Medical Travel Today

Greetings,

We're thrilled to open this issue of Medical Travel Today with a SPOTLIGHT interview featuring Regina Herzlinger of the Harvard Business School. One of the nation's most respected healthcare analysts, Professor Herzlinger spoke with us regarding the future of the industry, how it affects both local and global economies, the role healthcare reform may play, and more. We’re grateful to Professor Herzlinger for sharing her insight with us.

In addition, we have the first installment in a three-part series on Guatemala prepared by our publisher Laura Carabello and her associate Dana Taormina. Plus, in our DESTINATION USA section we revisit CyberKnife Denver, a free-standing radiation therapy center we first interviewed at the time of their opening in June.

As always, we welcome your feedback (both good and bad), story ideas, and press releases.

Editor's Note: The author of numerous books on healthcare, including Who Killed Health Care?, Market-driven Health Care, and Consumer-driven Health Care, Regina Herzlinger is one of the nation's most respected healthcare analysts.

She is frequently called upon to contribute her opinions to numerous publications including The Atlantic, Wall Street Journal, BusinessWeek, and The National Review.

She recently spoke with Medical Travel Today regarding the future of the industry and its impact on both local and global economies.

Medical Travel Today (MTT): What will be the economic impact of medical tourism on the United States, as well as the global economy? Do you believe the projections for growth in medical travel are on target or “out of this world?”

Regina Herzlinger (RH): I don't think the projections are too optimistic although it's hard to tell accurately what the exact number will be and it, of course, very much depends on what comes out of healthcare reform.

If we end up with a very centrally controlled healthcare reform, then medical tourism is unlikely to burgeon. This type of approach is simply unlikely to permit competition, which is so much what medical travel is about.

However, if we end up with universal coverage without a tightly controlled governmental infrastructure, clearly then there will be greater opportunity for medical travel.

Take a country like Switzerland that has universal coverage but no government program. It works wonderfully there. If we had this approach, it would lead to people finding the medical travel option attractive. The Swiss program allows for travel under their system and people do exercise the option.

However, if the care we get is government run, well, then the government makes the decisions, and those decisions would be more politically driven by special interest groups than true individual decisions. An individual will make a decision based on the value to them, whereas the government would be beholden to powerful stakeholders, including domestic hospitals, and, of course, unions. If the unions aren't in favor of global travel for care, it's unlikely to become an option for consumers.

All that said, I don't think we'll see a government-controlled program, but we will see expanded access. That is, consumers will have more options in terms of health insurance. Plus, there will be various tax remedies leading to more people buying health insurance for themselves.

MTT: Will government programs (Medicare/Medicaid) be likely to introduce medical travel options?

RH: No. They're typically laggards in adopting innovations because they are politically indebted to special interests that want to maintain the status quo and avoid the introduction of new competitors. They're very slow even when the benefits are obvious.

I think it will first advance through the private insurance sector. As it becomes clear that this is a do-good, do-well activity—that is, people get good care at good rates —then there will be pressure on the government to adopt it.

I think what we will eventually see is the Medicaid market going to places like Mexico and Costa Rica for care where there's a better value for their healthcare dollar, due to the fiscal pressure on the states that fund these programs and the large populations that are in the South.

The Medicare market, when it happens, is more likely to be worldwide, and not just Central and South America based.

MTT: Employer adoption of medical travel benefits has been slower than anticipated. Do you think that more employers will be looking to incorporate this type of benefit in 2009, 2010?

Upfront you've got companies like Hannaford, which is always an early mover on any healthcare service innovation. These types of companies are very innovative, an anomaly really, so in a way they don't count towards the statistics.

The way healthcare innovation adoption works is first you get 20 percent of employers on board. The next big group jumping on board accounts for another 20 percent, and then you get the laggards, the last 40 percent.

My gut is that the first 20 percent will be made up of large, self-insured companies that have trouble affording coverage…. Large manufacturing companies have a terrific incentive to make it happen – but they're often unionized so it's not possible. But non-unionized employers, say construction and agriculture, they'll be the ones to make this happen. They have the economic incentive to do it.

You may see some medium or small companies, but their impact will be very small. Small companies are unlikely to do it unless medical travel facilitators become better at reaching out to them. For a CEO of a small company to arrange care abroad for her employees is simply too cumbersome.

Medium-sized companies, say less than 5,000 employees, would be good candidates for medical travel. They usually buy an insurance policy at a fixed price. In these situations if the insurance does not cover medical travel, no one's going to do it.

MTT: What are your thoughts on the idea that medical tourism negatively impacts local economies where the care is being provided? Do you perceive growth for the new breed of domestic medical travel?

RH: I can't get too excited about that. There's always the charge that you're catering to rich tourists. It's true for even resort hotels. But catering to the rich with medical travel allows local economies to learn a lot about how to bring quality care to the middle class citizens.

In India, for example, many hospital chains are geared toward the upper class and the medical tourist. As a result, they are organized very differently. Rather than an everything-for-everyone model, they have spokes for specialized facilities, hubs for high level care, and telemedicine. All this leads to a much more efficient delivery of healthcare, which ultimately brings more services to the middle and lower class.

Just look at the early history of the car industry. The first cars were built for the rich. At the time a car cost as much as a house. But pretty soon cars became largely middle class because of the efficiencies learned through the experience of building them for a few. The lessons learned by building for the upper class led to cars becoming accessible to the middle class.

I certainly think the argument is well intended, but it doesn’t follow laws of economics. Most innovation is developed for specialized wealth sectors, but in the process you learn how to serve the middle class. You learn how to do whatever it is your doing— be it building cars or computers or delivering healthcare—very well, and as you drive down the cost, you become more efficient. That then makes it feasible to bring the service or product to the middle class and even the poor. They also have computers and cars.

In the short run, medical travel may displace services, but in the long run it will improve them.

The other thing to be mindful of is that when you cater and build to foreigners, this growth is largely being funded by external capital. That's not government money that's being spent there. And no matter how you look at that, it's good for the local economy.

It's essentially found money coming into their economy. Just look at India. Their entire gross domestic product is about a trillion dollars. The U.S. healthcare system alone is $2.3 trillion. How can they not gain from getting a piece of that?

MTT: What are the greatest opportunities for growth and development in the industry?

RH: Vendors might try targeting the mid-sized employers in the United States. I think that’s an underpenetrated market. And as far as I know nobody is focusing on small employers. I understand that because it's very costly, but since most uninsured people would be prudently interested in healthcare savings, this would be a real opportunity area.
Otherwise the industry, as far as the supply of facilities, is moving very well.

MTT: What countries/regions do you think are best poised to take advantage of these opportunities?

RH: That's an interesting question. I think countries have the opportunity to grow in the areas that are in synch with their local cultures. Cultures can really shape specialization.

Take Thailand for example. Thailand is the leading destination for gender alteration surgery, and that's largely because the Thais are so open and accepting of it. To them it's just correcting a natural mistake—a man born into a woman's body or vice versa. With that kind of culture, they are of course very good at that type of procedure and at understanding the patient needs.

Right now India is experiencing burgeoning prosperity and subsequently the diseases of prosperity. As it turns out, Indians also have a propensity for those diseases—diabetes and cardiovascular disease. It's really become an epidemic because as they've gotten more prosperous it's triggered what some might call a genetic proclivity. I think this makes India more likely to become the place to go for care in cardio and diabetes issues in the future.

As in these examples, the centers of excellence in the future will reflect the cultural and medical needs of that culture.

MTT: What does the United States need to do to become a lead medical travel destination or to stop the outmigration of patients?

RH: You often hear people say that healthcare is local. There's no evidence of that. It's just a saying. We have no experience with what people really want to buy in healthcare because most of their expenses are shaped by insurers’ choices.

We've seen that when people are motivated by economics, as per Hannaford, they're willing to send their employees to other states for care.

The U.S. market will also be driven by increased transparency. You know, I can sit here and read the label on my yogurt and tell you that it has 25 percent of the recommended calcium I need for the day, but I can't tell you who the best doctor in town is for a given procedure.

Pretty soon we'll have REAL transparency, like, how many people died when a doctor did a certain procedure, how many people got an infection at that hospital, how many medical errors were committed at that one. I'm talking about real data and outcomes.
I recently needed toe surgery. I was told "this guy's the best" and so on. Now, I value opinions, but when it comes right down to it I like to look at data. As it turns out I have a friend at a big insurer who sent me data about the doctors who do the type of surgery I needed on women my age. The doctor that was recommended to me had done zero. Zero! I ended up going to a different state to a different doctor who does 20 of these procedures a week. I didn't hesitate for one second to make that drive.

That kind of information should be available to everyone. People should be asking “why didn't I know the hospital had 40 percent infection rate?” It's a very valid question, and we should be furious that information is simply not out there.

In time we'll have greater transparency. The demand for it will be consumer-driven and the government will ultimately respond. It will be a huge driver for where people go for care.

The idea that healthcare is local is supported only by the absence of information.

About Regina E. Herzlinger (reginaherzlinger.org)

Regina E. Herzlinger is the Nancy R. McPherson Professor of Business Administration Chair at the Harvard Business School. She was the first woman to be tenured and chaired at Harvard Business School and the first to serve on a number of corporate boards. She is widely recognized for her innovative research in healthcare, including her early predictions of the unraveling of managed care and the rise of consumer-driven healthcare and healthcare-focused factories -- two terms that she coined. Money has dubbed her the “Godmother” of consumer-driven healthcare. She was profiled most recently by BusinessWeek in “If Health Care Were Run like Retail” and by Roll Call in “Obama, Congress: Take a Look at the Swiss Answer to Health Care.”

All her healthcare books have been best sellers in their categories. Her newest book, Who Killed Health Care? (NY: McGraw-Hill, 2007), was selected by the U.S. Chamber of Commerce as one of the ten books that changed the debate in 2008. Noted Merrill Matthews, “There are two powerful, well-respected, and highly accomplished women who are driving the health care reform debate in the United States. One is Secretary of State Hillary Clinton, whose first attempt at dramatically reforming the U.S. health care system turned into a political disaster. The other is Harvard Business School economist Regina Herzlinger, one of the country’s most knowledgeable and articulate experts on the U.S. health care system, who has been pointing the way toward a ‘consumer-driven’ system for years.”

She has won the Consumers’ for Health Care Choices Pioneer in Health Economics award, the American College of Healthcare Executives’ Hamilton Book of the Year award twice, the Healthcare Financial Management Association’s Board of Directors award, and Management College of Physician Executive. Modern Healthcare’s readers regularly selected her among the “100 Most Powerful People in Healthcare” and Managed Healthcare named her one of healthcare’s top ten thinkers. In recognition of her work in nonprofit accounting and control, she was named the first Chartered Institute of Management Accountants Visiting Professor at the University of Edinburgh. In addition, she has delivered many keynote addresses at annual meetings of large healthcare and business groups, and been selected as one of the outstanding instructors of the Harvard Business School MBA Program.

Professor Herzlinger has served on the Scientific Advisory Group to the U.S. Secretary of the Air Force and as a board member of many private and publicly-traded firms, mostly in the consumer-driven health care space, often as chair of the Governance and Audit subcommittees.

Regina Herzlinger received her bachelor’s degree from MIT and her Doctorate from the Harvard Business School.

After attending the Service Summit 2009 in Guatemala City, Guatemala, Medical Travel Today will feature a three part series on “Guatemala: A burgeoning medical travel destination. For more information on the Service Summit visit www.servicesummit.com

Starting off this series will be a focus on two of the country’s premiere hospital facilities. Not only is Guatemala recognized as a beautiful travel destination with a warm climate and mountainous and volcanic regions, but also as an excellent option for high quality care at affordable rates. Guatemala healthcare services are highly competitive with other medical travel destinations.

Guatemala is an appealing place for tourists to retreat, relax, or explore, as well as seek high quality treatment and care. A popular tourist location is the historic town of Antigua, Guatemala; known for its well-preserved Spanish Mudéjar influenced Baroque architecture and ruins of colonial churches. With excellent proximity to the United States, Guatemala is located in Central America, neighboring Mexico to the north and Belize, El Salvador, and Honduras to the east and south. With three million inhabitants, Guatemala City is the largest town of Guatemala.

Church ruins in Antigua, Guatemala

Herrera Llerandi Hospital
One of the major medical facilities in this city is the Herrera Llerandi Hospital headed by Christian Guillermo, president of the institution. It was founded in 1963 and has approximately 250 medical specialists practicing in over 15 areas of medicine. Providing comprehensive treatment to patients, the professional staff has an outstanding reputation and offers excellent services. Herrera Llerandi reports that it is undergoing Joint Commission International accreditation and expects to complete the process in 2010. The Credentials Committee also regularly evaluates the hospital.

This prestigious institution features comfortable and modern facilities for patients and the most advanced medical technology and equipment, with 70 beds and 13 intensive care unit (ICU) beds. The ICU has a modern, integrated system, which allows specialists to provide close, personalized attention to patients. Herrera’s ICU has a one-to-one nurse-to-patient ratio and three-to-one ratio through the entire hospital. It is regarded as a leader in care of cardiovascular disease and maintains strategic alliances with leading hospitals across the globe.

For diplomatic personnel, employees and executives of major companies, and international delegates, Herrera Llerandi is a popular choice for treatment. The hospital also features private suites with garden views that have space for a traveling companion.

Garden view from private rooms in Herrera Llerandi

Centro Médico Hospital
Centro Médico Hospital is also located in Guatemala City. It has a reputation for being one the best medical institutions in Guatemala, with an array of different services and prestigious staff led by Carlos Enrique Sandoval, chief medical officer. The hospital carries a mission to provide specialized services along with integrated preventive and curative medicine through a personalized team based on the highest quality science and technology in the health field. Centro Médico is the only hospital with a helicopter landing pad location. They value integrity, excellence in care and service, teamwork, innovation, comfort, and safety.

When patients enter the facility they are given a care package and a warm welcome from staff members who answer questions and cater to specific needs, making the patient’s welfare their top priority. With a variety of different types of rooms, this facility is extremely accommodating and comfortable with 72 beds and 12 ICU beds. The rooms are equipped with the highest technology, which enables staff to efficiently and effectively care for patients. Cento Médico expects to achieve Joint Commission International Accreditation in the spring of 2010.

Financial Mirror, by Elena Demosthenous

Having competitive and successful healthcare businesses is important not only for the people, but also for the economy, especially in countries where services and tourism are the major sources of income, like Cyprus.

Healthcare providers, especially hospitals, invest a lot to maintain their image, try to recruit the best medical staff, and use the best equipment. All of these efforts happen at a time when they must also be cost-conscious. But is this enough? What about patient satisfaction? Nowadays patients desire high quality service, particularly as healthcare costs rise. They seek value, and their satisfaction is critical to the hospitals’ growth and success, because when patients are satisfied there is a significant reduction of the professional liability risk exposure. By focusing on patient satisfaction strategies, healthcare providers can enhance their services to avert potential malpractice claims because happy patients do not sue. It’s significantly less expensive to keep patients satisfied than to pay litigation costs.

Nevertheless, this is a big challenge since the experience a patient goes through is a complex assembly of multiple interdependent processes. These processes can be grouped under four categories: Referral/Access, Registration/Admission, Treatment/Care and Discharge/Exit. Each one of these groups includes a combination of tangible factors (physical and environmental facilities) and intangible factors (organizational/interpersonal factors) that interactively contribute to the patients’ overall experience and satisfaction.

Intangible factors are usually the ones that are left behind or not given enough attention. Patient dissatisfaction often is a result of their inadequacy -- while at the same time satisfied patients justify their satisfaction based on those intangible factors.

Implementation of hospital accreditation standards is a very valuable tool to achieve patient satisfaction by covering these intangible factors, and by identifying and setting requirements for all the above processes.

Consistency and uniformity are important elements and provide a feeling of security and reassurance that the staff is competent. This is why evidence of clearly defined and consistent procedures regarding all medical and administrative processes increases patient satisfaction and perception of the level of quality care received.

Patients can easily distinguish between well-trained and content staff members and staff members who lack knowledge and experience. Friendliness and courtesy are surely non-negotiable qualities when working in healthcare, and it is the responsibility of a hospital’s management to provide for its development, improvement, and assessment.

Patients have rights, therefore issues related to privacy and confidentiality, medical records, valid consents, etc. are very important. Patients need to feel that these rights are recognized and respected. On one hand, it is reassuring for them, and on the other hand it creates a feeling of credibility for the hospital.

Information and proper communication is also critical and has a direct impact on patient satisfaction. With an emphasis on transparency and quality reporting in healthcare, the patient becomes an informed consumer, with increased needs and demands: in order to meet these demands, hospitals should have processes in place to ensure straight-forward communication so that patients receive all information related to their rights, condition and treatment, possible risks, and follow-up actions. Additionally, the quality of patient-doctor interaction is negatively correlated with complaints in many surveys, whereas positive interaction is linked with fewer professional liability claims.

The way patients’ needs are addressed can have an extremely negative or positive impact on a patient’s experience. These needs may include special medical conditions, disabilities, language and cultural differences, etc. It would be completely erroneous for a hospital to ignore these, especially if one considers the emotional stress patients sometimes go through.

The hospital discharge experience also has bearing on patient satisfaction. Timely and efficient discharging is highly appreciated whereas delays and mistakes in the financial settlements cause frustration. Moreover patient satisfaction depends a great deal on whether they feel cared for -- and if they are asked to give feedback on the services received in order to share their complaints and suggestions. Indeed, keeping patients satisfied is not an easy and simplified situation because healthcare provision is a complicated process, especially because patients’ needs can be so similar and, at the same time, so different. Keeping patients satisfied is about developing processes and culture within the organization. Involving a variety of staff members, it’s a continuously changing effort adjusting to changes and fluctuating needs, while surviving in a very competitive market. As mentioned above, implementation of hospital accreditation standards can greatly assist in achieving this. Elena Demosthenous is a chemist, working as a Standardisation Officer at the Cyprus Organisation for Standardisation (CYS).

Zurich hospital turns away U.S. health tourists
Thomas Stephens, swissinfo.ch
Zurich University Hospital has stopped treating North American "medical tourists," fearing million-dollar claims from litigious patients if operations go wrong.

Hospitals in the canton of Valais have also adopted measures to protect themselves against visitors from the United States, Canada, and Britain.

"The directive applies only to patients from [the United States and Canada] who come to Zurich for elective [non-essential] health treatments," Zurich University Hospital spokeswoman Petra Seeburger told swissinfo.ch. "It is not because treatment is not financed; it is because of different legal systems."

In a statement the hospital said it was "not prepared to risk astronomical damages or a massive increase in premiums."

Seeburger emphasized that the restrictions only affected people not domiciled in Switzerland.

"Of the 170,000 patients Zurich University hospital treats annually, about 3,000 come from abroad and 30 are North Americans. These are mainly emergencies and would of course continue to be treated," she said. "Most patients choosing the Zurich University Hospital come from countries near Switzerland, the Middle East, or Russia."

Consent forms
In the southern canton of Valais, medical tourists have to sign a "specific consent form," which states that the limits of responsibility are fixed in Swiss civil law. Bernard Gruson from Geneva University Hospital said all patients have to sign a consent form, whether they are foreign or not.

"As long as a patient is sufficiently insured or has paid a deposit, we'll treat them," was the response from university hospitals in Bern and Basel.

"We have good liability insurance – including for foreign claims," said Andreas Bitterlin from Basel University Hospital, which last year treated around 100North Americans as inpatients.

Health tourism pioneer
Switzerland has a long history of medical tourism, dating back to the 19th century when wealthy travelers came to "take the waters." In the early days healing mineral waters and fresh alpine air promised miracle cures for all kinds of diseases, notably tuberculosis.
Today, private Swiss clinics advertise surgery in in-flight magazines while agencies specializing in organizing medical treatment for foreigners offer a deluxe service covering everything from interpreters to visas.

People travel to Switzerland for a broad range of treatments and procedures, plastic surgery included. One well-publicized patient was Italian Prime Minister Silvio Berlusconi who came to Switzerland for an eye operation two years ago. The late Saudi King Fahd also underwent medical treatment in Switzerland.

Discreet Switzerland
The health tourism sector is estimated to be worth SFr900 million ($870 million) a year as Switzerland's reputation for healthcare excellence holds firm. Nevertheless, experts believe Switzerland could still do more to attract wealthy foreigners looking for top-class treatment.
A study on Switzerland's potential in this area, carried out by Zurich-based think tank the Gottlieb Duttweiler Institute, highlighted complex cases requiring specialist treatment. Discreet Switzerland could also offer privacy to VIPs, it said.

A forecast by Deloitte Consulting published in August 2008 projected that medical tourism originating in the United States could jump by a factor of ten over the next decade. An estimated 750,000 Americans went abroad for healthcare in 2007. The growth in medical tourism has the potential to cost U.S. healthcare providers billions of dollars in lost revenue, it said.

Anthem Blue Cross and Blue Shield Introduces SmartSense(R) and Premier, Price-Conscious Individual Plans Targeted at the Uninsured

ST. LOUIS, Sept. 29 /PRNewswire/ -- Anthem Blue Cross and Blue Shield (Anthem) introduced two suites of PPO products called SmartSense® and Premier that will provide Missourians with more affordable options for individual insurance. These products are currently being sold with effective dates of October 1, 2009.

SmartSense is a new price-conscious, choice-driven health insurance plan ideal for individuals, "early" retirees, students and the uninsured. "SmartSense represents one of the best Anthem plans," said Dennis Matheis, president of Anthem Blue Cross and Blue Shield in Missouri. "Most individual plans on the market today offer limited choices. SmartSense can be tailored to fit your needs - and is one of our lower priced products, with premiums ranging from as little as $38 to $141 per month for a healthy 25-year old male." Anthem's SmartSense plans provide coverage for up to three physician office visits a year before a member has to meet a deductible, a number of preventive benefits and a choice of prescription drug coverage options.

SmartSense is designed to provide protection against expensive and unexpected medical bills and offers a variety of deductibles, starting at $500, that allow consumers to find a premium they can afford. Plans offer:

The Premier plan is designed for customers who want the security of a comprehensive benefit design with lower out of pocket costs. This plan is also a good choice for families with children, or those planning to have children. Comprehensive prescription drug coverage is included with no deductible for Tier 1 drugs (including generic and limited brand name drugs) and a separate deductible for all other covered drugs. The Premier plan provides unlimited coverage for office visits before having to meet a deductible, provides a number of preventive benefits, and offers the ability to add maternity coverage.

"Anthem's goal is to reduce the percentage of Missourians who are uninsured," Matheis said. "As we move forward, we'll continue to focus on providing affordable plan options like Anthem's SmartSense and Premier while maintaining the high quality and value-added benefits consumers have come to expect from us."

Members choosing SmartSense and Premier have access to more than 10,000 Missouri network doctors and specialists and nearly 100 hospitals. These plans also provide coverage outside the state of Missouri through the Blue Card program. Term life and dental plans are also available at an additional cost.

For more information about SmartSense, Premier and other Anthem products, contact your local Anthem Blue Cross and Blue Shield agent or call 1-888-641-5224, or visit us at www.ANTHEM.com.

Mexicali Health Care Partners With Health Travel Technologies To Manage Its Medical Tourism Business Infrastructure

San Francisco, CA — Health Travel Technologies, architect of the medical tourism industry’s most comprehensive technology and services platform for medical travel management, has signed an agreement with Mexicali Health Care to provide the technology infrastructure for managing its international patient operations.

Mexicali Health Care was formed in response to the long-term trend of U.S. patients – particularly from California and Arizona – crossing the border for dental and surgical care at significant savings over U.S. prices. A recent study by the UCLA Center for Health Policy Research estimated that nearly 1 million people from California alone seek medical, dental, or prescription services in Mexico each year. Mexicali Health Care’s partnership with Health Travel Technologies is designed to keep pace with that demand.

“Mexicali is very serious about becoming a major international healthcare provider,” said Carlo Bonfante, a prominent investor in the Mexicali Health Care enterprise. “As a new entity, Mexicali Health Care was starting at ground zero and needed to work with a company that could guide us in building procedures for establishing a professional system for processing and managing patients. Working with Health Travel Technologies has helped us to get up and running with minimal up-front investment. Now we have the capability to grow our business and focus on healthcare delivery instead of the details of handling medical tourism.”

Health Travel Guides CEO Herb Stephens adds, “Our core business is providing behind the scenes operational support for international health care providers. Our technology platform has been architected specifically to take the headache out of providing medical tourism services for large international hospitals, and our experience on the consumer end enables us to help newer entries into the medical travel field develop a brand and quickly begin generating request for surgery quotes and patient flow.”

Health Travel Guides is the first and only technology and services company dedicated to managing the complex needs and growth of the medical tourism industry. The company’s systems currently process more than 1 million international travelers representing more than $500 million in financial transactions per year.

According to Stephens, Health Travel Technologies is the ideal solution for any business currently offering, or planning to offer, medical travel services – including medical tourism facilitation agencies, online travel agencies, hospitals, insurers, and businesses.

“Health Travel Technologies supports the marketing, operations, and brand objectives of medical tourism providers; our business model means our success is always aligned with our clients,” said Stephens.

Medical tourism continues to garner considerable attention as a growing number of U.S. employers, consumers, and other stakeholders explore cost-effective healthcare options for their organizations. Experts currently estimate the size of the medical tourism market to reach $100 billion by 2012.

According to Stephens, this increased volume creates a significant issue for international healthcare providers servicing an international patient base.

“Medical tourism is here,” said Stephens. “We’re well beyond the point of asking, is this a safe, quality option? The superb level of healthcare in Mexico and other countries is indisputable. The question now is how can the growing volume of international patients be most effectively managed?”

Health Travel Technologies provides a centralized, automated system for managing medical tourism – not just booking procedures and travel, but also strategic marketing, Web-page hosting, quote management from multiple sources, as well as accounting, billing, collections, loan servicing, and insurance offerings.”

About Mexicali Health Care
Mexicali Health Care is a network of northern Mexico’s top physicians and two major hospitals, Hospital de la Mujer and Hospital Hispano Americano. Mexicali Health Care formed specifically to provide Americans, and all international travelers, with quality, comprehensive medical and surgical care options at prices far below those in the United States.

Its unbeatably priced surgical packages and quiet, relaxed atmosphere make Mexicali Health Care the ideal provider for patients, especially women, interested in elective surgeries such as bariatric surgery or anti-aging procedures, done in a private setting.
Although Mexicali Health Care’s medical tourism program is newly developed, their hospitals already treat about 8,000 medical travelers a year who cross the border on foot and by car from nearby U.S. towns, and provide treatment options to meet any healthcare need.

About Health Travel Technologies
Health Travel Technologies is a subsidiary of Health Travel Guides. A technology and services company, HTT operates and licenses an award-winning platform specifically developed to handle the many demands of health travel.

Founded in 2006, and headquartered in San Francisco, Calif., with operations in San Diego, Calif., Health Travel Guides is a privately held company. Health Travel Foundation is a non-profit organization dedicated to providing quality care abroad to people who are unable to afford healthcare procedures or services.
For more information about Health Travel Technologies visit www.healthtravelguides.com.

Companion Global Healthcare Adds Barcelona’s Teknon Hospital to Network

Columbia, S.C. – Medical travel facilitator Companion Global Healthcare Inc. has accepted Centro Medico Teknon in Barcelona, Spain, into its network of accredited, international hospitals that treat American patients at prices substantially lower than those at U.S. facilities.

The addition of Teknon Hospital represents another option for Companion Global Healthcare’s individual clients and employer group members to obtain surgery and other care from a credentialed facility at preferred prices. All Companion Global Healthcare network hospitals are accredited by the Joint Commission International, and rates are up to 90 percent less than at hospitals in the United States.

A complete list of network hospitals is available at www.CompanionGlobalHealthcare.com.

“Teknon employs the latest technology in every area of patient care, and we are delighted to include this hospital in our network,” said David Boucher, president and COO of Companion Global Healthcare. “Teknon has years of experience in treating American patients, and it offers amenities such as a VIP lounge, a business center, computers, snacks, newspapers and televisions that contribute to a complete positive experience for the patient.”

Teknon and Companion Global Healthcare worked closely with MAPE Tourism Consulting of Spain to facilitate the agreement.

Based in Columbia, S.C., Companion Global Healthcare offers medical travel concierge services and an international network of dental clinics and accredited hospitals to individuals, as well as to self-insured employer groups. An employer can save tens of thousands of dollars any time a single employee chooses treatment at a Companion Global Healthcare network hospital, even after factoring in travel expenses.

Companion Global Healthcare Inc. provides medical and dental travelers with round-trip assistance and customer service, as well as preferred pricing at its network facilities. It serves as a single launch point for appointments, travel arrangements, case management coordination services upon return to the United States, medical travel insurance, and help with claims filing.

Employer groups interested in restructuring their benefit plans to include Companion Global Healthcare’s network and services should call 1-800-906-7065.

Healthcare Infrastructure Driving Medical Tourism in Malaysia
EMAILWIRE.COM, September 23, 2009 - New Delhi, India - According to our new research report titled "Malaysia Medical Tourism Outlook 2012," medical tourist arrivals in Malaysia will continue growing at a fast pace. With the developed healthcare infrastructure, medical tourist arrivals in Malaysia are forecasted to grow at a compound annual growth rate (CAGR) of over 23 percent between 2009 and 2012.

As per our findings, Malaysia has one of the most developed healthcare infrastructures in the region and is considered a paradise for healthcare facilities and hospitals. Malaysia presents tough competition to its regional rivals in terms of cost and is much superior in terms of healthcare services, healthcare infrastructure, English-speaking staff, foreign-trained specialist doctors, and strict government regulations on maintaining high standards of healthcare delivery systems. With all these advantages, Malaysia appears as the most promising market for medical tourism.

Moreover, the report says that better services at private hospitals in Malaysia are also fueling the growth of medical tourism in Malaysia. Here it is noted that the healthcare system is Malaysia is dominated by private hospitals. At the end of 2008, there were 144 public hospitals and 224 private hospitals in Malaysia, which means private hospitals account for more than 60 percent of the total number of hospitals. Increasing healthcare expenditure in Malaysia is the major driving factor behind the growth of private hospitals infrastructure. The total healthcare expenditure grew at a CAGR of 13.7 percent from 2003 to 2008, reaching US$ 7.6 Billion in 2008.

"Malaysia Medical Tourism Outlook 2012" provides an in-depth analysis of the present and future prospects of the Malaysian medical tourism industry. It looks into Malaysia's medical tourism industry in detail with a focus on different parameters like inbound tourism, expenditure by inbound tourists, healthcare infrastructure, etc. This report provides strategic insight to clients so that they can evaluate the opportunities for their success in the Malaysian medical tourism industry.

The research also features forecast on vital industry segments, including forecast for the Association of Southeast Asian Nations (ASEAN) tourism, international tourist arrivals, international tourism receipts, medical tourist arrivals, and medical tourism receipts.

Medical Travel Today first talked with Gregg Dickerson, M.D., of Denver CyberKnife a mere two weeks after they opened this past June. A free-standing radiation therapy center dedicated to treating patients with tumors using image-guided radiosurgery, Denver CK treats patients with brain, spine, lung, prostate, pancreas, liver, head and neck, and other conditions.

At the time of their opening, Dr. Dickerson shared, "We're getting a lot of calls, including ones from folks several states away." He also relayed that they were planning an aggressive advertising campaign including television and newspaper. We decided then to revisit the practice after they had been operating a few months to check in on the volume and source of the current patient stream.

Gregg Dickerson (GD): It's going great. Our schedule is currently full for the next month and a half out for prostate treatments. Our consult volume is high and diversifying. We're right on track with where we wanted to be.

MTT: When we talked in June you had only done prostate treatments. Is that still true?

GD: Happily, no. I'd say 75 percent of our cases are prostate, but we're also seeing an increase in spine and neurosurgical treatments.

GD: In part, but there's also been an education taking place among physicians. Some just needed to learn we are here, what we have to offer, and how we can help them in the care of their patients.

But I can say that after one of our commercials run, the phones do start to ring. And what's interesting is that the calls aren't just in-state. We've had calls from California, Alaska, Nebraska, Wyoming, and even France. What happens is a friend or loved one in the Denver area sees the spot then gets in touch with the potential patient and says, “Hey, you should check this out." It's been very interesting.

GD: We did 65 consults in our first three months. We're currently doing 12 to 15 cases per month, each with 1 to 5 individual treatments, with a goal of 20 to 30 cases per month by the end of the first year. Based on the trending, I think we're in good shape to hit that goal.

While the advertising has certainly helped on the patient side, we've also hired a physician liaison to help on the doctor side of things. He has a biotech background and goes directly to doctors' offices to educate them on the equipment and training. Making the doctors aware of all their treatment options is proving very helpful.

MTT: As you look to the year ahead you clearly see the opportunities. But what do you see as potential obstacles?

GD: Without a doubt, insurance continues to be the biggest obstacle. In this part of the world, most don't cover CyberKnife for prostate treatments. I did hear that Highmark, an East Coast Medicare contractor, is now covering it. We're optimistic that will be a trend that spreads to Colorado.

But currently we're dealing with a lot of disappointed BlueCross, Cigna, and United patients who aren't covered and are essentially pigeon-holed into more costly, more invasive treatments with considerably more side effects.

It's really unfortunate because you're not only talking about costing patients more in terms of expense and the pain of recovery, but there are important quality of life issues attached to the decision.

Studies have shown that CyberKnife leads to a less that 10 percent impotence rate versus 50 to 100 percent through traditional treatments. That's not a slim margin of difference. Plus the patient walks out of the treatment room and back to a normal life rather than being laid up for days or having to suffer months of side effects caused by other treatments.

If we could remove the insurance hurdle, I think we'd hit our 12-month goal in considerably less time and make a lot of prospective patients happier in the process.

In the meantime, we have set up a self-pay option for patients who are underinsured. Essentially, if the patient is underinsured, we provide a discounted rate. It's not the same as being fully covered, but it does make the CyberKnife option more of a possibility for some.

MTT: You mentioned an uptick in other types of treatments. Tell us about that.

GD: We're currently active with intercranial work, spinal tumors, and non-axial nerve sheath tumors.

We're trying to build up lung treatments and have a great success story with our first patient. I think we'll try to build that into a campaign so we can share it with a broad audience.

We're also getting ready to participate in the STARS (International randomized study to compare CyberKnife® Stereotactic Radiotherapy with surgical resection in stage I non-small cell lung cancer) trial with M.D. Anderson. It's focused on surgery versus radiosurgery for lung cancer, from very early stages to the most advanced. It's truly a landmark study and we're thrilled that we’re going to be a part of it.

About Gregg Dickerson, M.D.
Dr. Dickerson graduated from the Indiana School of Medicine in 1984 and completed his residency in radiation oncology at the Thomas Jefferson University Hospital in Philadelphia, serving the final year as chief resident and Fellow of the American Cancer Society. For the following 14 years, Dr. Dickerson practiced radiation oncology in Indiana, performing as the director of Radiation Oncology at Ball Memorial Hospital and president of East Central Indiana Radiation Oncology, from 1990-2002. Gregg served as a flight surgeon in the Air National Guard for almost 10 years and also served as the president of the Indiana and Mississippi Radiological Societies. He has also served as member of the Small and Rural Practice Committee of the American College of Radiology. Dr. Dickerson has more than five years of CyberKnife experience, having started the 12th CyberKnife center in the country (Jackson, Miss.) in 2004 and, most recently, serving as a clinical assistant professor of Radiation Oncology at St. Louis University School of Medicine.

Dates for Costa Rican Medical Care's Medical Tourism Conference Announced

There’s still time to sign up to attend Costa Rican Medical Care's Medical Tourism conference in San Jose, Costa Rica October 6-7.

"People can read about Medical Tourism or attend seminars with Medical Tourism providers, but the only way to really learn about Medical Tourism is to experience it first hand. The purpose of our seminar is for insurance company executives, employee benefit mangers, health insurance agents, third-party administrators, and others is to experience first hand the hospitals, physicians, dentists and other medical service providers that Costa Rican Medical Care works with. Once people see the quality of the health care Costa Rica has to offer, they will be comfortable working with us and recommending our services to their people," said Tim Morales.

"We feel it is important for us to provide these educational seminars at a price people care afford, so we proud to be working with The Barceló San Jose Palacio, a five-star hotel to accomplish this and we have priced this event at only $799.00 all included."

Who Should Attend?

Employee Benefit Advisors
HR Mangers
Insurance Executives
Health Agents
TPAs
Health Savings Account Providers
Self Insured Firms
Individuals interested on saving on healthcare treatments

For more information on attending this event please visit http://costaricanmedicalcare.com/seminar_oct_6_7
or call Costa Rican Medical Care at 262-348-1300.

Omanexpo Organizing Major Health Exhibition for October 19-21, 2009

In view of the rapid growth of Oman’s health and medical sector, Omanexpo LLC is currently organizing an international exhibition called MedHealth & Wellness to be held on October 19-21, 2009, at the Oman International Exhibition Centre in Seeb. MedHealth & Wellness 2009 will showcase everything required in achieving and maintaining good health and well-being.

Supported by the Ministry of Health (MOH), the three-day international exhibition will feature medical tourism, health products and services, laboratory and medical equipment, pharmaceutical products, hospital and clinic infrastructure, sports and fitness, and alternative therapies.

“We envision MedHealth & Wellness 2009 as the definitive event in Oman for everything related to healthcare, medicine, and fitness. It will be highly relevant to all medical professionals in the sultanate as well as to everyone looking for ways to effectively improve their health,” says C.J. Paul, general manager of Omanexpo LLC, the leading exhibition management company in the sultanate. Paul pointed out that, with the official support of the Ministry of Health, MedHealth & Wellness 2009 is expected to attract the participation of leading companies in Oman’s vibrant health and medical industry.

In line with this, a briefing on the exhibition will be held on April 20 at the Crowne Plaza Muscat to inform all medical equipment suppliers in Oman about MedHealth & Wellness 2009. “The strong presence of local companies in the exhibition will prominently showcase the quality of healthcare in the sultanate and also clearly reflect the continued development of Oman’s vibrant health and medical industry,” Paul stresses.

Apart from local companies, MedHealth & Wellness 2009 is also expected to attract many international exhibitors who want to take full advantage of the growing opportunities in the sultanate’s medical sector. In addition to the Ministry of Health, MedHealth & Wellness 2009 is also supported by Middle East Health magazine as the print media partner; Malaysia Healthcare.Com, Global Ayurveda and Placid Way as the online media partners; and Becker Travel as the official travel partner.

For stall reservations or for more information on MedHealth & Wellness 2009, please contact Melwin D’Cunha, Project Manager, at tel. no. +968-24660124, mobile no. +968-92881982, or e-mail melwin@omanexpo.com. More details about the event are also available online at www.omanexpo.com/medhealth.

Date Set for Healthcare Travel Exhibition & Congress in Dubai: October 27-29, 2009

With the healthcare travel industry poised to play an important part in Dubai's growth strategy, the Institute for International Research (IIR) Middle East, the organizers of the first medical tourism conference in the United Arab Emirates (UAE), which concluded in Dubai, recently have reported high levels of interest from a potentially huge international market.

"Research unveiled at the event indicated a global market of around two million medical travelers a year and an industry constrained by hospital capacity and lack of consumer familiarity with medical travel," says Sietske Meerloo, marketing manager at IIR Middle East and organizer of Healthcare Travel Exhibition & Congress. IIR Middle East is also the organizer of the Arab Health Exhibition and Congress, the region's premier event for Middle East healthcare that takes place in Dubai 27-29, October, 2009.

“Large numbers of hospitals and clinics around the world are attempting to tailor their health services to cater to medical tourists," Meerloo added. "Several major insurance companies offer a travel component in their policies, and governments are looking closely at policies to take account of the trend."

The health care event was officially opened by Haidar Al Yousuf, M.D., transition director at the Dubai Health Authority, who highlighted the importance the Authority is placing on the future of medical tourism.

"As we look to develop our domestic health strategy, we also want to develop a joint strategy with our colleagues in the Department of Tourism & Commerce Marketing (DTCM), for the future of health tourism in Dubai," says Dr. Al Yousuf. "The health care sector in Dubai will become an increasingly attractive place for international health care investors, providers, services, facilities, and other health care professionals."

PlanetHospital, a California-based leader in medical tourism, used the event as a platform to announce the official opening of its Jeddah Saudi Arabia office to serve inbound and outbound medical tourists from the Arabian Gulf region.

"The Gulf has the potential to drive growth in medical tourism," says Mohammed Alarifi, managing director for the new operation. "It is not only a destination from where patients seek medical care abroad but is also becoming a medical tourism destination itself thanks to major hospital developments throughout the region."

The American Hospital Dubai also had high visibility at the event. There was "a lot of exchange of experience among colleagues from around the world," says Naser Saleh, director of marketing and sales. “On the conference side, the sessions were very informative."

Gary Miller, CEO of Health Travel TV, says the event had been important for them. "We have a unique product, and we’re the only broadcast media here dedicated to this area. I’m coming back to Arab Health in January."

Organized in association with the International Medical Travel Association, the Healthcare Travel Exhibition and Congress was supported by the UAE Ministry of Health and the Health Authority of Abu Dhabi. Platinum sponsors were Singapore Medicine. Gold sponsors were the American Hospital Dubai and Dubai Health Authority. For details about Arab Health events, please visit: www.arabhealthonline.com

Healthcare Abroad and Health Tourism 1st International TEMOS Conference
November 15-17, 2009 in Cologne / Germany

TEMOS is pleased to announce the 1st International TEMOS Conference on “HEALTHCARE ABROAD AND HEALTH TOURISM” in Cologne, Germany from November 15-17, 2009.

The main objective is to bring together the parties and markets of:

Health insurance companies and payers from Germany and Europe
Hospitals and medical facilities from all over the world
International facilitators, health tourism operators and telemedicine providers

to discuss about quality management, and the potential of health tourism & healthcare services abroad – from the stakeholders’ perspective.

To push these conference topics we have the pleasure to introduce several international experts as members of the TEMOS Conference Advisory Board, for example:

Health insurance: Dr. Franz Benstetter, Head of Operational Services Munich Health, Munich Reinsurance Company.

Medical facility: Dr. Kalyan S Sachdev, M.D., Chairman and founder of Privat Healthcare Group, member of the governing Board of Indian Spinal Injuries Center.

Telemedicine: Prof. Dr. Michael Nerlich, M.D., Head of the Department of Trauma at the University of Regensburg Academic Medical Center Surgery, President of the International Society for Tele' and eHealth (ISfTeH).

Science & Economics: Prof. Dr. Wolfgang Goetzke, Director of gewi-Institute for health economics, Co-founder of the Fresenius University in Cologne, Coordinator of the regional initiative “Health Cologne” and “Health Region Cologne Bonn”.

Click here to find additional members of the Advisory Board.

Please also visit the Conference Website for registration and further information!

Register now via the Online Registration Form and benefit from the early bird rates!

Please contact info@temos-conference.com or the conference hotline +49–2203–601 3000
for any questions regarding the International TEMOS Conference.

Exhibitors can increase their profile by choosing between several attractive sponsoring options for this event. Please get in touch with us to learn more about your opportunities.

Please note: You can ideally combine the attendance of the TEMOS conference with a visit to MEDICA®, the world’s largest exhibition for ' technology, which is held in the neighbouring city of Duesseldorf from November 18-21, 2009.

National Newspaper confirms support for Health & Medical Tourism Show
The Independent Newspaper has confirmed support of the forthcoming Destination Health exhibition, which is set to take place on 17 - 18 April 2010 in London.
Destination Health is a brand new exhibition designed exclusively for people planning to travel abroad for all types of treatments.

If you are involved in any aspect of health tourism, then you should be exhibiting at Destination Health.

For everything from heart disease to hip replacements, breast implants, and medical spas, Destination Health is dedicated to every area of health tourism. It brings together thousands of patients and medical providers under one roof and offers an exclusive platform to meet people who are ready to invest in their personal health, body image, and well-being.
Whatever the size or nature of your business, if you want to promote and increase awareness of your health and medical travel services in a focused and dedicated environment, you should be at Destination Health.

To find out more, visit the Destination Health website or call us on + 44 (0) 20 8230 0066 or email sales@destinationhealth.co.uk

SITUATIONS WANTED:

International Patient Development in your Country – Medical Tourism

With present economic down turn I would like to offer my skills and global experience to develop much needed healthcare business.
I am sure my experience in medical tourism will provide original strategy as I come from the other side of the world.

Now is the perfect time to participate in global healthcare which is the world's second largest industry.

I would like to know if I can bring my successful career to work for your organisation to develop international business.

For further information visit www.surgeryexpress.com or contact me at as@surgeryexpress.com

JOBS:

Director of Quality Improvement

As the Director of Quality Improvement, you will be responsible for the planning, developing and directing QI functions. Provide leadership, management and supervision of the QI Department operations and staff. Ensure quality of healthcare services rendered meets or exceed professionally recognized standards. Develop and implement measures and controls to achieve company's goals.

Requirements:
BSN/BS/BA Degree in Healthcare related field. Master's Degree in Healthcare a PLUS
QI experience – min. 5 years; Managed Healthcare – min. 5 years.
Knowledge of NCQA standards.
Medicaid experience – min. 2 years.
Management Experience – min. 5 years.
Knowledge of applicable state, federal and third party regulations with special emphasis on Medi-Cal Managed Care.
Excellent communication skills.
Proficiency with computer information systems and software.
Strong analytical and problem solving skills.

Salary is commensurate with experience.
Located in Jackson, MS, USA.

For consideration, please forward your CV w/salary requirements to vvanover@headwaycorp.com or apply at www.headwaycorp.com/jobs

EEO/AA/M/F/V/D

To submit your job posting or a description of your desired position to ahaar@cpronline.com. Please keep text to 100 words or less.