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© 2013 Medical Travel Today

Medical Travel Today is a publication of CPR Strategic Marketing Communications, a public relations firm based near New York City that specializes in healthcare and life sciences, with an international clientele. CPR, its Partners, and clients are at the nexus of where medical travel is today, and where it will be tomorrow.

Laura Carabello

Amanda Haar

Managing Editor
Stephanie Clark


Table of Contents

From the Editor

From the Editor: This week in Medical Travel Today, Amanda Haar

News in Review

Nicaragua Bets on Medical Tourism

Oman Aims to Become Regional Hub for Medical Tourism

Vitals Healthy for UAE's Billion-Dirham Growth in Medical Tourism

GB Project Pursues Medical Tourism

Medical Tourists Flock to Las Vegas for Treatments


Paula Wilson, Joint Commission International


Richard Krasner: Immigration Reform on the Horizon - What it Means for Medical Tourism and Workers' Compensation


Medical Travel and Orthopedics

Industry News

Can Medical Tourism Save Us From Obamacare?

Patients Beyond Borders Announces Taiwan Simplified Chinese Edition

New Hope for Type I Diabetes Patients

Medical Tourism for Cancer Patients in Latvia

McGill University Health Centre Claims Provided Care Was Not "medical tourism"

Upcoming Events

19th World Congress of Aesthetic Medicine of the UIME

ITB Health Tourism Battle - ITB Destination Day at the ITB Berlin Convention 2013

PANASALUD International Medical Tourism Conference 2013

Kuwait Medical Tourism Congress and Exhibition Scheduled for March 2013

4th Moscow Medical and Health Tourism Congress

Shanghai Medical and Healthcare Tourism Show

2013 CMTR European Medical Tourism Research Symposium

International Board of Medicine and Surgery (IBMS) Mini Medical Conference

Global Connected Care Conference & 4th Meditour Expo

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Global Health Voyager


Volume 7, Issue 4

By Amanda Haar, Editor


When Paula Wilson joined the Joint Commission International (JCI) in 2011, access to the organization's vast knowledge and data was accessible to "members only." Fast forward to two years later and Paula Wilson has put a plan into motion to change that.

As explored in this week's SPOTLIGHT with Wilson, it's clear the JCI has a new and exciting vision for promoting patient safety and quality initiatives amongst all healthcare organizations.

Returning with another PERSPECTIVES column is Richard Krasner who tackles the issue of immigration reform and what it means for medical tourism and workers compensation.

By the way, Krasner's last column (accessible here) generated some interesting discussion. You can read it on our website medicaltraveltoday.com. Feel free to add to the discussion.

As always, we welcome your comments, story ideas and press releases.


Amanda Haar, Editor

Log onto Facebook and join the Medical Travel Today Group. Look for recent news, trends, and post discussions in the board. If you would like to see something in Medical Travel Today let us know in the discussion board. If you have a question, post it there!

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Paula Wilson, President and Chief Executive Officer, Joint Commission Resources and Joint Commission International

SPOTLIGHT: Paula Wilson, Joint Commission International  

Editor's Note: Medical Travel Today last talked to Paula Wilson in 2011, a few weeks after she assumed her role with Joint Commission International (JCI). As she herself stated, "I don't think I even knew where the restrooms were at that point."

Since that time she has not only gained her bearings but has helped JCI advance a number of key initiatives, and continues to contribute to a vision for promoting patient safety and quality initiatives amongst all healthcare organizations -- not just those accredited by JCI.

We're grateful to her for taking time out of her schedule to share with us a bit about JCI's success and goals for the future.

Medical Travel Today (MTT): It has been a busy few years in your not-so-new role. Looking back, what do you consider to be the most significant activities in which you and JCI have been engaged?

Paula Wilson (PW): Well, it's never me individually. Everything we do here is always a team effort. I just have the privilege of helping drive the effort.

Looking back, what I see is that we've really improved the value of accreditation.

We've done this in a few ways and we're far from done. In fact, we're in the midst of a lot of change and creating new programs, many of which will be implemented in January 2014.

But in terms of what we've already accomplished, we certainly stepped up the International Library of Measures. As an accreditation organization, we're all about measuring and tracking. We've made great strides in terms of amassing important quality and safety data. We're now able to look at it in new ways, and we've developed new methods for gathering it, too.

What this means for our customers is that they'll be able to view their performance over time, as well as compare it to other organizations in their country, region and even globally. That's the beautiful thing about accreditation. Everybody is using the same standards of measurement so the comparisons are meaningful. It's truly apples to apples.

Another significant change is that providing data is no longer voluntary. It's a requirement of JCI. As a result, collection and measurement is much more consistent. From a global perspective, I believe this is relatively unique. And it's something that's truly driven from our leadership. They recognize that the only way to drive performance is to measure performance.

The other major initiative we embarked upon last year and implemented at the beginning of this year is a new set of standards for academic medical centers.

These new standards acknowledge and include medical education and human subject research in the evaluation of quality and patient safety activities of academic medical center hospitals. In the past, these items were essentially unrecognized. This answers a lot of needs from our end, as well as our customers. It's pretty exciting.

Another area where we're tightening things up, if you will, is in the area of disease-specific certification. We noticed several health authorities, particularly in the Middle East, where interest in certification programs for specific diseases like diabetes and heart disease is very high. We fine-tuned our ability to certify those clinical programs, too.

In addition, we revamped our whole internal infrastructure. When I came on board everything was paper-based - the applications, tracking scheduling, all of it.

Now it's all automated. The ease of use for our customers is extremely high. Beginning the first quarter of this year all applications can be completed and submitted online. Last year we introduced technology that allowed our surveyors to do their reporting online. In the next quarter our customers will have that same ease of access. Our goal is to be fully automated.

In 2014, we'll be issuing the fifth edition of our accreditation standards, as well as a major redesign of the survey process. We've done extensive focus groups and have had numerous conversations with customers on how to improve the accreditation process and make it more meaningful -- and took their input into consideration as part of the redesign.

The other thing we'll be exploring is a way to do an unannounced survey in an international environment. There are a number of challenges to making this a reality, but we're working to solve them.

All these initiatives are a part of bringing more value to accreditation and making it easier for our customers to interact and engage with us. It's all about creating more touch points.

MTT: How about shifts? How have you seen the industry evolve?

PW: I'm not sure if this is a shift, but everybody is looking for a way to be in this business.

When I first arrived here, the talk was all about big guys - the Bumrungrads, Apollos, and so on.

But recently I was in Germany and spent a day with a smaller organization trying to get accredited. They're interested.

I also spent time with a public health organization that was working with a non-profit group and trying to figure out how to link their efforts and build a medical travel business in Germany.

Turkey is another growing market, and I think all of the Middle East sees opportunity in the industry. Certainly Malaysia is looking to Singapore as a source of patients. Add to that list South America, the Philippines, Eastern Europe, they're all now making a play for business.

A few years ago, these countries or regions were either not on the radar of medical travel or at least in the periphery.

The other thing that has happened is the mature market places, like Thailand, are now paying more attention to local populations. Medical travel is certainly part of their growth plan but so is the emerging middle-class and the population of contiguous countries.

The medical traveler has evolved, too. Two years ago the general impression of the typical medical traveler was a Westerner connecting medical travel with a vacation. I may be wrong, but I think now you have more people traveling specifically for care. The choice is now, first, who do I want to replace my knee? And second, can I vacation around it? Before it was about the beach and then what care can I get while I'm there? I see that as having completely reversed.

MTT: Let's talk about accreditation. Is the demand up or down?

PW: It's definitely growing at a nice steady pace. In October 2012 we broke the 500 mark for the number of accredited organizations.

The types of organizations seeking accreditation are getting more diverse, too. It used to be just hospitals, but now there's a steady increase in ambulatory care networks and specific clinics seeking accreditation. It's changing our case mix and we welcome it.

MTT: To what do you attribute the increase?

PW: I think the insurance companies and other payers are giving more attention to accreditation - and not necessarily just JCI accreditation. That's helping to drive numbers. Ministries of Health, too, are getting better at the medical travel business and are looking to ensure their country offers a true quality experience. There's just a much bigger focus on patient safety.

I'll say this is a very positive environment for anyone in the accreditation business.

MTT: Is the demand for accreditation regional or particular to specific types of facilities?

PW: In the European region we're seeing more interest from academic medical centers.

In the Middle East there's much more demand coming from ambulatory networks. The same trend is starting to develop in Asia-Pacific countries. I'm not really sure what's driving the different segment growth in different regions, but it's definitely how the numbers are running right now.

MTT: What are the biggest obstacles to successful accreditation and has that changed at all over the past two years?

PW: Leadership is such a key part of successful accreditation. You really need a committed CEO and Board. I think this is still the biggest obstacle. Their involvement is key to maintaining accreditation. There's a saying we use around here - You don't prepare for the next survey. You prepare for the next patient.

If you're tending to your patients thoughtfully and responsibly, you should be able to do the survey any day of the week. But that has to be driven from the top down.

International CEOs, like domestic CEOs, are deeply involved in the business of healthcare. That is making payroll, financial and regulatory integrity the big operational stuff... they tend to spend more time on balance sheets than quality reports.

But we see a direct relationship between the attention paid to quality reports and the success of an organization. Our challenge is educating and bringing leadership along to understand that.

Often what happens is a team is appointed inside the hospital and charged with handling accreditation every three years. It's usually a team of top people, including a senior nurse, who are experts on standards and processes. It's not uncommon for CEOs to delegate the task and forget it. As long as they make it through the survey they're happy. For whatever reason, it's not translating that the data gathering, work and forms are actually related to improving the patient experience and outcomes.

There's also the matter of physician engagement. Many physicians, not all mind you, but many see quality as something other people do. That's the quality department's job. This is especially true for physicians who aren't employed by the hospital. Right now only 40 percent of physicians are employed by hospitals. The other 60 percent are less vested in the organization. There's not necessarily a sense of responsibility to the quality measures of the hospital.

The other thing to consider is that we have schools for surgeons, schools for nurses, schools for pharmacists, schools for imaging professionals, and so on. They all become sort of silo-ed experts. But when school is over they have to operate as part of a team. But they don't get that training. The best care is delivered by a team that understands how to communicate, when to communicate, and whom they should communicate with. When communication breaks down, as it often does, quality suffers.

MTT: What do you anticipate being the key area(s) of focus for JCI in the year ahead?

PW: Continuing to build interactions, be it day-to-day, week-to-week, or month-to-month, with our customers. We really want to drive up the value and the number of touch-points.

In addition, there are a lot of organizations simply not ready for accreditation, but that doesn't mean they can't benefit from the knowledge and experience we have to share. We're looking at ways to have an impact from an educational and training perspective at these organizations, as well as those that are accredited.

Of course we need to do it cost-effectively so they can take advantage. But that's a goal: to make quality training available to many organizations regardless of their accreditation status.

We actually have a task force on globalization that is charged with global learning in 2013. They're trying to determine how we can have a greater impact on the education and access to information of all healthcare providers. We really want to extend our influence. We have a lot of good content and knowledge. It's a matter of figuring out how best to share what we know as broadly as possible.

Finally, we're also working hard on honing the survey and standards. We'd like to develop a more continuous accreditation methodology so that it's not just something that happens every three years. We'd like to develop meaningful programs and ongoing opportunities for dialogue for the in-between time. Quality shouldn't be viewed as something that "happens" as needed. It's got to be ongoing and we're going to do what we can to ensure that.

About Paula Wilson

Paula Wilson is president and chief executive officer of Joint Commission Resources (JCR) and its international division, Joint Commission International (JCI). She has more than 30 years of experience in the healthcare industry. Most recently, she provided management and strategic planning expertise as a consultant to public, nonprofit and private organizations. She was previously the vice president for policy at the United Hospital Fund, leading efforts to shape public policy changes related to insurance coverage, healthcare financing and Medicaid. Early in her distinguished career, Ms. Wilson served in several senior positions in the administration of New York Governor Mario Cuomo, including the executive deputy commissioner of the New York State Department of Health. She also served as deputy director of the New York Division of the Budget, and as a program associate for Health and Human Services on the governor's staff.

Ms. Wilson taught financial management and public and nonprofit administration at Columbia University School of International and Public Affairs, and graduate courses in healthcare financial management and corporate compliance at the Wagner School of Public Service at New York University.

She received her master's degree in social work from the State University of New York at Albany, is a member of the Board of the New York City Health and Hospitals Corporation, and serves on the finance committee of the Saint Mary's Center, Inc., a nursing home for people with AIDS.


Richard Krasner: Immigration Reform on the Horizon - What it Means for Medical Tourism and Workers' Compensation

Five years ago, members of a risk management discussion group I belong to on Yahoo Groups raised the question of whether or not illegal immigrants (i.e. undocumented immigrants) were entitled to workers' compensation benefits. The answer most of the respondents gave was yes, but with some restrictions, depending upon the state. One respondent in particular even provided the group with documents from the Independent Insurance Agents & Brokers of America, Inc. (IIABA) that gave the pros and cons in the debate on whether undocumented immigrants were entitled to benefits or not.

The purpose of this post is not to rehash the debate points, but to explore what impact impending immigration reform, which has been promised by the Obama administration in the upcoming second term of his presidency, will have on workers' compensation. I will also explore the likelihood that injured newly legal immigrant workers, especially from Mexico and other Latin American countries, will avail themselves of the benefits of medical tourism to their home countries as an option if injured on the job.

According to the IIABA White Paper, which cited a Pew Hispanic Center report published in 2006, there are probably 11 to 12 million undocumented immigrants in the US, depending upon how many "self-deported" recently due to the current US economic slowdown, of which, demographically, this represents 5.4 million men, 3.9 million women, and 1.8 million children. In addition, there are 3.1 million children who are US citizens having been born here (64 percent of all children of the undocumented) from one or more parent.

President Obama's Executive Order last year gave many of these children a reprieve from deportation while they are attending college here, and until more comprehensive reform can be achieved for all undocumented immigrants. Undocumented immigrants account for almost one-third of all foreign-born residents of the US, and about 80 percent of these are from Mexico and other Latin American countries.

The report also states that out of the total number of undocumented adults, 9.3 million, 7.2 million (77 percent) are employed and account for around 5 percent of the US workforce. They comprise a disproportionate percentage in some industries, such as 24 percent of farm workers, 17 percent of cleaning workers, 14 percent of construction workers, and 12 percent of food preparers.

These industries typically account for much of the claims filed under the US workers' compensation system. Within a particular industry, undocumented workers comprise a higher percentage of more hazardous occupations, e.g., 36 percent of insulation workers and 29 percent of all roofing employees are estimated to be undocumented.

In my post, The Stars Aligned, I briefly touched upon the issue of immigration reform's impact on medical tourism for workers' compensation in regard to Mexican workers in the US. But since President Obama, and Florida Sen. Marco Rubio have recently outlined different reform plans, which I will discuss here in this post, it is important to mention first how undocumented workers are treated under the various laws each state has established to govern their workers' compensation systems.

The other document I mentioned that one of the respondents had forwarded to the discussion group was a chart of the laws governing workers' compensation and undocumented workers. Undocumented workers are entitled to workers' compensation benefits in 38 states, however, six states have statutes that allow or restrict benefits for various reasons, such as if the employment was obtained under false pretenses (FL); disability benefits were payable if they were unable to work because of the injury (GA); they were entitled to medical, but not disability benefits because of a commission of a crime under the Immigration Reform and Control Act (IRCA) of 1986 signed by Ronald Reagan (MI); vocational rehabilitation benefits were covered since the worker could get employment outside the US (NV); disability payments were recoverable at US wages rather than those of the home country, if the employer was aware or should have been aware of the undocumented status (NH); disability benefits were not payable if the worker was unable to work due to his status, and not the injury (NC).

Three states, California, Georgia and Nebraska, have statutes that indicate that undocumented workers are not entitled to benefits in certain situations. California case law established that undocumented workers could be refused vocational rehabilitation benefits. Georgia case law ruled that disability benefits were not payable if the worker was unable to work due to his status and not his injury, and Nebraska case law established that a worker named Ortiz could be refused vocational rehabilitation benefits because he could not legally work in the US and did not plan to return to Mexico to work. Only Wyoming has a statute that expressly includes only "legally employed...aliens." And case law in 1999 confirmed that undocumented were not entitled to benefits. Eleven states, Alaska, Delaware, Indiana, Maine, Missouri, Rhode Island, South Dakota, Vermont, Washington State, West Virginia and Wisconsin, were listed in the chart as unknown as to whether or not undocumented are entitled to benefits.

As we begin the second Obama Administration, immigration reform has risen to the top of the list, only to be preceded by the debt crisis and the fiscal cliff. As I mentioned above, both President Obama and Sen. Rubio have outlined their own versions of what immigration reform would look like. Sen. Rubio's plan would rely more on skilled workers, such as engineers and seasonal farm workers, while tightening border enforcement and immigration laws -- something that would please his right-wing allies on talk radio. Sen. Rubio's plan would not provide blanket amnesty to those already here.

On the other hand, President Obama's plan, as outlined in a recent New York Times article, would seek to give undocumented workers a path to citizenship. Sen. Rubio's plan would focus more on merit and skill as prerequisites for entry into the US, much like earlier immigration laws passed in the 1920's and other decades. The President's plan would be broader and more immediate, and would probably have less of an impact on the economic stability of those industries that currently rely on undocumented workers.
Whatever form immigration reform will take, the opportunities to offer medical tourism as an option to injured undocumented workers, once they achieve some legal form of citizenship, will no doubt increase. The likelihood that something will be done this year has already been the topic of many news programs and even has been discussed by congressional leaders, such as Sen. Harry Reid, the Senate Majority leader.

Once the currently undocumented can legally remain in the US and continue to work in the industries they occupy, the more likely the possibility that they would opt to go to their home country for medical treatment, should they get injured on the job. This is true especially with benefits that include not having language or cultural barriers and the ability to be visited by friends and family living there. Given all this, they will be more open to receiving treatment at facilities they normally could never get into. And as many of these countries are fast becoming "rising stars" as medical tourism destinations, the more likely they will want to get treated at the best hospitals in their countries, which will have a huge impact on their recovery, well-being and standing with friends and family. Also, the financial burden of not having to look for a job back home and being able to return to the US will convince them to opt for medical tourism as injured workers.


Medical Travel and Orthopedics
By Gabrielle White, RN, CASC, Executive Director, Ambulatory Services & Network Development, Hoag Orthopedic Institute

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Orthopedics is one of the most promising specialty areas for medical travel. In fact, a growing number of employers are sending employees to Centers of Excellence (COE), provider organizations that specialize in a particular area, delivering better outcomes and cost-efficiency through high volume. Procedures, such as joint replacement, spine surgery, knee and shoulder reconstruction or repair, and hand and feet procedures, performed at COEs have been especially beneficial for patients.

At Hoag Orthopedic Institute (HOI) and its subsidiary, Orthopedic Surgery Center of Orange County (OSC), there is a slow and steady stream of patients who travel for surgery -- some from as far away as Alaska and, occasionally, from overseas. For HOI and its two surgery centers, OSC and Main Street Specialty Surgery Center (MSSSC), the volume of orthopedic procedures performed in 2012 reached over 10,700, making HOI the largest center for orthopedic care delivery in California.

Individuals travel for orthopedic surgery for various reasons, including:

Word-of-mouth -- referrals and seeing the results of a friend or family member who traveled for care is often enough to convince people to make the trek to a COE that offers a coordinated program and high-performing specialists.

Lack of options -- If a patient needs to travel distances to receive appropriate care, it makes sense to travel to a COE, which offers high quality at a reasonable cost. COEs are able to offer lower rates because of the high volume they perform for certain procedures. For example, OSC recently performed an ankle procedure on a patient from another part of the US. While the patient was a little apprehensive to be traveling to an unfamiliar environment for surgery, the options provided in the patient's hometown were limited -- and 300 percent more expensive. The patient's employer paid all expenses for the patient and spouse to travel to Southern California, while still saving on cost compared with local treatment.

Self-insured - Self-insured employers, in particular, seek options to reduce their growing healthcare expenditures. Medical travel offers cost-effective care without sacrificing quality, and employees are able to reduce their out-of-pocket costs. Working with the insurance provider, some employers are now seeking COEs for orthopedic procedures, with a focus on quality.

Mitigating Expensive Complications
One key contributor to high healthcare costs is post-surgical complications. While complications can occur at any facility and with any specialist, COEs are more likely to deliver the best results.

Employers or payers incent patients to travel for care by offering options that produce value: great outcomes and lower overall cost. Educating employees about COEs and engaging them in the process of their own healthcare are two effective strategies for achieving cost-savings through a medical travel program.

HOI recently performed a total hip replacement on a young patient from a southern state. Travel expenses for the patient and a companion were covered by the employer. Instead of paying 50 percent out of pocket for the procedure, the patient paid five percent by travelling to HOI, a preferred provider. By relying on preferred provider networks, payers know they are providing access to high-quality care - no matter where the facility is located.

Reference Pricing
With reference pricing, an employer or insurer makes a defined contribution toward covering the cost of a particular service and the patient pays the remainder. For example, a patient from a neighboring county traveled to Orange County to consult with one of HOI's top surgeons for joint replacement. The driving force behind the patient's decision was that HOI is priced within the reference price of the payer, so the patient did not have to pay a difference or overage for the hospital care. At the local hospital, the patient would have had to pay tens of thousands of dollars for the same procedure after the payer covered the reference price.

Effective Medical Travel Programs
It's important to find a medical travel program that offers pre- and post-operative care coordination, with secure transfer of patient records. Diagnosis can be done remotely with imaging and reports from providers in the patient's locale or through the third party administrator. Phone consults are standard, as is a pre-op visit a few days prior to surgery. On their return home, patients are armed with their medical records, reports and instructions from the specialist, hospital and physical therapist for continuation of care.

About Gabrielle White, RN, CASC, Executive Director, Ambulatory Services & Network Development, Hoag Orthopedic Institute

Gabrielle graduated as a Registered Nurse from Monash University-Gippsland, in Victoria, Australia, in 1989, and moved to California in 1994.  Her career has been focused on Peri Operative Services and Administration. Over the past 11 years, Gabrielle has been the director of Orthopedic Surgery Center of Orange County (OSC), where she oversees clinical and business operations.  OSC is a subsidiary of Hoag Orthopedic Institute (HOI).  In 2008 she formally introduced Travel Medicine to the surgery center and developed the global/bundle-pricing model for OSC and now HOI. Gabrielle's experience has led to her selection to participate in the Integrated Healthcare Associate's team for development of a bundled payment pilot model in California. Gabrielle was chosen by Hoag as primary director in the $80M development, construction and start-up of Peri Operative Services for Hoag Orthopedic Institute. Since its opening in late 2010, HOI has become the highest volume orthopedic specialty institute in the Western United States. Gabrielle's primary role for HOI is executive director of Ambulatory Services and Network Development.

Industry News

Can Medical Tourism Save Us From Obamacare?

The rise of first-rate hospitals abroad may provide a vital lifeline for Americans.

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Written by Jim Epstein of Reason.com. Reprinted with permission.

Outside of the United States, going to another country for medical care can lead to survival and recovery for patients otherwise facing certain death or long waits for treatment at home. Nigeria has no oncological care to speak of, so cancer-stricken citizens are increasingly going abroad for modern care. Battle-wounded Syrians are getting life-saving surgeries in Turkish hospitals. Canadians come to the U.S. to avoid average wait times of four months for non-emergency procedures.

If the double whammy of Obamacare, which will be fully up and running in 2014, and a rapidly aging population creates pronounced health-care shortages, more and more Americans may soon start looking abroad for fast, affordable, and effective treatments for all sorts of medical problems.

The global health-care industry is booming, which is creating new opportunities for medical travelers to purchase everything from discount dental work to state-of-the-art heart surgery. The international accreditation agency known as Joint Commission International evaluates the quality of hospitals around the world. It has given its stamp of approval to 546 hospitals worldwide and the list is growing faster than ever.

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Foreign governments and hospitals are staking big dollars on promotion and infrastructure in an effort to burnish their reputations as medical destinations. That enthusiasm was on display last October at a medical tourism industry conference in Miami, which drew participants from 90 countries. Turkey, which paid close to $100,000 in exchange for prominent branding at the conference, drew 500,000 foreign patients in 2011. Medical tourists brought the country $3.5 billion in revenue in 2011, according to the head of the Turkish Healthcare Travel Council, Emin Çakmak.

Josef Woodman is the founder of Patients Beyond Borders and the author of several guidebooks to the medical tourism industry. He says foreign hospitals face more pressure to keep their costs down than their U.S. counterparts because their patients generally pay their bills out of pocket. And even highly skilled doctors in most countries earn significantly less than in the U.S. In India, heart-valve replacement surgery costs one-tenth of what U.S. hospitals charge. A knee replacement in Thailand runs about one-third of the U.S. price. In South Korea, gastric bypass surgery can be had for half the U.S. price.

The globalization of health care means countries are specializing in certain kinds of care. Turkey excels in pediatric cardiology. Singapore is a destination for oncological care. Chinese heart patients needing top-notch angioplasty go to Japan. Israel and Barbados excel in fertility treatment. Costa Rica and Hungary have become dentistry destinations. Thailand excels in a wide range of specialties thanks in part to its renowned Bumrungrad International Hospital, which serves 400,000 foreign patients a year.

Port Charlotte, Florida-based orthopedist Sam Hess is part of a group that's working to open a full-service hospital on the Caribbean island of St. Maarten. Hess says he's grown tired of the legal and bureaucratic headaches of practicing medicine in the U.S. "I still love what I do, but the issues I have to deal with that have nothing to do with patient care take a lot of wind out of my sails," explains Hess. "We have to assign more and more of our staff to address insurance concerns and approvals. We order tests we don't need to cover ourselves legally."

Hess would also like the freedom to offer treatments that aren't legal yet in the U.S. Medical tourism offers doctors and patients a way around the FDA's often slow-moving approval process. Consider an orthopedic procedure called Birmingham Hip Resurfacing that gives younger patients an alternative to a total hip replacement. It was invented by a British Surgeon in 1991, but the FDA didn't approve the technique until 2006. In the interim, patients flocked to Chennai, India, to be treated by star surgeon Vijay Bose.

Medical travelers don't always make wise choices. Many seek out bogus stem-cell treatments for disorders like autism, multiple sclerosis, Down syndrome, and depression. Researchers anticipate that one day stem cells will be used to treat a broad range of diseases and conditions, but so far they've have been clinically proven effective only for certain blood disorders.

Harvard Law professor I. Glenn Cohen, the author of a new book about the globalization of health care, says the stem-cell industry could be largely self-regulating if patients had access to better information online. The scarcity of reliable performance data is a major problem in the medical tourism industry, according to Harvard Medical School Professor Sharon Kleefield, who is working on developing better methods for gathering information from foreign hospitals. There's no ranking of the best global hospitals by specialty, which Kleefield thinks would go a long way towards convincing skittish U.S. employers and insurance companies to partner with foreign health-care providers.

Most medical tourists traveling out of the U.S. are seeking procedures that traditional health insurance companies don't cover - such as dental work, plastic surgery, and in vitro fertilization (IVF). But that's likely to change as health care becomes scarcer. Obamacare, which will be fully enacted in 2014, increases the demand for health care without doing much to grow the number of doctors, nurses, and hospital beds necessary to meet that demand. The aging of the baby boom generation (those born between 1946 and 1964) is already putting a strain on resources. By 2025, there will be 64 million Americans over the age of 65. That's almost double the number at the start of the century.

Some U.S. patients will follow in the footsteps of the nearly 50,000 Canadians a year who forego their insurance coverage and pay out of pocket for better and immediate treatment abroad. Medical tourism may also flourish within the regulatory confines of Obamacare.

Southern Methodist University's Nathan Cortez argues in an soon-to-be published essay that there's nothing in the Affordable Care Act that specifically prohibits insurance companies from encouraging their clients to use foreign providers. It's also possible that insurance plans that utilize medical tourism could be offered on the state-based insurance exchanges, although the U.S. Department of Health and Human Services may choose to interpret the law in ways that makes that difficult.

Whatever the hurdles, the often-impeccable quality and low prices available abroad will lead more patients to travel for treatment in the coming years. "You're going to see huge competitive forces coming to bear on the U.S. health care system," says Josef Woodman of Patients Beyond Borders. "And god knows, we need it."

For a related video by the author, click here.

Industry News

Patients Beyond Borders Announces Taiwan Simplified Chinese Edition

Newest translated edition targets health and wellness travelers from mainland China

Description: maaThe Taiwan Task Force for Medical Travel (TTFMT) and Patients Beyond Borders jointly announce the launch of Patients Beyond Borders: Taiwan Edition, Simplified Chinese Translation for international distribution in January 2013.

Supported by the Taiwan government, hospitals, and related private organizations, the guidebook, originally published in 2009, will be fully updated and translated into Simplified Chinese, and will offer an in-depth overview of Taiwan's leading international hospitals, medical specialties and procedures, selected health travel agents, nearby recovery and guest accommodations, and area travel information.

Healthcare consumers, particularly those from neighboring China in search of quality and value, will find Taiwan's prices for medical procedures to be on par with other leading international healthcare destinations such as Thailand, South Korea and Singapore. Taiwan currently offers 14 facilities with clinical accreditation from the Joint Commission International (JCI), which provides additional comfort to the international medical traveler seeking the highest level of care.
"Taiwan offers some of the best healthcare in Asia," says Patients Beyond Borders CEO Josef Woodman. "With a long and respected history of quality healthcare, exceptional facilities, and affordable prices, Taiwan continues to be a premiere choice among Chinese patients seeking top-quality healthcare and wellness services in the region."

Recent initiatives by the Taiwanese government to simplify and expedite the medical visa process for Chinese patients, coupled with an increase in direct flights from China to Taiwan, have attracted significant numbers of visitors from China. Further fueling the 20%+ growth, a new government policy implemented earlier this year allows hospitals to apply for visas for groups of up to 30 mainland Chinese citizens seeking medical treatment, health screenings and cosmetic procedures.

"The release of Patients Beyond Borders: Taiwan Edition, Simplified Chinese Translation, will now allow Chinese-speaking patients everywhere even greater access to one of the world's most comprehensive healthcare systems," says Dr. Mingyen Wu, CEO of TTFMT and Secretary-General, Taiwan Nongovernmental Hospitals and Clinics Association. "We are pleased to be working with Patients Beyond Borders on this project."

Patients Beyond Borders: Taiwan Edition, Simplified Chinese Translation will be available through a variety of sources including Alibaba, Amazon China, Baidu (Chinese-language search engine), Dangdang (digital book distributor), Renren, and libraries (Digital Library of China) as well as the Patients Beyond Borders and TTMFT websites.

Industry News

New Hope for Type I Diabetes Patients
Traveling4Health and Retirement announces sponsorship of World Renowned Stem Cell Surgeon lauded for research and treatment of Diabetes

Traveling4Health and Retirement (THR) announces their choice of a stem cell surgeon sponsor in Buenos Aires, a popular South America destination location for overseas retirement and medical travel.

"We are pleased to promote Dr. Alejandro Mesples as our medical services sponsor in Buenos Aires," said Ilene Little, CEO of Traveling4Health and Retirement.

Dr. Mesples has published several papers in medical journals on the results of his research and therapy and is widely known and accepted as the authority on stem cell-based surgery for diabetes using the patient's own stem cells.

Recent results of his ongoing research were published in Volume 3 No.1, 2013 of the SCD Medical Journal, paper ID 1080044.

The sponsor selection was based on patient-generated reviews, interviews with the company leadership, and the strong support for the potential of the therapy and associated research as expressed in letters received from professors at the University of Padua in Italy and a professor of Endocrinology at Johns Hopkins.

"When patients rave about their medical outcomes and a provider's customer service, that gets our attention," said Ilene Little, "We only promote doctors and accept destination sponsorships from doctors whose patients and professional peers recommend their services."

Download and listen, for free, to the father of a nine-year old girl describing her stem cell treatment by Dr. Mesples on the 1/15/13 "Know Before You Go Show" aired on the Overseas Radio Network.

"Lara was eight years old and had a diagnosis of type 1 (or juvenile) diabetes newly diagnosed (one month prior to my prescribing her treatment plan)," said Dr. Mesples, "In September, 2011, we performed a liver implant of bone marrow stem cells in order to stop the auto-immune attack to the pancreas.

"Normally this type of diabetes is secondary to antibody-mediated destruction and its evolution is marked by the increase of antibodies levels, low c peptide (low pancreatic function), and early use of insulin in high doses.

"Today, the young patient has negative antibodies and uses very little insulin. Of course she is in strict control with her local doctor who is amazed by what he is seeing."

In the article, "Best Doctor for Stem Cell Surgery for Diabetes," Dr. Mesples said, "The clinical evolution of stem cell treatment for diabetes is very important for the patient and family. Our treatment is the only one to report such impressive results."

Traveling4Health.com, the first resource of its kind connecting travelers interested in alternative medical treatments, presents viable medical provider sources from around the globe.

Traveling4Health and Retirement is proud to introduce travelers to Dr. Mesples as our selected sponsor of stem cell treatments for Diabetes.

Traveling4Health.com gives the latest information and news about affordable medical and dental care. Traveling4Health And Retirement continues to spearhead the advancements in medical treatment sourcing, the only resource of its kind for travel and health advocacy.

Knowledge about medical travel options, commonly referred to as medical tourism, is easily accessible through the website Traveling4Health.com

"Patients really are becoming more and more comfortable taking advantage of medical travel options for cost and quality considerations," said a THR spokesperson.

Traveling4Health.com is the definitive resource bringing together subject experts to inform members about the newest medical advancements in patient medical services and expert medical providers. Traveling4Health and Retirement leads the industry with insightful, informative content and reviews of medical providers posted by patients who travel for medical treatment.

Traveling4Health and Retirement continues to expand its reach with its purpose to inform individuals about international medical services and destination locations presenting American-quality healthcare and medical treatment. Travelers, medical professionals, and people desiring to learn more about THR's growing user community and health providers may visit Traveling4Health&Retirement. Persons or care providers interested in working with Traveling4Health and Retirement should contact Ilene Little at +1.888.844.1005; Fax: +1.888.844.1005; Skype at Ilene. Little for additional information.

Industry News

Medical Tourism for Cancer Patients in Latvia

DailyNewsEgypt.com-The treatment of cancer is constantly changing and many scientists are involved in trying to find a cure for one of the deadliest diseases we are confronted with in modern times. The small country of Latvia is at the forefront of one of the latest treatments for many forms of cancer that is attracting patients from all over the world.

It all began with Latvian scientist Aina Muceniece who began her career in 1945 at the A. Kirchenstein Institute of Microbiology. After years of study the first laboratory for virotherapy as a treatment for cancer was established at the institute, which led to the development of the medicine Rigvir.

To continue reading click here.

Industry News

McGill University Health Centre Claims Provided Care Was Not "medical tourism"

Editor's Note: Surgeons at the McGill University Health Centre (MUHC) took umbrage with a story that appeared in The Gazette (dailygazette.com) related to the care provided to a Kuwaiti woman in 2011. The story (found here) suggests that the patient's care received priority over the needs of Canadian citizens and casts a harsh light on the relationship between the MUHC and Montreal Medical International, Inc., a private company involved in an $86-million hospital-services agreement with the government of Kuwait in 2010 that makes regular use of MUHC doctors and nurses.

The response penned by Dr. Gerald Fried, surgeon-in-chief at the McGill University Health Centre, can be accessed here.

Upcoming Events

19th World Congress of Aesthetic Medicine of the UIME

February 14-16, 2013 - Cape Town International Convention Centre, Cape Town, South Africa

The 19th World Congress of Aesthetic Medicine of the UIME will focus on a scientific program combined with teaching, training and live workshops to educate doctors from all over the world on the latest trends, new techniques, discoveries, products and devices in the field of aesthetic medicine. The exhibition will be a showcase of international companies from various continents with products, devices and techniques relating to aesthetic and anti-aging medicine.

It is the first time in history that this world congress is being held in an African country and is one of the most important aesthetic medical events to ever take place in Southern Africa. Aesthetic medical professionals from over 47 countries are expected to participate with 42 exhibition stands.
The congress is a Continuing Medical Education (CME) accredited event.

To learn more or to register click here.


ITB Health Tourism Battle - ITB Destination Day at the ITB Berlin Convention 2013

March 7, 2013 - Messedamm 22 D-14055, Berlin

Following up on 2012's great success, the ITB Berlin Convention and visitBerlin will present the second round of the ITB Health Tourism Battle on ITB Destination Day, March 7, 2013. The event is designed to provide insight into international best practices, challenges and trends in health tourism -- a long-term tourism growth market. Worldwide, there has been an increase in the number of destinations and travel companies focused on health tourism and developing new products in this sector. The Health Tourism Battle will feature nine short and dynamic presentations in English on excellent, creative, unique or innovative products and destinations related to health tourism. Each four-minute presentation will be voted on by the audience, with the winner receiving an award and prize.

To learn more or to register click here.


PANASALUD International Medical Tourism Conference 2013

Description: panasalud2
March 14, 2013 - Horacio Alfaro Hall of the Panama Chamber of Commerce, Industries and Agriculture, Panama

Panama's first major international conference on medical tourism and global health will bring together more than 150 professional groups and five international speakers to share historical market data, current statistics, knowledge on the formation of multi- disciplinary business structures and commercial and risk preparation for small, medium and large companies. As medical and health tourism becomes a budding industry in the Republic of Panama, this conference seeks to bring together doctors, dentists, clinics and hospitals to acquire knowledge and experience directly from medical tourism experts.

To learn more or to register click here.

Kuwait Medical Tourism Congress and Exhibition Scheduled for March 2013

Kuwait Medical Tourism Congress and Exhibition invites local, regional and international best hospitals and medical tourism facilitators for a three-day convergence focusing on networking among the stakeholders, high quality of medical services, and the investment opportunities in healthcare throughout the world.

Slated for March 19 - 21, 2013, at the Crowne Plaza Hotel in Kuwait, the event will see the participation of some of the leading names in the medical tourism and healthcare industry. The conference will comprise workshops conducted by renowned international speakers. The workshops will cover topics that range from medical tourism, current medical research initiatives, the latest innovations in the health sector, future business opportunities in healthcare, insurance, and healthcare quality to the globalization in healthcare.

To learn more or to register click here.


4th Moscow Medical and Health Tourism Congress

March 20-23, 2013 - EXPOCENTRE Fairgrounds, Moscow, Russia

Russia's biggest medical tourism project of 2013, Moscow Medical and Health Tourism Congress will bring together key players of the business world. The mission of this congress is to discuss the integration of Russia and the CIS into the global health systems and improve ways of communication.

Key topics include:

  • Russia and the Commonwealth of Independent States (CIS) countries - key players in the global medical and health tourism market
  • Effective business development programs in Russia and CIS countries
  • Case studies by professionals and unique business models
  • Development of voluntary medical insurance in Russia
  • Russian insurance companies and the global medical tourism market
  • Health tourism: the specifics of business, its geography and market volumes in Russia and CIS
  • Medical tourism and the practical experience of foreign clinics
  • Quality and safety of medical services for international patients
  • Legal seminar: Russian and international legislation in medical tourism

To learn more or to register click here.

Shanghai Medical and Healthcare Tourism Show

April 2-4, 2013 - Everbright Exhibition Center, Shanghai

The 2013 Shanghai Medical & Healthcare Tourism Show (SMTS) aims to provide a platform for communication and cooperation among suppliers, destinations, hospitals, insurance companies, hotels and other professionals of global medical and healthcare tourism products. SMTS opens a window for the large number of potential customers and professionals in China to know more about global medical and healthcare tourism products. Based on full preparations, SMTS has won strong support from China's health authorities and tourism officials.

To learn more or to register click here.

2013 CMTR European Medical Tourism Research Symposium

April 26-27, 2013 - Heidelberg, Germany

The Center for Medical Tourism Research (CMTR) examines the business, clinical, economic, ethical, legal, marketing, operational, policy, social justice and societal impacts of the medical tourism, medical travel, dental tourism, health tourism, wellness tourism, fertility tourism, transplant tourism and retirement tourism industries worldwide.

The 2013 CMTR European Medical Tourism Research Symposium is open to all interested stakeholders in this emerging global industry.

Keynote speakers include:

  • Dr. Melanie Smith, Budapest Business School, associate professor and researcher in Tourism at the Budapest Business School in Hungary
  • Dr. Laszlo Puczko, managing director, Xellum Consulting, LTD, and teacher at the Budapest College of Communication and Business in Hungary

A conference fee of 50 Euros is due onsite. Government and student fees are 25 Euros with valid verification of government or student status.

To learn more or register click here.

International Board of Medicine and Surgery (IBMS) Mini Medical Conference

April 29-May 1, 2013 - Tampa Bay, FL

The International Board of Medicine and Surgery's (IBMS) Mini Medical Conference in Tampa Bay, Fla., will feature key speakers Dr. Sharma, executive director of IBMS India in Mumbai, and Dr. Rai of the India Medical Association.

During the conference, IBMS will meet with various institutions in the Tampa Bay area to share information about medical tourism.

To learn more or to register click here.

Global Connected Care Conference & 4th Meditour Expo

June 5 and 6, 2013 Hyatt Regency - Orange County, CA

This two-day international conference will bring together professionals from all over the world to discuss the latest trends and opportunities in global healthcare. The conference will include presentations by some of global healthcare's biggest decision makers and thought leaders. Conference themes include:

  • Global Physician Referral Networks and Patient Care-The Next Generation of Care
  • Self-Funded Insurance Groups-Providing Healthcare Travel Alternatives
  • Business Processes and Advanced Global Healthcare Marketing Strategies
  • Integrating Global Healthcare Technologies with Medical Travel
  • Legal Issues in Global Care
  • Accessing the US healthcare market: both inbound and outbound
  • Dental Tourism
  • M-health, Telemedicine and Electronic Healthcare Information Platform

To learn more or register click here.

Medical Travel Today: Opinions and Perspectives on an Industry in the Making

Medical Travel Today - the authoritative newsletter for the worldwide medical travel industry - is pleased to announce publication of a new book, "Medical Travel Today: Opinions and Perspectives on an Industry in the Making.

Featuring 40 of the newsletter's most compelling interviews from the first five years of publication, the volume chronicles the explosive growth of international medical tourism as witnessed and experienced by some of the key stakeholders and players. A must-read for anyone interested or involved in the industry.

News in Review

Nicaragua Bets on Medical Tourism

NicaraguaDispatch.com - A new medical tourism resort is currently being erected in San Juan del Sur that will boast 61 rooms, foreign chefs, ocean-view rooms, a four-star rating, and a whole floor dedicated to medical treatment for its guests. Speaking at this month's Central American Advantage Conference in Managua, the owner of the proposed medical resort, Nelson Estrada, told the audience that his development would be the first of its kind in Nicaragua. This hospital will offer clients a boutique hotel and an extensive range of medical procedures all under one roof. The medical resort will specialize in elective cosmetic surgery, but Estrada hopes to expand available treatments in the future.

Oman Aims to Become Regional Hub for Medical Tourism

ArabianGazette.com - The Sultanate of Oman has announced its plans to spend an estimated USD 1.5 billion on the construction of a medical complex. According to Ahmed Al Qasmi, director general for planning at the health ministry, the government would be inviting bids for the construction this year in northern Batnah. Batnah is a major city in the northern coastal region and boasts the second highest population in Oman after Muscat. After completion of its three phases, the project is expected to generate about 3,000 jobs.

Vitals Healthy for UAE's Billion-Dirham Growth in Medical Tourism
AMEInfo.com - The United Arab Emirates (UAE) is fast developing into a top draw for medical tourism in the region, with latest research estimating the market valuation at $1.6 billion, with a seven percent growth expected by end of 2013 as per market research firm Euromonitor. This is only fuelled further by the Economic Intelligence Unit Estimates, which calculates the UAE's healthcare spending to rise to a whopping $16.8bn by 2015.

GB Project Pursues Medical Tourism
Freeport.NassauGuardian.net.com - Top executives from the proposed Blackwood Point Resort & Spa descended on the Bahamas last weekend to discuss the inclusion of medical tourism in its offerings. While details remain scarce at this time, Guardian Business can confirm that international partners have begun face-to-face negotiations with local talent.

Medical Tourists Flock to Las Vegas for Treatments
Fox5Vegas.com - It has been one of Mayor Carolyn Goodman's top priorities, and now companies are taking advantage of Las Vegas in terms of medical tourism. One company even has hundreds of visitors from around the world coming to the valley just to get pregnant.

Editor's Note: The information in Medical Travel Today is believed to be accurate, but in some instances, may represent opinion or judgment. The newsletter's providers do not guarantee the accuracy or completeness of any of the information and shall not be liable for any loss or damage caused - directly or indirectly - by or from the information. All information should be considered a supplement to - and not a substitute for - the care provided by a licensed healthcare provider or other appropriate expert. The appearance of advertising in this newsletter should in no way be interpreted as a product or service endorsement by the newsletter's providers.