IHHR 5 - October 2018

Unlocking a world of wellbeing The importance of wellbeing policies for expats abroad

Industry voice How healthcare companies are finding ways to create shared value

Destination profile Healthcare and health insurance in the UAE

Issue 5 ¡ November 2018

TRAVELLING FOR TECH Innovative technologies are in great demand among international patients

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18. Unlocking a world of wellbeing The importance of wellbeing policies for expats abroad

12. Destination profile Healthcare and health insurance in the UAE

22. Travelling for tech Innovative technologies are in great demand among international patients

16. Industry voice Medix Global on how healthcare companies are finding ways to create shared value

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Hi! How are you? I hope you’re all well! Question for you: Have you ever wondered how healthcare and health insurance function in the UAE? You have? Well, we’ve got you covered with a destination profile piece on this very topic!

We also explore the importance of wellbeing policies for expats abroad – with research indicating that expats are two and a half times more likely to suffer from depression than ‘local’ workers, these benefits are crucial.

Victoria Zolkiewka at William Russell, Aetna International's Medical Director

accessing technology not available at home is typically the number two reason for travelling overseas for treatment – after gaining access to the latest drugs

patients. “In price-agnostic source markets such as China, the Middle East and Russia, accessing technology not available at home is typically the number two reason for travelling overseas for treatment – after gaining access to the latest drugs,” says Pete Read of Global Growth Markets.

Last – but by no means least! – Sigal Atzmon of Medix Global tells us how healthcare companies are finding ways to create shared value, and how this can lay the foundations to simultaneously provide patients with better medical outcomes and improved medical cost management for their insurers.

I hope you enjoy this issue. Please do get in touch if you are keen to contribute. I’d love to hear from you!

Bye for now, and until next time – stay healthy!

Dr Mitesh Patel and Steve Nyce of the Research and Innovation Centre at Willis Towers Watson delve into why.

Elsewhere this month, we look at some of the technological innovations that are prompting people to travel for treatment, with telemedicine, 3D printing and AI attracting international

Lauren Haigh @Medical_Editor editor@ihhr.global

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NEWS

AI breakthrough in detecting eye diseases A trial at Moorfields Eye Hospital in the UK has found that an artificial intelligence (AI) system was as effective as world leading experts at detecting eye disease in patients.

Powered by Google’s AI company DeepMind, the system was able to identify more than 50 types of eye disease in seconds, with 94-per-cent accuracy.

The hospital also said that in around 1,000 tests

the system was able to identify more than 50 types of eye disease in seconds performed by the system, not one case that would lead to an urgent referral was missed. The system is due to begin clinical trials next year, and could possibly be with hospitals within three years, according to Moorfields.

Nearly 15,000 historic and anonymised 3D, high definition optical coherence tomography retinal scans were examined by the AI system in order to ‘teach’ it to diagnose conditions. It then scanned a further 1,000 patients currently at Moorfields and its results were compared to the findings of the hospital’s consultant ophthalmologists and specialist optometrists.

Pearse Keane, a consultant ophthalmologist at Moorfields and scientist at the UCL Institute of Ophthalmology, told The Evening Standard: “They are pretty stunning results and could, I think, transform the whole speciality of ophthalmology in the next few years.”

Emergency rooms to blame for the cost of healthcare The New York Times has published an opinion piece by Dr Glenn Melnick, Professor of Public Policy at the University of Southern California and a researcher at its Schaeffer Center for Health Policy and Economics, in which he says that emergency rooms are to blame for the ‘out of control cost of healthcare’.

Dr Melnick stated that regulations concerning emergency room care are one of the most powerful forces behind cost increases. “These regulations have granted hospitals what is essentially a monopoly over emergency room patients, allowing them to charge basically whatever they want,” he claims.

He also said that to ensure readily available emergency treatment, most states require healthcare plans to tell all their members to go to the nearest hospital in an emergency and that insurance will cover the visit. He said that this is meant to ensure timely access to needed care and tends to work well. However, Dr Melnick explained that the problem is that these rules afford hospitals great pricing power when they’re negotiating with health insurance companies.

billed charges to health plans increased from $6,900 per day to more than $19,500 per day “Increasingly, hospitals have learned that if they demand higher prices from health plans and do not get them, the hospitals can just cancel their contract.

They will still get paid for treating emergency patients under those plans – and in fact will be paid more, because those patients will be out of network,” he says.

Dr Melnick highlighted that data from California illustrates how hospitals have exploited this situation, with total billed charges by hospitals having risen by US$263 billion to $386 billion from 2002 to

2016, despite the fact that the number of patients being admitted did not increase. Furthermore, billed charges to health plans increased from $6,900 per day to more than $19,500 per day.

“This astronomical run-up in billed charges gave California hospitals leverage to demand and receive much higher prices for in-network patients, too. The average price paid by health plans to hospitals for all care grew almost 200 per cent — to $7,200 per day from $2,500,” said Dr Melnick. “In effect, they could threaten: Pay us $7,200 per day to sign a contract or $19,500 per day for emergency admissions without a contract.”

Dr Melnick said that it is important for patients to be aware of this fight between hospitals and insurers as whenever insurance companies have to pay more, so too do patients, in the form of premium increases. “An American family of four with an employer-sponsored preferred provider organisation health plan now pays on average more than $28,000 a year for healthcare. If nothing changes, health care prices and insurance premiums will continue to grow,” he concluded.

Moroccan healthcare startup receives funding from AXA Moroccan startup DabaDoc has welcomed AXA as its first institutional investor. DabaDoc, which was launched in 2014 by brother and sister Driss and Zineb Drissi Kaitouni, allows users to find doctors and book appointments online. It helps thousands of patients to connect with doctors through its platform each month and has already expanded into Algeria. The funding from AXA Assurance Mexico will enhance the company’s footprint in its

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existing markets and further develop its offering.

“We are at the inception of a disruption in the way healthcare is delivered. Having AXA as a shareholder adds an important dimension to our mission of democratising access to healthcare. We are excited about further growth prospects with this partnership and the expertise provided by AXA in our existing and future markets,” said Zineb Drissi-Kaitouni.

Philippe Rocard, CEO of AXA Assurance Morocco, said: “AXA is committed to transforming its role of indemnity payer into a partner facilitating the lives of its customers, thanks to its services. As such, we are happy to contribute to the growth of DabaDoc, an amazing Moroccan startup. DabaDoc offers innovative services in the healthcare space, especially by facilitating patient journeys.”

NEWS

Catalia Health working with American Heart Association on healthcare solutions Patient care management company Catalia Health, which provides an artificial intelligencepowered patient engagement platform, has joined the American Heart Association’s Center for Health Technology & Innovation’s Innovators Network in pursuit of innovative and scalable solutions in the healthcare market.

Via the partnership, the companies will work to deliver the Association’s guidelines in an innovative way that meets the needs of the increasingly diverse patient population suffering from heartrelated ailments, including heart failure.

Catalia Health’s personal healthcare companion product, Mabu, provides content about heart health through a guided conversational approach that is available whenever a patient requests it. It also supports patients living with chronic illnesses such as congestive heart failure, rheumatoid arthritis and late-stage kidney disease, and completes daily check-ins using tailored conversations with patients to help them manage care routines and overcome the challenges of isolating illnesses, while providing

insights to healthcare professionals about patient health, progress and adherence to treatment.

“We’re on a mission to address both parts of the healthcare equation: improving patient outcomes and expanding the current capabilities and efficiency of healthcare companies,”

said Dr Cory Kidd, Founder and CEO of Catalia Health. “This new milestone with the American Heart Association solidifies a critical step in further enhancing our technology and expanding our reach to even more people struggling with chronic disease.”

Expert Care from London’s Leading Centre for Neurology and Neurosurgery Known the world over as the ‘home of neurology and neurosurgery’, Queen Square in Central London provides a wide range of expertise, specialising in everything from headaches and back pain to more complex neurological conditions.

Queen Square Private Healthcare offers state-of-the-art diagnostic facilities and a fully comprehensive and convenient service from within the world renowned National Hospital for Neurology and Neurosurgery.

To find out more, please contact our dedicated referrals team on: +44 (0) 20 3448 8948 referrals@qsprivatehealthcare.com www.qsprivatehealthcare.com

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NEWS Aon expands employee private healthcare scheme to include cover for gender dysphoria Global professional services firm Aon plc, which provides risk, retirement and health solutions, has announced that it has expanded its employee private healthcare scheme in the UK to include

frequent gaps in insurance coverage have hindered many individuals from receiving adequate treatment cover for gender dysphoria. The scheme is administered by UK healthcare specialist Bupa.

Gender dysphoria is defined by strong, persistent feelings of identification with the opposite gender and discomfort with one’s own assigned sex that results in significant distress. It is a recognised medical condition, for which treatment can be appropriate, and not a mental illness. There has been a rapid increase in the number of people experiencing gender dysphoria, and yet frequent gaps in insurance coverage have hindered many individuals from receiving adequate treatment.

In 2016, Aon demonstrated its commitment to the provision of adequate cover to individuals experiencing gender dysphoria by developing

one of the UK market’s first gender dysphoria coverage solutions. “Diversity is the foundation on which we have built our world-class organisation.

Given our commitment to an inclusive culture, we have chosen to introduce gender dysphoria cover within our own benefits package. This is a significant change to our scheme and enables members to access different levels of professional treatment, which could include counselling and support services through to surgical procedures,” said David Battle, CEO of Employee Benefits UK,

Aon. “Gender dysphoria is a recognised medical condition, yet it is excluded from many employers’ private healthcare schemes. We believe this is wholly inappropriate. The late James Kenrick, who served as our Head of Health Care Consulting Services, was a pioneer in bringing gender dysphoria cover to our clients and developed one of the market’s first coverage solutions. We will continue to build on this legacy and are proud to be leading the industry in providing such inclusive benefits for Aon colleagues in the UK.”

The potential of digital health tools A new report from healthcare company Philips explores the potential of digital health tools to enable data to be used more effectively. The future

health index report, called Moving data to the heart of health systems, highlights the importance of data in modern healthcare, analyses data and

conducts interviews with leaders who are making value-based healthcare happen around the world.

It also investigates how the obstacles that face the integration of electronic health records and the application of AI in healthcare can be overcome.

The report offers five key recommendations to

the smooth exchange of health information is central to delivering better value drive better healthcare data collection, analysis and use in order to deliver value-based healthcare.

These are: get regulation right, modernise education, end top-down implementation, prove and explain value and harmonise data standards.

“The Future Health Index’s latest report shows that the smooth exchange of health information is central to delivering better value in healthcare,” said Jan Kimpen, Chief Medical Officer for Philips. “By connecting people, data and systems we can create a network that allows information to flow seamlessly across care providers, locations and systems. It is through data that the outcomes that define value are tracked, measured and improved. Yet, health systems around the world are still struggling to collect, organise, analyse and use health data in a meaningful way. The recommendations made in the FHI are designed to address these very challenges and provide actionable next steps that healthcare leaders can take to optimise the value provided by the digital tools they are investing in.”

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INDUSTRY VOICE

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NEWS

Daily aspirin may be harmful for the elderly New research has found that daily aspirin may be harmful for healthy older adults, refuting the widely accepted belief that a daily dose of aspirin can be a way to protect healthy people from cardiovascular disease.

The research reinforces the results of a study published in August that found that daily low dose aspirin was too risky to be prescribed to patients at moderate risk of heart disease. Both in this and the new study, researchers found a significant risk of internal gastric bleeding caused by the medication, which thins the blood.

“We knew there would an increased risk of bleeding with aspirin, because there always has been,” said study co-author Dr Anne Murray, a geriatrician and epidemiologist at the Hennepin Healthcare Research Institute and the University of Minnesota, US. “But not only did it not decrease risk of disability or death, it did not decrease the risk of heart attack and stroke, and there was an increase in the rate of death.”

The goal of the study, which was published in the New England Journal of Medicine, was to discover whether low-dose aspirin could prolong healthy, independent living in seniors who had not shown signs of heart disease. It followed 19,114 seniors with a minimum age of 70 for Caucasian participants and 65 for AfricanAmerican and Hispanic volunteers – 2,411 from the US and 16,703 from Australia – for an average of 4.7 years. At the end of the trial, 90.3 per cent of the aspirin-treated patients were still alive, compared with 90.5 per cent of those who received placebos. Rates of physical disability and dementia were similar between the groups, as were the rates of coronary heart disease, heart attacks and strokes.

The rate of internal bleeding was found to be the main difference and the researchers also found that there was an increase in cancer deaths in the aspirin-treated group, which surprised the researchers. “There was a small increase in the number of deaths overall in the aspirin group, with the largest proportion of deaths due to cancer,” said Murray. “It is possible pre-existing cancers may have interacted with the aspirin.”

Survey reveals women’s point of view on men’s health A new study by Cleveland Clinic in the US has found that, in heterosexual couples, significant others play an influential role in encouraging men to take their health seriously, as do the mothers, daughters and friends of men. Two online surveys among around 2,000 US men and women aged 18 and older found that 83 per cent of women encourage their male significant other to have their health checked once a year, while 30 per cent of men believe they don’t need to do so because they are ‘healthy’.

The survey is part of Cleveland Clinic’s third annual education campaign called MENtion It, which it said aims to address the fact that, generally speaking, men often don’t mention health issues or take steps to prevent them.

This year, for the first time, Cleveland Clinic surveyed women as well as men to understand how mothers, wives, spouses/significant others, daughters and friends can encourage

California, US-based clinical stage biotechnology company International Stem Cell Corporation (ISCO) has announced that its R&D team has developed novel methods that efficiently generate human liver-like tissue.

The company is working to provide a viable 3D

printable treatment option for patients on the liver transplant waiting list, with the potential to significantly reduce waiting times. The 3D liver structures are produced from human pluripotent stem cell derived-liver progenitor cells (hpLPC).

As the hpLPC can be derived from any kind of pluripotent stem cells using ISCO’s proprietary highly efficient and scalable differentiation method, there are vast opportunities for licensing

IHHR

women are oftentimes the health decision maker in the family Glickman Urological and Kidney Institute.

“Many of our male patients admit to only seeing their doctor after their significant other has encouraged them to go. We wanted to make sure we captured their point of view on men’s health since they play such an important role.”

The survey also found that both sexes turn to the internet as much as to their doctor when a health concern comes up – with 27 per cent of men and 27 per cent of women researching their symptoms online.

3D printing human livers

there are vast opportunities for licensing the technology for use in drug development

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the men in their lives to stay healthy.

“When it comes to the health of their husbands, fathers, brothers, or sons, women are oftentimes the health decision maker in the family,” said Dr Eric Klein, Chairman of Cleveland Clinic’s

the technology for use in drug development.

“Such realistic 3D representations like the one we’ve developed will be invaluable for the future study of the abnormalities in liver diseases, as well as testing the efficacy of certain drug therapies,” said Dr Russell Kern, Executive Vice-President and Chief Scientific Officer of ISCO. “For us, the next phase will involve testing the structures in rodents to see whether or not they will engraft and start functioning like a real liver.”

NEWS

European academics failing to report results of clinical trials Head of the Evidence-Based Medicine DataLab at the University of Oxford, UK, and lead author of the study. “But equally, some people may have an ideological commitment to a particular treatment, which may lead them to, either consciously or unconsciously, slow down the dissemination of findings contradicting that treatment.”

The study noted that some researchers might information from studies...should be available in a timely manner to help doctors and patients make decisions

According to the findings of a new study, when it comes to reporting the results of clinical trials, European academics are failing. Researchers analysed data from the European Union’s Clinical Trial Register and found that 50 per cent of the listed trials have not complied with guidelines, which state that results must be reported within 12 months.

The results, which were published in the BMJ, show that only 11 per cent of trials run by academic centres – such as those led by

universities, governments, hospitals or charities – had published outcomes after completion. In addition, only 11 of the major sponsors of clinical trials – entities that are responsible for at least 50 trials on the register – had reported 100 per cent of results, all of which were companies.

“For academics, the reason for not reporting results may be a matter of poor knowledge management or staff turnover, where a clinical academic has gone back to work as a doctor,” said Ben Goldacre,

hold back information because they are aiming to publish in high-profile journals, which can take longer than the 12-month deadline set by the guidelines. Elizabeth Loder, Head of Research at the BMJ, said it’s not necessary to wait for a full publication to disseminate information: “Results can also be reported on trial registration sites or in preprints. The important thing is that the information from studies, which rely on the goodwill of volunteers, should be available in a timely manner to help doctors and patients make decisions.”

In an effort to increase awareness of the issue, the AllTrials campaign, led by Goldacre, has launched a tool called EUTrialsTracker, which ranks clinical-trial sponsors by how many results they have reported.

Digital health company HealthTap improves patient experience Digital health company HealthTap has announced that it is celebrating providing more than seven billion answers to a wide range of health queries – nearly one for each human on earth.

The company strives to provide people with immediate access to top medical experts and their trusted health advice anytime, anywhere.

Alongside the announcement, the company has released an extensive update to its technology platform, which delivers ‘augmented intelligence technology’ that is designed to improve the patient

can now be achieved digitally thanks to the power of augmented intelligence,” said Geoff Rutledge, Chief Medical Officer at HealthTap. “We’re drawing on the shared expertise of 140,000 doctors to deliver meaningful insights, but we also understand how important it is to connect directly with a doctor when the time is right. By rewiring the healthcare experience to be as useful and convenient as your

favourite consumer apps, everybody wins.”

The HealthTap platform represents one of the largest repositories of healthcare information ever created, with expertise on more than 800 topics. The company said that improvements to the updated augmented intelligence technology include: greater accuracy, interactions that feel more human and a more consumer-friendly interface.

The HealthTap platform represents one of the largest repositories of healthcare information ever created care experience. This augmented intelligence presence is called Dr AI and uses an app to engage patients in order to learn more about their symptoms before directing them to the most useful next step of care to resolve their problem.

HealthTap said that the technology isn’t designed to replace a doctor’s expertise or presence, but rather to assist patients and doctors to achieve better health outcomes faster and with less effort. “It’s amazing to consider that what might once have required seven billion doctor visits

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NEWS

Healthcare leaders recognised

Three senior leaders at the Hospital for Special Surgery (HSS) in New York, US, have been named in Crain’s New York Business’ inaugural Notable Women in Health Care in NYC list.

The list is part of a year-long series from Crain’s to celebrate women in the workplace.

Nominees were required to be in the healthcare industry in the New York City metropolitan area in an administrative or clinical role. The finalists were selected by a Crain’s team based on a combination of professional achievements, community service, track record of mentoring others, and promotion of diversity and inclusion in the workplace. The finalists are: Lisa Goldstein, Chief Operating Officer; Dr Catherine H. MacLean, Chief Value Medical Officer; and Dr Hollis Potter, Chair of the

The list is part of a year-long series from Crain’s to celebrate women in the workplace Department of Radiology and Imaging.

“We are pleased to have three colleagues honoured for their exceptional professional, civic and philanthropic achievements,” said Louis A. Shapiro, President and CEO of HSS. “We have cultivated a culture at HSS based on excellence, passion, integrity, creativity and teamwork, which supports career growth and leadership opportunities. Each member of the HSS family plays a vital role in the success of our organisation. Dr MacLean, Dr Potter and Ms. Goldstein lead by example on our continuous path to ‘better’.”

Goldstein ensures that the quality of care and the patient experience helps HSS achieve its mission in an ever-changing healthcare environment. She leads operations and oversees all of the expansion and growth plans for HSS. Dr MacLean is nationally recognised as an expert on healthcare quality and value and has a diverse leadership experience. Dr Potter is the Director of the National Institutes of Health-funded MRI Laboratory and is recognised for her expertise in developing MRI applications for orthopaedic conditions.

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The effect of travel times on nurse staffing A new study published in the Journal of Neuroscience Nursing has found that accompanying patients for imaging scans and other procedures has a significant impact on nurse staffing rations for specialist nurses on neurocritical care units. The study states that patients in a neurologic critical care unit require more staffing to account for the frequent neurologic assessments, charting and travelling.

“Neurocritical care units are unique from other critical care areas,” the study authors Michelle Hill and Jessica DeWitt of Riverside Methodist Hospital, Ohio, US. “These imaging and diagnostic examinations are often time sensitive and may happen at any time. This started us asking the question, ‘Are neurocritical care nurses

Approximately 4.5 hours of a 12-hour shift were spent off the unit performing 14 hours of work on a 12-hour shift?’”

In order to answer this question, the study authors assessed the relationship between different nursing tasks, including neurological assessment, documentation, and travelling with patients for diagnostic tests. They also explored the effects of patient severity of illness (acuity) and nurse experience. They found that, over

30 days, neurocritical care nurses spent more than 226 hours travelling with patients and the main tests and procedures involved were computed tomography and magnetic resonance imaging scans and vascular interventional radiology procedures. “Approximately 4.5 hours of a 12-hour shift were spent off the unit travelling for these tests, indicating that at least one nurse was off the unit for 38 per cent of the shift,” the authors said.

The authors recommended a new ‘circulator’ nurse position, who would travel and assist with patients, freeing primary nurses on the unit to stay with their patient. They also recommended three new ‘one-to-one’ staff positions, allowing highacuity patients or those with multiple diagnostic tests scheduled to be assigned to a dedicated nurse.

Americans unsure if cover extends beyond US According to a new survey from travel insurance comparison website InsureMyTrip, worrying numbers of Americans are not sure whether their health insurance works outside of the US. Respondents were asked ‘Does your domestic health insurance cover any doctor or hospital visits while travelling outside the US?’, and over half of people polled (56 per cent) said they didn’t know whether their domestic health insurance plan would cover any emergency doctor or hospital visits while travelling outside the country, while 22 per cent said their domestic health insurance would offer no coverage and the remainder said they thought their insurance plan would offer coverage.

The survey was conducted from 7-10 August 2018 and generated 498 completed responses from

people aged 35 and over who identify as American.

InsureMyTrip said that travellers who are unsure about whether they have coverage should contact their health insurance company to find out if emergency medical coverage will extend outside of the US as coverage can vary depending on the specific plan and the area of travel. “Policyholders may discover they have either ‘in-network’ coverage, limited coverage, or no coverage at all,” it said. InsureMyTrip also said that travellers should be aware of the following: deductibles (the amount a patient must pay for covered services before insurance kicks in); co-insurance (the amount a patient is responsible for a covered healthcare service) and co-payments (a set amount owed for a covered healthcare service).

DESTINATION SPOTLIGHT

World-class care in the heart of London

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With over 500 consultants covering every medical, diagnostic and surgical specialty, we are able to treat patients with even the most complex care needs, from kidney transplants to cancer.

situated in London, with excellent transport links to the cultural and shopping centres of the city.

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DESTINATION SPOTLIGHT

HEALTHCARE AND HEALTH INSURANCE IN THE UAE

I

n the UAE, there is a comprehensive, government-funded health service, in addition to a burgeoning private health sector. Healthcare in the UAE is regulated at the federal and emirate levels, with federal-level legislation dating back to the 1970s and 80s. Public healthcare services are administered by a number of regulatory authorities, including: The Ministry of Health and Prevention, Health Authority Abu Dhabi (HAAD), the Dubai Health Authority (DHA) and the Emirates Health Authority (EHA). HAAD was created to regulate all healthcare sectors – public/private, provider/payer/ professionals – while SEHA (which is Arabic for ‘health’) is the largest public provider. In 2015, a new health insurance

Doctors per

2.5

1,000 population:

programme was launched in Dubai by the UAE Government to support nationals not covered under any other governmentfunded health insurance scheme.

High-quality healthcare Increased government spending during strong economic years is believed to have helped create the generally high standards of healthcare found in the UAE. According to the World Bank, life expectancy in the UAE was 77.54 in 2015. In addition, according to the World Health Organization (WHO), fewer women are dying during or after pregnancy. In fact, rates of maternal deaths were reduced to six cases in 100,000 live births in 2016, down from eight in 2013.

“Antenatal care and care after pregnancy are all helping to reduce maternal deaths.

The improvement in technology has also been a factor,” said Dr Hiam Ahmed Harfoush, specialist in obstetrics and gynaecology at Burjeel Hospital.

The UAE Vision 2021 National Agenda aims to build a world-class healthcare system in the country. The Agenda was launched by H.H. Sheikh Mohammed

bin Rashid Al Maktoum, Vice-President and Prime Minister of the UAE and Ruler of Dubai, at the closing of a Cabinet meeting in 2010. It aims to place the UAE among the best countries in the world by the Golden Jubilee of the Union and is divided into six different pillars: worldclass healthcare, competitive knowledge economy, safe public and fair judiciary, and a first-rate education system. Due to the creation of a world-class healthcare infrastructure being a top priority for the government of the UAE, the sector has advanced and expanded in the past few years.

Growth through technology According to recent reports, it is estimated that the UAE’s health sector will grow by 60 per cent between 2016 and 2021 and be worth more than AED (UAE Dirham) 103 billion by 2021. The driving factor of this growth is predicted to be technology. Indeed, the country came out on top of Philips’ Future Health Index report published last year, which measures countries’ perception of accessibility and integration of healthcare systems and the

DESTINATION SPOTLIGHT

adoption of connected healthcare. This is due to positive views on the current state of integration throughout the health system and patient and healthcare professional readiness to adopt technology.

According to the report, examples of technology innovations that have been implemented at the national and local level include: an electronic health system; a preventative health public service called the Weqaya Programme in Abu Dhabi; 24/7 telemedicine; and a number of smartphone apps to encourage people to forge connections with healthcare.

Another recent report said that the UAE earned the highest regional score on the Middle East Healthcare Access Index compiled by BMI Research, highlighting the importance of technology in healthcare. “Advanced healthcare systems and compulsory health insurance in Abu Dhabi and Dubai, and the continuous adoption of new technologies in the healthcare system, will support the UAE’s position,” it said. “Innovation in clinical services and the use of new technologies in disease diagnosis and treatment will drive a more patient-centric healthcare system.”

An attractive destination The UAE Government is keen to increase the number of medical travellers coming to the UAE by establishing Dubai as a centre of healthcare excellence in the region. A number of hospitals in the UAE are offering innovative therapies, which makes it an attractive destination for high-quality treatment. One example of this is when, earlier this year, Emirates Hospital Jumeirah, an Emirates Healthcare company, announced that it was partnering with ReGen Medical Management Dubai to launch a new stem cell and regenerative medical centre. Another example is the introduction of a new knee joint replacement technology, ‘Arabic Knee’.

Challenges and the future When it comes to healthcare challenges, the UAE is dealing with healthcare burdens similar to other parts of the world, such as rising incidence of heart disease and cancer.

More unusual challenges include a high incidence of congenital diseases due to the large number of consanguineous marriages, and a rapid increase in the prevalence of obesity and metabolic syndrome due to

Total expenditure on health as % of GDP (2014): 3.6 Total expenditure on health per capita (Intl $, 2014): 2,405 a rapidly changing lifestyle to one that is more affluent and sedentary.

According to the Embassy of the UAE in Washington, US, healthcare delivery in Abu Dhabi is undergoing a significant transition, for which the key goals are: improving quality of care, expanding access to services, shifting from public to private providers and implementing a new financing model. In order to further develop its healthcare system, the UAE is working with leading global institutions, including US-based institutions such as The Cleveland Clinic Abu Dhabi, The Johns Hopkins Medical School, The Susan G. Komen Breast Cancer Foundation and The Children’s National Medical Center. ■

Life expectancy at birth m/f (years, 2016): 76/79

FROM VOLUME TO VALUE: HEALTHCARE PROVIDERS MUST PLAY THEIR PART TO REFORM A STRUGGLING GLOBAL HEALTH SYSTEM

By Andrew Coombs, Group Commercial Director at HCA Healthcare UK By 2020, global spending on healthcare is expected to reach a staggering $8.7tn1. Health systems across the world are contemplating the challenges that come with managing the health of a population that is living longer but increasingly with chronic and multiple health conditions.

Never before has there been a greater motivation to reform the way healthcare is delivered.

The UK’s state-run National Health Service (NHS) embarked on a programme of improvements five years ago called Getting It Right First Time2, which is putting the theory from John Wennburg’s seminal 2010 research into unwarranted variations in care into clinical practice3.

As private providers of healthcare operating in a global market, I believe that the NHS’ Getting It Right First Time programme reinforces three ways in which we too must change in order to operate more efficiently, contain costs more effectively and most importantly, continually deliver even better outcomes for our patients. The 2018 Deloitte Global Health Care Outlook report refers to this as the “shift from volume to value”4: 1. Clinicians must be front and centre of change Having been piloted by the British Orthopaedic Association, Getting It Right First Time now covers more than 30 clinical specialisms, each led by those who have both broad and deep understanding of the specialism they are trying to improve. Having foremost consultants leading the programme from the outset has been pivotal to how well it has been embraced by the teams implementing it5.

In 2018, HCA UK restructured its hospital network to align our major clinical specialisms by Department – matching the very best healthcare systems in the world. The Departments comprise of over 1,000 consultant members, and are led by some of the most esteemed leaders within their fields; the Chief Medical Advisor to the Cardiovascular and Respiratory Department, for example, is celebrated by his peers as a ‘father of electrophysiology’. Each Department focuses on ‘getting it right first time’ by: setting quality standards through data and peer-reviewed research, the streamlining and optimisation of patient pathways, and innovation within their specialism.

Within these Departments, we are incredibly

lucky that consultants from world-renowned teaching hospitals, including University College London Hospitals, St Bartholomew’s Hospital and Great Ormond Street Hospital, choose to work with us. They have built up their expertise through decades of research into new treatments and techniques. Every day across our hospitals, these consultants come together within each of their respective specialisms and sub-specialisms as part of multidisciplinary teams to debate, challenge and agree treatment options for patients with the most complex illnesses and life-limiting conditions. We combine the broad and deep skillset of these clinicians to put our patients on the best possible pathway - so that a second, third or fourth opinion is debated first time round.

2. Quality reform must be underpinned by data As providers of healthcare, whatever our quality ambitions entail, they must be underpinned by high quality data. A fundamental component of Getting It Right First Time is in the way it uses intelligence drawn from national data sets to find new opportunities for learning and improvement.

The clinical analytics team at HCA UK lead the way in the UK private healthcare sector, delivering real-time insights and analysis to our frontline clinicians (see Diagram A).

In 2017, Professor Sir Bruce Keogh announced our partnership with the prestigious CASS Business School to develop the next leaders in healthcare.

Our clinical scientists and research fellows are

working together to carry out ground-breaking research, using machine learning to predict the needs of our patients before they have even entered hospital. In the future, nursing levels on the wards will be coordinated in this way, too.

We are developing new ways to parse natural language, so that we can understand more about how our patients would like us to improve.

We do all of this not simply because it makes commercial and operational sense. We do it because we are a learning organisation; we have a moral obligation to seek out the challenges that are going unchallenged in healthcare.

3. Healthcare must be delivered within a robust regulatory structure It is not just in the acute hospital setting that Getting It Right First Time is helping us to think about healthcare reform.

As healthcare providers, we must embrace armslength oversight to drive up quality standards and ensure that we are held accountable for the care that we deliver. Having a robust and transparent regulatory system is one of the reasons that the UK is consistently ranked top in a list of developed nations’ healthcare systems, which also include

Diagram A: A nurse’s view of one, six-week episode of data from a patient who has experienced a major haemorrhage following surgery

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France, Germany and the United States6.

In England, the independent regulator of health and social care is the Care Quality Commission (CQC). It ranks every healthcare provider in the country on a four-point scale from Inadequate to Outstanding. HCA UK has the highest proportion of Outstanding hospitals of any provider group7.

We are the only private provider in the country to be accredited for our cancer care by the European Society of Medical Oncology (ESMO).

We are the only private maternity provider to be accepted by the Royal College of Obstetricians and Gynaecologists. We are JACIE accredited for our stem cell and bone marrow transplant services. In every hospital, across every service, we are seeking out ways to raise the benchmark of outstanding care.

But driving up quality standards is not simply something that should be done within our hospital walls. We are striving for sector-wide collaboration in the delivery of excellent care. This year, we announced the introduction of the HCA UK Advisory Board, comprised of pre-eminent leaders within the healthcare sector. Our Chair is the former Chairman of NHS Improvement, Ed Smith CBE. The Advisory Board provides strategic insight to our senior leadership team; helping us to deliver long-term change in the way healthcare is delivered in the private market.

Conclusion: Creating a virtuous circle Now more than ever, global health systems must take advantage of the appetite and opportunity for change.

I believe that what Getting It Right First Time really

demonstrates is that to effect the greatest change in healthcare, we need to recognise that continuous improvement is created through a virtuous circle of increasing quality standards through intelligent use of data, underpinned by an organisational culture that embraces change and shares a collective vision amongst those delivering the care to our patients.

We are replacing faulty aortic valves without a single stitch. For every patient living with cancer, we are investing in our clinical research arm to find the next breakthrough. Soon, we will be the only private hospital group in the UK to carry a commercial license for CAR T-cell therapy – one of the very latest treatments for certain cancer types.

As providers and insurers of healthcare, it is incumbent upon us to work together to consider how we respond to the changing needs of our customers. Disruptive, computer-based technologies are revolutionising healthcare and enabling consumers to take greater control over their health and wellbeing.

We must use artificial intelligence to change the way we deliver care for the better. We must take advantage of innovations in robotics to pioneer minimally invasive, minimal access surgery that reduces risks and increases recovery time. We must learn the lessons that predictive analytics in big data can teach us to seek out new ways to improve, grow and thrive. We must use this technology to keep our patients safer, and we must embrace rigorous and robust independent regulation that checks the checker.

These techniques and technologies are being carried out by the pioneers in medicine who are fundamental to delivering our ambitious agenda for change. We are working more efficiently, encouraging greater transparency within the private healthcare sector and above all, delivering outcomes that are helping to change the lives of the patients we serve. ■

For HCA UK, this is not only a strategic imperative; it’s also a philosophical one. Our ethos is that above all else, we are committed to the care and improvement of human life. We are diagnosing diseases earlier than ever before with state-of-the-art molecular genetic testing. We are halting the progression of Multiple Sclerosis with a ground-breaking stem cell transplant. We were the first private hospital group in the UK to perform a living donor auxiliary liver transplant.

Andrew Coombs is the Group Commercial Director at HCA Healthcare UK, part of HCA - the world’s largest provider of private healthcare. He is also the former Managing Director of AXA PPP International and Finance Director of AXA PPP Healthcare.

For more information, please email global@hcahealthcare.co.uk or visit www.hcahealthcare.co.uk References 1. Cooper, Terri et al, 2018 Global health care outlook: the evolution of smart healthcare, Deloitte, 2018 2. Briggs, Professor Timothy, Getting It Right First Time: Improving the Quality of Orthopaedic Care within the National Health Service in England, British Orthopaedic Association, 2012 3. Wennburg, John, Time to tackle unwarranted variations in practice, British Medical Journal, 2011 4. Cooper, Terri et al, ibid.

5. Timmins, Nicholas, Tackling variations in clinical care – assessing the Getting It Right First Time programme, The King’s Fund, 2017 6. Schneider, Eric, O’Sarnak, Dana et al, Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care, The Commonwealth Fund, 2017 7. Accurate as of October 2018. Source: www.cqc.org.uk

Preparing for surgery at The Princess Grace Hospital, one of the first private providers in the UK to offer radical prostatectomy procedures using the da Vinci surgical robot

INDUSTRY VOICE

TAKING RESPONSIBILITY IN A BROKEN SYSTEM Sigal Atzmon, CEO at Medix Global, discusses how healthcare companies are finding ways to create shared value

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ecent research1 in the US surveyed over 2,000 doctors about how much medical care they thought was unnecessary in their medical speciality.

The response from doctors showed that 20.6 per cent of overall medical care was unnecessary. Considering the various medical complications that can come from any form of treatment, these are alarming figures.

Current medical approaches are deeply flawed as there is a constant conflict between healthcare providers, payers and patients. With medical costs skyrocketing and patient satisfaction at an all-time low2, a different approach is clearly required. The imperative to improve quality and decrease cost in medical care is prompting stakeholders to focus on shared value-based care through a patient-centric approach.

This is part of a wider shared value movement that began from an article in the Harvard Business Review3; one that looks at the crucial connection between the economic competitiveness of businesses, communities and the eco-systems they operate in. Rather than being another form of corporate responsibility, the focus is on creating value. This value is then ‘shared’, creating a mutually beneficial arrangement for everyone in the system that meets both

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societal needs and those of businesses to remain profitable. This philosophy has become a driving force for businesses across a number of industries.

What does shared value in healthcare look like?

The shared value approach is the value found at the intersection between the healthcare provider, the payer and the patient. This intersection is where doctors reduce unnecessary overuse and misuse of medicine, and provide medical care according to evidencebased and international standards.

It is also where insurance companies keep their members' fees in check by not being required to reimburse medical institutions for unnecessary and invalid tests and procedures, and where the patients are guaranteed quality care and optimal outcomes. This intersection is also known as personal medical case management (PMCM).

PMCM providers assign a case management team comprised of a nurse and a specialist doctor. The case management doctor reviews the case and consults with a global network of specialists to get multiple opinions. The doctor is able ensure accessibility and implementation of quality medical care and reduce unnecessary overuse and misuse of medicine.

Once multidisciplinary consultations have been made, the case management doctor will explain the diagnosis in detail to the patient. The case management doctor will then recommend the most optimal treatment option and the leading treating specialist for that particular disease.

Building the future The evolution of healthcare services towards a shared value approach ensures the correct diagnosis and treatment while preventing unnecessary consultations, medications, treatments, procedures or surgeries, avoiding misuse and overuse while optimising healthcare outcomes.

The shared value approach lays the foundations to simultaneously provide patients with better medical outcomes and improved medical cost management for their insurers, thereby keeping insurance premiums sustainable. Only by sharing the value with payers, providers and patients is a future with affordable and accessible quality healthcare possible. ■ References 1 Lyu, H. et al. (2017). Overtreatment in the United States. Public Library of Science.

2 www.bmj.com/content/360/bmj.k943.full 3 https://hbr.org/2011/01/the-bigidea-creating-shared-value

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FEATURE

UNLOCKING A WORLD OF WELLBEING

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Anthony Harrington explores the importance of wellbeing policies for expats abroad

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oing abroad to work is an excellent way for most people to get outside their comfort zone. For some, this is an exciting and rewarding thing to do; there is a potent little saying, to the effect that ‘a comfort zone is a nice place, but nothing grows there’. However, more multi-national employers the world over are increasingly recognising that being an expat, particularly a first-time expat in a strange country, can be stressful and disorientating. Of course, the majority of companies who ask staff to go and work abroad will provide insurance and medical health cover for those staff. But many of the problems that expats face lie outside the world of work and occur in the individual’s private life.

Getting children settled in foreign schools is a challenge, for example. The language itself and unfamiliar foods, coupled with the challenge of finding out how to cope with an unfamiliar culture, can generate stress – and this is quite apart from the difficulties that can arise if

said. “What we find – and we have a great deal of experience to draw on in this area – is that moving abroad can be hugely stressful. People do it for a variety of reasons: for adventure, for financial gain, or to further their careers, but such a move can come at a high cost. What we are looking to do with our expat wellbeing policies is to make it easier for both the employer and the executive concerned.”

Expat mental health concerns The statistics on what could be loosely termed expat mental health concerns, more than bear out the idea that being parachuted into a foreign culture and society can be disorientating. Proper research on the topic is thin on the ground, but a 2011 study entitled The Mental Health Status of Expatriate versus U.S. Domestic Workers led by Sean Truman, Director of Clinical Services at the Truman Group, showed that expats are two and a half times more likely

it’s time to focus serious attention on the problem of expat mental health and to explore potential solutions the expat or family members are need medical treatment. For all these reasons, a growing number of insurance companies are adding employee wellbeing policies to their portfolio of corporate and private offerings. Victoria Zolkiewka at William Russell, which specialises in international health and insurance policies, points out that expat wellbeing policies are a core part of the company’s brand and product portfolio. “We believe that a wellbeing policy is just as important as a health policy. It is unarguable that a focused, healthy executive is going to perform a lot better for their organisation than one that is stressed out. So that makes expat wellbeing the company’s concern, even if the stress is coming from factors external to the work environment,” she

to suffer from depression than ‘local’ workers. Truman and his colleagues conducted a two-group study based on questionnaires designed to compare the mental health status of an expatriate population to a domestic, US, nonexpat population. Unsurprisingly, the study concluded that expat employees experienced a significantly higher range of risk for mental health and substance use disorders, than their US counterparts.

They were two and a half times more likely than executives in the ‘local’ group to report suffering from periods of high anxiety and depression.

Several mental health counsellors told researchers from William Russell that their experiences with expats more than bore this out. Chris >>

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Neill, based in Spain, said that rates of depression, or the feeling that life is meaningless, could be up to 50 per cent higher among expats.

Reports by expats of anxiety issues were also common, he said. “People with anxiety stop enjoying activities that used to give them pleasure. They don’t want to go out any more and they start ruminating on the past or worrying about the future.”

Zolkiewka points out that there are a number of areas outside of work that are often cited by expats as sources of deep concern. Worries over how the health systems work in the new country are high on the list of expat concerns, as are concerns over financial security, given that the expat is often a stranger in a land unknown to them and feels removed from all the usual support systems. This is precisely what expat wellbeing policies are – or should be – designed to address, she said. “Our wellbeing policies start with a basic package and there are a series of addon options that the employer or individual expat can take to provide additional protection,” Zolkiewka said. The younger demographic, moving abroad for the adventure or experience, tends to take the basic package. “Where people are, say, into their thirties or older, and are moving abroad with their family, they are much more concerned with adding in options that will future-proof their lifestyle choices and security. So they go in for higher levels of cover. Life protection becomes very important, as does income protection.

Counselling services for stress, anxiety and depression are also valued and are available as part of the insurance,” she added.

Life-changing illnesses One of the innovations the firm has introduced is a policy for expats designed to deal with life changing illnesses such as cancer. The policy can cover new innovative techniques such as the DNA testing of potential cancer tumors. “Our full cancer cover starts from tumor DNA mapping and covers the patient through all the treatments, including reconstructive surgery, if required,” Zolkiewka said.

She added that providing comprehensive health, financial and life cover can go a long way to removing potent sources of stress for expats.

Expat insurance specialist Aetna International recently produced its own white paper on expat mental health challenges and has designed expat wellbeing policies to provide cover across the areas highlighted in the paper. The paper cites the case of a US woman expat working in the Persian Gulf who took her own life in February last year. “Her fellow

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expats were shocked, in part because the woman had been ‘vivacious and full of life’, and in part because her death brought to mind their own struggles,” the paper notes. One of her colleagues, an expat from the UK noted on the company’s website: “It could have been me, just as it could have been one of many others I knew in the Gulf with untreated or improperly treated mental health issues.”

Aetna International Medical Director Dr Mitesh Patel said that in the company’s experience, for many expats, working in an unfamiliar context far removed from friends and family can be a recipe for disaster. “We believe that it’s time to focus serious attention on the problem of expat mental health and to explore potential solutions,” he said. Aetna conducted its own study, in 2017, of 500 US expats to gauge what they found most disturbing about being away from home. The overwhelming conclusion that came out of the study was that expats missed their support networks, friends and family, the most. “Not having those

support networks compounds stress and anxiety for expats abroad, so providing an all-embracing support network is one of the major things we try to build in to our expat wellbeing policies. This includes providing support to expats for whatever may crop up in their personal lives as well as work-related stresses,” Dr Patel said.

It is unarguable that a focused, healthy executive is going to perform a lot better for their organisation than one that is stressed out A preventative approach Dr Patel also said that he is a firm believer in employers taking a more preventative

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approach to expat stress, depression and anxiety risks by introducing third party provider solutions such as employee assistance programmes. “At best these not only tackle mental health concerns when they arise, but also encourage broader employee wellness. This helps by addressing issues before they escalate,” he commented. Where expats are relocating under their own initiative, they would be best advised to consider preparing for the challenges they may face and seeking support before and during their move.

“Increasing knowledge around mental health issues and the support available can change attitudes towards those with mental health, and the behaviour of those coping with issues,” he emphasised.

Aetna has an In Touch Care offering, which has been designed specifically to help in these instances. “We offer oneto-one support to vulnerable members and provide ongoing support, ensuring that wherever they are in the world they have quick and easy access to the help they need. Since this service launched for our Americas’ members, we have seen a decrease in mental health claims costs per member, suggesting that our support may have reduced the frequency of their visits to mental health treatment providers,” Dr Patel said. He explained that under Aetna employee assistance programmes, clients get telephonic support for workers for all manner of concerns, including life events like births and deaths. Under these schemes, employees get 24-hour access to counselors.

There is also a vHealth, or virtual healthcare service, which connects workers direct with specialists, either internationally, or back home. If you or a member of your family needs psychiatric counselling while working abroad, in, say, Japan, it is comforting to be able to talk to a psychiatrist that shares the same cultural values and knows where you are coming from on the issues that matter to you. Virtual counselling has some key benefits besides being in touch with a specialist from your own culture. Because it is virtual, there is no need to travel to the consultant’s offices and some clients may find it somewhat freeing not to be in the same locale as the counsellor. While this is still very much a niche optional offering, we may well be heading towards a near future where employers regularly provide this as a standard part of a wellness package for their employees, Patel suggested.

Crucial support The In Touch Care programme Aetna provides uses predictive analysis to find, engage and help members with chronic

conditions such as diabetes and chronic kidney disease. The programme then provides one-to-one nursing support

there is still a need for insurance companies offering wellbeing programmes to work harder at communicating just how important these programmes can be to individuals living abroad which includes looking at the individual’s support network, which will often include the employer. Steve Nyce, Senior Economist and Director of the Research and Innovation Centre at Willis Towers Watson pointed out that US companies

have tended to lead the way over the last two decades, in providing expat wellbeing policies for their staff serving abroad as well as for local staff. “The typical US company today offers nearly 15 different programmes to support the physical and emotional wellbeing of their employees,” he said. However, Nyce recommends that employers really look at the detail of what is on offer and put some time and effort into communicating the benefits of the programmes they choose to employees. Survey studies tend to show that fewer than one in three employees see their employer’s wellness programme as relevant to a healthy lifestyle and less than half think that these programmes meet their needs.

Clearly, there is still a need for insurance companies offering wellbeing programmes to work harder at communicating just how important these programmes can be to individuals living abroad. They can literally be the difference between life and death. ■

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FEATURE

TRAVELLING FOR TECH From advanced remote robotic surgery, gene-editing and cancer-killing nanobots to remote sepsis patient monitoring apps and blockchain enabled cancer screening, the future for medical technologies has never been brighter. Tatum Anderson reports

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A

lthough many of these technologies are in their infancy, innovative technologies are in great demand among international patients. Pete Read, CEO of strategic research and advisory firm Global Growth Markets, said: “In price-agnostic source markets such as China, the Middle East and Russia, accessing technology not available at home is typically the number two reason for travelling overseas for treatment – after gaining access to the latest drugs.”

Unsurprisingly, the US is seen as having the most advanced medical technology available to international patients, followed by the UK, Germany and Japan. Singapore is seen as the medtech gold standard within Southeast Asia, for patients from Indonesia and Malaysia, he added.

So, which technologies are patients travelling for? Establishing that is not as easy as it sounds said Josef Woodman of

Patient Beyond Borders: “There’s precious little formal research, so much will be anecdotal.”

It’s clear that patients travel for cancer treatments. The latest advances are cell-based therapies that use the body’s immune system to target cancer cells.

Chimeric Antigen Receptor T cells (CAR-T) are showing great promise in clinical trials for blood cancers such as leukemia and, increasingly, in solid tumors (breast, brain, dermatological), said Edwin McCarthy at City of Hope, California, US. “We are one of the handful of hospitals authorised to administer the first two therapies approved by the US Food and Drug.

Numerous other experimental trials are ongoing,” he said.

According to Jithu Jose, Head of International Business Division of the Middle East and South Asia for Apollo Hospitals Group, patients are travelling

for stereotactic radiosurgery or so-called gamma knife or CyberKnife technology, used for highly selective brain radiation therapy. It’s marketed as brain surgery without the knife – using a focused beam of gamma radiation on smaller tumours in the brain. It’s also offered by world-class providers such as London’s Great Ormond Street Hospital for Children and Tufts Medical Centre in Boston, US. But cancer patients are also travelling to India for other specialist innovations.

“We handle the highest Oncology inflow of medical travellers to South Asia right from bone marrow transplant (BMT) to Cyberknife,” Jose explained. Robotic surgery has been crucial too. Apollo was the first in India to use Mazor Robots for spine and Da Vinci Robots and its innovations have been driven from the top he said. “We are a three-decade old corporate entity. Our Chairman Dr >> Prathap C Reddy has reversed the

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FEATURE

brain drain of doctors from India to a great extent, by getting the best of technology, balancing cost factors and keeping up with globally competent clinical standards,” he said. “We introduced the first cyberknife in South Asia and soon we will commence the first Proton Beam Therapy Center in India.

Proton beam therapy Another popular innovation that patients are travelling for is proton beam therapy according to Patient Beyond Borders’ Woodman. “A high number of affluent Chinese lung cancer patients are flooding hospitals in the US, Korea and other destinations due to brutal air pollution in the major cities,” he said. Chinese paediatric patients are also receiving treatments at US hospitals. Many of them are travelling specifically for proton beam therapy, which uses beams of protons (sub-atomic particles) to destroy cancerous cells. It is sold as a treatment that will cause far less damage to surrounding tissue compared to conventional radiotherapy and is in demand for treating cancer in critical areas; such as brain tumours in young children, whose brains are still developing.

Florida-based UF Health Proton Therapy Institute was one of the first to adopt proton therapy in the US and reckons it is the largest paediatric proton therapy programme worldwide. It has even created a programme for Chinese paediatric patients who visit the US for treatment, including tele-consultations before and after treatment in Florida, Woodman

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said. In Europe, Germany has become a global centre for proton beam therapy in recent years, with hospitals such as the Friedrichshafen Clinic welcoming hundreds of patients from China, according to Global Growth Markets’ Read. Although not for long, it seems.

“More recently, as proton therapy technology has become more widespread in China and globally, demand from international patients is tailing off to some extent,” he said.

Telemedicine Telemedicine as a precursor to travel is growing enormously too, said Read.

“Many patients are starting off their journeys with a video or teleconsultation – either by video for diagnosis or for a second opinion with a foreign doctor – and then have follow-up consultations after procedures,” he said. Medical travel facilitators such as Concord CHC in Beijing link patients directly with the hospital. Shanghai startup MediStar Health connects cancer patients with foreign doctors via teleconference and translates records too.

Hospitals, including India’s Apollo Group, are providing large-scale telemedicine services to patients, and some, such as the Mayo Clinic, provide services to doctors that wish to consult with its specialists for medical opinions. The service is even text-based, to save a third of the time of face-to-face appointments and meetings do not have to be scheduled.

India’s Sri Ramakrishna hospital is participating in Tata Communications’s

new Gloheal telemedicine service to offer second opinions to rural patients.”

Interestingly, physicians based in Kenya and Rwanda, for example, can also access a diagnosis and a treatment plan. “We give these services at a very affordable cost and general practitioners in these regions use our services due to the nonavailability of certain specialities or due to logistics delays and costs incurred by the patient,” said V Ramakrishna, COO of SNR Sons Charitable Trust, which runs the hospital. “All our speciality doctors who are specialised in critical cases and surgeons use this facility and give second opinions. These opinions can also be given on hand-held devices, providing the correct bandwidth is available.” One great advantage of the system is that after the consultation they can either remain at home, or travel knowing that the hospital is familiar with their case. “Any patients travelling to our hospital are treated by the same doctor who has given the telemedicine opinion. Therefore, the patient saves hugely on costs for outpatient services,” he said.

Dentistry Some innovations by themselves will not encourage patients to travel. Patients are unlikely to be travelling because their medical records are eventually part of a blockchain. But they will, however, if technologies make travel more convenient.

Patient Beyond Borders’ Woodman said that dental clinics and dental departments of hospitals that serve international >> patients are increasingly deploying

FEATURE

World-class care. Here for you.

Our reputation for top quality health care and beautiful location on the Pacific Ocean attract patients from around the world. We offer multi-lingual concierge services to guide you on your journey, assisting you before your visit and during your treatment in San Diego, and coordinating follow-up with your doctor back home.

International patients benefit from our nationally ranked care in multiple medical and surgical specialties, including: >>

Cancer

>>

Neurology and neurosurgery

>>

Cardiology and heart surgery

>>

Orthopedics

>>

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Pulmonology

UC San Diego Health is known for outstanding, culturally competent patient care. Patients’ families also enjoy the cultural and recreational attractions that make San Diego a popular tourist destination, famous for its year-round mild climate.

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FEATURE CAD/CAM instrumentation, along with in-house laboratories, so they can competitively offer same-day treatments for crowns, veneers, implants and bridges, for example. “This allows travelling patients to save significantly on travel and accommodations costs due to multiple trips to a cross-border facility,” he said. 3D printing is enabling many of these dental services too.

3D printing This kind of personalisation is in great demand. Some hospitals are fitting custom-made 3D bone or joint implants, prosthetics and skin for burns victims.

But medical travellers are also accessing surgeons who are using 3D models on which they plan extremely complex surgical procedures. Paediatric surgeons at SickKids in Canada, say 3D models have become vital in the planning of intricate operations on tiny organs for example. “As personalised medicine takes a stronger footing (in large thanks to the advancements in medical tech), procedures and treatments will be increasingly individualised,” asserted Jordan Mills, CEO of MirrorMe3D, a specialist 3D printing company. “You see this happening at a micro-level with 3D printing of medication to individualise dosage levels up what we’re doing, which is helping surgeons with individualised planning for an aesthetic outcome.” Mills’ company works with cosmetic surgeons and reconstruction specialists to create life-sized 3D models of patients’ noses and faces, using scans or photos that are manipulated according to changes requested from their surgeon. Surgeons use models to plan cosmetic procedures, but also in consultation with patients.

“Doctors can obtain 3D models ahead of a virtual consult and use it to show the patient potential outcomes,” she said.

“Many patients want to see a 3D model of themselves and some feel it helps them better understand what types of changes to expect post-operatively. This makes the model an incredibly important communication tool and often helps patients and surgeons with setting more realistic expectations.”

Artificial intelligence Another technology that travellers may not specifically travel for, but innovators say may improve their chances, is AI. The hope is that it will be able to diagnose prostate, ovarian, lung and bowel cancer at an early stage and can reduce deaths.

Algorithms might detect pneumonia on a chest X-ray or identify a patient at risk of sepsis or acute kidney injury. They might

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Some hospitals are fitting custom-made 3D bone or joint implants, prosthetics and skin for burns victims. But medical travellers are also accessing surgeons who are using 3D models on which they plan extremely complex surgical procedures automatically generate a discharge letter that would usually be time consuming to write.

Today, Moorfields Eye Hospital is using AI to analyse retinal scans, University College London hospitals is utilising it in radiotherapy planning, and Imperial College London in mammography scans. They are collaborating with DeepMind Health, owned by Google’s parent Alphabet, on these projects. AI is also being used by hospitals to help doctors make clinical decisions based on the best available information by keeping up with the enormous scientific papers, guidelines and other important information for them. IBM’s Watson for Health technology – specifically Watson for Oncology (WFO) scours the cloud for medical journal peer-reviewed studies, case studies, newest clinical guidelines from around the world and process them, recommending personalised evidencebased treatments. The system has been used by Bumrungrad International Hospital (BIH) in Thailand, Icon Group in Australia, Grupo Angeles Servicios de Salud in Mexico, Mãe de Deus in Brazil, Taipei Medical University in Taiwan, and three South Korean hospitals.

Nan Chen, Senior Director of R&D and Clinical Data at BIH, has championed the technology. “WFO is one example of the key technologies that will help clinicians harness the increasing amounts of data that is becoming available as both medicine and treatment become more personalised for each individual patient,” he said. “As we treat more than half a million from over 190 countries each year, these technologies are increasingly important to provide the level of care that our patients have come to expect.”

He added that doctors, sometimes in locations where there are no oncologists – such as BIH-owned hospital in Mongolia – could use clinical WFO decisions confidently. In fact, last year, researchers from BIH and IBM Watson compared decisions made by WFO with oncology specialists at BIH’s Horizon cancer centre and found 81 per cent agreement on retrospective cases (70 per cent for breast, 56 per cent for cervical, 90 per cent for colon, and 94 per cent for rectal cancer for example).

Critics say, however, more independently verified proof that WFO works is required, and less US-focused treatment recommendations. BIH did not respond to requests for comment, although researchers said discordance was largely attributable to BIH oncologists’ preferences, including favouring non-US guidelines for certain cancers, patient preferences, including toxicity, cost and logistic concerns. “Other reasons for non-concordance included recommended US treatment options not available in Thailand,” they said.

It seems that as innovative technologies race ahead, the rules and public debates on when or whether they are appropriate trail along behind, as does the independent medical evidence establishing whether they work. AI has come in for criticism when it’s at odds with data protection rules. Many monitoring apps have not been peer-reviewed or approved by medical bodies such as the US FDA. And, said Woodman, stem cell applications continue to be oversold to patients everywhere.

NHS Choices, a UK science-based health information source, warns that not all overseas clinics providing proton beam therapy do so based on the best available evidence. “They heavily market their services to parents who are understandably desperate to get treatment for their children. Proton beam therapy can be very costly and it is not clear whether all children treated privately abroad are treated appropriately,” it said.

Whether patients travel for appropriate services, therefore, will be up to how much good-quality information, rather than hype, is available. ■

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YOUR ESSENTIAL GUIDE TO GLOBAL MEDICAL PROVIDERS

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Antwerp University Hospital (UZA)

BRAZIL

BS

Doctors Hospital

BELGIUM

INTERNATIONAL HOSPITALS DIRECTORY

CliniCassi Brasilia Norte CliniCassi Brasilia Sul

AZ Glorieux

Grupo de Apoio ao Adolescente e Crianca com Cancer - GRAACC

AZ Groeninge

Hospital 9 de Julho

AZ KLINA vzw

Hospital Alem†o Oswaldo Cruz

AZ Maria Middelares

Hospital Alvorada

AZ Monica

Hospital BP Mirante

Jan Yperman Hospital

Hospital Cardio Pulmonar

Onze Lieve Vrouw Ziekenhuis

Hospital Copa DêOR

sint-Jozefskliniek Izegem

Hospital de ClÍnicas de Porto Alegre

Universitair Ziekenhuis Brussel

Hospital Dona Helena

UPC KU Leuven (University Psychiatry Hospitals Leuven)

Hospital e Maternidade Santa Joana

Az Damiaan

Hospital Geral de Itapecerica da Serra - Seconci - SP OSS Hospital Infantil Sabarà

Gouwelozestraat 100, 8400 Oostende, BELGIUM

BRAZIL

tel: (+32) 59 41 40 40

Hospital Mãe de Deus Rua José de Alencar, 286 – Porto Alegre/RS BRAZIL

website: azdamiaan.be

Acreditar Oncologia S.A

tel: 0055 51 3230 2150

Acreditar Oncologia S.A. - Unidade Anchieta Acreditar Oncologia S.A. - Unidade PIO X

Hospital Marcelino Champagnat

Aeromil Taxi Aereo LTDA

Hospital Mater Dei Contorno

Americas Centro de Oncologia Integrado

Hospital Memorial Sao Jose Ltda

Amil Resgate Saude - Alphaville

Hospital Moinhos de Vento

Amil Total Care Cincinato Braga

Hospital Paulistano

Associacao do Sanatorio Sirio - Hospital do Coracao

Hospital Pro Matre Paulista

Brazil Hospital Sirio E. Libanes

Hospital Pro-Cardiaco

CCC Centro de Combate ao Cancer

Hospital Rios D’OR

CEHON - Centro de Hematologia e Oncologia da Bahia

Hospital Samaritano

Centro de Estudos da Saude do Trabalhador e Ecologia Humana

Hospital Santa Catarina

Clinica Odontologica Omint

Hospital Santa Joana Recife

28 IHHR

website: maededeus.com.br

Hospital Santa Paula

COLOMBIA

BRAZIL

INTERNATIONAL HOSPITALS DIRECTORY

Hospital TotalCor Instituto do Cancer do Estado de Sao Paulo

Cl’nica Universitaria Bolivariana Hospital General de Medellín Hospital Universitario de San Vicente Fundación

Hospital Pablo Tobón Uribe

Intensive Care Serviços M_dicos Hospitalares Nucleo de Oncologia da Bahia

Calle 78 B # 69 – 240 Medellín COLOMBIA

Oncocentro Oncologia Clinica e Medicina Interna de MG - S.A. Pronep Lar Internaç†o Domiciliar LTDA

tel: 0057 4 4459000

Pronep S†o Paulo Serviços Especializados Domiciliores Hospitalares Ltda Hospital Universitario San Ignacio

Rede D’OR Hospital e Maternidade Sao Luiz

MEDICOS Y AUDITORES SAS

S.O.S. Vida - Inovando em Saude

Centro M_dico Bournigal

Samaritano Botafogo Hospital SBIBAE - Programa Einstein na Comunidade de Paraisopolis Serviço de Referência Nacional em Filarioses - SRNF do Centro de Pesquisas...

Centro M_dico Punta Cana Grupo Rescue Hospital General de la Plaza de la SaludÊ Hospital Metropolitano de Santiago

Sociedade Beneficente Israelita Brasileira Albert Einstein - SBIBAE

La Unión Médica

Total Care AMIL - Botafogo

Adam International Hospital

EGYPT

Sociedade Beneficente de Senhoras Hospital Sirio-Libanes

Total Care AMIL Unidade Barra da Tijuca Total Care Unidade Jardins

As-Salam International Hospital Hassabo International Hospital

International Medical Center

City Clinic Varna BULGARIA

DOMINICAN REPUBLIC

Real Hospital Portugues de Beneficencia em Pernambuco

website: hptu.org.co

ACIBADEM City Clinic Tokuda Hospital EAD

Clinic Km 42,Cairo Ism. Desert Rd., Cairo Near To El Sherouk City, Gate 2 Cairo, EGYPT

bul. “Nikola Y. Vaptsarov” 516, 1407 Sofia, BULGARIA tel: (+359) 2/403 4000

website: tokudabolnica.bg

tel: (+20) 224 775 902

website: imc.org.eg/imc

Luxor International Hospital

Greenberg Medical Centre International Medical Center Vita Hospital

CO

Cl’nica El Rosario

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HONG KONG

GREECE

Sharm International Hospital

INDIA

EGYPT

INTERNATIONAL HOSPITALS DIRECTORY

AMC Aseel Hospital for Medical Care

Narayana Multispeciality Hospital, Jaipur

CrossBorderMedCare

National Institute of Ophthalmology

Rajagiri Hospital

Euromedica General Hospital of Rhodes

Matilda International Hospital

Chunangamvely Aluva – 683 112 Kerala, INDIA

41 Mount Kellett Road, The Peak, HONG KONG

tel: (+91) 484 66 55 000

website: matilda.org

Satguru Partap Singh Hospital

Apollo Gleneagles Hospitals, Kolkata

SevenHills Healthcare Private Limited

Apollo Hospital, Chennai

Sri Ramachandra Medical Centre

Apollo Hospital, Hyderabad

Wockhardt Hospitals Ltd Unit: Adams Wylie Memorial

Apollo Hospitals Enterprise Limited, Navi Mumbai

Awal Bros Hospital Batam

Apollo Hospitals International Limited

INDONESIA

INDIA

Narayana Hrudayalaya Pvt. Ltd.

Awal Bros Hospital Bekasi

Apollo Hospitals, Bangalore

Awal Bros Hospital Pekanbaru

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

Awal Bros Hospital Tangerang

Asian Heart Institute and Research Center Pvt Ltd

Dr Kariadi General Hospital

Aster Medcity

DR Sardjito Hospital

Care Institute of Medical Sciences

Dr. Mohammad Hoesin Hospital, Palembang

Columbia Asia Referral Hospital, Yeshwanthupur

Dr. Wahidin Sudirohusodo Hospital, Makassar

Continental Hospitals Limited, Hyderabad

Eka Hospital

Fortis Hospital Limited, Mulund

Eka Hospital Pekanbaru

Fortis Hospital, Bannerghatta Road

Fatmawati General Hospital

Fortis Hospital, Cunningham Road

National Cardiovascular Center Harapan Kita

Fortis Hospital, Mohali

RS Pondok Indah - Puri Indah

Indraprastha Apollo Hospitals

RS Pondok Indah - Pondok Indah

Maharaja Agrasen Hospital, Punjabi Bagh

RS Premier Bintaro

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

RS Premier Surabaya - PT Affinity Health Indonesia

Medanta - The Medicity

RSUP Dr. Hasan Sadikin Bandung

Moolchand Hospital

RSUP Sanglah

30 IHHR

website: rajagirihospital.com

RSUPN Dr. Cipto Mangunkusumo Rumah Salit Pusat Angkatan Darat (RSPAD) Gatot Soebroto

ISRAEL

INDONESIA

INTERNATIONAL HOSPITALS DIRECTORY

Tel Aviv Medical Center The Baruch Padeh Medical Center Poriya

Siloam Hospital Bali

The Chaim Sheba Medical Center

Siloam Hospitals Kebon Jeruk

The Jerusalem Princess Basma Centre

Siloam Hospitals Lippo Village

The Lady Davis Carmel Medical Center ITALY

BIMC

Centro Chirurgico Toscano Srl

BIMC Hospital Kuta

Via dei Lecci, 22 52100 Arezzo ITALY

Assuta Hospital Tel Aviv

tel: (+39) 0575 3335

Augusta Victoria Hospital Barzilai Medical Center

Fondazione Poliambulanza

Edith Wolfson Medical Center

IRCCS Centro San Giovanni di Dio Fatebenefratelli

Elisha Hospital

Universita Campus Bio-Medico di Roma

Galilee Medical Center

UPMC San Pietro FBF - Advanced Radiotherapy Center MALAYSIA

Hillel Yaffe Medical Center Kaplan Medical Center

website: centrochirurgicotoscano.it

Gleneagles Penang (Pulau Pinang Clinic Sdn. Bhd.) 1, Jalan Pangkor 10050 Penang, MALAYSIA

Loewenstein Hospital Rehabilitation Center Mayney Hayeshua Medical Center

tel: (+604) 2229 111

Meir Medical Center - Clalit Health Services

website: gleneagles-penang.com

Pantai Hospital Penang

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

Prince Court Medical Centre

39 Jabotinsky St., Petah Tikva ISRAEL tel: (+972) 3 937 6363 Rambam Health Care Campus

The Tun Hussein Onn National Eye Hospital

website: clalit.co.il

MEXICO

ISRAEL

Fullerton Health Indonesia

Centro Oncologico de Chihuahua Clinica Cumbres Chihuahua Global Doctors International Medical Clinic

Red Crescent Hospital Jerusalem Schneider Children’s Medical Center of Israel Shaare Zedek Medical Center Soroka Medical Center

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Calle Adolfo Rosado Salas No 999 entre 85 av y 85 av .bis, C.P. 77670 Cozumel, Q.Roo, MEXICO tel: +52 (987) 869 55 55

NL

Hospital Amerimed Cozumel Islamed Sa De Cv

VieCuri Medisch Centrum

PORTUGAL

MEXICO

INTERNATIONAL HOSPITALS DIRECTORY

Centro Hospitalar Cova da Beira, E.P.E.

Escala Vila Franca - Sociedade Gestora do Estabelecimento, S.A.

website: amerimedcozumel.com

Hospital Beatriz Angelo - SGHL

Hospital CMQ

Hospital da Senhora da Oliveira - Guimaraes EPE

Hospital de Especialidades (Baja Medical Response)

Hospital de Cascais Dr. Jose de Almeida

Hospital Galenia

Hospital Lusiadas Lisboa

Hospital Mexico

Hospital Lusiadas Porto

M_dica Sur S.A.B. de C.V.

Hospital Sao Goncalo de Lagos - Aljezur

Obesity Control Center (Cyntar SC)

Hospital Sao Goncalo de Lagos - Odemira

Salud Digna Para Todos I.A.P.

Hospital Sao Goncalo de Lagos - SÜo TeotÑnio

Luz Saúde SA

Grand Med hospital

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

Intermed Hospital

tel: (+976) 7701 11 11

website: intermed.mn

SOS Medica Mongolia UB International Clinic

tel: +351 213 138 260 RU

United Famili Intermed Hospital Chinggis Avenue 41, Khan-Uul District 15, Uildver 17040, Ulaanbaatar, MONGOLIA

Euromed Clinic

SINGAPORE

MONGOLIA

Tropicana Medical Centre

NETHERLANDS

Centro Hospitalar de Leiria, E.P.E.

Fullerton Healthcare @ Ocean Financial Centre

website: www.luzsaude.pt

Gleneagles Hospital - Parkway Hospitals Singapore Pte Ltd (Network)

UB Songdo Hospital

Infectious Disease Partners Pte Ltd (Farrer Park Medical Centre)

Acibadem International Medical Center

Infectious Disease Partners Pte Ltd (Mount Elizabeth Novena Specialist Centre)

Amphia Ziekenhuis

Institute of Mental Health

International Health Center The Hague

KK Women’s and Children’s Hospital

Isala

Mount Elizabeth Hospital - Parkway Hospitals Singapore Pte Ltd (Network)

Groteweg 5, 8191 JS Wapenveld, NETHERLANDS tel: (+31) 38 424 50 00 SGE International Healthcare Services

32 IHHR

website: isala.nl

National Cancer Centre of Singapore Pte Ltd National Healthcare Group Polyclinics National Heart Centre Singapore National Skin Centre National University Hospital

Parkway East Hospital - Parkway Hospitals Singapore Pte Ltd (Network) Raffles Hospital

TURKEY

SINGAPORE

INTERNATIONAL HOSPITALS DIRECTORY

Acıbadem Healthcare Group Fahrettin Kerim Gökay Cad. No:49 34662 Altunizade İstanbul, TURKEY

Singapore General Hospital (SGH) SingHealth Polyclinics

tel: +90 530 976 8398

SPAIN

Tan Tock Seng Hospital

Hospital Clinica Biblica

Anatolia Hospital AVENIDA 14, CALLE 1 Y CENTRAL, SAN JOSÉ, SPAIN

tel: 506 2522 1000

Caybasi Mh 1352 Sk No 12 , 07100 Antalya, TURKEY

website: clinicabiblica.com

tel: +90 242 249 33 00

Best Doctors

tel: +34 91 308 56 22

Istanbul Florence Nightingale Hastanesi A._.

Medipol Mega Hospitals Complex Memorial Ankara Hospital

Özel Medicabil Hastanesi

website: bestdoctors.com/spain

Medical Response International

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

Quironsalud Hospitales USP Hospital de Marbella

tel: (+90) 444 8 112

Hospital Clinica Benidorm UAE

Hospitales San Roque Maspalomas

THAILAND

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

Vejthani Hospital

website: medicabil.com

Al Amana Home Health Care LLC

Belhoul European Hospital

Vithas Xanit International Hopsital

Samitivej Sukhumvit Hospital

website: anatoliahospital.com

Gayrettepe Florence Nightingale Hastanesi

C/ Almagro, 36 1ª planta 28010 Madrid SPAIN

Bumrungrad International Hospital

website: acibademinternational.com

PO Box : 4674, Dubai, UAE tel: (+971) 4 345 4000

website: belhouleuropean.com

website: bangkokhospital.com

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Sharjah International Holistic Health Center

USA

UAE

INTERNATIONAL HOSPITALS DIRECTORY

Broward Health International

Sheikh Khalifa General Hospital

1608 SE 3rd Avenue, Ste 503-B, Ft Lauderdale, FL 33316, USA

Sunny Specialty Medical Centre Tawam Hospital

tel: +1 954 767 5587

UK

Thumbay Hospital Umm AlQaiwain - Primary Healthcare Centers in Umm Al Quwain-Ministr...

Bumrungrad International

Universal Hospital LLC - Abu Dhabi

Cancer Treatment Centers of America

University Hospital Sharjah

Children’s Health (Dallas)

York Diagnostic Laboratories, JLT

Children’s Hospital Colorado

HCA Healthcare

Children’s Hospital Los Angeles

242 Marylebone Road, London, NW1 6JL, UK tel: +44 (0)20 37335966

website: www.hcahealthcare.co.uk

Imperial Private Healthcare

email: Sbaig@browardhealth.org

Children’s Hospital of Philadelphia, The Children’s Mercy Hospital Children’s National Medical Center Cincinnati Children’s Hospital Medical Center City of Hope Cleveland Clinic

Various locations across Central and North West London UK tel: +44 (0)20 33117700

website: imperialprivatehealthcare.co.uk

Queen Square Hospital

tel: +44 (0)20 34488948 website: www.qsprivatehealthcare.com

USA

Duke Medicine Global Emory Clinic Florida Hospital

8-11 Queen Square, London, WC1N 3AR, UK

Ann & Robert H. Lurie ChildrenÕs Hospital of Chicago Atrium Health Baptist Health International Baylor St Lukes Medical Centre Boston Childrens Hospital Brigham and Women’s Hospital (Partners HealthCare International)

34 IHHR

Cook Children’s Health System

Flywire Health Brand Group Hospital for Special Surgery Houston Methodist Global Indiana University Health

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

website: jmhi.org

James Cancer Hospital (OSU), The

USA

USA

INTERNATIONAL HOSPITALS DIRECTORY

Sharp Global Patient Services

Johns Hopkins Medicine International

8695 Spectrum Center Blvd., San Diego, CA 92123, USA

Kennedy Krieger Institute Lahey Hospital & Medical Center

tel: +1 888 265 1513

Massachusetts General Hospital (Partners HealthCare International)

website: sharp.com

Mayo Clinic

St. Joseph’s Hospital and Medical Center/Barrow Neurological Institute

Medstar Georgetown University Hospital

Stanford Health Care

Memorial Hermann-Texas Medical Center and TIRR Memorial Hermann

Texas Children’s Hospital

Memorial Sloan-Kettering Cancer Center

UC San Diego Health System International Patient Program

Minnesota International Medicine

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

Moffitt Cancer Center Mount Sinai Medical Center

tel: +1 619 471 0466

Navigant Consulting Nemours Children’s Health System

Uchicago Medicine

Northwell Health

UCLA Health

Northwestern Medicine

UCSF Medical Center

NYU Langone Health

University Health System (San Antonio)

Ochsner Health System

University of Cincinnati Cancer Institute

Ohio State Uni Comprehensive Cancer Centre

University of Colorado Health

Penn Global Medicine

University of Michigan Health System

3400 Spruce Street Philadelphia PA 19104 USA website: pennmedicine.org Philadelphia International Medicine

website: health.ucsd.edu/internation

University of Pennsylvania Health System University of Southern California UPMC USCSF Health Yale International Medicine Program

Princeton HealthCare System Roswell Park Cancer Institute Rush University Medical Center Scripps Health

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