IHHR 7 - May 2019 by International Hospitals & Healthcare Review

MAY 2019

The perfect medical provider What do assistance companies look for?

The Amazon of healthcare Dr Mitesh Patel, Medical Director, Aetna International

Destination spotlight: Greece Access to, and issues associated with, healthcare in Greece

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Hello! And thanks for joining us for another edition of the International Hospitals & Healthcare Review. As usual, we bring you the latest in international patient care and everything you need to know about the latest goings-on in the world of hospitals and healthcare. We open with a selection of news, covering innovations in healthcare, accreditations, health insurance and infrastructure. If you wish us to consider your company news, feel free to send a press release to news@ihhr.global. This issue’s feature is on building medical networks and explores what a company providing emergency assistance in remote locations looks for in a medical provider. “I believe the traits looked for by insurers are the same as those looked for by assistance companies. We want to make sure our members are at ease knowing they can get quality medical care without having to worry about the billing portion,” says Justin Tysdal, CEO of US-based insurer Seven Corners. We also bring you a Destination Spotlight piece, in which we investigate access to, and issues associated with, healthcare in Greece, exploring how the country’s healthcare system deals with the growing inﬂux of annual visitors and expatriates.

4-6. NEWS The latest in international patient care

8-9. INDUSTRY VOICE: The Amazon of healthcare Dr Mitesh Patel, Medical Director, Aetna International

Editor-in-chief: Ian Cameron Editor: Lauren Haigh Sub-editors: Mandy Langfield, Stefan Mohamed, Sarah Watson, Robyn Bainbridge Advertising sales: James Miller, Kathryn Zerboni Design: Robbie Gray, Will McClelland, Tommy Baker Finance: Elspeth Reid, Alex Rogers, Kirstin Reid Contact: Editorial: editorial@ihhr.global +44 (0)117 922 6600 ext. 3 Advertising: sales@ihhr.global +44 (0)117 922 6600 ext. 1 Subscriptions: subscriptions@voyageur.co.uk Online: www.itij.com/international-hospitals-and-healthcare @IHHRonline

Dr Mitesh Patel, Medical Director, Aetna International, discusses ‘The Amazon of healthcare’, a one-stop-shop for healthcare needs where different technological pieces, individual health data and personalised medicine all come under one platform. And in this issue’s Q&A, Dr Peter Mills, Associate Medical Director of Cigna Europe, highlights global health challenges and shares his wish for improved focus on ensuring people get the right care, at the right time and in the right place. If you wish to discuss any of the content in this edition, or put forward an idea for future content, drop us a line at editor@ihhr.gobal. For now, enjoy the issue and, until next time, stay healthy!

Lauren Haigh Editor @Medical_Editor

16-17. Q&A: The right care, at the right time Dr Peter Mills, Associate Medical Director, Cigna Europe

10-14. DESTINATION PROFILE: Greece

22-26. FEATURE: The perfect medical provider

Access to, and issues associated with, healthcare in Greece

What does a company providing emergency assistance in remote locations look for in a medical provider?

Published on behalf of Voyageur Publishing & Events Ltd Voyageur Buildings, 19 Lower Park Row, Bristol, BS1 5BN, UK The information contained in this publication has been published in good faith and every effort has been made to ensure its accuracy. Neither the publisher nor Voyageur Publishing & Events Ltd can accept any responsibility for any error or misinterpretation. All liability for loss, disappointment, negligence or other damage caused by reliance on the information contained in this publication, or in the event of bankruptcy or liquidation or cessation of the trade of any company, individual or firm mentioned is hereby excluded. The views expressed do not necessarily reflect those of the publisher.

Printed by Pensord Press Copyright © Voyageur Publishing & Events Ltd 2019. Materials in this publication may not be reproduced in any form without permission. INTERNATIONAL HOSPITALS & HEALTHCARE REVIEW ISSN 2515-7981 (PRINT) ISSN 2515-799X (ONLINE) ISSUE 7

NEWS Best US states for doctors Personal finance website WalletHub has released a new report, 2019's Best & Worst States for Doctors, in which Montana is revealed to be the best state for doctors to practise medicine and New York the worst. WalletHub compared the 50 states and the District of Columbia across two key dimensions, ‘Opportunity & Competition’ and ‘Medical Environment’, which were evaluated using 18 key metrics including average annual wage of physicians to hospitals per capita and quality of public hospital system. Overall score was obtained by grading each metric and calculating a weighted

Al Baraha Hospital in Dubai renamed Al Kuwait Hospital Dubai’s Ministry of Health and Prevention (MoHAP) has announced that Al Baraha Hospital has been renamed Al Kuwait Hospital. The Ministerial Decree No. 16 of 2019 states that Al Baraha Hospital will be replaced with Al Kuwait Hospital wherever mentioned in any federal legislation or official correspondences. Dr Abdul Rahman bin Mohammad bin Nasser Al Owais, Minister of Health and Prevention, commented on the announcement: “The renaming of Al Baraha Hospital to Al Kuwait Hospital came in accordance with directives of His Highness Sheikh Mohammed 4

average across all metrics. Mississippi was found to have the highest average annual wage for surgeons (adjusted for cost of living) at US$316,828, which is 2.7 times higher than in the District of Columbia, the lowest at $117,763. The lowest number of physicians per 1,000 residents was found to be in Oklahoma, at 0.99, while the highest was in the District of Columbia (6.2). The highest projected share of the population aged 65 and older by 2030 is in Florida, at 27.08 per cent, and the lowest annual malpractice liability insurance rate was found to be in Nebraska – $4,977.

bin Rashid Al Maktoum, VicePresident, Prime Minister and Ruler of Dubai, in recognition of the hospital’s historic role since Sheikh Rashid bin Saeed Al Maktoum opened it in 1966, in the presence of Sheikh Sabah Al-Salim Al-Sabah, Emir of Kuwait. Since that time, the hospital is delivering outstanding healthcare services for inhabitants of Dubai and its surroundings, in addition to providing treatment and medications.” Youssif Al Serkal, Assistant Under-Secretary for the Ministry’s Hospitals Sector, said that the Hospital has achieved rapid growth and added value to Dubai’s healthcare system, supporting the health sector with efficient new facilities and exceeding patient expectations.

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Abu Dhabi hospital awarded for excellence in international patient care Avivo Group's National Hospital has received TEMOS accreditation for excellence in international patient care. It is the first multi-speciality hospital in Abu Dhabi to do so. Temos International Healthcare Accreditation (TIHA) is a worldwide independent accreditation body focused on the quality of international patient management from the medical and non-clinical perspectives. Its goal is to support the improvement and optimisation of the quality of medical treatment and non-clinical services for international patients in medical facilities worldwide. National Hospital is a 22-bed multi-speciality hospital that was originally established in 1994 to serve as a community medical centre but evolved into a hospital four years later. It is associated with healthcare provider Avivo Group and strives to meet the best of international standards. Dr Dilshaad Ali, CEO of Avivo Group, commented on the achievement and what it means: “It's an honour to be associated with TEMOS and it is a tremendous accomplishment for Avivo Group and National Hospital. We are the first hospital in Abu Dhabi to

receive the TEMOS accreditation for quality in international patient care. The prestigious accreditation has validated our high standards, our commitment, and our quality. This important accreditation will help us to become a quality and clinical excellence leader in the international medical care realm.” Dr Ravipreet Singh, General Manager, Avivo Group – Abu Dhabi, said that receiving the accreditation is an important milestone: “The medical tourism market is a challenging market where patients have particular needs when undergoing treatment abroad. Pre- on-site- and post-treatment take place in different countries and need to be managed properly to assure high-quality and costeffective medical care during all phases of the treatment process.”

Chatbot for Dubai patients

Dr Dilshaad Ali, CEO, Avivo Group

Dubai, UAE-based healthcare services provider Avivo Group is set to launch the second phase of its AI-powered chatbot, AVY, which it hopes will help eliminate the waiting time of patients at the Group’s clinics and hospitals. Avivo Group is the first healthcare provider in the UAE to introduce an AI-powered chatbot to assist its patients 24/7. The second phase will integrate appointment schedules with clinical

NEWS Bringing AEI technology into hospitals BPU International, a subsidiary of BPU Holdings – which is currently creating an advanced artificial emotional intelligence (AEI) technology – is partnering with SEVA Technology, a company that is working to devise innovative software solutions for improving patient outcomes on delirium and dementia research. The research, AEI Framework, involves the creation of an AI mobile application to aid hospital patients with the detection and treatment of delirium and dementia, and the companies hope it can be applied within hospitals. It will involve building an AEI-based chatbot, framework and interactive applications using human conversational scripts, developed by BPU. AEI Framework will be able to track and learn patients’ routine

patterns and set reminders for medication and assess psychological and physical symptoms outside the doctor's office. IoT devices afford it the ability to detect unwanted falls and high distress levels and immediately alert hospitals and the patient's doctor. “Amid the rising demographics of the ageing population, the growing number of patients who require special care is rising. We are finding smart ways to assist already taxed nursing care services through the use of AEI,” said Dr Nimit Agarwal, Co-Founder of Seva Technology. BPU Holdings CEO Oh SangGyoon said: “We are thrilled to bring AEI Framework to life. SEVA is a perfect partner for us as we both have the same vision to bring AEI technology into hospitals. This is just the beginning of what AEI can do for improved healthcare, self-care and betterment of life."

Carlos Art Nevarez, BPU Holdings, and Dr Salim Hariri, SEVA Technology

systems to provide a basic awareness of specialities and medical problems to patients and their caregivers. Via the Avivo Group’s websites and social platforms, AVY interacts with patients and caregivers and helps them to find doctors, schedule their appointments, locate specific Avivo Group clinics or hospitals and facilitate smooth access to required treatments. “We have successfully implemented a customer service chatbot for all the

websites and social media platforms of AVIVO Group to improve the patient engagement process and the customer experience,” said Dr Dilshaad Ali, CEO of Avivo Group. He also said that the latest digital innovations create an abundance of opportunities for reshaping how healthcare facilities deliver patient services and enable them to improve outcomes, enhance clinician satisfaction, improve efficiency and more effectively manage costs.

Digitisation of medical records can benefit insurance A new research project is planned between the Chartered Insurance Institute (CII) and SAMI Consulting to explore how the digitisation of medical records can improve access to insurance. The digitisation of medical records and the collection of health data on apps and wearable technology means that there is extensive underwriting data available to insurers. The new project will explore how this can be used to benefit consumers by providing improved access to insurance and protection products. The CII said that the partnership could be particularly beneficial for customers with pre-existing conditions who could benefit from faster application and claims processes. The claims process can currently vary from days to weeks, largely due to the time it takes to establish medical information. “In an ideal world, digitisation of medical records should create far greater engagement between patients and their medical conditions to improve their prognosis and increase their wellbeing. We are already seeing this through the growth in health apps and to some extent though the availability of data through summary care records available on line. For consumers, it could lead

to greater trust and claims certainty because underwriting would be based on medical records and not applicant memory. As for GPs, it could create cost savings and save time responding to life insurance medical report requests,” said Richard Walsh, Fellow of SAMI and research lead. “The CII and SAMI are consulting with a wide range of stakeholders across the medical profession, insurance sector and consumer groups to collect evidence for a report, which will be published later in the year. The report will lay the foundation for secure, ethical sharing of digital data in order to benefit consumers.” Dr Matthew Connell, Director of Policy and Public Affairs at the CII, said: “Consumers are more aware than ever of the value and importance of their personal data, and this initiative is an excellent example of professionals taking the initiative in setting strong standards that both protect consumers and realise the opportunities involved in digitisation. New technology is moving fast, and we will explore how the future might look like in this field. While our focus will be on protection insurance there may also be implications for other sectors regarding sharing digitised medical information.” 5

NEWS Building sustainable health infrastructure A global healthcare awareness initiative has been launched by drug delivery and development company CURE Pharmaceutical and global multi-stakeholder initiative United Smart Cities. The goal is to promote education and innovation in delivering cost-effective and sustainable treatments to the global population and the collaboration

was borne from concerns about rising healthcare costs. “CURE was founded on the principles of affordability and global accessibility of medications,” said Rob Davidson, CEO of Cure Pharmaceutical. “We are driven to finding healthcare solutions for people of all ages and demographics and we are honoured to be in service to this cause with United Smart Cities. Our mutual goal is to invigorate health and elevate living standards through education and sustainable new technologies.”

Kari Eik, United Smart Cities Co-Director and Secretary General of the Organization for International Economic Relations - one of the organisations that established the United Smart Cities programme - commented: “We are happy to add CURE Pharmaceutical into United Smart Cities’ private sector partnership pool. Health infrastructure is a key focus area for the United Smart Cities programme, and we look forward to engaging with health solution providers from diverse

sectors to jointly contribute to the development of robust, sustainable health infrastructure for smart sustainable cities worldwide.”

Clinerion expands into Hungary

Mohamed Najajreh, CMRC Director of Quality, with CMRC Team and JCI Surveyors Credit: CMRC

CMRC receives JCI accreditation Cambridge Medical and Rehabilitation Center (CMRC) in Abu Dhabi, UAE, has received accreditation from Joint Commission International (JCI). JCI works to improve patient safety and quality of healthcare in the international community, and one of the ways it does this is by offering international accreditation and certification. CMRC received accreditation for its overall standards of patient value; it said that the re-accreditation is, in part, thanks to its affiliations with best-in-class universal authorities and foundations, including an association with the Spaulding Rehabilitation Network, a Harvard Medical School Teaching Hospital, and Commission on Accreditation of Rehabilitation Facilities. 6

“Our triennial JCI re-accreditation represents a very significant milestone in the quality and patient safety journey for CMRC,” said Group CEO Dr Howard S. Podolsky. “Once again, achieving the Gold Seal from JCI is an incredible testimony to the outstanding care we provide to our patients and their families. This accomplishment is a true endorsement of our patientcentric culture; where we place the patient and their family at the centre of everything we do to facilitate and enhance the healing journey of our patients. As the Group CEO, on behalf of the Board of Directors, I am extremely proud of, once again, achieving this incredible level of success as we endeavour to provide world-class care, to every patient, every day.”

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Medical data informatics company Clinerion has expanded into Hungary, adding the University of Debrecen to its international patient network, which it said will help to bring treatments to patients in Hungary faster. The University’s Clinical Center is currently running more than 360 trials. It services over 56,000 patients in Debrecen, Hungary, and has study sites dedicated to anaesthesiology and intensive care, internal medicine, dermatology, paediatrics, cardiology, neurology, oncology, orthopaedics, pathology, psychiatry, pulmonology, rheumatology, surgery, ophthalmology, obstetrics and gynaecology, and urology. Its activities are overseen by its Coordination Center for Drug Development. Professor Dr Dénes Páll, Director of the Center, said that its primary mission is to strategically and operationally support clinical

trials to be implemented at the University of Debrecen. “We aim to foster collaborative relationships with all study sponsors and to develop future key and strategic partnerships with all current and potential partners based on professionalism and mutual benefit,” he said. “We are committed to sharing relevant knowledge about clinical trials with patients, their family members, and the public in general, as well as other healthcare professionals to promote the added value of personal participation in such trials. Additionally, we focus attention on the implementation of initiatives coming from individual sites and principal investigators concerning improving efficacy, efficiency and patient centricity of the clinical trial process.” Ian Rentsch, CEO of Clinerion, commented on Clinerion’s new addition: “We are very pleased to bring treatments and medicines to patients in Hungary faster, and also allowing clinical studies in the country to be more efficient. The University of Debrecen, with its wide range of therapeutic areas and deep expertise, will be a great addition to Clinerion’s global site network.”

INDUSTRY VOICE

THE AMAZON OF HEALTHCARE

platform that makes sense to the individual. With Amazon, you chose only the products you want out of millions of options, with the Amazon of healthcare you’d only be presented with the services you want or need.

Dr Mitesh Patel, Medical Director, Aetna International, discusses the idea of a one-stop-shop for healthcare needs that offers personalised care

hen we think of online retailer Amazon, we think of one place where we have access to everything from electrical goods, to toys, books and clothes. The ‘Amazon of healthcare’ concept is the idea there can be an interconnected platform where people have access to all their healthcare needs. It would be possible to access past health records, personalised health recommendations, an online pharmacy and health insurance all in one place. Data from wearable fitness trackers such as those 8

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on mobile phone or devices such as Fitbits could also be stored in this platform, and would help tailor products specific to individual needs. Currently, there are lots of different platforms and lots of different ways in which data is being collected, but it’s not being used to its full potential because no one holds the whole picture. Think of the ‘Amazon of healthcare’ as a onestop-shop for healthcare needs where different technological pieces, individual health data and personalised medicine all come under one

A beneficial model One of the biggest benefits to this model of healthcare is the opportunity for tailored health solutions and personalised care. With multiple data sources feeding into one platform, the products and services that an individual will be offered can be hyper-personalised. In the past, by medical necessity, there has been more of a one-size-fits-all approach, but the Amazon of healthcare model would change this. Unique healthcare recommendations can be made based

There can be an interconnected platform where people have access to all their healthcare needs

INDUSTRY VOICE With multiple data sources feeding into one platform, the products and services that an individual will be offered can be hyper-personalised

Healthcare systems can achieve positive results in the face of a rise in lifestyle and other related diseases, by taking a preventative care approach on an individual’s distinctive health profile and will mean that advice is totally unique. From improved access to certain medicines, to being more involved in treatment plans, personalised care can transform the patient experience and ultimately provides better outcomes for the individual. Personalised care takes into account the whole individual and provides a treatment that is as unique as every individual. There is consensus amongst the medical

community that personalised care is the preferred form of treatment. In January, the NHS published a long-term plan to establish a model of personalised care in every local health system. At Aetna International we really believe that there is no one-size-fits-all approach and tailoring care to an individual is not only the right way to treat patients it is the best way to treat patients. The scalability offered by this healthcare model is also a huge benefit, more information can be disseminated to many more people via an online platform, than can be done via an in-person consultation. Additional trends Another growing healthcare trend is AI, which is a huge trend across a variety of different sectors and healthcare is no different. I think, in 2019, we could see developments in AI technologies which will enable healthcare professionals to provide a higher quality service, resulting in clinicians being able to spend more time with patients due to a reduction in the time taken to do other aspects of their job. I think we’re also seeing a shift towards a more holistic view of a person’s health. In the past, healthcare professionals have tended to focus on a patient’s illness or symptoms in isolation. Now, we’re looking at a person’s life as a whole and asking what impact other factors, such as their lifestyle, educational background and home environment, may be having on their health.

having to visit a doctor, is an area that is growing rapidly. Technology can bridge the gap between the small number of medical professionals, such as doctors and nurses that are available, and the larger number of patients requiring support. Preventative care In addition to the adoption of technologies and new models, healthcare systems can achieve positive results in the face of a rise in lifestyle and other related diseases by taking a preventative care approach. Rather than waiting to treat people once they’ve become sick, reducing the number of people getting ill in the first place can make a huge difference to overcoming ill health in any population and ultimately help governments save money in the long term. Governments and healthcare systems can take simple steps such as vaccination programmes and encouraging people to attend regular health check-ups in order to reduce the incidence of disease. The cause of lifestyle-related diseases is in the name, if health care systems can support their populations to make better choices about their own health then there will be less of a burden on medical professionals in the long term. ■

Additionally, with technology we have the opportunity to deliver treatment much more widely than in the past, through the use of apps and the internet. Virtual healthcare, where patients can receive treatment online without 9

DESTINATION SPOTLIGHT

Robyn Bainbridge reports on access to, and issues associated with, healthcare in Greece Long considered to be the ‘Cradle of Western Civilisation’, Greece is an idyllic tourist destination, with more than 200 inhabited islands. But when it comes to needing medical assistance, how does the healthcare system deal with the increasing influx of annual visitors and expatriates?

ourists flock to the sun-soaked region each year, mainly coming from Europe, and a large number also come from the US, according to data from the World Tourism Organization. Simon Worrell, Global Medical Director of international private medical insurance provider Collinson, pointed out that ‘a colossal 32 million tourists visit Greece each year’ – up by two million each year since 2014 – and as a result, the Greek health system can be subject to considerable strain. Dr Dimitris Koliniatis, CEO of Athens Assistance, a worldwide medical assistance and air ambulance services provider based in Athens, added: “Greece has been profoundly affected by the global financial crisis, with wide-ranging economic, social and political consequences,” and this a concern that assistance companies and local healthcare facilities both identify with. Worrell continued: “A 40-per-cent reduction in healthcare spending has been attributed to the economic hardships experienced in Greece over the last decade.” As a result of this economic crisis, there is a certain variability between healthcare provided and facilities available within the public and private sectors. There are public hospitals all over the country; particularly concentrated in the mainland of Greece. Inez Tissink, Co-ordinator of International Activities at InterAmerican, a local assistance company based in Athens, noted that the best public hospitals are the ones 10 International Hospitals & Healthcare Review

connected to a university, and Dr Koliniatis detailed that most geographical departments are covered by a university hospital. “There are university hospitals in Alexandroupoli, Heraklion Crete, Ioannina, Thessaloniki, Rhodes, Athens and Larisa,” Tissink said. Private hospitals In terms of private hospitals, Tissink said that most are of an international standard – especially those in Athens and Thessaloniki. “They have the appropriate accreditations and some are specialised,” she said. “Euroclinic Athens has a paediatric hospital, the ‘Onassio’ in Athens is specialised in cardiology, and ‘Iaso’ in Athens is specialised in gynaecology, obstetrics and maternity.” Healthcare Executive and General Manager of Onassis Cardiac Surgery Center Dr Panos Minogiannis said that private facilities in Greece ‘possess ultra-modern units equipped with state-of-the-art technology, acclaimed and experienced medical staff and scientific consulting groups’. “They focus on specialised medical services, adapted to the personal needs of each patient, aiming at maintaining the high level of providing medical services,” he extrapolated. He added that the Athens Medical Centre (Iatriko Kentro Athinon) and non-profit hospitals like the Onassis Cardiac Surgery Center offer reliable and effective clinical options for patients. Clara Giannakopoulou

of Thessalonicaheadquartered assistance company Healthwatch SA also pointed out that the Iatriko Group, which has seven clinics within Greece, has accreditation from international authorities. In addition, there are still more private clinics scattered across the rest of the country, although Tissink said that these are ‘of less quality’, with the exception of Euromedica Rhodes, Iasis General Clinic in Chania, Crete and the InterClinic in Heraklion Crete.

Greece has been profoundly affected by the global financial crisis, with wide-ranging economic, social and political consequence Public vs private So, what are the reasons for the variability between standards of healthcare in the public and private sectors? And how does this affect patients’ access to medical care? On the one hand, European patients with a valid European Health Insurance Card (EHIC) need pay nothing in public hospitals. However, Tissink explained that, due to crisis and austerity measures, public healthcare has suffered a lot, and largely because there has been a ‘huge exodus’ of skilled professionals. Dr Koliniatis also referenced this problem, explaining that ‘diminished funds’ and a ‘shortage of resources’ that arose as a result of the ‘global financial crisis’ resulted in a decrease in the number of doctors available: “More than 15,000 physicians left the country to work abroad.” Overall, there is little argument to suggest that doctors and physicians in Greece are not highly skilled in both the public and private sectors. Indeed, Dr Minogiannis said that the Greek

DESTINATION SPOTLIGHT healthcare workforce is ‘one of the best educated workforces in the EU and recent investments have introduced state-of-the-art equipment in all service lines. “One could argue that a patient in Greece receives European standards of care for significantly lower prices,” he added. Tissink further emphasised that medical staff are very well trained and highly capable, thanks in part to the fact that, when a Greek person is training as a doctor, they are required to do part of their internship at one of the many tiny and ill-equipped ‘health centres’, where they learn, very quickly, to do all manner of tasks in a high-pressure environment. “It is a huge loss for Greek medicine that so many of these excellent doctors have left the country,” she mused. Tissink also explained that, because many of the medical professionals leave the country, bedside manners in the public sector are non-existent, and relatives are called upon to take care of hospitalised family members with regards to food and personal hygiene. Giannakopoulou noted that even newer public hospitals, such as GH Rhodes, which employs skilled doctors and has a good level of medical care, is subject to an ‘overload of work and lack of equipment’, meaning that the staff there cannot perform as well as they are capable of doing. In addition, public hospital waiting times, especially for less serious or outpatient cases, are a huge problem. Giannakopoulou highlighted that, due to the economic crisis, the population that attends public hospitals is now much bigger, as they cannot afford private facilities. Due to this, there are often bed shortages in public hospitals – with beds spilling into corridors. “If, for example, the ICU in one hospital is full, the patient will be taken to the next hospital with ICU capacity,” commented Tissink. Giannakopoulou also highlighted that, for public healthcare, there is no discrimination between local and international patients; everyone must wait their turn, and often, where it is not deemed ‘urgent’, surgery can be postponed to ensure emergency cases have access to the facilities.

A 40-per-cent reduction in healthcare spending has been attributed to the economic hardships experienced in Greece over the last decade 12 International Hospitals & Healthcare Review

Due to what Tissink describes as a ‘dire situation’ in public hospitals, most people who can afford to have taken out private insurance. This covers them for admission to any private facility and transport from any remote area of Greece to an appropriate hospital in Athens, either over land by one of the provider’s ambulances, or by air ambulance or helicopter, all organised by the provider, said Tissink. Dr Minogiannis drew upon the problem with funding, organisation and delivery of healthcare services in Greece and how this causes an imbalance between the public and private sectors. He noted that the system is financed by the state budget, social insurance contributions, private insurance contributions and private payments. “It suffers from the absence of cost-containment measures and defined criteria for funding, resulting in sickness funds experiencing economic constraints and budget deficits,” claimed Panos. “Private payments, therefore, are almost 45 per cent of total healthcare expenditures.” Savvas Karagiannis, Communications Manager, Business Development Division of Athens Medical Group – a private medical group that provides quality primary and secondary care at its centres throughout the country – noted that Greece has been lagging behind nearly all EU countries in terms of health insurance coverage – ranking 27 out of 28, according to OECD data. Karagiannis explained: “About 60 per cent of health spending in Greece is publicly funded, compared with about 80 per cent in the EU,” and the debt crisis that

began in 2009 means that the situation for public hospitals has worsened. In fact, noted Karagiannis, in 2015, the government spent only four per cent of the GDP on the healthcare system, compared to 10 per cent in 2009. Geography and healthcare The geographical spread of Greece means that, unsurprisingly, there are some smaller islands that don’t have access to the same technologies and capabilities that some of the larger mainland clinics and hospitals have. And this geographical layout further impacts patients’ access to healthcare. Dr Minogiannis explained that primary care in remote areas is provided by public health

DESTINATION SPOTLGHT About 60 per cent of health spending in Greece is publicly funded, compared with about 80 per cent in the EU centres. Further to these, hospital emergency rooms and clinics are available, as well as ODCs, diagnostic centres, multispeciality surgeries and private ambulatory offices. “All private insureds and cross-country EU patients are also covered, albeit with certain geographic variability,” he said. The main two metropolitan centres of Athens and Saloniki, as well as other major areas like Thessaly and the Peloponnese, along with the islands of Crete, Corfu, Rhodes and Khos provide greater access to high level services. He noted that smaller islands are connected through air and/or boat transport to the mainland. Worrell detailed: “[Although] hospitals that are located in more remote regions of Greece have the capacity to stabilise an acutely unwell patient, for conditions that require specialist facilities, such as cardiac interventions following a heart attack, patients usually need to be transferred to centres of excellence in Athens.” He stated that originally, these medical flights used to be organised by the Greek National Health System (the ESY), but that in more recent years, these flights are few and far between, ‘necessitating

insurance companies to step in with private air ambulances’. That being said, Worrell added, once patients have been transferred to Athens, they rarely need to be evacuated further afield. Dr Koliniatis noted that, in touristit areas and resorts, primary care depends on private facilities, of which there are many, and all are equipped to accommodate patient needs. He explains that these facilities are closely linked with hotels, guides, taxis, port agents, and so on, and all of these play a ‘fundamental role in patient direction’. Tissink explained that InterAmerican is easily able to manage issues around patient steering: “We have agreements in place with most private hospitals in Greece.” Dr Koliniatis added: “Further direction depends on assistance company procedures, network and knowledge of the local healthcare map. This is the only way to overcome issues of quality, time and costs, as it is in every highly touristic country.” Tissink also emphasised that private facilities on some of the most touristic islands, including Corfu, Zakynthos, Crete and Rhodes are ‘very expensive for the local population, and even more expensive for the tourists’. Meeting in the middle The Greek healthcare system throws up further issues for both assistance providers and hospitals. Dr Koliniatis explained that, due to problems with supplies, access and infrastructure, problems that arise are often solved by inter-hospital cooperation and referrals. He noted that public hospitals charge by diagnosis related group, and some accept direct billing by foreign insurance companies, though not all. The bills, he says, are non-negotiable and not audited,

but charges are regulated by the Ministry of Health and are kept relatively low. Tissink said that public hospitals will not often accept Guarantees of Payment from foreign companies. But InterAmerican, he noted, can arrange for direct payment through one of its local cooperators in the event that such issues arise. However, there are positives to arranging treatment through public hospitals for assistance providers. “There are standard fees, there is never a question of overtreatment or overcharging, and the patient is discharged as soon as his/her treatment can be continued at home,” Tissink noted. On the other hand, Giannakopoulou warned that the private sector tends to overcharge and overtreat, although she noted that this can be controlled through agreements on course and discounts, and that clinics do generally accept deductions that are fully justified. Dr Minogiannis said that co-ordination with foreign insurers, especially for emergency care, poses a certain challenge at times. “Payment issues have occurred on occasion,” he said. “But in general, all major private institutions have set up international departments to smooth out such issues.” Dr Koliniatis further highlighted that pricelist agreements and audits are able to ensure cost containment in private facilities, and are sometimes even essential in some destinations where the charges can be unjustified and not customary. InterAmerican clients also have access to a 24/7 four-digit telephone number (1010), with the possibility to speak to a physician, who will then advise them on further steps to 13

DESTINATION SPOTLIGHT be taken and which hospital would be most appropriate for the specific problem. There is also an extensive network of InterAmerican doctors across Greece, who will make suitable recommendations for each case. Communication challenges Another issue worthy of note is that communication with public facilities sometimes leaves a lot to be desired: it is quite difficult to contact doctors and obtain medical information or medical reports, and Tissink ascribes this to the medical staff being overworked. Worrell said: “As ever, communication is easier with private medical facilities, which are often more attentive to the requirements of assistance companies.” And Tissink proposed a solution: “In the rare case that the inhouse doctor is unable to communicate with the treating doctors, one of our own doctors is sent to the hospital to get the information we need.” Dr Minogiannis noted that, despite private hospitals exhibiting remarkable success in attracting international patients, the main challenges they face have to do with language barriers, even though almost 90 per cent of hospital staff are fluent in English. Dr Koliniatis noted that some private hospitals that have dedicated international patient depart ents ‘offer excellent communication and cooperation with assistance companies’. Worrell expounded: “Taking all this into

account, at Collinson, the approach that we take with managing cases in Greece is to firstly ensure that the patient’s condition can be treated at the facility to which the patient is admitted. Once in hospital, our experienced multilingual team of doctors, nurses, and assistance specialists will contact the admitting facility directly to obtain regular medical reports. When necessary, the patient will be transferred to a superior facility – as the healthcare facilities are variable in Greece, this is often required.” He also said that, thereafter, keeping a close eye on patients will ensure that the most appropriate treatment is received. And once the patient has sufficiently recovered, it is then possible to arrange for the safe repatriation of the patient to their home country. “In this way, although the local healthcare may be patchy, patients are protected, and receive the best available attention,” he reasoned. A flourishing sector Despite the issues that the recent economic crisis has brought about, Greece remains a popular tourist destination and has much to offer international patients, with low-cost medical fees in the public sector and highly skilled medical professionals that populate the mainland and smaller islands of Greece. The vast disparity between services offered within the private and public sector presents

A DVERTO R I A L

HYGEIA Hospital is an Athens-based hospital that treats international patients throughout the year. HYGEIA Group Commercial Director Stella Gioni reveals more 14 International Hospitals & Healthcare Review

Communication is easier with private medical facilities, which are often more attentive to the requirements of assistance companies both issues and opportunities to assistance companies, whether local or international. The main issues for both assistance providers and local hospitals continue to revolve around communication and cost inconsistencies between the public and private sector. Assistance providers are bridging these gaps by setting up cost containment methods, including cost audits and direct billing with many of the medical facilities, as well as deploying local co-ordinators throughout Greece to counter issues with communication. Furthermore, hospitals that have set up international patient departments experience fewer setbacks when dealing with international assistance companies. Long-term, it seems likely that the private healthcare sector will continue to flourish in Greece, and assistance companies that continue to work closely with healthcare facilities will benefit accordingly. ■

HYGEIA Group offers a variety of medical services for people of all ages in one location in Athens, which facilitates easy relocation of the patient and their travel companions. HYGEIA Hospital offers medical services to adults while MITERA Hospital offers paediatric, gynaecological, and maternity services to adults and children. Private hospital groups like HYGEIA Group offer their own certified car ambulance ﬂeet and are able to transfer patients from Athens International Airport or Piraeus port, which are the biggest tourist hubs in Greece. HYGEIA and MITERA are located within 25 km from both of these locations, allowing fast and reliable pick-up and patient transportation to the hospital, within a matter of minutes. HYGEIA ambulance cars can even travel throughout mainland Greece and organise the safe transportation of patients, with an escort doctor, if needed.

INTERVIEW

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INTERVIEW

THE RIGHT CARE, AT THE RIGHT TIME Dr Peter Mills, Associate Medical Director of Cigna Europe, discusses customers wherever they are accessing his interesting journey to this role, highlights global health challenges, care in the world. an individual is and shares his wish for improved focus on ensuring people get the right Ifunwell and requires care there are many care, at the right time and in the right place different things for them to deal with, and our Could you provide an insight into your background? I started off as a regular doctor, training in medicine at the Royal Free Hospital School of Medicine in London, UK, and worked in a variety of hospitals doing the usual junior doctor rotations before specialising in respiratory diseases. At the end of the ‘90s I became very interested in technology; this was during the original dot-com boom and the idea of digital in such an analogue industry was pretty much laughed at. I was fascinated, however, by the internet and could really see the opportunity to transform the way we acquired knowledge and subsequently researched things. The big question though at this time was 'how can we bring technology and health together?'. With a broad vision, I was involved in starting a company called vielife, which provided digital health solutions designed to improve the health and wellbeing of businesses and their workforce. The company had some success in the US and Europe and was subsequently acquired by Cigna in 2006 who were in the marketplace for a solution. I joined Cigna also at this time, and I now work as Associate Medical Director for Cigna Europe. I think it’s important to maintain my roots, though, and still practise as a physician one day a week. I’m currently working at the Whittington Hospital in London, focusing mainly on the treatment of tuberculosis.

We are still stuck in a very reactive state – we get sick, we fix it and the insurers pay out 16 International Hospitals & Healthcare Review

What are your current research interests? I’m particularly interested in population health and how, as a nation, we can be more proactive with health issues. We are still stuck in a very reactive state – we get sick, we fix it and the insurers pay out. With increasing global populations and healthcare expectations I see real opportunities to utilise technology, digital, mobile and genetics to understand the various health risks and put in place approaches to help deliver solid solutions. Can you discuss your role at Cigna? I am the clinical director for Cigna Europe, and responsible for the medical management of the UK and Spanish domestic and European corporate books of business. This involves overseeing a team of doctors and nurses who provide clinical support and guidance for our

role is to support them through this. But it’s not just about accessing the care; our nurses also provide support and guidance as our customers go through their treatment. If a person is going through cancer or cardiovascular disease, for example, their whole world has been turned upside down. We help them and their family through the emotional upheaval as well as the physical side of the illness. Today, I’m dealing with the child of a globally mobile employee who has psychological health issues and looking at where in their host country would be the best to help them. No case is ever the same, but that’s what is enjoyable about it. I also look after a non-clinical team, the people that work behind the scenes to guarantee payment to our care providers around the world. It’s a very complex role due to the countless global healthcare systems that we are faced with, so this

INTERVIEW team must be extremely knowledgeable and up to speed with an ever-changing healthcare system. The final part of my role is to manage the global medical assistance part of Cigna, which involves a team who work on-call, 24/7, to support individuals who become acutely unwell in a location that perhaps doesn’t have a good level of care. For example, someone who may become involved in a road traffic accident or develops respiratory problems and they are based in Iraq or Afghanistan. We would step in to ensure they are moved to a centre of excellence, which could involve mobilising an air ambulance. It’s a big responsibility and you must be sure it’s always the right thing to do. What do you see as the key challenges facing European healthcare, and how can these be tackled? The challenge is worldwide; how do organisations, nations, taxpayers, whoever the funder may be, continue to provide good-quality coverage to populations, while maintaining affordability. The costs of delivery are rising considerably, more than corporate or industry wealth, and this is a real challenge. We need to find new and innovative ways of treating and curing conditions, and unfortunately these things take time and money. This sits high on our agenda at Cigna, and we are continually looking at how we can manage costs more effectively. A lot of this will involve developing closer relationships with providers and ensuring we are more aligned to package up common complaints, such as routine knee replacements. If we can provide that ‘up-front’ visibility, it will drive quality from providers and help us as a leading provider of health benefits and services across Europe to offer better affordability. Can you discuss some of the innovative healthcare solutions you have been involved in creating and what their impact has been? My involvement in the digital health ‘revolution’ back in the ‘90s is definitely a career highlight. It was fun and exciting, and really satisfying. I was involved in a team that essentially pioneered one of the first digital health management solution companies, and to be able to then take that to Cigna, a company who shared that vision and who continue to embrace new technology, has been a great journey.

What would you say are the key challenges in health and wellbeing facing corporates? One of the key challenges we face is around preventing work-related ill health and encouraging people to be more proactive about their health and wellbeing. By embracing a wellness culture and motivating staff to get involved in wellbeing programmes, we can work together to support people to make lifestyle changes. This ultimately helps to create a happier workforce, helps reduce absenteeism and aids the individual to lead a better life. While the intentions are there in many workplaces, there’s still a lot of work to be done. We need to build on the great work that’s going on to ensure we sustain staff engagement, build employee trust and provide even more tools to help detect or prevent serious illness and help people stay healthy.

Can you highlight your proudest achievement to date? There has been a number over the years, but I have to say graduating from medical school was a great moment. It was such a long period of study, and I was hugely proud (and relieved) when I graduated. The development of vielife is another proud achievement. To start something from the smallest idea in an industry that was so far removed from technology, and to then build that into something that a big healthcare provider like Cigna wanted to purchase, was pretty amazing. What areas will you be focusing on in the coming five to 10 years? What specific goals do you have in mind? Hopefully retirement! On a serious note, I think more focus is needed on making sure people get the right care, at the right time and in the right place. If this approach is taken, then we can only get positive outcomes. We need to ensure that customers can access the appropriate care provider and, furthermore, that they can access those providers no matter where they are in the world. Data, AI and medical innovation powered by AI is on the agenda, and we recognise that. There will no doubt be a lot of governance surrounding it, but it’s an area we are already looking at and thinking about. It’s not going to be straightforward, but certainly in the next 10 years it’s going to be a bigger part of our everyday life in the healthcare sector. ■ 17

CONFERENCE REVIEW

SANTO DOMINGO ITIC Americas 2019 – in brief The International Travel & Health Insurance Conference (ITIC) Americas event took place in Santo Domingo, on the beautiful island of the Dominican Republic

fter a busy networking breakfast, ITIC Americas 2019 began with an address from Alejandro Cambiaso, President and Founder of the Dominican Republic Health Tourism Association, who shared with the audience his insights into the inner workings of the local healthcare system. He shared statistics and data showing the number of public and private facilities on the island, as well as explaining the workings of the funding system that forms the backbone of healthcare provision. An overview of some of the top hospitals on the island serving international patients highlighted the different specialities available, which include cardiovascular care and oncology; however, dental treatments, general and plastic surgery are currently the most popular treatments for medical tourists. During the discussion following Alejandro's presentation, the fact that medical tourism has pushed forward the development of medical services in general on the island was emphasised – as the public healthcare system lacks the resources to cater to tourists, private providers catering to international patients are considered the best place for tourists to go. There is an upcoming move towards the development of urgent care centres on the island, said Alejandro, which will help to treat tourists needing emergency care.

An overview of some of the top hospitals on the island serving international patients highlighted the different specialities available

Dale Buckner, President and CEO of Global Guardian, then focused on the issue of data security in communications. Medical records have a financial value, said Dale, and for hackers, medical records are extremely valuable in significant numbers. The problem, he explained, is that ‘every single thing you do now is trackable – if you have a cellphone in your pocket, or a laptop, depending on how you connect to wi-fi, you are making your information and that of your company accessible to hackers’. The positive and negative effects of advances in medical technology was the next topic under the ITIC microscope, with contributions from Eduardo Cruz of Humano Seguros, Arturo Aceves-Serrano of Philadelphia International Medicine, and Dr Cai Glushak from AXA Partners. Diagnosis and treatment have both been revolutionised by the application of telemedicine services, whether this is applied through online consultations or wearable technology, according to Arturo. However, there are challenges that need to be overcome in order to ensure telemedical service availability – these include legal, protection, privacy and access to internet connections.

Diagnosis and treatment have both been revolutionised by the application of telemedicine services

Agreeing that telemedicine has the potential to improve care and access to medical services, Dr Glushak asked whether or not utilisation rates could increase as a result of telemedicine services, which would actually mean insurers would spend more as they have more members using their services, and while there are savings to be made, perhaps the cost difference isn't as significant as it could be. Dr Glushak's presentation focused on medical spending from AXA's point of view, identifying where in the world is currently more expensive for a traveller to become sick. Eduardo's presentation considered what factors are driving healthcare cost increases, one of which is the development of technology – and this applies to wearables, drug development and 3D printed devices. The advent of the Internet of Everything has taken over from the Internet of Things, and the application of this to healthcare information gathering and feedback to users and insurers could be very valuable. “Biology,” he concluded, “is going to be the new software.”

CONFERENCE REVIEW said Eugene Delaune from Europ Assistance. Sourcing an air ambulance company just before a hurricane can also become extremely troublesome, as hospitals will pre-emptively evacuate their patients, and this is when having established agreements with local providers mean an insurer can be less affected by the drop in provision.

The second day of ITIC Americas began with a panel session on treatment and evacuation options in the Caribbean, with contributions from Gonzalo Castillo Lopez from Helidosa, Dr Ferial Ladak, Medical Director of Global Excel Management, and Dr Frank Gillingham, Chief Medical Officer of GeoBlue, who was first on stage. Dr Gillingham discussed the reasons behind a medical evacuation, detailed the tiers of assessment that GeoBlue uses to make a decision on whether or not an evacuation is necessary, and listed the typical conditions from which patients are suffering that result in a medical evacuation, as well as the conditions that

wouldn't necessitate a medevac. Moving on, he then explained how he chooses his partner medical providers and air ambulance operators, and shared information about how GeoBlue rates the care provided in different Caribbean nations, with details about the islands from which the company always evacuates members. Dr Ladak's presentation detailed the challenges faced by international insurers with clients needing medical care in the Caribbean, which include a misrepresentation of abilities, a lack of quality medical information, a focus on insurance coverage (patients not being treated until coverage is confirmed) and a refusal to allow patients to go to a higher level of care. By sharing details of case studies involving medical evacuations, Dr Ladak highlighted these issues, and how they can adversely affect patient outcomes and thus underline the need for prompt medical evacuation from certain places, especially when patients are suffering from certain conditions that depend upon immediate high quality treatment.

The mid-morning session focused on the challenges insurers and assistance companies face during the Atlantic hurricane season. These include staffing issues in local hospitals just before a storm hits (staff will leave the island), and then afterwards the possible damage to infrastructure that makes communication with treating facilities difficult,

Abbe Bendell, Vice-President of International Services at Broward Health International, focused on the issue of hospital preparedness during the hurricane season, which is a constant process of ensuring adequate provisions are in place should the facility take a direct hit from a storm. As a hurricane approaches, a hospital will consider whether or not patients should be moved to a place of safety. Abbe highlighted certain other issues that insurers should be aware of, which include determining when a hospital will stop accepting patients and which international patients (and their families) can be moved to a hotel or flown home. â&#x2013;

ITIC events are geared towards educating the insurance community, with providers such as hospitals and air ambulance operators in attendance to demonstrate working practices and explain processes. ITIC Americas 2019 saw more private hospitals and medical centre personnel in attendance than ever before, demonstrating how vital these services are to the international health and travel insurance community.

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FEATURE

THE PERFECT MEDICAL PROVIDER What does a company providing emergency assistance in remote locations look for in a medical provider? Tatum Anderson reports

n addition to medical excellence, Julia d'Astorg, Global Head of International Medical Assistance and International Medical Network at AXA Partners, said she requires medical providers to be ready for patients. “We need to select, in advance, the best, most adequate and nearest providers,” she said. “Because it’s not when a person breaks their leg hiking in Thailand that we’re going to start looking at where to put them. And if we sent them to 22 International Hospitals & Healthcare Review

a paediatric hospital, it would immediately be clear that a network doesn’t work.” For a company like this, the benefit of a provider network is knowing exactly who to contact in a particular location for a particular problem so that time isn’t wasted trying to find someone able to help. “We call our providers when our patients are in need of support and medical care,” d'Astorg said. “Having full clarity on how to get fast access to a bed or an ambulance is key

to working hand in hand.” AXA has an international medical network department team made up of 40 experts in 26 countries. This team works closely with 80 in-house doctors and nurses to build a network of 40,000 providers worldwide and an additional 890,000 providers in the US. The team of experts is not only passionate about medicine, but able to maintain a good relationship with hospitals, said d’Astorg, and the remit is clear: “Our mission is to assess the best hospitals and experts that are relevant to our customers’ needs. It’s not only about assessing, though, it’s about securing access,” she said. Best-in-class services Unsurprisingly, insurers and assistance companies told the International Hospitals & Healthcare Review that they look for providers able to provide the best-in-class services with reasonable and comparable prices, and those

FEATURE that put the wellbeing of the patient first. Companies also said it’s important for medical providers to be open about their limitations. “No provider can provide an end-to-end solution; the best outcome is achieved when we plug in one or more providers. In that sense, trust is very important,” said Elyah OuladMehdi, a colleague of d’Astorg’s and Head of International Medical Network – Europe. “Then we can have an open dialogue.” This dialogue involves talking about challenges providers might be facing both internally and externally, as well as their needs. Often, the expert team is working on a regular basis with co-ordinators, nurses and doctors at hospitals with whom they have worked several times in the past. They may even have worked together on cases where they have managed to save lives or, tragically, lost them. “That creates a bond,” Oulad-Mehdi said. Trust in partners has other benefits. It enables companies to better anticipate costs, as well as the kinds of services they will receive. “Being able to get an aircraft to take off for a mission that will cost over €100,000 or performing a very urgent and potentially lifesaving surgery just by calling them or sending them an email stating that we will pay is important,” he explained. “This is the trust. Because it is important to know we are working with providers that are not

going to take advantage of the situation to make more money than was agreed.” For Justin Tysdal, CEO of US-based insurer Seven Corners, the benefit of having an established network of quality medical providers is that his members have access to these providers wherever they are located. “We get calls from members who, prior to purchasing insurance, will ask if we work with overseas providers and if we have a website,” he explained. “These two factors are often enough to put them at ease before overseas travel.”

Key attributes Tysdal said he looks for certain key attributes in medical provider partners. He wants assurance that providers will accept his insured members whenever they present at a facility for treatment, and also requires ease of access and direct billing facilitates for insured members around the world. Good quality of service and good rates – especially discounts – are also key, as are the location of the facility and reputable reviews. Most in the business will be looking for similar attributes, said Tysdal: “I believe the traits looked for by insurers are the same as those looked for by assistance companies. We want to make sure our members are at ease knowing they can get quality medical care without having to worry about the billing portion.” Tysdal said that many of the quality medical providers used by Seven Corners are referred by embassies and have positive online reviews. But his company carries out its own due diligence too. “From a claims and anti-fraud perspective, the quality and detail of the medical records as well as invoice consistency and reliability are tell-tale signs we are dealing with a good quality medical provider,” he said. In addition, Seven Corners keeps an eye on reviews via social media sites, and requests and reviews credentials and licences prior to contracting. A good way for Seven Corners to monitor its providers is to keep track of others in the same area who are not part of the network. “We also look at the locations of other providers and types of services located near the facility,” Tysdal explained. 23

FEATURE

Different tactics Insurers and assistance companies tend to have different schemes to assess medical providers. Some perform detailed inspections using their own teams, others use third parties on the ground, some set up rating systems for different hospitals. Assistance company MSO International employs local network managers in strategically important African countries, specifically Kenya, the Democratic Republic of Congo, Nigeria, Tunisia, Senegal, Zimbabwe, Madagascar and South Africa. “This local expertise allows us to quickly shortlist potential partners, who are then vetted against a standardised audit and questionnaire,” said Brenda Durow, General Manager of MSO. Though they are not all clinically trained, these network managers are extremely skilled and use a checklist compiled by the company’s medical team and take photos of the facility and equipment to share with the medical adviser. Audits also allow companies to differentiate between providers for certain customer groups. High-end members will require a specific kind of provider, for example. “This requires us to 24 International Hospitals & Healthcare Review

limit the network to providers who are able to meet this expectation for a VIP experience, but at a consequently higher cost to the insurer,” said Durow. Expat members, who are more familiar with the area they are in, when compared to a travel policy holder, tend to have different expectations. “Assistance or travel policy members are usually short-term travellers who do not have local knowledge, thus making it a little more challenging to manage their expectations,” Durow said. Other companies, such as Seven Corners, for example, have neither formal inspections nor rating systems. Instead, as claims are received they review the invoices and medical documents thoroughly to ensure only medically necessary treatments are performed and prices are comparable to similar providers. “If we receive any negative or questionable feedback from members, we will follow up with the providers and remove our contracts with them as necessary,” said Tysdal. “We do not have any rating schemes; however, based on the type of service, we’d still verify that a cost is justified and not above normal.”

Trust in partners … enables companies to better anticipate costs as well as the kinds of services they will receive Errant medical providers Challenges come when hospitals are not up to scratch. Insurers and assistance companies say they try to steer clear of providers who do not have the wellbeing of the patient as their main focus and clearly try to take advantage of a difficult situation to make money. Nola Guirunga, a Network Operations Manager at MSO International, said there are tell-tale signs that a provider is not up to scratch. “A provider who cannot supply the required documentation will raise alarms at contracting stage. However, once contracted, if there are any dubious practices then we would pick it up in their billing or member feedback,” she said. When assessing claims, MSO looks specifically for over-servicing, and duplicate or potentially

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FEATURE these myriad challenges that may not be the fault of the hospital. It has had to temporarily withdraw network managers from Nigeria and Zimbabwe or move patients quickly away from an area where the quality of the medicines cannot be guaranteed due to storage problems.

fraudulent claims. “We monitor claims received against usual and customary treatment and tariffs for the area,” she said. “We would also inspect them when we do our regular provider visits.” Here they use the same checklist that was used during the contracting phase and if there are any notable discrepancies from one visit to the next, they would give the facility the opportunity to explain or correct. “If they no longer meet our requirements, we will remove them from our network,” Guirunga explained. Quality of service varies across the globe and even within the same country. In the more remote regions of South America, North, West and East Africa, and Nepal, it is often hard to determine the level of medical care that can be provided, said Seven Corners’ Tysdal. In most cases, patients are sent to the only reachable medical provider. The administration of these patients can also be challenging. “Consistency and quality of medical records, as well as invoice formats, vary greatly depending on the culture and location of the medical provider. For similar reasons, not all hospitals have the latest technology, which can result in longer processing,” he explained.

Having full clarity on how to get fast access to a bed or an ambulance is key to working hand in hand Indeed, political or social unrest makes the Central African Republic a no-go area on a more or less permanent basis, while other parts of the world see periodic incidents of terrorism or unrest. In Chad in Central Africa, temperatures can regularly exceed 45 °C, and storage conditions (especially at customs level) are often poor. MSO said that flexibility is required to deal with

26 International Hospitals & Healthcare Review

Flexibility is also key in Angola, where in the capital city there are basic rural clinics as well as sophisticated first-world capabilities. “We have contracted providers who may have the necessary equipment to perform sophisticated diagnostics and treatment and so receive referrals, only to find that the technicians or skills needed to operate the equipment are not available,” said Guirunga. “This could harm the relationship with our client and creates confusion in the minds of members – who know that they should be able to receive treatment, but are then informed it is not available in that facility and alternative arrangements have to be made.” MSO audits its providers against the benchmark of an average private facility in South Africa, checking everything from piped oxygen or cylinders, to flooring, emergency room staffing and equipment. It assesses the quality of concierge services, radiology, pathology and cold chain storage, among other departments. There can also be variance in the local legal framework surrounding healthcare and cultural differences in a particular country. Some doctors employed on the continent are embargoed by

Zimbabwe, due to their historic association with the previous regime, which makes it impossible for international funders to pay their claims, or even reimburse members. “This requires very diplomatic and transparent negotiations with facilities to ensure that they are able to manage their financial risk, while still providing quality care to our members,” said Guiringa. Case-by-case basis When members use providers that aren’t within the network, this can cause headaches too, especially when providers do not want to sign contracts said Tysdal. The option then, is to negotiate on a case-by-case basis. “In other situations, facilities do not wish to work with insurance companies based on past experiences and will ask for payment upfront. These are all challenges Seven Corners can navigate on behalf of its members,” he said. Oulad-Mehdi astutely sums up the need for flexibility and adaptability when dealing with medical providers and ensuring the best for their members: “Our network is a living and evolving creature, we have to keep our finger on many pulses to understand the impact that social, environmental, geopolitical changes will have on our providers and ultimately on the services provided to our members,” he explained. “We always try to pre-empt them and respond with alternative solutions that take those changes into account. Preparedness is key,” he concluded. ■

INTERNATIONAL HOSPITALS DIRECTORY (A-Z)

EGYPT (continued)

BRAZIL Hospital Mãe de Deus Rua José de Alencar 286 – Porto Alegre/RS BRAZIL 0055 51 3230 2150

Hospital 9 de Julho Hospital Alemão Oswaldo Cruz Hospital Alvorada Hospital Copa D'Or Hospital de ClÍnicas de Porto Alegre Hospital Dona Helena Hospital e Maternidade Santa Joana Hospital Geral de Itapecerica da Serra - Seconci - SP OSS Hospital Infantil Sabarà Hospital Memorial Sao Jose Ltda

BULGARIA

Luxor International Hospital Sharm International Hospital AMC Aseel Hospital for Medical Care

GREECE Dr. Vittorakis General Practitioner/Polyclinic Main Road Platanias Chania Crete GREECE 0030 28210 60606 vittorakis.gr

CrossBorderMedCare Euromedica General Hospital of Rhodes

HONG KONG Matilda International Hospital

ACIBADEM City Clinic Tokuda Hospital EAD

41 Mount Kellett Road The Peak

COLOMBIA

HONG KONG matilda.org

Hospital Pablo Tobón Uribe Calle 78 B # 69 – 240 Medellín COLOMBIA

INDIA Rajagiri Hospital

0057 4 4459000 hptu.org.co

DOMINICAN REPUBLIC Centro Médico Bournigal Centro Médico Punta Cana Grupo Rescue Hospital General de la Plaza de la SaludÊ

EGYPT International Medical Center Clinic Km 42,Cairo Ism. Desert Rd., Cairo Near To El Sherouk City, Gate 2 Cairo EGYPT (+20) 224 775 902 imc.org.eg/imc

Adam International Hospital As-Salam International Hospital Hassabo International Hospital

Chunangamvely Aluva – 683 112 Kerala INDIA (+91) 484 66 55 000 rajagirihospital.com

Apollo Gleneagles Hospitals, Kolkata Artemis Hospital (a unit of Artemis Medicare Services Ltd.) Asian Heart Institute and Research Center Pvt Ltd Columbia Asia Referral Hospital, Yeshwanthupur Continental Hospitals Limited, Hyderabad Medanta - The Medicity Moolchand Hospital Satguru Partap Singh Hospital

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INTERNATIONAL HOSPITALS DIRECTORY (A-Z)

ISRAEL

PORTUGAL

Rabin Medical Center/Beilinson & Hasharon Hospitals (Clalit Health Services)

Luz Saúde SA

39 Jabotinsky St. Petah Tikva

Rua Carlos Alberto da Mota Pinto 17-9.º 1070-313 Lisboa

ISRAEL

PORTUGAL

(+972) 3 937 6363 clalit.co.il

ITALY

+351 213 138 260 www.luzsaude.pt

RUSSIA

Centro Chirurgico Toscano Srl Via dei Lecci 22 52100 Arezzo ITALY (+39) 0575 3335 centrochirurgicotoscano.it

Fondazione Poliambulanza IRCCS Centro San Giovanni di Dio Fatebenefratelli Universita Campus Bio-Medico di Roma UPMC San Pietro FBF - Advanced Radiotherapy Center

MALAYSIA Gleneagles Penang (Pulau Pinang Clinic Sdn. Bhd.) 1, Jalan Pangkor 10050 Penang MALAYSIA (+604) 2229 111 gleneagles-penang.com

Pantai Hospital Penang Prince Court Medical Centre The Tun Hussein Onn National Eye Hospital

MEXICO

Euromed Clinic

SINGAPORE Fullerton Healthcare @ Ocean Financial Centre Gleneagles Hospital - Parkway Hospitals Singapore Pte Ltd (Network) Infectious Disease Partners Pte Ltd (Farrer Park Medical Centre) Infectious Disease Partners Pte Ltd (Mount Elizabeth Novena Specialist Centre) Institute of Mental Health KK Women’s and Children’s Hospital National Heart Centre Singapore National University Hospital Parkway East Hospital - Parkway Hospitals Singapore Pte Ltd (Network) Rafﬂes Hospital Singapore General Hospital (SGH) Tan Tock Seng Hospital

SPAIN Best Doctors C/ Almagro, 36 1ª planta 28010 Madrid SPAIN +34 91 308 56 22 bestdoctors.com/spain

Hospital Clinica Biblica

Hospital Amerimed Cozumel Islamed Sa De Cv Calle Adolfo Rosado Salas No 999 entre 85 av y 85 av .bis, C.P. 77670 Cozumel, Q.Roo MEXICO

Avenida 14, Calle 1 Y Central San José SPAIN 506 2522 1000 clinicabiblica.com

+52 (987) 869 55 55 amerimedcozumel.com

Centro Oncologico de Chihuahua Clinica Cumbres Chihuahua Hospital CMQ Hospital de Especialidades (Baja Medical Response) Hospital Galenia Hospital Mexico

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INTERNATIONAL HOSPITALS DIRECTORY (A-Z)

SPAIN (continued) Hospital Unv. HM Montepríncipe

TURKEY Acıbadem Healthcare Group

Av. de Montepríncipe, 25 28660 Boadilla del Monte Madrid

Fahrettin Kerim Gökay Cad No:49 34662 Altunizade İstanbul TURKEY

SPAIN

+90 530 976 8398 acibademinternational.com

(+34) 914 452 126 hmmonteprincipe.com

Hospital Unv. HM Puerta del Sur

Anatolia Hospital

Av. de Carlos V, 70 28938 Mostoles Madrid

Caybasi Mh 1352 Sk No 12 07100 Antalya TURKEY

SPAIN (+34) 914 452 126 hmpuertadelsur.com

Hospital Unv. HM Sanchinarro

+90 242 249 33 00 anatoliahospital.com

Özel Medicabil Hastanesi

Calle Oña, 10 28050 Sanchinarro Madrid

Fethiye Mahallesi, 1/A Mudanya Yolu Küre Sok Fethiye Mahallesi 16140 Nilüfer/Bursa TURKEY

SPAIN (+34) 914 452 126 hmsanchinarro.com

Medical Response International Quironsalud Hospitales Hospital Clinica Benidorm Hospitales San Roque Maspalomas Vithas Xanit International Hopsital

(+90) 444 8 112 medicabil.com

Gayrettepe Florence Nightingale Hastanesi Istanbul Florence Nightingale Hastanesi Medipol Mega Hospitals Complex Memorial Ankara Hospital

UAE

THAILAND Bangkok Dusit Medical Services

Belhoul European Hospital PO Box : 4674 Dubai

2 Soi Soonvijai 7, New Petc buri Rd., Bangkok 10310

UAE

THAILAND

(+971) 4 345 4000 belhouleuropean.com

+66(0)2-310-3000

bangkokhospital.com

Bumrungrad International Hospital Samitivej Sukhumvit Hospital Vejthani Hospital Vibhavadi Hospital

Al Amana Home Health Care LLC Tawam Hospital Thumbay Hospital

UK HCA Healthcare

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242 Marylebone Road London NW1 6JL UK 020 3131 4193 hcahealthcare.co.uk

INTERNATIONAL HOSPITALS DIRECTORY (A-Z)

USA (continued)

UK (continued) Imperial Private Healthcare

Sharp Global Patient Services

5 Wharf Rd London W2 7BL

8695 Spectrum Center Blvd. San Diego CA 92123

USA +1 888 265 1513 sharp.com

020 3311 7700 imperialprivatehealthcare.co.uk

Queen Square Hospital

UC San Diego Health System International Patient Program

8-11 Queen Square London WC1N 3AR

136 W. Dickinson Street Suite 109, San Diego CA 92103-8222

USA +1 619 471 0466 health.ucsd.edu

qsprivatehealthcare.com

USA Broward Health International 1608 SE 3rd Avenue Ste 503-B, Ft Lauderdale FL 33316 USA +1 954 767 5587 Sbaig@browardhealth.org

Jackson Memorial Hospital International 1500 NW 12th Avenue Suite 829 East, Miami FL 33136 USA +1 305 355 1211 jmhi.org

Boston Childrens Hospital Brigham and Women’s Hospital (Partners HealthCare International) Cleveland Clinic Cook Children’s Health System Duke Medicine Global Emory Clinic Johns Hopkins Medicine International Mayo Clinic Mount Sinai Medical Center Northwestern Medicine Ochsner Health System Philadelphia International Medicine Uchicago Medicine

VIETNAM Family Medical Practice Co. Ltd 12th ﬂr, Diamond Plaza 34 Le Duan, Dist 1, HCM

Penn Global Medicine 3400 Spruce Street Philadelphia PA 19104

VIETNAM (848) 3822 7848 vietnammedicalpractice.com

USA pennmedicine.org

Philadelphia International Medicine 1801 Market Street, Suite 710 Philadelphia PA, 19103 USA 215-575-3737 philadelphiamedicine.com

Atrium Health Baptist Health International Baylor St Lukes Medical Centre

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