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© 2017 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

Managing Editor
Nathan Molinari

Assistant Managing Editor
Brittany Tedesco


From the Editor

From the Editor: This month in Medical Travel Today, Laura Carabello

News in Review

Croatia Among Most Promising Health Tourism Destinations in Europe

Five Ways to be a Savvy Medical Tourist and Enjoy a Vacation

American-made biosimilars a differentiator in U.S. market, Coherus

U.S. infant mortality rates down 15 percent

Care Coordination in U.S. Lags Other Developed Nations

Deadly fungal infection that doctors have been fearing now reported in U.S.

Spotlight Interview

Manish Chandra and Pankaj Chandra, Vaidam Health

Industry News

Four Technological Advancements That Could Change the Medical Tourism Landscape as We Know It

Integral Healthcare

Singapore losing medical tourists? Reasons to ponder

Los Algodones Enjoys Medical Tourism Boom Despite U.S. Mexico Tension

Bill aims to protect medical staffs when teams cross state lines

Global Medical Tourism Market By Treatment Type and by Region - Industry Analysis, Size, Share, Growth Trends and Forecasts (2016 - 2021)

Group travel to Ethiopia from Sheffield to help improve health services

Accommodating variations on the theme of Health Tourism

CMS postpones expansion, implementation of bundled payment programs


Upcoming Events

Medical Fair India 2017

Healthcare Travel Expo and International Medical Forum

Indonesia Health, Medical Treatment and Tourism Expo

MediWorld - China International Medical Travel Show

China International Medical Tourism Fair 2017

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Volume 9, Issue 9

Dear Colleagues:
This month, we learned about some key trends in the medical tourism landscape: 

  • The decline of Singapore's medical tourism rate
  • Four technological advancements that could change the positioning of medical tourism destinations
  • Global medical tourism market trends and forecasts

India remains front and center, with a growing number of patients across all medical conditions -- orthopedics, cardiac surgery, spine, neurology, transplants, cancer and IVF -- traveling to India for treatment. Check out our interview with the co-founders of Vaidam Health.

We are going to begin featuring emerging partnerships between U.S. Centers of Excellence and hospitals outside the United States.  We would love to hear from U.S. based institutions and hospitals around the world that are either interested in pursuing relationships or exploring collaborative opportunities for knowledge transfer and patient referrals. Please be in touch! 

Laura Carabello
Executive Editor and Publisher
Medical Travel Today



Global Health Voyager

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For more information, visit http://www.medicaltraveltoday.com


Manish Chandra and Pankaj Chandra, Vaidam Health

About Vaidam Health
Vaidam Health (www.Vaidam.com) is the go-to place for people seeking treatment abroad. Currently focused on patients traveling to India, Vaidam Health offers high quality, affordable treatment with unmatched personal care. The Vaidam Health team has assisted thousands of patients across all medical specialties, such as orthopedics, cardiac surgery, spine, neurology, transplants, cancer and IVF.

Www.Vaidam.com offers a self-help tool that allows users to input desired treatment and country, and get answers to their top questions about cost, best doctors, best hospitals, visa and travel.

The Company has active ties with 70+ hospitals in India, and has served patients from 25+ countries, including Africa, Australia and the Americas. Founded in the New Delhi region of India in 2016, Vaidam Health is ISO 9001 and 27001 certified.

Website: www.vaidam.com
Email: hello@vaidam.com
Phone: +91 965 000 1746



Pankaj Chandra


Manish Chandra


About Pankaj Chandna, Co-Founder, Vaidam Health
Pankaj Chandna has more than 12 years of experience in building a deep network of hospitals and doctors in India. He has traveled and worked with private and government health institutions in India, the U.S., Chile, South Africa, Singapore and Thailand.

Before starting Vaidam Health, Pankaj worked as the vice president of Sales for Lybrate, India’s leading doctor-connect platform. Between 2007-2011, Pankaj worked with hospitals in the U.S., helping them to increase their efficiency in serving patients.

He earned his MBA at the Indian Institute of Management, (IIM Lucknow) and a graduate degree in Engineering from the National Institute of Technology (NIT-Kurukshetra).


About Manish Chandra, Co-Founder, Vaidam Health
Manish Chandra has nearly 15 years of experience on Internet platforms. He has worked with e-business teams at Agilent TechnologiesIRCTC.co.in, India’s largest travel e-commerce business, and British Telecom.

Before starting Vaidam Health, Manish was the assistant vice president, Product Management, at ShopClues.com, one of India’s largest e-commerce companies. As one of the initial employees at ShopClues, Manish gained experience in building and scaling product management, operations and customer experience.

He earned an MBA from the Indian Institute of Management (IIM Lucknow) and a graduate degree in Engineering from Delhi College of Engineering (Delhi Technical University).


Medical Travel Today (MTT): Could you give us some background about Vaidam and how you got involved with the company?

Manish Chandra (MC): Our personal experiences have led us to realize the need to create a high-quality source of information for people seeking advanced treatment or surgeries.

While researching this idea, we found that this problem is amplified for people seeking treatment abroad.

The medical tourism space is fragmented and many small and medium players exist.

Pankaj and I decided to change this, building Vaidam.com as an online destination for those seeking medical travel options and creating a medical travel platform for patients travelling to India.

Patient anxiety goes beyond just finding a good doctor and hospital. We took the idea a step further by actively helping the patients in case assessment, quotation, travel planning and hospitality in India.

Thus, we founded Vaidam Health and launched Vaidam.com.

Along with the rich profiles of doctors, we have curated profiles of the hospitals, articles on treatment and patient stories.

We are also building a new and exciting tool called the treatment cost estimator which gives the patient an idea of estimated total costs (i.e. treatment cost, airfare, hotel, visa, food, travel and miscellaneous costs.)

Vaidam also has a patient relationship network team comprised of doctors to work on patient’s queries and help with personalized treatment plans, quotes and travel planning. The team also assists in live consultations.

Our concierge team ensures patients are cared for from the time they arrive at the airport to the time they fly back, post-surgery.

MTT: Is your focus direct to consumers or business-to-business? How are you operating?

Pankaj Chandna (PC): Vaidam receives inquiries from patients, directly.

We also work with insurance companies and government(s). Since our network is wide, we are able to procure very competitive quotes for patients.

A combination of an on-ground patient assistance team and a platform with information and self-help tools is a compelling option for B2B players to work with us.

Recently, we received our certification for ISO 9001 and 27001 - a standard for Service Quality and Information Security - so we are well equipped and certified.

MTT: Which procedures are most popular?

MC: Private sector healthcare facilities in India have experienced an incredible uptick in quality over the last 20 years. The doctors and facilities are now comparable to the best in the world.

As a result, we frequently take-on cases for orthopedic and joint replacement, cardiac surgeries, spine, neurology, cancer, transplants and general surgery.

We also see high number of inquiries for IVF and cosmetic treatments.

MTT: Are your services available throughout India? What regions does your model serve?

PC: We have formed a strong network of doctors and hospitals; MoUs with 70+ JCI and NABH accredited hospitals across the country.

We also have some boutique clinics with excellent doctors and infrastructure.

We began in the New Delhi region, so we have a strong presence there, however, we have expanded our services to other cities like Mumbai, Chennai, Bangalore and Ahmedabad.

MTT: How can employers incent or educate their workforces to consider the opportunity for medical travel?

MC: Get a world-class treatment at a fraction of the cost and a great opportunity to closely experience the people, culture and hospitality of another country.

However, it should be planned well. A company like ours can be a great asset to them.

MTT: Can you explain to our readers how your revenue model works?

PC: We have MoUs with the hospitals. We get revenue from the hospitals for marketing them through our platform and servicing their patients.

What fees are associated with this type of service?

Ninety percent of our patients do not pay us any fees.

In special cases, if a patient needs custom services like a second opinion, we charge, as we also pay the doctor. If a patient needs a full-time attendant in or outside the hospital, we charge a concierge fee. These fees are presented beforehand.

MTT: What if an employer or plan sponsor has a restrictive network and a doctor is out of network?

MC: Our network runs deep.

Usually the list of doctors/hospitals is discussed with the employer or sponsor in advance. If there is enough time we get to add the hospital or doctor in our network, which previously, has not been a challenge.

MTT: How do you assess quality from one doctor to another?

PC: We factor in multiple variables while creating a profile of the doctor.

Certain criterion like the doctor’s qualification, specialty, and years of experience and work history are included for review. We also take note of a doctor’s research papers and publications, go through his patients’ feedback, as well as any available media coverage.

We keep our ears and eyes open on who's-who in the industry.

We have a dedicated Medical News section on Vaidam where we curate news about hospitals and doctors for the benefit of our patients.

MTT: Do you know of any competitors? If so, what sets Vaidam apart from them? If not, please provide our readers with more about how you are paving the way.

MC: Competition is not our focus as the medical travel industry is global. We concentrate more on providing services to patients while maintaining the highest levels of service.

Vaidam aims to be the ‘go-to’ place for international medical travelers.

Our team is a mix of doctors, healthcare professionals, engineers, content creators, operatives and digital marketers, so we bring a different approach to the industry’s table.

MTT: How many patients have taken advantage of this platform to date?

PC: As of late, we have received around 9,000 inquiries on Vaidam.com.

Not all the enquiries are the same in respect to treatments or the requirements of patients, so it gets segregated into classified segments where we then provide assistance, accordingly.

Vaidam utilizes its own CRM and systems to manage patient cases and maintain a personalized relation with them.

MTT: What changes do you expect to see in the future of the medical tourism industry?

MC: While there are many things that one would expect to change, here at Vaidam, we would like to see the standardization of information.

We expect stakeholders and service providers to be more open in sharing data, for number of cases handled, success rates, price range of treatment, price of components, list of facilitators, etc.

Typically, this information is unavailable or fragmented. Patients are making critical healthcare decisions. The standardization of information creates a stronger sense of confidence and ease, leading to the eventual increase and growth of the medical travel industry.

Industry News

Four Technological Advancements That Could Change the Medical Tourism Landscape as We Know It

The next wave of medical tourism growth will be assisted by superior technological systems and services.

Author: Namrata Gada, Senior Manager, Business Research and Advisory, Aranca, a global research and advisory firm

Medical tourism is not a recent phenomenon. From the time of the Sumerians (circa 4000 BC), who constructed the earliest known health complexes that were built around hot springs, to the 18th and 19th centuries when Europeans and Americans travelled to remote areas with health retreats to find cures for tuberculosis, quality healthcare - wherever it could be found -- has been a common pursuit. Fast-forward to 1997, when the Asian economic crisis and the collapse of Asian currencies prompted government officials in these nations to market premiere destinations for international healthcare, at a fraction of what Western countries could offer. 

Traditional models that depended on cost arbitrage, reduced waiting times, a highly skilled and English-speaking healthcare workforce, and interventional government policies have helped emerging Asian nations, as well as certain South American countries, such as Brazil and Mexico, to attract healthcare tourists from the United States, Canada and Europe.

What will fuel the next wave of growth in medical travel? Technology-enabled healthcare practices.

The global medical tourism market is estimated to reach USD32.51 billion by 2019, clocking a CAGR of 17.9 percent from 2013 to 2019. Technological advancements that improve patient outcomes, reduce costs, and increase the availability of self-regulating social reference and review platforms will become dominant health tech themes globally.
Healthcare tourism destination countries, such as Thailand, China, Singapore, India, Brazil, the Philippines, and Malaysia, have already jumped on this bandwagon, investing heavily to merge technological advancements with healthcare services in order to increase their share of the global medical tourism market.

Technological Advancements That Could Revolutionize Medical Tourism

Electronic Heath Records (EHR)

Cloud storage enables doctors and solution providers to access medical records of patients in real-time, no matter where they are located. Patient clinical notes, diagnostic scans, medical administrator records, and discharge summaries can be accessed in flexible digital formats that are far more comprehensive and easy to read. Digitization of healthcare records has led to increased efficiency in understanding patient data, thereby enhancing patient service and safety.

Cloud-based EHR solutions have also helped to lower patient costs because case studies can be accessed and leveraged for similar medical problems. Additional benefits include identification of probable drug interactions, storage of diagnostic test results and after-care.

The adoption of a standardized EHR system is likely to lead to an increase in the capabilities of foreign medical facilities in developing countries to attract more medical tourists from developed/industrialized countries. In a medical tourism environment, a standardized, interoperable electronic medical record (EMR) can be utilized to manage patient care across hospital systems and across multiple countries.


Promoted by doctors and institutions to develop a doctor-patient relationship at the consultation level first, these technologies have drastically reduced treatment times, and given patients a plethora of options to choose from before they finalize on their medical travel destination.

India’s Apollo Hospitals, for instance, developed Apollo Telehealth Services (ATHS) to set up global telemedicine centers and telehealth camps, undertake remote patient monitoring, and conduct virtual rounds. The Indian hospital chain currently derives approximately 15 percent of its annual revenues from medical tourism.

In 2010, the National Health Security Office and Health System Management Institute, along with Prince of Songkla University (PSU), collaborated to develop a project for introducing telehealth in southern Thailand, with the expectation of revitalizing telemedicine in that country. The main goal of the program was to connect tertiary hospitals to other hospitals by video, including conferencing, tele-home care and web-based consultation and education.

To better serve a geographically dispersed population, the University of Mississippi’s Medical Center developed a 141-patient pilot telemedicine pilot program that used remote video visits. Patients in the program received tablets and connected devices to check vital signs. Physicians contacted the patient if vital signs fell below a certain level or patients failed to check in.

As a result of the program, medical adherence grew from 60 to 96 percent, and nine cases of diabetic retinopathy were detected that otherwise would have been missed. Programs such as this demonstrate how mobile technology is making healthcare delivery more efficient and effective.

Mhealth or Mobile Health

Around 52.4 percent of the global online population access the internet from their mobile devices, and more than half of the global population is estimated to go online using mobile devices by 2020. With the rise in social media sites and apps, digital technology is championing the cause of medical tourism. Mobile apps, such as Lybrate, HelpingDoc, and online portal Fairmed, allow patients to access doctors for a second opinion. Caremondo is the booking.com for medical travel.

Patients can choose, compare and book doctors, hospitals, and treatments across 22 countries while offering fringe benefits to access visa processing facilities, flight and hotel bookings, as well as translations.

Apps are also being developed to improve physician accuracy of disease diagnostics and recommendation of treatment. For instance, Isabel, a differential diagnosis tool, enables physicians to confirm the patient diagnosis by covering over 6,000 disease presentations and symptoms.

Medical Databanks

There’s a staggering amount of healthcare data being generated every day. Governments are looking at creating digital healthcare databases meant to help hospitals and other stakeholders access information on a real-time basis from a global repository. Doctors can even view the information of their smartphones through encrypted data on the cloud and advise patients on-the-go.

Governments across leading medical tourism markets have set up dedicated portals and apps to highlight services, list healthcare providers and facilitators, and assist in booking travel and lodging, among other things. Countries are participating in forums, such as World Medical Tourism & Global Health Congress and the Asia Medical Tourism Congress, with an increased focus on their advanced technological offerings. The recent Asia Medical Tourism Congress in India focused on telemedicine in the majority of its sessions: The Future of Telemedicine and Health, Using Medical Tourism Technology to Power your Healthcare Business, and so on.

An entire ecosystem is being developed to ensure that inbound tourism, coupled with superior technology, resonates with medical tourists. Government and hospital portals are highlighting the availability of travel options, cheaper insurance (if permitted by law) and treatment costs, tariff options, and preparatory aspects required before visiting the country to ease the journey of inbound medical patients. Thailand, Korea and Taiwan have developed individual apps to offer similar facilities to potential medical tourists.

Exhibit 2: Top Medical Tourism Hotspots

Adoption of Disruptive Technologies Will Decide Who Wins Patients in the Future

Rapid technological evolution will ensure that countries with sophisticated and highly competent technological infrastructure will gain the lion’s share of inbound medical tourists. Disruptive outcomes emerging from Internet of Things (IoT) -- the inter-networking of physical devices, vehicles, buildings, and other items -- 3D printing, and personalized apps will further enhance patient care and lure patients to countries that adopt them first.

IoT will provide an array of data to hospitals, including patient socio-eco-demographic and cultural background, health status and medical history. This could be leveraged by hospitals to identify potential patient groups based on personal and social habits, and for sending reminders for annual follow-up visits or check-ups. Diagnostic test results, such as recordings of ECGs, digital images of X-rays, MRIs and CAT scans, could be used to create implants or replacement parts through 3D printing.

The creation of personalized medicine using technology will be a potential game-changer, as well, because countries will highlight innovative treatment prescriptions customized for the individual. This could potentially lead to better "customer loyalty" among patients and increase revenues and market share.

Artificial intelligence (AI) systems could also enhance the adoption of EHRs. They can scan through data from digital records and help medical practitioners provide better patient outcomes, reduce treatment costs, and simplify the workflow management of patient data. Hospitals will adopt these rapidly in order to reduce the per-hour time spent by doctors, and bring synergies across multiple hospital departments. Likewise, 3D printing systems could leverage AI networks to gather real-time data of the affected body part and create 3D printed parts or medical images.

Medical destinations are eager to create the technologies or even buy them in order to enhance their medical service portfolio. Countries are eager to adopt technologies to drive medical tourism, but the protection of healthcare confidential information would be a complicated undertaking and will be the deciding factor. Countries have to overcome the various data protection hindrances like integration and intertwining of systems, data explosion and protection of confidential data without delaying and disrupting critical healthcare services.

Looking ahead, any country vying for a spot among the world’s best medical tourism destinations must begin now by investing considerable time and resources in technology that will help them achieve their goals.

About Namrata Gada
Namrata Gada is senior manager, Business Research and Advisory, Aranca, and manager of the Healthcare, Travel and Tourism and Financial Services sectors. She has assisted and overseen a number of projects across healthcare delivery, including medical tourism in emerging markets across the Asia-Pacific region and the Middle East, and a few developed markets in Europe. Namrata has been associated with Aranca for over seven years, and has expertise in market insights, business plans, feasibility studies and market entry strategy assessments. Previously, she was associated with Dow Jones Consulting India Private Ltd. and The Hindu Business Line. She earned an MBA in Finance from SP Jain School of Global Management, Singapore and a Bachelor’s in Mass Media (Journalism) from Mumbai University.

Industry News

Integral Healthcare
by Richard Krasner, MA, MHA, CEO & Principal Consultant, FutureComp Consulting - The Future of Workers' Comp, Founder/Content Writer, Transforming Worker's Comp Blog

Doubling down on contentious issues is not just confined to the realm of politics.

An article in Monday’s Journal of the American Medical Association (JAMA) states that single payer for the United States is politically infeasible, and concludes that to achieve universal coverage without single payer, enforcing the individual mandates and assessing real penalties for not purchasing insurance is the best option.

To bolster their argument, the authors, Regina E. Herzlinger, Barak D. Richman and Richard J. Boxer, point to three countries that have a private-sector insurance system. These countries are Switzerland, Singapore, and Germany.

After exploring two other options, creating risk pools for enrollees with preexisting conditions, and pooling costly patients into Medicare, the authors contend that the individual mandate, which the Supreme Court characterized as an annual tax, would be assessed against individuals who did not purchase health insurance within that calendar year.

The authors believe that while it is vilified by some, it is attractive for the following reasons: it is easy to implement, is effective in pooling risk, and reflects the values of individual responsibility (more on values later).

But the authors are mistaken. Many Americans will balk at paying for health insurance, with or without penalties, for individualistic, libertarian reasons. Also, those individuals who are unemployed and who have not filed tax returns for several years, at least under the ACA as it is now enacted, will not be able to get even a subsidy to pay for it. (My own situation that I contacted my Congressman about twice.)
Per the authors, Swiss citizens must purchase health insurance, if they do not, the government does it for them. And the insurers can implement debt enforcement proceedings against anyone failing to pay for insurance, collect a penalty and any back premiums.

Singapore has compulsory contributions from employers on behalf of their employees to create medical savings accounts, and it is up to the employee to maintain these accounts for expenses such as health and disability insurance premiums, hospitalization, surgery, rehabilitation, end-of-life care, and outpatient services. Failure to do so is subject to garnished wages and other legal actions. The unemployed, or poor are eligible for subsidies.

Lastly, German insurance is funded by compulsory contributions to private insurers levied as 7.3 percent of income. Those who are unemployed have it taken out of their benefits plus means-based sliding-scale subsidies, and uninsured, self-employed individuals who try to purchase insurance are faced with payment of back premiums for the uninsured period.

Some of the methods described above have been suggested here in the U.S., or are part of the ACA already, but is not sufficiently strong enough for the authors, or maybe part of the "repeal and replace" packages now stalled in Congress. Therefore, the authors have decided to double down on the one part that the GOP wants to eliminate and that many Americans find onerous -- paying a penalty for not having insurance.

But is this really the right way to go, as I mentioned in yesterday’s post, "Damned If You Do, Damned If You Don’t."

To answer that question, I would like to introduce you to Spiral Dynamics and the next generation economic system, MEMEnomics.

Spiral Dynamics is a biopsychosocial theory of human development based on the research of the late psychologist Clare W. Graves. Graves was a contemporary of Abraham Maslow, whose "hierarchy of needs" was the first psychology model of a hierarchical nature of human development.

Graves’ framework, called the "Levels of Human Existence," relates to Maslow’s needs, but Graves realized that Maslow’s model did not adequately express the dynamics of human nature, the process of emerging systems, or the open-endedness of the psychological development of a mature human being.

"Briefly, what I am proposing is that the psychology of the mature human being is an unfolding, emergent, oscillating spiraling process marked by progressive subordination of older, lower-order systems to newer, higher-order systems as an individual’s existential problems change. Each successive stage, wave, or level of existence is a state through which people pass on their way to other states of being. When the human is centralized in one state of existence, he or she has a psychology, which is particular to that stage. His or her feelings, motivations, ethics and values, biochemistry, degree of neurological activation, learning system, belief systems, conception of mental health, ideas as to what mental health is and how it should be treated, conception of and preference for management, education, economics, and political theory and practice are all appropriate to that state."

Graves proposed that all the forces shaping the marketplace, whether individuals, groups, or cultures, should be looked at from a more integral view that includes the biologic, psychologic, and sociologic aspects, and to examine them in an ever-evolving dynamic culture. He placed these dimensions into eight known hierarchical levels of existence called value systems.

Graves’ ideas would have remained confined to the academic world if it was not for his colleagues, Don Beck and Christopher Cowan, who patented Graves’ work into what they called Spiral Dynamics, taking the name from Graves’ explanation of human psychology. They even wrote a book by that title, which should be read first to gain full understanding of the theory.

When they began their work, they translated Graves’ levels (he used pairs of letters starting from "A" to "H" and from "N" to "U" to represent the life conditions and ways in which humans solved their existential problems) to colors (Beige, Purple, Red, Blue, Orange, Green, Yellow, and Turquoise). This was a way to better memorize the vMEMEs, borrowing the term, meme, from Richard Dawkins, or value systems.

The following table shows the vMEMEs and the percentages found in the population, plus the percentage of power they have in human society. It is important to note that the American population can be found in the last three levels. It is the Blue/Orange vMEMEs that control much of the political, social, and economic agenda of the U.S., and explains why Green’s values have had a hard time getting accepted, which is why the U.S. is unable to make the leap to the next tier.

Dawkins described memes as "a unit of cultural information that is capable of self-replication and uses the human mind as a host." For Beck and Cowan, vMEMEs, or value-systems memes begin to shape how individuals, organizations, and cultures think. Along the way, Beck partnered with philosopher Ken Wilber, whose Integral approach was adapted to Spiral Dynamics into Spiral Dynamics Integral.

The following chart illustrates the AQAL model of Spiral Dynamics Integral.

There are two alternating types: individualistic and expressive, and group-oriented and sacrificial. Both types alternate, and with the passage of time, existential problems arise within each value system that can no longer be solved at the current level. The pressure and energy created by the value system’s inability to solve its problems leads to the emergence of the next level, spiraling upwards and alternating between the types.

So, for example, Capitalism is an individualistic vMEME system, whereas Socialism is a collective vMEME system.

Which brings us to discussing MEMEnomics. MEMEnomics is a composite of the words "meme" as we have been discussing, and economics. The book titled MEMEnomics, by Said W. Dawlabani, is sub-titled, "The Next-Generation Economic System."

I have read it once, and in the process of re-reading it for better understanding, it explains clearly through Spiral Dynamics why the financial difficulties of the last decade occurred, and guides us to a better, integrated, and holistic future. Dawlabani says that the difficulties the U.S. is facing today (published in 2013) are a result of the evolution from one system to another.

But most importantly, Dawlabani examines the history of the American economy from colonial times to the present day through a memenomic framework, that corresponds to the levels of human existence found in Graves’ work.

These two charts illustrate MEMEnomics and Spiral Dynamics better.

Already, there are changes occurring in the economy that signal that there is an evolution. The emergence of the sharing economy found in companies like Uber, Lyft and Airbnb, are just some of the examples of this emergence. The green economy, as in environmentally friendly, is an example of the healthy side of the Green vMEME, and even exhibits some aspects of Yellow Sustainability.

So where does healthcare fit in all this?

Healthcare as it is provided for in the U.S., is mostly through employers, government programs aimed at specific demographic groups such as the poor, elderly, and children, and through private insurance sold by insurance companies.

The reason for the passage of the ACA was to eliminate some of the disadvantages in employer and private health insurance plans, and to ensure coverage for all by making people purchase coverage. But that has angered many, and is the main reason for the repeal and replace rhetoric in Washington.
The authors of the JAMA article, like many before them, are doubling down on a method of providing coverage that is trapped within the Orange vMEME system. Yet, as Spiral Dynamics and MEMEnomics have shown, there must be an evolution in the way we think about many aspects of human life, healthcare and its provision included.

We must build the healthcare system of the future now, not the healthcare system of the past. Spiral Dynamics and MEMEnomics points us to a future where all aspects of human civilization is integrated and holistic, and healthcare is a part of that integration.

Any doubling down on the value systems of the past as human development spirals upward is unhealthy and must be avoided. If we continue to require the purchase of a commodity such as health insurance (Orange vMEME - value system) when human development has transcended and included Orange and moved on past Green into Yellow or Turquoise, it would be like Americans living today living like their ancestors did back in Roman times.

I don’t think that is possible, nor is it desirable. And neither is the solution the authors have recommended. We must integrate all our current healthcare systems into one integrated system, including Workers’ Comp, not because it will save money (which it will), but because human development is headed in that direction.

Not to do so is harmful to the spiral and to human development.


Industry News

Singapore losing medical tourists? Reasons to ponder
by Dr. Prem

Drprem.com- That medical tourism is mainly driven by the cost factor has once again been proved with Singapore, one of the top medical tourism destinations in Asia seeing a steady decline in this sector. Once famous for selling specialists services in complex treatments, Singapore no longer appeals to medical travelers.  Though the cost of medical care and support in Singapore is higher than in India or Thailand, it is still about 50 percent cheaper than in the U.S. Even the cost is lesser than in well-known Latin American destinations.


As per the stats provided by the Singapore Tourism Board, receipts from medical tourism raised to S$777 million from 2009 peaking at S$1.1 billion in 2012. It dropped 25% to S$832 million in 2013 showing a slight growth to S$994 million in 2014. There was no data released by the board in 2015. This silence speaks a lot.

A few years back, prime medical centers of this top Asian destination used to remain crowded by medical tourists from China, India, Russia and Middle East countries. Gradually, patients from less developed countries like Indonesia, Malaysia, Thailand, Cambodia and Mongolia started dropping their anchors to this Republican shore painting a rosy picture in Singapore's medical tourism market. Many celebrities favored Singapore owing to the superb medical infrastructure and facilities where they can maintain their privacy and relax.

The gradual development of Asian markets:

In the past few years, the global medical tourism sector saw the fast emergence of other Asian nations as hot medical tourism destinations attracting western tourists with a more competitive price package. Not only this, their medical care infrastructure got revamped with Thailand, Malaysia and India getting more JCI-accredited hospitals, considered as the gold standard.

This added more credibility to their service and support. Malaysia has been posting encouraging numbers making its presence felt in this sector. Vietnam, Philippines, Myanmar, Indonesia and Bangladesh are also increasing their market share with attractive value added services.

Minimizing the quality difference in medical treatment:
Engaging highly talented specialists and staff in healthcare service by the emerging Asian destinations has been another big reason for Singapore's decline in medical tourism. Singapore may have the best talents but minor quality difference is not affecting the preference of tourists who are unhesitatingly choosing the low cost medical services in the emerging destinations. Here they are getting the best value for money including great vacationing options.

Combining medical and wellness tourism:

Vacationing forms an integral part of medical tourism and the neighboring countries of Singapore are pushing wellness and medical vacation in unique packages surrounding complete mind and body wellness. These destinations with year-round sun and exotic destinations offer the perfect ambience that aids in quick recovery of the patient. Singapore lagged somewhere in this aspect.

More expensive/less attractive factor ruling Singapore:

Appreciation of the Singapore dollar is another obstacle in Singapore's medical tourism growth curve. It has made everything very expensive for the outsiders. Transportation, accommodation, eating and even shopping have become more expensive. Adding the medical cost, it goes beyond the budget. This is forcing travelers to look for cost effective options which other Asian countries are readily offering.

Lack of transparency in medical costs:

While cost factor dominates medical tourism, lack of transparency in treatment costs is bound to have a negative effect.  This has been observed mainly in private clinics that take pride in providing state-of-the-art facilities.  There is no fixed fee guideline for the medical practitioners. Hidden costs that surface during the discharge of patients are shocking enough.

Bundle packages are offered but that often does not include room or ward charges and fees for other medical support. If there is a need for additional stay due to some complications, the cost will know no bounds. Many patients end up paying a high amount of additional charges beyond their anticipation.
As a result, foreign tourists are no longer feeling confident to avail treatments in such clinics in spite of their reputation. The credibility of such clinics eroded which is damaging enough for the sustenance of medical tourism market.

Inability to adjust the cost factor as per the market demand:

The same demand-supply rule played a great role in the decline. Singapore's private healthcare sector runs on the free-market model. To make Singapore more attractive for medical tourist, many medical practitioners invested in real estate, creating a huge medical infrastructure with state-of-the-art facilities and hiring the best professionals.

As Singapore grew steadily in medical tourism a few years back, the entire operating cost shot up and foreign visitors also happily paid for that. But when the costs reached beyond the affordable limit, medical tourists started looking at other options. Now with the downturn, these medical service centers are unable to lower the treatment costs as their operating cost is still very high.

Lack of initiative promotional campaigns:

 While the tourism ministries of the neighboring Asian countries like India, Thailand, Malaysia and Indonesia are playing active roles in promoting their medical tourism potential, the Singapore government is not taking enough initiative to regain its popularity. Creating new marketing strategies is the order of the day, but Singapore is not taking steps to reverse the declining curve.

To view the original article, click here.

Industry News

Los Algodones Enjoys Medical Tourism Boom Despite U.S. Mexico Tension
by Stephanie Sanchez

Kawc.org- Business is booming on the border despite increasing tension between the U.S. and Mexico over a wall and immigration policy.

One small Mexican town has become known as "Molar city" because of dental tourism.

Americans and others visit the over 350 dentists there for low prices and fast service. Most of these dentists rely on "street hustlers" to recruit new patients.

KAWC’s Stephanie Sanchez went to Molar city to find out how this unusual job works.

Doctor Angel Camarena set up his practice in Los Algodones, Mexico two years ago.

His shop is located inside a newly constructed plaza  - away from street view.

"The truth is I’m still young here in Algodones," Camarena said in Spanish. "It’s been two good years. Tourists here are great people. They’re always seeking best prices for the best work."   
Like many dentists here, Camarena uses a "jalador," local Spanish slang for "a person who pulls people in."

Jaladores greet people as soon as they cross the border into Mexico.

Forty-year old Alan Pacheco is a jalador in Los Algodones. He is not a medical professional but he wears gray scrubs.  

"I like to do that because I like to look more legit," Pacheco said. "They actually believe it more than if I’m just wearing some Levi’s."

Pacheco is one of about 80 jaladores in Los Algodones. They get paid a finder’s fee to connect patients with dentists. Speaking English helps.

Pacheco learned as a young undocumented immigrant in the U.S.

"After I turned 14, I got out of hand, I was justa troublemaker," Pacheco said. "And I got deported, which was the best thing for them to do...to deport me. Right now I have a better life."

Pacheco was a street vendor for a while.  Then one day, 17 years ago, he helped a tourist find a dentist. 
Pacheco said the key to his job is to be friendly, and helpful.

"You got to talk to them like you know them...so they feel comfortable," Pacheco said. "I say break the ice, you got to do that. Otherwise you can’t be a jalador."

Pacheco said Los Algodones has changed a lot over the years, much of it in response to dental tourism.
But the town hasn’t kept up with its infrastructure.

"The streets don’t have a name on them. They don’t have signs, you see," he said. "So they get lost quick, that’s when I come in."

That’s how Pacheco first met 78-year old George Bater from Montana. He and his wife Karen have been coming to Los Algodones for years. They met Pacheco on one of their trips. 

Pacheco works for several dentists in town and he said he steers his clients to the good ones.
"That’s the first thing I search for is the quality of work," he said.

But not all jaladores are like Pacheco. A former Mexican tourism official says some jaladores can be too aggressive. Pacheco says that’s not how he works.

"I consider myself a jalador but not by pulling people ," he said. "I just ask them where they are going and what they need and take them the right way."

Pacheco won’t say how much he makes but he says he has built a good life.

"I make good money. I got three kids and I got my own house. My own car and I pay my kids school and everything."

A brand new medical plaza recently opened in Los Algodones.

The company that owns it hopes to build on the dental tourism model by offering expanded medical services.

A Baja California Tourism official said the push to make Los Algodones an international medical tourism destination won’t stall because of President Donald Trump’s push for an expanded border wall.

One local dentist said businesses could see a boost if the U.S. repeals and replaces the Affordable Care Act.

Medical tourism in Los Algodones, Baja California, Mexico is booming despite tension between the U.S. and Mexico.

A dentist's office is hidden inside a plaza with curious vendors and a taco stand.

Alan Pacheco is among 80 "jaladores" who recruit new patients for dentists in Los Algodones, Baja California, Mexico.

Many new dentists in Los Algodones, Baja California, Mexico, hire "jaladores" to recruit new patients and establish a client base.

Medical tourists from all over the country and the world seek low prices on dental work in Los Algodones, Baja California Mexico.

There are over 350 dentists to choose from in Los Algodones, Mexico. Dental offices can be found anywhere you go while visiting the town.

There are hundreds of billboards advertising dental offices in Los Algodones.

To view the original article, click here.

Industry News

Bill aims to protect medical staffs when teams cross state lines
by Dr. David Geier Special to The Post and Courier

postandcourier.com- The U.S. House of Representatives recently took a major step to ensuring athletes have access to the best medical care when traveling to compete.

The Sports Medicine Licensure Clarity Act (H.R. 302) aims to protect medical professionals who work in sports medicine - doctors, athletic trainers and physical therapists - and travel with high school, college and professional teams.

Introduced by Brett Guthrie of Kentucky and Cedric Richmond of Louisiana, the bill specifies that medical services provided by physicians, athletic trainers and other sports medicine professionals to an athlete while in another state would be felt to satisfy licensure requirements of that secondary state.

Numerous sports medicine organizations have pushed for this legislation, including the National Athletic Trainers’ Association, the American Medical Society for Sports Medicine and the American Academy of Orthopaedic Surgeons.

Currently physicians obtain a medical license to practice in a particular state. Medical liability insurance covers them to treat patients in that state. Most of the time, this arrangement is sufficient to allow that physician to perform his or her job. The challenge comes for medical professionals who work with teams that travel to other states to play games or compete in tournaments.

The process of obtaining a state license to practice can take weeks or even months. If an orthopedic surgeon or athletic trainer knew the team would play frequently in a neighboring state, he or she could apply for a full license in that state. But at the college and pro levels, teams often play in 10 states or more in a season. Plus, in the playoffs a team might find out where it is playing only a few days in advance.

Medical professionals can’t complete licensure applications and requirements that fast.

It’s more than just convenience, though. Doctors and athletic trainers need to know their medical insurance will cover them when working in another state. They shouldn’t be forced to choose between treating one of their injured athletes and risking malpractice issues or staying home and not traveling with the team.

The bill is important for athletes as well. If passed into law, athletes will be treated by doctors and athletic trainers who know them and know their medical and injury history. If their team doctors and athletic trainers can’t evaluate and treat them, then their care would fall to the medical staff of the home team or doctors of local emergency departments or urgent care facilities.

The bill now heads to the Senate. If passed, it will go to the president to be signed into law. This bill was passed by the House in 2016, but Congress adjourned before the Senate approved it.

This legislation might be even more important for athletic trainers than team physicians. I’ve explained several times in this column just how important athletic trainers are for teams and their players. They provide a myriad of services to the athletes, spending countless hours with their teams over the course of the season.

March is National Athletic Training Month. The slogan for this year’s campaign is "Your Protection is Our Priority." Like team physicians, athletic trainers play a crucial role in protecting the health and safety of their athletes. Hopefully this legislation will soon better protect them while they do their jobs.

David Geier is an orthopaedic surgeon in Charleston. For more information on sports medicine topics, go to DrDavidGeier.com.

To view the original article, click here.

Industry News

Group travel to Ethiopia from Sheffield to help improve health services

thestar.co.uk- Health workers who have supported Ethiopia hospitals for over 17 years have visited the country.

Six members of Sheffield Health Action Resource for Ethiopia, (SHARE), recently visited St. Pauls Hospital in Addis Ababa and Ayder Referral Hospital in Mekelle.

The group helped with infection prevention and patient safety work, the improvement of laboratory facilities and a biomedical engineering project.

They also delivered dental equipment, helped refurbish the children’s playroom in Ayder Hospital, and visited an orphanage to deliver more than 300 second-hand school uniforms donated by children from Sheffield.

SHARE is an international health link between Sheffield Teaching Hospitals NHS Foundation Trust, (STH), and hospitals in the Tigray region of Ethiopia.

Bio-medical engineers have visited every year since 2008 to assist with developing services and infrastructure, and have established a nursing library with donated text books, as well as shipping over IT systems, beds and medical equipment.

The chair of SHARE, Cariad Evans, a consultant virologist at STH, first visited Ethipoia ten years ago.

She said: "It was great to visit again and see how the vision has come to life. It is a very valuable experience for people on both sides, and you do find that when people return, their perspective has changed dramatically.

"You develop leadership skills and learn how to cope in unfamiliar conditions." For more information about SHARE please contact Cariad by emailing her at cariad.evans@sth.nhs.uk.

To view the original article, click here.

Industry News

Accommodating variations on the theme of Health Tourism...making room for all

by Constantine Constantinides, M.D., Ph.D.

The Amman Declaration

...Configuration of Health Tourism in terms of the 8 Segments (ht8)

At the Global Healthcare Travel Council General Assembly Meeting (Amman - Jordan, 27 February 2017), it was unanimously agreed that the Global Healthcare Travel Council (GHTC) would adopt, support and promote the 8 Segment approach to Health Tourism Sector configuration (a.k.a. ht8).
This came to be known as the Amman Declaration.

The 8 Health Tourism Segments are:

  • Medical
  • Dental
  • Spa
  • Wellness
  • Culinary
  • Sports
  • Accessible
  • Assisted Residential 

Aiming to serve the best interests of all stakeholder groups

...through the introduction of Permissionless Innovations

Arriving at the ht8 approach to configuring the Health Tourism Sector was not something dreamed up the night before and introduced the morning after.

It was the result of a painfully long process of considering and reconsidering, listening to and contemplating criticism - and considerable self-criticism and doubt.

The objective was to ensure arriving at a configuration system that served the best interests of all stakeholder groups.

And it was an example of what is known as Permissionless Innovation (read more on this below).

Suggestions and Demands

...of Supporters and Detractors

On a number of occasions - along the way - I have been confronted by supporters and detractors who have suggested or demanded:

  • More Segments
  • Fewer Segments
  • Renaming of some Segments
  • Scrapping the whole idea 

I listened to and carefully considered each "informed opinion" as patiently as I could.
My intention has always been to respond with measured and well-considered counter-arguments - although, on occasion - out of exasperation -- my responses may have come across as defensively aggressive.

Allaying Fears

...and accommodating well-informed beliefs and well-meaning vested interests

No doubt, several feared that ht8 was undermining their beliefs of what really constituted "Health Tourism" - or that it threatened their vested interests.

To allay the fears of both groups, it needs to be pointed out that ht8 was designed in a way which could easily accommodate "well-informed beliefs" and "well-meaning vested interests".

In simpler and clearer terms, practically any and every (rational) variation on the theme of Health Tourism (or what one claimed to be part of Health Tourism) could be accommodated by one or more of the 8 Segments.

Permissionless Innovation

...with due attribution to Adam Thierer

As already pointed out, ht8 is an example of Permissionless Innovation.

And due attribution needs to be given to Adam Thierer (a senior research fellow with the Technology Policy Program at the Mercatus Center at George Mason University) for giving a name to the type of innovations healthCare cybernetics has been introducing to the Health Tourism Sector (including ht8).
Permissionless Innovations are those which do not seek the prior blessing of public officials - or other "institutional players" -- before they are developed and deployed.

In his book "Permissionless Innovation: The Continuing Case for Comprehensive Technological Freedom" Adam Thierer argues that if permissionless innovation is stifled, the result will be fewer services, lower-quality goods, higher prices, diminished economic growth, and a decline in the overall standard of living.

Adam Thierer concludes: permissionless innovation has fueled the success of the Internet and much of the modern tech economy in recent years, and it is set to power the next great industrial revolution-if we let it.

The multiple benefits and advantages of ht8

...what is there not to like about it?


  • accommodates practically all well-informed beliefs and well-meaning vested interests
  • allows all tourism destinations to also become health tourism destinations
  • expands the industry so that it can address a broader market - meaning more business for all
  • makes every tourist / traveler a potential health tourist
  • makes health tourism an attractive choice - in fact, a lifestyle choice for all (and all ages)

So, what is there not to like about it?

Industry News

CMS postpones expansion, implementation of bundled payment programs
by Emily Mongan

mcknights.com- The Centers for Medicare & Medicaid Services is pushing back the implementation date for its recent rule creating a bundled payment program for cardiac care, as well as changes to the Comprehensive Care for Joint Replacement program. Further delays also are being considered.

The cardiac care models, announced late last year, would create bundles for patients who receive cardiac rehabilitation, suffer heart attacks or undergo heart surgery. The models were slated to begin demonstrations on July 1, 2017, and run through 2021. A fourth bundle was also finalized, focusing on patients who undergo non-replacement surgery following a hip fracture.

To view the original article in its entirety, click here.


Industry News

Global Medical Tourism Market By Treatment Type and by Region - Industry Analysis, Size, Share, Growth Trends and Forecasts (2016 - 2021)

The global medical tourism market has been estimated to be valued at USD 14,278 million, and it is anticipated to reach a market value of USD 21,380 million by the end of 2021 at a projected CAGR of 8.41% during the forecast period, 2016 to 2021.

Medical tourism involves travelling to another country for obtaining medical treatment. It is a high-growth industry driven by globalization and rising healthcare costs in the developed countries. A study shows that in United States, about 750,000 residents travel abroad for healthcare each year. A range of governments across the globe has taken up various initiatives to stimulate and improve the medical tourism in the respective countries in order to improve patient care and help expand the market. Many countries could see potential for significant economic development in the emergent field of medical tourism. Cosmetic surgery, dental care, elective surgery, fertility treatments, cardiovascular surgery and genetic disorder treatments are the most preferred healthcare treatments in this sector.

High cost of medical treatment in the developed countries and availability of those treatments at a lower cost in other countries have fueled the development of medical tourism. In addition, the availability of the latest medical technologies and a growing compliance on international quality standards drive this market. The use of English as the main working language solves the problem of communication and patient satisfaction, adding to the growth of this market. Enhanced patient care, health insurance portability, advertising and marketing help the medical tourism industry to grow at a fast rate. On the other hand, infection outbreaks during or after travel, issues in following up with the patients before returning to their own country, and medical record transfer issues are the factors restraining the growth of the tourism industry. However, the unavailability of certain treatments at a lower cost hampers this market more than any other factors.

The global market for the medical tourism industry is segmented based on treatment type (cosmetic treatment, dental treatment, cardiovascular treatment, orthopedics treatment, bariatric surgery, fertility treatment, eye surgery and general treatment) and geographical regions. Cosmetic treatments hold the largest market share, as cosmetic surgeries are not covered by insurance.

Based on geography, the market is segmented into North America, Europe and Asia-Pacific. APAC holds the largest market share, followed by Europe. Thailand and Malaysia are strong markets with prospect for significant growth, followed by Korea.

The key players in the global medical tourism market are Bangkok Hospital Medical Center, Asian Heart Institute, Apollo Hospitals Enterprise Ltd., Bumrungrad International Hospital, Fortis Healthcare Ltd., Min-Sheng General Hospital, Raffles Medical Group, Prince Court Medical Center, KPJ Healthcare Berhad, and Samitivej Sukhumvit.

For more information please click on:

Industry News

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Upcoming Events

Medical Fair India 2017

April 6-8, 2017 - Pragati Maidan, New Delhi
To learn more or to register click here.

Healthcare Travel Expo and International Medical Forum

April 25-27, 2017 - Exhibition Center Kyiv Expo Plaza, Kiev City, Ukraine
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Indonesia Health, Medical Treatment and Tourism Expo

May 11-14th, 2017 - Jakarta Convention Center - Indonesia
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MediWorld - China International Medical Travel Show

May 12-14, 2017 - Portman Ritz-Carlton, Jing'an district, Shangha, China
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China International Medical Tourism Fair 2017

May 19-21, 2017 - Shanghai, China
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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

Croatia Among Most Promising Health Tourism Destinations in Europe
total-croatia-news.com- The award for one of the most promising health tourism destinations in Europe was presented to Croatia during the HTI conference in Rovinj.

Five Ways to be a Savvy Medical Tourist and Enjoy a Vacation
NYTimes.com- When costly medical or dental work is unavoidable, consider traveling overseas and utilizing the savings from lower-cost care for a luxurious vacation.

American-made biosimilars a differentiator in U.S. market, Coherus
in-pharmatechnologist.com- U.S. patients and physicians favour domestically-made biosimilars according to Coherus Biosciences. But if quality is assured should the manufacturing location matter?

U.S. infant mortality rates down 15 percent
CNN.com- Infant mortality rates have reached new lows, according to a report released by the U.S. Centers for Disease Control and Prevention on Tuesday.

Care Coordination in U.S. Lags Other Developed Nations

medscape.com -- U.S. patients are more likely to experience gaps in coordination among healthcare providers than their counterparts in other high-income nations, a new study suggests.

Deadly fungal infection that doctors have been fearing now reported in U.S.
washingtonpost.com- Nearly three dozen people in the United States have been diagnosed with a deadly and highly drug-resistant fungal infection since federal health officials first warned U.S. clinicians last June to be on the lookout for the emerging pathogen that has been spreading around the world.


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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.