THIS WEEK IN MEDICAL TRAVEL TODAY
Volume 3, Issue 25

by Amanda Haar, Editor

Greetings,

From the unfortunate death of a model due to complications from surgery to a proposed tax on procedures in the United States, plastic surgery abroad has captured the headlines over the past few weeks.

While on the surface the news doesn't appear great for the industry's reputation, it at least put the focus on consumer options and brought safety issues to the forefront. Reputable providers and organizations will seize this opportunity to highlight what they're doing to ensure patient safety and, thus, build consumer confidence.

Moving on, be sure to check out Part Two of the Roundtable Discussion begun in our last issue regarding the potential impact of health care reform. We invite readers to share thoughts and ideas on the topic and the participants' comments.

Amanda Haar, Editor
ahaar@cpronline.com

PERSPECTIVES

Editor's Note: The following is Part Two of the recent Roundtable Discussion hosted by Medical Travel Today on the impacts of health care reform on medical travel. 

Moderated by Sam Havens, a member of the Board of Directors of BridgeHealth Medical, and former Health Care Division president at Prudential, participants included:

Charles M. Cutler, M.D., consultant and former chief medical director for National Accounts at Aetna

Blair Gifford, associate professor of Health Administration and Management at the University of Colorado  

Dale N. Lyman, senior vice president of Cost Management Strategies and Stop Loss Administration at Meritain Health

Cyndy Nayer, president and chief executive officer of the Center for Health Value Innovation
(full participant bios are found at the end of the transcript)

Part One of the discussion can be found here. The third and final part will be featured in the next issue of Medical Travel Today.

Sam Havens (SH):  Well, that does lead us to a focus on the domestic market and our second question. "Many high quality U.S. hospitals and providers with excess capacity now offer less expensive options. Will this type of medical travel be more attractive to employers and payers than the widely publicized international medical travel programs?" What do you think?

Blair Gifford (BG): I’m not quite sure how to answer that. I think it will certainly be attractive; will it be more attractive than international medical travel programs? I would say certainly in the short term it might be. It will certainly be a lot easier to facilitate domestic travel 300 miles from one state to another state but ultimately, and we’ve already heard this in the conversation, international medical travel might kick in, especially if the value is appreciably different and better. I do think that both domestic and international options will be considered by many people now in terms of the cost savings and the value.

Cyndy Nayer (CN): Sam, I absolutely echo what Blair is saying and would like to take it a bit further. I think that domestic travel will be a stepping-stone to international medical travel. I think most people would understand travel for cancer care, and they may understand travel for heart care or a transplant. Beyond that I don’t think they understand it. I also think that in the short term, and especially with the political reform, they are forced to look at where there is capacity and a higher quality of care and, again, a faster return to work.

I think we also have to work on perceived problems with medical travel in the minds of plan sponsors. For example, the perennial question of "what if something happens?" What if someone has a blood clot on the plane on the way home from Singapore? Well, the truth is that same person can have that same blood clot driving from St. Louis to Kansas City. The potential for problems exists no matter where the patient goes. The more we get people into the medical travel arena – whether it’s domestic or international — the more they will understand that. 

Dr. Charles Cutler (CC): I agree with Cindy entirely, and one of the plusses about domestic travel is that you can have more cost effective domestic travel than internationally. When I did this kind of analysis for a larger employer, essentially the cost savings for the medical care needed to be some multiple of the travel cost.  For example, if the travel cost to Singapore is $5K the minimum savings needs to be $5K, which means the cost of the procedure generally is going to range, let’s say, $20K overall. For domestic travel it’s a totally different story because, as Cindy alluded to. The cost of driving in your car from St. Louis to Kansas City is well short of $5K so you can have a procedure where the cost savings are $1K, and it will still be cost effect to encourage that kind of domestic travel.

SH:  Just get on Southwest Airlines.

CC: Get in your car or on Southwest Airlines. And so the number of procedures that are financially viable significantly increases. I totally agree with what Cindy was saying in terms of acceptability depending on the introduction, volume, and word-of-mouth, and feeling comfortable with travel. So the more procedures and the more opportunities there are for travel the more comfortable people will feel with both short and long distance travel.

SH:  Do you think the domestic travel will sort of lean in this direction?

Dale Lyman (DL): Oh, yeah. I think Cindy’s comment about the stepping stone is very accurate, in fact I think our experience with clients has been that there’s a mental block related to going outside their primary care giver. Once you break that mental block, whether you’re doing a trip to Texas for knee surgery or going down to Costa Rica for knee surgery, it’s not a big leap to go a thousand miles further overseas. I do think it will lead the way, and it’s easier for people to break that mental barrier when they’re doing it domestically. So I do see that as a mental stepping-stone. And as far as the health reform goes, one of the things that I think will happen on that is that there will be a certain amount of care. The care will be limited to a degree, and individuals may have less access to the caregivers they chose or they want, but that will precipitate this moving away from a specific caregiver and looking for options. So I think the reform effects will also cause people to look beyond what has been the traditional caregiver role. And once they make that step then the steps to domestic then the step to international are just progressive and logical steps.

SH:  I have another piece to this question if you don’t mind. What impact, if any, does the rise in domestic travel have on existing institutions and their pricing? In other words, would we actually get some competition that would bring down the costs of your local hospital if more people were suddenly moving outside of that location to get care somewhere else?

CN: Sam, we’ve actually got some experience in that in the market place here. My good friend Peter Hayes at Hannaford, when he began sending elective surgeries to Boston because he couldn’t get transparency and cost information from local facilities, well, it changed the dynamic in his home state of Maine so that there now are transparencies. We’ve seen a couple of other companies that have reached out and said we’re going to offer care in other areas and countries, and what happened was that local facilities brought their joint replacement and other prices down to meet the cost of the other facilities. So we are beginning to see exactly what you suggested, Sam.

CC: I would agree with Cindy that part of the effect of the threat of travel is that it’s a disruptive market force, which then causes the local institutions to reconsider how they want to position themselves. I think it will have an effect especially where the markets have an institution with excess capacity. I’m not sure if it will have an effect on markets where the institution already have long waiting lists, but for a place like Maine certainly it can have a significant effect -- especially for those procedures where there’s a significant profit margin for the institution. So the case that Cindy described, for a hospital to lose  joint replacements as one of their procedures where there’s a significant profit margin is much more of a threat than for other conditions where they are making less money or even losing money on those admissions.

SH:  Any comment on that, Blair?

Blair Gifford (BG): I’ll just say in the Denver market there are some price pressures coming into play now. We are seeing providers or institutions starting to respond by categorically lowering their prices. I’m not sure if that’s driven by the threat from potential travel to other locations in the U.S. or international or what’s going on in the Denver market. We are now starting to see full-page advertisements in the Denver Post, listing prices and comparing prices between on institution and another. These ads don't get into things like quality and other measures, but they are trying to wake consumers up to the options that are out there.

SH:  Very good. Next question:  While cost is one obvious deterrent keeping patients from getting necessary care, is this the main feature that payers find the most appealing? Is that the most appealing issue to people who pay for the care? Why don’t we start with Dale?

DL: I would say it is. The cost benefit is really for the employer groups. It’s the main and really only driver. The cost has to outweigh the risks and also the myths about potential lawsuits and problems and things like that. If the cost and good education can overcome that, that is the key in our experience in the employer groups. That’s pretty much it. It all comes down to money.

CC: But I would just add that you need to think cost broadly. I think Cindy or someone alluded to this earlier -- many employers are looking at the overall cost, not just the specific medical expense so that if you can get less costly care, including the time out of work and the rehabilitation period and all of the other things that figure into the employer’s overall cost, that makes a significant difference. So, for example, the Centers of Excellence program for organ transplants, which has existed for some period of time may appear to be more costly on a cost-per-admission basis because they tend to be at higher cost institutions. But the overall cost in terms of avoidance of complications, avoidance of re-transplantation, is significantly lower overall. So I think we need to think more broadly than the cost-per-admission when looking at cost as a factor.

SH:  One aspect of this, Cindy, if you can comment on it, is there a difference in the way a small employer looks at this and a very large employer looks at this?

CN: Yes. A couple of things. First if a small employer loses a person from their work force for a period of time it’s a significant percentage compared to a larger employer. The ability to cover for that person is just not as easy for the small company so in real terms it’s a bigger loss to the employer. Therefore getting someone out the door, treated appropriately, and back to work without what I call recidivism, that is without re-entry or complications, is incredibly important. Now, then the question is how are we defining small employers? Well, if you’re talking about someone with five people in their office and one person is out then that’s 20 percent of their work force. If you’re talking 100 employees and one person is out that’s just one percent of the work force. Now that's still significant but again, compare that to a company that has 100,000 employees…it becomes a numbers game. 

The second thing that's just as serious a consideration is the recourse the employers have and the ability to think more globally. At a small employer, the person making those considerations could be the CEO or CFO or any of those people. In most cases those people are also doing multiple jobs. 

A large employer is more channel-focused. A person can say, "I’m the HR person, and I can think this through and figure out the cost effectiveness, quality effectiveness, return-to-work scenario, etc." That makes a big difference as well the amount of time and effort it takes an employer to make that kind of change. It’s a very different proposition at the smaller employer. It may in fact be harder except, I want to take a step back here for a moment, and note that we’re talking about acute care.

The reality is we need to put chronic care on the table here. In that respect a smaller employer has a bigger impact because of chronic care condition. If I send somebody away for a week but they come back better able to control their diabetes that’s going to have huge value in the market place. Huge.

CC: There is one other big difference and that is that small employers tend to be fully insured and larger employers self-insured. The flexibility in benefits design is so much greater for the self-insured employers that it can be an impediment for the fully insured. In addition for the fully insured market, I think plans are concerned about the potential responses of regulators and how they would need to position this benefit.

SH:  Dale, do you see the same issues between the smaller and larger employers?

DL: Yeah, I do on the training and education part that Cindy’s talking about. The only difference I would say is with smaller employers when they do have to deal with a chronic issue or even an expensive acute issue the financial impact can be much greater than on a larger employer. We've found small employers to be more enthusiastic about this and to be more accepting of it when they’ve had an issue come up. If they've got a two million-dollar budget suddenly they’re looking at some catastrophic cost that wouldn't be catastrophic to a larger company but could ruin their profit margin for the year, it’s an issue. Where we’ve seen it is the market with 50 to 300 employees. Under 50 it’s mostly fully insured but you get above that and people are starting to come to the self-funded arena, starting to be a little more creative. They don’t have the HR department with them to really channel it through, but they do have 30-type budgets, so the impact on the budget becomes a driver for the owner to become more creative.
The second thing is that they can be more creative. The smaller the company the easier it is for them to adapt. Larger companies it’s a little harder for them to adapt and the one thing about international travel is that it’s a fairly fluid, adaptive environment.

SH:  Blair, any comment on this particular piece?

BG: It has been covered quite well. I would just like to echo with the final thought about the small employer.  The small employer might be a little more flexible or maybe taking more chances, if you will, on international travel options.

SH: Let’s focus on the fifth question, and I actually have some sub pieces, but let’s start with the fifth question—how do you expect a public option might influence the direction of medical travel? I mean that’s fully understanding that we don’t really have any idea what this public option is going to do or the so-called cooperative option. It’s a little vague here at the moment, assuming what we do know about the language that’s been talked about in the House bill, what reaction do you think the public option will have on the direction of medical travel? Why don’t we start this time with Chuck.

CC: Well, you said it all depends on what the public option is I think there are a few scenarios. One potential scenario is if the public option uses Medicare prices.  These are a lot lower than commercial insurers pay, so a lot of the financial advantages of medical travel will be diminished. There are other political issues to consider with a public option. Some states don’t like exporting anything out of the state much less outside of the US, and Medicare doesn’t pay for anything outside of the US. If the public option has those kinds of constraints then certainly i it would be a significant concern and could put a damper on medical travel. On the other hand, one of the other things that has been talked about that a public plan can do is make transparent more cost quality -- just as Medicare has made quality transparent for Medicare beneficiary. And that could have a positive effect on medical travel.

SH:  How about Dale this time?

DL: I think the public option’s biggest effect is going to be, again, to form a secondary system or external system. We’ve seen it in the British public health program; we’ve seen it in the Canadian health program in which people go outside of the public system to get their care. We work with a couple of companies, one in particular, up in Canada where their main effort is to ship people into the quality Centers of Excellence in America for cheaper care —  and basically to get the care. So I think if the public option does come through, we will have these external options or outside-of-the-norm options, such as the domestic or international medical travel. I also think that there’s an issue, and I hate to use this word, related to the concept of rationing of care. Rationing of care or limitation of choices will cause people to try to look for alternatives and, if they can afford it, they will go for these alternatives. And if it’s not that much more expensive then it will make it even more popular. The final thing I would say is that public option, government-run entities, especially in the health field, are just not responsive and not adaptive, and I don’t see how they can say they will be. Right now fully insured carriers struggle with the concept of adapting and the concept of international travel, and government-run entities will struggle even more so. 

SPOTLIGHT: Jeff Schult

Editor's Note: In this week's SPOTLIGHT we catch up with Jeff Schult, author of Beauty from Afar and the original editor of Medical Travel Today.

While Jeff stepped away from this publication two years ago, he didn't walk away from the medical travel industry.  He was kind enough to share with us what he's been up to and how he's continuing to contribute to the growth of the medical travel industry.

Jeff Schult

Medical Travel Today (MTT): Let's start with how you first got interested and involved in medical travel.

Jeff Schult (JS): Although my background is in journalism, from 1995 to 2002 I was building and managing Websites for telephone and Internet companies. I was also dealing with a recurring dental issue that my insurance did not cover.

One day I was reading an online mailing list. The conversation that day was about outsourcing of resources and technical support. I was reading along and someone made a point that it wasn't just technical jobs or even financial services that were being outsourced but also health care. They related a story about a friend going to Bumrungrad Hospital in Thailand for surgery. That got me thinking – “Hmm. Maybe I can afford to get my teeth fixed out of the country.”

I immediately started doing research into my options, the costs and benefits. In fairly short order I had found a dentist in Costa Rica who could perform what I needed for far less than I could get it done for in the United States.

I happened to mention to a friend who was a reporter that I was thinking about going for dental care. She immediately saw it as a great opportunity for a news story and suggested I write about the experience.

I asked the dentist I had selected, Telma Rubinstein at Prisma Dental in Costa Rica, if it was OK if I wrote about my trip and she was fine with that. They didn't hesitate for a moment.  That lack of hesitation and complete confidence pretty much sealed the deal for me. As anyone in PR or journalism knows, a story has the ability to make or break your business. These guys clearly believed in what they were doing and that was enough for me.

The story, which was originally supposed to be 3,000 words, evolved into 10,000 words and became a cover story in The Hartford Courant's Sunday magazine, Northeast.
In the 20 years I'd been writing, I never got the kind of feedback on a story that I did to that piece.

I got mail from people all over the country asking me how I went about my research, how I handled travel, and so on. Many people just wrote to share their similar positive experiences for dentistry, plastic surgery … you name it.

So I realized that there were a lot of people engaging in medical travel, and it occurred to me that there might be a book I could write on the subject.

Another friend put me in touch with an agent and within five months I had a book on the market.  So that's how Beauty from Afar came into being.

I did a lot of speaking and networking to promote the book. Somehow through it all I met Laura Carabello (publisher of Medical Travel Today) and helped get this publication going and served as editor for the first few months.

I was, of course, still in touch with the folks at Prisma Dental and really became great friends with them. They'd been doing dental care for 20 years and had never done any marketing. Most of their American patients found them through word-of-mouth.
The article obviously brought them a lot of business and the book helped both them and Costa Rica further establish itself as a destination for medical travel.

The Prisma folks wanted to do some marketing, but they had the same problem so many medical-based businesses have when they want to market themselves to Americans. They just didn’t know what to do to expand beyond word-of-mouth and their Website.

Competition for dental patients was growing, both within Costa Rica and from dental practices in other countries.

At that time, I wasn’t sure what else they could do, other than to start advertising online with Google, Yahoo, etc. – which they hadn’t done. But again – everyone has a Website. Everyone buys online advertising. The only other thing I could think of is that they should have a blog, so I got up to speed with that technology, and I launched one for them. And we could see almost right away that it was helping with search engines, helping with web traffic and exposure.

I used that experience in working with the folks at BridgeHealth Medical to develop a blog in 2008. Again, I found that it boosted visibility and credibility online. That project has been put aside for a bit, though, as the company has focused on other opportunities.

But I’d learned how to make it work and saw the results. Beyond the technical skills in software, search engine optimization, etc. – it took good writing more than anything else, knowing how to write for a chosen audience. So it was something I knew how to do for medical tourism businesses.

We ramped up the Prisma blog from there; I told them we needed more content about who they were, what they do day-to-day, what it’s like for patients -- human stories. And there isn’t a lot of that out there coming from medical providers. It’s the kind of information that makes prospective patients feel more comfortable, like they can know the dentists and the staff.

And, according to Alexa.com, we’ve made the Prisma dental Website and blog the most popular of any single dental practice in the world. It’s not huge – it’s 100 to 200 visitors a day. But that’s a lot for a dental practice. And it’s 10 times the traffic from two years ago. I have to think it has helped them grow, even in a tough economic climate.

MTT: Clearly you think it's an effective marketing tool for medical travel. Can you explain what about it makes you a believer?

JS: Absolutely.

First, search engines love blogs. A well-written blog maintained with the proper key words provides the engines with fresh new content every day.

Second, compared to other marketing efforts it's relatively inexpensive. Basically every other day I log on and write about the types of patients Prisma is seeing and what's going on in the office. For someone who might be thousands of miles away, this type of insight is humanizing. And the Prisma story is great material.

They're a husband and wife team who anyone couldn't but like within five minutes of meeting them. They're childhood sweethearts who went to dental school together and work 10 to 12 hours every day to restore people's teeth and with it, their sense of confidence and well-being.

And they do the BIG cases. I'm talking about full mouth reconstructions at a rate of about one per day.  They perform over 300 reconstructions a year and most of them are done on Americans.

MTT: Do you know if at this point the blog is how most people are finding Prisma?

JS: The Web traffic numbers indicate that more than half the people who find the Prisma Website (www.prismadental.com) enter the site through a blog page.
As I said earlier, the Alexa traffic rating the Prisma dental Website and blog is the number one trafficked dental site in the world.

When we started, the site was ranked about three millionth in the world. In June, we broke into the top million. In October, we broke past 500,000th. That’s of all Websites in the world. And 90 percent of the visitors are from the U.S. and Canada. For a comparison – Prisma is ranked higher than the major hospitals in Costa Rica for Website traffic. It took some time but it seems to have been worth it. When Prisma launched a Facebook page in July to complement the site and blog, they had more than 400 “friends” within two months. So that’s another humanizing factor, and patients on Facebook can go and interact with the Prisma staff and other patients that way.

Alexa provides a very rough estimate of comparative Web traffic, and there may well be sites that do better than Alexa indicates. Still, it accurately reflects the rise in Prisma’s traffic.

MTT: Okay, that's fairly convincing. But let me ask, how did you do it? There are plenty of blogs out there not pulling that kind of traffic.

JS: I think what I did and continue to do differently is that I think about the search from the perspective of the consumer.

For the most part, they're not thinking "dental Costa Rica." They're thinking “I need to get my teeth fixed how do I do it affordably.” And frankly, their first thought is local.  They first think of the next town over, or the city an hour away -- where can they go to get what they need.  

The thing I do for Prisma is to write something about the patients who come through. We'll say "George from Mississippi" or "Mary from New York." People then find it because the New York or Mississippi identifier makes it local. Then they dive in and find out how someone from their area made this trip and saved that kind of money. It's not a deal closer but it is a door opener, which is pretty much all any good marketing effort can do.

MTT: What kind of time commitment does the blog require of the folks at Prisma?

JS: At this point in time, it's quite minimal. They trust me to make editorial decisions and stay on top of it. Right now I do the updates without any approval process.

MTT: What other projects are you working on right now?

JS: I've been busy putting my medical travel book Beauty from Afar up online, since it has just gone out of print after three years, and I own the rights to it again. I'm currently posting it, page by page, at www.beautyfromafar.com and adding updates and commentary. It's been interesting, and satisfying, to discover how much of what I wrote still holds true.  For example, in 2006 I said I thought the industry would grow at a rate of 10 percent per year. That's probably pretty close to reality.  I also noted in '06 that most medical travel would be regional. That is, people from Texas would still mostly be going to Mexico rather than Thailand, Europeans would stay in Europe rather than coming to the U.S., etc. And the truth is, the number of people traveling from, say, Iowa to Thailand is really quite small. But that kind of thing makes for a compelling news story so it gets written about more.

I’m also working on an entirely unrelated book project. I consider myself a writer, first and foremost. But that can be a pretty chancy career.

And I’ve just started doing some writing and Web work for MedTrips, a medical travel startup based in Florida. MedTrips is focused initially on providing health care from top-level facilities in Europe for North Americans. I think they’re handling things the right way and I’m pleased to be involved with them.

About Jeff Schult
Jeff Schult currently lives in Massachusetts. He can be reached at jss@beautyfromafar.com and maintains Websites at www.jeffschult.com. www.beautyfromafar.com and www.prismadental.com/blog.

INDUSTRY NEWS

Proposed plastic surgery tax in U.S. could enhance medical tourism

Editor's Note: A more in-depth version of this story is available for purchase from The Tico Times at this link.

The Tico Times -- There's at least one sector celebrating a proposed tax on plastic surgery in the United States, and that's the people who cater to medical tourism.
Each year, hundreds of thousands of North Americans look offshore for tummy tucks, facelifts, and breast enhancements, knowing they can pay a fraction of the costs they would have to fork over in the United States.

Costa Rica, a three-hour flight from the U.S., has absorbed a large percentage of patients and, with the addition of the proposed tax, medical experts expect a greater influx. The 5 percent tax on elective cosmetic procedures was proposed as part of the 2,074-page health reform bill presented by U.S. Democrats this month. The tax is expected to generate $5.8 billion to help fund the $849 billion health system overhaul.

But plastic surgeons in the United States have launched a campaign to prevent the tax, arguing that its effects would result in discrimination against women, who represent 86 percent of cosmetic surgery patients there.

“This tax is effectively a ‘soccer mom' tax that will adversely impact mainstream American wives and mothers, who are the majority of plastic surgery patients,” says  Renato Saltz, M.D., president of the American Society of Plastic Surgeons (ASPS). “As doctors, we understand and appreciate the need for health care reform, but taxing physicians and cosmetic surgery procedures to pay for the reform is not realistic or beneficial.”
ASPS noted that only 10 percent of the respondents on a recent survey reported a household income of over $90,000, “which clearly refutes the suggestion that elective surgery taxes are ‘luxury or ‘sin' taxes affecting a privileged few,” according to a statement released earlier this month.

The bill was given a nod by the Senate on Saturday, Nov. 21 and is currently awaiting further debate.

 Thailand is 'in network'? Employers and Insurers Embrace Medical Tourism

By Greg Wahlgen, AOL Daily Finance

© 2009 Weblogs Inc. LLC Daily Finance is a trademark of AOL Inc. Used with permission.

Like some 47 million other Americans, Nancy Sowa doesn't have health insurance. So when her doctors last year told her she needed a total hip replacement, the office manager for a non-profit did what a growing number of U.S. citizens are doing: She headed abroad. At Wockhardt Hospital in Bangalore, India, the 56-year-old was put up in a hospital "suite" far swankier than what she would typically find in the U.S., with a computer, fridge, cable TV, sitting area, and an extra bed for her travel companion.

More to the point, the two-hour surgery in July, performed by an orthopedic surgeon trained in the U.S. and Australia, was a success. Four months later, the Durham, N.C. resident is feeling like her old self again, going for long hikes and planning her next vacation. The final tab for the procedure, including rehabilitative therapy and round-trip airfare for two? $12,000. That's a fraction of the $45,000 to $90,000 she had been told the surgery would cost at home.

"I wouldn't have been able to do the surgery in the United States," says Sowa. "I didn't have to explore taking out a second mortgage or tapping family members because I had this other option."

With Americans able to save 50 to 90 percent by going to places like India, Thailand, and Costa Rica, the uninsured aren't the only ones considering the medical tourism option. Increasingly, U.S. employers, faced with soaring health care costs that are expected to rise another 9 percent in 2010, are sending their workers overseas for care. Many of the companies exploring the option are small- to medium-sized firms that are self-funded -- meaning they're responsible for paying out their own health care claims.

Insurers like Blue Cross Blue Shield are getting into the act, too. For good reason: Even when employers or insurers waive co-pays and deductibles and throw in airfare and spending money for the patient and a companion -- some of the typical incentives offered to employees who have medical procedures done abroad -- they can still save $40,000, $50,000, or $60,000 per surgery, depending on the procedure.

No Longer Just for Face Lifts and Tummy Tucks

"The biggest driver is cost savings," says David Boucher, who leads Companion Global Healthcare, the company launched by Blue Cross Blue Shield of South Carolina in 2007 to provide health tourism plans to employers. "But when members come back, they also tend to say really good things about their experience."

In the past, medical tourism was primarily for the wealthy who jetted off to Brazil and South Africa for face lifts and tummy tucks. More recently, however, the middle class and uninsured have also been boarding planes for elective surgeries they couldn't afford in the U.S.

In fact, Americans are becoming increasingly nonchalant about hopping continents to go under the knife. Some 180,000 Americans went abroad for treatment in 2007, says Josef Woodman in his book Patients Beyond Borders. As employers and insurers start offering medical travel as part of their health plans, those numbers could explode.

For now though, the number of U.S. employers that are making places like Bumrungrad International hospital in Bangkok "in network" is still small. Renée-Marie Stephano, president of the Medical Tourism Association in West Palm Beach, Fla., estimates that the number of employers offering treatment options abroad is less than 10 percent. And, of the nearly 350 companies Companion Global Healthcare has signed on through its affiliates, no more than 30 employees so far have made health trips abroad, says Boucher, who is based in Columbia, S.C.

"We're very happy with where we are," Boucher says. "It's very clear from the numbers that employers are not just jumping into the deep end of the pool. They are taking an appropriate, measured approach to it."

Sending Patients Abroad Spurs Backlash

They have reason to be cautious. In 2006, Blue Ridge Paper Products in Canton, N.C., abandoned plans to pay for an employee to have shoulder and gall bladder surgery in India after his union raised questions about the quality of care and medical liability overseas, The New York Times reported. The employee had volunteered to go in exchange for a share in the savings that would have come from doing the work in India, the paper said. But the United Steelworkers union sent a letter to the U.S. Senate and House committees overseeing health care saying it opposed what it called a "shocking new approach" of sending workers to low-cost counties for health care -- and it demanded the worker get a health care option within the United States, The Times reported.

Besides questions regarding quality of care and legal recourse, other concerns have come up. Among them, with cheap care overseas beckoning, will employers discourage their employees from seeking treatment in the U.S. by raising deductibles or other methods? And what will follow-up care be like back at home, especially if there are complications after surgery abroad?

"If you look at the American College of Surgeons, they are reluctant about having to pick up after another doctor's mistakes, especially by one not in this country," says Judy Dugan, research director with the Santa Monica, Calif.-based consumer advocacy group Consumer Watchdog.

Dugan agrees the cost of medical care is out-of-hand in the U.S., but she says industry and policy makers should look for ways other than medical tourism to bring it down. "If medical globalization were to become sizable in the U.S., it would no doubt cost good jobs in the country, from the top surgeon on down to the person who makes your bed," she says. "Do we really want to go with the salary bottom overseas, rather than look for cost containment in the United States?"

Not Everyone Boards a Plane

Most employers use medical tourism facilitators, which typically handle travel and health care arrangements for their employees. Despite lingering stereotypes of hospitals in developing countries as squalid facilities overrun with the deathly ill, many say these outfits actually offer cutting-edge care equal to or superior to what many hospitals offer in the U.S. The facilitators say they work exclusively with hospitals accredited by globally-recognized accreditation agencies, such as the Oakbrook, Ill.-based Joint Commission International.

"There are top quality hospitals all around the world, not just in the U.S.," says Tom O'Hara, president of medical tourism facilitator Surgical Trip, based in Boca Raton, Fla.

Mexico City to Build World-Class Hub for Medical Research
Campus Biometropolis to be "Sustainably Designed" by Renowned Firm, Foster + Partners

MEXICO CITY, Dec. 1 /PRNewswire/ -- The government of Mexico City today announced it will build a world-class center for biomedical and nanomedical research, called Campus Biometropolis. The center for medical research and development will be integrated with the National Autonomous University of Mexico, the top Spanish-speaking university in the world. The research complex, scheduled to begin construction in 2010, has been designed by the internationally-acclaimed architectural firm, Foster + Partners, whose previous works include the Hearst Tower in New York City and Berlin's Reichstag building.

Campus Biometropolis, which will attract significant investment over the next several years, will become an engine for the transformation of Mexico's economy. Mexico has first-class human resources and considerable infrastructure to position itself as the leading knowledge center for Latin America. It will attract medical tourism, deliver multiple medical services for the U.S. economy and become a platform for world-class clinical research.

This state-of-the-art research and development cluster will look to attract pharmaceutical and biomedical companies and organizations from around the world. Given its close proximity to corporate laboratories, start-ups, and public research institutions, it will provide fertile ground for R&D, and offer an environment to accelerate product development and commercialization. As one of the world's leading financial capitals, Mexico City is an ideal location for companies looking to access Spanish-speaking markets.

"Mexico City's Campus Biometropolis is the cornerstone of a broader vision to transform Mexico City into a knowledge capital," says Mexico City Mayor Marcelo Ebrard. "This is a critical investment in the future of Mexico City, taking us a step further toward becoming a global hub of scientific and technological excellence."

Mayor Ebrard continues, "As one of the most vibrant cities in the world, Mexico City is the ideal location for pharmaceutical and biomedical companies and organizations looking for new development opportunities and access to new markets."

Campus Biometropolis will be sustainably designed and built, and will be composed of hospitals, laboratories, and medical universities, as well as residential and retail areas. In addition, the complex will include a natural reserve and will become a model for green buildings and water conservation. This project is in accordance with Mayor Ebrard's plan to transform the city into one of the most environmentally-conscience and sustainable cities in the world.

The medical hub is at the core of Mayor Ebrard's General Development Plan, which was designed to convert Mexico City into Latin America's premier knowledge economy. The five-year plan, launched in 2007, aims to create more equity for Mexico City's inhabitants by building a sustainable and inclusive city, promoting equality through better health, education, and technology and improving the competitiveness of the Mexican capital.

UPCOMING EVENTS

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

European Medical Travel Conference 2010 Draws Widespread Participation

May 5-7, 2010; Monastier di Treviso, in the immediate vicinity of Venice

U.S./Venice Italy – December 10, 2009 -- The largest international congress focused upon “Health Tourism and Cross Border Healthcare” in Europe will take place for the third consecutive time at the Congress Centre of Park Hotel Villa Fiorita, May 5-7, 2010 (www.emtc2010.com ).  Based upon a new organizational partnership between Health Care Strategy Intl. Munich and Sogedin S.p.A. Italy, the “European Medical Travel Conference 2010” leverages the patronage and cooperation of the Ministry of Health and the Ministry of Tourism of the region of Veneto.

“The location of this event is Monastier di Treviso, in the immediate vicinity of Venice, and is expected to draw about 350 to 450 participants from all over the world -- especially from Europe, Italy and the United States,” notes Dr. Uwe Klein, chairman of the event.  “The Conference is a platform for physicians, hospitals, hotels, tourism agencies, patient services, IT services, associations, organizations in the field of medical tourism, WHO and EU bodies, as well as ministries of health and representatives of the tourism sector worldwide. A detailed overview of all anticipated attendees, speakers and other information is available on the Web site.”

A roster of speakers from all parts of the world  -- decision makers and top-class experts in their respective fields -- have already confirmed their participation.  They include:

• Anuja Agruwal, e-MedSol
• Susan Frampton, Planetree International
• Jerome Mee, Atlantic Health Group
• Rob Passmore, AllMedicalTourism.com
• Maria Todd, Mercury Healthcare
• Jadeha Naresh, International Wellness and Healthcare Travel Association
• Jeff Schult, MedTrips
• Laura Carabello, CPR Communications, Medical Travel Today, and Your Medical Travel
• Vic Lazzaro, BridgeHealth International
• David Boucher, Companion Global Healthcare 

Presentations will address:

• Transatlantic Medical Travel: American insurance and intermediating companies are seeking contractual partners in Europe for cooperation in both directions, legal aspects and solutions, quality of providers and services.
• Liberalization of Patient Mobility:  The EU progresses chronologically and is closely intermeshed with the actual, rapidly developing market situation. The Conference brings together content owners and decision makers of European, cross-border possibilities of treatment. The topic of patient security is a key focus, while providers -- in cooperation with insurance companies and patient organizations -- are the drivers for progress.
• Large Insurance Companies, such as AOK and Techniker KK, are adapting their portfolios in medical care to meet European and regional demands. The region of Veneto is playing an outstanding part in this process. The central topics are opportunities and challenges of cross-border medical care from the perspective of cost advantages, patient orientation and especially patient security.
• Classical Home Countries of Health Tourists such as Saudi Arabia, Oman, Kuwait, and UAE are changing their strategies for choosing institutions of medical care and are concurrently reducing public expenses on the patient stream to foreign countries. The requirements of patient security, cost transparency and service orientation have increased significantly, as well.
• The Cruise Medical Tourism option is on the brink of breakthroughs in market requirements.  In particular, the Mediterranean Sea is demanding more offers from “sea-based healthcare” in cooperation with “land-based healthcare,” especially for medical wellness and elective medicine. A special workshop with further learning character (acquisition of a certificate) will be offered on the subject of “Maritime Medicine.”
  

The two-day event also includes a Welcome Reception for informal get-to-know meetings, keynote lectures, thematically oriented workshops, panel discussions, organized B2B meetings, a Gala Dinner and the potential for excursions.  Service providers have the opportunity of booking a booth within the framework of an industrial exhibition.
 
The registration for participation takes place via the Munich Congress Office by e-mail, fax or by registration on the website.

Contact: Dr. Uwe Klein, HCSI, Rosental 6, 80331 Munich. Phone: 089-1011 9222. Fax: 089-1011 9221. Email: info@emtc2010.com. Website: www.emtc2010.com

Organisation: Health Care Strategy Int. GmbH (HCSI) and Sogedin S.p.A. in cooperation with Public Health Regione Veneto, Venezia, Italia.

V.i.S.d.P.(responsible according to publication law in Germany) Dr. Uwe Klein, HCSI, address as below.

Asia Medical Tourism & Wellness Congress @ Kuala Lumpur, Malaysia May 13-14, 2010

Kuala Lumpur, Malaysia will be hosting an international event next year in Berjaya Times Square. Medical Tourism & Wellness Congress (GLOW 2010) will be an international trade exhibition running concurrently with a multi-stream conference session.

GLOW 2010 will gather senior-level decision makers across the health care, wellness, and corporate executive sectors from around the world to brainstorm on issues concerning their industry.

The objectives of the Congress are:

• To bring together our clients who are senior decision makers in major organizations across the region (100 - 150)
• To provide an exciting neutral platform for vendors/solution/service providers to position themselves effectively
• To conduct marketing/ advertising and promote brand awareness
• To conduct business development activities to a targeted focused audience
• To network and benchmark with professionals as well as other vendors and solution/service providers

GLOW 2010 will bring together our clients who are key corporate professionals in the medical, spa, and wellness sectors across the Asia Pacific and Middle East region to provide an exciting platform for vendors and solution providers to position themselves effectively. We estimate in excess of 100 to 150 senior-level decision makers for the exclusive conference in addition to walk-in trade visitors of over 1,500 for the exhibition.

A wide variety of sponsorship opportunities are available. Visit http://www.glow2010.com/ to learn more.

Central and Eastern Europe Medical Tourism and Healthcare Summit  
May 17-18, 2010, at the Aristos Hotel, Zagreb, Croatia

Medical Tourism in Central and Eastern Europe has been increasing rapidly. The region as a whole offers a variety of affordable treatments and procedures within easy reach of most travelers.

Global Engage, in partnership with Global Health Consulting of Croatia, is pleased to announce this international summit, which will bring together and showcase facilitators, providers, and medical organizations from across the region including Croatia, Bosnia and Herzegovina, Macedonia, Serbia, Bulgaria, Romania, Hungary, Slovakia, Slovenia, Czech Republic, Poland, Lithuania, Latvia, Estonia, Ukraine, and surrounding countries to meet and network with senior level delegates from all over the world.

The Central and Eastern Europe Medical Tourism and Healthcare Summit will include an exhibition area, workshops, and a two-day conference agenda featuring an international speaker panel focusing and sharing their experiences on current issues affecting medical tourism and health care in the region and the world in general.

A further dedicated conference stream will focus on dental medical tourism providing an educational platform for dentists in the Central and Eastern European region to develop their business internationally and attract foreign patients to their practices.

There will be adequate time provided for networking and forming collaborations with potential partners over business lunches, drinks reception, and a gala dinner and the opportunity to visit local medical facilities.

Attend as a delegate or if you prefer to gain increased exposure for your company or organization please enquire about our exclusive exhibition, sponsorship, and marketing options.

To view further details of the conference agenda, speakers, sponsorship, and registration details please visit - http://www.globalengage.co.uk/central_eastern_european_medical_tourism_summit.html

Or to discuss your participation in more detail contact Steve Hambrook (Conference Director). Tel +44 (0) 1865 811 189 or email steve@globalengage.co.uk