Fatmawati General Hospital

Gujarat – Narayana Hrudayalaya Pvt. Ltd.

Jakarta – RS Pondok Indah - Puri Indah

Gurugram – Medanta - The Medicity

Jakarta – RS Pondok Indah-Pondok Indah

Haryana – Artemis Hospital (a unit of Artemis Medicare Services Ltd.)

Jakarta – RSUPN Dr. Cipto Mangunkusumo

Karnataka – Apollo Hospitals, Bangalore

Jakarta – Rumah Salit Pusat Angkatan Darat (RSPAD) Gatot Soebroto

Karnataka – Fortis Hospital, Bannerghatta Road

Jakarta – Siloam Hospitals Kebon Jeruk

Karnataka – Fortis Hospital, Cunningham Road

Jawa Tengah – Dr Kariadi General Hospital

Kerala – Aster Medcity

Jawa Timur – RS Premier Surabaya - PT Affinity Health Indonesia

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Palembang – Dr. Mohammad Hoesin Hospital, Palembang

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Rehovot – Kaplan Medical Center

Pekanbaru – Awal Bros Hospital Pekanbaru

Safed – Ziv Medical Center

Riau – Eka Hospital Pekanbaru

Tel Aviv – Assuta Hospital Tel Aviv

Sukajadi – RSUP Dr. Hasan Sadikin Bandung

Tel Aviv – Tel Aviv Medical Center

Sulawesi Selatan – Dr. Wahidin Sudirohusodo Hospital, Makassar

Tel Aviv – Yitzhak Shamir Medical Center

Tangerang – Awal Bros Hospital Tangerang

The Lower Galilee – The Baruch Padeh Medical Center Poriya

Tangerang – RS Premier Bintaro

– Mayney Hayeshua Medical Center

Tangerang – Siloam Hospitals Lippo Village

Albese con Cassano – Casa di Cura Villa San Benedetto Menni

West Jakarta – JEC@Kedoya Eye Hospital

Arezzo – Centro Chirurgico Toscano Srl

West Jakarta City – National Cardiovascular Center Harapan Kita

Bergamo – Humanitas Gavazzeni

Yogyakarta – DR Sardjito Hospital

Brescia – Fondazione Poliambulanza

Co. Kilkenny – Aut Even Hospital

Brescia – Presidio Ospedale dei Bambini - Umberto I

Galway – Merlin Park Imaging Centre

Castellanza – Istituto Clinico Mater Domini - Casa Di Cura Privata Spa

Ashkelon – Barzilai Medical Center

Catania – Humanitas Centro Catanese di Oncologia Spa

Beer Sheva – Soroka University Medical Center

Genova – Istituto Giannina Gaslini

East Jerusalem – The Jerusalem Princess Basma Centre

Messina – COT Cure Ortopediche Traumatologiche S.p.A.

Eilat – Yoseftal Hospital

Milan – European Institute of Oncology (Istituto Europeo de Oncologia)

Galilee – Galilee Medical Center

Milano – CDI Centro Diagnostico Italiano S.p.a

Hadera – Hillel Yaffe Medical Center

Naples – Ceinge Biotecnologie Avanzate Scarl

Haifa – Elisha Hospital

Naples – S.D.N.S.p.A.

Haifa – Rambam Health Care Campus

Palermo – Istituto Mediterraneo per i Trapianti e le Terapie ad Alta...

Haifa – The Lady Davis Carmel Medical Center

Rome – IRCCS Centro San Giovanni di Dio Fatebenefratelli

Holon – Edith Wolfson Medical Center

Rome – Ospedale Pediatrico Bambino Gesu

Jerusalem – Al-Makassed Islamic Charitable Hospital

Rome – Universita Campus Bio-Medico di Roma

Jerusalem – Augusta Victoria Hospital

Rome – UPMC San Pietro FBF - Advanced Radiotherapy Center

Jerusalem – Shaare Zedek Medical Center

Rozzano – IRCCS Istituto Clinico Humanitas

Jerusalem – St. John Eye HospitalÊ

Udine – Azienda Ospedaliero Universitaria “Santa Maria della Miseric...

Kfar Saba – Meir Medical Center - Clalit Health Services

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Fujisawa-shi – Shonan Fujisawa Tokushukai Hospital

Palestine – Red Crescent Hospital Jerusalem

Hamamatsu – Seirei Hamamatsu General Hospital

Petah Tikva – Rabin Medical Center/Beilinson & Hasharon Hospitals (C...

Kagoshima – Medipolis Proton Therapy and Research Center

Petah Tikva – Schneider Children’s Medical Center of Israel

Kamakura City – Shonan Kamakura General Hospital

Raanana – Loewenstein Hospital Rehabilitation Center

Kamogawa City – Kameda Medical Center

Ramat Gan – The Chaim Sheba Medical Center

Kanagawa Prefecture – Hayama Heart Center >>

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Kumamoto – Saiseikai Kumamoto Hospital

Nairobi – The Aga Khan University Hospital Nairobi

Miyagi-ken – Japanese Red Cross Ishinomaki Hospital

Manama – Al Kindi Specialised Hospital WLL

Nagano – Aizawa Hospital

Busan – Goodwill Dental Clinic at Hadan

Okinawa – Chubu Tokushukai Hospital

Hawalli – Dental 8 Clinic

Osaka – McSYL Tatsumi Clinic & Hospital

Kuwait City – Taiba Hospital

Prefecture – Kurashiki Central Hospital

Salmiya – New Mowasat Hospital

Saitama – Saitama Medical University International Medical Center

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Beirut – American University of Beirut Medical Center

Sapporo – Sapporo Higashi Tokushukai Hospital

Beirut – Bellevue Medical Center Beirut

Tochigi Prefecture – Japanese Red Cross Ashikaga Hospital

Beirut – Clemenceau Medical Center, affliated with Johns Hopkins Int...

Tokyo – Geriatric Health Services Facilities Yokohama

Beirut – Dr.Elias Warrak Eye Hospital, Advanced Eye Care

Tokyo – IUHW Mita Hospital

Beirut – Mount Lebanon Hospital

Tokyo – Juntendo University Hospital

Vilnius – JSC Northway chirurgijos centras

Tokyo – Mitsui Memorial Hospital

Vilnius – SK Impeks Medicinos Diagnostikos Centras

Tokyo – NTT Medical Center Tokyo

Vilnius – UAB Kardiolita

Tokyo – Sainokuni Higashiomiya Medical Center

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Skopje – Clinical Hospital Acibadem Sistina

Tokyo – St. Luke’s International Hospital

Skopje – Specialized Hospital for Surgical Diseases ZAN MITREV SKOPJE

Tokyo – Tokyo Midtown Clinic

Johor Bahru – KPJ Johor Specialist Hospital

Yaese – Nanbu Tokushukai Hospital

Kuala Lumpur – Gleneagles Kuala Lumpur (A branch of Pantai Medical C...

Amman – Al Khalidi Hospital & Medical Center

Kuala Lumpur – Institut Jantung Negara

Amman – Biolab

Kuala Lumpur – International Specialist Eye Centre

Amman – Istishari Hospital

Kuala Lumpur – KPJ Ampang Puteri Specialist Hospital

Amman – Jordan Hospital & Medical Center

Kuala Lumpur – Pantai Hospital Kuala Lumpur

Amman – Jordan University Hospital

Negeri Sembilan – KPJ Seremban Specialist Hospital

Amman – King Hussein Cancer Center

Penang – Gleneagles Penang (Pulau Pinang Clinic Sdn. Bhd.)

Amman – The Specialty Hospital

Penang – Penang Adventist Hospital

Ar Ramtha – King Abdullah University Hospital

Petaling Jaya – The Tun Hussein Onn National Eye Hospital

Astana City – JSC “National Centre for Neurosurgery”

Pulau Pinang – KPJ Penang Specialist Hospital

Astana City – JSC “National Research Cardiac Surgery Center”

Sarawak – Normah Medical Specialist Centre

Astana City – JSC Republic Diagnostic Center

Selangor – B.P. Clinical Lab Sdn. Bhd.

Astana City – National Childrens Rehabilitation Center of University...

Moka – Apollo Bramwell Hospital (now Wellkin Fortis Hospital)

Astana City – National Research Center for Maternal and Child Health...

Chihuahua – Centro Oncologico de Chihuahua

Astana City – Republican Diagnostic Center Branch of “University Med...

Chihuahua – Clinica Cumbres Chihuahua

Astana City – The Hospital of the Medical Center of President’s Affa...

Ciudad de Mexico – The American British Cowdray Medical Center IAP -...

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Quintana Roo – Hospital Galenia

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Leiria – Centro Hospitalar de Leiria, E.P.E.

Sinaloa – Salud Digna Para Todos I.A.P.

Lisbon – Hospital Beatriz Angelo - SGHL

Tijuana – Obesity Control Center (Cyntar SC)

Lisbon – Hospital Lusiadas Lisboa

Tlalpan – M_dica Sur S.A.B. de C.V.

Odemira – Hospital Sao Goncalo de Lagos - Odemira

Del. Cuajimalpa – The American British Cowdray Medical Center IAP - ...

Porto – Hospital Lusiadas Porto

Ulaanbaatar – Intermed Hospital

S‹o Teot—nio – Hospital Sao Goncalo de Lagos - S‹o Teot—nio

Yangon – Pun Hlaing Siloam Hospital

Vila Franca de Xira – Escala Vila Franca - Sociedade Gestora do Esta...

Nijmegen – Radboud University Medical Center

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Al Wakrah – Al-Wakra Hospital - Hamad Medical Corporation

Managua – Hospital Metropolitano Vivian Pellas

Doha – Al Borg Medical Laboratories - Madinat Khalifa, Qatar

Lagos – Lagoon Hospitals

Doha – Al Khor Hospital

Muscat – Muscat Private Hospital

Doha – Hamad General Hospital

Muscat – Starcare Hospital

Doha – Hamad Medical Corporation Ambulance Services (HMCAS)

North AlGubra – Al Borg Medical Laboratories-North AlGhubra-Oman

Doha – Heart Hospital

Ruwi – Badr Al Samaa Hospital Muscat

Doha – Home Healthcare Services Doha

Islamabad – Ali Medical Centre

Doha – Magrabi Center for Eye, ENT and Dental

Islamabad – Shifa International Hospitals Ltd.

Doha – Micro Health Laboratories

Karachi – Aga Khan University Hospital - Pakistan

Doha – National Center for Cancer CareÊand Research (NCCCR)

Panama – Hospital Punta Pacifica

Doha – Qatargas Doha Medical Center

Panama City – Clinica Hospital San Fernando

Doha – Qatargas Medical Services Department

Lima – Clinica Anglo Americana (British American Hospital)

Doha – Rumailah Hospital

Lima – Clinica Anglo Americana (British American Hospital)

Doha – WomenÕs Hospital, Hamad Medical Corporation

Lima – Clinica Internacional S.A. - Sede Lima

Zekreet – The Cuban Hospital

Lima – Clinica Internacional S.A. - Sede San Borja

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Co. Cork – Affidea Diagnostics - Cork City & Mallow

San Pablo – Clinica San Pablo SAC

Co. Donegal – Affidea Diagnostics - Letterkenny

Makati – Makati Medical Center

Co. Dublin – Blackrock Clinic

Manila – Asian Hospital and Medical Center

Co. Galway – Bon Secours Hospital, Galway

Manila – The Medical City

Co. Galway – Galway Clinic

Quezon City – St. Luke’s Medical Center - Quezon City

Co. Kerry – Bon Secours Hospital, Tralee

Taguig – St. Luke’s Medical Center (Global City) Inc

Co. Kildare – Affidea Diagnostics - Naas

Alcabideche – Hospital de Cascais Dr. Jose de Almeida

Co. Meath – Medilink Ambulance Ltd

Aljezur – Hospital Sao Goncalo de Lagos - Aljezur

Co. Silgo – Kingsbridge Private Hospital Sligo

Covilh‹ – Centro Hospitalar Cova da Beira, E.P.E.

Cork – Bon Secours Hospital, Cork

Creixomil – Hospital da Senhora da Oliveira - Guimaraes EPE

Cork – Mater Private Hospital Cork >>

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Dublin – Affidea Diagnostics - Dublin

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Al Khafiji – Al Khafji Joint Operations Hospital “KJOH”

Dublin – Affidea Diagnostics - Dundrum

Al Khobar – Al Borg Medical Laboratories Al Khobar

Dublin – Affidea Diagnostics - Tallaght

Al Khobar – Procare Riaya Hospital

Dublin – Beacon Hospital

Al Madina Al Munawara – Magrabi Eye & Ear Center - Al Madina

Dublin – Bon Secours Hospital, Dublin

Al Noor – Al-Noor Specialist Hospital, Holy Capital Health Affairs D...

Dublin – Hermitage Medical Clinic

Al-Ahsa – Al Moosa Specialist Hospital

Dublin – Mater Private Hospital

AlHada – Al Hada Armed Forces Hospital

Dublin – Medicall Ambulance Ltd.

Aseer – Magrabi Eye & Dental Hospital - Aseer

Dublin – Royal Victoria Eye and Ear Hospital

Aseer – Saudi German Hospital - Aseer

Dublin – Sports Surgery Clinic

Asir – Al-Hayat National Hospital - Assir

Dublin – St. Vincent’s Private Hospital

Az Zahran – Johns Hopkins Aramco Healthcare

Dublin – St. Vincent’s University Hospital

Buraydah – Al Qassim National Hospital

Dublin – Vhi HomeCare

Dammam – Al Borg Medical Laboratories - Dammam

Dublin – Vhi Medical Centres

Dammam – Al Imam Abdulrahman Bin Faisal Hospital - Dammam

Dublin – Affidea Diagnostics - Northwood

Dammam – Almana General Hospital - Dammam

Kilkenny – Affidea Diagnostics - Kilkenny

Dammam – Arrawdha General Hospital

Limerick – Bon Secours Hospital Limerick at Barringtons

Dammam – Dammam Medical Complex

Portlaoise – Heart ER Ltd

Dammam – Dhahran Eye Specialist Hospital

Waterford – Affidea Diagnostics - Waterford

Dammam – King Fahad Specialist Hospital, Dammam

Waterford – UPMC Whitfield Cancer Centre

Dammam – King Fahd Hospital of the University

Daegu – Dukyoung Dental Hospital

Dammam – King Fahd Military Medical Complex

Bucure_ti – Spitalul Baneasa - Regina Maria Reteaua Privata de Sanatate

Dammam – Magrabi Eye Center - Dammam

Moscow – JSC Medicina

Dammam – Mouwasat Hospital - Dammam

Moscow – Kuntsevskaya - Fantasy Group of Medical Companies (Network)

Dammam – Saud Al Babtain Cardiac Center (SBCC)

Moscow – New Cherry Boxes - Fantasy Group of Medical Companies (Netw...

Dammam – Security Forces Hospital Dammam

Moscow – Prospect Mira - Fantasy Group of Medical Companies (Network...

Hail – King Khalid Hospital - Hail

Moscow – Rechnoy Vokzal metro station - Fantasy Group of Medical Com...

Hofuf – Almana General Hospital - Al Ahsa

Naberezhnye Chelny – Regional Emergency Medical Center of Naberezhny...

Jazan – Al Borg Medical Laboratories Jazan

Al AhsaÊ – King Abdulaziz Medical City, Al Ahsa

Jazan – Al Hayat National Hospital - Jazan

Al Hofuf – Al Ahsa Hospital

Jeddah – Al Borg Medical Laboratories Co. Ltd.

Al Hofuf – Hussein Al-Ali Hospital

Jeddah – Al Borg Medical Laboratories King Road, Jeddah

Al Hofuf – Prince Sultan Cardiac Center Alhassa

Jeddah – Al Borg Medical Laboratories, Madina Road, Jeddah

Al Jubail – Royal Commission Health Services Program - Jubail

Jeddah – Dr. Erfan & Bagedo General Hospital

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Jeddah – Dr. Soliman Fakeeh Hospital

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Riyadh – Health Oasis Hospital

Jeddah – International Medical Center

Riyadh – King Abdulaziz Medical City, Riyadh

Jeddah – King Abdulaziz Medical City, Jeddah

Riyadh – King Fahd Medical City, Riyadh

Jeddah – King Abdulaziz University Hospital (KAUH)

Riyadh – King Faisal Specialist Hospital and Research Centre, Riyadh

Jeddah – King Fahd Armed Forces Hospital, Jeddah

Riyadh – King Khaled Eye Specialist Hospital

Jeddah – Magrabi Eye, Ear & Dental Hospital _ Jeddah

Riyadh – King Salman Hospital Riyadh

Jeddah – Magrabi Hospital - Riyadh

Riyadh – Mouwasat Hospital Riyadh

Jeddah – Saudi German Hospital - Jeddah

Riyadh – Prince Sultan Cardiac Center

Jubail – Al Borg Medical Laboratories, Jubail

Riyadh – Prince Sultan Military Medical City

Jubail – Almana General Hospital - Jubail

Riyadh – Riyadh Care Hospital

Jubail – Mouwasat Hospital - Jubail

Riyadh – Saudi German Hospital - Riyadh

Khamis Mushait – Al Borg Medical Laboratories - Khamis Mushait

Riyadh – Sultan Bin Abdulaziz Humanitarian City

Khobar – Almana General Hospital - Khobar

Wadi ad-Dawasir – Armed Forces Hospital Wadi Al Dawasir

Khobar – Saad Specialist Hospital

Yanbu – Royal Commission Medical Center

Makkah – King Abdullah Medical City

– Armed Forces Hospital, Southern Region

Mecca – Al Bayt Medical Center

Thuwal – KAUST Health

Midinah – Saudi German Hospital - Madinah

Singapore – Changi General Hospital

Northeast of Riyadh – Sanad Hospital

Singapore – Fullerton Healthcare @ Ocean Financial Centre

Qatif – Mouwasat Hospital - Qatif

Singapore – Gleneagles Hospital - Parkway Hospitals Singapore Pte Lt...

Riyadh – Al Borg Medical Laboratories, Qordoba, Riyadh

Singapore – Infectious Disease Partners Pte Ltd

Riyadh – Al Borg Medical Laboratories, Sahafa, Riyadh

Singapore – Infectious Disease Partners Pte Ltd (Farrer Park Medical...

Riyadh – Al Borg Medical Laboratory - Riyadh - OLaya Branch

Singapore – Infectious Disease Partners Pte Ltd (Mount Elizabeth Med...

Riyadh – Al Hammadi Hospital

Singapore – Infectious Disease Partners Pte Ltd (Mount Elizabeth Nov...

Riyadh – Al Hayat National Hospital-Riyadh (HNH-R)

Singapore – Institute of Mental Health

Riyadh – Al Hokama

Singapore – KK Women’s and Children’s Hospital

Riyadh – Al Iman General Hospital

Singapore – Mount Elizabeth Hospital - Parkway Hospitals Singapore P...

Riyadh – AlFarabi Laboratory

Singapore – Mount Elizabeth Novena Hospital - Parkway Hospitals Sing...

Riyadh – Care National Hospital

Singapore – National Cancer Centre of Singapore Pte Ltd

Riyadh – Dallah Hospital

Singapore – National Dental Centre of Singapore Pte Ltd

Riyadh – Dr. Abdul Rahman Al Mishari Hospital

Singapore – National Healthcare Group Polyclinics

Riyadh – Dr. Sulaiman Al Habib Hospital

Singapore – National Heart Centre Singapore

Riyadh – Dr. Sulaiman Al Habib Hospital Takhassusi

Singapore – National Skin Centre

Riyadh – Dr. Sulaiman Al Habib, Assuwaidi Hospital

Singapore – National University Hospital >>

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Singapore – Parkway East Hospital - Parkway Hospitals Singapore Pte ...

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Alicante – Hospital Universitaro del Torrevieja

Singapore – Raffles Hospital

Badalona – Hospital de Neurorehabilitaci— Institut Guttmann

Singapore – Singapore General Hospital (SGH)

Barcelona – Centro Medico Teknon

Singapore – Singapore National Eye Centre

Barcelona – Eap Dreta De L’Eixample S.L.P

Singapore – SingHealth Polyclinics

Barcelona – Hospital CIMA

Singapore – Tan Tock Seng Hospital

Barcelona – IMO Instituto de Microcirugia Ocular

Ljubljana – Morela Okulisti, Center for Eye Surgery

Benimodo – Consultorio de Benimodo - Centro de Salud de Carlet (Netw...

Maribor – Oftamed D.O.O.

Bizkaia – Clinica IMQ Zorrotzaurre

Ljubljana – ARTROS, Center for Orthopedic Surgery and Sports Medicine

Catadau – Centro de Salud Catadau - Centro de Salud de Carlet (Network)

Busan – Gowoonsesang Kim Yang Che Skin Clinic

Crevillent – Consultorio Auxiliar de Crevillente San Felipe Neri - C...

Busan Metropolitan City – Ellium Plastic Surgery Clinic

El Realengo – Consultorio Auxiliar de Crevillente El Realengo - Cent...

Busan-Jin Gu – Busan BalgeunSeSang Eye Clinic

Llombai – Consultorio de Llombai - Centro de Salud de Carlet (Network)

Busanjin-gu – Kimbyoungjoon Ledas Varicose Vein Clinic

Madrid – Hospital Sanitas La Moraleja

Daegu – Daegu Mir Dental Hospital

Madrid – Hospital Sanitas La Zarzuela

Daegu – Efil Plastic Surgery Clinic

Madrid – Instituto de Oftalmolog’a Avanzada

Dongseong-ro 5-gil – Allforskin Dermatology Clinic

Madrid – Vithas Hospital Nuestra Senora de America

Gangnam – THELINE PLASTIC surgery clinic

Malaga – Hospital Vithas Xanit Internacional

Gangseo – MizMedi Women’s Hospital

Pamplona – Clinica Universidad de Navarra

Gwangju – Mir Dental Hospital Gwangju

Pontevedra – Hospital Povisa S.A.

Gyeonggi-do – Ajou University Medical Center

Reus – Sagessa Salut ABS Reus V

Gyeonggi-do – CHA Bundang Medical Center, CHA University

Torrevieja – Centro de Salud de San Luis

Gyeyang-gu – Sejong General Hospital

Colombo – Asiri Central Hospital

Incheon – INHA University Hospital

Colombo – Durdans Hospital

Seoul – EWHA Womans University Medical Center

Colombo – The Lanka Hospitals Corporation PLC

Seoul – Kim’s Eye Hospital

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Changhua City – Changhua Christian Hospital

Seoul – Korea University Anam Hospital

Kaohsiung – E-Da Hospital

Seoul – Severance Hospital, Yonsei University College of Medicine

Kaohsiung – Kaohsiung Medical University Chung-Ho Memorial Hospital

Seoul – The Catholic University of Korea, Seoul St. Mary’s Hospital

New Taipei City – Taipei Medical University - Shuang Ho Hospital, Mi...

Seoul – Yonsei University Gangnam Severance Hospital

Taichung City – China Medical University Hospital

Suwon – Smile-Line Dental Clinic

Taichung City – Tungs’ Taichung MetroHarbor Hospital - Wuchi Main Site

Yangsan-si – Pusan National University Yangsan Hospital

Tainan City – Tainan Municipal An-Nan Hospital China Medical University

Alfarp – Consultorio de Alfarp - Centro de Salud de Carlet (Network)

Taipei – Nobelgroup eye clinic Taipei

Alicante – Hospital Universitario del Vinalopo

Taipei – Universal Eye Center

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Taipei City – Koo Foundation Sun Yat-Sen Cancer Center

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Bangkok – Siriraj Piyamaharajkarun Hospital

Taipei City – Taipei Medical University Hospital

Bangkok – Sukumvit Hospital

Taipei City – Taiwan Adventist Hospital

Bangkok – Synphaet Hospital

Dar es Salaam – The Aga Khan Hospital, Dar es Salaam

Bangkok – Vejthani Hospital

Bangkok – Bangkok Hospital Chinatown

Bangkok – Vibhavadi Hospital

Bangkok – Bangkok Hospital Medical Center

Bangkok – Wuttisak Clinic Siam Square Branch

Bangkok – Bangkok International Dental Center

Bangkok – Yanhee Hospital

Bangkok – Bangpakok 9 International Hospital

Chang Wat – Krabi Nakharin International Hospital

Bangkok – BB Clinic

Chang Wat – Thabo Crown Prince Hospital

Bangkok Dusit Medical Services

Chang Wat Chon Buri – Chonburi Hospital

Wansa Phaerakkakit (Fon) Senior PR Manager

2 Soi Soonvijai 7, New Petchburi Rd., Bangkok 10310, THAILAND tel: +66(0)2-310-3000

email: info@bdms.co.th website: bangkokhospital.com

Chiang Mai – Bangkok Hospital Chiang Mai Chiang Mai – Chiangmai Ram Hospital Chonburi – Aikchol Hospital Chonburi – Samitivej Sriracha Hospital

Bangkok – BNH Hospital

Hua Hin – Bangkok Hospital Hua Hin

Bangkok – Bumrungrad International

Khon Kaen – Khonkaen Ram Hospital

Bangkok – Chaophya Hospital Public Company Limited

Khon Kaen – Kranuan Crown Prince Hospital

Bangkok – Jetanin IVF Clinic

Khon Kaen – Queen Sirikit Heart Center of the Northeast

Bangkok – Kamol Cosmetic Hospital

Nakhon Pathom – Metta International Eye Center

Bangkok – Kluaynamthai Home Care

Nakhon Sawan – Srisawan Hospital

Bangkok – Kluaynamthai Hospital

Nonthaburi – Asia Cosmetic Hospital Co., Ltd.

Bangkok – Ladprao Eye Center

Nonthaburi – Nonthavej Hospital

Bangkok – MALI Interdisciplinary Hospital

Nonthaburi – The World Medical Hospital

Bangkok – Navamin 9 Hospital

Pattaya – Bangkok Hospital Pattaya

Bangkok – Nopparat Cosmetic Clinic

Phitsanulok – Pitsanuvej Hospital

Bangkok – Phyathai 2 Hospital

Phuket – Bangkok Hospital Phuket

Bangkok – Piyavate Hospital

Phuket – Phuket International Hospital

Bangkok – Praram 9 Hospital

Phuket – Sea Smile Dental Clinic

Bangkok – Rachvipa MRI Center

Samut Sakhon – Mahachai Hospital Public Company Limited

Bangkok – Ramkhamhaeng Hospital

Samutprakarn – Chularat 3 Theparak Hospital

Bangkok – Samitivej Srinakarin Hospital

Songkhla – Sikarin Hatyai Hospital

Bangkok – Samitivej Sukhumvit Hospital

Surat Thani – Sri Phala Clinic

Bangkok – Sikarin Hospital

Suratthani – Bangkok Hospital Samui >>

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INTERNATIONAL HOSPITALS DIRECTORY

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Trat – International Clinic Koh Chang

T

BŸyŸkçekmece – Fatih University Sema Clinical Treatment & Research C...

Udon Thani – AEK Udon International Hospital

Gebze – Anadolu Medical Center (Anadolu Saglik Merkezi)

Amersfoort – NL Healthcare Clinics - Oogziekenhuis Zonnestraal - Ame...

Istanbul – ‚ukurova University Medical Faculty

Amsterdam – Academic Medical Center (AMC)

Istanbul – Acibadem Maslak Hospital

Amsterdam – NL Healthcare Clinics - Oogziekenhuis Zonnestraal - Amst...

Istanbul – Acibadem Mehmet Ali Aydinlar University Atakent Hospital

Doetinchem – NL Healthcare Clinics - Oogziekenhuis Zonnestraal - Doe...

Istanbul – American Hospital

Emmeloord – NL Healthcare Clinics - Oogziekenhuis Zonnestraal - Emme...

Istanbul – Bahçelievler Hospital - Medical Park Healthcare Group

Gorinchem – Rivas Zorggroep

Istanbul – G_ztepe Hospital - Medical Park Healthcare Group

Haarlem – NL Healthcare Clinics - Oogziekenhuis Zonnestraal - Haarlem

Istanbul – Hisar Intercontinental Hospital

Hilversum – NL Healthcare Clinics - Oogziekenhuis Zonnestraal - Hilv...

Istanbul – Istanbul Aydin University Hospital of The Faculty of Dent...

Hoogeveen – NL Healthcare Clinics - Oogziekenhuis Zonnestraal - Hoog...

Istanbul – Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Su...

Lelystad – NL Healthcare Clinics - Oogziekenhuis Zonnestraal - Lelys...

Istanbul – Istanbul Yeni Yuzyil University Gaziosmanpasa Hospital

RL Breda – Amphia Ziekenhuis

Istanbul – Kadõk_y Florence Nightingale Hospital

Rotterdam – Maasstad Ziekenhuis

Istanbul – Kolan International Hospital Sisli

s-Hertogenbosch – Jeroen Bosch Hospital

Istanbul – Medicana International Istanbul Hospital

Utrecht – UMC Utrecht

Istanbul – Medipol Mega Hospitals Complex

Venlo – VieCuri Medisch Centrum

Istanbul – Medistate Kavacik Hospital

Zaandam – NL Healthcare Clinics - Oogziekenhuis Zonnestraal - Zaandam

Istanbul – Neolife Tip Merkezi (Neolife Medical Center)

Zwolle – Isala

Istanbul – Npistanbul Brain Hospital

_i_li / _stanbul – Memorial Ankara Hospital

Istanbul – Ozel Pendik Bolge Hastanesi

_i_li/_stanbul – _i_li Florence Nightingale Hospital

Istanbul – Turkish Red Crescent Society North Marmara Regional Blood...

_i_li/_stanbul – _stanbul Florence Nightingale Hastanesi A._.

Istanbul – Yeditepe University Dental Healthcare and Research Center

_zmir – Ozel Tinaztepe Hastanesi

Istanbul – Yeditepe University Hospital

_zmir – Sifa Universitesi Bornova Saglik Uygulama Ve Arastirma Merkezi

Izmir – Izmir University Medicalpark Hospital

Adana – Acibadem Adana Hospital

Izmir – Kent International Hospital

Adana – Medline Adana Hastanesi

Izmir – Turkish Red Crescent Society - The Aegean Regional Blood Center

Ankara – Ankara Guven Hospital

Kadikoy/Istanbul – Sonomed Medical Imaging and Health Services

Ankara – Bayindir Hastanesi

Sisli/Istanbul – Memorial Sisli Hospital

Ankara – Hacettepe University Hospitals

– Dunya Goz Hastanesi Bursa – Private Medicabil Hospital

Ankara – Turkish Red Crescent Society Middle Anatolia Regional Blood...

Antalya – Memorial Antalya Hospital

U

Abu Dhabi – Adnoc Ruwais Hospital

Ata_ehir – Memorial Ata_ehir Hospital

Abu Dhabi – Al Ahalia Hospital

Be_ikta_/Istanbul – Gayrettepe Florence Nightingale Hastanesi

Abu Dhabi – Al Amana Home Health Care LLC

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INTERNATIONAL HOSPITALS DIRECTORY

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Abu Dhabi – Al Marfa Hospital

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Abu Dhabi – Magrabi Eye and Ear Center - Daycare Surgery Center - Mu...

Abu Dhabi – Al Noor Hospital

Abu Dhabi – Manzil Health Care Services

Abu Dhabi – Al Noor Hospital, Airport Road Branch

Abu Dhabi – Medeor 24x7 Hospital

Abu Dhabi – Al Rahba Hospital

Abu Dhabi – Mediclinic Al Noor Hospital

Abu Dhabi – Al Salama Hospital

Abu Dhabi – National Ambulance LLC

Abu Dhabi – Al Shrooq Health Services Center

Abu Dhabi – NMC Royal Hospital

Abu Dhabi – Amana Healthcare Medical and Rehabilitation Hospital

Abu Dhabi – NMC Specialty Hospital LLC

Abu Dhabi – Ambulatory Healthcare Services (Network)

Abu Dhabi – Prince Medical Center One Day Surgery

Abu Dhabi – Americare L.L.C.

Abu Dhabi – ProVita International Medical Center

Abu Dhabi – Arab Euro Home Nursing LLC

Abu Dhabi – Samaya Specialized Center

Abu Dhabi – Bayti Home Healthcare LLC

Abu Dhabi – Seha Emirates Hospital

Abu Dhabi – Brightpoint Royal Women’s Hospital

Abu Dhabi – Sheikh Khalifa Medical City

Abu Dhabi – Burjeel Hospital

Abu Dhabi – Tawam Hospital

Abu Dhabi – Cambridge Medical Rehabilitation Centre

Abu Dhabi – Universal Hospital LLC - Abu Dhabi

Abu Dhabi – Cleveland Clinic Abu Dhabi

Abu Dhabi – Zayed Military Hospital

Abu Dhabi – Corniche Hospital

Ajmam – Rashid Center for Diabetes and Research

Abu Dhabi – Dar Al Shifaa Hospital

Ajman – Sheikh Khalifa Women and Children Hospital

Abu Dhabi – Dubai Aluminum Company LTD Clinic

Ajman – Thumbay Hospital

Abu Dhabi – Emirates French Hospital

Al Ain – Ain Al Khaleej Hospital

Abu Dhabi – Emirates International Hospital

Al Ain – Al Ain Hospital

Abu Dhabi – Exeter Medical Center For Bone & Joint Health

Al Ain – Mediclinic Al Hili

Abu Dhabi – Ghayathai Community Hospital

Al Ain – New Medical Centre Specialty Hospital

Abu Dhabi – Gulf Diagnostic Center Hospital ÊÊ

Al Ain – Nurses Without Borders Home Healthcare

Abu Dhabi – Gulf International Cancer Centre

Al Ain – Oasis Hospital

Abu Dhabi – Health Point Hospital LLC

Al Ain – Universal Hospital - Al Ain

Abu Dhabi – Imperial College London Diabetes Centre

Al Dhaid – Al Dhaid Hospital

Abu Dhabi – Lifecare Hospital L.L.C

Al Muhaisnah – Al-Muhaisnah Primary Health Care Center

Abu Dhabi – Lifecare Hospital, LLC, Branch - 1

Bur Dubai – Aster Hospital Mankhool Dubai

Abu Dhabi – Lifewise Home Healthcare LLC

Deira, Dubai – Prime Medical Center LLC, Deira

Abu Dhabi – LLH Hospital

Dubai – Abeer Al Noor Polyclinic

Abu Dhabi – LLH Hospital (Musaffah)

Dubai – Advanced Care Medical Centre

Abu Dhabi – Madinat Zayed Hospital

Dubai – Airport Medical Centre - Rashid Hospital

Abu Dhabi – Mafraq Hospital

Dubai – Al Badaa Health Center - Dubai Health Authority Primary Heal...

>>

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INTERNATIONAL HOSPITALS DIRECTORY

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Dubai – Al Baraha Hospital

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Dubai – Curewell Diagnostic Center

Dubai – Al Barsha Health Center - Dubai Health Authority Primary Hea...

Dubai – Deira City Medical Diagnostic Centre

Dubai – Al Garhoud Private Hospital

Dubai – Dr. A.R. Shamma Medical Center

Dubai – Al Jameela Polyclinic

Dubai – Dr. Azzam Al Abdul Razzak Clinic

Dubai – Al Khail Medical Centre

Dubai – Dr. Badani Diagnostic Center

Dubai – Al Khawaneeh Health Center - Dubai Health Authority Primary ...

Dubai – Dr. Ismail Polyclinic Clinical Laboratory

Dubai – Al Lusaily Health Center - Dubai Health Authority Primary He...

Dubai – Dr. Sirajudeen Medical Centre

Dubai – Al Mamzar Health Center - Dubai Health Authority Primary Hea...

Dubai – Dr. Sulaiman Al Habib Hospital

Dubai – Al Mankhool Health Center - Dubai Health Authority Primary H...

Dubai – Dr. Sulaiman Al Habib Hospital, Dubai

Dubai – Al Mizhar Health Center - Dubai Health Authority Primary Hea...

Dubai – Dr. Taher H. Khalil Clinic

Dubai – Al Qauz Health Centre - Primary Healthcare Centers in Dubai-...

Dubai – Dubai Hospital

Dubai – Al Qusais Health Centre - Primary Healthcare Centers in Duba...

Dubai – Dubai London Clinic

Dubai – Al Rashidiya Al Noor Polyclinic

Dubai – Dubai London Clinic and Specialty Hospital

Dubai – Al Refaa Health Centre - Primary Healthcare Centers in Dubai...

Dubai – Dubai Police General

Dubai – Al Safa Helth Center - Dubai Health Authority Primary Health...

Dubai – Elite Medical Centre

Dubai – Al Tadawai Medical Centre

Dubai – Emirates Hospital

Dubai – Al Taif Medical Centre

Dubai – Emirates Specialized Laboratory (A Branch of Alborg Medical ...

Dubai – Al Towar Health Center - Dubai Health Authority Primary Heal...

Dubai – General Medical Centre Laboratory

Dubai – Al Zahra (Pvt) Medical Centre

Dubai – Global Hawk Imaging and Diagnostics

Dubai – Al Zahra Hospital

Dubai – Hatta Hospital

Dubai – Al Zahra Private Hospital Dubai

Dubai – Hor Al Anz Primary Healthcare Center

Dubai – AlIttihad Primary Healthcare Center

Dubai – IBS Laboratories for Research and Medical Analysis

Dubai – AlRashediya Primary Healthcare Center

Dubai – International Modern Hospital

Dubai – American Academy of Cosmetic Surgery Hospital

Dubai – Jehad International Medical Clinic

Dubai – American Hospital Dubai

Dubai – Karama Medical Centre

Dubai – Aster Jubilee Medical Complex

Dubai – KHALIDHA MEDICAL CENTRE L.L.C

Dubai – Belhoul European Hospital LLC

Dubai – Latifa Women and Children Hospital

Dubai – Biosytech Medical Laboratory

Dubai – Lifeline Hospital

Dubai – Bourn Hall Clinic

Dubai – Magrabi Eye Center - Day Care Surgery

Dubai – Burjeel Hospital For Advanced Surgery

Dubai – Magrabi Eye Hospital - Outpatient Surgery Center

Dubai – Canadian Specialist Hospital, Abu Hail

Dubai – MEDCARE Hospital LLC

Dubai – City Centre Clinic

Dubai – Medcare Orthopaedics and Spine Hospital

Dubai – Conceive Gynaecology and Fertility Centre - Conceive Gynaeco...

Dubai – Medeor 24x7 Dubai

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INTERNATIONAL HOSPITALS DIRECTORY

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Dubai – Medical Specialists Centre Al Barsha Laboratory

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Mezzanine Floor – Sharjah International Holistic Health Center

Dubai – Mediclinic City Hospital

North Ras Al Khaimah – Ibrahim Bin Hammed Obaidullah Hospital

Dubai – Mediclinic Dubai Mall

North Ras Al Khaimah – Sheikh Khalifa Specialty Hospital

Dubai – Mediclinic Middle East

Ras Al Khaimah – Al Oraibi Hospital

Dubai – Mediclinic Welcare Hospital

Ras Al Khaimah – RAK Hospital

Dubai – Medicorp Gulf Medical Clinic

Ras Al Khaimah – Ras al Khaimah College of Dental Sciences Fzc Medic...

Dubai – Medinova Diagnostic Centre

Sharjah – Central Private Hospital

Dubai – Medsol Al Abbar Laboratory for Research and Medical Analysis

Sharjah – Conceive Gynaecology and Fertility Centre - Conceive Gynae...

Dubai – Medsol Histopathology and Specialty Laboratory

Sharjah – Dr. Sanjay Medical Centre

Dubai – Micro Health Medical Laboratories

Sharjah – Jwan Murad Medical Center & IVF & Test-Tube Babies

Dubai – Nad Al Hamar Health Center - Dubai Health Authority Primary ...

Sharjah – New Hope Gynaecology & Fertility Hospital

Dubai – Nasser Medical Consultant Center

Sharjah – Primary Healthcare Centers in Sharjah - Al Hamriyeh Center

Dubai – Neuro Spinal Hospital

Sharjah – Primary Healthcare Centers in Sharjah - Al Rifa’a Health C...

Dubai – NEW APOLLO POLYCLINIC.

Sharjah – Primary Healthcare Centers in Sharjah - Alkhalidiyeh Healt...

Dubai – New Medical Centre Specialty Hospital

Sharjah – Primary Healthcare Centers in Sharjah - AlQarain Health Ce...

Dubai – Nice Care Medical Center LLC

Sharjah – Primary Healthcare Centers in Sharjah - Wasit Healthcare C...

Dubai – NMC Hospital LLC

Sharjah – Sunny Specialty Medical Centre

Dubai – PH Diagnostics

Sharjah – University Hospital Sharjah

Dubai – PRIME Hospital

Sharjah – Zulekha Hospital Sharjah

Dubai – Qamar Al Madina Medical Center

Umm Al Qaiwain – Al Khazan Health Center - Umm AlQaiwain - Primary H...

Dubai – Rashid Hospital

Umm Al Quawain – Sheikh Khalifa General Hospital

Dubai – Saudi German Hospital - Dubai

Umm Al Quwain – Al Salama Health Center Primary Healthcare Centers i...

Dubai – Thalassemia Center

Umm Al Quwain – Umm AlQaiwain - Primary Healthcare Centers in Umm Al...

Dubai – Thumbay Hospital, Dubai

London – London Vision Clinic

Dubai – Trust Medical Laboratory

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Ha Noi – Vinmec International Hospital

Dubai – UpToDate Medicare Centre

Ho chi Minh – Cao Thang Eye Hospital

Dubai – York Diagnostic Laboratories, JLT

Ho Chi Minh City – FV Hospital

Dubai – Zabeel Health Center - Dubai Health Authority Primary Health...

Ho Chi Minh City – Vinmec International Hospital-Central Park

Falaj Al Mualla – Falaj AlMualla Healthcare Centre Fujairah – Al Sharq Hospital Fujairah – Kalba Hospital Fujairah – Thumbay Hospital, Fujairah

To have your company listed in our service directory contact the sales department now: sales@airmedandrescue.com +44 (0)117 925 51 51 (opt.1)

Madinat Zayed – Al Dhafra Family Medicine Center

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