Part One of our interview with Zachary Rozga was featured in Issue 22 of Medical Travel Today and can be accessed via this link.  

Medical Travel Today (MTT):  What are some of the other key issues that you are reviewing? ZR:  Right now, we doing some general investigation:  What is going on out there in Medical/Health tourism?  What can we ascertain from a preliminary investigation talking with the industry?  Finally, where can the IDB eventually partner with someone to actually leverage the experience and strength in a project? The IDB is a fairly important political entity within the Latin American Caribbean Region, and we are well positioned to help. With our previous experience within the sustainable tourism industry, the IDB was one of the first entities to work on the Global Sustainable Tourism Council, GSTC, which has now been taken over by the UN Foundation. Since then, it’s been a moving entity, and it has really shaped what we know of as the sustainable tourism industry. Again, I think this is kind of what we’re looking at with the medical tourism industry today.  It is just this wide-open expanse, and everybody involved has their own belief of what it is and what it can become. So, if you’re on the supply side or if you’re on the demand side, you feel like you have the only right answer and everybody else is wrong. Those sentiments are creating benchmarks, and we are saying, “I think this is someplace where we can play a role in this evolving industry.” We can leverage past experience working with the GSTC in the early days to shape something sustainable and inclusive for medical travel. But I also want to point out that we want to make sure we partner with the right people who are active this industry.  We are really one small cog in the wheel. MTT:  The lure of the Caribbean Islands, Central and South America to Americans is so attractive for medical travelers — places that are familiar, destinations they know and have seen advertised, and countries where their friends and relatives have traveled. For the American medical traveler, sustainable tourism and medical tourism go hand-in-hand. ZR:  I agree, however, I think we have to break through some of the rhetoric from the supply side, whether or not the country is really trying to use medical travel as a national strategy. In effect, what we have seen on the ground in some cases is what they are really doing is taking away good doctors from the local people.  It’s essentially pulling away resources from rural areas and the best doctors are now basically servicing international clients. That’s one negative example that we’ve seen.  Another one, on the very extreme side, is this whole issue about “farming of retinas” in Colombia. These are some of the negative things we want to address through some sort of project.  Whether that’s creating an accreditation body or some type of criteria for responsible medical travel remains to be seen.  That’s an idea for a project. MTT:  From the supply side and from all of these destinations, this is something that is needed — because until it happens, this whole initiative will not really materialize or reach its optimal growth.  Is there a way to balance what you’re talking about with the positive aspects of medical tourism?  ZR:  Yes, I think so. If you are looking at the situation from a 50,000-foot perspective, there are so many stakeholders involved both on the supply and demand side. You have non-tourism people, health people and then you have tourism people trying to capture patients as clients — and then you have the public sector. And then you have consumers who often don’t even consider themselves tourists — they consider themselves patients. Here is another sort of left-field example in this area of what is a medical tourist:  Because I live in Seattle, I know half a dozen relatives who drive up to Canada every three months or so to go buy meds. Now, are they medical tourists?  I would have to say yes. I mean they are going up there specifically to buy drugs, but they are also driving three hours.  Often, they’ll stay somewhere along the way even if it is just to eat a meal — so that’s another part that needs to be understood. Here’s another personal example that I think illustrates your question about the market potential:  I lived in South Africa for over three years, and the amount of Brits that came down there for something as routine as dental care was incredible.  They would come down there for two weeks, get their teeth fixed, relax on the beach and still pay less than they would in the UK for dental services. MTT: And the Americans are going to Costa Rica for the same thing.  ZR:  I know.  So, we know there is something big going on here. From a purely IDB project perspective another important thing for us to find in this pre-project stage is to identify the organization that can take on and manage a project of this magnitude. As I mentioned earlier the MIF is a technical assistance partner and also a source of counterpart funds. This is the reason we have begun talking to GKEN.org and its leaders, but we also believe that in order for this thing to truly gain traction, it’s going to need some other partners — and we are going to need some money (matching funds). At this stage, as I indicated, we are very much in a scouting and investigative stage.  I wasn’t even sure that I would take this interview with you!  But I said okay.  I was thinking less of it from an interview perspective, but more from an investigative side. Someone I think we really would like to talk to is the Gates Foundation.  That is really their primary motive — to improve healthcare on a global level.  That is also why I think we have to look at this both from people travelling to receive care and from those traveling to provide care.  Our project will have to not focus strictly on patient travel, which I make a rough back-of-envelope estimate at 50 percent of medical travel market, but I might be wrong. At this stage, this is where we are really trying to understand the landscape.  Again, one of the characteristics of an IDB-funded project is that we need to have an executing agency. An executing agency has to fit into a certain set of parameters.  They have to have the operational capacity to be able to deliver an IDB project.  Part of the reason I was discussing this with GKEN was to see if it could be an executing agency. We are also looking to just continue talking to other people, as I don’t foresee us starting a project this year.  I see the rest of the year as continuing discussions with people like you who are passionate about this new industry and want to see something change — and who also can see themselves benefiting from this by being a leading-edge person and really pulling together a great team. MTT:  What will be your personal involvement? ZR:  From my own personal perspective, and why I am so interested in this, is because I think I’m one of the few people investigating this burgeoning industry that actually has a background and training in tourism. So far, every other person I’ve come across during our preliminary investigation who is involved in medical travel has a background in health.  That’s why I guess I am really very intrigued by this project.  I’d like to think I have something to lend to this that’s a little bit of a different perspective, and I fully intend to stay attached wherever I can to the unfolding process. And speaking from the institutional perspective of the IDB, they want to know how we can use medical tourism as a catalytic process to improve SME’s.  In this case, we’re talking about clinics, but also I think it is important to improve access to health services for the local population through medical travel. MTT:  I think you can. ZR:  That is why they would get involved in this project. The thing that is very interesting for me is that, although the IDB does all of this development work in sustainable tourism, the MIF does not yet have a health agenda.  My guess is that the reason they have not addressed the issues of health is because they have been focused on microfinance, agricultural development and those types of things. But I think the unique opportunity we have right now on the tourism side is this:  If we can introduce health to its full extent, it has the potential to get on to a broader radar within the MIF. MTT:  Think of it this way:  When an American patient chooses to go to Mexico for bariatric surgery, and spends $11,000 or more on the medical care – plus the tourism and recovery services — wouldn’t that expenditure go a long way in supporting the primary care of the local population? ZR:  Right — and even better if the facility is in an underserviced area both from a healthcare and tourism perspective.  I think that’s where we are looking at taking a project. This is on the right side of the ledger, but I have seen some instances where the local population is specifically cut off from high quality medical care geared for the medical tourist. One example is some high-class clinics in Cape Town, South Africa. I think the same thing happens in Brazil. MTT:  What is your timeframe for initiating this project? ZR:  I need to talk to my partners at the IDB to provide an exact answer. After speaking with you, and I have to say I’ve been very pleased that we had this conversation, I’d like to think that we could spend a little more time formally putting the pieces together and hopefully bump this agenda up the priority queue. In any event, I hope that we can start a project in early to mid-2012.       About Zachary Rozga Zachary Rozga is an international sustainable development expert, with a focus on sustainable tourism and small business development, working for the Inter-American Development Bank Multi-lateral Investment Fund. Zachary has been working in tourism for over 10 years and in sustainable development for over five years. Zachary received his Bachelor’s in Business from the University of Colorado at Boulder, majoring in Finance and International Business in 2001, and he received his Master’s  in Sustainable Development and Tourism from the George Washington University in Washington, D.C., in 2005. [email protected] 360-593-4444   About the Multilateral Investment Fund (MIF) Funded by 39 donors, the Multilateral Investment Fund/MIF supports private sector-led development benefitting the poor — their businesses, their farms, and their households. The aim is to give low-income populations the tools to boost their incomes, as well as to provide  access to: markets and the skills to compete in those markets;  finance; and basic services, including green technology. A core MIF mission is to act as a development laboratory – experimenting, pioneering, and taking risks in order to build and support successful micro and SME business models. To make effective use of MIF projects, the MIF is committed to:

1. rigorous results measurement and impact evaluation, and
2. active knowledge-sharing so that the most promising solutions are widely known and can be taken to scale.

The MIF finances about 100 projects per year, with a total finance volume of about US$100 million. MIF project benefits reached over 600,000 individuals and businesses in 2010. The MIF works through technical assistance grants, lending and equity investments, as well as through combinations of these tools when both capacity-building and risk-sharing finance are needed for success. It is the largest international technical assistance provider to the private sector in Latin America and the Caribbean, and always works with local, mostly private partners to help fund and execute projects – civil society organizations, industry associations, foundations, universities, cooperatives, companies and financial institutions. Every dollar approved by the MIF leveraged more than US$2 from partners in 2010.