by Jack Schafer Part Two will appear in MTT Volume 8, Issue 14, set for publication on June 3, 2015 In the early 1990’s, I sold my engineering firm and became a wholesale worldwide group tour operator because that was my passion.  More than 20 years later, I became involved in a different type of tourism when I partnered with a retired physician, and became a patient facilitator in a new industry called medical tourism. Nearly every American commodity item since the 1990’s had been outsourced to some degree, and opening our borders to fair international trade was in many ways immediately painful – but, during the past decades, it has become equally beneficial, and as the world became a smaller place, it was unavoidable. Most American soft goods manufacturing has had to evolve to accommodate inexpensive labor, and major industries that are owned, such as our automobile, agriculture and heavy equipment, have forced us to re-think and compete on a global scale… and we’ve done that! Now in the past dozen years, America has become a worldwide competitor in most manufacturing industries. One of our largest of all-commodity items in this country is healthcare. But rather than allowing it to open to world trade, over the past decade our government has decided to limit it, regulate it, control it, socialize it, and finally standardize and subsidize insurance that medically limits all Americans equally. Growing in the background since the early 2000’s, the medical tourism space has become one of the best-kept secrets in healthcare today. Yes, millions of people travel outside of their home country, spending billions of dollars per year, to find affordable and superior healthcare. Not only are individuals spending their own money to explore this option, but in recent years, self-insured companies and even insurance companies are exploring the “overseas option.” This once unknown industry is becoming a viable option, and in doing so, it is becoming not only a popular medical option for many, but it’s becoming a valuable new market for the travel professionals. The travel and tourism industry is one of the world’s largest, with a global economic contribution (direct, indirect and induced) of almost seven trillion U.S. dollars annually (2013 study by The World Travel and Tourism council). As a wholesale tour operator in that industry for over 30 years, I can confirm those numbers are probably conservative, yet the product distribution channel that had been the ultimate outlet to the passenger, especially on the leisure travel and tourism side, has succumbed to direct purchase savings offered directly by the providers on the internet. Consumers don’t need an agency to sell them an airline ticket, or help them select a cruise. These are simple enough tasks in the travel and tourism industry for the customer to do themselves. And that is where medical tourism is different. Certainly, some savvy and experienced world travelers are comfortable connecting directly with a medical provider and making their own arrangements, but the majority of medical tourism travelers want advice, support and encouragement. For something serious, they want a local agency that they can visit with and share with their families and friends. They like a distributor that is anchored down on a street corner in their hometown, has been there for years, and will be there when they return. Unfortunately, there has never been a clear and formal process to deliver the medical tourism product to the potential tourism client or patient. In fact, it’s still a matter of prospective if they are a travel client having a medical procedures while visiting a foreign country, or a medical patient that has to travel to another country to receive their procedure.  Having been 20 years in the travel and tourism industry — and now 10 years in medical tourism — I still see the process from both sides. This presentation is my effort to integrate the process to the collective benefit of both industries and ultimately the client/patient. The medical tourism industry is not as simplistic as a patient specifically traveling for a procedure, or having a procedure performed in the middle of their trip. Through the years, it has evolved into categories of process, and each requires a different professional and expertise. The traditional medical tourism patient is a first time or an inexperienced traveler, requiring a professional assisting them in organizing their international travel requirements. These travelers require special assistance with visas, passports, packing lists, ticketing, ground travel to and from the airport, as well as a great deal of advice and encouragement. These are just some of the roles of an “outbound travel professional,” which also include coordinating the client’s needs with a travel professional in the host country, the “inbound travel professional.”  Just some of these responsibilities range from the initial meet and greet at the airport upon arrival, assistance through customs, passport and visa, luggage assistance, ground transportation, hotel accommodations (possibly having services available for special needs, diets, etc.). Most medical travelers arrive in the host country with a companion, whose needs and wants would certainly be different, as they are not scheduled for the medical procedures, but how much do they want to participate? The medical portion of this trip is followed by a recovery period, and those considerations must be factored in. A typical patient might be two to three days in the hospital, and three to four days in the recovery process – either in a special facility or back at the hotel selected to accommodate those needs. The typical time in the host country, both pre- and post-procedures could be up to two weeks. Ground transportation is a big thing, as is providing communications (a cell phone and ensuring there are internet connections available), and there could be dozens of additional revenue/commissionable opportunities. Now, I’m sure I’ve missed many of the travel professional opportunities and responsibilities, but I have purposefully missed everything related to the coordination of the medical process and procedures itself — and for very good reason. Medical tourism is an industry of professionals, as is the medical community. The anesthesiologist is not a surgeon. He/she is aware of the medical process, and performs in coordination with the surgeon as part of the surgical team, but not the surgeon.  The travel professional involved in the medical tourism process is part of the medical tourism team, but not responsible for any of the medical process, procedures, records or even suggestions. They are positioned on the travel and tourism side, yet there is an opportunity for them to promote and market the medical process, with no more involvement than they have piloting the plane when they sell a ticket. Working with medical providers and facilitators is where the travel agent has the opportunity to earn a “finder’s fee,” simply by taking the client that contacted them, and putting that client in direct contact with the professionals on the “medical side “of the process. It is also where the travel professional becomes the most valuable member of the team -they are directly in contact with the client, and can reach out and touch the medical traveler.