Medical Tourism Magazine | Issue 20 | International First by MT Association

Y o u r

G u i d e

t o

I n t e r n a t i o n a l

M e d i c i n e

Medical Tourism ISSUE 20

International Groundbreaking Medical Discoveries Pg 9

Healthcare in China~ A Trip to the Orient Pg 50

Adapting To Changes in the Medical Tourism Market Pg 34

Medical Malpractice in the Realm of Medical Tourism Pg 58 ÂŠ Copyright Medical Tourism Association

April / May 2011

THESE HOSPITALS ARE AMONG

THE BEST

INTERNATIONAL

HOSPITALS

ALL HOSPITALS ARE MEMBERS OF THE MTA

IN THE WORLD

AFRICA

THE NAIROBI HOSPITAL www.nairobihospital.org

BAHAMAS

ISRAEL

ASSAF HAROFEH MEDICAL CENTER www.assafh.org

JORDAN

DOCTORS HOSPITAL www.doctorshosp.com

JORDAN HOSPITAL www.jordan-hospital.com

BRAZIL

THE SPECIALTY HOSPITAL www.specialty-hospital.com

HOSPITAL ALEMAO OSWALDO CRUZ www.hospitalalemao.org.br

CHINA

BEIJING UNITED HOSPITALS & CLINICS www.ufh.com.cn

COLOMBIA

CLUSTER DE SERVICIOS DE MEDICINA Y ODONTOLOGIA MEDICAL AND DENTAL SERVICES CLUSTER www.medellinhealthcity.com

COSTA RICA

HOSPITAL CLINICA BIBLICA www.hcbinternational.com

ECUADOR

MALAYSIA

PRINCE COURT MEDICAL CENTRE SDN. BHD. www.princecourt.com

MEXICO

ALMATER HOSPITAL http://www.almater.com

MEDICA SUR S.A.B DE C.V www.medicaltourismmexico.com.mx

PANAMA

HOSPITAL PUNTA PACIFICA www.hospitalpuntapacifica.com

SOUTH KOREA

CONCLINA C.A. HOSPITAL METROPOLITANO www.hospitalmetropolitano.org

SEOUL WOORIDUL SPINE HOSPITAL www.wooridul.com

GUATEMALA

SEVERANCE HOSPITAL YONSEI UNIVERSITY HEALTH SYSTEM http://www.yuhs.or.kr/en

INDIA

SHUANG HO HOSPITAL http://shh.tmu.edu.tw/

GUATEMALA HEALTH & WELLNESS TOURISM COMMISSION, AGEXPORT www.healthwellnessguatemala.com MOOLCHAND HEALTHCARE GROUP www.moolchandhealthcare.com MEDANTA – THE MEDICITY www.medanta.org NARAYANA HRUDAYALAYA www.narayanahospitals.com SEVENHILLS HOSPITAL www.sevenhillshospital.com

April / May 2011

www.bumrungrad.com BANGKOK HOSPITAL MEDICAL CENTER www.bangkokhospital.com

UNITED ARAB EMIRATES

AMERICAN HOSPITAL DUBAI www.ahdubai.com GMC HOSPITAL www.gmchospital.com

UNITED STATES

BAPTIST HOSPITAL www.baptisthealth.net

HCA EAST FLORIDA DIVISION www.saludinternacional.com JACKSON MEMORIAL HOSPITAL INTERNATIONAL www.jmhi.org

VIETNAM

FV HOSPITAL – FAR EAST VIETNAM LIMITED www.fvhospital.com

TAIWAN

TAIPEI MEDICAL UNIVERSITY HOSPITAL http://tmuh.tmu.edu.tw/ WAN FANG HOSPITAL http://wfh.tmu.edu.tw/

THAILAND

BUMRUNGRAD INTERNATIONAL

Editorial

BACK TO WHERE

IT ALL BEGAN

Rappelling at Pacuare Lodge Costa Rica 2011

n May 2007, a little idea turned into a big reality when the Medical Tourism Association was started. Founded on a notion of need for direction and collaboration, the trade association was brought to life with new and innovative means of bringing stakeholders together to collaborate on industry trends and requirements for strong growth in the future. The first of such projects was the creation of Medical Tourism Magazine, with its first release in December 2007. As subject matter for that issue, I took a trip to Costa Rica to see what all the hype was about this country so well known for dentistry and cosmetic procedures. You may remember my summary of the healthcare and tourism experienced during the trip in Issue One. (See http://www.medicaltourismmag.com/ article/costa-rica-big-trip-little-country.html ) How things have changed since that time. Costa Rica now is very well known for orthopedics, spinal surgeries, bariatric procedures and cardiology. A healthcare cluster called ProMed was developed to bring the stakeholders together and to work collaboratively to establish high quality certification criteria for its members. At the conference during the first week of May 2011, much was said about the development of healthcare clusters around the globe. I presented case studies of Jordan, Korea, Singapore and Thailand and representatives from Colombia, Argentina and Panama added theirs to provide a good feel for where the market started in those regions to where it is today. In this issue of Medical Tourism Magazine, we have brought to light many other beginnings, which we have called “International Firsts.” Our intention is to raise awareness of some of the top international state of the art procedures which were performed across the globe and likely are unfamiliar to

Rappelling at Pacuare Lodge Costa Rica 2007

you. We may know these procedures exist, but where did they begin? How were they developed? By whom? Just as the Medical Tourism Association was the first international trade association for the medical tourism industry, we are seeing more and more groups of stakeholders working together for the first time, putting their competition aside for a common goal. We see public and private sector working together in some cases for the first time as well. In the upcoming issues of Medical Tourism Magazine, we will be featuring a new healthcare cluster case study where one message, one voice serves the interests of the masses. Feel free to provide us with updates.

Renée-Marie Stephano

Renee-Marie Stephano is the President of the Medical Tourism Association™ . Ms. Stephano is also the Editor-in-Chief of the Medical Tourism Magazine, Health Tourism Magazine and Healthcare Development Magazine. Having a background in international marketing and relations, health law and litigation, she provides a valuable service to the Medical Tourism Association™ in these fields. Ms. Stephano speaks regularly at international healthcare conferences on the Legal Issues Surrounding Medical Tourism and in the United States to employer groups, insurance groups and physician associations. Renee-Marie consults international government ministries, private sector organizations and NGO’s about the growth of the global healthcare industry and accreditation, providing marketing assistance to promote their countries high quality of care. Ms. Stephano works with governments and healthcare clusters in the development of their Medical Tourism Initiatives. Ms. Stephano recently is the co-author of three books : “Developing an International Patient Center: A Guide to Creating the Best Patient Experience”, the book “The Medical Tourism Facilitator: A Best Practices Guide to Healthcare Facilitation for International Patients” and the book: “Medical Tourism ~ An International Healthcare Guide For Insurers, Employers and Governments.” Ms. Stephano can be reached at Renee@MedicalTourismAssociation.com

April / May 2011

Massimo Manzi, Director of Promed and Jorge Osorno, MTA

Bill Cook, Hospital Clinica Biblica; Jorge Osorno, MTA; Jerad Portner, Groupo Do It

Costa Rica Snapshot s

Eric DeYcaza, Ageless Wonders Panama and Jorge Osorno, MTA 4

April / May 2011

Renée-Marie Stephano, President MTA © Copyright Medical Tourism Association

MEDICAL TOURISM

EDITOR-IN-CHIEF & PUBLISHER

Renée-Marie Stephano, Esq.

ASSOCIATE EDITORS

Jonathan S. Edelheit Gabriella Vicuña Olivia Goodwin

ONLINE MAGAZINE EDITOR

Marinés Mazzari

REGULAR AUTHORS

Renée-Marie Stephano, Esq. Jonathan S. Edelheit Bill Cook Dan Cormany Dr. Prem Jagyasi Gabriella Vicuña Michael Bina

CONTRIBUTING AUTHORS

Daniela Abratt Olivia Goodwin John R. Reeves III Pramod Goel Dr. Michael Sigler Sandra Corbin Dr. Kanti Daya Alex Lifschitz Cagri Kanver Ernie Lehmann MedTravel Ecuador Tony Ryzinski Chad Holloway Junhui Yan Johnson Daniel Mueller

ART DIRECTOR

Renée-Marie Stephano, Esq.

ART DEPARTMENT

Dinier Quirós

MAIN OFFICES

10130 Northlake Blvd. Suite 214-315 West Palm Beach, Florida 33412 USA Tel:561-791-2000 Fax: 866-756-0811 info@MedicalTourismMag.com www.MedicalTourismMag.com

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April/May 2011

Medical Tourism AT A GLANCE

Editorial

Back to Where it All Began

In May 2007, a little idea turned into a big reality when the Medical Tourism Association was started. Founded on a notion of need for direction and collaboration, the trade association was brought to life with new and innovative means of bringing stakeholders together to collaborate on industry trends and requirements for strong growth in the future.

BY RENÉE-MARIE STEPHANO

Features

International Firsts ~ Groundbreaking Medical Discoveries

Healthcare in China ~ A Trip to the Orient

The progression of technology and medical discoveries is astounding. Doctors, physicists, scientists and engineers across the globe have brought fame to their countries for their contributions to the medical field, whether discovering the vaccine for a disease, creating lifesaving equipment or performing a first-of-its-kind surgery.

BY DANIELA ABRATT

Economics

Is Preventative Care the Answer to Reducing Health Care Costs in America?

Chronic illnesses and preventable diseases currently make up about three-fourths of the overall burden of healthcare costs. This is a staggering statistic simply because chronic and preventable diseases are just that – preventable. The goal of this article is to prove that there is indeed a connection between reduced medical costs and a healthy lifestyle, and that in much the same way that public awareness has brought down the teenage pregnancy rate for the first time in decades, such is possible for chronic disease prevention as well.

Medical Tourism: Improving the Standards of Global Health Care

BY JOHN R REEVES III

News and Insights

Adapting To Changes in the Medical Tourism Market

BY PRAMOD GOEL

Medical Malpractice in the Realm of Medical Tourism

Medical malpractice causes enough confusion for doctors, lawyers and patients when it occurs locally. However, when brought into the larger sense of international travel, it can be even more difficult to understand and manage.

BY DR. PREM JAGYASI

April / May 2011

Nailing down the PERFECT healthcare system is a challenge every country faces; perfect may never be possible, but hopefully a system that works for the majority of people will be in the near future, on a global basis. With a booming 1.3 billion population China has modernized education and housing for all of those people, unfortunately healthcare hasn’t been able to keep pace with those developments. There have always been issues with quality and availability of healthcare, now due to China growing richer and becoming more and more modern the population are coming in contact with more diseases and heading towards a system that can’t currently support it. BY RENÉE-MARIE STEPHANO AND OLIVIA GOODWIN

T hese high costs are driving many patients to visit developing countries in order to obtain medical care. This sale of advanced care to foreign visitors has come to be known as medical tourism, an economic movement that has cleverly combined the two gigantic industries of tourism and medicine. Countries across the globe are jumping on the medical tourism bandwagon and putting more focus on delivering stellar care and a more positive experience for the patient.

BY DR. MICHAEL SIGLER

Medical Tourism in Barbados

Technological advances, doctor training and standards of healthcare in small-island, developing states such as Barbados are encouraging more and more people from Europe and America to pursue medical tourism as the solution to their healthcare needs. Many are frustrated with the high costs of healthcare and long wait periods for the majority of procedures in their domicile.

BY SANDRA CORBIN

TeleHealth ~ The Way of the Future

Despite a competitive global marketplace, Telehealth fosters cooperation and medical codependency for patientcentered programming as a novel necessity and viable commodity for medical tourism. Telehealth is already making great strides due to its ability to create easyto- use systems that lower costs, communicate globally, integrate traditional and modern treatments, coordinate all information into a “cloud” database, enhance privacy and security, provide overall convenience and provide treatment to and information from anywhere in the world.

BY DR. KANTI DAYA

April/May 2011

Medical Tourism AT A GLANCE

Brazil and Healthcare Globalization

With a population reaching 200 million and an active internal consumer market of over 110 million (and growing), Brazil has many things going its way: stable and sustained growth of the economy, political stability and ample availability of investment capital. Another important aspect that allowed this considerable development (in times of world economic crises) was the recognition by Brazilian business leaders and government officials that technologies were transforming and would affect the business world.

BY ALEX LIFSCHITZ

Technology Improves Cancer Cure Rate on a Global Basis

In the past doctors didn’t know if the tumor had shifted or grown because they didn’t have the ability to X-ray the tumor prior to treatment. “We were semi-blind in delivering this treatment,” said Dr. Alvaro Martinez, Chairman of Radiation Oncology for Beaumont Hospitals and the initial inventor of the Omnibeam. “Now we can have the “target of the day”, the spatial position of the tumor and surrounding normal tissue, every tumor has normal tissue,” he adds.

BY OLIVIA GOODWIN

Barcelona ~ Avant-Garde of Culture, Art, and Medicine

Featuring a lyrical backdrop of rustic-modern European architecture, the melodic sounds of the Spanish guitar, and 2010 World Cup Soccer Champions, the Catalan capital of Barcelona on the Mediterranean Sea, possesses a rich heritage and ambiance. Home of the world’s first full face transplant, technological advancement and innovative research is a resounding theme within healthcare in Barcelona.

BY GABRIELLA VICUÑA

The Efficacy and Utility of Online Education for Continuing Medical Education

In today’s healthcare environment, continuous professional development (CPD) is a must for medical professionals and those supporting the healthcare enterprise, such as hospital administrators and medical travel facilitators. It is more important now than ever, to focus on “continuous” development because of the rapid cycles of global discovery, improvement, and creation in both the clinical and administrative realms of healthcare.

BY CHAD D. HOLLOWAY, JUNHUI (GRACE) YAN JOHNSON AND DANIEL MUELLER

Electronic Health Records Survey Synopsis

The CDC’s National Center for Health Statistics estimates that more than half of office-based physicians have adopted a basic EHR, while just over 10 percent have adopted a fully functional system. As adoption of advanced health information technologies increases, EHR systems will impact patients and physicians alike. With this in mind, a survey was conducted with both patients and physicians to determine attitudes about the adoption of EHR.

BY TONY RYZINSKI

Networking for the Conference

The MTA has realized the importance of implying a user friendly and effective networking software, this is the reason why this year the conference will be imple¬menting an exclusive software program that will allow attendees to pick and choose who they would like to pre-schedule a meeting with. Some of the new and improved features include an attendee directory with photos bios that allows each participant to upload their photo, add their interests, include a bio and add “tags” so that people may find easier.

BY MEDICAL TOURISM ASSOCIATION

University of Richmond Partners with MTAEarning a Medical Tourism Certification

Insurance company, facilitator, broker, travel agency or hospital: no matter who you are working for, medical tourism is thriving. To enhance education on medical tourism all over the world, the Medical Tourism Association and the University of Richmond, VA, have launched a Medical Tourism Certification program. The University of Richmond’s School of Continuing Studies will work in partnership with the MTA in creating a curriculum and selecting instructors.

Sustainability

Healthcares Dual Demands Fiscal Responsibility and Quality Care

The US healthcare system consumes approximately 32 billion gallons of water and $6.5 billion in energy per year while producing 2 million tons of waste. Every day that a healthcare provider burns more energy, uses more water and creates more waste than it requires is another day of pouring both money and resources down the drain. Every unit of energy, water, and waste processing is purchased at the expense of an investment directly enhancing the quality of patient care.

BY CAGRI KANVER

Q &A

Buyers of Healthcare & their Growth in the Industry Q &A with Brad Cook

It was estimated that in 2010 over 6 million Americans would travel abroad for healthcare. Costa Rica has become a large part in the development of medical tourism. Brad Cook, Director, International Department, for Hospital Clínica Bíblica, a JCI accredited hospital in Costa Rica, shares his thoughts on the growth of the industry.

BY MEDICAL TOURISM ASSOCIATION

April / May 2011

ÂŠ Copyright Medical Tourism Association

MEDICAL TOURISM

International ~

Firsts Groundbreaking

Medical Discoveries

By DANIELA ABRATT Are you afraid to go to the doctor? If you’re scared today, imagine seeing a physician 300 years ago. Now the drill guns and needles don’t seem as frightening, right? The progression of technology and medical discoveries is astounding. When we see a stethoscope or have an eye exam, we tend to forget they took years to develop, as did everything else in the health field. So where were these scientific breakthroughs made?

octors, physicists, scientists and engineers across the globe have brought fame to their countries for their contributions to the medical field, whether discovering the vaccine for a disease, creating lifesaving equipment or performing a first-of-its-kind surgery. Let’s explore the achievements in various regions of the world.

of numerous medical discoveries and inventions. Australia made the history books in 1926 when Dr. Mark Lidwell created the first electronic pacemaker, which was then used to revive a stillborn infant at the Crown Street Women’s Hospital in Sydney.

The 1930s saw a breakthrough in eye surgery. Dr. Svyatoslav Fyodorov successfully applied the idea of refractive surgery and perfected radial keratotomy, a procedure which corrects nearsightedness. The Russian doctor later developed the surgery for myopia. In 1989, Dr. Ioannis Pallikaris performed the first LASIK surgery in Greece.

Australian nurse Elizabeth Kenny stirred controversy in the 1930s after using a radical method to treat children with polio. This method later became internationally acclaimed and is now known as physiotherapy. Later, in 1948, Melbourne psychiatrist John Cade discovered the value of using lithium carbonate (usually just called lithium) to treat bipolar disorder and similar conditions.

The land “down under” is most commonly known for kangaroos, the outback and the Great Barrier Reef. But this home of beach-loving beauties and koala bears is also the site

The cochlear implant was also developed in Australia. Led by Professor Graeme Clark, a team from the University of Melbourne invented the device, and the first person received

April / May 2011

MEDICAL TOURISM the implant in 1978 at the Royal Victorian Eye and Ear Hospital. The “bionic ear” reestablishes a sense of sound to the profoundly deaf or severely hard of hearing. Think back to your teen years. Did you have braces? Well you can blame your discomfort and straight teeth on Percy Begg, the Adelaide native who, in the 1940s and 1950s, modernized an expensive and painful orthodontic system into the one we use today. Australia is also known for its microsurgery thanks to the work of surgeon Earl Owens. A graduate of the University of Sydney, Owens pioneered the use of microsurgery, surgery performed under powerful microscopes which enables the surgeon to rejoin the finest capillaries, facilitating the reattachment of amputated limbs and the reversal of vasectomies, among other functions. In 1968, Owens used microsurgery to reattach a finger of a two-year-old child in Sydney, the first operation of its kind in the world. In the 1990s, researchers from the University of Queensland led by Professor Ian Frazer developed the world’s first vaccine to prevent cervical cancer. The vaccine attacks the human papillomavirus known to cause cervical, vaginal and vulvar cancers. It was approved for use in the United States in 2006 and released to the market under the name Gardasil.

Europe was the birthplace of a myriad of medical innovations. One of Germany’s earlier medical advances occurred in 1890 when Emil von Behring discovered the vaccine for diphtheria, an acute infectious disease which affects the respiratory tract and subsequently other organs as the bacteria spreads through the bloodstream. Because of the widespread distribution and use of the vaccine, diphtheria is now a rare occurrence throughout the world. As of 2010, there were fewer than five cases a year in the United States.

Owens pioneered the use of microsurgery, surgery performed under powerful microscopes which enables the surgeon to rejoin the finest capillaries. Just five years after the vaccine was created, Wilhelm Konrad von Roentgen developed the X-ray. The physicist described this new type of radiation as one that enabled the imaging of objects hidden by dense materials. After taking images of his own skeleton, he called it “X-radiation” because so little was known about it at that time. Germany is also the site of perhaps one of the most profound and fascinating medical progressions in modern times. In 2010, Timothy Ray Brown, an American-born Berlin citizen living with HIV and leukemia, was diagnosed as HIVfree. His treatment began in Berlin in 2007 when he received a transplant of HIV-resistant stem cells in treatment of his acute myeloid leukemia. Dr. Gero Huetter, of the University Medicine Berlin, thought this treatment would best tackle both the HIV and the cancer. He and his team suspected that the HIV stored in his cells might begin to replicate after his immune system recovered from the stem cell transplantation, but this was not the case. Prior to the transplantation, the “Berlin Patient,” as Brown became known, underwent intensive chemotherapy and radiation to kill all his immune defense cells. The day of the transplant, he stopped taking his antiretroviral drugs. About 13 months after the surgery, his cancer relapsed, and he began a second round of chemotherapy followed by another transplant of HIV-resistant stem cells. This led to complete remission of his cancer. About three and a half years after the initial transplantation, Brown’s blood cells and plasma showed no evidence of HIV. Another country with a variety of medical claims to fame is France. In 1816, René Laennec invented perhaps one of most recognizable and widely known pieces of medical equipment: the stethoscope. The subsequent decades followed with the discoveries of a number of vaccines. Louis Pasteur developed two vaccines, the first in 1881 for anthrax and the second in 1882 for rabies. In 1896, André Chantemesse developed one for typhoid fever, and in 1927, bacteriologist Albert Calmette and veterinarian Charles Guerin developed one for tuberculosis. France also paved the way for a series of nontraditional transplants, performing the world’s first successful hand transplant on Sept. 23, 1998. Clint Hallam, of Perth, Australia, received a new right hand a few years after his was amputated in a sawing accident in a New Zealand prison where he was being held on a fraud conviction. Dr. Jean-Michel Dubernard led a team of international physicians in the 13-hour surgery in Lyon. The operation was successful, but Hallam did not

April / May 2011

properly follow his post-operative immunosuppressive and physical therapy regimen, leading to the eventual rejection and amputation of the hand in 2001. In 2000, Dubernard made history again when he led a 50-member surgical team in the world’s first double-hand transplant in Lyon. After a 17-hour procedure, Denis Chatelier received two new hands after his were blown off by the premature explosion of a homemade model rocket. The world’s first arm and hand transplant occurred in Malaysia on May 18, 2000 on a one-month-old girl. Chong Lih Ying was born with a severely deformed left arm and received the limb from her identical twin sister who died at birth. French surgeons at Amiens Hospital performed yet another groundbreaking surgery in 2005. Dr. Bernard Devauchelle headed the surgical team, which included Dubernard, in a 15hour procedure to give Isabelle Dinoire a new face. After waiting six months for a donor, the doctors performed the world’s first partial face transplant using facial tissue from a brain-dead woman to give Dinoire a new mouth, nose and chin. Her face initially became disfigured after she had overdosed on sleeping pills (in a possible suicide attempt) and was then mauled by her labrador, Tania. She said her dog had never bitten anyone before and believes she was just trying to wake her up.

The world’s first arm and hand transplant occurred in Malaysia on May 18, 2000 on a onemonth-old girl. In 1940, Dr. Austin T. Moore performed the first metallic hip replacement at The Johns Hopkins Hospital in Baltimore, United States. This method was improved upon in 1960 in Manadalay, Burma where Dr. San Baw created ivory hip prostheses. Two years later, British surgeon John Charnley performed the first low-frictional torque arthroplasty using an artificial hip made of plastic and metal with a ball-and-socket joint. Charnley is regarded as the founder of modern hip replacements because of the revolutionary design of the actual replacement, surgical technique by which to implant it, ways to better prevent infections and optimize the flow of surgery, and methods of teaching this procedure. Two pioneering organ transplants occurred in the U.S. The first kidney transplant was performed by Joseph E. Murray in 1954 at the Peter Bent Brigham Hospital in Boston and the first lung transplant by James D. Hardy in 1963 at the University of Mississippi Medical Center in Jackson. The U.S. is also home to the first artificial heart, completed in 1957 in a dog at Cleveland Clinic. The first artificial heart to be implanted in a human took place in 1969 at the Texas Heart Institute. Denton Cooley performed the surgery using a pneumatically-driven, Dacron-lined plastic heart designed by Argentinean-born Domingo Liotta. However, this heart was intended to sustain cardiac patients temporarily until they could receive a transplant. Only in 1982 was a permanent artificial heart created at the University of Utah. Robert Jarvik invented the device made of plastic and titanium and powered by compressed air. This surgery was performed five times, but each patient eventually died, the longest surviving 620 days after surgery. An artificial, electrically-powered heart is currently under development. If a successful one is created, it will reduce the need for heart transplants.

South African professor Christiaan Barnard performed the world’s first heart transplant in 1967 at the Groote Schuur Hospital in Cape Town. The patient, Louis Washkansky, suffered from gross heart failure and received the heart from a young woman who had been severely brain-damaged after a car accident. After years of work, English biologist Robert Edwards and physician Patrick Steptoe developed the process of in vitro fertilization, leading to the birth of the first test-tube baby, Louise Brown, on July 25, 1978 in Oldham. Since then, about four million children have been born via IVF worldwide. The world’s first separation of adult Siamese twins occurred at Raffles Hospital in Singapore on July 6, 2003. The Iranian sisters were born conjoined at their heads. Their brains were separated after a 52-hour surgery involving a team of 30 Singaporean and international specialists from the U.S., Japan, France and Switzerland. However, due to massive blood loss and poor circulation, they both died a few hours after surgery. Scientists at the University of Calgary and the Calgary Health Region in Canada developed the world’s first MRIcompatible surgical robot in 2007. The NeuroArm is operated by a surgeon from a computer and operates in conjunction with a real-time imaging to give surgeons control at the microscopic level. The idea revolutionized neurosurgery. The health profession has progressed tremendously over the last century. Doctors and scientists have found ways to ease our pain and accelerate diagnoses, so we can take comfort in the sight of X-rays and lasers rather than tremble at the overwhelming intricacy of the machinery. As technology becomes more even more specialized, one can only imagine the many new “firsts” the world will see in years to come. n About the Author Daniela Abratt is a Communications Intern with a focus on Journalism for the Medical Tourism Association. She is currently pursuing a Bachelor of Science in Journalism with a minor in International Development and Humanitarian Assistance at the University of Florida, where she is also a member of the Golden Key International Honour Society. Daniela writes for MTA’s Medical Tourism Magazine and Health Tourism Magazine.

April / May 2011

PRESS RELEASE

“Dr. Alejandro Badia, Medical Director And Founder Of The Badia Hand To Shoulder Center, Visited Guatemala Invited By The Country Amcham” Miami, Florida (April 2011). - Dr. Alejandro Badia, worldrenowned hand and upper limb surgeon, arrived to Guatemala City invited with representatives from Jackson Memorial Hospital, World Wide Medical partners, Baptist Health South Florida and Katalyst, The Hispanic Medical Marketing Group. The Guatemalan – American Chamber of Commerce together with twenty health and tourism local companies have created a cluster that works under the Guatemalan AmCham network. This organization is basically targeting the US market. Dr. Badia affirms– “I’m thrilled with my second visit to Guatemala. I have a lot of patients from this beautiful country that visit our Miami office. I have had the pleasure to meet President Alvaro Colóm, and know about his interest in supporting this mission on Guatemala’s growth in the medical tourism industry, creating a bridge between Guatemala and Miami. The Badia Hand to Shoulder Center and The International Orthopedic Group (IOG) are willing to cooperate and to work together for mutual benefits. Our goal is to offer our patients services according to their needs and possibilities”. Dr. Alejandro Badia has recently accepted, in Milan, the presidency of the ISSPORTH (International Society for Sport Traumatology of the Hand). The goal of ISSPORTH is to educate athletes, trainers and physicians alike about the nuances of athletic hand and wrist injuries. Alejandro Badia, MD, FACS is a hand and upper extremity surgeon. He studied physiology at Cornell University and

obtained his medical degree at NYU, where he also trained in orthopedics. A hand fellowship at Alleghany General Hospital in Pittsburgh was followed by an AO trauma fellowship in Freiburg, Germany. He runs an active international hand fellowship, serves on the editorial board of two hand journals, and organizes a yearly Miami meeting for surgeons and therapists that are devoted to upper limb arthroscopy and arthroplasty (www.miamihandcourse.com). This international meeting is held at the world-renowned Miami Anatomical Research Center (M.A.R.C.), the world’s largest surgical cadaveric training lab that Dr. Badia co-founded in 2005. In 2008, he completed the Badia Hand to Shoulder Center, a fully integrated clinical facility for the upper limb encompassing digital radiography, MRI extremity imaging, Integra rehabilitation facility and the Surgery Center at Doral. More recently, Dr. Badia inaugurated OrthoNOW, the first immediate orthopedic care center in South Florida which is staffed by surgeons from the International Orthopedic Group (IOG), a group of surgeons from lower extremity, upper limb and spine subspecialties who also treat elective orthopedic problems in international patients. He is member of the ASSH, AAHS, AAOS as well as honorary member of many foreign hand surgery societies. n He can be reached via www.drbadia.com, a patient education portal and website for hand surgeon academic exchange, or via (305) 227-HAND at the Badia Hand to Shoulder Center or at OrthoNOW, (305) 537-7272.

President of Guatemala, Alvaro Colóm welcoming Dr. Alejandro Badia, his International Patient Coordinator, Ms. Eneida Cruet and representatives from World Wide Medical Partners, Baptist Health South Florida and Katalyst, The Hispanic Medical Marketing Group.

April / May 2011

MEDICAL TOURISM

Barcelona ~ Avant-Garde of Culture, Art, and Medicine By GABRIELLA VICUÑA Featuring a lyrical backdrop of rustic-modern European architecture, the melodic sounds of the Spanish guitar, and 2010 World Cup Soccer Champions, the Catalan capital of Barcelona on the Mediterranean Sea, possesses a rich heritage and ambiance. Home of the world’s first full face transplant, technological advancement and innovative research is a resounding theme within healthcare in Barcelona.

hroughout this picturesque city, one can’t help but to appreciate “the face of Barcelona Architecture,” compliments of world-famous architect, Antoni Gaudí. Boasting one of the most unique and distinctive architectural styles in modern history, Gaudí’s work is greatly influenced by forms of nature, which is evident in the use of curved construction stones, twisted iron sculptures, colorful tiles arranged in mosaic patterns and organic-like forms, indulging locals and tourists alike with a breathtaking visual experience. His designs were quite different from those of his contemporaries and years beyond his time. Gaudí’s greatest gifts to Barcelona include Park Güell, a mystical park with astonishing buildings, sculptures, and tile work. Located in the heart of Park Güell is Gaudí’s old home which is now open to the public as a museum. A UNESCO World Heritage Site and quite possibly the number one, most visited attraction in Barcelona, the Sagrada Familia Church, is a giant Roman Catholic Church, featuring a spectacular façade facing the rising sun to the northeast dedicated to the birth of Jesus Christ. Its three entrances symbolize the three virtues: Faith, Hope and Love. The most powerful, the Nativity Façade

is dedicated to his birth and even depicts a cypress tree which symbolizes the tree of life. The Glory façade is dedicated to his glory period. The Passion façade is symbolic of his suffering. Four towers complete the façade and are each dedicated to a Saint; Matthias the Apostle, Saint Barnabas, Jude the Apostle, and Simon the Zealot. Two chameleons can be found at either side of the façade, and are symbolic of change. Among other famous landmarks throughout the city is Port Olímpic, a stylish marina on the Mediterranean coastline, best known for hosting the sailing events for the Olympic Games of 1992. Located between the beaches of Icaria and Barceloneta, Port Olímpic welcomes its visitors with a gigantic bronze whale

Like with artisans in arts and architecture, the realm of Facial Plastic Surgery requires an undoubting level of artistic skill from surgeons. April / May 2011

MEDICAL TOURISM sculpture located between twin skyscrapers of the Hotel Arts Barcelona and the Mapfre Tower. This lively area offers bars, restaurants and clubs. La Rambla is a quarter of a mile, treelined pedestrian mall between Barri Gòtic and El Raval, it connects Plaça Catalunya in the center with the Christopher Columbus monument at Port Vell. The name “rambla” refers to an intermittent water flow in both Catalan and Spanish, and is derived from the Arabic “ramla” which means “sandy riverbed”.

BARCELONA SHOWING FACE Like with artisans in arts and architecture, the realm of Facial Plastic Surgery requires an undoubting level of artistic skill from surgeons, primarily because their masterpieces are the first thing the world sees of their patients. Though other face transplants had occurred prior to this surgery, the surgery in Barcelona was the first to involve the entire face, including the nose, lips, jaw, teeth, muscle tissue, skin and cheek bones, thereby making Barcelona home of the first full face transplant. The surgery, which was the culmination of two years of planning, took 24 hours and a team of 30 surgeons, led by Dr. Joan Pere Barrett, Head of the Plastic Surgery Department at the Vall d’Hebron University Hospital in Catalonia on March 20, 2010.

Although the man has been given someone else’s face, he will not take on the looks of the donor. In the first part of the operation, the soft parts of the face, including veins and arteries, were extracted before firmer tissue was removed. The young man’s arteries and veins were then isolated and the donor’s face checked to ensure there was a complete flow of blood. The final part of the surgery involved transplanting bones and connecting nerves to the new face. The patient, Oscar, a Spanish farmer who accidentally blew most of his face off, including his nose and jaw, with a gun in 2005, leaving him unable to breathe, swallow or speak properly. Nine earlier surgical attempts to rebuild his face had failed. Following the success of the surgery, Dr. Joan Pere Barret, said, “The patient has scars on his forehead and his neck but they will become invisible in the future. He has seen himself when he told us he wanted to and psychologists said he was ready. It was a week after the operation and he reacted well, saying he was satisfied with the result.” Although the man has been given someone else’s face, he will not take on the looks of the donor, who died in a road crash. Instead, his new face will be a hybrid, identical to neither his old one nor the donor’s but reminiscent of both. Facial transplants are highly controversial, as they have many psychological risks, much more so than regular organ transplants. Patients have to undergo a number of psychological evaluations, and surgeries must be approved by an ethics committee.

AT THE CUTTING EDGE OF MEDICINE ~ INSTITUTO UNIVERSITARIO DEXEUS A benchmark center in many of its specialties, USP Dexeus was one of the first private university centers in Spain. Featuring 126 rooms, 13 VIP Suites and13 operating rooms, Instituto Universitario USP Dexeus is a private academic hospital offering services and surgical care in specialties including Reproductive Medicine, Cardiology, Neurology, Endocrinology, Nephrology,

April / May 2011

Otolaryngology and Oncology. It has a strong team of more than 400 doctors and incorporates the latest technological advances and research, making it one of the top medical centers in its region. “The MTA’s regional office in Barcelona will assist in the better development and delivery of educational programs in all of Western Europe”, said Renée-Marie Stephano, President of Medical Tourism Association and Editor-in-Chief of Medical Tourism Magazine. Instituto Universitario USP Dexeus is very conveniently located in the city, in the center of the so-called “triangle of knowledge”, where the financial, university and research sectors join together, reinforcing its vocational training, also known as the “Hospital of Knowledge”.

BRIGHT FUTURE FOR BARCELONA Patients have been traveling to Barcelona for treatment for decades, and as a leader in healthcare in its region, this city and think tanks within its healthcare system and tourism authorities have come together and embarked on a mission to put this splendid city on the map of the medical tourism industry. The MTA certainly applauds their efforts and we look forward to working closely with our members Catalunya Turisme www. CatalunyaTurisme.com and Wings 4 Business in providing a world-class platform to educate the industry globally on the vast opportunities at hand. n References www.catalunyaturisme.com http://www.portolimpic.es/ http://www.vhebron.net/vhpresea.htm http://www.dexeus.es/web/instituto-universitario-usp-dexeus/inicio Gabriella Vicuña serves as a Global Program Coordinator for Medical Tourism Association in areas which span events, membership, and publications. As an Associate Editor of the Medical Tourism Magazine and Health Tourism Magazine, Ms. Vicuña also provides editorial leadership for the MTA’s publications. Ms. Vicuña holds a degree in Business Administration and Tourism from the University of Florida. Prior to joining MTA, she was involved in patient services within an academic setting and in the private sector. Ms. Vicuña can be reached at Gaby@medicaltourismassociation.com

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April / May 2011

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MEDICAL TOURISM

Technology Development Improves Cancer Cure Rate

on a Global Basis

By OLIVIA GOODWIN

When a cancer patient would come to a hospital for radiation treatment, physicians would use sometimes week old scans of the tumor to direct radiation treatment. In the past doctors didn’t know if the tumor had shifted or grown because they didn’t have the ability to X-ray the tumor prior to treatment. “We were semi-blind in delivering this treatment,” said Dr. Alvaro Martinez, Chairman of Radiation Oncology for Beaumont Hospitals and the initial inventor of the Omnibeam. “Now we can have the “target of the day”, the spatial position of the tumor and surrounding normal tissue, every tumor has normal tissue,” he adds.

he idea for this technology developed from the need to reduce the amount of radiation affecting surrounding tissue, they needed to be more accurate when delivering treatment to lessen the side effects, and therefore increasing radiation effectiveness. Computer technology allows the Omnibeam to compare live computed tomography images (CT scans) to previous ones. After comparing images it automatically adjusts the radiation field during treatment to account for a patients movements and natural repositioning of internal organs. A robotic table was developed to move in different directions and position the patient during the CT to more effectively pinpoint the treatment area. “With prostate cancer you have to find ways to protect the rectum and bladder, with lung cancer it’s the heart and spinal cord,” said Dr. Martinez. This new technology became

possible because we developed this machine with Elekta, Inc., they were the manufactures of the linear accelerator and we were the inventors of the CT that’s placed on the accelerator.” After six years of development from start to finish, the Omnibeam entered full clinical operation in 2007. This form of cancer treatment has improved the cancer cure rate in patients

Even if a certain cancer improved by just three percent, we have improved your outcome, for us even one percent improvement is important, said Dr. Martinez. April / May 2011

MEDICAL TOURISM with various types of cancer including; lung, breast, prostate, gynecological, and pediatric. Since the development of this technology the cancer control probability has had an overall improvement in different cancers anywhere from three to 30 percent. “Even if a certain cancer improved by just three percent, we have improved your outcome, for us even one percent improvement is important,” said Dr. Martinez. This technology has cut treatment time from 20 to 50 percent, this improvement has been correlated with less side effects. A treatment done in three minutes compared to 10 is going to be more effective, because it is related to motion, if an organ is moving for less time it allows the position to be more accurate.

With the distribution of this machine to hospitals around the world, the most advanced form of radiation treatment has become much more accessible and feasible. “The longer it takes the more uncertainties there will be, it is less likely that a patient will wiggle around in three minutes compared to 10 or 15,” commented Dr. Martinez. Dr. Martinez has worked with patients from multiple countries including; Australia, France, Canada, Brazil and Argentina. Initially, the Omnibeam attracted a large number of international patients that would travel to Royal Oak Beaumont Hospital for treatment. Once the economic crisis hit there was a decrease, but is now improving once again. Treatment is offered in a number of sessions ranging anywhere from three to 40, depending upon the location of the tumor and what sensitive organs are around, some require smaller doses. “If international patients come for three treatments they will probably stay for five days, and if they come for 40 treatments they will stay around 50 days, it just depends, they will either be in a hotel for less than a week or for as long as eight weeks,” said Martinez. With the success of the Omnibeam, it has become a global form of cancer treatment. Two of the three Beaumont Hospitals have it and the third will have it in a month. Multiple countries have incorporated this into their treatment process; Elekta, Inc. produced it and has sold more than 150 of these machines globally. With the distribution of this machine to hospitals around the world, the most advanced form of radiation treatment has become much more accessible and feasible. n ________________________________ i Beaumont Hospital, (http://cancer.beaumonthospitals.com/ omnibeam-invention)

About the Author Olivia Goodwin serves as communications coordinator for Medical Tourism Association. She travels around networking and developing ideas for Medical Tourism Magazine and the Association. Olivia holds a degree in Multimedia Journalism from Florida Atlantic University. She may be reached at Olivia@MedicalTourismAssociation.com

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April / May 2011

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April / May 2011

MEDICAL TOURISM

Medical Tourism in

Barbados By SANDRA CORBIN Technological advances, doctor training and standards of healthcare in small-island, developing states such as Barbados are encouraging more and more people from Europe and America to pursue medical tourism as the solution to their healthcare needs. Many are frustrated with the high costs of healthcare and long wait periods for the majority of procedures in their domicile.

he term “medical tourism” was coined by travel agencies and the mass media to describe people traveling across borders to obtain medical treatment. Over the past two years, in Barbados in particular, travelers have been seeking elective as well as complex specialized surgeries such as joint replacements, dental and cardiac care, cosmetic procedures and even depression treatment. Some also travel with a care worker for convalescence purposes. Barbados is among as many as 50 countries that have been highlighted as ideal medical tourism spots. The first tourists came to Barbados for its healing qualities, clean air, fresh breeze and sunshine. In particular, the east coast’s rugged landscape, strong winds and lashing white foaming seas were popular retreats, with many people seeking spiritual upliftment and others searching for alternative treatments. At that time, many were wealthy and could afford to travel internationally. However, today, not everyone has the personal means by which to travel for healthcare. So, insurance

April / May 2011

companies who are willing to cover the cost of foreign medical care are making the dream become a reality for the less well-off. "In 1751 at the age of 19, George Washington visited the island with his brother who was ill with tuberculosis. Barbados' warm climate was recommended to assist with his brother’s health." - "A Handbook on Tourism..." published by the BTA in 2002. By 1966, Barbados won independence from the British, although it still has a Governor General and recognizes the British Royal family as its Head of State. In fact, the parliamentary system is modeled after the British system of rule. Barbados is a popular, high-end destination. With its typically tropical climate, daytime temperatures range between 75°F to 85°F (24°C to 29°C), and the heat is moderated slightly by northeast trade winds. The country is lucky because, although it is in the hurricane belt, the storms miss the island

because of its geographic position. However, it does have the occasional two-day tropical rainstorms. The island is 34 km (21 miles) in length and 23 km (14 miles) in width, a total of 431 sq km (166 square miles). It is situated in the western area of the North Atlantic and 100 km (62 miles) east of the Windward Islands and the Caribbean Sea. The dry season in Barbados stretches from January to June. Today, Barbados is seen as the hub of the Caribbean, and it could offer a realistic solution to the worldwide healthcare debate. Individual professionals are using the Internet and other media to draw patients from across the globe. As a result, they have developed their particular fields of specialization into million dollar operations. In this feature, we take a look at some of those who spearheaded the vision for medical tourism in Barbados. The Barbados Fertility Centre, founded by Dr. Juliet Skinner, provides a world-class and unique approach to in vitro fertilization through a stress-reduced holiday environment along with a tailor-made treatment program. Stress plays a major factor in the fertility of and treatments for a couple. The levels of success at the Centre have shown that this approach to IVF works. In 2007, Joint Commission International, the U.S. health facility accreditation program responsible for setting healthcare industry standards, awarded the gold seal of approval to Barbados Fertility Centre. This prestigious accreditation award is aimed at reassuring patients of the quality of the medical establishments they choose for treatment. JCI conducts stringent assessments to ensure that healthcare offered across the world is transparent so patients can make an informed choice.

Today, Barbados is seen as the hub of the Caribbean, and it could offer a realistic solution to the worldwide healthcare debate. Aqua Medical was established by Dr. E.D. Armogan, who is from a well-known family of medical practitioners on the island, and has been able to utilize his international scientific and medical expertise to provide the best nonsurgical cosmetic care to his clients. Armogan graduated from the University of Western Ontario in Canada in 1990. He holds a specialty degree (CCFP) and a fellowship (FCFP) in his field. With a commitment to providing the latest in technological and medical advances, Armogan is one of the few cosmetic physicians in Canada to be fully certified both as a Botox injector and a Restylane & Perlane injector. In addition, he has received certification for the latest revolutionary treatment for fat and cellulite reduction called Lipo-Dissolve/Body Sculpting. Armagon is also a member of several professional associations, some include: • American Academy of Aesthetic Medicine • International Academy of Cosmetic Dermatology • Canadian Medical Association • London Academy of Medicine • Barbados Medical Association • St. Joseph’s Hospital • International Society for Lipolysis Therapy

• World Society of Anti-Aging Medicine • American Society for Laser Medicine and Surgery (ASLMS) He provides the innovative and effective non-surgical cosmetic and aesthetic treatments utilizing the most up-to-date procedures supported by the latest research. The centre also provides training for medical professionals from Canada in addition to industry research and development initiatives. Barbados has a high standard of care accessible to everyone. Queen Elizabeth Hospital is the country’s main hospital with 600 beds. There are also eight government-run polyclinics providing free care for minor issues, five geriatric facilities and various child care organizations. Tourists tend to visit the privately run Sandy Crest Medical Centre on the west coast or FMH Emergency Medical Clinic in the south when they have an emergency situation. All pharmacies on the island may dispense medication to tourists. Over six years ago, the founders of Sandy Crest recognized that there was a pressing need for an urgent care facility in the northwestern part of the island that could serve Barbadians and visitors. The founder, Dr. Malcolm Grant, was informed by one of his patients that the regional company Barbados Shipping and Trading was selling a building on the west coast. Grant and his wife, Carole-Anne, believed that it would the perfect location for a comprehensive medical facility. His long-time friend Dr. Brian Charles, a consultant emergency and dive physician, agreed. The Clinic was to have guiding philosophies that should underpin the design of the facility. Grant said “(1) that the patient should be at the center of the design with a practical physical lay out (2) that the clinic should attract well-qualified and patient-friendly staff and the best available practitioners of the science of emergency medicine (3) that Barbadians – all sons of the earth should be able to access the facility and enjoy its services and (4) that high quality modern finishes should be utilized, supplemented with a warm and inviting décor.” The name Sandy Crest represents a hybridization of Sandy Lane and Sunset Crest. The clinic prides itself on the fact that it

April / May 2011

MEDICAL TOURISM offers a five-star service at an affordable price to everyone. It is a facility that every Barbadian can be proud of. The directors, too, can be proud of their achievements. They have developed a facility that would be the envy of others in the world due to its setup, quality of staff and location.

In addition to this clinic, Barbados has an impressive list of alternative health and medicine practitioners in the following areas: • Osteopathy

“We have a great team in place that has worked very hard to bring this to this point,” Charles said on the clinic’s website. “Every little detail was taken into consideration.”

• Acupuncture

The centre even has a sports injuries specialist on board and has had overseas athletes utilize the service. Sandie Yeadon, a physical rehabilitation specialist, is one of the key members of this team.

• Self improvement

For those who are in need of some alternative therapies, The Maas Clinic, situated on the south coast, is a must and is the first of its kind in the island. This integrated osteopathic healthcare centre was founded and is run by a highly recommended British-trained holistic osteopathic physician Laurens Maas and his wife, Cathie.

• Chiropractics

The clinic provides a range of therapies including: osteopathic medicine, cranial sacral therapy, power-assisted manipulations, cold laser therapy and massage, myo-fascial acupuncture, kripalu bodywork, posture pro and neuromuscular therapy, deep-tissue massage and traction therapy. It also offers nutritional programs, golf rehabilitation and sports injury programs. There is even a café and health conscious supermarket on site.

• Massage • Spiritual retreats • Reiki • Reflexology

The Sparman Clinic Wellness Centre is the jewel in the crown for the island. It is the only walk-in chest pain clinic in Barbados that can make a diagnosis within one hour of arrival. A full cardiac evaluation includes a consultation, a physical examination and an EKG. Additional testing of a noninvasive or invasive nature can be performed. The centre, founded by Dr. Alfred Sparman, has developed an international clientele due to the following services: • 24-hour cardiac emergency service • GE Innova-fixed Cath lab operating room • Seven-bed recovery room with ICU • Ambulance service • Laboratory • Pharmacy • Gym for cardiac rehab • Shuttle service to and from airport/seaport The clinic, originally opened in 2009 to provide cardiac rehabilitation, has opened to the general public by providing personal trainers and membership packages. Some packages include a full body massage, a consultation with an in-house dietician and a quaint welcome pack, which includes a towel, T-shirt and heart watch. The centre employs top professionals, such as certified trainers Darius Skeete and Falicia Austin with over 14 years of diverse experience and knowledge. In fact, Austin not only provides clients with her fitness wisdom, but she also actively participates in national fitness competitions. Sparman has worked tirelessly toward the thrust for medical tourism in the island and was finally rewarded with concessions granted by the Barbados government to assist his project. Upon receiving his award, he said, “Rest assured, the savings will be passed on to Barbadians and visitors. They will be exposed to some of the best cardiac care in the region when they use the services of the Sparman Clinic. Every aspect of its operations is computerized, including the dispensation of drugs, and the clinic has a very advanced medical records system, which is unique to the region.” At the time, no one could have foreseen that the support from the government would help the clinic grow and attract a patient base not only from the region but also from North America and beyond. Sparman promised the Barbadian people that the clinic would be a strategic partner with the government, providing services to some public patients free of charge or at a greatly

April / May 2011

reduced rate in other cases. He also has plans to establish The Sparman Foundation, which will provide funds to indigent patients for heart care. In 2001, the Sparman Clinic gained recognition as the first clinic in the region to perform angioplasty, house a seven-bed unit including an Intensive Care Unit, and have a pharmacy, a catheterization laboratory and a cardiac rehabilitation area. The facility cost about $20 million to construct.

There are also eight government-run polyclinics providing free care for minor issues, five geriatric facilities and various child care organizations. Lastly, orthopedic and trauma surgeon Chode Prashad operates from a private facility called BayView Hospital. Prashad is one of many orthopedic surgeons at BayView, some specializing in: • Shoulder and elbow surgery • Total joint reconstruction • Pediatric orthopedics • Foot and ankle surgery • Spine surgery • Musculoskeletal oncology • Surgical sports medicine • Orthopedic trauma • Hand surgery Part of the success experienced by orthopedic surgeons in Barbados can be attributed to the fact that insurance overseas covers most treatments, often excluding knee and hip replacements. As a result, orthopedic surgery has emerged as one of the main treatments performed overseas due to the low cost and freedom to choose where to have the surgery performed.

Europe and America can no longer be supported by the healthcare system in places such as South America where their students, volunteers, health professional trainees and researchers work temporarily to anticipate future work in resource starved countries. The lack of international accreditation still poses a major issue for the country. Medical practitioners in Barbados have to be registered with the Ministry of Health and are approved under the department’s stringent criteria. Alternative health practitioners also have to display their qualifications and are visited by the Health Department. Additionally, there are premises that would pass international accreditation. They have all the qualifications, but sadly, some are lacking the motivation or financial means to apply for such accreditation and to see the vision and potential for their facilities if they were to earn it. The only hope the industry has is to gain further support from the Barbados government. Sealy’s words and Sparman’s achievements offer some comfort to sector professionals ready to take on the challenge. Canada’s health costs are rising, with costs in the Caribbean about 50 to 80 percent less than Canada’s and the United States’. It is only logical that Canada’s government, healthrelated organizations and NGOs are interested in working with Barbados to solve their country’s healthcare needs. If patients are concerned about where to stay while undergoing treatment, there are a number of hotels available, many of which now offer spa amenities such as facials, massages, saunas, steam rooms and whirlpools or Jacuzzis that can be utilized at any time. Some of the world famous hotels and spas include: • Sandy Lane • Royal Westmoreland • Almond Resorts Inc, Club and Spa • Divi Heritage Hotel • Amaryellis Beach Hotel • Accra Beach Hotel • Tamarind Cove Hotel

In November 2009, a delegation of consultants attended the Medical Tourism Association’s Global Medical Tourism Conference held in Los Angeles, United States. At the conference, they had several requests to conduct business in Barbados from insurance companies and medical practitioners. For example, orthopedic surgeons from Canada wished to send patients to Barbados’ shores or to perform surgeries themselves on the island.

Its location, climate, world-class hotels, professional standards and medical facilities have poised Barbados to showcase medical tourism in its entire splendor. n

On April 1-2, 2008, the Trade Facilitation Office Canada and the Caribbean Export Development Agency hosted a major international meeting called “Caribbean Health & Wellness Tourism” in Bridgetown, Barbados. Attracting leaders from Canada and 10 Caribbean nations, the meeting explored ways that these countries could work together to develop Caribbean health and wellness services for use by North American consumers. The Barbados Minister of Tourism, the Honorable Richard Sealy, told the audience that Barbados needed to exploit the US$40 billion health and wellness industry. He said that the industry is beginning to overtake and grow at a much faster rate than global tourism – the fastest growing industry in the world – so it is essential for Barbados to add health tourism to its other tourism amenities.

About the Author Sandra Corbin, in 2000 she founded Strategy Consultants a public relations and marketing consultancy based in Barbados and developed a network of key affiliates across the globe www. strategyconsultantsgroup.com. Since 2009 she has been secretary then member of the Constituency Council for St James North, who has been appointed to address the needs of people in the area. She may be reached at: Tel: 246-231-3597, Email: strategy@sunbeach.net

• Soothing Touch Spa

April / May 2011

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MEDICAL TOURISM

Is Preventative Care

the Answer to Reducing Healthcare

Costs in America?

By JOHN R. REEVES III

With the passing of the recent Obamacare initiative, the potential for added fuel to an already out-of-control fire has many involved with American healthcare worried about the ever-increasing costs associated with the American medical system. As Obamacare gains steam and begins to unfold, the need for cost combative ingenuity increases. Chronic illnesses and preventable diseases currently make up about three-fourths of the overall burden of healthcare costs. This is a staggering statistic simply because chronic and preventable diseases are just that – preventable.

he goal of this article is to prove that there is indeed a connection between reduced medical costs and a healthy lifestyle, and that in much the same way that public awareness has brought down the teenage pregnancy rate for the first time in decades, such is possible for chronic disease prevention as well.

IS PREVENTATIVE CARE THE ANSWER? As of 2008, healthcare costs in the United States exceed 17 percent of the gross domestic product, a figure that breaks down to roughly $7,600 per resident. As far as industrialized nations are concerned, not one even partially comes close to America’s record output per resident. It takes only a brief stroll down any American street to see just how unhealthy American citizens are as a whole. Our newer generations are continually moving further and further away from the once valued healthy lifestyles of the past. That being said, reducing healthcare costs has become a serious issue in the U.S. Does every American hold an individual key to the 309,047,796-piece puzzle that is our tremendous healthcare cost? Could the retort to such

a conundrum be something as straightforward as lifestyle change? And if so, how can something as simple as preventive care or healthy lifestyle promotion possibly be the answer to augmented healthcare costs? For much of this century, the decrease in acute illness and the comparative increase in chronic disease have fueled inflation in medical costs. Since a great increase in cost has arisen from the area of chronic disease, it seems logical that if we can somehow curb or prevent chronic disease, the demand for healthcare can then be diminished. Statistics show that most chronic diseases

As of 2008, healthcare costs in the United States exceed 17 percent of the gross domestic product, a figure that breaks down to roughly $7,600 per resident. April / May 2011

MEDICAL TOURISM are, in fact, preventable. The World Health Organization released a report in 2005 titled, “Preventing Chronic Diseases: a vital investment,” in which it outlined in detail how chronic diseases could be prevented and controlled, therefore reducing deaths and improving lives. While the goal of that article was not American healthcare cost reduction, its concepts of chronic disease prevention can be used as a potential blueprint for such. Facts remain facts. Preventable illnesses make up approximately 70 percent of the burden of illness associated with American healthcare costs, so this seems like a much simpler and more affordable avenue than total healthcare reform. Promoting healthy lifestyle choices could also eliminate the vast majority of chronic diseases. There have been studies confirming that by presenting medical consumers with selfmanagement materials such as pamphlets, magazines, books and even computer aides, service-usage rates improved by 7 percent to 17 percent, while providing only nominal medical guidance. The money spent for such self-management materials is a fraction of what it would cost to fix these illnesses with surgical intervention once they cross the point of no return. The American healthcare system needs to follow the same mindset currently used to battle preventable events such as teen pregnancy, sexually transmitted disease and recreational drug use through government and private organization awareness programs. Millions of dollars are spent annually for these awareness programs; why should preventable disease and the promotion of healthy living be any different? The law of supply and demand applies to healthcare spending in that if we reduce the need, the demand for medical services will also be reduced, therefore reducing prices. By implementing a stronger focus on healthy well-being and preventative care, we can undoubtedly reduce the need for our

citizens to seek out continual medical assistance for preventable problems. It may be difficult and costly initially, but over the long-run it would indubitably prove beneficial. The answer does not lie in throwing around all sorts of money – that we do not even have – in order to get all American citizens covered under medical insurance programs. Doing so has the potential to “feed the beast.” Statistics show that a good majority of those uninsured are also facing preventable chronic illnesses, which would, without a doubt, raise healthcare costs even more. The solution to any problem lies in getting to the base of the problem and changing it for the better. Preventive care and lifestyle change are the most cost effective solutions to healthcare overspending, and both lie at the base of America’s problems. It would not take much effort in order to make a turn for the better. America just needs to realize that all problems are not solved monetarily; some require only a little motivation, a goal and some elbow grease. n

About the Author John R Reeves III is a graduate student at Buckingham Graduate School of National American University in Rapid City, South Dakota. He is the founder and CEO of Reeves International Medical Tourism, which is dedicated to assisting those unfamiliar with the medical tourism process in obtaining cost-effective health care alternatives throughout the world.

Service-usage rates improved by 7 percent to 17 percent, while providing only nominal medical guidance.

April / May 2011

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April / May 2011

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MEDICAL TOURISM

Brad Cook Director, International Dept, Hospital Clínica Bíblica. Costa Rica

Buyers of

Healthcare and their Growth in the Industry,

Q&A

By MEDICAL TOURISM MAGAZINE

Traveling for medical care is becoming more and more common as an alternative for treatment. The growth of the industry is happening rapidly in today’s society, with the development of the Medical Tourism Association. This has helped to take the idea of going to another country for treatment, from being a far out and sometimes scary thought to making a lot of sense to patients insured and uninsured. With hospitals becoming accredited and some insurance companies offering this to clients, it has become a very reputable and smart way to get the care you need. This industry has already grown exponentially in the last few years; imagine what is to come in the future. By 2012 it is estimated that 1.6 million Americans will be traveling abroad for healthcare, the industry is growing by 35%. Costa Rica has become a large part in the development of medical tourism. Brad Cook, Director, International Department, for Hospital Clínica Bíblica, a JCI accredited hospital in Costa Rica, shares his thoughts on the growth of the industry. Q: Why has Costa Rica been such a huge attraction to buyers? A: Because of factors such as lower cost for medical procedures, positive country image, perception of a high quality public healthcare system, three JCI accredited hospitals, close proximity to the U.S., and an organization such as PROMED that is promoting the country’s healthcare. Q: Tell us about the buyers of healthcare visiting your hospital? A: We are mostly seeing representatives from large self funded companies, brokers, and representatives from government run institutions in large U.S. cities, averaging about 10-15 per month. Q: Why do you think it’s continuing to grow? A: Business leaders have expressed to us that their organization’s healthcare costs are increasing, so they are looking for innovative ways to lower costs. Also growth is due to increasing awareness of medical tourism thanks to the MTA, facilitators and PROMED. Q: What does the future look like? A: The future is very bright for us as we are one of the most successful hospitals in Latin America. Both private and public sectors have worked hard to position Costa Rica as the top destination in the region and one of the most attractive medical tourism destinations globally. With the healthcare crises in the U.S., and Canadians looking for quick availability, we feel the future for medical tourism in Costa Rica is bright, especially as medical tourism awareness grows.

A way proven to be effective in the growth of medical tourism has been to develop a healthcare cluster consisting of an independent organization of hospitals, clinics, medical professionals and the government in a specific city, state, or region. Costa Rica has done this effectively with PROMED a Council for the International Promotion of Costa Rica Medicine. Their goal is to bring together health service providers, tourism service providers and other marketers of goods and services related to health and tourism. They ensure the quality of services provided by the private health industry in Costa Rica and their international promotion, with the intention of consolidating the country as a center for global medicine and a major destination for medical tourism. “Some destinations or hospitals don’t understand why they aren’t having the success that hospitals like Clinica Biblica have. It’s because they aren’t launching the right initiatives and they just think if they open their doors to medical tourists they will come. You have to work for it, brand yourself and get out there more.” During 2010, it is estimated that Costa Rica received between 20,000 and 30,000 medical tourists. Dr. Jorge Cortés, President of PROMED states, “The positive growth of the industry within the last few years allows us to set a goal to attract 100,000 medical tourists within the next five years.” n

April / May 2011

MEDICAL TOURISM

Medical Tourism:

Improving the Standards

of Global Health Care

Western Patients Are Taking Advantage of Expert Care at Reduced Costs By DR. MICHAEL SIGLER In the United States, medical care is on the rise, and the current costs are already unbearable for many. These high costs are driving many patients to visit developing countries in order to obtain medical care. This sale of advanced care to foreign visitors has come to be known as medical tourism, an economic movement that has cleverly combined the two gigantic industries of tourism and medicine.

WHY PATIENTS ARE GOING THE DISTANCE

COST OF PHARMACEUTICALS EXPOSED

Countries across the globe are jumping on the medical tourism bandwagon and putting more focus on delivering stellar care and a more positive experience for the patient. They might provide amenities such as private rooms, healing gardens, natural light and so much more. Patients with a strong concern for the environment can easily locate hospitals that put a major focus on being “green.” These hospitals are continually finding effective ways to become more environmentally friendly while also saving precious funds that can then be spent on cutting edge medical technology.

One of the biggest stressors on a patient is the overall cost of care. This includes physician charges, hospital charges, any diagnostic testing charges and, of course, pharmaceuticals. We should all be aware by now that pharmaceuticals represent a very large portion of these costs. Why? Well, hospitals, physicians and diagnostics may represent half of the overall cost of care, but many patients are placed on prescriptions that they must take once to multiple times daily in order to achieve wellness. Let’s review the cost of age management medicine as an example.

The medical services that are typically sought by medical tourism travelers include simple elective procedures, but many also travel to other countries to obtain more complex and specialized surgeries. Nearly every area of healthcare is sought by travelers, including age management preventive medicine and anti-aging treatments, and for good reason! The cost of medical care in countries like Panama is remarkably lower than what patients would pay for the same care in the U.S.

Testosterone, a hormone that declines in both men and women as they age, is a stimulant for the sex drive. However, it is also an important factor in the maintenance of muscle mass, bone density and overall strength. Testosterone can be administered topically, orally or via patch, pellet or injection.

April / May 2011

The raw cost of testosterone is 1 cent to 2 cents per injection. That’s for the raw materials; therefore, pharmaceutical

companies can purchase enough of this in raw form for $1 to manufacture more than a year’s worth of injections for one patient. After testosterone is purchased in raw form, manufactured into the injection form, tested and packaged for sale, the typical charge per prescribed month in the U.S. can be as much as $200, or about $2400 per year. Estrogen and progesterone are female hormones that both play a large role in the maintenance of strength, bone density, sexual function and mental function. These hormones also counteract the effects of menopause. Both of these hormones are manufactured in several forms, either synthetic or natural and topical or oral. The cost of Bioidentical Estriol in the U.S. ranges from $40 to $140 per month and an average of $840 per year, while the cost of Bioidentical Progesterone ranges from $30 to $130 per month and an average of $780 per year.

Pharmaceutical companies can purchase enough of this in raw form for $1 to manufacture more than a year’s worth of injections for one patient. Human Growth Hormone is now costing patients, on average, about $12,000 a year. Herbal hGH tablets vary from as little as $35 a bottle to as much as $100 a bottle. However, the more commonly prescribed injections are the most expensive, with an average monthly cost of $1,000. Yet, the average cost of the raw material to create the average patient’s yearly total of hGH injections costs roughly $500. At such extreme prices for pharmaceuticals, the costs alone are enough to cause panic in a patient. Years ago, pharmaceuticals accounted for 10 percent of the total cost of healthcare; however, we are now witnessing an increase that is forcing them amount to nearly 25 percent for the average patient and beyond for those with serious health issues. People are becoming frustrated because they don’t have a clue what to do about it, but medical tourism is alleviating that frustration. Many countries that participate in medical tourism are also the proud homes of several compounding pharmacies. These pharmacies are rigorously tested, as are the prescription medications they develop. Patients can often obtain a significant savings on their prescriptions, as well as their overall medical care, simply by participating in medical tourism.

WHAT PATIENTS SHOULD KNOW Currently, more than 50 countries report that medical tourism is a large part of their industry. Yet, accreditation and a variety of other standards vary widely worldwide. In fact, there are some destinations that could be more dangerous for medical tourists than others. It is more important than ever to be knowledgeable about the countries that a tourist visits. High crime rates, poor medical standards and overall safety should always be a concern of travelers. Of course, it can certainly be overwhelming when a health issue arises that requires traveling a great distance for the necessary care. The first priority of an excellent clinic participating in medical tourism should be to remove the patient’s stress. There are highly skilled teams in many clinics that will go above and beyond expectations to ensure that the patient and the patient’s family are as comfortable and relaxed as possible. This has been found to be the best approach to help the patient focus on the road to wellness. With that in mind, patients should always be able to rely on the staff of

specially trained international care coordinators to provide the absolute highest level of service in a careful, compassionate and completely respectful environment. When patients arrive in a country with the main goal of getting medical care, they should be able to immediately meet with their coordinator. This individual will act as a personal guide to the patient and familiarize them with the hospital and any individuals that will be performing the procedure or caring for them during their stay. The guide should be able to impeccably blend the patient’s medical needs with any individual preferences, as well as any cultural, linguistic or religious preferences, into a custom-made experience. This individualized treatment makes the foreign hospital feel so much more like home and greatly reduces patients’ stress, the first step in creating a positive medical tourism experience. n About the Author

Michael O. Sigler, M.D., is Executive Director and Co-Founder of Age Management Panama, Live Well Pharmaceuticals and Age Management Education & Research Foundation. He also currently serves as a medical tourism consultant for Johns Hopkins Medicine International. He also wrote Testosterone and Growth Hormone Normalization: A Retrospective Study of Health Outcomes, published in the prestigious Journal of Multidisciplinary Healthcare. Headquartered at the Consultorios Medicos Punta Pacifica in Panama, Dr. Sigler and the Age Management Panama team specialize in Age Management Medicine & Rejuvenology in an effort to help people across the globe. The comprehensive, interdisciplinary approach includes Hormonal Therapy – Growth & Bio-identical, Men’s Health – Andropause & Sexual Function, Women’s Health – Menopause & Perimenopause, Health & Lifestyle Assessment – Nutrition & Exercises, Executive Health Evaluations and a wealth of Rejuvenology aesthetic medical spa surgical procedures, all helping lead the art and science of appearance, health and performance enhancement.

April / May 2011

MEDICAL TOURISM

Adapting to

Changes in the Medical Tourism Market

By PRAMOD GOEL

Due to the huge proliferation in the medical tourism market, medical providers and facilitators wishing to increase their customer base and services should acknowledge the equally rapid growth of knowledge of the industry by consumers. Devising concepts and solutions for attracting, keeping and growing your customer base, creating an enhanced marketing edge over competitors and surviving and thriving in todayâ&#x20AC;&#x2122;s increasingly competitive medical tourism market means medical facilitators have to step up to the plate in a number of areas. These areas include taking advantage of viral marketing, learning the latest in electronic medical records management and information technology, and most of all, understanding the consumer - what he wants and how to deliver those services for overall satisfaction.

Current Medical Tourism Environment Medical tourism has gone through its early growing pains and has developed into a large and viable medical option for global travelers from countries around the world. The medical tourism market offers big industry opportunities for providers willing to take the time and make the effort to create sustainable, patient-centered resources that meet the needs of medical patients. In order to do this, we also have to understand the growing competition between countries around the world, which currently involves over 20,000 providers in 60 countries

April / May 2011

competing for the same medical tourism dollars, which is projected to be upward of $100 USD billion. Due to this, the industry is currently facing a critical challenge of more supply than demand, which creates a highly competitive marketplace. Under these circumstances, the medical service providers must research and understand their specific market viability before providers can reap the full potential of medical tourism. The medical tourism market is extending beyond the needs of early adopterâ&#x20AC;&#x2122;s market to the mainstream market, which requires special attention and focus to gain a competitive edge. As little as five years ago, medical tourism offered opportunities, though such opportunities offered often incomplete solutions

ÂŠ Copyright Medical Tourism Association

to medical travelers. Today, the medical tourism market is changing. Healthcare consumers are becoming more educated, exploring the available global choices and looking for more structured environment, which offers knowledgeable people, seamlessly integrated processes, along with cutting edge technologies, research and medical developmental methodologies and tools when it comes to their medical care. To attract these new mainstream customers one must take the time to learn, adopt and align your products and services to meet their needs. As medical providers enter the next phase of medical tourism, it’s essential to understand the different demands of every individual. Patient-centered care requires open communication, transparency in pricing and communication, technologies and procedures, and careful research and development when it comes to wining patients. Therefore, the mainstream market is going to want a proven system for confidentiality, credible references and resources when it comes to information. Take advantage of interdisciplinary and variable information systems that includes not only competitive pricing, but electronic medical record transmission and information technology sharing in multiple languages and formats.

Mainstream Market Patient Acquisition The patient acquisition process is a never-ending endeavor. Establishing a foothold in the mainstream market requires dedication, focus on details and the demands of the consumer market, as well as sustainable medical options and a willingness to adapt services to meet the needs of potential patients. The supply chain of patient acquisitions follows a natural process of finding a consumer market, selling them a specific product, and profiting by your concept. Three basic phases are required in the patient acquisition process, including: • Finding Your Customer Market Base • Nurturing Relationships • Ensuring Complete Customer Satisfaction in Services Following the patient through the medical care process, from point of contact to post treatment or surgical care may also require the use of electronic medical record (EMR) technology involving telemedicine, documentation and report transactions facilitation, telemedicine conferences, and longdistance pre and post operative care offered to each and every individual patient. Doing so ensures a complete solution to a medical situation and encourages positive feedback and excellent customer satisfaction, not only with medical care provided, but also with care, attention, and courtesy provided by the medical provider facilitating the entire process. In order to be competitive in this growing market place, medical providers must provide transparency in information. Medical consumers want to know about: • Surgical Procedures in Detail • Price Ranges for Surgeries with Upfront Pricing • Travel Packages for Consumer Viewing • Issues Regarding Airport Arrival and Departure • Transportation to and from Hospital or Clinic Facilities • Access to Local Amenities and Sightseeing • Language Issues/Translators One of the most important aspects of facilitating global medical care is the transition from vertical styles of marketing to the exploding potential of viral marketing with multi-touch

and mutli-mode marketing strategies. The Internet places competitive markets on more even footing than ever before, and therefore, competition for the same markets. Taking advantage of viral marketing, blogging, social networking and other creative avenues of marketing and promotion drives the mainstream medical tourism field today. The Internet offers medical travelers from every corner of the world access to the availability, technology, and credentials and qualifications of surgeons, facilities, and other health care providers with the click of a mouse. Generation X and Generation Y demand and expect transparent information models. They know how to access information and have grown accustomed to it. Therefore, access to such information, resources and access to medical providers is the difference between success and failure today. Understanding the customer, their concerns, and their focus directly affects sales efforts by providers. Consultation and easy yet confidential transfer and sharing of medical information is essential whether patients are looking for traditional surgical procedures or taking advantage of the growing field of telemedicine. Viral marketing endeavors must not only attract and maintain contact and education with the upcoming “baby boomer” generation, but also offer the tools, knowledge base, and information systems that younger generations expect and demand.

Information Technology Leads the Way The development of electronic medical records (EMR) and technology offers consumers and medical providers around the world a green, efficient and fast way to transport medical information from primary care providers to facilitators around the globe. Confidentiality and security of such information is a concern to medical consumers and facilitators regardless of their origins are destinations. Electronic records help boost efficiency in health care delivery options and offer increased use of telemetry, an increasingly popular mode of communication between patient providers, regardless of location. For example, a cardiac specialist in Rochester, New York, may discuss patient care with physicians in India or Brazil, sharing information found in patient’s records including but not limited to images and other valuable data. Telemetry engaged live conference calls that may or may not include the patient himself.

April / May 2011

MEDICAL TOURISM Medical providers and facilitators around the world should be ready, willing and able to inform consumers regarding accumulation of health information, how such information will be disseminated, and openly and honestly answer questions or concerns regarding confidentiality, security, effectiveness, and quality healthcare protocols in regard to such transfers. EMRs are the future of medical information and recording.

should correlate to your specific customer value proposition as well as return on investment from that channel. The key performance indicator (KPI) of a channel depends on total patient acquisition cost. The smaller the cost of acquiring a patient is that the better profitability margin you can expect, and hence better business sustainability.

In this respect, it takes a well-defined and workable team of providers to cross multiple gaps in the medical tourism process, from contacting a provider, to arranging important documentation such as visas and passports, processing medical records and accessing multiple and sometimes-complex information systems and language barriers in other countries.

A medical provider may have the most advanced medical or surgical equipment at your disposal, but if you forget to connect to the patient’s spiritual, emotional, or mental needs, you may never get a chance to use it. Nurture and build trusting relationships with prospective patients and help them to understand what they’re facing, what their options are, and help them make decisions.

Defining your Customer Value Proposition

It’s All About the Patient

Defining your customer value proposition means taking the time to develop your own identity. It is essential to define how consumes will perceive your organization; whether you offer the best product, best total solution, or best cost. Today medical providers mix the three distinct value propositions into one message, which blurs the message and doesn’t offer a brand identity. The mainstream consumer relates to a distinct identity, which separates them and gives competitive edge in their category class.

Understand your patient. Establish a foothold in the mainstream market. Focus on details and demands of the consumer market, with sustainable medical options and a willingness to adapt services to meet the needs of potential patients. Find your consumer market, sell them a specific product, and profit by your concept. Nurture relationships and ensure complete customer satisfaction in services.

Three major characteristics should be identified as you attempt to focus your marketing efforts on certain client characteristics, which include focusing on individuals, who: • Prefer to Work with Market Leaders • Don’t Like to Take Risks • Are Price Sensitive • Are Looking for Credible References and Complete Solutions in Regard to Their Needs • Are Looking for Reputable and Global Standards in Patient-Centered Care and Established Business Standards When it Comes to Providers To stay competitive in today’s market, medical tourism providers must integrate the people, processes and systems involved in the tourism market. That means tailoring sales and marketing strategies to meet the needs of the customer, not the other way around. Building strong brand awareness addresses the specific needs of your target audience and creates a sustainable, satisfactory and pleasurable customer experience. When focusing your efforts on profitability, find out who your customers are and what’s important to them. Learn how to find them and help them to recognize your brand. Provide the ultimate in customer services and create a unique value proposition for you and your business. Profitability in the medical tourism industry means creating excellent and sustainable treatment results in customer satisfaction and experiences that will encourage them to recommend your services to others. Without customer feedback and support, your efforts will go nowhere.

How To Market and Win the Mainstream Customer! Medical providers today must focus on designing their services, networking, promotion and marketing endeavors toward the end user - the patient. Various marketing channels can be utilized to reach the mainstream consumer such as internet, insurance agencies, local medical provider referral base, print media advertising, TV/Radio advertising, and word of mouth. The specific channel strategy you choose

April / May 2011

Select the right marketing channel that meets your needs, which will enable you to reach your business goals. Create a distinct message that attracts customers, nurture communication through multi-touch and multi-mode strategies. Patientcentered care requires open communication, and transparency in pricing and communication. Define your customer value proposition. Develop your own identity. Define how consumers will perceive your organization - whether you offer best product, best total solution, or best cost. The mainstream consumer relates to a distinct identity, which separates them and gives competitive edge in their category class. Stay competitive in today’s market. Integrate the people, processes and systems involved in the tourism market by tailoring sales and marketing strategies to meet the needs of the customer, not the other way around. The bottom line is to communicate with your customers. Communication is essential. Without communication, your marketing efforts will fail. When it comes to crossing the chasm creating the best in healthcare delivery systems abroad, communication was, is, and will continue to be the foundation of your efforts. n

About the Author Mr. Pramod Goel is president and founder of PlacidWay, a leading portal in an emerging market of health and wellness tourism. PlacidWay is the ultimate internet resource for the health and wellness tourism industry. PlacidWay helps improve top line performance, enhance competitive position and achieve the most productive organizational alignment among people, processes, and systems. PlacidWay opens the door to an entire world of the finest in medical and wellness programs, presenting top experts in critical care, cosmetic procedures, complementary and alternative medicine and medical spa retreats. You can differentiate yourself in this highly competitive medical tourism market and gain competitive edge through PlacidWay. Mr. Goel may be reached at, pgoel@placidway.com.

MEDICAL TOURISM

University of Richmond Partners With MTA ~

Earning a

Medical Tourism

Certification

fficially open to students in 2011, the professional certificate program will require six courses to complete and will be available in both English and Spanish, top languages learned or spoken in the world. The courses will be offered completely online, allowing the program to reach an international audience. Each course will cost $199 and will take four weeks to complete. Students will be able to participate in these courses anywhere, at any time and at their own pace during the four-week period. “We are very excited to partner with the Medical Tourism Association, which has clearly established itself as the leader in the industry,” said Stephanie Bowlin, Non-Credit Program Manager at the University of Richmond. “We feel this program will be invaluable to potential students from around the world who are looking for certification in medical tourism.” In the online classroom, students will be able to view lectures and presentations, read articles, engage in discussions with other students and faculty, answer questions and take quizzes. In addition to earning the Professional Studies Certificate from the University of Richmond, students will also earn Continuing Education Units, or CEUs, for each class they complete. Courses can be taken individually or as part of the entire certificate program. The Medical Tourism Certification will provide a standard of best practices for those who work in this field.

“This is the first certification program for medical tourism taught by an established and leading university and educational system,” said Renée-Marie Stephano, President of the Medical Tourism Association. “This program will be a great opportunity for those individuals in the industry who are looking for advanced education and to set them apart.”

We are very excited to partner with the Medical Tourism Association, which has clearly established itself as the leader in the industry. The School of Continuing Studies primarily serves nontraditional students; the certificate will cover many different topics from risks management, medical network, marketing to continuity of care. According to Bowlin, University of Richmond is looking forward to working with the MTA to bring in some of the leaders in medical tourism and international healthcare as professors and teachers for this online certificate program. n

April / May 2011

MEDICAL TOURISM

Healthcareâ&#x20AC;&#x2122;s Dual Demands

Fiscal Responsibility

and Quality Care

By CAGRI KANVER

or healthcare managers striving to balance the competing demands of fiscal responsibility and quality care, the elimination of unnecessary operating expenses and the increased allocation of resources into patient care is a demonstration of good management. However, decisions relative to energy and water are mission critical for a hospital. Because it requires the highest level of expertise in many different areas of inquiry, the challenge is daunting. Successful development of an Environmental Action Plan requires a team equipped to draw upon state-ofthe-art technology and design concepts and an everexpanding knowledge base followed by financial analysis,

April / May 2011

project management, stakeholder engagement, metrics and data management and communication skills focused on implementing the plan.

We approach the task in a continuous improvement context that utilizes a team of global specialists. We bring the best talent to the table only as and when needed for the specific task at hand. ÂŠ Copyright Medical Tourism Association

We approach the task in a continuous improvement context that utilizes a team of global specialists. We bring the best talent to the table only as and when needed for the specific task at hand.

Energy/Water Resource Management We assess existing energy and water utility consumption and costs by setting a baseline to be measured against and then identify alternative energy and water efficiency measures with a focus on decision quality. A technology assessment would determine whether existing systems can accept and manage the data necessary to measure and report performance, then a team will implement actions necessary to support the plan’s success. We maintain decision quality by properly framing the problem, establishing clear decision criteria and well-articulated institutional values. We focus on achievable options and clean tradeoffs, utilizing meaningful information and logical reasoning based upon the data at hand and improvement targets selected. We strive to ensure that the process is transparent to stakeholders and we seek a commitment to action. One way this is accomplished is by making the information and data analysis available to stakeholders at appropriate levels.

Carbon Emissions Planning Carbon emissions planning benefits progressive institutions that (1) recognize the significant cost exposure associated with a future price on carbon, and/or (2) want to brand themselves as leaders and innovators. For institutions desiring to brand themselves as leaders and healthcare’s dual demands fiscal responsibility and quality care healthcare’s dual demands fiscal responsibility and quality care innovators, we will augment the Environmental Action Plan analysis with the potential risk of financial exposure due to carbon emissions. We will develop a comprehensive strategy that addresses the implications of alternative carbon metrics (carbon- or energy-intensity per patient or per bed, rather than the per-square-foot metric used by the building industry). This approach would shift the focus from the building to the patient, expanding the audience from facilities to operations. And likely drive very different solutions.

Waste Stream Management Approximately 23% of hospital waste streams consist of medical and hazardous waste with the remaining waste classified as trash or recyclable. Any waste streams that are not separated can be 100% medical. We assess the current waste stream and benchmark that against peer organizations as part of a preliminary assessment. Next, internal waste control processes are assessed along with procurement policies, regional pricing and regional regulatory requirements. Next, utility allowances, hospital waste infrastructure, recycling and repurposing opportunities are further explored to increase efficiency and lower costs. We then identify alternative options using the decision quality process described above. Results include a reduction in waste separation errors through mechanization of the waste stream, lower storage and cartage costs and lower FTE costs related to waste stream management.

Metrics and Information Management Following the assessment of energy, water and waste protocols and data management, we recommend alternative solutions and, working with the procurement organization, assist in selection, procurement and implementation of technology solutions. A typical solution would interface with an existing Integrated Workplace Management System (IWMS) or Computer Aided Facility Management (CAFM ) system to manage data for reporting at facility management, operations and executive dashboard levels in the organization. We identify current inputs and outputs of energy, carbon, water and waste

and assign costs per unit, using industry-specific metrics. This forms the benchmark against which we will measure savings and efficiency.

Employee Engagement Program To ensure the successful implementation of new operating protocols, we develop an employee engagement program that enlists and encourages employees to engage in new behaviors supportive of the organizational goals. Employees are asked to share their innovative idea to reduce operating costs. Utilizing the technology applications implemented at the outset of the engagement, cost savings affected through the implementation of employee innovations are measured, reported and recognized, building support and enthusiasm among the employee population. n About the Author Cagri Kanver has nine years of progressive experience in the field of global real estate development as a consultant. He advised global corporate real estate clients in multiple areas of strategy and operations improvement initiatives. He led number of engagements in the areas of strategic / business planning & programming, market research / analysis for global site development and sustainability strategies. Cagri performed professional projects in four different continents for over 20 clients, specializing in the Middle East and Asian markets. He developed key global client relationship in academic, aviation, corporate, government and healthcare markets. Prior to joining HOK, he worked for Deloitte Consulting as a senior consultant where he was responsible for sustainable development projects and asset management & portfolio optimization for global perspective for Fortune 500 companies.

April / May 2011

MEDICAL TOURISM

TeleHealth~ The Way of the Future By DR. KANTI DAYA Despite a competitive global marketplace, telehealth fosters cooperation and medical codependency for patient-centered programming as a novel necessity and viable commodity for medical tourism. Due to its flexible nature, thousands of disciplines and therapies will soon be applying telehealth methods to their curricula. Telehealth is already making great strides due to its ability to create easy-to-use systems that lower costs, communicate globally, integrate traditional and modern treatments, coordinate all information into a “cloud” database, enhance privacy and security, provide overall convenience and provide treatment to and information from anywhere in the world. For medical tourism, this means a new opportunity for growth, access to medical specialty development, creative application of traditional and modern healthcare methods, increased travel for patients and specialists, substantial research and development programs, competition and a more cooperative effort between foreign entities and healthcare providers.

Definitions By definition, “telehealth” utilizes new technologies for more efficient and effective means of healthcare. Telehealth provides the most extensive database available, with data, video, images, and more all stored on servers, the web, or in the “cloud.” The data can then be easily shared and accessible,

April / May 2011

enabling interaction between reliable and secure sources from anywhere in the world in interpretable language. Telehealth delivery covers such programs as pre-care consultations or physical exams between long-distance providers over the Internet or the use of robotic technology for more extensive personal care. Real-time tracking and remote monitoring keep patients and healthcare providers connected and up-to-date on patient care. Telehealth and telemedicine are similar, but they are not the same and are often confused. Telemedicine focuses on medical consultations and clinical services using new

Information is updated continuously in real time, allowing for continuous benchmark and baseline data to be easily available 24/7 at a minimal cost all year long. © Copyright Medical Tourism Association

technology, whereas telehealth delivers the treatment, services and information by applying more sophisticated, integrated technology systems. It can serve many functions in terms of preventative and remedial processes while providing solutions to continuous healthcare regime challenges. Telehealth thereby actually lends itself to a more extensive market for telemedicine services. The combined use of telehealth and telemedicine creates a unique situation for a true global medical marketplace allowing foreign entities to 1) express themselves in terms of specialties to be utilized by and applied in a larger marketplace, 2) provide more extensive coordination of care, 3) advance and share medical research and development quickly, 4) work collaboratively on healthcare challenges as they evolve, and 5) compete effectively by creating higher standards and more specialized levels of healthcare.

Benefits of Telehealth The benefits of telehealth are numerous. Telehealth is a patient-centered application whereby all patients and caregivers benefit from world-class service thatâ&#x20AC;&#x2122;s literally available at their fingertips. Extensive assessments and opinions can be coordinated and accessed by patients and others from home, work and even during travel. Patients and their families can compare treatments and care in order to properly address their concerns and make their decisions. This provides a comfort level when traveling for leisure or medical purposes. When travel is not an option, patients and care givers can benefit from remote services which can enhance local healthcare programs and regiments.

Post-procedural remote monitoring, essential for patient safety and comfort, will alleviate any complications and provide real-time updates to healthcare providers and families in various locations. Since its initial application, telehealth has allowed for efficiency, cost effectiveness, continuity of care and elimination of waste and potential for error. Healthcare providers communicate in real time with other healthcare providers, specialists and patients as well as with insurance companies and family members, depending on the treatment and agreements. Reactions from treatments are detected immediately. Response time, hospital stays, recovery time and time away from home or work are reduced. Information is updated continuously in real time, allowing for continuous benchmark and baseline data to be easily available 24/7 at a minimal cost all year long. By using telehealth, healthcare providers are able to track progress and make quick decisions while sharing information in a shorter period of time. The use of special data storage programs and units through cloud computing enables unlimited amounts of data to be stored safely and accessed securely. Even if a system crashes or electricity goes out, the information will still be stored, updated and accessible. Finally, since the cloud has no actual physical home, it can be accessed anywhere in the world. This changes the dynamics of healthcare and allows for new mobile medical programs that were never before thought possible. Medical breakthroughs can be shared instantaneously and effortlessly for urgent needs and emergencies. Even when unprecedented health issues arise, governments, healthcare providers and specialists can tap into an immediate collaborative effort while identifying reliable resources that are readily available for all emergencies.

ÂŠ Copyright Medical Tourism Association

Tracking Real-time tracking is perhaps the most unique benefit in telehealth to date. Real-time tracking by way of new technology connects patients and healthcare providers continuously, adding to accountability and compliance while eliminating confusion, human error and waste in the healthcare process. Situations such as uncertainty caused by multiple prescriptions and the containers in which they come in often result in under- or overdosing, wasting time in healthcare recovery and possibly repeating the whole program or adding even more prescriptions to correct new problems. When telehealth is correctly applied, the health regiment is followed more closely by both the patient and the healthcare provider. When the health regiment is accurately followed, follow-up consultations are minimized, follow-up treatments as a result of noncompliance and repetitive treatments are eliminated, and risks are lowered across the board. In some cases, new telehealth applications can actually cut treatment timelines, allowing patients and healthcare providers to move forward in other directions for overall good health. The loop is a closed one and will continue to be sustainable for as long as the patient and healthcare provider require. When a system is closed and waste, cost and risk factors are lowered, and both healthcare providers and patients benefit from lower insurance and medical costs. In addition to tracking the patientâ&#x20AC;&#x2122;s compliance, the new medical devices and programs track valuable information efficiently for medical research and development use. Authorized groups can extract anonymous statistics from the cloud for a wide range of research and development purposes. Resources and more research can be added in real time to produce beneficial programs for worldwide applications and continual development of care.

Implications for Medical Tourism Services are already the most important competitive edge for medical tourism dollars. Since geographical areas provide a variety of treatments and facilities, service and safety standards are the focal point and primary concern, eliciting an element of care and comfort that is only available through telehealth and complimented by medical tourism. Countries are able to compete and build up medical tourism more effectively by concentrating on specialty programs and developments that provide comfort for the patient and care givers. Patients who could not travel due to medical reasons will now have more opportunity to travel and may even travel further.

April / May 2011

MEDICAL TOURISM Should a patient decide to travel under medical treatment or for medical treatment, telehealth provides an easy and quick transfer of pertinent, substantial and reliable medical records, allowing ample time for preparation procedures for pre- and post-application. Complete, secure and extensive records already organized and stored in the cloud are easily accessed and appropriately interpreted. Prior to and during travel, virtual meetings can occur to build patient comfort and awareness levels regarding accreditations and competence, second opinions, new treatments and cutting edge combinations of treatments and opinions available from various and remote locations. Patient-planning may include pre-screening of facilities, medical expertise and costs. All interested parties can sufficiently apply and implement compliance and validation procedures from the onset. Remote monitoring and followup health regiments can then continue anywhere in the world through the application of new telehealth procedures. Postprocedural remote monitoring, essential for patient safety and comfort, will alleviate any complications and provide real-time updates to healthcare providers and families in various locations. Patient warnings and precautions can be programmed into the system for daily communication to lower risk even more. Service increases, costs and risks are lowered, and managed care becomes a team approach. Telehealth creates a unique opportunity for medical tourism to take a more “center stage” approach by building relationships around the technology and providing forums in various countries whereby specific geographical matters can be addressed as they evolve. As telehealth tightens its partnership with medical tourism, enhancement and exposure to new medical possibilities will continue to provide better treatment and easy access to a variety of types of treatment while eliminating barriers. Telehealth enhances the quality each provider and facility offers and gives patients access to knowledge about and care from those entities. Facilities and providers become individually branded based on their level of service, cost, unique offerings, expertise and creative solutions. Physicians all over enjoy connectivity and enhancement of their own offerings. With the cost and time savings, patients can add additional medical and leisure programs to further their safety measures and lengthens their stay abroad.

The Future Telehealth becomes even more important as patient safety and comfort continue to be the focal point of healthcare

concerns. However, as with most new technology and development, there are challenges. Crossing state and national lines means adjusting to regulatory concerns, merging costs and new ways of dealing with knowledge-sharing among public and private entities. The nature of medical business and its effect on local and global economies are adjusting and changing dramatically as they demand immediate reliance on global cooperation. With time, these challenges will work themselves out for the betterment of all concerned. As the population within the United States ages, the need for specialized and efficient healthcare measures becomes a top priority. As a result, national healthcare initiatives have made unprecedented moves to support and endorse telehealth while positioning the country’s own medical tourism program. Insurance companies and Medicare now cover most programs and offer incentives for implementation. In some cases, the non-use of telehealth treatment may cause liability concerns for all parties in the near future. While the rising costs of healthcare and shortage of facilities continue to hamper the growth of the medical industry today, telehealth coupled with medical tourism provides new opportunities for tomorrow. Companies and facilities that utilize telehealth methods will have more competitive advantages in the future. Medical tourism companies that get connected will indeed benefit the most, for together both industries set the bar for worldwide quality healthcare. n

About the Author Dr. Kanti Daya is the chief executive and medical officer of DayaMed. He holds two bachelor’s degrees in medicine and surgery from Bangalore University in India, among other educational achievements. He specializes in the identification of life-threatening epidemics, sexually-transmitted diseases, airborne infectious diseases and cardiovascular and cerebrovascualr diseases. Dr. Daya also developed the first PPD test and the syphilis screening test used by the U.S. military. His latest product is the MedPod, a telehealth prescription-drug dosing mechanism that uses a light or audio signal to remind patients when to take their medicine.

Authorized groups can extract anonymous statistics from the cloud for a wide range of research and development purposes.

April / May 2011

INTEGRATIVE ALTERNATIVE HOMEOPATHIC PREVENTATIVE

YOUR GUIDE TO OVERSEAS HEALTH & MEDICAL WELLNESS Health Tourism Magazine is a bi-monthly on-line publication, 100% dedicated to the education and raised awareness of health, wellness, alternative and medical wellness issues.

Visit us at www.HealthTourismMagazine.com and read about: The World’s Top Destinations for Health & Wellness Tourism, Innovative Alternative Treatment & Medical Wellness Around the World, Industry Trends, Preventative Treatment and Health Tourism Events.

Advertise with Us! Reach thousands of potential clients, employees, industry participants and other important publics. Generate and sales leads from healthcare professionals, buyers and sellers. © inquiries Copyright Medical Tourism Association Contact Us: 001.561.791.2000 - info@HealthTourismtMagazine.com

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HEALTH &WELLNESS I N T E R N AT I O N A L

April / May 2011

P A R T O F W O R L D M E D I C A L T O U R I S M & G L O B A L H E A LT H C A R E C O N G R E S S

www.WellnessConference.com

MEDICAL TOURISM

Electronic Health

Records Survey

Synopsis

By TONY RYZINSKI

The adoption of electronic health records has grown in recent years as the U.S. government’s incentive plans and the benefits of these systems are realized by more and more office-based physicians. The CDC’s National Center for Health Statistics estimates that more than half of office-based physicians have adopted a basic EHR, while just over 10 percent have adopted a fully functional system. As adoption of advanced health information technologies increases, EHR systems will impact patients and physicians alike. With this in mind, a survey was conducted with both patients and physicians to determine attitudes about the adoption of EHR.

OBJECTIVES The study examines the effect of implementing an electronic health record system on both physicians and their patients. The purpose is to understand how the perceptions of physicians who use EHR systems differ or are similar to the perceptions of the patients who recall seeing their physician use the system. The results of the study will help design solutions that maximize the benefit to physicians and their patients.

KEY FINDINGS About 42% physicians use an electronic health record solution to document their patient care and about 1 in 3 uses an EHR during a patient encounter.

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Overall, 62% of physicians and 81% of patients have a positive perception of documenting patient care electronically. Forty-five percent of patients had a “very positive” perception of their physician or clinician documenting patient care with a computer or other electronic device More than 60 % of physicians feel the best benefit to using EHR is the access they have to patient records in real time. Physicians also believe that the ability to seamlessly share information with other doctors, pharmacies and payers are one among the most important benefits.

The majority of survey respondents agreed with the statement that EHR will help improve the quality of health care (78% of patients; 62% of physicians). While both physicians and patients believe that EHR will help improve the quality of healthcare, both groups have concerns about privacy and the security of EHR (81% of patients; 62% of physicians).

Overall, 62% of physicians and 81% of patients have a positive perception of documenting patient care electronically. Given their use of and exposure to the security measures used to keep electronic medical records secure, physicians using an EHR have fewer concerns about the security of records. Forty-seven percent of patients recall seeing their physicians or nurse/assistant taking notes in a computer of other electronic device while only 39% of patients saw their physicians or their nurse/assistant taking notes directly into a computer during treatment, Results: Physicians and patients agreed on the benefits of using electronic devices to document patient care during an encounter. The most important benefits of EHR systems agreed upon by the two groups are: • Gives the physician access to patients’ medical records and history in real time. • When appropriate, helps the physician securely and seamlessly share information with other doctors, pharmacies and payers.

• Helps the physician make good decisions about patient care, ultimately driving the quality of patient care. Overall, most physicians and patients agree that medical records stored electronically will help improve patient care. Within this study, findings agree that physicians and other clinicians are quick to point out that EHR is a tool to help them become better doctors. As with other types of businesses, patients are increasingly expecting that their doctor offer them access to electronic medical records, and patient e-tools, whenever and however they want and as a result are driving the adoption of electronic health records. n Methodology: The study was conducted online from 12/8/2010 to 12/21/2010. The survey was sent to 7,738 physicians or other clinical users of a Sage product or service. The patient survey was sent to 18,000 healthcare consumers. Statistically, the sample size is large enough that the findings are applicable to the population. About the Author Tony Ryzinski, Senior Vice President, Marketing of Sage Healthcare Division , he is responsible for all aspects of the company’s marketing within the healthcare market. Ryzinski’s professional career has been fully involved in the healthcare field. About Sage Healthcare Division They provide integrated electronic health records, EDI applications and practice management systems to approximately 80,000 physicians and thousands of ambulatory care practices throughout North America. These systems enable physicians and practice managers to better manage their practices and improve quality of care. This division is based in Tampa, Fla., and is a division of Sage North America. For more information, please visit www.sagehealth.com or call (877) 932-6301.

April / May 2011

ÂŠ Copyright Medical Tourism Association

MEDICAL TOURISM

The Efficacy and Utility of

Online Education for Continuing Medical Education By CHAD D. HOLLOWAY, JUNHUI (GRACE) YAN JOHNSON, and DANIEL MUELLER

ATTAINING GLOBAL COMPETITIVENESS Patients are increasingly researching foreign lands for economical, high-quality care and then traveling the world to obtain that care. Thus, from the patient’s perspective, updated skills are critical in the selection of a physician or surgeon. Most importantly, in our opinions, state of the art skills are necessary to ensure that patients receive the best care possible. Secondarily, these skills are needed to remain competitive from a marketing perspective. In addition to the clinician, the business personnel supporting the clinical activities must be knowledgeable of the global best practices, as well as, standard international requirements in healthcare administration. For example, administrators need to know the best ways to submit claims to insurance companies to ensure timely payment of their

claims and manage their “days in accounts receivable”. Can the hospital file claims electronically? Does the claim need to be on a specific form (e.g., a HCFA)? As another example, for new building projects, administrators must understand state of the art facility designs which maximize clinical quality and efficiencies, energy conservation, and patient satisfaction, while reducing full time equivalents and the necessary space requirements to accomplish required activities.

In the “flat”, global, clinical environment in which we live and work, no one person or organization has a monopoly on efficient, quality care. April / May 2011

MEDICAL TOURISM In the “flat”, global, clinical environment in which we live and work, no one person or organization has a monopoly on efficient, quality care. New and more effective methods of treating patients are developed constantly. These include new surgical methods, technologies, or pharmaceuticals. For example, a new procedure may be developed and performed in one hospital, medical school, or country. Until other organizations learn about the new procedure, they can neither perform the procedure nor improve upon it. Continuous education assists healthcare providers in learning about, discussing, and improving upon the ideas and technologies discovered by others.

CURRENT METHODS OF CONTINUING PROFESSIONAL DEVELOPMENT Currently, a variety of options exist for CPD. One option is for a hospital to identify and pay a subject matter expert to travel to one’s facility to provide the training to the clinical or administrative staff. Another option is for a facility to send one or several healthcare providers to a conference or seminar to attend training. A variation on this theme is to use a “Trainthe-Trainer” model where a single clinician or staff member represents a group at offsite training, receives the training, and then returns to a facility or medical group to train the clinical or administrative staff who did not attend the offsite meeting.

Therefore, online education can potentially improve clinical and administrative quality, ensure that global breakthroughs are disseminated quickly and efficiently, and be tracked and used for marketing, CME, and CPD purposes. These methods of education have several disadvantages. First, the cost of sending staff members to a conference or several conferences can be expensive; a typical clinical staff member must attend more than a single conference to stay current with his or her discipline. Second, depending on one’s local laws and regulations, in the case of a train-the-trainer model, the staff receiving the training from the individual who attended the offsite training may not be eligible for Continuing Medical Education (CME) credits, potentially impacting their professional licenses or the facility’s accreditation. Third, while the conference attendees are absent, additional staff must cover for them, compounding costs, and, in certain circumstances, utilizing staff members trained in other specialties to care for patients.

THE ONLINE SOLUTION One way to overcome or temper these disadvantages and to ensure that an organization’s staff is current in global best practices and cutting edge ideas and technologies is through the use of online education programs. Today, virtually everyone in healthcare has access to the internet all of the time or, at a minimum, a portion of the time. Staff members can utilize the online education from the convenience of their homes, after hours, or during a “slow time” at work, thus, preventing the extra staffing that has to occur for one to attend an offsite conference. We are not suggesting that staff members never attend professional conferences. In fact, we support attendance at professional conferences, and view online continuing education as a high quality supplement to conference attendance and an opportunity for professionals to increase their knowledge even more than they would have increased it by only attending a

April / May 2011

conference. In certain situations, online education has been combined with a face-to-face session. For example, one group of surgeons discovered a new surgical procedure developed elsewhere through an online educational program. They then invited the inventor of the procedure to their facility for an in person demonstration. The combination of these methods was far more effective than either one utilized independently. Online education is appropriate for a variety of audiences, but discretion must be used. We recommend online education for clinicians who have developed their core skills and need to improve them. For example, a practicing surgeon could benefit greatly from observing a new surgical procedure; this person, after all, has the fundamental surgical skills and could understand both the conceptual explanation and tactile maneuvers. However, we would not advocate this training for someone who has never touched a scalpel. In healthcare, some of the audiences and potential topics include: (1) Surgeons receiving instruction on how to use a new piece of technology; (2) Nurses receiving instruction about treating specific types of patients or how to improve customer satisfaction; and, (3) Medical Travel Facilitators participating in a certification program. In fact, it was recently announced that an online Medical Tourism Certification Program is being offered by the Medical Tourism Association (MTA) and the University of Richmond’s School of Continuing Studies. Within online education, a professional can receive the education via a variety of formats. First, the instruction could be delivered live via a webinar where students can interact with the instructor. Second, the instruction could include a video of a previous live presentation or one produced specifically for the online format. Third, the material may be presented by text and slides that the recipient of the education reads. Finally, the material may be a combination of a portion or all of the above.

EVALUATION AND REPORTING FOR CME,CPD AND ACCREDITATION It is important for personnel receiving the education to understand the information. In many cases, testing can be performed by the provider of the educational program to ensure that the “students” understand the conceptual material. This also assists the educator in understanding the portions of the material that were clearly communicated to participants and which sections should be revised for enhanced understanding by the participants. While a high-quality, online program coupled with an evaluation mechanism to ensure that the audience understands the material are critical, advanced systems can also record, track, and summarize these results for participants and external parties. Specifically, when participants want to utilize their

participation in the program for external purposes, such as government-mandated CME or CPD credits, JCI accreditation documentation, or marketing purposes, advanced systems can provide the summarized documentation. In our experience, a question commonly asked by US patients seeking care internationally is, “Has Dr. X had any training in the US?” With the right system and documentation, if “Dr. X” has taken online courses developed and approved in the US, he can easily prove that he has taken the courses and this can be verified by the independent third party offering the online program. Therefore, online education can potentially improve clinical and administrative quality, ensure that global breakthroughs are disseminated quickly and efficiently, and be tracked and used for marketing, CME, and CPD purposes. In the traditional model of face-to-face continuing education, costs can be significant on a per person basis. With online CPD and CME, packages or memberships are available for hospitals or governments to purchase for a wide variety of the healthcare clinicians and administrators, typically, costing far less than educating each person individually or even utilizing a train-thetrainer model.

Staff members can utilize the online education from the convenience of their homes, after hours, or during a “slow time” at work, thus, preventing the extra staffing that has to occur for one to attend an offsite conference.

CONCLUSION In conclusion, online education can be extremely beneficial to clinicians and administrators who want to identify cutting edge technologies, pharmaceuticals, procedures, and management techniques to improve the quality of the healthcare, the efficiency of the organization, and the marketing position of the organization. In addition, it is a cost effective method to provide CPD and CME credits to clinical and administrative professionals. n

About the Authors Chad D. Holloway, Ph.D., is founder and president of Global Health Solutions LLC, an international healthcare company providing continuing professional development, economic analysis and recommendations, and marketing, contracting, and strategic planning services for hospitals, governments, insurance companies and other stakeholders. For information about Global Health Solutions, please call (618) 444-1552 or email info@globalhealthsolutionsus.com. Junhui (Grace) Yan Johnson, Ph.D., is a partner with Global Health Solutions and an Assistant Professor of Economics at Lindenwood University. Professor Johnson’s research interests include development economics, financial economics, and health economics, with a recent focus on healthcare financing, comparative cost-effectiveness analysis of international healthcare systems, and the impact of continuing professional development on various healthcare settings. Daniel K. Mueller, Ph.D., is a partner with Global Health Solutions and past assistant vice chancellor for International Affairs at Washington University School of Medicine and the director of International Healthcare Services for BJC Health System. In his combined position, Dr. Mueller worked to increase global awareness of the reputations and available services of BJC hospitals and of Washington University School of Medicine physicians.

April / May 2011

MEDICAL TOURISM

Healthcare in

China~ A Trip to the Orient

By RENÉE-MARIE STEPHANO and OLIVIA GOODWIN Nailing down the PERFECT healthcare system is a challenge every country faces; perfect may never be possible, but hopefully a system that works for the majority of people will be in the near future, on a global basis. With a booming 1.3 billion population China has modernized education and housing for all of those people, unfortunately healthcare hasn’t been able to keep pace with those developments. There have always been issues with quality and availability of healthcare, now due to China growing richer and becoming more and more modern the population are coming in contact with more diseases and heading towards a system that can’t currently support it. 1

HEALTHCARE STRUCTURE In the United States people decide whether to go to a hospital, minute clinic, specialist or general practitioner based on insurance and severity of illness. In China, the average person would go to a hospital for any condition; most services are centered at hospitals. China has 290,000 types of healthcare facilities, but hospitals are the main source for healthcare due to quality of care you could receive. Only 20,000 out of the 290,000 are classified as hospitals and are highly regulated. Most people don’t trust going anywhere else for serious illnesses.2 Since the 1950’s the delivery of healthcare in China, has had a three-tier structure for rural and urban areas. The first-tier

April / May 2011

consisted of farmers who had a minimal amount of medical training; these were considered the primary care physicians. The second tier of care was commune health centers that were staffed by junior doctors. The communes were not equipped to handle large numbers of patients or serious illnesses. When serious illnesses would occur the second-tier would send them to the third-tier which was county hospitals, staffed with senior doctors. This system soon fell apart and healthcare became the responsibility of the local government. Not every region could afford adequate healthcare.3 The healthcare system has been revamped but still runs on the three-tier or Grade 1-3 structure. Around five percent (1,200) of hospitals in China are Grade3; these have the best doctors, equipment and offer the best healthcare in China. Larger cities like Shanghai and

Beijing host the majority of Grade 3 hospitals, smaller cities may have one or none at all. These hospitals have on average 500 or more beds, and they typically see anywhere from 3 to 4 thousand patients a day. Due to the high volume, it could take a whole day to be seen by a doctor, and a couple days after that before you are given a bed at the hospital if needed. Grade 3 hospitals are regulated by Ministers of Health (MOH) and must follow strict guidelines, which is why most people will only receive care from a Grade 3 facility.4 Grade 1 and 2 facilities aren’t as high in traffic due to lack in quality of care, equipment and highly trained doctors. Grade 2 is the better option the doctors have more training and are regulated by MOH. Grade 1 is the bottom of the barrel for healthcare, and these are located all over China and are the most accessible. These facilities are barely utilized, people would rather travel miles and wait days to be seen by a qualified doctor. Grade 3 hospitals handled over 30% of healthcare in China in 2008, even though they only make-up five percent of hospitals in China.5

IN THE NAME OF HEALTHCARE REFORM Little to no health insurance has always been an issue in China, a lot of times it would rely on local governments or even out of pocket for the patients. While the issue has been improved gradually over the years, the process of a healthcare reform is still in place. The quality of care, system inefficiency and low health insurance coverage are problems in the process of being mended. In 2007 the total health expenditure was around $167 billion (U.S.), and the number has increased over the last few years.6

If China’s private-sector health system develops sufficiently, China could become a key destination for medical tourism. Some medical practitioners in the U.S. use different forms of alternative medicine regularly and years ago China began using Western medicine along with Traditional medicine. In January 2011, HHS.gov announced that the U.S. and China will be working together to strengthen the contribution of U.S. companies to China’s healthcare reforms. The U.S.-China public private partnership on healthcare (PPPH) will focus on strengthening and enhancing cooperation in rural healthcare, personnel training, emergency response, medical information technology and management systems; through this they will also find ways to maintain and support the belief of traditional Chinese medicine. Though PPPH, the Chinese Ministry of Health will be consulted before any changes are made in order to stay within China’s health sector development priorities. There will be an office in Beijing with a full-time staff devoted to the functioning of this organization.7

TRADITIONAL AND WESTERN MEDICINE Healthcare in China is widely recognized as using Traditional Chinese Medicine (TCM), and rightfully so as it originated there, its first recorded history dates back to over 2,000 years ago. The more modern form of TCM that is taught in universities today was formed during the Revolution in 1911. Around this time China started to modernize and began incorporating Western medicine, which led to the government wanting to completely abolish the use of TCM. Due to the lack of Western practices and TCM being a less expensive form of healthcare it managed to keep its place in

Renee-Marie Stephano, President of MTA next to a photo of the last Queen of China Chinas healthcare system.8 However, today it is practiced side by side with Western medicine. “The main practice of healthcare in China today, is an integrated medical system that incorporates Western medicine with Traditional,” said Natasja Sproat registered Traditional Chinese Herbalist and Acupuncturist. “Many hospitals in China, like the one I trained in, in Shen Yang has a Western medical ward, an acupuncture ward with many styles of acupuncture used, and a gynecology and pediatrics ward that primarily uses herbal medicine, many doctors there are trained in both modern medicine and traditional,” she adds. Each culture has different values and beliefs, for the Chinese how they practiced medicine was a major cultural difference compared to Western medicine. The Chinese perception is that humans are microcosms of the surrounding universe interconnected with nature and subject to its forces; therefore health and disease are dependent upon balancing the function. 9 The Chinese belief consists of key components for maintaining and balancing your health and each component is intertwined with one another. The Yin-yang theory consists of two opposing forces that complement each other and therefore shape the world and all living things. This theory is said to influence Qi, the life force that flows through the body and regulates a person’s spiritual, mental, emotional and physical health maintaining a balance is how one stays healthy. 10 There are several forms of alternative medicine; the most common ones are acupuncture and Chinese herbal medicine. • Acupuncture- is performed by placing thin needles on certain parts of the body in order to break up the blockages and allow the normal flow of Qi, it is said to restore, the balance, thus restoring health to the mind and body. • Chinese herbal medicine- herbs are given in the form of capsules, powders, teas or tinctures that are derived from plants, minerals and animal products. Both have been proven to work, but its overall effectiveness is questioned, especially when used in the United States. Much of the research that’s been conducted that proves effectiveness was done in China in the 70s, 80s and 90s and doesn’t meet the standard in the West. However, the World Health Organization

April / May 2011

MEDICAL TOURISM has a list of around 72 symptoms, clinically proved that acupuncture can treat. As for Herbalism, “the effectiveness stands alone when we see more and more herbs used and sometimes patented by pharmaceutical companies,” said Sproat. “I recently went to hospital in Melbourne, Australia with malaria that I caught in India and was treated with Artemisia (Qing Hao), it was this herb that cured me,” she said.

ON THE ROAD On April 15-20, the China Medical Tourism Company and the Ciming Group invited Medical Tourism Association Founder and President Renee-Marie Stephano to inspect health centers catering to medical tourists in Beijing and Shanghai. The tour included visits to Shanghai’s Dongfang Hospital, as well as the State Administration of Traditional Chinese Medicine and Ciming Health Check Group offices in Beijing. Ms. Stephano received a traditional Chinese medicine health check-up during her Beijing visit. “I was very impressed by the Chinese medical facilities, not only the quality but also the combination of traditional Chinese and Western treatments available,” Ms. Stephano said. “Traditional Chinese Medicine gives China a strategic position in the global market because it’s unique.” “If China’s privatesector health system develops sufficiently, China could become a key destination for medical tourism,” she added. The major urban centers of Beijing, Shanghai and Guangzhou have already attracted growing numbers of medical tourists due to high technology, affordability and quality of service. Also to note is Hainan Island which is currently being marketed for its natural beauty as therapeutic for foreign patients receiving treatment there. Finally, a new city called Harbour City in Pudong Shanghai, is in the process of development with the aim of being the first green and healthy city surrounding the largest manmade lake in the world.

DESTINATION SHANGHAI According to a recent report from Global Times, Shanghai is expected to attract 50,000 to 100,000 foreign patients in the next three years, each spending an average of $10,000 to $15,000 per trip. Through a Medical Tourism Products and Promotion Platform that is supported by five municipal bureaus, Shanghai intends to boost its marketing this year in the global marketplace. “We offer a platform between patients and Shanghai hospitals,” said Dr. Yang Jian, the founder and CEO of China Medical Tourism Company and the person who is spearheading the platform in Shanghai. “Hospitals only take charge of the surgery, and we are responsible for the preand after-sales service on this platform, including the whole itinerary planning,” he added. On a recent trip to Shanghai, Renée-Marie Stephano, President and Editor-in-Chief of Medical Tourism Magazine, extended a workshop to the stakeholders in the region with the assistance of Dr. Yang Jian. “The natural tourism industry in Shanghai, combined with the new platform for medical tourism, the high quality of healthcare and the combination of eastern and western medicine will provide for strong growth of international clientele to the region,” said Ms. Stephano. “The challenge will be the identification of competitive procedures and the effectuation of a strategy to look first to the existing patient flow of the facilities,” she added.

come to Shanghai for gamma knife surgery, which is banned in some countries. “We conduct nearly 30 consultations every month, and 10 percent of them end up making the trip,” Dr. Yang said. One of the biggest concerns of the growth of international patient platforms is the sheer fact that most of the hospitals are at high capacity. Although the public hospitals in China are required to use 90% of their resources for local patients, Dr. Yang estimates that most of these facilities are still not using all of the remaining 10% of their resources for international patients, therefore diluting the concern for over capacitation.

I was very impressed by the Chinese medical facilities, not only the quality but also the combination of traditional Chinese and Western treatments available. During the workshop, Ms. Stephano was asked many questions about the common concerns of liability, over capacitation, transparency and accreditation. However it was clear that the providers in Shanghai see the development of medical tourism as a good opportunity to justify more development, create more jobs, generate revenue, and improve medical services for local as well as international patients.

DESTINATION BEIJING Through the assistance of the National Institute for Traditional Chinese Medicine, a workshop was held in Beijing to discuss the opportunities unique to the city. In China, we are seeing a growth in patient numbers who seek all types of different procedures ranging from Traditional Chinese Medicine (TCM) to Orthopedics. Beijing is an ultra-modern, world-class city that continues to boom after hosting the 2008 Olympics, and Shanghai is arguably the most dynamic city in the world. In the upcoming month, through the assistance of the National Institute for Traditional Chinese Medicine,

Traditional Chinese Medicine gives China a strategic position in the global market because it’s unique.

Some of these specialties have been identified as gamma knife therapy, traditional Chinese medicine and stem cell technology. According to Dr. Yang, every year, more than 300 Argentineans

April / May 2011

the Medical Tourism will assess the possibility of developing a regional office in Beijing to better assist with its program development and education programs. As for its healthcare, the main Beijing United Family Hospital is located in Beijing’s Lido area northeast of the city. Beijing United Family Hospital and Clinics (BJU), the flagship facility of China’s first and largest foreign-invested international healthcare group, United Family Healthcare (UFH), is one of China’s only two truly full-service international standard hospitals — the other is its sister, Shanghai United Family Hospital and Clinics (SHU). BJU has internationally recognized and certified doctors from 15 different countries and regions, including the U.S., U.K., Australia, Belgium, China, Malaysia, Hong Kong and Canada, and a fully Englishspeaking, 180-strong nursing staff treating patients from over 110 countries every month. To date, Beijing United Family Hospital has been a medical destination for patients from areas in East Asia where premium medical care is unavailable, such as eastern Russia, Mongolia, Khazakhstan, Turkmenistan, Tajikistan, some South Asian countries and elsewhere in the region. Additionally, the majority of patients continue to come from Beijing’s expatriate community, representing over 110 different countries and living, working or studying in China for short or more permanent stays.

Podcast by Kent Kedl, China Healthcare Land of Opportunity, technomicasia.com/blog/2009/08/30/chinahealth-care-the-land-of-opportunity/ 1

Podcast by Kent Kedl

An Economic Analysis of Health Care in China by Gregory C. Chow, Princeton University (http://www. princeton.edu/ceps/workingpapers/132chow.pdf) 3

Podcast by Kent Kedl

International Society for Pharmacoeconomics and Outcomes Research, (.ispor.org/htaroadmaps/ChinaMD. asp#1) 6

http://www.globalhealth.gov/news/news/01192011b.html

American National Standard Institute (purifymind.com/ HistoryMed.htm) 8

National Institutes of Health, (nccam.nih.gov/health/ whatiscam/chinesemed.htm) 9

National Institutes of Health and documented in the Huang Di Nei Jing the Chinese medicine text

AN EYE INTO THE FUTURE Dr. Yang Jian estimates that in 2012, China should have 200,000 medical tourists each year with an average expenditure of $10,000 per patient per visit, despite the fact that medical tourism seems almost non-existent in China. The founder and chief executive officer of China Medical Tourism and Shanghai Medical Tourism Products & Promotion Platform (SHMTPPP) knows that China has to deal with tough competitors such as India, Thailand, Singapore, South Korea, Malaysia, and the Philippines. “Foreign patients are interested in coming to China, but they don’t know who to get in touch with as there are no readily available numbers or names to contact,” said Dr. Yang. Another problem is bringing the stakeholders together to generate one voice and one vision for the region because each group has different interests. “At the beginning, we asked ourselves how to bring all parties - hospitals, travel agents, airlines, trade offices, and even translators - onto the same page as us,” explained Dr. Yang. And thus, SHMTPPP was born. The marketing group set up offices in Los Angeles (LA) and Jakarta, hoping to lure overseas Chinese to Shanghai for medical purposes. It is estimated that there are 1 million Chinese residing in LA and 2 million in Jakarta. “The fact that there are 40 million overseas Chinese globally made us realize that we should take full advantage of this window of opportunity,” said Dr. Yang. SHMTPPP will act as a comprehensive concierge, organizing everything from before the patient arrives to well after the patient leaves. What about the savings? Dr. Yang estimates that a coronary bypass is about 40% less in China than in the US and so the uninsured marketplace as well as the insurance and employer marketplace is of primary consideration for the platform development in China. Compared with other competitive countries, the pricing in China is equated to those of Thailand, less than Singapore and more than India. This gives it a competitive advantage. Dr. Yang predicts that due to high quality of care, combined services and affordability, it could grow by as much as 100 or 200 percent annually during the initial three years. n

About the Authors: Renee-Marie Stephano is the President of the Medical Tourism Association™ . Ms. Stephano is also the Editor-in-Chief of the Medical Tourism Magazine and Health Tourism Magazine. Having a background in international marketing and relations, health law and litigation, she provides a valuable service to the Medical Tourism Association™ in these fields. Ms. Stephano speaks regularly at international healthcare conferences on the Legal Issues Surrounding Medical Tourism and in the United States to employer groups, insurance groups and physician associations. Renee-Marie consults international government ministries, private sector organizations and NGO’s about the growth of the global healthcare industry and accreditation, providing marketing assistance to promote their countries high quality of care. Ms. Stephano works with governments and healthcare clusters in the development of their Medical Tourism Initiatives. Ms. Stephano recently is the co-author of three books : “Developing an International Patient Center: A Guide to Creating the Best Patient Experience”, the book “The Medical Tourism Facilitator: A Best Practices Guide to Healthcare Facilitation for International Patients” and the book: “Medical Tourism ~ An International Healthcare Guide For Insurers, Employers and Governments” Olivia Goodwin serves as communications coordinator for Medical Tourism Association. She travels around networking and developing ideas for Medical Tourism Magazine and the Association. Olivia holds a degree in Multimedia Journalism from Florida Atlantic University. She may be reached at Olivia@MedicalTourismAssociation.com

April / May 2011

Chicago, Illinois USA

October 25 th - 28 th 2011 Marriott Renaissance Schaumburg Convention Center Hotel

World Medical Tourism & Global Healthcare Congress

Learn About The Latest Trends In Medical Tourism And Network With Industry Professionals

Up To 10,000 Pre-Scheduled Networking Meetings 100+ Speakers • 140+ Exhibitors • 400+ Buyers Up To 1,500 Attendees From Over 87 Countries “+” = UP TO

five Leading Healthcare Conferences

one LOCATION

ONE EXHIBIT HALL 5X THE TRAFFIC HEALTH &WELLNESS I N T E R N AT I O N A L

AN INTERNATIONAL HEALTHCARE DEVELOPMENT CONFERENCE

P A R T O F W O R L D M E D I C A L T O U R I S M & G L O B A L H E A LT H C A R E C O N G R E S S

www.MedicalTourismCongress.com • info@MedicalTourismCongress.com • 001-561-792-6676

Medical Tourism & Buyers of Healthcare Converge in ChicagoLand! The 4th Annual World Medical Tourism and Global Healthcare Congress is gaining momentum with registration already up by 200% at this time compared to last year’s Congress. After hearing about the success of last year’s conference, the next one more than five months away has already drawn a crowd of industry professionals wanting to be among the first to register, ensuring a spot at this year’s congress. This year’s theme is “Patient in Emerging Markets” will focus on some of the upcoming largest growth areas of Medical Tourism in Russia, Ukraine, CIS Countries, China, Japan, the Middle East, GCC regions and Africa. The conference will have a strong focus on attracting buyers of healthcare in these emerging regions.

THIS YEAR’S TRACKS INCLUDE: 1 Medical Tourism 2 Inbound and Domestic Medical Tourism 3 Healthcare Development / Sustainability 4 Global Benefits / Expatriate Benefits 5 Healthcare Investement 6 Health & Wellness

This year we are taking networking to the next level with our new and improved Interactive Networking Software. Utilize the sophisticated online networking software to request dozens of private one-on-one networking meetings while at the conference. In three days you can network with health insurance companies, employers, medical tourism facilitators, governments, and top hospitals and healthcare providers from around the world.

New to this year’s conference, will be a chance to network with participants from the Employer Healthcare Congress, one of the US’s largest employer and insurance healthcare conferences, which will have integration for certain networking functions.

Some of the preliminary featured and expert speakers so far are: • • • • • • • • • • • • • •

Bill Rancic - Entrepreneur and winner of The Apprentice Dr. Robert Rey - as featured on Dr. 90210 Dr. Cecil Wilson - President, American Medical Association (AMA) Hon. Prof. Peter Anyang’ Nyong - Minister for Medical Services Ministry of Medical Services, Kenya Mouhanad Hammami, MD-President, National Arab American Medical Association Yakov Elgudin, MD, PhD, FACS - President, Russian American Medical Association Vladimir Budiansky - Medical Director, Moscow Doctor Jacqueline Madrigal - Human Resource / Benefits Manager, American Apparel Jack Norton - Human Resources Manager, Blue Lake Casino & Hotel Muna Almuallem - Manager of International Benefits, Mary Kay Inc. Chris Russo - President and Chairman of the Board American Society of Travel Agents (ASTA) Renee-Marie Stephano, Esq. - President, Medical Tourism Association David Jaimovich - President and Founder, Quality Resources Intl. Dr. Hisham Diwani - General Manager, Health Insurance, Ministry of Health –Syria

• J. Edson Pontes M.D - Senior VP International Medicine, Detroit Medical Center • Stacy Dreyfus - Founder, Orchid Resorts & Escapes • Samer Ellahham, MD,FACP,FACC,FAHA,FCCP - President, International Association of Healthcare Quality • Karen H. Timmons - Former President and Chief Executive Officer, Joint Commission International and Joint Commission Resources • Dr. Terry Stevens - Managing Director, Stevens & Associates • Bill Ruschhaupt - Chair, Global Patient Services, Cleveland Clinic • Rosanna Gomez Moreno - CEO, RGM Global • Colin Rohlfing - Assoc. AIA, LEED AP BD+C - Sustainable Design Leader, Hellmuth, Obata & Kassabaum Inc. • Pamela Frank - Executive Director, Worldwide EgyptianAmerican Cancer Network • Maria Shepherd - Founder, Data Decision Group • David Collins - Healthcare Division, Colliers International • LeAnne Stefl - Senior Vice President and Director of Global Client Advocacy, Willis’ Multinational Employee Benefits

www.MedicalTourismCongress.com • info@MedicalTourismCongress.com • 001-561-792-6676

MEDICAL TOURISM NETWORKING

The New and Advanced Networking Software Offered at this Year’s World Medical Tourism and Global Healthcare Congress this October in Chicago

>> Personalized Conference Calendar

n its 4th year, the World Medical Tourism Congress promises to be the best one yet; featuring up to 1500 attendees, 100+ speakers and sponsors from over 87 countries. The Prescheduled One-on-One Networking Meetings is rated the best benefit of attending the conference. In three days a participant will be able to hold a number of face-to-face meetings that would take years of travelling to different countries and cities to accomplish. Harvard Business Review Analytic Services found that of the 2300 readers polled, 95% believe that face-to-face meetings are the key to success in building long-term relationships and 89% agreed face-to-face meetings are essential to sealing the deal. The MTA has realized the importance of implying a user friendly and effective networking software, this is the reason why this year the conference will be implementing an exclusive software program that will allow attendees to pick and choose who they would like to pre-schedule a meeting with. The software takes networking to a whole new level and will meet all of your networking needs and more. Some of the new and improved features include an attendee directory that allows each participant to upload their photo, add their interests, include a bio and add “tags” so that people may find easier.

>> Attendee directory with photos and bios

The software makes it easy to pre-schedule networking meetings with fellow attendees and exhibitors, browse the online agenda and plan which sessions you will attend. See who is attending each talk and start discussions with other attendees about the topic. Print and take with you your complete schedule of networking meetings and sessions you will be attending.

>> NO Shutdown Period!

>> Link up your Twitter, LinkedIn, Facebook

Every participant will be able to add their Twitter feed to their profile. Once you register to the networking software you will be able to see who is attending the congress from your LinkedIn or Facebook Contacts.

>> Email Notifications for New / Cancelled Meetings

As soon as someone requests a new meeting or cancels, you will get an email in your personal inbox letting you know. There will be no more missed opportunities to meet or unexpected cancelled meetings.

>> Mobile networking on your iPhone / Blackberry / Android

Once the networking software is open it will stay open, even during the conference.

This is the one event per year where Employers, Self Funded Health Plans, Insurance Companies, and Medical Tourism Facilitators that are looking to outsource healthcare overseas have the opportunity to meet with top International Hospitals and Medical Tourism Companies in one place for the ultimate networking event. “The MTA is continuously striving to improve the technology utilized at our annual congress as well as the overall effectiveness and ROI of our attendees, therefore we are very excited to utilize this year the latest networking software at the annual congress in Chicago that promises to be the most dynamic yet”, said Jonathan Edelheit, CEO Medical Tourism Association. n

Contact Silvana Maldonado Silvana@medicaltourismcongress.com www.MedicalTourismCongress.com US 561-792-6676

You may now access your calendar, attendee profiles and more on the go. You will not need a computer to access our software anymore.

April / May 2011

www.MedicalTourismCity.com

A New Social Network Has Been Launched!

Join “The City” Today and Begin Networking on a Global Scale >> Medical Tourism City helps facilitate an open forum and communication amongst those professionals involved in medical tourism and global healthcare and to facilitate business networking. >> The social network has reached over 1300 members from over 75 different countries since it started. >> Users range from insurance companies, health insurance agents, medical tourism facilitators, hospitals, doctors, governments, consultants and more.

www.MedicalTourismCity.com

April / May 2011

MEDICAL TOURISM

Medical Malpractice in the Realm of Medical Tourism By DR. PREM JAGYASI

here are no universal laws that regulate how individual countries handle medical malpractice. Within the realm of medical tourism itself, there is no regulating body to which patients with medical malpractice concerns can report to. Without regulations and standardizations, medical tourism has the potential to be a hub of medical malpractices in which unqualified healthcare professionals treat naïve patients. This is why the concept of medical malpractice is so important to address and discuss for individuals involved in the medical tourism industry. This article will try to tackle the concept of medical malpractice in the realm of medical tourism so that both healthcare professionals and consumers are aware of the consequences. Let’s discuss what medical malpractice is in the first place: Medical malpractice is the act of professional “wrongdoing” by a healthcare or medical professional catering to the needs of a patient. Malpractice occurs through negligence by act or omission where medical providers stray from the accepted medical practices within their profession that could

April / May 2011

potentially result in harm or fatalities to the patient. Healthcare professionals have a responsibility to treat patients to the best of their ability, so when a physician or another medical professional deviates away from standard medical procedures (even in the form of unintentional medical errors), they have to be accountable to their patient and for their mistake.

ETHICS AND LEGALITIES Medical malpractice is often viewed through two sides of a spectrum—an ethical aspect and/or a legal aspect. Any act of wrong-doing in which the results of the malpractice have a negative impact on a person’s life, community or country could be considered unethical, regardless of whether or not it meets a patient’s expectations. Malpractice and the violation of ethics

Malpractice and the violation of ethics are more severe when the action is performed intentionally and with the understanding that such practices could be harmful. © Copyright Medical Tourism Association

are more severe when the action is performed intentionally and with the understanding that such practices could be harmful.

laws, creating a disparity in legal regulations for, letâ&#x20AC;&#x2122;s say, an American traveling to prime spots like India or Thailand.

Intentional acts of medical malpractice all fall under the sphere of unethical practices. The justice system of certain countries has placed great emphasis on legal consequences when an act of medical negligence has occurred.

EXAMPLES OF MEDICAL MALPRACTICE WITHIN MEDICAL TOURISM

This retribution usually comes in the form of a monetary reward (where the patient sues the healthcare provider) or by fixing the medical error made. Cases such as these have initiated the large legal response we see today into the realm of medical malpractice. Patients have decided they want some sort of retribution when a medical error occurs, and this is often tied to the litigious aspect of it. This has resulted in patients having the ability to file a medical malpractice claim and sue their healthcare professional when they feel they have been wronged. Nowadays, physicians practicing in countries with stringent medical malpractice regulations can get sued over any case of medical malpractice (intentional or not) so much so to the detriment of their career. Some countries, like the United States, take the issue of medical malpractice very seriously, causing doctors to purchase malpractice insurance in order to protect themselves (one of the reasons for the high cost of healthcare in the U.S.). However, some medical tourism destinations might not have such strict

ÂŠ Copyright Medical Tourism Association

The risk of medical malpractice occurring within medical tourism is very high, especially because patients are traveling outside their comfort zones and away from the legal and ethical systems they are used to. Physicians can convince foreign patients to let them perform unethical procedures and can also refuse to grant them legal recourse in the case of a medical error. The numbers, cases and examples of medical malpractice are endless and are happening on a daily basis. Here are a few common examples of medical malpractice that have been highlighted or reported.

Physicians practicing outside their country Since there are no universal laws or standards in place dictating medical malpractice, physicians can travel outside their country and consult or even treat foreign patients in a region where they are not licensed to practice. This could be detrimental for patient safety and for the reputation of medical tourism.

Lack of transparency of foreign physicians Since the majority of communication between a patient and physician during medical tourism occurs when both parties are in different countries, there is a great potential for physicians to be unethical. Prior to a patient flying in for treatment,

April / May 2011

MEDICAL TOURISM the patient could receive a lot of false information about the procedure in order to lure them into travelling. This is due to a lack of transparency and additionally a lack of regulation. These two issues combined are a great hurdle for medical tourism to overcome in the near future.

Lack of legal recourse for the patient If a medical error has been made or an act of negligence has occurred in the form of medical malpractice, a patient has the right to duly receive retribution. This retribution usually comes in the form of a monetary reward (where the patient sues the healthcare provider) or by fixing the medical error made. However, when it comes to medical tourism, the variations in the legal systems of different countries could prevent a patient from receiving any legal recourse.

One of the greatest issues is the lack of legal regulation for cases of medical malpractice. The fact that no standards are in place or no regulation body has been created in order to address the very relevant issue of medical malpractice is weakening the industry and all it has to offer. Patients should have a right to retribution if negligence has been done upon them and doctors need to take responsibility for their actions. Additionally, as individuals invest in the medical tourism industry, we need to work together to ensure that patients have the safest medical journey possible and that they have an outlet to voice their cases when medical negligence occurs. Finally, we need to create a sound support system for practitioners to protect themselves in the case of unfortunate results or complications that have occurred because of unintentional practice. n

Unethical Practices There are several examples of how foreign physicians can utilize unethical practices with foreign patients. These include: charging higher prices to international patients as compared to locals, covering hospital documents in the local language and refusing to provide translator services, misuse of medical technology (via using technological means to predict or even influence the characteristics of the foetus or through unethical organ transplant procedures) and not providing the patient with enough pre- and post-operative information. All these unethical cases also fall into the category of medical malpractice; however, depending on the legal system of the medical tourism destination they might or might not have a legal affiliation.

CONCLUSION The concept of medical tourism might have been in practice for centuries, but due to the recent widespread globalization, the medical tourism industry has been burgeoning and is set to continue growing well into the future. But there are several hurdles that we still have to face in order to keep the reputation of medical tourism strong.

About the Author Dr. Prem Jagyasi is a Chartered Marketing, Management & Health Tourism Consultant in Dubai, United Arab Emirates. Dr Prem Jagyasi is world renowned Health Tourism / Medical Tourism Consultant. He provides exceptional, extensive and high-end consultancy services to Healthcare Organizations, Medical Travel Facilitators, Governments and SemiGovernment Authorities. He is serving Medical Tourism Association (A Non-Profit Organization) as a Chief Strategic Officer, and is responsible to develop, execute and monitor marketing, brand and communication strategies. He is also closely involved with MTA team to create, protect & foster industry standards, quality of care projects & strategic developments. He may be reached by email at drprem@jagyasi.com web: www.drprem.com

or iversal laws n u o n re a dical Since there dictating me e c la p in s rd tside standa can travel ou s n ia ic s y h p n treat malpractice, onsult or eve c d n a y tr are n u their co n where they io g re a in ts n foreign patie to practice. not licensed

April / May 2011

ÂŠ Copyright Medical Tourism Association

MEDICAL TOURISM

Brazil

and Healthcare Globalization By ALEX LIFSCHITZ

Business in Brazil is booming. It is one of the main target countries for international investment: infrastructure, communications, transport, pharmaceuticals, tourism, education and healthcare. With a population reaching 200 million and an active internal consumer market of over 110 million (and growing), Brazil has many things going its way: stable and sustained growth of the economy, political stability and ample availability of investment capital.

nother important aspect that allowed this considerable development (in times of world economic crises) was the recognition by Brazilian business leaders and government officials that technologies were transforming and would affect the business world. Thus, they expanded their businesses and objectives beyond the local market, focusing and operating in a global scale. At the same time, they maintained and increased the conservative and controlled approach of the financial aspects of banking and business development, giving big value to internationalization and long-term planning. This brief summary is intended to introduce the vigorous development of Brazil’s healthcare capabilities and quality. Up to the end of the ‘90s, many Brazilians would travel abroad for specialized and high-technology medical treatments. Today, with the high amount of investments dedicated to hospitals, technology, teaching, training, research and personalized patient care, this tendency has completely turned

around. São Paulo, South America’s largest city and neuralgic business center, is also its medicine capital. The city is the engine that leads Brazil as a major international medical travel center, offering world-recognized, quality medical procedures with affordable pricing. São Paulo receives about 12 million visitors each year, attracting them to some of the 72,000 yearly events and conferences and to work, study, shop and take care of their health. In 2009, 900,000 people came for some type of health treatment; of these, more than 50,000 were foreigners, mainly from the United States, South America, Europe and Africa.

São Paulo receives about 12 million visitors each year, attracting them to some of the 72,000 yearly events and conferences and to work, study, shop and take care of their health. April / May 2011

MEDICAL TOURISM The only question will be regarding the U.S. healthcare reform plan, but we don’t think that it will be a deterrent to healthcare globalization. More uninsured Americans will suddenly have coverage, but medical costs will probably increase; the reform plan does not directly deal with the existing causes of the high medical costs such as the pharmaceutical industry (price of products), hospital operational costs and the cost of doctors’ personal insurance (transferred to patients bills). The onslaught of patients to an already burdened and expensive healthcare system will compromise access to care, forcing people to find providers and services outside U.S. borders, and Brazil will be ready to provide that care. São Paulo hospitals’ high quality and safety, medical procedures and surgeons are world-known, mainly in cardiology, transplants, oncology, plastic and reconstructive surgery, orthopedics, bariatric surgery, urology, dentistry and human reproduction. Brazil is well-positioned to become one of main locations for healthcare travel due to its proximity to the U.S. (in terms of time zone, occidental culture, tourism options and peopleoriented services), Europe and Africa. The U.S. will be the major force used to implement the globalization of healthcare travel, mainly because of the American B2B market . We consider that Central America and Brazil are in a privileged position to take the most advantage of this trend.

April / May 2011

Globalization and its benefits are everywhere, so why not in healthcare? n

About the author Alex Lifschitz is the CEO of Sphera International, a health platform specialized in giving solutions to a full-range of health institutions, from governments and health insurance companies to medical providers and patients. It focuses on facilitating services between patients and providers of healthcare, tourism and concierge services. Sphera is a multinational company with offices in Brazil (São Paulo and Fortaleza), Spain (Barcelona) and the U.S. (New Jersey). It’s the only healthcare travel company with operational infrastructure in three continents.

PRESS RELEASE

Medical Tourism Association™ Hits Los Angeles, the Entertainment Capital of the World

eaturing hundreds of exhibitors from all around the globe the 2011 LA Times Travel & Adventure Show featured the top travel destinations, attractions, activities, resorts, products, and services; captivating consumers worldwide. As part of this year’s Consumer Awareness Campaign, the Medical Tourism Association™ met with hundreds of Travel Agents, and their partners, Hospitality and Hotel entities, spearheading its major campaign to develop more and more international patient programs through organic travel arrangements. Global Program Coordinator Gabriella Vicuña stated, “We were really encouraged to find so many travel agents already working with people who travel for healthcare or wellness around the globe. It was terrific to spread the word about the Medical Tourism Association™ and its many membership benefits and programs.” (http://www.medicaltourismassociation.com/en/benefits-ofmembership.html) While educating about a new notion to many, our efforts were successful at raising awareness to our new consumer website MedicalTourism.com (http://www.medicaltourism.com/) which currently is ranked number one on Google. The Medical Tourism Industry represents a booming niche in the travel market. MTA now has delegates in over 87 countries following its development with almost 1200 attendees at last year’s annual Congress. The 4th World Medical Tourism & Global Healthcare Congress will reinvent itself yet again in the Chicago area, October 25 – 28 2010. The theme of this year’s event, “Emerging Markets” will prove to be an event you will not want to miss ~ bigger, better, and with many more new topics for all to gain knowledge, network, and to walk away with the excitement that this venue and the industry brings. There will be a special segment focused on the Travel & Hospitality Industries and hope to gain knowledge into this ground breaking industry. (http://www.medicaltourismcongress.com/ )

The 4th World Medical Tourism and Congress is an excellent way to meet a myriad of potential business partners from all over the world including Europe, Eastern Europe, Asia, Middle East and Gulf Coast Countries as well as from the United States and Latin America. The travel partners in these countries will prove to be the next spokes in the growing medical tourism wheel. For more medical tourism news and information, go to Medical Tourism Magazine online. (http://www.medicaltourismmag.com/ ). n About the MTA The Medical Tourism Association™ (also referred to as Global Healthcare Association and Medical Travel Association) is the first international non-profit trade association for the medical tourism and global healthcare industry made up of the top international hospitals, healthcare providers, medical travel facilitators, insurance companies, and other affiliated companies and members with the common goal of promoting the highest level of quality of healthcare to patients in a global environment. The Association promotes the interests of its healthcare provider and medical tourism facilitator members. The Medical Tourism Association™ has three tenets: Transparency in Quality and Pricing, Communication and Education. http://www.medicaltourismassociation.com/en/index.html Contact Lisbeth Stein Membership Coordinator US 001.561.791.2000 Lisbeth@MedicalTourismAssociation.com

Gabriella Vicuna, Global Program Coordinator for MTA and Olivia Goodwin, Communication Coordinator for MTA at the Los Angeles Times Travel Show 2011.

April / May 2011

PRESS RELEASE

MTA Announces Preliminary Speaker Lineup

he Medical Tourism Association is pleased to announce the preliminary lineup of speakers and sponsors of the 4th Annual World Medical Tourism and Global Healthcare Congress to be held October 25-28, 2011 Chicago. In its 4th year, the World Medical Tourism and Global Healthcare Congress promises to be better than ever featuring up to 1500 attendees, 100+ speakers and sponsors from over 87 countries. This year’s theme is “Patients in Emerging Markets,” focusing on some of the largest growth regions for traveling patients including Russia, Ukraine, CIS Countries, China, Japan, Africa, the Middle East and GCC regions. The strong Buyers VIP program targets buyers of healthcare in these emerging marketplaces. Not only has the MTA brought together buyers from across the globe, but the Association has expanded its educational platform and reached out to some of the most inspiring speakers for stronger business development. “The world of healthcare is changing at a rapid pace. It is important that the MTA changes along with it,” said Renée-Marie Stephano, President of the Medical Tourism Association and Editor in Chief of Medical Tourism Magazine. “Our speakers this year and Ministerial participation will serve to provide the most advanced knowledge available in the industry about emerging and existing markets. This congress is the best opportunity to bring executives from around the world together to learn, share and network to achieve your business objectives,” she added. The preliminary list of speakers and sponsors is as follows: Bill Rancic ~ Entrepreneur and Winner of the First Season of the Famous TV Show, “Apprentice” Dr. Robert Rey ~ Cosmetic Surgeon and Star of the Hit Show, “Dr. 90210” Hon. Prof. Peter Anyang’ Nyong ~ Minister for Medical Services, Kenya Vladimir Budiansky ~ Medical Director, Moscow Doctor Corp. Jacqueline Madrigal ~ Human Resource/Benefits Manager, American Apparel Jack Norton ~ Human Resources Manager, Blue Lake Casino & Hotel Muna Almuallem ~ Manager of International Benefits Mary Kay Inc. Mouhanad Hammami, MD ~ President, National Arab American Medical Association Yakov Elgudin, MD, PhD, FACS ~ President, Russian American Medical Association Chris Russo ~ President and Chairman of the Board, American Society of Travel Agents (ASTA) Dr. Hisham Diwani ~ General Manager of Health Insurance for Ministry of Health, Syria

Karen H. Timmons ~ Former President and Chief Executive Officer Joint Commission International and Joint Commission Resources J. Edson Pontes M.D ~ Senior VP International Medicine, Detroit Medical Center Samer Ellahham, MD,FACP,FACC,FAHA,FCCP ~ President, International Association of Healthcare Quality Bill Ruschhaupt ~ Chair, Global Patient Services, Cleveland Clinic David Jaimovich ~ President and Founder, Quality Resources Intl., Former CMO of JCI Dr. Terry Stevens ~ Managing Director, Stevens & Associates Rosanna Gomez Moreno ~ CEO RGM Global Stacy Dreyfus ~ Founder, Orchid Resorts & Escapes This is the one event per year where Employers, Self Funded Health Plans, Insurance Companies, and Medical Tourism Facilitators that are looking to outsource healthcare overseas have the opportunity to meet with top International Hospitals and Medical Tourism Companies in one place for the ultimate networking event. “The World Medical Tourism and Healthcare Congress is the most important gathering of Healthcare professionals to learn about more information about the issues we all face in today’s market. When it comes to the issues about Healthcare Reform, nearly every piece of information is discussed to aid implementation once and when it becomes law. The Congress also allows for networking with the current and new vendors and facilitators to make sound decisions as to where to send our clients for alternative practical costs for exceptional medical and dental treatment.” Ramon Sandoval, Trusted Insurance Services The conference is the dedicated annual event of the Medical Tourism Association, the nonprofit trade association in the Medical Tourism industry, http://www. medicaltourismassociation.com and media partner Medical Tourism Magazine, http://www.medicaltourismmag.com the only dedicated magazine for the medical tourism and global healthcare industry, and by Medical Tourism City, www. medicaltourismcity.com, a social network for the medical tourism and global healthcare industry with over one thousand participants from over sixty countries. The 4th World Medical Tourism and Global Healthcare Congress will also feature four additional conferences, the Global Benefits Conference, http://www.globalbenefitsconference. com, focusing on international employers and insurance companies, the Healthcare Development Conference, www. healthcaredevelopmentconference.com , focusing on the growth of medical tourism in the healthcare sector and the building and development of healthcare facilities around the world, the Healthcare Investment Conference, http://www. healthcareinvestmentconference.com, creating awareness about healthcare investment opportunities around the world and the Health and Wellness Conference, http://www. wellnessconference.com focusing on the continuous growing health and wellness industry. n Contact Silvana Maldonado Silvana@medicaltourismcongress.com www.MedicalTourismCongress.com US 001-561-792-6676

April / May 2011

PRESS RELEASE

Medical Tourism Association Travels the World in a New York Minute

very year The New York Times holds a Travel Show where travelers, vacationers, travel agencies and of course destinations come together for one weekend to entice us with their many options and adventures. This year as part of its Consumer Awareness Campaign, the Medical Tourism Association™ stepped out on the town with its exhibition and education at the show, meeting all of the expectations of a trade based and consumer based event. The Medical Tourism Association (MTA) met with hundreds of Travel Agents, and their partners, Hospitality and Hotel entities, spearheading its major campaign to develop more and more international patient programs through organic travel arrangements. Membership Coordinator Lisbeth Stein stated, “We were really encouraged to find so many travel agents already working with people who travel for healthcare or wellness around the globe. We were overjoyed to spread the word about The Medical Tourism Association™ and its many membership benefits. “While educating a new concept to many of the consumers who came through the exhibition on the second and third days of the event proved to be a challenge, our efforts were successful at raising awareness to our new consumer website MedicalTourism.com (http://www.medicaltourism.com/). The large volume of traffic going to the site last week actually crashed our server,” she added. The Medical Tourism Industry represents a booming niche in the travel market. MTA now has delegates in over 87 countries following its development with almost 1200 attendees at last year’s annual Congress. The 4th World Medical Tourism & Global Healthcare Congress will reinvent itself yet again in the Chicago area, October 25 – 28 2010. The theme of this year’s event, “Emerging Markets” will prove to be an event you will not want to miss ~ bigger, better, and with many more new topics for all to gain knowledge, network, and to walk away with the excitement that this venue and the industry brings. There

will be a special segment focused on the Travel & Hospitality Industries and hope to gain knowledge into this ground breaking industry. (http://www.medicaltourismcongress.com/) The 4th World Medical Tourism and Congress is an excellent way to meet a myriad of potential business partners from all over the world including Europe, Eastern Europe, Asia, Middle East and Gulf Coast Countries as well as from the United States and Latin America. The travel partners in these countries will prove to be the next spokes in the growing medical tourism wheel. n About the MTA The Medical Tourism Association™ (also referred to as Global Healthcare Association and Medical Travel Association) is the first international non-profit trade association for the medical tourism and global healthcare industry made up of the top international hospitals, healthcare providers, medical travel facilitators, insurance companies, and other affiliated companies and members with the common goal of promoting the highest level of quality of healthcare to patients in a global environment. The Association promotes the interests of its healthcare provider and medical tourism facilitator members. The Medical Tourism Association™ has three tenets: Transparency in Quality and Pricing, Communication and Education. http://www.medicaltourismassociation.com/en/index.html . Contact Lisbeth Stein Membership Coordinator US 001.561.791.2000 Lisbeth@MedicalTourismAssociation.com

April / May 2011

M TA M E M B E R HOSPITALS Almater Hospital SA de CV Fco. I Madero No 1060 Mexicali, BC Mexico 2110 City : Mexicali, BC Country : Mexico Phone : 686-523-8000 Fax : 686-553-5235 Website : www.almater.com American Hospital Dubai P.O. Box 5566 Dubai - UAE Dubai UAE Phone: 971-4-336 7777 Fax: 971-4-309 6325 Website: www.ahdubai.com Assaf Harofeh Medical Center PO Beer Ya’akov Zerifin 70300 Israel Telephone: 972-8-9779589 Fax: 972-8-9779526 Website: www.assafh.org Bangkok Hospital Medical Center 2 Soi Soonvijai 7, New Petchburi Road Bangkok 10310 City : Bangkok Country : Thailand Phone : (+662) 310 3455 Fax : (+662) 310 3115 Website : http://www.bangkokhospital.com Baptist Hospital South Florida 8940 N. Kendall Drive Suite 601E Miami Florida 33176 City : Florida Country : United States Phone : 7865964643 Fax : 7865963648 Website : www.baptisthealth.net Beijing United Hospitals & Clinics #2 Jiang Tai Road, Chaoyang District Beijing, 100015 PRC Beijing, China Phone : 59277085 Fax : 59277200 Website : www.ufh.com.cn Conclina C.A. Hospital Metropolitano Avenida Mariana De Jesus S/N y Nicolas Arteta Quito Pichincha Ecuador City : Quito Country : Ecuador Phone : 593 2 3998000 Fax : 593 2 2269247 Website : www.hospitalmetropolitano.org Doctors Hospital #1 Collins Avenue P.O. Box N-3018 Nassau, Bahamas Telephone: 242-302-4600 Fax: 242-323-4801 Website: www.doctorshosp.com FV Hospital - Far East Medical Vietnam Limited 6 Nguyen Luong Bang, Saigon South (Phu My Hung) District 7, Ho Chi Minh City VIETNAM Telephone: (84-8) 411-3333 Fax: (84-8) 411-3334 Website: www.fvhospital.com International Patient Services Telephone: (84-8) 411-3420 Email: international@fvhospital.com International Guide: http://international. fvhospital.com

April / May 2011