Medical Tourism Magazine | Issue 21 by MT Association

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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 21

GREAT HOSPITALS

NEED

GREAT DOCTORS Pg 7

Public-Private Partnerships for Sustainable Growth of Medical Tourism Pg 51

Comfort Zone ~ Satisfying Patient and Health Provider Demands Pg 41

The Challenges of Implementing High Quality Healthcare in Jamaica Pg 56

June / July 2011

ÂŠ Copyright Medical Tourism Association

THESE HOSPITALS ARE AMONG

THE BEST

INTERNATIONAL

ALL HOSPITALS ARE MEMBERS OF THE MTA

HOSPITALS

IN THE WORLD

AFRICA

THE NAIROBI HOSPITAL www.nairobihospital.org

BAHAMAS

ISRAEL

THAILAND

ASSAF HAROFEH MEDICAL CENTER www.assafh.org

BUMRUNGRAD INTERNATIONAL www.bumrungrad.com

JORDAN

BANGKOK HOSPITAL MEDICAL CENTER www.bangkokhospital.com

DOCTORS HOSPITAL www.doctorshosp.com

JORDAN HOSPITAL www.jordan-hospital.com

BRAZIL

THE SPECIALTY HOSPITAL www.specialty-hospital.com

CHINA

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

GMC HOSPITAL www.gmchospital.com

COLOMBIA

ALMATER HOSPITAL http://www.almater.com

MEXICO

UNITED STATES

HOSPITAL ALEMAO OSWALDO CRUZ www.hospitalalemao.org.br BEIJING UNITED HOSPITALS & CLINICS www.ufh.com.cn CLUSTER DE SERVICIOS DE MEDICINA Y ODONTOLOGIA MEDICAL AND DENTAL SERVICES CLUSTER www.medellinhealthcity.com FUNDACION CARDIOVASCULAR HOSPITAL www.FCV.Colombia.org

COSTA RICA

HOSPITAL CLINICA BIBLICA www.hcbinternational.com

ECUADOR

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

GUATEMALA

MALAYSIA

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

PANAMA

HOSPITAL PUNTA PACIFICA www.hospitalpuntapacifica.com

SOUTH KOREA

SEOUL WOORIDUL SPINE HOSPITAL www.wooridul.com

SEVERANCE HOSPITAL YONSEI UNIVERSITY HEALTH SYSTEM http://www.yuhs.or.kr/en SHUANG HO HOSPITAL http://shh.tmu.edu.tw/

INDIA

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

NARAYANA HRUDAYALAYA www.narayanahospitals.com

AMERICAN HOSPITAL DUBAI www.ahdubai.com

BAPTIST HOSPITAL SOUTH FLORIDA INTERNATIONAL SERVICES 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

GUATEMALA HEALTH & WELLNESS TOURISM COMMISSION, AGEXPORT www.healthwellnessguatemala.com MEDANTA – THE MEDICITY www.medanta.org

UNITED ARAB EMIRATES

WAN FANG HOSPITAL http://wfh.tmu.edu.tw/

SEVENHILLS HOSPITAL www.sevenhillshospital.com

June / July 2011

Editorial

DRIVING THE

MOMENTUM T

he Momentum has never been stronger for the medical tourism industry and the Medical Tourism Association. The interest in medical tourism is reaching its highest global peak ever and the MTA has more initiatives in motion for 2011-2013 than ever before. We have launched more projects and to support and sustain the current growth of the industry as well as to infuse even faster and broader ranged growth for patients traveling for healthcare. MTA initiatives are threefold in effect: to raise awareness of the high quality, affordable opportunities to travel for healthcare for the individual consumer; to educate with a purpose of long term adoption and implementation of international healthcare options by international employers and insurance companies; and to educate local and federal governments worldwide to foster improved and increased Public Private Partnerships of stakeholders and to generate the increased support of governments and NGO’s for the initiatives of hospitals and healthcare providers to raise the quality and delivery of care to local and international patients. MTA will be releasing the results of its extensive survey conducted this year which had an overwhelming response. We have learned there is a tremendous growth of interest from Insurance and Employer groups worldwide. And while we have heard marketing and consulting firms talk down about the US market, disenchanted with the rate of implementation for medical tourism programs or serving their own personal agendas in other countries. What we found through the surveys is that the educational programs we have developed through webinars, workshops and conference have really started to take effect. Specifically in the US market, a large IMO is creating a membership group starting from 10,000 initial members up to 100,000 licensed insurance agents to provide information on healthcare reform and also medical tourism so these agents can present to their clients. These educational networks are an important big step towards obtaining buy-in for from the employers they recommend products to. So stay tuned, they are fired up! The greatest announcement for our Membership this year is the opportunities evolved from the launch of www.MedicalTourism. com website under MTA management. We are excited to announce that our new patient/consumer awareness website is up and running at www.Medicaltourism.com. Totally redesigned with a new look, feel and user accessibility options, the site will be translated into eight different languages. In the next few weeks the Arabic and Spanish versions will be up and running with Russian, Chinese, and Japanese to follow immediately thereafter. The MTA is dedicating a good amount of resources to boost the content and accessibility of information to raise awareness of medical tourism and to achieve a central point of information for patients to access timely data on destinations, procedures and providers in various regions. We expect to add thousands of pages of content to the website over the next twelve months. One of our new branding programs is the Healthcare and Medical Tourism Destination Guides which will be in print and online free of charge at www.MedicalTourism.com, providing patients and consumers unlimited access to detailed information about various cities and countries offering healthcare services to traveling patients. The first destination healthcare guide will be unveiled on the website by October 25th, just in time for the MTA’s annual conference.

June / July 2011

This year’s conference, October 25-28th is going to be our best yet with excellent content and improved networking and virtual exhibition opportunities as well as onsite exhibition in a convention hall. The theme of this year’s event is “Patients in Emerging Markets.” October 25, 2011 is dedicated to our members with access to exclusive roundtables and presentations and workshops. A majority of our speakers this year are new speakers whose perspectives will inspire and educate. If you are considered a “buyer of healthcare,” be sure to apply for our “Buyers of Healthcare VIP Pass,” as we will be covering the cost of up to 400 buyers this year from all over the globe. It will be a great event with inspiring Keynote Speakers and we will be announcing the winners of the International Medical Tourism Leadership Awards during the conference. I am proud of the healthcare leaders and faculty that have applied and have been nominated for these distinguished awards. Since we have partially integrated our conference this year with the Employer Healthcare Congress, which is one of the largest US health insurance conferences, we anticipate the greatest exposure to networking opportunities to date for medical tourism attendees to have with employers and the insurance industry. Attendees will also have a great opportunity of networking with international insurance companies and employers through the full integration of the Global Benefits and International Insurance Conference that is organized within the medical tourism conference this year. Why Chicago? Chicago is well known for being a leader in reforming public schools, enhancing public safety and security initiatives, providing affordable housing in attractive and economically sound communities, ensuring accessibility for all and fostering, social, economic and environmental sustainability. It is also the central location of many of the largest employers in the USA and globally. And, most importantly, it is one of the largest cities of populations of international medical associations, consular offices and offers direct flights from all over the globe. We look forward to seeing you there! n

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

MEDICAL TOURISM

EDITOR-IN-CHIEF & PUBLISHER

Renée-Marie Stephano, Esquire

ASSOCIATE EDITORS

Jonathan S. Edelheit Gabriella Vicuña Olivia Goodwin

ONLINE MAGAZINE EDITOR

Marinés Mazzari

REGULAR AUTHORS

Renée-Marie Stephano, Esquire Jonathan S. Edelheit Bill Cook Dan Cormany Dr. Prem Jagyasi Gabriella Vicuña Cristina Cardona Daniel Benzler

CONTRIBUTING AUTHORS

Shawn Connors Vibhu Talwar Adalto Felix de Godoi Anita Medhekar Monica Wainbarg June Smailes Emilio Williams Gabriel Rosales Javier Vera Cucchiaro Patricia Velazquez Horacio Lostia Pablo Salvador Lucas Roic René A. Cadillo

ART DIRECTOR

Renée-Marie Stephano, Esquire

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

REGIONAL OFFICES

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www.linkedin.com/company/medical-tourism-association www.twitter.com/medtour www.medicaltourismcity.com www.facebook.com/medicaltourismassociation

June / July 2011

June/July 2011

Medical Tourism AT A GLANCE

Editorial

Driving the Momentum

The Momentum has never been stronger for the medical tourism industry and the Medical Tourism Association. The interest in medical tourism is reaching its highest global peak ever and the MTA has more initiatives in motion for 2011-2013 than ever before. We have launched more projects and to support and sustain the current growth of the industry as well as to infuse even faster and broader ranged growth for patients traveling for healthcare.

BY RENÉE-MARIE STEPHANO

Features

Great Hospitals Need Great Doctors

Even the best facility is dependent on another key ingredient; the doctors and medical staff who work there. They are the people on whom the reputation of the hospital depends; good doctors attract new clients by recommendation. Conversely, serious negative publicity can be generated by the exposure of poor medical practice. As patients become better informed, so the level of their expectations of care rises.

Food Service, Meet Your New Patron, the Medical Traveler The boom in medical tourism has increased the need

BY DR. JUNE SMAILES

for hospitality staff training and education. The foodservice facet is no exception. While restaurants and hotel food and beverage operations are already seeing the demand for healthy menu options and safer food handling practices, the medical tourist segment could quite literally make these compliances a matter of “life and death.” BY DAN CORMANY AND MIRANDA KITTERLIN

Coordinated Care: What Hospitals Around the Globe Can Learn from the Experience of U.S. Hospitals

Healthcare in the United States, and in many other places around the globe, is living a watershed moment: the advent of Accountable Healthcare, or pay-for-performance. This trend describes the increase pressure by payers (both governments and private insurances) for healthcare providers to show better clinical outcomes efficiency and patient satisfaction, proportionally correlating payments to specific measurements on those fields.

BY EMILIO WILLIAMS

Comfort Zone ~ Satisfying Patient and Health Provider Demands

Medical Tourism is a fast moving and incredibly challenging market place. There are many organizations wishing to jump on the bandwagon and there are many too who are falling off very quickly! Success requires a thorough understanding of ever changing patient demands.

BY ADRIAN MYRAM

The Challenges of Implementing High Quality Healthcare in Jamaica

The demand for effective care for cardiovascular diseases will exert major economic pressure on health systems in developing countries in the years ahead and will further threaten social order and structures in these countries, unless innovative and ingenious approaches are identified to sustainably mitigate the circumstances.

BY ERNEST MADU

June / July 2011

Economics

Rob a Bank for Healthcare- The Only Option in 2011?

This indeed did seem like the only option for Richard James Verone, a 59-year-old from North Carolina, who robbed a bank on June 9, 2011 claiming this was the only way for him to get coverage; because they have to provide healthcare in prison.

BY JONATHAN EDELHEIT

Medical Tourism ~ An Engine to Growth in the Consumption of Medical Equipment

In many countries medical tourism has been a model of economic activity with a significant growth in recent years. This is particularly the case in Asia and Latin America, both emerging as major players in this market. Some of these countries have been treating patients worldwide for decades. Combining the experience gained with existing technology, increased knowledge and participation in international medicine; this has influenced the consumption of medical equipment and is currently becoming an engine for growth in the healthcare industry

BY ADALTO FELIX DE GODOI

June/July 2011

Medical Tourism AT A GLANCE

News & Insights

The 4th World Medical Tourism & Global Healthcare Congress

The 4th World Medical Tourism & Global Healthcare Congress will open its doors to all key players in the healthcare industry from October 25-28th in the city of Chicago, Illinois. With a special focus on bringing buyers of healthcare from different parts of the world, the 4th edition promises to provide the perfect platform for buyers, providers and governments to connect and learn about global healthcares latest trends.

BY CRISTINA CARDONA

Medical Tourism- The Indian Angle

59 X

Current Trends in Esthetic Surgery

Due to the rise in number of non-invasive and miniinvasive procedures, patients now demand optimal results after less-aggressive, lower-risk, brief-recovery surgeries. Plastic Surgery has evolved in the last decade regarding surgical techniques and development of new technologies.

Medical tourism has augmented partly because of increasing healthcare costs in developed countries, crossborder medical training and persistent air travel. The growth of medical tourism industry is marked globally, encompassing around 50 countries in all continents. The leadership is shown by several Asian countries like India, Singapore and Thailand. South and Southeast regions of Asia attract around more than a million medical travellers per year. BY BHAWANA SAHU

B Y JAVIER VERA CUCCHIARO, PATRICIA VELAZQUEZ, HORACIO LOSTIA, PABLO SALVADOR, LUCAS ROIC AND RENE CADILLO

Your Employees Will Be Global Healthcare Consumers — Are You Prepared to Communicate with Them?

A “perfect storm” of trends occurred about 10 years ago in the music industry, and it changed the landscape of that business forever. A fresh wave of consumers suddenly had a new host of Internet tools and a profound sense of empowerment. The conventional method of buying music would soon be history. Get ready, because a similar storm is brewing in the healthcare industry, and an important disruption is about to occur to the conventional system of wellness communication.

BY SHAWN CONNORS

Saving Lives

Effect of Weight Loss Surgery on Metabolic Disorders in the Obese and Non-Obese

It is estimated that 190 million people worldwide have diabetes and it is likely that this will increase to 324 million by 2025. The logic dictates that it will always be easier and cost-effective to prevent diseases rather than treating them, even more so if these diseases are chronic and life threatening such as in the case of diabetes, high blood pressure and the rest of the diseases that accompany the metabolic syndrome.

BY DR. GABRIEL ROSALES

June / July 2011

Sustainability

Public-Private Partnerships for Sustainable Growth of Medical Tourism

Medical tourism is a predominant niche market and of special interest within the tourism segment and the globalized health care service industry. This industry is being facilitated by the destinations’ government, private corporate sector involved in the medical-care and the tourism industry.

BY ANITA MEDHEKAR

Q&A

Medical Tourism Q&A from New MTA Member: Sanivisit International Travel for Medical Purposes~ A Growing Option in Finding Value in Healthcare

Sanivisit is a Company dedicated to the facilitation of Medical Tourism, and is located in Reston, Virginia, USA. Sanivisit provides a complete VIP service; helping the patient schedule a travel itinerary and coordinating all logistical details associated with the medical procedure and vacation. Sanivisit has partnered with Clinica Colsanitas S.A., a premier medical provider based in Colombia, and one of the top healthcare organizations in Latin America.

MEDICAL TOURISM

Great Hospitals

Need Great Doctors By DR. JUNE SMAILES The last few years have seen major improvements in the quality of medical care in hospitals offering medical tourism services across the world. The impact of accreditation has served to ensure that safe practice has been disseminated and accreditation awarded to facilities that, after rigorous inspection, have proved that they meet the standards of the accreditation body.

atients are therefore more easily able to identify facilities that have policies and practices in place that evidence the commitment of the establishment to high quality medical care. The increased use of internet sites to assist patient choice allows potential patients to make more informed choices taking both cost and safety into account. However, the facilities and policies of a medical establishment tell only part of the story. Even the best facility is dependent on another key ingredient, the doctors and medical staff who work there. They are the people on whom the reputation of the hospital depends; good doctors attract new clients by recommendation. Conversely, serious negative publicity can be generated by the exposure of poor medical practice. As patients become better informed, so the level of their expectations of care rises. Doctors are, in general, conscientious practitioners who work incredibly hard to offer the best possible service to their patients. They are committed to providing high quality care and take pleasure and pride in the outcomes of their work.

June / July 2011

In many settings, they work independently and receive little professional feedback from peers or management. This can make the life of a quality manager with a batch of new hospital policies to disseminate, and with the responsibility of informing medical staff using the hospital of the latest agreed safe practices, challenging. I have personally seen examples of hospital managers being reluctant to question known bad practice in case the popular doctor would choose to work elsewhere to avoid changing a lifetimeâ&#x20AC;&#x2122;s habits, resulting in loss of revenue to the hospital. The measurement of outcomes provides a useful tool to ensure that practices within the hospital are optimal. This is

The increased use of Internet sites to assist patient choice allows potential patients to make more informed choices taking both cost and safety into account. ÂŠ Copyright Medical Tourism Association

particularly useful in surgical specialities and to monitor indicators such as infection control. Poor performance on these indicators can ensure that a review of practice highlights areas requiring further investigation, training and resultant change in practice. Increasingly, patients are asking for outcomes evidence and in the case of surgeons, evidence also of the number of procedures performed by particular surgeons before committing to surgery. Whilst most doctors will be excellent ambassadors for the hospital or clinic, a particular challenge, especially with doctors who are not directly employed by the hospital, is to identify those few doctors who are not performing adequately, either because of training needs or for personal reasons. A poorly performing doctor risks not only the health of their patient but also the reputation of the hospital. Doctors are good at helping their patients, but may be less good at helping themselves when necessary. They are less likely than their patients to ask for help for their own medical problems, especially if they are suffering from what they perceive would be a stigmatising illness such as mental health difficulties, alcohol or drug abuse. Self prescribing or ‘corridor consultations’ may replace conventional care, as the doctor struggles with the concept of taking on the patient role whilst maintaining their own professional practice. Early identification of these doctors enables adequate confidential support to be offered to ensure that appropriate action is taken to protect both the doctor, hospital and, crucially, the patient from the inevitable long term consequences of poor performance. Setting up a system to identify these individuals requires several key components. Firstly, the system must be seen as having some advantage for doctors taking part. It must not be perceived as a performance management tool but as a supportive and confidential process. Doctors must trust that it exists for their benefit as well as for patient care. It must be

The measurement of outcomes provides a useful tool to ensure that practices within the hospital are optimal.

evidence based and the assessment not rely solely on the doctor’s own perception of their performance. An annual review, or appraisal, can serve the purpose well. Often, preparation for the review is seen by doctors as the most helpful part of the process providing an opportunity to think about what has happened over the past year, reflecting on how much work has been done and how much has been achieved, and to think about what feels important for the coming year. In the vast majority of cases the review will be an opportunity for the doctor to celebrate all the hard work they have done and to discuss any problems they are experiencing working at the hospital. This, in itself, acts to boost morale and increase loyalty to the hospital. Maria Bugeja, owner of Saint James Hospital Malta, was keen to look at developing a system to offer annual reviews to medical staff at the hospital. In 2009 a team of experienced external medical appraisers were invited to conducted appraisals of both medical and management staff. The experience of the hospital was overwhelmingly positive. Post appraisal feedback sought from staff involved in the process. The second round of reviews in 2010 once again proved to be successful with numerous areas for development of services within the hospital identified, allowing the hospital to improve systems and staff morale. In order to conduct a meaningful review, it is essential that evidence of both achievements and difficulties is submitted. Evidence that is useful in these reviews includes the doctor describing exactly what their job entails, personal audits, outcome data, significant or critical event discussion, and evidence of learning which implies not only attending courses, but also how that learning has been put into practice to benefit patient care. See enough patients and all doctors will receive complaints. Some will be minor and some more concerning. Discussion of the effect of the complaint on subsequent care ensures that lessons are learned. Doctors tend to be perfectionists and a serious complaint can significantly undermine confidence. A review of all complaints received throughout the year may highlight areas which need addressing by the hospital if common themes recur. Health, in its widest sense, should be addressed, ensuring that any problems that may affect patient care are identified and appropriate support offered. Doctors should be strongly encouraged to seek medical help when required and to, when necessary, have an independent view of their ability to work safely. Poorly performing doctors or doctors in difficulty have often already been identified by staff who may not have an easy way of communicating their concern. There are many examples of tragedies that could have been averted if concerns had been shared. Numerous multisource feedback tools are available enabling anonymous feedback from colleagues to be included in the annual review. This area needs to be addressed sensitively as it is important that doctors do not feel threatened that this may result in the ‘losing face’. In reality the feedback is usually excellent and always helpful. One doctor recently was amazed that her colleagues wished she would sometimes ‘say no’. She was exhausted with too much responsibility on her shoulders but felt obliged to take on more and more when asked. Her colleagues were in fact delighted to be more involved themselves and relieved that she was able to decline further responsibilities.

June / July 2011

The basis of the review discussion is one of mutual trust and honesty. In order to make this possible it is important that ground rules are established at the beginning of the discussion. These will vary according to the values of the organisation but the basis should be of a confidential discussion with the proviso that should any issues come to light which may adversely affect patient care that these will be acted upon accordingly. An agreed written record of the discussion is kept by the doctor and the hospital and a personal development plan agreed following the discussion. This should address learning and professional development needs with objectives, deadlines and plan for each need. Different organisations will have their own view as to how much detail should be included in the record and who can have access to it. As part of the discussion the doctor should be invited to give their feedback on the organisation, what works well and what could be improved upon. Sometimes, similar themes emerge throughout several reviews giving the hospital an opportunity to reflect upon possible improvements. Often simple changes can make a big difference and make doctors feel they are both valued and listened to. The review can be a time when frustrations and concerns are shared and it is essential that adequate training is offered the reviewer. The choice of person is vital; most doctors prefer to have a discussion with another doctor, but probably not one with whom they work closely. An independent reviewer model can facilitate more honest and open discussion. It is essential that the reviewer, or appraiser, has adequate training to prepare them for this role which requires a combination of well developed listening skills, empathy, and ability to both support and challenge. Should significant difficulties be identified, support mechanisms must be readily available. Health related issues must be handled sensitively but robustly with the involvement of healthcare professionals. Some doctors feel â&#x20AC;&#x2DC;stuckâ&#x20AC;&#x2122; and unable to resolve their work related difficulties or career choices alone. An effective local mentoring scheme can enable doctors to find their own solutions and move on in their career. Mentoring, or coaching, should be conducted by appropriately trained individuals who are able to facilitate personal and professional growth of the individual.

So, why is all of this important? Successful medical tourism provision, whether international or domestic, requires excellence at many levels. The facility needs to be of high quality and to be seen to practice in safe evidence based way. It requires effective marketing and a reputation for having good outcomes. However, most importantly, it requires its staff to uphold that reputation. The annual review of doctors serves two important functions. The vast majority of reviews will acknowledge the evidenced hard work done by the doctors, listen to concerns and frustrations and agree action plans for the coming year. The important minority will identify doctors in difficulty and offer support to enable them to have the best chance to return to effective practice before patient care is compromised. Doctors have a duty of care to their patients, but also to themselves, to ensure that they are performing safely to the best of their ability. As with all quality initiatives, the important thing is that ultimately the patient benefits. A safe doctor is more likely to have a satisfied patient. n

Dr. June Smailes MB ChB DCH DRCOG qualified as a doctor in Sheffield, UK in 1981. After working for 25 years in clinical settings in hospital and family medicine, including being senior partner of a 4 doctor practice, she became interested in the assessment of quality of healthcare. Becoming a lead surveyor and Board Member of Trent Accreditation Scheme in 2006, she had the opportunity to visit medical facilities internationally as well as presenting at meetings on the importance of improving quality in healthcare. Following training in Doctor Appraisal and Mentoring, and with 4 years experience in providing these services, she offers advice and training to organisations wishing to set up tailored systems to suit their organisation. Contact junesmailes@btinternet.com for further information.

Doctors have a duty of care to their patients, but also to themselves, to ensure that they are performing safely to the best of their ability.

June / July 2011

ÂŠ Copyright Medical Tourism Association

MEDICAL TOURISM

The 4th World Medical Tourism

& Global Healthcare Congress By CRISTINA CARDONA

Experience Chicagoland Chicago is a city of big business; it houses many of the largest employers in the world such as United Airlines, Motorola and Walgreens. In addition to being a hub for business; this multicultural city welcomes its visitors with a rich history, architecture and a wide variety of recreational options. Chicago is well known for being a leader in reforming public schools, enhancing public safety and security initiatives, providing affordable housing in attractive and economically sound communities, ensuring accessibility for all and fostering, social, economic and environmental sustainability.

Bringing all Key Healthcare Players Together This year, Chicago will be the witness, host and active participant of the 4th World Medical Tourism and Global Healthcare Congress, the largest Congress in the industry which will contribute to the city’s diversity by welcoming healthcare industry players from all parts of the world.

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The theme of this 4th edition of the Congress will be “Patients in Emerging Markets”. Regions such as Russia, Ukraine, CIS Countries, China, Japan, the Middle East, GCC regions and Africa, which are going through significant economic and development growth are also experimenting a boom in medical tourism. With the goal of getting all the key players in the industry together, the Congress will be the perfect platform to educate and present the latest trends in global healthcare. Employers, Insurers and Governments who are greatly concerned about rising healthcare costs are facing the challenge of providing the best quality healthcare while trying to reduce their costs. Considering the growing diversity of the workforce, multinational companies are exploring different options among which one of them is international healthcare. This Congress will offer an opportunity to connect with other employers and international insurers who have implemented medical tourism

and global benefits programs in order to discuss challenges, opportunities and best practices in this field. In addition, healthcare providers are more than ever forced to compete more effectively and to foster innovation in multiple areas in order to attract more patients to their facilities due to the globalization of healthcare. According to the Deloitte 2011 Survey of Healthcare Consumers, patient willingness to engage in managing their healthcare is evolving; and, they also believe there are opportunities for their healthcare system to improve in the areas of cost efficiency, effectiveness and clinical effectiveness. These two factors are driving healthcare providers to compete more effectively and to build a brand in international healthcare. The 4th World Medical Tourism and Global HealthCare Congress will be the perfect networking platform to meet with insurance companies, employers, governments, medical tourism facilitators, medical tourism companies and other key players from across the world in order to learn strategies on how to attract domestic and international patients. As a result of a growing number of patients that are traveling overseas looking for quality of healthcare, the Hospitality Industry is also growing faster. Research suggests that patients traveling overseas travel with a companion; and, they usually spend as much as five times more than a regular patient. This has opened valuable new business opportunities for hotels, resorts and spas which offer the perfect environment for rehabilitation and relaxation after a surgery or other treatments. The Congress will facilitate the connection with buyers of healthcare and hospitality providers in order to develop new business relationships and long term partnerships.

The Power of Networking Networking is much more than shaking hands, introducing yourself and talking about your business or organization. It is a people business. It’s about establishing long term relationships looking for ideas that can bring people together and add value to all parties involved. As Thomas Friedman advanced in his book, “The World is Flat,” there has been a perceptual shift required for countries, companies and individuals to remain competitive in a global market where historical and geographical divisions are becoming increasingly irrelevant. The Internet and social networking sites have created a global platform for multiple forms of collaboration. One of the main advantages of this Congress is the networking software which is specifically designed for the attendees to aid in connecting with other participants. The number of face-to-face meetings that any attendee will be able to hold in three days of the conference would take years of traveling to different countries and cities to accomplish. This tool will allow attendees to pick and choose who they would like to pre-schedule a meeting with and to create a profile with photos, bios and organization information. It will also provide integration with other social networks such as LinkedIn and Facebook. Lastly, attendees will be able to use the software through their own iPhone, Blackberry or any other mobile device as well as to receive on time email notifications for cancelled or re-scheduled meetings.

The Heart of the Congress Speakers are the heart of the Congress, bringing with them extensive knowledge and a vast experience in their respective fields of expertise. From business professionals to worldwide recognized doctors including human resource experts, Ministers of Tourism and Health from different countries as well as directors of international patient departments, the Congress will gather an outstanding array of speakers.

June / July 2011

Honorary Prof. Peter Anyang’ Nyong, Minister of Medical Services of Kenya, will speak about the state of healthcare in Africa. Attendees will be able to receive interesting insight about one of the growing upcoming largest growth areas of medical tourism as well as other consumer markets. Jon Casey, Director of International Benefits of Google, will present the development and execution of Google’s global benefits strategy that includes a focus on infrastructure, wellness and innovation, which will help other companies learn about global benefits from one of the top Fortune 500 companies. Innovation and good management are two of the main ingredients for success in every industry. Bill Rancic, entrepreneur and winner of the First Apprentice TV show hosted by Donald Trump, will communicate his vision on how to succeed in business and in life. From the T.V. show Dr. 90210, Dr. Robert Rey, a plastic surgeon who specializes in minimal scar plastic surgery will share the latest trends in plastic surgery which is one of the main reasons why patients travel overseas. Dr. Rey’s valuable experience will attract the interest of doctors and other healthcare professionals looking for the newest procedures in the field.

Four Integrated Conferences in one Congress Medical Tourism and Global Healthcare is a growing market and a vast industry that involves many players with specific interest in healthcare. The four integrated conferences in the congress will cater to the various key players in the industry. The 2nd Global Benefits Conference will gather employers, international insurance companies as well as foreign governments, consultants, brokers, agents, travel insurers, air ambulance companies and anyone involved in purchasing and providing expatriates with health and travel insurance coverage. The 2nd Healthcare Development Conference will focus on the development and design of healthcare projects that are “green” in response to the increasing concern for sustainability which has become a priority for many companies who are dedicated to finding solutions for the sustainability of the planet.

As the healthcare industry grows, investment in this field also rises with expectations of high returns for investors. The 1st Health Investment Conference theme, “Emerging Markets for Healthcare Investment”, will present international investment opportunities in the healthcare sector. Lastly, the 1st Health and Wellness Conference will address topics including integrative medicine, corporate health and global spa trends due to the increasing number of people concerned about improving their overall balance in life through healthy eating and activities. The conference will also discuss how wellness programs at the workplace are progressively being adopted by companies in order to improve the health and wellbeing of their employees as well as reducing healthcare costs.

Partial Integration with the Employer Healthcare Congress For the first time, the 4th World Medical Tourism and Global Healthcare Congress will have a partial integration with the Employer Healthcare Congress. The latter is one of the largest U.S. health insurance and healthcare congresses in the country that incorporates four conferences. The Self Funding Employee Conference will provide an open forum for employers to present their needs while at the same time providing the opportunity to connect with TPA’s, PBM’s, Reinsurers, MGU’s, Brokers, agents and consultants. As the U.S. health coverage environment evolves, working Americans are increasingly turning to voluntary employee benefits to supplement core coverage. Voluntary benefits can now offer added financial security to employees with no direct costs incurred by employers. The Voluntary Benefits Conference is aimed to address these issues and more. In addition, the Corporate Wellness Conference will address topics such as corporate wellness programs which encourage people to take measures to prevent diseases and to adopt

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lifestyles that are healthier. While some corporations have started expensive corporate wellness programs, others have attained savings or increased productivity by just implementing a few simple initiatives that promote healthier lifestyles. The Corporate Wellness Conference’s theme “Creating a Healthy Culture” will focus on the importance of creating a healthy culture where employees believe in their wellness program and trust in sharing information with their employers. Lastly, the National Healthcare Reform Conference will focus on how U.S. healthcare reform affects buyers and providers of healthcare. The National Healthcare Reform Conference will be a fast paced advanced educational and networking event focused on providing answers and solutions. The 4th World Medical Tourism & Global Healthcare Congress will gather all key industry players in Chicago with the goal of achieving a worldwide collaboration for the advancement of global healthcare. n

About the Author Cristina Cardona is the Global Congress Manager of the World Medical Tourism and Global Healthcare Congress. Ms. Cardona received her Bachelor’s Degree in Communications from the Universidad Complutense of Madrid, Spain, and she is currently working towards her MBA at Nova Southeastern University. She has a background in Marketing and Communications having worked in different industries designing successful marketing and customer service strategies.

ChICAgO, ILLINOIS USA

OCTOBEr 25Th - 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 Key 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

AN INTERNATIONAL HEALTHCARE DEVELOPMENT CONFERENCE

dr. hisham diwani General Manager Health Insurance, Ministry of Health - Syria

Philip Pfrang

Preliminary Featured & Expert Speakers

President Russian American Medical Association

Deloitte & Touche LLP

Jacqueline Madrigal

Chris russo

david Jaimovich

Human Resource/ Benefits Manager

President and Chairman

President and Founder

Board American Society of Travel Agents (ASTA)

Quality Resources Intl.

renee-Marie Stephano, Esq. President Medical Tourism Association

J. Edson Pontes M.d

Bill ruschhaupt

Senior VP International Medicine

Chair, Global Patient Services

Detroit Medical Center

Cleveland Clinic

Mouhanad hammami, Md President National Arab American Medical Association

Ori Karev Former CEO

Samer Ellahham, Md,FACP,FACC,FAhA President International Association of Healthcare Quality

Avi Smith Benefits Manager

LeAnne Stefl Senior VP - Director, Global Client Advocacy

B & H Photo

Willis North America

Stacy dreyfus Founder

rosanna gomez Moreno

American Apparel

Orchid Resorts & Escapes

Karen h. Timmons Former President and Chief Executive Officer Joint Commission

International and Joint Commission Resources

UnitedHealth International

Former Chief Marketing Officer JCI

dr. B.K. rana Deputy Director National Accreditation Board for Hospitals and Healthcare Providers (NABH) Quality Council of India

Colin Rohlfing Assoc. AIA, LEED AP BD+C Sustainable Design Leader Hellmuth, Obata & Kassabaum Inc.

CEO RGM Global

Missy Jarrott Director of Human Resources Chatham Steel Corporation

Maria Shepherd Founder

david Collins Healthcare Division

Sherry Kaufield Executive Director, International Services Joint Commission International

Tracy J. Mabry

Shady Fawzy Nawar Middle East Contracting & TPA Development Manager

dr. Prerna Mona Khanna Medical Contributor

Bupa International

FOX Chicago News

Colliers International

Yvonne grassie

Greenberg Traurig, P.A.

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Muna Almuallem Manager of International Benefits Mary Kay Inc.

Jack Norton Human Resources Manager Blue Lake Casino & Hotel

Lead Partner of the Health Care & Life Sciences Merger & Acquisitions Transaction Services Group

Yakov Elgudin, Md, Phd, FACS

Cheryl Matheis Senior VP of Policy Strategy & International Affairs Group AARP

Data Decision Group

Greenberg Traurig, P.A.

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Michael Wesclitz Director, Global Benefits

Christopher Khoury Advanced Consultant, Healthcare Practice

dr. Mahesh C. goel Md, FrCS, MCh, MBA

Philip Morris International

Gallup

Indiana University /Mcgol Associates

Bernard Merkel

Simon hudson Endowed Chair in Tourism and Economic Development University of South Carolina, Columbia

Stuart Brown Vice President Multinational Employee Benefits Willis

Minister Counselor. Head of the Food Safety, Health and Consumer Affairs. European Union Commission

dr. Tadanori Tomita Chairman of the Division of Pediatric Neurosurgery and the Director of the Falk Brain Tumor Center

Childrenâ&#x20AC;&#x2122;s Memorial Hospital

Claudio Querol Leader of Smart + Connected Communities Latin America

Shannon Kraus, AIA, MBA, AChA Senior Vice President HKS, Inc.

dr.ghada M. El ganzouri Head of Business Development office and a Board Member

Ganzouri Specialized Hospital

dr. Saif AlJaibeji, Md, MBA, MhA, Phd

Cisco

dr. remon Farouk Abdel-Sayed Vice President Egypt In-Touch Assistance

Ira Coleman Partner

rolando rodriguez President and CEO

Scott A. Edelstein Partner, Washington DC

McDermott Will & Emery LLP

Jackson Memorial Foundation

Squire, Sanders & Dempsey LLP

gail vittori Co-Director Center for Maximum Potential Building Systems

Patrick doyle Senior Climate and Energy Officer Inter-American Development Bank (IDB)

david P Kalin Md MPh Executive Director International Board of Medicine and Surgery (IBMS)

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Medical Director- Care Management Programs

Green Crescent Insurance Company - PJSC

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2011 Speakers - Continued

Jeff Jensen, AIA

Manuel gómez-Ortigoza

dr. Tamas varhelyi

CTO

Professor and General Manager

HKS, Inc.

Grup Pegaso

Compudoc Plc.

dr. Shetty Heart Surgeon

david J. Bryan, CEBS Marketing Consultant

Founder of a new healthcare facility in the Cayman Islands

Norfolk Mobility Benefits-MSH Americas

Maureen Kennedyharlan

Peter L. godfrey FIA, EA

Director, Global Benefits

International Benefits Actuary and Principal Aon Hewitt

Principal and Senior Vice President

Joy Global

vladimir Budiansky

James Woomer, MSN, CrNA President and CEO Advanced Practice Nurse International

Medical Director Moscow Doctor

Phil Borden, CEBS US Compliance & International Benefits Kohler Co.

Linda Brodsky, Md Founder Expediting the Inevitable Internationally-renowned pediatric otolaryngologist

John O’donnell, drPh, MSN, CrNA

Associate Director for Nursing Simulation The Peter M. Winter Institute for Simulation, Education, and Research

Check our website for regular updates

Medical Tourism Experts & Buyers of healthcare Meet in ChicagoLand! The 4th Annual World Medical Tourism and Global Healthcare Congress is moving fast forward with registration already up by 200% at this time compared to last year’s Congress. The theme “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.

CONgrESS TrACKS: 1 Medical Tourism 2 Inbound and domestic Medical Tourism 3 healthcare development / Sustainability 4 Global Benefits / Expatriate Benefits 5 healthcare Investement 6 health & Wellness

New and Improved Interactive Networking Software. 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.

MEDICAL TOURISM

Food Service:

Meet your

New Patron, the Medical Traveler By DAN CORMANY AND MIRANDA KITTERLIN The boom in medical tourism has increased the need for hospitality staff training and education. The foodservice facet is no exception. While restaurants and hotel food and beverage operations are already seeing the demand for healthy menu options and safer food handling practices, the medical tourist segment could quite literally make these compliances a matter of “life and death.”

KNOWLEDGE OF RESTRICTED DIETS A key consideration when serving the medical tourist will include knowledge of restricted diets and ingredient effects. A pinch of salt or a dollop of butter may appeal to restaurant patrons, but it will certainly conflict with the recommendations of some recovery plans. Food preparation in the traditional food outlet is done in one of two ways: innovatively following one’s instincts and skills for creating what tastes good, or alternatively, following explicit instructions. The menu and recipe decision maker in a property serving the medical tourist will require in-depth knowledge of restrictive diets and dietary health considerations, as well as an understanding of how ingredients affect the body (i.e. Bouillon cubes equal sodium equals a no-no for those suffering from congestive heart failure or kidney disease). Operations will also want to take into account ingredients that can cause minor, but equally uncomfortable complications, such as those with high amounts of chemical additives, sugar, salt, and fat. It will be important to have access to a dietitian regularly for consultation.

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Staff responsible for simply following food preparation directions will also benefit from knowledge of such dietary restrictions. To these chefs it must be explained that necessity of avoiding “creative freedom” or being careless in food preparation when serving this new segment of the traveling public. Chefs frequently enjoy exercising some creativity, so it will be important that they understand the reasons behind such insistence of sticking to a recipe. Knowledge and expression of the severity of consequences may increase awareness and responsibility in all levels of the foodservice establishment. For example, any employee who understands that the germs on their hands can actually kill one of their guests who may have a weakened immune system is more likely to wash and sanitize as frequently as needed. Foreseeable areas for additional training will include preparation and service knowledge, attitudes and practices. A traditional foodservice outlet may not recognize the dramatic effects that otherwise acceptable practices can have on at-risk

(or patient) populations. For example, foods prepared in advance may contribute to the increased risk of food poisoning, but it is not uncommon for a restaurant to participate in these practices on a daily basis. Kitchen staff will routinely cook and hold partially prepared menu items and ingredients. Everyday tasks such as utensil storage will require a greater attention to detail in an aftercare setting, so as to maintain the utmost of sanitary conditions. Dietary considerations need not only by focused on foods that are not recommended for a recovering patient, but also on items that may be recommended to aid in healing. Menu items that are low in salt, sugar, fat, and chemical additives will prevent uncomfortable complications, such as bloating or constipation. Ingredients with high fiber, nutrient and vitamin contents may play a role in expedited recovery, and whole foods should take precedent over processed foods (i.e. baked potatoes versus French fries, whole grain breads versus refined white breads, and fresh fruit and vegetables versus canned, sugary or sodium laden versions). Other menu considerations should include lean protein offerings, which could come from lean poultry cuts, nuts, beans, or protein powder supplements – a stark contradiction to the ever-present cheeseburger. All operations should consider offering a “smoothie” like item on their menus, as it is an ideal approach for supplements, and is often a desired option for those suffering from a decrease in appetite or painful intake or digestion side effects.

The ways that food is procured, stored and prepared play a critical role in preventing foodborne illness. This is not just a kitchen concern. The preparers of the menus and the servers must also be educated on the needs this new clientele poses. In restaurants and hotel facilities serving many medical travelers, special menus or specially identified portions of the regular menu may help guide the guest to those items most appropriate. If a destination is serving a specific sort of medical traveler, such as India’s emphasis on cardiovascular patients, the wait staff may be trained in the special needs of such recovering guests. Verification that menus have been checked and confirmed by dietician experts will provide peace of mind for the medical traveler in assuring their diet is appropriate, and also assist servers in guiding not only the traveler to appropriate menu offerings.

FOOD SAFETY In addition to dietary considerations, operations serving the medical tourist population will require an increased focus on food safety. Foodborne illness and insufficient food safety practices continue to remain a significant problem in the foodservice industry. In the United States alone it is estimated that 1 in 6 (48 million) individuals become ill from foodborne illness, causing 128,000 hospitalizations and 3,000 deaths annually. At risk populations, such as recovering patients, are at a significantly increased risk for severe outcomes in the event of a foodborne disease. While death may be an extreme outcome of unsafe foodborne disease and unsafe food handling, symptoms such as abdominal cramping, fever, diarrhea and dehydration are very common, and can cause not only patient discomfort, but damage to stitches and a critical weakening of the immune system. As described by the Department of Health and Human Services Centers for Disease Control and Prevention, foodborne disease is caused by consuming food or beverage that has

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been contaminated by disease-causing pathogens, poisonous chemicals, or other harmful substances. There are more than 250 food borne diseases, thus there is no “one syndrome” associated with foodborne illness. However, the initial (and most frequent) symptoms include abdominal cramping, nausea, vomiting and diarrhea. The most common diseasecausing pathogens are Campylobacter, Salmonella, E. coli and Calicivirus (or Norwalk-like virus). Campylobacter is responsible for the most food-related cases of diarrhea in the world, and is primarily contracted by eating undercooked chicken or foods that have come into contact with raw chicken; this often occurs from cross-contamination due to inadequate or infrequent hand washing or insufficient cleaning and sanitization. Salmonella and E. coli have gained a great deal of recognition due to the media’s coverage of foodborne illness outbreaks, and both can cause severe complications and life-threatening infections. Norwalk-like virus, or Calicivirus, is an extremely common occurrence, yet is rarely diagnosed, as the laboratory test is not widely available, and it usually resolves itself within two days. This illness is characterized by acute gastrointestinal illness, and is typically spread by infected food preparers’ interaction with ingredients and utensils. The ways that food is procured, stored and prepared play a critical role in preventing foodborne illness. Facilities will need to take great care to ensure that ingredients have been purchased from reputable and “safe” suppliers. Proper cleaning, refrigeration, freezing, thawing, cooking, storage, and handling of food, as well as frequent cleaning and sanitizing work stations, equipment, utensils, and hands remain critical to safe food preparation and consumption. Granted, restaurant and hotel foodservice employees are typically required to have some training in proper food handling, but many practices and precautions may not be taken as seriously in the typical kitchen as compared to a hospital foodservice facility. Properties serving the medical tourist will need to ensure that its staff are trained and held to the utmost standards of food safety practices. The types of food most often associated with foodborne illness are raw meat, poultry, eggs, and shellfish. Foods that combine the products of more than one animal are also a risk, such as ground meat, milk, and eggs: a carton of eggs can contain eggs from a dozen different chickens, making it statistically more likely for the unit to contain ingredients from a contaminated bird. Using the same analogy, one hamburger or one glass of milk may contain products from hundreds of different cows. Nonetheless, bulk products play an essential role in commercial foodservice, and will not be replaced – but foodservice outlets can direct more attention to these ingredients with the knowledge of the increased risk they pose.

Additionally, improper washing of raw fruits and vegetables can cause illness, a step that sometimes receives less recognition, as raw meat products are seen as far more of a threat than other food items. Such washing may, in itself, be a problem in areas with limited potable water, so some menu items offered medical travelers may need to be restricted not because of their inherent problematic nature, but because there is not a way of preparing them that does not expose the traveler to potentially contaminated water. In some countries, the average traveler has been warned for years to avoid fruits that cannot be peeled, or lettuce that may have been washed in questionable water. For the medical traveler, an extension of this precaution seems prudent.

Dietary considerations need not only by focused on foods that are not recommended for a recovering patient, but also on items that may be recommended to aid in healing.

Restaurants offering to collaborate with hospitals seeking medical tourists may usually count on a positive response from such facilities; the international patient offices will appreciate dining facilities which demonstrate such proactive care for their medical guests. Equally important is having menus in the language of the traveler, so they may have a degree of certainty that what they are ordering is in keeping with their recommended diet. In some countries, where the usual diet may be quite different from that of the travelerâ&#x20AC;&#x2122;s native land, explanation of menu content will also help reassure the traveler that the items are not only on their diet, but something they are comfortable in consuming â&#x20AC;&#x201C; no small step toward peace of mind for the medical tourist already under the emotional stress of traveling for medical procedures. Something as simple of a photocopied sheet, available upon request, detailing content and describing local ingredients, can be a significant reassurance to someone in recovery. Are these additional costs worthwhile for the restaurant? Each will need to judge for itself, but if a medical traveler finds a restaurant at which he or she feels comfortable at which to dine, given that recovery time in the country after an operation may be up to two to four weeks, the loyalty of that customer and their family during the recovery process may lead to repeated patronage. n About the Authors Dan Cormany is a Visiting Assistant Professor at the School of Hospitality and Tourism Management at Florida International University and is finishing up his doctoral dissertation on medical tourism. He has a Master of Science in Hotel Administration from the University of Nevada, Las Vegas, and a Master of Arts in Higher Education Administration from Bowling Green State University. He has also studied at the University of Hawaii and University of South Florida, and has a Bachelors degree in communication from the University of Akron. He may be contacted at dancormany@yahoo.com Miranda Kitterlin is an Assistant Professor in the School of Hospitality, Sport and Recreation Management at James Madison University. She received her doctoral degree in Hospitality Administration from the University of Nevada, Las Vegas, with an emphasis in Food and Beverage Management. Prior to beginning a career in academia, she worked for 11 years in the restaurant industry. Miranda holds a Master of Human Resources Management and a Bachelor of Science in Hospitality Management from the University of Louisiana, Lafayette with a concentration in dietetics.

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MEDICAL TOURISM

Your Employees Will Be

Global Healthcare

Consumers —

Are You Prepared to Communicate with Them? By SHAWN CONNORS

IMPORTANT TRENDS ARE AT WORK These powerful fronts are colliding: • Fast, self-help access to healthcare sources and data. Healthcare consumers arm themselves with information by simply using their fingertips. Credible Internet sources abound, and today’s patients can quickly scan reports, share links, ask questions and post comments. • Rising healthcare costs, coupled with anxiety about money issues. Apprehension and hypertension persist. The recession might be over, but widespread worry about medical (and other) expenses remains. Many employees are largely covered under their current insurance plans for a variety of medical issues, and some folks also feel confident that they have funds in reserve, but now more than ever, they occupy a global buyer’s market. Healthcare consumers, like savvy retail

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shoppers, are price-conscious and determined to locate maximum overall value. • Confusion about the future of the U.S. healthcare industry. Are your employees confident that they’ll qualify for a heart surgery or another major procedure in a few years? The more confusing the U.S. healthcare system gets — and the more bickering that persists over upcoming laws and regulations — the more consumers

The simple truth: Individuals will choose to travel for care when the care is of higher quality, more affordable and/or or more easily available than what they can receive at home. © Copyright Medical Tourism Association

will seek alternative options for care. In general, we don’t like waiting around, especially in order to be told what to do.

PATIENTS ARE REALIZING THEIR POWER The combination of these powerful trends will generate at least one important outcome: More of your employees are going to become global patients. “Medical tourism,” the practice of traveling to receive medical, dental or surgical care, isn’t new, but it’s changing. U.S. residents have long been traveling to other countries for care, particularly for cosmetic surgery, dental work, procedures not covered by insurance and procedures not yet approved by the U.S. Food and Drug Administration (FDA). Today, however, many “medical tourists” are fully insured employees seeking all kinds of care—cardiology procedures, orthopedic surgery, spinal fusions, cancer treatments, bariatric surgery, fertility treatments, eye surgery and many more.

The more confusing the U.S. healthcare system gets — and the more bickering that persists over upcoming laws and regulations — the more consumers will seek alternative options for care. The biggest attraction for medical tourists is no secret — cost savings that are often huge. A heart-valve replacement priced at $200,000 or more in an American hospital can cost $10,000 in India, according to the University of Delaware, and that price includes airfare and a post-operative vacation package. Medical tourists receiving care in Thailand save about 70 percent on average, and ones traveling to Latin America typically save at least 50 percent, according to the Medical Tourism Association. The simple truth: Individuals will choose to travel for care when the care is of higher quality, more affordable and/or or more easily available than what they can receive at home. “Many people believe markets perform better than governments in allocating resources, and are much faster to respond to the demands of consumers,” says Fred Hansen, a physician and journalist. “Patients are realizing that the power of the consumer vote, exercised many times every day on choices in different markets. The Internet and cheap airfares have greatly increased consumers’ opportunities and choices by creating new consumer-driven markets.” In hopes of securing a piece of that market, several countries, especially India, Singapore and Thailand offer stateof-the-art facilities that specifically cater to medical tourists. These facilities have advanced technologies and equipment, and often employ physicians trained and board-certified in the United States.

EMPLOYERS AND BENEFIT FIRMS ARE RESPONDING More employers and employees are giving medical tourism options serious consideration. A June 2010 survey conducted by the Medical Tourism Association at a Society for Human Resource Management (SHRM) conference found that 48% of the employers surveyed are “interested” in offering medical tourism to their employers on a voluntary basis, with 36% indicating they “might be interested.”

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Experts say the medical tourism industry could turn a corner if enough U.S. employers and insurers actively promote and underwrite it. Medical tourism is now being considered by industry giants like CIGNA, Aetna and BlueCross BlueShield, all of whom say they have either started or will soon start pilot programs that will offer partial travel medical insurance. Other insurers have already launched pilot programs: • Wellpoint began offering a pilot program with Serigraph Inc., a Wisconsin-based printing company. Under the program, members of Serigraph’s health plan can elect to travel to India to undergo certain procedures, including major joint replacement and upper and lower back fusion, and pay lower out-of-pocket costs. • IDMI Systems Inc., a Georgia-based automation software developer, contracted with Companion Global Healthcare to provide medical tourism options for certain medical procedures to employees and dependents covered by the company’s self-funded health plan.

DISRUPTIONS ARE COMING We believe more companies will realize the credibility and viability of medical tourism, and will begin offering options for employees. Also, companies with self-funded plans will begin incentivizing employees to travel abroad for care. The coming rise in medical tourism will be disruptive to the conventional healthcare system in profound ways: • It will reduce the power of coalitions’ purchasing power when they approach healthcare providers. • It will lead to new “centers of excellence” located across the world. Latin America is already becoming one for dental work, and India is becoming one for heart surgery. • It will showcase the fact that employers aren’t going to give up their rights to affordable healthcare in an open, global economy.

ARE YOU PREPARING? Are medical tourism options right for your employees? You need to take into consideration several different factors, including current health plan choices, employee demographics, risk associated with receiving care abroad and the medical tourism benefit options offered by insurers. No matter what you think of medical tourism, it’s wise to prepare your communication. If you choose to help employees seek overseas care, what messages and education materials can you offer so they can gain a clearer understanding of medical tourism’s advantages? Providing and promoting these materials will help them decide whether medical tourism is right for them. If you choose to not help employees seek overseas care, how will you communicate that decision and defend your reasoning? Here are the two most common questions employees have about medical tourism, and perspective you can share: • Why don’t more insurers offer medical tourism options? Insurers want to take reasonable measures that providers overseas have the credentials to provide adequate care. They’re also concerned with continuity of care — for example, how much are they willing to cover for physical therapy back in the U.S.?

• Do treatments take place in low-quality facilities? Not usually. Medical tourists can find facilities abroad that are as good as ones in the U.S. About 220 overseas hospitals are certified by Joint Commission International, and most doctors who treat medical tourists have trained in the United States, Australia, Canada or Europe. In addition to answering employees’ questions, here is news to keep in mind when considering (or implementing) a medical tourism benefit option: • New medical tourism guidelines have been created. U.S. organizations have begun to establish medical tourism guidelines and programs to assist people in choosing appropriate healthcare for their needs. Employers should ensure employees have a wide range of materials available to them to help them decide which route to care is appropriate. These resources include new medical tourism guidelines from the American Medical Association that the organizations says employers, insurance companies and other entities that facilitate or incentivize medical tourism should adhere to. The guidelines suggest that patients should be referred only to facilities that have been accredited by recognized international accrediting bodies, such as the Joint Commission International or the International Society for Quality in Health Care. • The Medical Tourism Association recently launched its Quality of Care Project. The project focuses on enhancing transparency of the quality of care worldwide so that employers, patients and insurers can better assess

and compare facilities around the world. The project aims to create a single methodology for reporting certain statistics and quality indicators, so that individuals and companies can compare health care facilities’ quality, costs, patient volumes and patient safety records. n

About the Author

Shawn M. Connors is president of Hope Health. He believes behavior change requires a mix of both art and science. He founded the International Health Awareness Center, Inc. (IHAC) in 1981, ch focuses on the importance of communication in positively affecting workplace cultures. Recently, he worked with a talented team to develop a workable, realistic health communication system, empowering thousands of workplaces and community-based clients to communicate more effectively with new media. Shawn has earned the respect of marketing professionals and health educators alike. About Hope Health Hope Health, based in Kalamazoo, MI, is an experienced, multimedia content provider offering new perspectives in wellness and benefit communications to workplaces and community organizations. Website: www.hopehealth.com

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MEDICAL TOURISM

Rob a Bank

for HealthcareThe Only Option in 2011? By JONATHAN EDELHEIT

erone handed a note to the teller claiming he had a gun, and demanded $1 US dollar. After she gave it to him, he sat in the bank’s lobby waiting for the police to arrest him. He asked only for one dollar so that it would be clear his motive was not to rob the bank, but get arrested to receive care. He has no job, two ruptured disks and a growth on his chest. He hoped he would be sent away to prison for three years and that would allow him time to get all the medical care he needed to be healed. Verone told reporters, “If it is called manipulation, then out of necessity because I need medical care, I guess I am manipulating the courts to get medical care.” Unfortunately for Richard, it is estimated he will only get sentenced to 12 months in prison, and may not get all the medical treatment he intended to. I think as individuals, many of us who are involved in the healthcare and health insurance industry forget about the people who don’t have or can’t afford health insurance. We forget to put ourselves in their shoes, to feel their fears, pain and desperation. We are removed by it all, because while it is an emotional topic, we have health coverage, we may not be happy with it, it may be expensive, but we have it. It’s not a healthcare crisis; it’s a healthcare disaster. It’s not getting better, it is only getting worse, and the passage of healthcare reform legislation will just continue to degrade it, as costs are increasing. Is this what America has come to? People committing crimes so they can get free medical care from the state while

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in prison? There are more and more Americans like Richard who don’t have jobs, and in the future small employers may be forced to lay off more employees because of rising healthcare costs. Many small employers are getting renewals on their group health insurance as high as 40%. That’s crazy! What happened to the promises of lower costs under healthcare reform? People are starting to finally realize, that’s all it was, promises, and we need real healthcare reform and soon. n

About the Author Jonathan Edelheit is CEO of the Medical Tourism Association™ and Associate Editor of the Medical Tourism Magazine. With a long history in the U.S. health insurance industry, including running a national healthcare administrator, Mr. Edelheit was the first person in the U.S. to implement medical tourism into health insurance plans. Mr. Edelheit is also editor of several leading U.S. health insurance magazines and organizes one of the largest U.S. healthcare conferences in the U.S. for employers and health insurance companies, the Employer Healthcare Congress. Ms. Edelheit is the co-author of “Medical Tourism: An International Healthcare Guide for Insurers, Employers and Governments.”Mr. Edelheit can be reached at Jon@MedicalTourismAssociation.com.

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MEDICAL TOURISM

Medical Tourism ~

An Engine to Growth in the Consumption

of Medical Equipment By ADALTO FELIX DE GODOI

In many countries medical tourism has been a model of economic activity with a significant growth in recent years. This is particularly the case in Asia and Latin America, both emerging as major players in this market. Countries like Thailand, India, Costa Rica, Brazil and Mexico are becoming quite competitive as destinations for medical tourism, exceeding international benchmarks established from most developed countries.

INTERNATIONAL ECONOMIC CRISIS ~ PRO’S & CON’S Some of these countries have been treating patients worldwide for decades. Combining the experience gained with existing technology, increased knowledge and participation in international medicine; this has influenced the consumption of medical equipment and is currently becoming an engine for growth in the healthcare industry. The international macroeconomic climate and unfavorable scenery in many developed countries in recent years has helped some emerging countries take advantage of the deterioration of strong currencies such as the dollar and euro, to import medical equipment at a lower cost, in comparison to years prior to the international crisis. Conversely, the currency of some countries such as Brazil actually appreciated, making it far more cost effective to import high-cost equipment in segments such as the healthcare

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industry. Though much of the equipment is aimed at the private healthcare sector, and consequently also utilized as a valuable marketing tool to engage and attract international patients with the “state-of-the-art”, “cutting edge technology”; the reality is that the benefits of such innovations trickle down to the local population by stimulating the economy of the destination and providing local patients with access to treatment options they may have not had before.

SUPPLY AND DEMAND ~ WHO’S WHO The worldwide growth of medical tourism can also be observed by the demand for medical and hospital equipment for countries in Asia and Latin America. There are currently about 12,000 companies worldwide that produce and sell

The reality is that the benefits of such innovation trickle down to the local population… © Copyright Medical Tourism Association

medical and hospital equipment generating revenues exceeding $50 billion USD, among which are well-known companies such as GE Medical Systems, Varian, Siemens Healthcare, Hill-Rom among other regional and national firms whose sales increased significantly in recent years. It is observed that countries working with medical tourism are some of the major buyers of medical equipment; a better healthcare infrastructure creates trust and attracts highly qualified demand, able to pay a premium price to have a top quality service. The same equipment used for an inhabitant serves the overseas patient as a sales strategy. Among the countries that consumed more medical and hospital equipment in recent years are countries embracing medical tourism as occurring in Latin America, for example, Brazil with a 25% growth in 2008 and importing about 34.28% of the region amount. The demand comes to be higher than in richer countries that do not necessarily have the equipment they sell in the same proportion of the countries, which are the “buyers”. The sale of the equipment in the U.S. between 2003 and 2007 was greater for countries involved in medical tourism than highly developed countries like Canada, Japan, Germany, Belgium, Switzerland and others in an average ratio of 10.1% more. Contributing to the expansion of the healthcare sector in the region and acting as an engine to the international economy importing equipment of high value-added from the country’s most affected by the crisis.

Companies worldwide that produce and sell medical and hospital equipment are generating revenues exceeding $50 billion USD. The largest importers of medical equipment in Latin America are Brazil, Chile, Mexico and Venezuela, which in 2008 accounted for 75.05% of the Latin American market share. Other countries consume at a slower pace as Bolivia, Paraguay and Uruguay. Obviously it’s impossible to state that just possessing advanced medical equipment increases the confidence of patients seeking medical treatment abroad, but the high technology in an existing healthcare facility helps promote and attract more patients instilling confidence in the healthcare facility. The graphic below shows the Latin America participation in the region with the consumption of medical equipment in the diagnostic imaging segment.

Percentage of medical equipment imported in 2008 by countries in Latin America Each country usually imports the equipments, which reflect their areas of expertise or specific needs for its healthcare system, renewing or increasing the public and private healthcare technology. The table below shows the proportion of most imported equipments in three of the main importer countries.

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Country

Brazil

Venezuela

Mexico

Equipments

Percentage

Magnetic Resonance Imaging

32.7%

26.0%

Echocardiography-Doppler

24.7%

Echocardiography-Doppler

37.3%

Gamma Cameras

25.9%

Mammography, Angiography and Densitometry

15.6%

Radiological screens, parts, accessories, X-ray

27.8%

Echocardiography-Doppler

25.6%

Magnetic Resonance Imaging

18.6%

According to ABIMED (Brazilian Association of equipment and products importers, medical and hospital suppliers) in the first quarter of 2010 the industry of materials, equipments, medicines and diagnostics generated 2,100 new jobs over the stock of labor in 2009. The Department of Labor also reported that the level of employment, taking into account the sum of the activities of the industry was 6.9% higher than the same period in March 2009. The acquisition of new equipments also resulted in hiring more skilled labor. Another interesting find is the growth of total pharmaceutical sales in the last five years, and despite the international crisis they will probably grow in three of the five regions studied, including Latin America. Region

2003 a 2008

2008 a 2013

North America Europe Asia, Africa & Australia Japan Latin America

5.7%

6.4%

13.7%

14%

2.7%

12.7%

14%

Medical tourism is experiencing a rapid growth worldwide, especially in countries within Asia and Latin America. Despite the international economic crisis, which affected many highly developed countries; they became important destinations for medical tourism attracting important part of the international demand and becoming world renowned in several medical specialties. With a comprehensive and advanced healthcare system and infrastructures, several countries in Asia and Latin America have also become accredited by international bodies, such as Joint Commission International (JCI) having the same quality level the best hospitals in the most advanced countries have, attracting skilled labor and consuming more high-tech and medical equipment than many others advanced countries. n

About the Author Adalto Felix de Godoi is a specialist in Strategic People Management and holds an Executive MBA in Strategic Business Management. He is also a healthcare consultant, teacher and author of several articles and books in the healthcare industry with over 22 years of experience.

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MEDICAL TOURISM

Medical Tourism Q&A from New MTA Member:

Sanivisit

International Travel for

Medical Purposes ~ A Growing Option in Finding Value in Healthcare

Q: How much can one save by going this route?

A: Medical Tourism takes place when people who reside in one country travel to another to receive medical, dental and/or surgical care, and are inclined to travel to obtain their perceived value. That value includes faster access to treatment, a higher level of quality health care, advanced research and technology or a value in cost.

A: The Journal of Financial Planning estimates that savings may range from 50 to 95 percent of the U.S. cost. Even factoring in the cost of airfare, hotel, rehabilitation and follow-up, local taxes and other incidentals, the cost reductions are substantial. One should ask a trusted Medical Tourism facilitator or an internationally recognized hospital for a breakdown of its quote before proceeding.

Q: How many Americans are traveling to obtain health care abroad? A: Numbers are hard to come by, but according to some estimates, no less than 500,000 Americans go abroad each year to get advanced medical care from more affordable hospitals and clinics in countries like Colombia, India or Thailand.

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Q: What precautions should a patient take before embarking in such a trip? A: A few recommendations include checking to see if there are patient testimonials available and if you could perhaps contact the patient that gave the testimonial as they were

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once in your shoes. Also, educate yourself on the licensing requirements, accreditation and best practices established by the destination and how the medical professional you are evaluating measures up. Q: What are the typical services offered by a medical tourism facilitator and what value does it bring to the patient? A: The Medical Tourism Facilitator provides you access to a selection of medical, ophthalmological and dental procedures delivered by highly qualified medical professionals in world-class facilities at international locations. Many offer customized, VIP services in the packages available. You will likely be escorted from the moment you arrive at the airport until you are ready to go home. Facilitators can arrange access to Private VIP waiting rooms at the hospital, dedicated driver, concierge services, guided tours and much! Q: What are the typical services offered by a medical Tourism Facilitator? A: At the point of origin you will have a dedicated case manager appointed to serve as your liaison with your hospital and your physician of choice as well facilitating communication between your home physician and your destination physician. He or she will also be your travel and logistics guide before you depart.

At the point of origin you will have a dedicated case manager appointed to serve as your liaison with your hospital and your physician of choice as well facilitating communication between your home physician and your destination physician.

With regard to your needs at the point of destination, the medical tourism facilitator will help you choose the accommodation that fits your needs and, through a local agent, assist you to find foreign language interpretation services, if needed, as well as assist with connectivity, local transportation, appointment coordination, etc. Q: Are there any other reasons why people chose an overseas destination to seek health care? A: Patients may be inclined to travel to offshore to have procedures that are not widely available in their own countries. For example, stem cell therapy for any one of a number of problems may be unavailable or restricted in industrialized countries but may be much more available in the medical tourism marketplace. Some patients, particularly those undergoing plastic surgery or seeking fertility treatments, choose to go to medical tourism destinations because they are more confident that their privacy and confidentiality will be protected in that setting. Q: What’s behind the dramatic cost benefits from obtaining health care abroad? A: The primary reason that medical centers in developing countries are able to provide healthcare services inexpensively is directly related to the nation’s economic status. Indeed, the prices charged for medical care in a destination country generally correlate with that nation’s per capita gross domestic product, which is a proxy for income levels. Accordingly, the charges for healthcare services are appropriate for the level of economic development in which the services are provided. Low administrative and medical legal expenses for overseas practitioners also contribute to the affordability of offshore medical care. n

About the Author Sanivisit International LLC (http://www.sanivisit.com) is based in Northern Virginia and may be contacted toll free at 1-877-836-3233

June / July 2011

COMMITMENT TO BUSINESS EDUCATION

OFFICIAL BOOKS

MEDICAL TOURISM

Coordinated Care:

What Hospitals around the Globe Can Learn from the Experience of U.S. Hospitals By E.M. WILLIAMS-LOPEZ

ith the increase in consumer and patient empowerment, and the growth in choices that patients have for quality healthcare in local, regional and international markets, patient satisfaction is a priority for all hospitals, independently of when (and not if), pay-for-performance will be coming to a particular market. Clinical Care Service Coordinators will have an important effect on how institutions prepare for Accountable Healthcare because they are helping to increase patient satisfaction, and are also freeing time from nurses so they can spend more time coordinating the clinical aspects of their visits and therefore having a more positive clinical impact on the patient.

Meet the Clinical Care Service Coordinators In the last year, Johns Hopkins has hired over twenty CCSCs, and the number will be increasing. Each coordinator

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is assigned to a nurse unit, or specific floor. Although these coordinators do not have formal clinical training, theyâ&#x20AC;&#x2122;re neither nurses nor physicians; their main function is not to be underestimated. A CCSC establishes a direct relationship with inpatients and their family members. They get to know patients and relatives in a more personal way. Hopefully that emotional rapport will increase feedback from patients and will give hospitals a chance to get things right

Coordinated care, a service provided by patient navigators, resulted into highly satisfied patients, who, in turn, became very loyal advocates for the institution. ÂŠ Copyright Medical Tourism Association

They get to know patients and relatives in a more personal way. Hopefully that emotional rapport will increase feedback from patients and will give hospitals a chance to get things right.

Around that time, Hopkins started investing heavily in new units that will serve as change agents in the journey to deliver world class services. Those units were staffed with patient coordinators, or navigators, that helped patients coming to Hopkins from overseas (Johns Hopkins International), or from out-side the state of Maryland (Hopkins USA). Contrary to CCSC who are based in one unit or floor, international and national patient coordinators are a one call full service, contact person for all aspects of a visit to the institution. These units demonstrated that coordinated care has a huge, measurable impact on patient, physician, and payer satisfaction. Most importantly, the units became very rapidly not just selfsufficient from a financial perspective, but very lucrative for the institution, and for the many institutions in the United States that developed national and international patient programs. Coordinated care, a service provided by patient navigators, resulted into highly satisfied patients, who, in turn, became very loyal advocates for the institution; a de-facto marketing department that would recommend the institution to friends and family members around the world. In many instances, that loyalty turned even into monetary contributions, or philanthropic gifts, to the development of the not-for-profit mission of Johns Hopkins. Hospitals around the globe interested in the medical travel segment should carefully look at the lessons learned from the in-bound medical travel segment in the United States.

Global Centers of Excellence Leading U.S. Medical Centers are a great case on best practices when it comes to the coordination of out-of-town patients. These centers learned very early into their out-oftown growth that non-clinical services are key for a successful play in the national and international arena. According to a study published in McKinsey Quarterly in November of 2007: “More and more patients are likely to base their choice for hospital on non-clinical aspects of the visit-like convenience or amenities.” Why is that? As quality of care increases in the U.S. and abroad, as more and more hospitals acquire the stamp of approval of an international accrediting body, patients take clinical quality for granted. CCSCs are highly trained in all aspects of customer service and patient satisfaction, with a special focus on service recovery. Service recovery is the strategy that allows hospital employees to turn a bad situation into a positive experience for our patients and their families. Service recovery is the best training that we can give to all our staff members, it should be mandatory, because it offers our troops the empowerment and skills to be ahead of the curve and prevent any bad situation from escalating into a full-blown patient complain.

World-Class Coordinators Years ago at Hopkins, the buzz word was “Service Excellence”. The institution had come to the realization that the service was not on the same level as the science. Many of the leaders and employees felt that it had fell into the narcissistic trap of treating patients as “you’re lucky we’re saving your life”. Things had to change, especially if the institution wanted to become a national and international destination for patients.

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On top of that, for most of us, the clinical aspects of the encounter are a mystery. Our first impression about the quality of a physician, a nurse, or a whole hospital, is not based on medical aspects of the encounter. Rather, our first and lasting impressions of a hospital are based, research shows, on “how well staff communicated with me”, or “the overall cheerfulness of the institution”, or “how quickly my concerns were addressed.” Coordinated care is especially important for out-of-town patients. We need to offer patients traveling from other locations a complete experience that will include all aspects of service before, during and after their appointments and visits to our hospitals. Proper continuity of care continues to be the thorn in the side of the international medical travel industry. It threatens the credibility of our whole industry and, most importantly, the safety of our patients.

To secure the proper continuity of care, many U.S. medical centers also employ one or two full time case managers, or clinical nurses who interact with clinical and non-clinical personnel to secure the proper continuity of care. Still the larger piece of investment will have to be on navigators and non-clinical coordinators. Hospitals will have to invest on those coordinators, our human capital, to secure the proper training and to make sure that those coordinators are happy and well engaged in their role. It has been demonstrated, over and over again, that without satisfied employees we canâ&#x20AC;&#x2122;t have satisfied patients.

More and more patients are likely to base their choice for hospital on non-clinical aspects of the visit-like convenience or amenities. The right processes, implemented by the right people will have to be supported by some simple technology solutions, tools that will allow the institution to track all aspects of a patient visits, his or her preferences, and will allow us to follow up properly and at the right times with the patients (birthdays, maybe, or time to schedule follow up appointments). Processes, people and technology, will be the three legged stool in which we can rest our Customer Relationship Management (CRM) strategy. CRM will result in loyal patients, and loyal employees, which in term will result in increased volumes, from our target markets, and revenues.

Cultural and Linguistic Services One of the areas that U.S. centers have excelled at is cultural and linguistic services. The natural cultural and

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linguistic diversity of the United States, has given these centers a competitive advantage over other locations around the globe. The need for cultural and linguistic competence is fundamentally important from our websites and marketing materials, to our actual in-person services. For example, how can a hospital outside the U.S. create a sense of quality and credibility to attract U.S. patients if their communications in English are not impeccable? And most importantly, are our physicians and nurses ready to handle the challenges of taking care of patients from a very different culture? Coordinators can also be a cultural broker between our institution and our patients. Most U.S. centers with international programs employ native, certified interpreters that can be assigned to patients from the same country, with the same languages, and in cases with the same religious background. At the end of the day, hospitals will have to invest in human capital, and culturally competent coordinated care, if they are serious about becoming an international player. Good pricing will not suffice to compete in the international arena unless it comes along with quality. Non-clinical coordination, as we have seen, is a tool we can use to easily improve the satisfaction of our patients traveling for healthcare. n About the Author E.M. Williams-Lopez is a former Managing Director and Strategic Advisor for Johns Hopkins Medicine International. He has traveled around the globe giving talks and seminars on patient experience, service excellence and cultural competency. He currently works as a consultant helping hospitals develop and implement strategies to build up new domestic, regional and international markets and coordinated patient programs. He can be reached at williams@strateghealth.com

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BE FEATURED OR LISTED AS ONE OF THE

Leaders in Medical Tourism & Global Healthcare

WHO’SWHO

OF MEDICAL TOURISM 2011 EDITION Don’t miss out in being featured in the main directory of Industry Leaders - Let future business contacts find you easily! Printed and Distributed at the 2011 World Medical Tourism & Global Healthcare Congress in Chicago Featured Year Long on the Medical Tourism Magazine Website Emailed to over 20,000 Healthcare Leaders INCLUDING Insurance Companies • Employers • Hospitals • Medical Tourism Facilitators • Governments • Healthcare Providers • Healthcare Leaders • Consultants and More

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WHO’S WHO 15 Categories to Choose From

• • • • • • • •

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OF MEDICAL TOURISM 2011 • • • • •

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MEDICAL TOURISM

Comfort Zone~

Satisfying

Patient and Health Provider

Demands By ADRIAN MYRAM

his is no easy ride but a nail biting rollercoaster that even the most experienced and seasoned professionals in our industry struggle with. It is about listening to what the market is saying, reading the trends and then reacting and adjusting your strategy to survive. People entering the business need to be brave and smart. This market has been compared to the Gold Rush. There are lots of people falling over themselves to take a piece of the action with very high and arguably misguided expectations. But beware the fools’ gold! This is still a very immature emerging market and has to be treated with respect and patience.

Medical Tourism Comfort Zones Medical Tourism is a term many use to describe the flow of patients across international borders. Our definition though is not so simple and black and white. As an organization committed to matching patients to healthcare providers around the world, we have our own insights into the market and what it represents. We believe Medical Tourism is a concept of patients travelling outside their neighborhood but fundamentally within their “Comfort Zone”. Understanding these ever changing Comfort Zones is critical to keeping up with the market and delivering an effective service for patients and healthcare providers. We recognize that the comfort zones vary for every single patient.

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What works for one patient may not for another. Some patients are frequent travelers and will think nothing of jumping on a plane and travelling across the world for surgery. Others will feel completely out of their depth but would be comfortable travelling within their own country. Comfort Zones are like ripples. They are stronger near the source and get weaker and weaker. The further away you travel from your home, the less likely it is you will be prepared to have surgery there. Healthcare providers are all pitching for a piece of the market and if you are trying to reach people on the furthest ripple you need to recognize that the target market is significantly smaller. There are often easier pickings nearer to home and there is still a massive market to explore for Medical Tourism within countries but these can be busy markets forcing people to push the boundaries along the ripples. This is a dangerous game and every provider has to decide which part of the market they want to operate in whilst recognizing that the market changes and it can change very quickly! These Medical Tourism Comfort Zones continually shift and understanding these shifts and reading what influences them is important. Take the US market for instance. In recent years we have seen a general trend that the Comfort Zone for US patients has shifted. There are still plenty of patients prepared to travel across continents but it is fair to say that there is a trend in US patients staying closer to home and travelling only as far as Latin America or staying within US borders. There are many

reasons for this – more competitive pricing in the US, improved quality in Latin America hospitals, political unrest elsewhere in the world or general economic instability to name a few. But rather than thinking the end is nigh for Medical Tourism it is simply a case of reading the opportunities. Some markets may shift in one direction, whether on a temporary basis or otherwise, but it is likely that opportunities will arise to compensate. Overall Medical Tourism is undoubtedly a growth market as a whole but you need to understand each individual market. The Comfort Zone for some US patients may have shrunk but Comfort Zones for other patients around the world are expanding for different reasons. Patients from Africa for instance are actively seeking to travel for treatment, as the opportunities may not be available in their own countries. We have adjusted our marketing not just to target familiar US and UK patient markets but also to seek out other patient markets around the world that may be less familiar but are craving to have access to Medical resources around the world.

Healthcare Provider Evolution As an organization working with patients from all over the world and dealing with healthcare providers in over 40 countries we have an enviable position to evaluate the market place. Healthcare providers have to be very targeted in their approach and we have seen many multinational facilitators take radical and necessary steps to change their strategies to react to the market place. Some have decided to move away from traditional procedures such as cosmetic surgery and focus in specialist areas such as stem cell therapies. Others have moved away from servicing certain geographic regions and grown their networks closer to home. Others still have moved away from patients groups recognizing that certain patients are more difficult to convert than others! As a lead generator servicing these providers we have worked with healthcare providers to understand the market place and even in our relatively short 3-year history we have evolved significantly and will continue to do so. Reacting to the market place is not just about understanding where patients are travelling to. It is equally about what they are prepared to travel for and why. Healthcare providers need to consider patient behavior as well as competitor behavior. It is a hugely complex world for those involved in Medical Tourism. Prices are changing around the world and it is clear more competitive pricing in the US and UK is having an impact on patients travelling further afield. It is not changing the fact that there is a growing Medical Tourism market but it is changing where patients are travelling to. Quality is also changing around the world and the improvement in quality and the work of accreditation and other bodies to promote this is opening up new markets. The accessibility of new cutting edge treatments around the world is also an important part in defining the market. There will always be centers of excellence whether in the USA or China for example and these will dictate where patients will be prepared to travel to. Healthcare providers are finding innovative ways to keep up with the pace and obtain a competitive advantage. In some cases doctors themselves are travelling to overseas clinics and hospitals and operating there to reduce costs for patients. Many providers are offering consultations for patients in their home countries to give patients assurances before the travel. It is also refreshing to experience that the objectives are not always about making money but also about making affordable healthcare more accessible around the world. This truly is a caring profession and Medical Tourism is now even evolving to doctors travelling to “outreach centers” in Developing Countries to treat groups of people locally that otherwise would not have access to their services.

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Finding the Balance We are caught in the sandwich between patients and providers and simply offer a dating service to match the two. Success for a lead generation company is about finding that balance between what patients want and what healthcare providers want. People want information, they are curious about the Medical Tourism market and they crave information. However, this does not mean they are ready to travel and commit to surgery overseas. Healthcare providers on the other hand want quality patients who are ready to travel. There is large area in the middle full of window shoppers! We act as a filter to separate the wheat from the chaff. We seek to satisfy the patients’ demand for information and ultimately, when they are ready we will introduce them to the most appropriate Healthcare providers that can satisfy their treatment needs.

The accessibility of new cutting edge treatments around the world is also an important part in defining the market. We are evolving away from patients making comparisons based purely on price towards providing information to allow patients to research and make informed decisions about their medical journey. We recognize that this is a difficult and oftencomplex decision for patients and it is not just about price. Price is just one factor and patients need information about quality, waiting times, new treatments and techniques etc. Patients will only be in a position to make a decision when they have fully understood all aspects. Travelling abroad for treatment involves risk and to keep them within their Comfort Zones they need information to help them manage this risk and provide the necessary assurances. Only then will they make a commitment to travel. Understanding patients and their Comfort Zones is one thing. This is just the starting point. Attracting the right patients and giving the healthcare providers the best chances of converting patients is all part of the challenge... n About the Author Adrian Myram is Chief Operating Officer of AllMedicalTourism.com and qualified as a Chartered Accountant with KPMG. He has extensive commercial experience across many industries including Medical Tourism. AllMedicalTourism.com is run by a group of Internet marketing experts. After a resounding success in the online travel industry they have brought the same web marketing knowhow to the Medical Tourism industry to help healthcare providers, from hospitals to facilitators, to find the patients they seek. AllMedicalTourism.com was founded on a very simple concept: matching patients seeking care with healthcare providers offering the very services these patients are seeking. It’s simple, and it’s effective. It has grown into a truly international operation with an impressive portfolio of healthcare providers covering a wide range of procedures in over 40 countries and attracting patients from all over the wide. They use highly targeted marketing techniques and a range of marketing channels to locate patients who use the internet to research their healthcare options for specific procedures. These patients are then matched to appropriate healthcare providers who can satisfy their needs on a real time basis. To find out more please visit their website at www.allmedicaltourism.com or join their patient community by searching for AllMedicalTourism on facebook.

June / July 2011

ÂŠ Copyright Medical Tourism Association

ChiCago, illinois Usa oCTober 25th - 28th 2011

Buyers of Healthcare

MEDICAL TOURISM

Current Trends in

Esthetic Surgery By JAVIER VERA CUCCHIARO, PATRICIA VELAZQUEZ, HORACIO LOSTIA, PABLO A SALVADOR, LUCAS S ROIC, RENÉ A CADILLO Due to the rise in number of non-invasive and mini-invasive procedures, patients now demand optimal results after lessaggressive, lower-risk, brief-recovery surgeries. Plastic Surgery has evolved in the last decade regarding surgical techniques and development of new technologies. Reduced-scar, liposuction-combined surgeries, represent now less traumatic procedures, delivering better results at a deep and superficial level, remodeling neighboring areas at the same time. On facial surgery, procedures are now combined with synthetic or fatty grafting, botulin toxin application, CO2 or laser resurfacing, elevation of eyebrow tail with barbed sutures, etc. Prosthetic implants have also evolved in their structure, variety size and projections. Moreover, new techniques like intimacy surgery have appeared on scene for both genders.

election of an optimally capacitated, matriculated surgeon, well trained on evaluating valid combinations of technologies and techniques, will influence on satisfactory outcome with minimal surgical risk.

NON-INVASIVE AND MINI-INVASIVE PROCEDURES There has been a rise in the number of the non-invasive and mini-invasive procedures. Fatty and synthetic fillers, botulin toxin injection, barbed sutures, medical depilation, radiofrequency, ultrasound cavitation, are some examples. With these options available, patient expectations on surgery have risen. Patients demand optimal results with less-aggressive, less-traumatic, lower-risk, short-recovery procedures. An

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increase in patients’ work-demands, and the amount of patient information available on the Internet, are also determining factors. In the last decade, plastic surgery has also evolved to satisfy those demands. Surgical techniques have evolved at the time new technology development and evolution has occurred. Surgeons have to remain objective, with clear medical criteria, avoiding false promises. In general there has been a rise of 700% on the frequency of non-invasive procedures with only a 25% rise on esthetic surgery. Other factors also influenced plastic surgery. Scar location and size on breast and abdominal surgery have adjusted to cloth size and shape (a difficult challenge sometimes) in order to render them hidden. Even hair styling has influenced scar modeling.

MACS (Minimal Access Cranial Suspension (Tonnard & Verpaele, 2002) is a good example of a technique that allows younger patients to be treated, with a less aggressive, more natural result. Barbed Sutures also help to rejuvenate face and neck on a less aggressive manner. Associations with fat grafting performed by a specialist, have excellent results. Other associations can be made to include resurfacing with CO2 fractional laser on perioral shrinking, botulin toxin for forehead and periocular shrinks, and elevation of eyebrow tail with suspensor threads.

In general there has been a rise of 700% on the frequency of noninvasive procedures with only a 25% rise on esthetic surgery. Similar trends are observed with abdominoplasties, where now a smaller, lower scar, is performed. Correction of separation of the rectum abdominal muscles should be considered in every case for good results. The introduction of Lipoabdominoplasties (Saldanha O., 2001), combining liposuction with conventional abdominoplasty, made results on this approach, even more satisfactory lowering risks and complications at the same time. Superficial liposuction (Souza Pinto E. 1982), allowed treatment of the back, arms, internal aspect of thigh and sacral areas with minimal cutaneous retraction, avoiding the use of ultrasound or laser technology, although these still remain an excellent alternative. Liposuction techniques have also evolved. They are more selective for fat, less painful and are performed with reduced blood loss. Thinner cannulas result in smaller scars. Laser technology allows treating lipodystrophy in a fast, less aggressive, fast recovering, manner allowing patients to resume normal activities in shorter times. Attention should be paid not to treat excessively large areas, or patients with a BMI higher than 30. Hydro-electrolytic disorders or extensive burning can occur in such cases. On these patients, laser can still be

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used associated to conventional techniques. Wavelength for laser technology comes now in 980 or 1210 nm on the same equipment, rendering better treatment of adipose tissue with optimal cutaneous retraction. All these procedures can be performed in an ambulatory setting, with 24-48 h. immediate follow-up. There has also been a rise in the use of fat grafting. Facial, gluteal and breast use are excellent examples. The possibility to combine these with growth factors has optimized the results and durability of treatments. In some cases, gluteal fat grafting results are good enough to replace implant placement for the same area. Associating liposuction of neighboring areas like hips and waist to gluteal treatment further enhances patient satisfaction. The term “liposculpture” describes the procedure that takes place when excess of fatty tissue is removed from an anatomic location to be immediately placed in another, thus “sculpturing” human shape. On the contrary, on breast surgery, implants are still dominating, but fat grafting is an option to be considered for patients without a familiar history of breast cancer. Precise and adequate indication, allow the face to be treated volumetrically with fat grafts, without incisions, and good results. All of these techniques have been questioned in the last 20 years. Today nobody has doubts about their value as individual treatment choices or enhancing others. Breast implants have improved their design and incorporated more options, allowing further personalized indications. For an example, anatomic implants exist in 9 to 12 different shapes for a given size. The optimization of surgical techniques, their prudential combination and the association to low-invasive or noninvasive procedures, have widely favored esthetic results. Is important to choose a well-trained, matriculated surgeon, which combines knowledge with good criteria, offers valid choices, does not create false expectations, and aims for the lower possible risk treatment. n For more information, please visit www.centrocirugiaestetica.com

June / July 2011

ÂŠ Copyright Medical Tourism Association

MEDICAL TOURISM

Effect of Weight Loss Surgery on Metabolic Disorders in the Obese and Non-Obese By DR. GABRIEL ROSALES Over the last 60 years there has been an impressive change in the human environment, behaviors and lifestyle. These changes have resulted in an increase in both, Type 2 Diabetes and macrovascular disease (heart attack and stroke). These rises must be attributed to the greater prevalence of obesity and consequent pathophysiologic condition, the so-called metabolic syndrome.

t is estimated that 190 million people worldwide have diabetes and it is likely that this will increase to 324 million by 2025. This epidemic is taking place both in developed and developing countries and the combination of obesity, diabetes and metabolic syndrome is now recognized as one of the major threats of human health in the twenty-first century. The logic dictates that it will always be easier and costeffective to prevent diseases rather than treating them, even more so if these diseases are chronic and life threatening such as in the case of diabetes, high blood pressure and the rest of the diseases that accompany the metabolic syndrome.

WHAT IS THE METABOLIC SYNDROME? The International Diabetes Federation has proposed a new practical definition, which includes the following: • Central Obesity • Waist Circumference above 94 cm for males and 80 cm for females in Caucasians (Europe and North America)

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• Plus any two of the following: • Raised tryglicerides • Raised HDL-C • Raised blood pressure • Raised fasting plasma glucose or previously type 2 diabetes The prevention, improvement and reversion of type 2 diabetes, high blood pressure and several other diseases associated with obesity are observed after all the Weight Loss Procedures. This statement has a scientific proven basis supported by several well planned studies, in articles such as Brethauer’s published in 2009 it was shown that Sleeve

Gastrectomy achieved a very high percentage of remission or at least a high rate percentage of improvement of this disease that affects obese patients. Another study by Himpens in 2007 demonstrated an Excess Weight Loss percentage of 66 after 3 years in patients who got the Gastric Sleeve or VSG. The results and benefits from Weight Loss Surgery on such diseases have even encouraged some investigators and patients to enroll on studies that involve Type 2 Diabetes patients with BMI’s as low as <35! There are several surgical options that have been developed through the last five decades, and one of the newest ones and most promising of these is the Gastric Sleeve. Even if in the USA the FDA “recently” approved this procedure many other countries in the world have been performing it for almost a decade with excellent results.

Up to now, it might seem that Weight Loss Surgery is or should be reserved only for severely ill patients or very obese patients, and this is very far from the truth. The Gastric Sleeve or Vertical Sleeve Gastrectomy (VSG) has the following advantages over other procedures: • It is a much less invasive bariatric procedure and therefore has a lower morbidity rate. • It does not involve the placement of a foreign device as in the gastric band. • It does not involve any risky stomach or intestinal rerouting. • Since there is no re-routing, there is no dumping syndrome. • It is the only procedure that involves the removal of the portion of stomach that produces the hunger hormone “ghrelin” so it will effectively reduce hunger strikes. • Fullness and satisfaction is achieved with just small portions of food. • It does not limit or restrict the type of food you are able to eat. You will be able to eat anything, but in small healthy portions. • The reduced intake of food because of the restriction and lack of hunger strikes results in dramatic weight loss! • Weight loss won’t be drastic in a very short period of time, letting your body and skin to more easily adapt to a constant and healthier weight loss pattern. • It adjusts to every person’s needs. Even if “adjustments” are neither possible nor necessary, the sleeve is considered a “smart” procedure that leads patients close to their goal weight and just after this, the weight loss stalls. • Requires no periodic and costly testing and measuring levels of vitamins, minerals, etc. It is practically maintenance free. • No need for uncomfortable preoperative intestinal or colon cleansing.

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According to this article up to now, it might seem that Weight Loss Surgery is or should be reserved only for severely ill patients or very obese patients, and this is very far from the truth, even though a patient for Weight Loss Surgery should be studied and should comply several criteria in order to be a real candidate, the benefits from Weight Loss Surgery can be obtained by many people. Here are some of the main criteria that a patient would need to meet in order to be considered a good candidate:

Criteria for laparoscopic weight loss surgery: According to the National Institutes of Health (NIH) consensus on gastrointestinal surgery for severe obesity, patients are candidates if they are morbidly obese (BMI > 40 kg/m2 or BMI ≥ 35 kg/m2 with co-morbidities), have failed attempts at diet and exercise, are motivated and prepared to make substantial changes in their eating habits, have no dependency on alcohol or drugs, well informed, free of significant psychological disease and have acceptable operative risks. As mentioned previously, numerous therapeutic approaches to this problem have been advocated, including low calorie diets, medication, behavioral modification and exercise therapy. However, the only treatment proven to be effective in longterm management of morbid obesity is surgical intervention. Surgically induced weight loss is associated with resolution or substantial improvement of co-morbid diseases in 75–100% of patients and reduced mortality compared with medically treated patients. n About the Author Dr. Gabriel Rosales and his team are highly skilled surgeons, board certified and in continuous training. They are in constant pursuit of learning the latest innovations in minimal invasive surgery in order to offer patients the best care possible. Even though Dr. Rosales likes performing general surgery procedures, in the last 5 years he has focused mainly on performing weight loss surgery since these kinds of procedures, specifically the laparoscopic Gastric Sleeve and Gastric Band have demonstrated to him that it is possible to offer patients a life changing experience. After dedicating most of his practice in recent years to bariatric surgery, Dr. Rosales has a combined experience of performing and assisting in more than 1500 bariatric procedures. Website: www.obesityfree.com

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MEDICAL TOURISM

Public-Private Partnerships for Sustainable Growth of Medical Tourism By ANITA MEDHEKAR Medical tourism is a predominant niche market and of special interest within the tourism segment and the globalized health care service industry. This industry is being facilitated by the destinations’ government, private corporate sector involved in the medical-care and the tourism industry.

urgery can be added to existing six “Ss” of tourism; sun, sand, sea, sex, safari and spirituality (Connell 2006). People have been for centuries travelling for health, healing and wellbeing to the ancient shrines and temples. Medical tourism is a billion dollar and fastest growing healthcare service industry worldwide, where patients travel overseas to other developing or developed countries for the enhancement or restoration of the individual’s health through medical intervention (Carrerra & Bridges 2006; Bookman & Bookman 2007; Herrick 2007; Ramírez de Arellano 2007; Healy 2009; Hopkins, Labonte, Runnels & Packer 2010). People are becoming more aware of their health needs and wellbeing. Today a growing number of medical tourists from developed countries such as UK, USA, Australia, Canada and Europe are travelling abroad to developing countries (MacReady 2007) like India, Poland, Thailand, Mexico, Costa Rica and Malaysia, with the main objective of obtaining immediate health care, in terms of diagnostic treatment, noninvasive or invasive surgery combined with a vacation. This trend is spreading fast due to high insurance and surgical cost, long waiting lists, and non-availability of certain treatment

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due to regulation in developed countries and lack of medical treatment or facilities in developing poor countries. Thailand, India, Singapore or Mexico are among preferred options in terms of a value in cost, little to no waiting period, state-of-theart medical treatment and facilities, qualified surgeons, English language proficiency, cultural affinity, exotic destinations, and above all international accreditation of the medical facilities and highly qualified medical professional doctors, nurses and hospital management support staff. Thus growth of the medical tourism phenomenon is based on two factors: (a) the number of foreign medical tourists travelling and (b) the amount of revenue they generate in terms of foreign exchange. Medical tourism can play an important

Medical tourism can play an important role in improving a country’s balance of payment position and foreign exchange reserve position. © Copyright Medical Tourism Association

role in improving a country’s balance of payment position and foreign exchange reserve position. Tourism has become one of the world’s largest service sector industries with enormous potential for further growth; however, it is sensitive to external factors, like terrorism, natural disasters, SARS virus and SWINE flu which can cripple the local economy at destinations in the developing countries (Medhekar & Haq 2010). According to Carrerra and Bridges (2006) at the international level, the health and medical tourism industry including medical tourism is sustained by 617 million individuals with an annual growth rate of 3.9% annually and worth US$513 billion. Medical tourism is an economic activity that involves trade in services from two distinct sectors of the economy: medicine and tourism (Bookman & Bookman 2007). According to Bookman and Bookman (2007), economic impact of medical tourism in developing countries is significant, as nearly 272,000 medical tourists visited India for complex medical procedures in 2007, bringing in US$ 656 million in foreign exchange earnings. Several Asian countries like Thailand, India, Malaysia and Singapore are dominant, and have sought to enter the market due to high-tech medical expertise and attractiveness of these countries (Connell 2006; Horowitz & Rosenweig 2007; Singh 2008; UNESCAP 2008). The growth of medical tourism can also be seen as an opportunity for regional innovation, regeneration, rejuvenation for economic development and growth in developing countries. Using medical tourism as an export-led growth strategy, many socio-economic challenges and problems faced by developing countries can be resolved, where there is decline in traditional industries.

Medical tourism is a macro-niche consisting of three main categories of treatment: non-invasive, diagnostic and invasive. This article suggests that public-private partnerships (PPP) will enhance the competitive advantage of the medical tourism industry. It will provide viable and alternative efficient and effective delivery of healthcare and medical tourism infrastructure facilities and value for money medical treatment to not only the foreign patients, but also to the local community, through collaboration and partnerships between the various key stake holders from the demand (medical tourists) and the supply side: Public sector (government at all levels and its departments, Government Business Enterprises), private hospitals and diagnostic clinics, pharmaceutical local community, business organizations and international medical service accrediting bodies, medical educational and research institutions along with World Medical Tourism Associations, World Tourism Organization (WTO), World Travel and Tourism Council (WTTC) and Asia Pacific Tourism Association (PATA).

MEDICAL TOURISM DEFINED Carrerra and Bridges (2006) have distinguished, defined and conceptualized the two terms medical tourism and health tourism. (Carrerra & Bridges 2006) specified that under “health tourism, mobility applies to both patients and providers in recognition of the psychic benefits gained by medical professionals in participating in medical mission” (p.450). Health Tourism is defined by Carrerra and Bridges (2006) as “the organized travel outside one’s local environment for the maintenance, enhancement or restoration of the individual wellbeing in mind and body”. A subset of this is medical tourism. Medical Tourism on the other hand is defined as “the

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organized travel outside one’s natural healthcare jurisdiction for the enhancement or restoration of the individual’s health through medical intervention” (p.449). Medical Tourism, can also be defined as “a phenomenon where a patient travels with or without a companion outside his /her country of residence, to another country internationally for medical treatment which could be risky and invasive and involves complex surgical procedures with the use of highly specialized medical equipment, technology and experienced surgeons, for the improvement of overall physical health and quality of life, combined with a vacation at an exotic destination” (Medhekar 2010, p.10). Medical tourism is a macro-niche consisting of three main categories of treatment: non-invasive, diagnostic and invasive. Within these three categories are various microniche specialized treatments and surgeries for example: dental, eye, cancer, spinal-fusion, cardiac, cosmetic, reproductive and orthopedic.

PUBLIC AND PRIVATE PARTNERSHIPS (PPP) IN MEDICAL TOURISM The Ministry of Public Affairs in British Columbia (1999) defines PPP in the following terms: Public-Private Partnerships (PPPs) are arrangements between government and private sector entities for the purpose of providing investment in public infrastructure, community facilities and related services. Such partnerships are characterized by the sharing of investment, risk, responsibility and reward between the partners (cited in Schaeffer & Loveridge 2002, p.170). PPP accounts for a very diverse range of cooperative or collaborative efforts. PPP can also be defined as cooperation and collaboration between the public sector enterprise, government (central, state and local), and the private sector for planning and implementing public and private sector medical tourism related infrastructure initiatives such as health, education, transport and communication for industries success (Medhekar 2005). Partnerships are essential for planning, implementing and managing federal, state and local government tourism related infrastructure investment initiatives for sustainable economic growth and development of a particular industry in a region. Sustainable PPP in medical and health tourism involves sharing of responsibilities, planning, accreditation of medical facilities and qualifications, service quality, product innovation, promotion, packaging, trade expos and marketing, undertaking financial risks, insurance, accountability and implementing various health and medical tourism packages (Medhekar 2010).

MEDICAL TOURISM Table 1: Stakeholders in the Medical Tourism Industry Category

Examples

Resource, Infrastructure owners/ Hospitals

Landholders, hospitals and medical centres, resort owners (public & private)

Resource, infrastructure managers/ Hospitals,

Hospitals, medical and resort managers (public & private), Professional medical and non-medical staff, Accrediting bodies

Providers of Medical Tourism related infrastructure

Hospital construction & design, building, power, gas, water, waste treatment, road, hospitals infrastructure accommodation, pharmaceuticals, medical waste management

Planning, development & control

Central, State and Local Government, ministry of foreign affairs & trade, private sector, Medical tourism associations, NGO, doctors, nurses, hospital staff, regulatory body, environment bodies, accrediting bodies- e.g. JCI

Deliverers of medical tourism related goods and services (supply chain)

Enterprise operators-hotels, airlines, hire cars, attractions, tour operators, travel agents, convention centres, restaurants, museums, and tourist events; e.g. trade & tourism fairs, religious events

Tourism /Medical tourism Destination developers and marketers, advertisers

Tourism commissions, Federal, State and Local Government, Private sector, Trade commission, Medical Tourism Associations, Medical Tour operators, Airlines, hospitality-accommodation, local transportation.

Employers & Employees

Medical specialist, Doctors, Nurses, Managers, hospitality, planning , communication, pharmaceutical, ICT, Finance, Infrastructure Maintenance, Health Insurance

Medical Tourist/ Domestic or International Patients

Domestic and international- health & medical tourists, medical package holidays, business travellers, backpackers visiting friends and relatives, international students, conference attendees and other tourist (e.g. spiritual, eco-tourists, cultural & adventure).

Supply Side

Demand Side

Source: Medhekar 2010 The Key stakeholders in tourism management according to (Weaver & Lawton, 2006) are the host communities and government, tourism industry, universities and educational institutions, NGO’s and the tourist (p.3). Cooperation and collaboration between the key state holders (see Table 1) from the demand and supply side is essential in case of medical tourism to be sustainable.

are accredited, efficient, effective, equitable and good quality of health care service to the medical tourists, and on the other hand, a medical tourism industry this is economical, socially responsible and environmentally sustainable.

Over the last decade, India has transformed into one of the most popular tourism destinations in the world, largely as a result of the government’s international “Incredible India” campaign with the private sector followed by “Global Health Destination” campaign by organizing international medical tourism trade expos (GOI 2003; GOI 2008). India is ranked second to Thailand in the world, based on a two year study by Deloitte International Healthcare research unit (TravelBiz 2009; IMT 2009). The study states that the key reasons for developed countries patients to visit India are low cost, absence of waiting list, best quality treatment with state of the art medical technology, international accreditation with Joint Commission International (Ramanna 2008; JCI 2010). It is important for the governments of various countries involved in medical tourism to have a re-look at their existing tourism policy in general and medical tourism policy in particular, and have a Public-Private Partnership (PPP) approach for its sustainability, with a view to attract sizeable private investment in this emerging health service sector export, position the country to promote certain regions as a health and medical tourism destination to locals and foreigners alike in niche areas of treatment and surgery. Moreover, it can be argued that for sustainable long term growth of medical tourism industry in an efficient and effective manner public and private sector partnerships is essential between the various key stake holders from the supply side for providing on one hand attractive, safe, secure medical facilities and surgical procedures which

Government of India (2003) budget for the first time announced to support trade in private sector medical tourism, and promoting India to developed countries as a world classhigh-tech healing destination for low cost medical treatment and procedures. Combining tourism with world-class medical expertise became a government policy in 2003, when the Finance Minister, in his budget speech called for India to become a “Medical Tourism Hub” (PC 2007). Various international medical tourism accreditation bodies such as: International Society of Quality in Health Care (ISQUAH) has approved India’s accreditation process along with National Accreditation Board for Hospitals (NABH) certification body, of the Indian Government. Further, Joint Commission international to date have accredited 17 hospitals in India. Indian National Health Policy, which was drafted by Prime Minister’s advisory council on Trade and Industry, states that, “the treatment of foreign patients/expatriates is legally an “export” and the same is eligible for all fiscal incentives extended to export earnings” (GOI 2003).

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AN EXAMPLE OF PUBLIC-PRIVATE PARTNERSHIPS IN MEDICAL TOURISM

Government of India and the various State level governments in India have also realized the positive economic and social benefit of medical tourism on the economy. Since the eleventh five year plan the government has promoted India as a “Global Health Destination” (GOI 2008), providing world class-hightech medical treatment at low cost. Various policy initiatives were introduced to make medical tourism a development

strategy. For example, since 2003, special medical tourism visa (M-Visa), along with Medical Escort Visa (MX) for an accompanying relative travelling with the patient to India for medical care was introduced, 100% foreign direct investment in medical infrastructure, research and development, fiscal incentives for businesses involved in medical service export sector, government sponsored annual international medical tourism trade expos, promoting pharmaceutical stem cell medical research, well developed internet online-medical tourism websites and above all emphasis on JCI accreditation for quality control (PC 2007; GOI 2008), to build confidence in the potential medical tourists to ensure standards regarding the quality of hospitals, health care and medical ethics. In the state of Maharashtra, Maharashtra Travel and Tourism Council, Federation of Indian Chambers of Commerce and Industry, along with private and public hospitals in Maharashtra, Medical Tourism Cooperation of Maharashtra in collaboration with FICCI have formed partnership, “to deliver value for money health care with human touch” to foreigners in Mumbai (MTCM 2010). Further, leading private hospitals in the medical tourism sectors are Fortis and Apollo who have formed partnership with Johns Hopkins Medicine International, and the Wockhardt Group, which is affiliated with Harvard Medical International, who manage a total of 26 hospitals across the subcontinent. These hospitals are actively seeking foreign partners to promote medical tourism to collaborate and cooperate with tour operators such as Thomas Cook and others in the hospitality and resort business and accrediting bodies (JCI 2010: Sengupta & Nundy 2005).

CONCLUSION Thus PPP at national, regional and international level between all key stake holders is essential for sustainable growth and development of medical tourism industry. Global partnerships and certification and accreditation by international accrediting bodies such as JCI, which is the most widely, accepted medical tourism industry benchmark, besides other global bodies such as Confederation of Indian industries (CII) accreditation for hospitals and India British Standards Institute (IBSI) are equally essential. Accreditation guarantees and determines the quality of global health care and reputation of the medical institution and their medical professionals which is valued by the international medical tourists. It is important to have PPP also between the key supply side stake holders in medical tourism industry such as government, private sector healthcare industry, global accrediting bodies, medicaleducational institutions, including travel industry together with other niche tourism segments, with can be packaged with medical tourism such as health, cultural, safari and historical, and other spiritual tourism types of retreats for patients if doctor and health permits. Global PPP and accreditation is very essential for overcoming barriers by patient to medical tourism, rights of the patient and their families build confidence in the quality of surgical service, protection from infection and to gain a credible reputation due to the increased demand for medical tourism, where world is soon becoming our hospital. n References

Bookman, M. Z. & Bookman, K. R. (2007), Medical Tourism in Developing Countries, New York, Palgrave Macmillan. Carrera, P. M. & Bridges, J.F.P. (2006), Globalisation and healthcare: understanding health and medical tourism, Expert Review of Pharmacoeconomics & outcomes research, Future Drugs, Vol.7, (1), pp: 447-445. Connell, J. (2006), Medical tourism: Sea, sun, sand and … surgery”, Tourism Management, Vol. 26, (6), pp: 1093-1100, (cited on 4-10-09). GOI (2003), Government of India (GOI) 2003 Health Sector in India, Budget Papers. GOI (2008), Eleventh Five Year plan 2007-12, Vol. 11: Social Sector, New Delhi Planning Commission, Government of India, New

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Delhi, Oxford University Press. Healy, C. (2009), Surgical tourism and the globalisation of healthcare, Irish Journal of Medical Science, Vol. 178 (2), pp: 125-127. Herrick, D.M. (2007), Medical tourism: Global competition in healthcare (NCPA Policy Rep, no. 304), http:// www.ncpa.org/pub/st/ st304, (cited on 3-3-2010). Hopkins, L., Labonte, R., Runnels, V. & Packer, C. (2010), Medical tourism today: What is the sate of existing knowledge? Journal of Public Health Policy, Vol. 31, (2), pp: 185-198. Horowitz, M. D., & Rosensweig, J. A. (2007) Medical TourismHealth Care in the Global Economy, The Physician Executive, Vol. 33, (6), pp: 24-31. IMT (2009), India ranks 2nd in med tourism, http://www. medicaltourism.org/consortium.jsp?sect=consortiumdetail&id=6, (cited on 15-8-2009). JCI (2010), International Society for quality in health Care, http:// www.jointcommissioninternational.org/ (cited on 3-3-2010). Jones, J. W. & McCullough, L. B. (2007), What to do when patient’s international medical care goes south, Journal of Vascular Surgery, Vol. 46, (5), pp: 1077-1079. Planning Commission (PC) (2007), Eleventh Five (5) Year Plan 2007-2012, Planning Commission India http://planningcommission.nic. in/plans/planrel/fiveyr/welcome.html (cited on 7-7-2009). MacReady, N. (2007), Developing countries court medical tourists. Lancet, Vol. 369, (9576), pp: 1849-1850. Medhekar, A. (2005), Public private partnership for infrastructure development in India rail/road, Public and private sector partnership, editor, Montanheiro, England, Sheffield Hallam University Press. Medhekar, A. & Haq, F. (2010), Marketing Indian Medical Tourism to Muslim Patients in an Islamic way, in the proceedings of the First International Conference on Islamic Marketing and Branding: Exploring Issues and Challenges, 29th-30th November 2010, Kuala Lumpur, University of Malaysia, pp:1-15. Medhekar, A. (2010), Growth of Medical Tourism in India and Public-Private Partnerships. Refereed paper presented at the Seventh International Institute of Development Studies, Conference on Globalisation and Development, Calcutta 13 to 19 December. MTCM (2010) Medical Tourism Council of Maharashtra (MTCA), Medical Tourism in Mumbai, http://www.ficci-mtcm.com/, (cited on 17-5-2010). Ramírez de Arellano, A. B. (2007), “Patients Without Borders: The Emergence of Medical Tourism.” International Journal of Health Services Vol. 37(1), pp: 193-198. Ramanna, M. (2006), Medical tourism and the demand for hospital accreditation overseas, http://www.law.uh.edu/healthlaw/ perspectives/2006%5C(MR)MedicalTourismFinal.pdf (cited on 7-72009). Schaeffer, P. V. and S. Loveridge (2002), “Towards an understanding of types of public-private cooperation” Public Performance and Management Review Vol. 26, (2), pp: 169-189. Sengupta, A. & Nundy, S. (2005), The Private Health Sector in India. British Medical Journal, Vol. 33, (1), pp: 1157-1158. Singh, P.K. (2008), Medical tourism, New Delhi, India: Kanishka Publishers. TravelBiz (2009), India ranks second in medical tourism; Deloitte research, March 30-2009, http://www.travelbizmonitor.com/indiaranks-second-in-medical-tourism-deloitte-research, (cited on 15-8-2009). UNESCAP (2004), Major Issues in Transport, Tourism and Infrastructure Development: Enhancing the Role of Tourism in Social and Economic Development and Major Initiatives of ESCAP: 1-11. Weaver, D. & Lawton, L. (2006), Tourism Management: Brisbane, Milton Queensland, John Wiley and Sons, Australia, Ltd.

About the author

Anita Medhekar is a Senior Lecturer in Economics at CQUniversity, Rockhampton campus, Australia. Her key teaching and research interests are in the areas of macro and macro economics, economics of developing countries, economics for business, international trade, and economics of the Asia-Pacific, health economics, tourism economics, medical tourism, privatization, public finance and policy.

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MEDICAL TOURISM

The Challenges of Implementing

High Quality Healthcare

in Jamaica By ERNEST C. MADU

n 2005, we embarked upon our mission to improve access and quality of cardiovascular care to the people of the Caribbean with the perspective that the current global imbalance in the availability of modern cardiovascular care has created an exploitative system which is morally unacceptable. Citizens from low resource nations expend considerable financial and emotional capital to access high quality cardiac care in high resource nations, further depleting limited reserves from the lower resource nations. We entered the local market to become the leader in cardiac care in the region, assuring patient satisfaction and improving operational efficiency in the delivery of sustainable world class cardiovascular care. Since we began our journey in Jamaica we have encountered and have learned to negotiate a myriad of structural, institutional and behavioral barriers that impede the development of sustainable, high-quality health service programs locally. Our experience in Jamaica provides a useful roadmap that could be beneficial to others that may seek to develop similar programs in a developing country.

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A DIFFERENT ENVIRONMENT We encountered an environment where most of the services we proposed were not offered anywhere in the English speaking Caribbean. Residents of these countries have long depended on facilities in Florida to access these services at exorbitant rates. More significantly, only the few elites with means and the access to the USA had any opportunity to do so. The majority had no options. Interestingly, that existing order was widely accepted as the natural order of things. Our plan, therefore, meant that the order of things would have to change. The old paradigm was not consistent with development. We had to change things to grant access to high quality cardiac care to all. Of course, change as a concept is always a controversial proposition anywhere. Entrenched interests that benefited from the existing status quo were predictably uncomfortable with the change we were bringing and resisted any change because of the uncertainties that change tends to bring. We encountered a completely different culture and mode of thinking. The

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paternalistic nature of the local healthcare landscape had created an exaggerated asymmetry of general health-related information. Patients depended solely on their doctors as the source of information for all their health-related concerns and few exhibited the seemingly natural curiosity to seek alternative opinions or more advanced diagnosis and treatment options that have become widely available as medicine and technology advances. Second opinions generated significant discomfort and covertly discouraged and so were not standard for most patients. The few patients that expressed interest in second or alternative opinions met with displeasure from the medical establishment. We also encountered significant bureaucratic hurdles in securing the necessary resources to establish our operations. We encountered disjointed and unwieldy approvals processes which added significantly to our risk exposure and general cost of doing business. These hurdles arose partly because of the high dose of skepticism, and partly because of the complexity of the operations we proposed. Also, unfortunately, the one dimensional approach of multilateral and international agencies to health development in developing nations have made people in many developing countries comfortable with the erroneous and misinformed thinking that CVD and other related non communicable illnesses are not a threat to the population. This thinking of course is illogical, particularly as developing countries continue to adopt western lifestyles and habits. The rising prevalence of cardiovascular diseases in developing countries is evidently linked to changes in lifestyle and diet, rapid urbanization and increase in the prevalence of traditional cardiac risk factors like obesity, hypertension, diabetes and smoking in these countries. Generally ignored was the fact that the prevalence of Hypertension in many Jamaican communities exceeds 40 per cent or 2 in 5 adults. Similarly, Diabetes, another independent risk factor for CVD, affects an estimated 20% of the local adult population. To reverse this trend therefore, it is imperative that we reshape or rethink our assessment of the scope of cardiovascular diseases in developing countries like Jamaica. There must be a paradigm shift.

FINANCIAL ASPECT The economic impact of cardiovascular diseases in developing economies is devastating, largely because workingage adults account for a high proportion of the CVD burden. In the Caribbean and South America, diabetes and cardiovascular disease will be responsible for three times more deaths and disability by 2025, affecting mainly individuals in their midlife years, disrupting the future of families, undermining social structures and depriving nations of workers in their most productive years, thus precipitating economic decline and underdevelopment. The epidemiologic transition taking place in developing countries with the rising tide of cardiovascular diseases presents a unique opportunity for innovative thinking to create affordable and sustainable solutions to meet the demand in these countries. This requires rethinking of our current mode of operation and smart use of technology, leveraging technological advances to take advantage of new market opportunities. Accessing financing and favorable terms of trade was yet another significant hurdle that we encountered in our quest for sustainable healthcare development. Most multilateral agencies seemed willing to provide basic aid to support short term “medical missions” to developing countries but uninterested in financing sustainable healthcare development. This is an issue of mental state and narrative. For some reason, the idiocy that all developing countries need is “dependency aid” has taken deep roots and is difficult to shake from the collective consciousness. Some of this thinking derives from deep-seated attitudes that devalue low resource nations and assume that certain levels of excellence are beyond the reach of these nations. The thinking has become so dominant and

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entrenched that well-meaning individuals with laudable and good intentions have unfortunately developed a mindset that encourages them to look at development in low resource economies through a dependency and subservient framework, and discourages them from thinking in the broader context of meaningful and sustainable development.

CHANGING THE PARADIGM We were determined to change that paradigm because we recognized that essential ingredients of sustainable development must include relevant education and appropriate use of technology. We designed our program to make maximum use of the advances in technology focusing on multi-modality systems that are readily adaptable to low resource settings, easily serviceable and durable enough to withstand the stresses of the local environment. We focused on skills acquisition and training of local talents to improve internal capacity and minimize the need for dependency on foreign entities. We trained our local staff in a way to empower them to believe in their abilities and to be change agents rather than to absorb foreign concepts without local content or relevance.

The few patients that expressed interest in second or alternative opinions met with displeasure from the medical establishment. We believed and still believe that in order to bridge the accessibility gap between the rich and poor nations of the world, the poorer nations must be granted access to modern technology through provision of affordable and sustainable technology solutions that are appropriate and adaptable to their environment. Technology application must have defined objectives that support national development priorities and goals. Policy direction should aim to encourage students who undertake learning technologies that improve outcomes and quality of life. This is one way to retain talent within countries and encourage brain gain rather than brain drain. This will build internal capacity and put nations on a progressive path to development and out of poverty and dependency. We remain resolute that developing nations can only rise through sustainable investment and development which includes relevant education, appropriate technology and infrastructural development, private sector investment and good governance. Through the successful execution of our business model in healthcare, we have shown that structural and behavioral barriers to development can be overcome with careful planning, smart design, and appropriate use of technology — while concurrently boosting internal capacity through training and skills transfer — sustainable and affordable high-quality cardiovascular care, anchored on aggressive prevention and treatment strategies, can indeed become a reality in lowresource economies. n About the Author Ernest Madu, MD, FACC – Dr. Madu is the founder of the Heart Institute of the Caribbean (HIC) which started operations in Jamaica in 2005 and the Heart Institute of West Africa (HIWA) which is currently in development in Nigeria. HIC is the regional center of excellence for cardiovascular care in the English speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region.

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. 58

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www.MedicalTourismCity.com

MEDICAL TOURISM

Medical Tourism~

The Indian Angle By BHAWANA SAHU

Mohan is amongst the thousands of software professionals in USA which have their origins from India. He usually visits his country and hometown once a year. He has ageing parents back home who possess manifold healthcare demands as the age levitates. With changing trends in healthcare and growing service industry, Mohan avails the joint benefits of leisure, home visit and availing medical facilities together. Unlike, Mohan several people who are non-residents as well as residents of USA and other neighboring countries of Asia; require constant medical attention for themselves and their families. These travellers who seek non-emergency medical benefits from the nations overseas are termed in the present scenario as medical tourists.

n a review report of medical tourism industry by Deloitte Centre for Health Solutions, it was assessed that the number of American patients seeking healthcare abroad was around 750,000 in 2007. A notable increase has been seen further down the years and it was observed that approximately more than 200,000 to half a million Americans travelled out of the country for medical procedures. Medical tourism has augmented partly because of increasing healthcare costs in developed countries, cross-border medical training and persistent air travel. The growth of medical tourism industry is marked globally, encompassing around 50 countries in all continents. The leadership is shown by several Asian countries like India, Singapore and Thailand. South and

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Southeast regions of Asia attract around more than a million medical travellers per year. These three countries collectively comprise of approximately more than 90% of the medical tourism market share in Asia, and have invested heavily in their healthcare infrastructures to meet the increased demand for accredited medical care through first-class facilities. Asia in itself generates revenues in billions and consists of 12.7% of the global market. A growth rate of 17.6% and 23%of

The demand for travel and tourism is expected to reach $431.7 billion by 2020. ÂŠ Copyright Medical Tourism Association

revenue growth is expected by 2012. The coalescing of quality healthcare at affordable costs and leisure tourism makes Asia one of the top choice destinations for medical tourists.

CREDIBLE INDIA One of the extensively growing sectors in India is accounted as medical tourism and is likely to witness an annual growth rate of 30 %, making it a 9,500-crore industry by 2015. The prospects of international travel to access quality medical care at affordable costs and without insurance barriers makes India one of the most appealing destinations for population abroad.

Estimates are that approximately 150,000 of people travel to India for low-priced healthcare procedures every year.

Availability of alternative medicine healthcare services, like Ayurveda, Homeopathy, Unani, etc. makes it all much more appealing. Also, combining the medical travel with pleasure trip adds to the appeal. Estimates are that approximately 150,000 of people travel to India for low-priced healthcare procedures every year. The influx of foreign tourists in India have amplified to greater levels as India continues to be a favoured tourist destination for leisure, as well as business travel. The Foreign Tourist Arrivals (FTAs) have increased at a CAGR of 8.1% between 2004 and 2009. The increased business travel is accounted to the growing economy; the great leap in the service industry over the past few years has led to increased corporate spending on business travel. Also, there has been witnessed a hike in inbound tourist arrivals, which can be subjected to the availability of wellequipped and managed hospital infrastructure and the low cost of treatment in India, compared to the developed countries. The rate of inbound tourist arrivals is expected to rise at 29% to reach U.S. $ 2.4 billion by 2012. Added advantage is provided by the uplifting government policies in India. The government led initiatives and campaigns such as Incredible India!, Colors of India, Atithi Devo Bhavah and the Wellness Campaign for promoting the Indian tourism and hospitality industry adds to the creation of appeal amongst the foreign tourists.

and thus trying not to encounter in future any supply-side constraints. Around 80% of foreign tourist arrivals in India are from the neighbouring countries and from Iraq, Afghanistan, the former Soviet Union, etc and now increasingly from Africa.

The Indian hotel industry remains a direct beneficiary of economic growth and of the growth in the tourism industry. There has been recorded a high demand for quality rooms, At present, the demand exceeds the supply, it has been marked the demand for hotel rooms is about 240,000 rooms, while the current supply of hotel rooms is around 100,000. Many healthcare organizations providing top most care to the medical tourists and being most opted include Apollo Group of Hospitals, Fortis Group of Hospitals and other major healthcare setups and diagnostic centres.

THE GREAT INDIAN ANGLE India is one of the fastest-growing travel and tourism markets in the world. The demand for travel and tourism is expected to reach U.S. $ 431.7 billion (INR 24,252.4 billion) by 2020. According to an industry intelligence report, India’s share in the global medical tourism industry will reach around three percent by the end of 2013. The December 2010 report -- titled “Booming Medical Tourism in India” – says that the industry should generate revenues of around U.S. $3 billion by 2013. The industry can be considered of being in its growth stage and is expected to grow 30 % annually till 2015. It is expected that CAGR (compound annual growth rates) in revenue in 2011-13 will be 26%. In terms of medical tourists, the number can reach approximately 1.3 million by 2013 at a CAGR of 19%. India is preparing for this expected growth

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* E: Estimate; F: Forecast Source: –Travel and tourism economic impact: India, 2010 World Travel and Tourism Council website, www.wttc.org, accessed 2 December 2010.

WHAT CAUSES THIS GROWTH? The drivers for this credible growth of Indian medical tourism industry can be accounted to several emerging trends which fuel the demand for medical tourism.

• Domestic Tourism is at its peak, with increase in affordability and affinity for leisure travel, the domestic tourism has resulted into an enormous growth of almost 15% per year.

better infrastructure like new airports in various cities and reduced fares of air travel improve connectivity between major cities in the country and result in creation of increased demand for hotels.

• India remains one of the most attractive destinations to foreign tourists, as it has a plethora of tourism destinations and quality care providing healthcare facilities at low costs. One gets to combine the leisure trip and medical travel together.

• Low and affordable cost of surgeries, diagnostics, treatment, and medicines in India, make it a destination to be looked at by the non-insured foreign citizens. Also, there has been noted increased visits for availing the facilities of cosmetic surgeries, dental surgeries and other minor or non medical emergency surgeries which are not covered under the insurance. This is backed up by the advanced technology usage and available expertise of qualified and certified healthcare professionals in India. The outpatient surgeries comprise of almost 75% of medical tourism procedures and, for many of these, consumer out-of-pocket payments are high, the option of medical tourism turns out to be more attractive.

• With globalization and economic growth, the middle class populace in India has grown more affluent and this has resulted into an affordable outbound travel. The ease of access and availability of attractive tour packages boost the outbound leisure travel from India. • Constant Up-gradation and Augmentation of tourism infrastructure and facilities, by the Ministry of Tourism at important tourist destinations, has helped in improving the accessibility to these places. In addition,

• With increased acceptance by employers and health plans targeting commercial populations make it easier for the tourists to access healthcare outside the vicinity of their own country. These on the other side benefits the employers to save on costs/ premiums to insurance companies. • Here for Better: With more and more healthcare facilities in India getting accredited by the Joint Commission International (JCI), the healthcare industry’s official accreditation institution for monitoring the quality of care provision. This has also accounted to an increase in number of foreign tourist arrivals for accessing medical care. • There are also Certified Facilitators, which have business relations with hospitals in India and abroad. They provide assistance to the medical/healthcare facility seekers and help them get the best healthcare packages that suit their needs. In conclusion, it can be said that with growing needs of healthcare and rising costs worldwide, one needs to find out a cost effective and non-quality compromising solution to the same. Medical tourism proves to be one of the robust solutions. In India, the medical tourism industry is still young and is exploring its nascent growth phases. Every industry comes with its own pros and cons. Not all medical care could be sought while travelling from one country to another. Yet, much of the non emergency care could be sought after while having a leisure trip. Affordable cost is an added advantage. It is expected that in years to come, with India emerging as a preferred destination for medical treatment, medical tourism in the country is expected to have a dramatic growth and this would be backed up by investments in healthcare sector inclusive of pharmaceutical and healthcare technology and by investments in tourism and hospitality industry. n

Constant Up-gradation and Augmentation of tourism infrastructure and facilities, by the Ministry of Tourism at important tourist destinations, has helped in improving the accessibility to these places.

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“Certainly, travel is more than the seeing of sights; it is a change that goes on, deep and permanent, in the ideas of living.” – Miriam Beard. About the Author Bhawana Sahu is the Business Development Manager and is involved inTele-radiology & Diagnostic Imaging for NM Medical in Mumbai. She is experienced in Business Development for Clinical Research, HR, and Administration (Diagnostic Imaging), Integrated Sales, Branding & Direct Marketing Activities, Strategic Partnership & Alliances. http://in.linkedin.com/in/bhawanasahu

PRESS RELEASE

Pioneer of surgical procedure preserves Singapore patient’s uterus while removing 20 fibroids (including 3 that measured over 9cm in diameter) Taipei Medical University Hospital

Media Contacts: Dr. Wei-Ming Liu 劉偉民主任, 0970-405-154, director of the Department of Obstetrics and Gynecology Ms. Hui-Chu Chang張惠珠, 0970-405-562 Mr. Pei-Fong Zou鄒沛峰, 0970-405-561 Ms. Ying-Jie Fang方瀅絜, 0970-405-550, Division of Public Affairs Date: July 13, 2011 Press conference time: 02:30 pm July 13, 2011 Press conference location: Weight Management Center, 14F Building No.3

Singaporean couple discovered that Mrs. Tan, 43, had multiple large uterine fibroids (benign tumors) in a routine physical examination in 2007. Since then the couple had consulted renowned gynecologists throughout Singapore and Malaysia. Since the Tans desire children, they were disappointed to be told each time that the preferred treatment was hysterectomy, or complete removal of her uterus. Recently, they heard from friends that the director of Department of Obstetrics and Gynecology in Taipei Medical University Hospital, Dr. Wei-Ming Liu, is a renowned specialist in this area of medicine. The Tans therefore decided to seek help in Taiwan from Dr. Liu. After Dr. Liu’s assessment, Mrs. Tan decided to undergo minimally invasive surgical removal of uterine fibroids combined with bilateral uterine artery occlusion (微創性子宮肌瘤摘除術合併雙側子宮動脈阻斷術). This pioneering surgical procedure successfully removed more than twenty fibroids of different sizes. Mrs. Tan recovered very well after the operation and was relieved of the symptoms that had troubled her for four years. Most importantly, Mrs. Tan’s uterus could be retained for the couple’s wish to have babies in the future. The director of Department of Obstetrics and Gynecology at Taipei Medical University Hospital, Dr. Wei-Ming Liu, said that because the couple urgently wanted to retain the possibility of having children, all the fibroids could be removed using this minimally invasive surgical technique. With the assistance of Taipei Medical University Hospital’s International Healthcare Center, the patient was hospitalized on July 5. She received surgery on July 6 to remove the fibroids, which included three very large ones between 9 and 10 cm in diameter. Because the surgery also protected the bilateral uterine arteries, the bleeding was only 20 cc. This method successfully avoided the necessity

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for blood transfusions and also lowered the chance of future recurrence of uterine fibroids. Mr. and Mrs. Tan were very satisfied with the results of this surgery and gave high marks to the hospital’s international medical team. Mr. Tan said that his career as an automobile dealer takes him traveling all over the world. Since his wife’s condition was diagnosed, he made every effort to search for possible treatments, without any satisfactory answer. After they decided to go to Taiwan to seek Dr. Liu’s opinion, the International Healthcare Center assisted each step of the way, from admission to post-surgical care and all special needs. Mr. Tan said, “I have travelled around the world for many years and had a lot of experiences in receiving health care services. The quality of international health care services at TMU Hospital, in its medical professionals, equipment and overall service, has achieved the best world standards.” The superintendent of TMU Hospital, Dr. Tzen-Wen Chen, said the high standards of medical care and service orientation with reasonable prices are Taiwan’s advantages in developing international health care services. Patients from the United States, Europe and mainland China come to Taiwan for treatment and to receive health check-ups and medical cosmetic services for these reasons. TMUH’s Center for Reproductive Medicine, its Gynecological Oncology and Chinese Traditional Medicine services and its Medical Cosmetic Center are favored by international patients and foreign diplomats in Taiwan. In addition to word of mouth, international guests choose Taiwan’s hospitals for health care services according to whether the hospital is certified by the U.S.-based JCI hospital accreditation organization. TMU Hospital has also achieved related international certifications and evaluations in the areas of quality management, environmental management processes, and information security. Dr. Liu further added that he received the World Conference of Gynecological Endoscopy Paper Award (Kert Samm Award) for his pioneering work on minimally invasive surgical removal of uterine fibroids in 2001. Over the past decade, he has performed more than 5000 operations, and has published more than 20 related papers. Many medical institutions have visited from around the world to witness his techniques and share his knowledge. TMU Hospital’s gynecologic team under the Dr. Liu’s leadership has reached the pinnacle of global achievement, and this technique can proudly represent Taiwan’s advanced health care in the international medical arena. n

PRESS RELEASE

MTA Announces Launch of iTunes Medical Tourism Channel As part of the commitment to education the MTA, has launched a channel on iTunes and has released it’s exclusive interviews, podcasts, and webinars in order to provide accurate information to people interested in learning more about this industry. PRLog (Press Release) – Jun 20, 2011 – “With over 160 million iTunes users across the globe, this new channel provides much greater exposure to the world about medical tourism. On initial launch of some of our first podcasts we had thousands of new listeners. We are committed to using the most cutting edge and modern media tools to get to the right audience, and iTunes is the answer,” said Jonathan Edelheit, CEO of the Medical Tourism AssociationTM . Medical Tourism Magazine Interviews- Audio http://itunes.apple.com/us/podcast/medical-tourism-magazineinterviews/id423849159

Medical Tourism T.V. - Video http://itunes.apple.com/us/podcast/medical-tourism-t-v/ id432891570

About the MTA

The Medical Tourism Association™ also referred to as Medical Travel Association, is the first membership based 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. Our 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.

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The MTA is the first international non-profit assn. made up of the top international hospitals, healthcare providers, medical travel facilitators, insurance companies, members with the common goal of promoting the highest level of quality of healthcare. For more information please contact Olivia Goodwin Social Media Coordinator Medical Tourism Association, Inc. US 001.561.791.2000 Olivia@MedicalTourismAssociation.com

PRESS RELEASE

Excellence in International Healthcare Leadership Award This award will be presented at the 4th World Medical Tourism & Global Healthcare Congress held in Chicago, October 25-28, 2011. PRLog (Press Release) – Jun 01, 2011 – The Medical Tourism AssociationTM (Global Healthcare Association) will be awarding a select group of leaders in international healthcare whose achievements have enhanced and brought innovation to the International Healthcare Industry and excelled at providing international healthcare quality and international patients services, which has contributed to the growth of traveling for high quality or less expensive healthcare.

DEADLINE FOR 2011 NOMINATIONS

This award recognizes a leader in the industry for providing an exemplary program or innovation consistent with the vision of the Medical Tourism Association’sTM goal to advance medical tourism and initiate education by engaging others, promote proven strategies, procedures and hospitals and to advocate for the need to ensure high quality healthcare at affordable prices. The award is to honor an individual whose professional accomplishments embody such qualities that drive this industry forward.

About the MTA The Medical Tourism Association™ also referred to as Medical Travel Association, is the first membership based 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. Our 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.

BENEFITS OF THE AWARD WILL INCLUDE: • Receiving a Leadership Award at the Medical Tourism and International Healthcare Conference • Participate in a Ministers of Health workshop and networking reception • Medical Tourism Magazine Feature: If recipient of the award agrees they will be featured in the magazine as an international healthcare leader and this will include an interview of the recipient in the featured piece in the magazine.

Call for Nominations starts on May 31st and ends September 20th. For any questions or information about the Medical Tourism Leadership Awards please contact us at: info@MedicalTourismCongress.com

### The 4th Annual World Medical Tourism & Global Health Congress will feature over 100 exhibitors and sponsors and up to 1,500 attendees from over 87 countries.

• An International Healthcare Leadership Award logo to put on a website • Award winners will be publicized in conference materials and will be given a ribbon for their name badge increasing networking possibilities with other attendees Nominations can be made on the World Medical Tourism & Global Healthcare Congress website. Nominees will be reviewed and chosen by a committee of the association. The award must be accepted by the person receiving it at the conference.

For more information please contact Olivia Goodwin Social Media Coordinator Medical Tourism Association, Inc. US 001.561.791.2000 Olivia@MedicalTourismAssociation.com

World Medical Tourism & Global Healthcare Congress CHICAGO, ILLINOIS USA

OCTOBER 25TH - 28 TH 2011 Marriott Renaissance Schaumburg Convention Center Hotel 64

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PRESS RELEASE

Medical Tourism Association™ Travels “Across the Pond” to Spread the Word The 2011 Travel Distribution Summit held in London was host to the top travel agents, airlines, hotels and affiliated business entities from around the globe. It served as a platform for the MTA to educate these companies about the industry. PRLog (Press Release) – May 24, 2011 – The Medical Tourism Association™ met with many of the travel agents and others in the hospitality and travel industry in order to continue its educational campaign to deliver information regarding medical tourism and its benefits with these travel partners. Membership Coordinator Lisbeth Stein stated, “We were excited to be able to educate the travel industry participants about the Medical Tourism Association™ and its many membership benefits and programs and also delighted with the many positive connections that were made.” (http:// www.MedicalTourismAssociation.com/en/benefits-of- ...) 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 2011, and 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. There will be a special segment focused on the Travel & Hospitality Industries for all to gain knowledge into this ground breaking industry. (http:// www.MedicalTourismCongress.com/ )

Contact Lisbeth Stein Membership Coordinator Medical Tourism Association, Inc. US 001.561.791.2000 lisbeth@medicaltourismcongress.com

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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 International Services 8940 N. Kendall Drive Suite 601E Miami Florida 33176 City : Florida Country : United States Phone : 7865964643 Fax : 7865963648 Website : www.baptisthealth.net

DIRECTORY

City : Bucaramanga Country : Colombia Phone : 6399646 Fax : 6399292 Website : http://www.fcv.org 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 G.M.C Hospital and Research Centre P.O. Box 4184 Ajman, United Arab Emirates City : Ajman Country : United Arab Emirates Phone : 97167463333 Fax : 9716746444 Website : www.gmchospital.com HCA East Florida Division 450 Las Olas Blvd. Fort Lauderdale, FL 33301 City : Fort Lauderdale Country : United States Phone : 954-767-5722 Fax : 954-767-5793 Website : www.saludinternacional.com Hospital Alemao Oswaldo Cruz Rua Jooo Juliao, 331 Paraiso Sao Paulo, 01323 903 Brazil Telephone: 5511 3549 1000 Fax: 5511 3287 8177 Website: www.hospitalalemao.org.br

Beijing United Hospitals & Clinics #2 Jiang Tai Road, Chaoyang District Beijing, 100015 PRC Beijing, China Phone : 59277085 Fax : 59277200 Website : www.ufh.com.cn

Hospital Clinica Biblica Calle Central y Primera Avenidas 14y16 San Jose, Costa Rica 1037-1000 Toll Free: 1-800-503-5358 Telephone: 506-522-1414 Fax: 506-257-7307 Website: www.hcbinternational.com

Bumrungrad Hospital 33 Sukhumvit 3 (Soi Nana Nua), Wattana Bangkok, 10110 Thailand City : Bangkok Country : Thailand Phone : +662 667 1000 Fax : +662 667 2525 Website : http://www.bumrungrad.com

Hospital Punta Pacifica Boulevard Pacifica and Via Punta Darien, Panama City 0831-01593, Panama Telephone: (507) 204-8024 Fax: (507) 204-8010 Website: www.hospitalpuntapacifica.com

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 Fundacion Cardiovascular De Colombia Calle 155A #23-50 Bucaramanga, Santander Colombia

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Istishari Hospital 44 Alkindi Street Amman, 11190 City : Amman Country : Jordan Phone : 96265001000 Website : http://istisharihospital.com/ Jackson Memorial Hospital International 1500 NW 12th Avenue Suite 829 Miami, Florida 33136 City : Miami Country : United States Phone : 305-355-5544 Fax : 305-355-5545 Website : http://www.jmhi.org Jordan Hospital Queen Noor Street Amman 11190 Jordan Telephone: +962 6560 8080 Fax: +962 6560 7575 Website: www.jordan-hospital.com

Medanta- The Medicity Sector 38 Gurgaon, Haryana 122001 India Telephone: 911244141414 Fax: 911244834111 Website: www.medanta.org Medica Sur S.A.B. de C.V Puente de Piedra #150 Col. Toriello Guerra Del Tlalpan Mexico City, Mexico 14050 City : Mexico City Country : Mexico Phone : 52 55 5424 6896 Website : http://www. medicaltourismmexico.com.mx Moolchand Healthcare Group Lajpat Nagar III New Delhi, 110024 India Telephone: 911142000000 Website: www.moolchandhealthcare.com Narayana Hrudayalaya NO 258/A Bommasandra Industrial Area, Anekal Taluk Bangalore, Karnataka 560099 India Telephone: 080-27835000 Fax: 080-27835207 Website: www.narayanahospitals.com Prince Court Medical Centre Sdn. Bhd 39, Jalan Kia Peng Kuala Lumpur 50450 Malaysia Telephone: +603 21600000 Fax: +603 21600110 Website: www.princecourt.com Seoul Wooridul Spine Hospital 47-4 Chungdam-dong, Gangnam-gu Seoul 135-100 Korea Telephone: +82-2-513-8157 / 8385 Fax: +82-2-513-8386 / 8454 Website: www.wooridul.com SevenHills Hospital Marol Maroshi Road Andheri East Mumbai Maharashtra 400059 City : Mumbai Country : India Phone : 00912267676767 Fax : 00912229250043 Website : www.sevenhillshospital.com Severence Hospital Yonsei University Health System 250 Seongsanno, Seodaemun-gu Seoul, Republic of Korea 120-752 Telephone: +82-2-2228-1482 Fax: +82-2-363-0396 Website: www.yuhs.or.kr/en/ Shuang Ho Hospital 291 Jhongjheng Rd. Jhonghe City, Taipei County 235 Taiwan City : Jhonghe City Country : Taiwan Phone : 886-2-2249-0088 X8807 Fax : 886-2-2248-0900 Website : http://shh.tmu.edu.tw/ Taipei Medical University Hospital 252 Wuxing Street, Taipei 11031, Taiwan Tel: +886-2-2737-2181 ext. 3336 Fax: +886-2-2737-4257 Email: ipc@tmuh.org.tw Website: www.tmuh.org.tw Taipei Medical University Wan Fang Hospital 111 Section 3, Hsing-Long Rd., Taipei 116, Taiwan

Tel: +886-2-2930-7930 ext. 7766 Fax: +886-2-8662-1135 Email: ims@wanfang.gov.tw Website: www.taiwanhealthcare.com Taipei Medical University Shuang Ho Hospital 291 Jhongjheng Rd., Jhonghe City, Taipei County 235, Taiwan Tel: +886-2-2249-0088 ext. 8807 Fax: +886-2-2248-0900 Email: tmushh@shh.org.tw Website: http://eng.shh.org.tw The Nairobi Hospital P.O. Box 30026 Nairobi, 00100 Kenya Telephone: 254 020 2846001 Fax: 254 020 2728003 Website: www.nairobihospital.org The Specialty Hospital P.O. Box 930186 Amman, 11193 Jordan City : Amman Country : Jordan Phone : 00962-6-5001111 Fax : 00962-6-5697425 Website : www.specialty-hospital.com SPECIALTY, COSMETIC, & DENTAL CLINICS Aestheticup Clinica Robles/ Aestheticup Dental House Virrey del Pino 2530 Ciudad Autonoma de Buenos Aires Buenos Aires, Argentina Phone : 1-866-816-9971 Fax : 541147860560 Website : www.aestheticup.com Barbados Fertility Centre Inc. Seaston House, Hastings Christ Church Barbados Telephone: 246-435-7467 Fax: 246-436-7467 Website: www.barbadosivf.org Cancun Cosmetic Dentistry Las Americas Shopping Mall, Store 215 Cancun 77500 Quintana Roo, Mexico Telephone: 998 106 8106 Website: www.cancuncosmeticdentistry.com Clinica Jose A. Rivas S.A. Avenida Carrera 19 #100-88 Bogota, Colombia Telephone: (571)616-3077 Fax: (571)257-8304 Website: www.clinicarivas.com Dental Polyclinic Dr. Hodzic & Center for Regenerative Medicine “MEDENT” 18, Istria Street Rovinj, 52210 Croatia Telephone: +385 52 842 500 Fax: +385 52 842 501 Website: www.poliklinika-dr-hodzic.com Instituto Bariatrico Dr. Betances C/Rafael A. Sanchez, Ed. Medicalnet Suite 405, Ens. Piantini Santo Domingo, Dominican Republic City : Santo Domingo Country : Dominican Republic Phone : 8097329400 Fax : 8095407070 Website : www.bariatrica.com

M TA M E M B E R Integra Medical Center Juarez 239 Nuo Progreso, Tamqulipas 88810 Mexico Telephone: 899-937-0260 Website: www.integramedicalcenter.com International Orthopedic Group Badia Hand to Shoulder Center 3650 N.W. 82nd Avenue, Suite 103 Doral, Florida 33166 United States Phone : 3052274263 Fax : 3055377222 Website : www.drbadia.com Lorenzana Dental Center Pasaje Sagrado Corazon 826 San Salvador, San Salvador El Salvador Telephone: (503) 2263-4572 Facsimile: (503) 2263-4575 Website: www.doctorlorenzana.com Prudent Hungary Dental Clinic 16 Lucsony Street Mosonmagyarouar , 9200 Hungary Phone : 36202199457 Website : www.prudenthungary.com San Patricio MRI & CT Center 280 Marginal Kennedy Guaynabo, Puerto Rico 00968 Phone : 787-620-5757 Fax : 787-620-5761 Website : www.sanpatriciomrict.com The Catholic University of Korea Yeson Voice Center The Institute of Performing Art Medicine Hyung-Tae Kim, MD, PhD 638-13 Ssanbong Build. 2nd Fl. Shinsadong, Gangnamgu Seoul, 135-896, South Korea Telephone:82-2-3444-0550 Fax: 82-2-3443-2621 Website: www.yesonvc.com Wintergreen Center for Rehabilitation AB Kyrkovage 13 Nykroppa 680 90 Sweden Telephone: 004659041888 Fax: 004659041889 Website: www.wintergreen.se MEDICAL TOURISM FACILITATORS Ageless Wonders Panama / Panama Medical Tourism Your Premium Health & Wellness Specialists 73rd street San Francisco, Palma Real Bldg., No. 12A Panama City, Republic of Panama US (224) 353-7701 Tel (507) 396-1640 support@panamamedicaltourism.com edeycaza@panamamedicaltourism.com http://www.agelesswonders-pma.com/ Angels Global Healthcare 10-799 O’Brien Drive Peterborough Ontario K9J 6X7 City : Ontario Country : Canada Phone : 7057435433 Fax : 7057415147 Website : www.angelsglobalhealthcare.com

June / July 2011

DIRECTORY

BYZAlliance Medical Travel & Medical Consulting Hakkiyeten Caddesi. Unimed Center No: 8/10 34349 Fulya - Istanbul Turkey Telephone: 90 212 240 82 99 Fax: 90 212 231 39 56 Website: www.byzalliance.com Cambria Healthcare Inc. 18101 Point Dookout Dr. Suite 139 Houston, 77058 United States Telephone:1-469-323-6119 Facsimile: 1-972-841-4856 Website:: www.CambriaHealthcare.com Catalunya Turisme Passeig de Gracia 105-3a-08008 Barcelona, Spain City : Barcelona Country : Spain Phone : 34934849900 Fax : 34934849888 Website : www.catalunyaturisme.com China Health Today 3551 19th Avenue SW Naples, Florida 34117 City : Naples Country : USA Phone : 866-768-1631 Fax : 239-244-8375 Website : www.chinahealthtoday.com Debson Medical Tourism 1200 McGill College Avenue Suite 1100 Montreal QC H3B 4G7 Telephone:1-877-900-DEBS(3327) Website: www.debsonmedicaltourism.com Diversified Surgical Management, LP 1015 North Carroll, #2000 Dallas, Texas 75204 City : Dallas Country : USA Phone : 214-843-0830 Fax : 214-853-4644 Website : http://www.dsmglobal.com/ Global Health Israel (GHI) 32 Shaham St., P.O. Box 7790 Petah-Tikva Israel Telephone: 972 3 9232202 Fax: 972 3 9229750 Website: www.globalhealthisrael.com Global Health Travel Cassandra Italia 80A O’Shannassy Street Sunbury, VIC 3429 Australia Telephone: +613-9744-5872 Fax: +613-9740-4243 Website: www.globalhealthtravel.com.au Green4Care 24 Rue Louis Blanc Paris, France 75010 City : Paris Country : France Fax : 01.55.26.94.95 Website : www.mymedicaltreatmentabroad.com Health Travel Guides 600 Townsend Street, Suite 120e San Francisco, CA 94103 City : California Country : United States Phone : 415-412-4811 Website : www.healthtravelguides.com KONGRESIST Travel Inc. Cumhuriyet Cad. No. 179 D. 15, Harbiye Istanbul, 34373

City : Istanbul Country : Turkey Phone : 902122312772 Website : www.kongresist.com Max Global Consulting Services House # 220, Street Charay Hesa Doham-eKartiparwan Kabul Afghanistan Telephone: +93 706 272 491 Med2Heal OHG Warschauer Strube 5 Frankfurt, Hesse Germany 60327 City : Frankfurt Country : Germany Phone : 49.69677.01438 Fax : 49.69207.36469 Website : www.med2heal.com Medical Retreat Abroad, LLC 6146 Whiskey Creek Drive Suite 723 Fort Myers, FL 33919 City : Fort Myers Country : United States Phone : 800-460-4166 Website : www.medicalretreatabroad.com Medical Services of Costa Rica Hacienda Los Reyes, casa 241 primera etapa, La Guacima, Alajuela Costa Rica Telephone: 00506 22203596 Fax: 00506 22203596 Website: www.medicalservicesofcostarica.com Medical Tour Experts, Inc. 8379 W. Sunset Road Suite 105 Las Vegas, NV 89113-2204 City : Las Vegas Country : United States Phone : 1-702-650-0011 Fax : 702-650-2292 Website : www.mte101.com MedicalTour International Co. Ltd. 2-3-9 Sawamura Matsumoto, Nagano 390-0877 Japan Telephone: 81263882810 Fax: 81263882322 Website: www.medical-tour.jp Medical Tourism Co, LLC 7000 Independence Parkway, Suite 160, PMN 149 Plano, Texas 75025-5741 USA Telephone: 972-814-1614 Fax: 1-800-661-2126 Website: http://www.medicaltourismco.com Medical Travel Riga Maza Nometnu Street 10-1 Riga LV1002 Latvia Phone: 37128652969 Website: www.medicaltravelriga.com Medical Treatments Management 340 South Lemon Avenue #7012 Los Angeles, Ca. 91789 City : Los Angeles, Ca Country : USA Phone : 1-800-870-6059 Website : mtmweb.biz Med Tour Pal - Astute Management Consultancy Private Ltd. A-204, Raj Darshan, Dada Patil Wadi, Naupada, Thane (West), Mumbai, Maharashtra India 400602 City : Mumbai Country : India Phone : 02225420304 Website : http://medtourpal.com/

Mediline Ahi Evren Cad.,Ata Penter, No 1, Kat G2 Maslak, Istanbul 34398 Turkey Phone: 905304035251 Website: www.medilineus.com Medpro Bavaria GmbH Falkenbach 75 Freyung 94078 City : Freyung Country : Germany Phone : 498551913528 Fax : 498551913456 Website : www.medprobavaria.com Med Tours Latinamerica 9a Avenue Sur + 12 C.Ote. 22A Colonia Utila Santa Tecla, La Libertad El Salvador, Central America City : Santa Tecla, La Libertad Country : El Salvador Central America Phone : 503-2229-3000 Website : www.labcofasa.com Medtral New Zealand Mercy Specialist Center 100 Mountain Road Epsom Auckland 1149 City : Auckland Country : New Zealand Phone : 64 9 623 6588 Fax : 64 9 623 6587 Website : http://www.medtral.com MedTravel Ecuador Av. de los Shyris 2811 e Isla Floreana Quito, Ecuador City : Quito Country : Ecuador Phone : 593-2 2433307 Fax : 593-2 2445364 Website : www.medtravelecuador.com MedVoy Inc. 1917 King Street Denver Colorado 80204 USA Telephone:720-771-6760 Facsimile: +1-866-254-0108 Website: www.medvoy.com Nirmal Hospitalities Siddanth Villa, Plot No 54157, Rsc 13, Goral II 480092 Mumbai,Maharastr India City : Mumbai Country : India Phone : 91 098 333 70334 Fax : 91 22 28693823 Website : www.nirmalhospitalities.com Pan American Dental Tours 30 Raymond Road North Salem, NY 10560 United States of America Telephone: 914-485-1026 Fax: 206-984-1889 www.panamdentaltours.com Spain Medical Services c/ Menorca, 2 bl. 6-1A Las Rozas, Madrid 28230 City : Madrid Country : Spain Phone : 34693902182 Website : www.spainmedicalservices.com SPA-MED-HOLIDAY Cecile Billiet Edificio Reforma Obelisco, St. 1106 Av Reforma 15-54, Z9 Guatemala City 01009 Guatemala Telephone: 00 502 2332 4648 / 00 502 593 79 438

M TA M E M B E R Skype: spa.med.holiday Website: www.spa-med-holiday.com Surgical Trip, LLC Thomas O’Hara 7491 North Federal Highway, Suite C-5, #293 Boca Raton, FL 33487 Telephone: (800)513-8996 Website: www.SurgicalTrip.com Transmed Tourism LLC 7629 Wynndel Way Elk Grove, 95758 Country : United States Phone : 916-752-5539 Fax : 916-647-4876 Website : http://www.transmedtourism.com URUHEALTH (Health and Tourism in Uruguay) Dr. Marcelo Rodriguez Av. Ricaldoni 2452 Montevideo 11600 Uruguay Telephone: (+598) 27114444 Fax: (+598) 27114444 Website: http://www.uruhealth.com Veiovis 93 S. Jackson St. #28310 Seattle, WA 98104-2818 USA Telephone: (671) 646-6012 Wbsite: www.veiovis.com

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Well-Being Travel Anne Marie Moebes 71 Audrey Avenue Oyster Bay, NY 11771 United States of America Telephone: (516) 624-0500 X2312 Fax: (516) 624-6024 Website: www.travelsavers.com GOVERNMENT/ HEALTHCARE CLUSTER Cluster Servicios de Medicina y Odontologia - Medical and Dental Services Cluster Calle 41 No. 55-80 Plaza Mayor- Entrada Norte-Piso 3 City : Medellin Country : Colombia Phone : 57 4 261 36 00, ext. 112 Fax : 57 4 513 77 57 Website : www.medellinhealthcity.com Health & Wellness Tourism Commission, Agexport 15 Ave. 14-72, zona 13 Guatemala City 01013 Guatemala Telephone: 00 502 2422-3400 ext 3418 Fax: 00 502 2422-3400 Websites: www.healthwellnessguatemala.com www.export.com.gt

Veiovis Country : Guam Website : www.veiovis.com

Korea International Medical Association 57-1 Noryangjin-dong, Dongjak-gu Seoul 156-800 Republic of Korea Telephone: +82-2-2194-7250 Fax: +82-2-2194-7380 Website: www.healthtour.co.kr

Vung Tau Tourist Sanatorium Medicoast Nguyen Thi Mai 165 Thuy Van St. Thang Tam Ward Vung Tau City, Viet Nam Telephone: 84.64.853857 or 64.510756 Fax: 84.64.852395 Website: www.medicoast.com.au

Plataforma Turistica de Madrid Plaza de la Independencia,6, Planta 3 Madrid 28001 Spain Telephone: +34912767235 Fax: +34912767223 Website: www.madridnetwork.org/turismo

Veiovis Country : Philippines Website : www.veiovis.com

TRAVEL AGENCIES & HOSPITALITY Asic Travel 08 Ramo Buildings, Elhay Elmotamaiez, 06th of October, Egypt Phone : 20238379858 Fax : 20238379857 Website : www.asictravel.com Celebrity Transportation Services, Inc. 220 SW 9th Avenue #204 Hallandale, Fl 33009 City : Hallandale, Florida Country : USA Phone : 954-328-6653 Website : www.ctsmiamilimo.com Las Vegas Convention & Visitors Authority 3150 Paradise Road Las Vegas, NV USA 89109 City : Las Vegas Country : USA Phone : 702 892 0711 Website : www.lvcva.com Travel World International, Ltd. Plot 3 Kimathi Avenue Uganda Pan Africa Hse PO Box 37017 Kampala, Uganda City : Kampala Country : Uganda Phone : 256312261990 Website : wwwtravelugandasafaris.com

June / July 2011

Porto Alegre Healthcare Cluster Travessa do Carmo St. 84 Rio Grande do Sul (RS) Porto Alegre 90050-210 Brazil Phone: 555132896717 Website: www.portoalegrehealthcare.org ProExport Colombian Government Trade Bureau 601 Brickell Key Dr Ste 608 Miami, Fl USA 33131 City : Miami Country : USA Phone : 305-374-3144 Fax : 305-372-9365 Website : http://www.proexport.com.co

INDUSTRY ASSOCIATIONS & CHAMBERS AAAHC International - Accreditation Association for Ambulatory Healthcare 5250 Old Orchard Road Suite 200 Skokie, IL 60077 USA Telephone: 8478536089 Fax: 8478539028 Website: www.aaahc.org CORPORATE MEMBERS CORPORATE GOLD MEMBERS Cardiac Care Europe a program by Clinical Liaison Sourcing AG 16 Oberallmendstrasse, CH-6203 Zug, Switzerland City : Zug Country : Switzerland Phone : 41417660320 Website : www.cardiaccareeurope.com Doctors Hospital #1 Collins Avenue P.O. Box N-3018 Nassau, Bahamas Telephone: 242-302-4600 Fax: 242-323-4801 Website: www.doctorshosp.com Equals3 Limited The Custom House EX 31 IEU Barnstaple, Devon United Kingdom Telephone: 44 845 056 8432 Fax: 44 845 056 8432 Website: www.equals3.co.uk GreenbergTraurig 450 South Orange Avenue Suite 650 Orlando, Florida 32801 City : Orlando, Florida Country : USA Phone : 407-254-2641 Fax : 407-650-8428 Website : http://www.gtlaw.com “Golden Health” Health Care Services Company “Golden Health” Health Care Services Company P.O. Box No. 5351 Abu Dhabi UAE City : Abu Dhabi Country : United Arab Emirates Website : www.goldenhealth.ae Istishari Hospital 44 Alkindi Street Amman, 11184 City : Amman Country : Jordan Phone : 96265001000 Fax : 96265698833 Website : http://www.istisharihospital.com/

Programa Disfruta Salud Peru Avda. Republica de Panama San Isidro, Lima 3647 Peru Telephone: 511 222 1222 Website: www.peruhealth.org

Konesens Research 389 Palm Coast Parkway SW, Ste. 4 Palm Coast, FL 32137 USA Telephone:1-866-533-9808 Fax: 1-888-533-4883 Website: www.konesens.com

Sugery Facilities Resources PO Box 9500 Gurnee, IL 60031 Country : United States Phone : 847-775-1970 Fax : 847-775-1985 Website : http://www. surgeryfacilitiesresources.com

Narayana Hrudayalaya NO 258/A Bommasandra Industrial Area, Anekal Taluk Bangalore, Karnataka 560099 India Telephone: 080-27835000 Fax: 080-27835207 Website: www.narayanahospitals.com

SurgeryOverseas.com London United Kingdom Telephone: +44 845 056 8432 Website : surgeryoverseas.com The Nairobi Hospital P.O. Box 30026 Nairobi, 00100 Kenya Telephone: 254 020 2846001 Fax: 254 020 2728003 Website: www.nairobihospital.org CORPORATE MEMBERS AB Complete Medi-Tour LLC 1060 S. Japlin Way Aurora, CO 80017 USA Telephone: 720-529-8474 Fax: 720-748-1047 Advanced Practice Nurse International 1455 Pennslyvania Avenue NW, Suite 400 Washington DC, 20004 United States Phone : 202-351-6835 Website : www.APNurseInternational.com Advatech Healthcare PVT. Ltd. 302 Mayfair Swarnadeep, 323 Purbalok Kolkata, West Bengal India 20099 City : Kolkata, West Bengal Country : India Phone : +9193397668653 Website : http://www.advatechhealth.com AllMedicalTourism.com 70A, Club Street, 069 443 Singapore Telephone: +44 (0) 845 057 4039 Fax: +44 (0) 845 057 4039 Website: www.AllMedicalTourism.com Altera Health, Inc. 4 Coachman Court East Brunswick, New Jersey 08816 USA Telephone: 917-699-6300 AIMIS Spine (American Institute of Minimal Invasive Spine Surgery) Kolonakiou Ave 25, Zavos Kolonakiou Center, Block A, Suite 201 Limassol, Cyprus City : Limmassol Country : Cyprus Phone : 00357 25 873 387 Fax : 00357 25 320 370 Website : www.aimisspine.com ASISER (Asisa Servicios Integrales De Salud, S.A.U) Av. Manoteras 24, 2nd Floor Madrid 28050 Spain Telephone: 34917329666 Fax: 34917329769 Website: www.asiser.es Cape Health Destination PO BOX 29, By-Den Weg Vlottenburg, 7604 Western Cape, South Africa Telephone: 0027-21-8813603 Website: www.capehealth.co.za Cardiac Care Europe a program by Clinical Liaison Sourcing AG 16 Oberallmendstrasse, CH-6203 Zug, Switzerland Phone : 41417660320 Website : www.cardiaccareeurope.com

M TA M E M B E R Caribbean Health Travel Magazine c/ natail a sanchez No. 45 Santo Domingo, Republica Domnicana Phone : 8097329400 Website : www.chtmagazine.com Carpatia Group Pm 2 Burebista, BID14, SC 3, 4th Fl, Apt. 79-80 Bucharest 031108 Romania Telephone: +40213228308 Fax: +40213228459 Website: www.carpatiagroup.com Catalunya Turisme Passeig de Gracia, 105-3a Barcelona, 08008 Spain Telephone: 34 934 849 900 Fax: 34 934 849 888 Website: www.catalunyaturisme.com China Health Today. 3551 19th Avenue SW Naples, Florida 34117 City : Naples Country : USA Phone : 866-768-1631 Fax : 239-244-8375 Website : www.chinahealthtoday.com Clements International 1 Thomas Circle NW, 8th Floor, Washington, DC 20005 USA Telephone: 202-872-0060 Fax: 202-466-9064 Website: www.clements.com Cosmas Health, LLC 3619 South Avenue Springfield, MO 65807 USA Telephone: 417-894-3359 Website: www.cosmashealth.com Commission of Graduates of Foreign Nursing Schools International 3600 Market St., Suite 400 Philadelphia, PA 19104-2651 USA Telephone: 215-222-8454 Fax: 215-495-0277 Website: www.cgfns.org Costamed Clinics Calle Primera Sur No 101 Cozumel, Mexico 77600 Telephone: (987)872-9400 Fax: (987)872-9400 Website: www.costamed.com.mx CMN 150 Commerce Valley Drive West, 9th Floor Thornhill, ON L3T 7Z3 Canada Telephone: 905-669-4333 Fax: 905-669-2221 Website: www.cmn-global.com Debson-ITS 466 Strathrona Westmount Quebec H342x1 Canada Telephone: 1-888-933-2ITS(487) Website: www.debsonits.com DentalCareBudapest.com 190. Szabadsag Street 2040 Budaors Hungary Telephone: 36 30 333 8888 Website: www.dentalcarebudapest.com Dentalight LLC 711 Bald Hills Road North Round Top, New York 12473 USA

June / July 2011

DIRECTORY

Telephone: 518-250-2550 Fax: 208-955-6187 Website: www.dentalightimplants.com Diversified Surgical Management, LP 1015 North Carroll, #2000 Dallas, Texas 75204 USA Telephone: 214-843-0830 Fax: 214-853-4644 El Salvador Medical Vipsal 1224 PO Box 025364 Miami FL 33102 City : El Salvador Country : El Salvador Phone : 503 226 34572 e-Medsol Pvt Ltd 34/1121 A, 129 BMRA Balakrishna Menon Road Cochin 682025 India Telephone: 091-484-3250706, 9846170036 Website: www.emedsol.biz Executive Education Programs UCLA 10960 Wilshire Boulevard, Suite 1550 Los Angeles, California 90024 USA Telephone: 310 267 5600 Fax: 310 312 1711 Website: http://emph.ucla.edu Fairmont Specialty 5 Christopher Way Eatontown 07724 USA Telephone: 732-676-9886 Fax: 732-542-4082 Florida Med-Retreat 1303 N. Tamiami Trail Sarasota, Florida 34236 City : Florida Country : United States of America Phone : 9419536949 Fax : 9419536867 Website : www.floridamedretreat.com Free Health, LLC. Telephone: 561-792-4418 Fax: 561-792-4428 Website: www.freehealth.com Gallup 111 South Wacker Suite 4850 Chicago IL 60603 USA Telephone: 312-288-2432 Fax: 312-357-0856 Website: www.gallup.com Global Benefit Options 10 Park Avenue, PO Box 25 Caldwell, NJ 07006 USA Telephone: 201-433-2222 Fax: 973-226-7774 Website: www.globalbenefitoptions.com Global Care Medical, Ltd. Zabotinsky 53 Ramat Gan, Israel City : Ramat Gan Country : Israel Phone : 00972-73-7888050 Website : www.gcmed.com Global Healthcare Concierge LTD PO Box 2277 Sag Harbor, NY 11963 USA Phone: 631-532-1868 Fax: 631-204-6667 Website: www.globalhealthcareconcierge.com

Global Health, Inc. 3214 Charles B. Root Wynd, Suite 213 Raleigh, North Carolina 27612 USA Telephone: 919-251-8605 Fax: 919-781-8782 Website: www.globalhealthinc.org

International Board of Medicine and Surgery P.O. Box 6009 Palm Harbor, FL 34684 USA Telephone: 813-966-1431 Fax: 813-925-1932

Global Health Solutions, LLC 358 West Lake Drive Edwardsville, IL 62025 USA Telephone: 618-444-1552

International Healthcare by Design 40 Annesley Ave Toronto, Ontario M462T7 Canada Telephone: 416-696-0000 Fax: 416-696-0011

Global Surgery Providers, Inc. 284 South Main Street Suite 1000 Alpharetta, Georgia 30188 USA Telephone: 877-866-8558 Website: www.globalsurgerynetwork.com

Invest Barbados Trident Financial Center Hastings, Christ Church Barbados, BB15156 Telephone: 246-626-2000 Fax: 246-626-2097 Website: www.investbarbados.org

Green4Care 24 Rue Louis Blanc Paris, France 75010 City : Paris Country : France Fax : 01.55.26.94.95 Website : http://www.green4care.org

Istishari Hospital 44 Alkindi Street Amman, 11184 City : Amman Country : Jordan Phone : 96265001000 Fax : 96265698833 Website : http://www.istisharihospital.com/

Hayes, Inc. 157 S. Broad Street Lansdale, PA 19446 USA Telephone: 215-855-0615 Fax: 215-855-5218 Website: www.hayesinc.com

Kahler Grand Hotel 20 SW Second Ave Rochester, Minnesota 55906 USA Telephone: 507-280-6200 Fax: 507-285-2586 Website: www.kahler.com

Health Links International 11435 Drummond Court Dallas, TX 75228 USA Telephone: 214-564-7341 U.S. Fax: 888-235-0208 International Fax: 425-974-7902 Website: www.healthlinksintl.com

MedicalTourism.com SJO 6767, 2011 NW, 79th Avenue, Doral Miami FL 33122 USA Telephone: 305-600-5763 Fax: 305-397-2893 Website: www.medicaltourism.com

Health Travel Guides 600 Townsend Street, Suite 120e San Francisco, CA 94103 City : California Country : United States Phone : 415-412-4811 Website : http://www.healthtravelguides.com HLV Health N Heal Pvt. Ltd. K-13 A Green Park Extn India 110016 City : New Delhi Country : India Phone : 911126180125 Fax : 911126180129 Website : www.healthnheal.com Homewatch CareGivers 7100E. Belleview Ave., Suite 303 Greenwood Village, CO 80111 USA Telephone: 303-758-5111 Fax: 303-758-1724 Website: www.homewatchcaregivers.com Hospital Scout Betenstr, 13-15 Dortmund 44137 Dortmund, Germany Phone : 492319144880 Fax : 4923191448888 Website : www.hospitalscout.com Indra Farmacia Holistica Alternativa Prol Chabacano no. 20 El Portico Corporate Office Queretaro Mexico 76902 City : Queretaro Country : Mexico Phone : 52 442 411 8804 Website : www.indrafarmacias.com

Medical Treatments Management 5940 S. Rainbow Blvd. Ste. 1001 Las Vegas, NV. 89118 United States Phone : 1-866-206-4174 Fax : 702-650-2292 Website : www.mte101.com Medical Tour Experts, Inc. 340 South Lemon Avenue #7012 Los Angeles, Ca. 91789 USA Phone: 1-800-870-6059 Website: mtmweb.biz Medi Czech Lazarska 13/8 Prague Czech Republic 12000 City : Prague Country : Czech Republic Phone : 420 222 542949 Website : http://www.mediczech.com MediNav International Pty. Ltd. 18 St Vincents Crt Minyana QLD Australia 4575 City : Minyama Country : Australia Phone : 61 408715697 Website : www.medinavinternational.com Medichol PTY LTD. 443 The Panorama Gold Coast, QLD Australia 4213 Phone: +61 438 932 753 Fax: +61 7 5525 3654 Website : www.medichol.com Medilink (Thailand) Co., Ltd. 404 Phaholyothin Road Samsaennai, Phayathai, Bangkok Thailand 10400 City : Bangkok

ÂŠ Copyright Medical Tourism Association

M TA M E M B E R Country : Thailand Phone : +662 619 2222 Fax : +662 619 2209 Website : www.medilink.co.th Medipassion Healing Inc. 33 Place Des Outaouais L’ile Perrot, QC J7V8K7 Canada Telephone: 514-577 7451 Fax: 1-800-410-0279 MedPro Bavaria GmbH Falkenbach 75 Freyung 94078 Germany Telephone: +49 8551 913528 Fax: +49 8551 913456 Website: www.medprobavaria.de Med Tours Latinamerica 9a Avenue Sur + 12 C.Ote. 22A Colonia Utila. Santa Tecla, La Libertad El Salvador, Central America City : Santa Tecla, La Libertad Country : El Salvador Central America Phone : 503-2229-3000 Website : www.labcofasa.com MedTravel Ecuador Av. de los Shyris 2811 e Isla Floreana Quito, Ecuador Telephone: 593-2 2433307 Fax: 593-2 2445364 Website: www.medtravelecuador.com Mintz Levin Cohn Ferris Glovsky and Popeo One Financial Center Boston, MA 02081 USA Telephone: (617) 348-1757 MOH Holdings Pte Ltd 83 Clemenceau Ave., #15-03 UE Square Singapore 239920 Singapore Telephone: +65-6622-0956 Fax: +65-6720-0980 Website: www.mohh.com.sg Narayana Hrudayalaya NO 258/A Bommasandra Industrial Area, Anekal Taluk Bangalore, Karnataka 560099 City : Bangalore Country : India Phone : 080-27835000 Fax : 080-27835207 Website : www.narayanahospitals.com Nirmal Hospitalities Siddanth Villa, Plot No 54157, Rsc 13, Goral II 480092 Mumbai,Maharastr India City : Mumbai Country : India Phone : 91 098 333 70334 Fax : 91 22 28693823 Website : www.nirmalhospitalities.com

DIRECTORY

Operations Worldwide Ltd Trans-World House, 100 City Road London, EC1Y2BP United Kingdom Telephone: +4402078710172 Fax: +4402078710101 Website: www.yoursugeryabroad.com Orbicare, LLC 2731 Executive Park Drive Suite 7 Weston, Florida USA 33331 City : Weston Country : USA Phone : 954 217 1116 Fax : 954 217 1113 Website : www.orbicare.com

Seattle’s Convention and Visitors Bureau 701 Pike Suite 800 Seattle, WA 98101 Telephone: 206-461-5828 Website: www.visitseattle.org

Perot Systems Services Mariano Otero 1249 WTC Torre Atlántico Piso. 7 Col. Rinconadas del Bosque Jalisco 44530 México Website: www.perotsystems.com.mx

Shanghai Sunshiny Health Consulting Co. Ltd. Rm 2208 No. 337 Zhon Zhu Road Shanghai International Medical Zone Pudong 201318 Shanghai China Phone: 0086-571-87215526 Fax: 0086-571-8726575

Physicians Alliance Limited #3 Grosvenor Close, Shirley Street, PO BOX EE17022 Nassau Bahamas Telephone: 242-326-4460 Fax:242 326 8874 Website: www.physiciansalliancelimited.com Premier Healthcare Professionals Inc 2450 Atlanta Hwy, Suite 601 Cumming, GA 30040 USA Telephone:678-460-1008 Fax: 678-460-1009 Website: www.travelphp.com Premiere Medical Travel Company, LLC James McCormick MD 6303 Owensmouth Avenue, 10th Floor Woodland Hills, CA 91367-2622 Telephone: 818-917-6189 Fax: 818-936-2101 Proglobal Today Inc. 362 Maple Avenue Washington, PA 15301 USA Telephone: 724-328-3139 Fax: 724-222-9525 Puerto Rico Med Links PO Box 1622 Morovis, Puerto Rico 00687 USA Telephone: 787-270-4060 Fax: 787-270-4061 Website: www.prmedlinks.com Re:Group Inc. 213 West Liberty St. Suite 100 Ann Arbor, MI 48104 USA Telephone: 734-327-6606 Fax: 734-327-6636 www.regroup.us

OneWorld Global Healthcare Solutions LLC 300 East Club Circle Boca Raton, FL 33487 USA Telephone: 248-250-3221 Fax: 248-547-7769 Website: www.oneworldglobalhealthcaresolutions.com

Rex Moulton-Barrett, MD, Inc. 2070 Clinton Avenue 4th Floor Alameda, Ca 94501 City : Alameda, California Country : USA Phone : 510-864-1800 Fax : 510-864-1180 Website : www.moulton-barrett.com

June / July 2011

Sanivisit International LLC City : Reston, Virginia Country : USA Phone : 1-877-836-3233 Fax : 1-703-910-3545

Passport Medical Inc. #355 W Olympic Blvd. Beverly Hills, CA 90212 Telephone: 800-721-4445 Fax: 866-716-4449 Website:www.passportmedical.com

NursesNow International Av. Hidalgo 2609 Col. Obispado Monterrey, Nuevo Leon 64800 Mexico Telephone: +528181234849 Fax: +528181234851 Website: www.nni.com.mx

RSU Healthcare Company Limited 11th Floor RGU Tower 571 Surhumvit 31, Surhumvit Rd Wattana Dist, 10110 Bangkok, Thailand City : Bangkok Country : Thailand Phone : 66 2 610 0300 Fax : 66 2 259 7787 Website : www.RSUHealth.com

Siam Wellness Services Ltd. 622 Emporium Tower 22nd Floor 22/7, Klongton, Klongtoey Bangkok, Thailand 10110 Telephone: +66 2664 9091 Fax: +66 2664 9094 Website: www.siamwellness.com Southeastern Spine Center and Research Institute 5922 Cattlemen Lane Suite 201 Sarasota, Florida 34232 USA Phone: 941-371-9773 Fax: 941-556-0341 Website: southeasternspinecenter.com Spur Interactive 3701 Kirby, Suite 1290 Houston, Texas 77098 USA Telephone: 713-357-7101 Fax: 281-664-4745 Website: www.spurinteractive.com Stackpole & Associates 1018 Beacon Street, Suite 201 Brookline, MA, 02446-4058 USA Telephone: 617-739-5900 Website: www.stackpoleassociates.com Sunflower Health Travel International 4850 Sapphire Way Cypress CA 90630 USA Telephone: 714-600-8485 Sunshine Medical Tourism, LLC 18950 US HWY 441 Ste. 205 Mount Dora, FL 32757 USA Telephone: 352-638-3578 Website: www.SunshineMedicalTourism.com Surgery Facilities Resources PO Box 9500 Gurnee, IL 60031 USA Telephone: 847-775-1970 Fax: 847-775-1985 Website: www.surgeryfacilitiesresources.com

Surgery Host (Servicio Medico de Tramites e Implantes S C) Ermita 1588-A Zapopan, Jalisco 45046 Mexico Telephone: 523335639981 Fax: 523336471806 Website: www.surgeryhost.com Surgery Solutions Abroad 100 Pine Ln Oak Ridge, 37830 USA Telephone: 865-441-5432 Fax: 865-481-0194 Website: www.surgerysolutionsabroad.com The Crowne Group, Inc. 1552 Boren Drive, Suite 100 Ocoee, FL 34761 USA Telephone: 407-654-5414 Fax: 407-654-9614 Website: www.crowneinc.com Transmed Tourism LLC 7629 Wynndel Way Elk Grove, 95758 USA Telephone: 916-752-5539 Fax: 916-647-4876 Website: www.transmedtourism.com U’REKA S’CAPADE SDN. BHD No. 726, Wisma Yoon Cheng, Unit A-5-1 (Level 05), 4 1/2 mile, Ipoh Road Kuala Lumpur, 51200 Malaysia Telephone: +6 03-62586321/+6 0362525388 Fax: +6 03-62505040/+6 03-62515144 Website: www.urekascapade.com UBIFrance-French Trade Office 3475 Piedmont Rd. NE, Suite 1840 Atlanta, Georgia 30305 USA Telephone: 404-495-1667 Fax: 404-495-1696 Website: www.ubifrance.fr UCLA School of Public Health EMPH Program 10960 Wilshire Blvd. Suite 1550 Los Angeles, California 90024 USA Phone: 310-267-5600 Fax: 310-312-1711 Website: www.emph.ucla.edu/index.asp URAC 1220 L Street NW Suite 400 Washington, D.C. 20005 USA Telephone: (202) 216-9010 Fax: (202) 216-9006 Website: www.urac.org URUHEALTH (Health & Tourism in Uruguay) Dr. Marcelo Rodriguez Av. Ricaldoni 2452 Montevideo 11600 Uruguay Telephone: (+598) 27114444 Fax: (+598) 27114444 Website: www.uruhealth.com Via Belleza Av. 15 Las Delicias No. 59-330 Maracaibo 4005 Venezuela Telephone: 58 414 3606 725 n

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June / July 2011