FROM THE EDITOR:
Medical Travel Today Editor Jeff Schult,
author of Beauty from Afar

There is a tremendous amount of information available about medical tourism today -- more than any one person can keep up with. What makes it even more difficult for providers and patients alike is that there is also an incredible amount of misinformation and rumor. Everyone -- business leaders, hospital executives, doctors and nurses and, of course, patients -- struggle to find good, relevant information and to figure out what it means for them.
We’re proud to present the first issue of Medical Travel Today. This week, we feature Part 1 of a conversation with David Boucher, who is leading Blue Cross/Blue Shield of South Carolina’s cutting-edge ventures into global health services for Americans.

We bring to you Stephanie Sulger, CEO of Medical Tours International, who shares with us her perspectives on the World Health Organization’s initial look at safety issues for medical travelers; and attorney and doctor Joseph McMenamin, a partner at the law firm of McGuireWoods in Richmond, Va., giving his overview of the legal issues involved in the industry.

Also, Laura Carabello, the publisher of Medical Travel Today, reviews "Who Killed Healthcare?", a new book by Harvard Business School Prof. Regina Herzlinger that provides ample ammunition for the ongoing policy debate in the U.S. about medical tourism. In our next issue, Dr. Michael Horowitz, M.D., MBA, examines the economics of outsourcing medical care in the first of a three-part series.

As you would expect, we also provide you with links to all the most recent medical travel news and events from around the world.

Medical Travel Today is intended as the must-read newsletter for the medical travel industry, a one-source stop that will keep any reader with an interest in international healthcare patients, trends and travel up to speed on the latest developments in medical tourism.

However, we also expect to evolve as a forum for the industry, within the industry. We encourage letters to the editor and will consider submitted articles for publication. Please address letters or queries to me at editor@medicaltraveltoday.com. We expect to become something that the medical tourism industry has so far lacked – an independent, non-partisan voice, forum and journal for those who are part of this new wave-next wave of healthcare.

See you out and about, around the globe. And feel free to write me anytime to let us know how we’re doing.

Jeff Schult, Editor
Mr. Schult can be reached at editor@medicaltraveltoday.com.

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SPOTLIGHT: BlueCross BlueShield of South Carolina has Companion for Overseas.

Editor’s Note: David Boucher is the assistant vice president for health care services at BlueCross BlueShield of South Carolina. In this capacity, he is administratively responsible for Companion Global Healthcare, commercial EDI transactions and provider e-commerce, provider education, the inquiry response center, complementary and alternative health programs and medical management services. In the past few years, Boucher has been quoted in more than 200 national health care publications, as well as on NBC Nightly News. Medical Travel Today caught up with Boucher in late July for a lengthy telephone chat. We’re publishing the edited transcript in two parts.

By Jeff Schult
Editor, Medical Travel Today
Copyright©2007

Hi David. Welcome to Medical Travel Today, and thanks for talking with us and our readers. We’ve been following the news about Companion Global Healthcare (a new subsidiary of BlueCross BlueShield of South Carolina) ever since you announced your medical tourism initiative in February. In a way, we’ve been waiting for you. For a while, it has seemed like just a matter of time before larger corporate healthcare entities in the U.S. became involved in medical tourism. You’re sort of “first in,” and moving fast. I wonder if you could give me a sense of some of the history and process that led BlueCross BlueShield of South Carolina to this point. Where did you begin?

I guess on a couple of fronts … By way of background I’m an ex-hospital CEO. I’ve worked with Quorum Health Resources and Quorum Health Group hospitals for about 15 years. So I’ve been on the provider side for a fairly significant amount of time and I was the CEO of hospitals in both North and South Carolina …

Currently and for the last several years with BlueCross of South Carolina, I directed our medical management programs for utilization management, disease management, complex care management … also provider satisfaction and Web technology on the provider side for commercial business. One of the other areas I also direct are our complementary and alternative medicine programs, where we’ve been the leader amongst the Blues in the whole area of value added programs …

We pre-negotiated discount programs with organizations like Belltone, TLC Vision, American Cosmetic Surgery Networks, companies like that, because we know that increasing numbers of our members and Americans in general are going outside of their standard benefit plans for various things that are health and wellness related.

So we’ve been fairly aggressive about that. Our members can show their ID card and they receive fairly significant discounts from our partners, and also have access to both discounts and various pre-priced procedures. So that’s one of the areas I manage.

Fast forward -- I’d been picking up in the popular media about this whole trend of medical tourism from the news … in Business Week, on 60 Minutes, etc. So I reached out to a couple of colleagues who dabble in international healthcare and I said, “Look, my wife and I are thinking about traveling to someplace exotic to check out this emerging trend ... so we asked around and, independently, two or three of them said: ’If you are going to make a trip, go to the medical tourism leader in the world, Bumrungrad International. That’s where you really want to go.’

I was thinking about the Philippines or South America or really any place, it was just that we decided we were going to do something different. So I reached out and struck up first an e-mail and then a phone conversation with Mack Banner, the CEO of Bumrungrad. Mack and I both worked for Quorum at the same time. He was at a Quorum facility in California at the same time I was a CEO at a facility in North Carolina. So we talked and he said, “Come on over, we’d like to show you around.”

So last June 30 (2006) we got on a plane and flew to Bangkok. Neither of us had been to Southeast Asia … and what I ended up doing there, basically, was a fairly intense, yet unofficial, hospital survey. Not the identical way the Joint Commission does … though I had participated in a number of JCAHO surveys here in the U.S. But I was pretty rigorous.

So we stayed at Bumrungrad Suites – the hospital-owned hotel -- about 50 yards from the facility. We were greeted at the airport 10:30-11:00 at night by the same concierge folks that greet other Bumrungrad medical tourists … I had asked Mack really not to do anything differently than they would when they greeted medical tourists. So we stayed at the Suites and walked back and forth to the hospital and spent a good part of our time from Friday morning through the following Tuesday evening with the hospital staff.

That was pretty much my “vacation.” I gowned up and went into the operating rooms, recovery rooms, central linen, central sterile supply, dietary, you name it and I was there. I spent a full day with Dr. Peter Morley, the medical director; The Bumrungrad staff was very forthcoming with quality and patient satisfaction information.

I was thoroughly impressed; I had never seen a hospital like that. And when you combine the quality with the hospitality level that they can afford to provide, and that the Thais enjoy proffering … well, my wife and I were just blown away with the whole experience.

When we had just boarded our departure flight at the Charlotte Airport, I remember telling my wife: “I think that this may be a life-changing experience. I have no idea what that means, but, I just think that we’re really going to learn and do some really interesting things.” And, as we were boarding our return flight in Bangkok, my wife said, without me even prompting her: “If myself or anybody in my family needs an operation and we can withstand a 25-hour flight, we’re coming to Bumrungrad.”

That was it for me; the marketing was done. My wife said that without the understanding that women make a majority of the healthcare decisions for their family. If she could make that call, so would a lot of other women, for their families. We’re true blue Americans -- my son is a Marine in Iraq right now, and so it was not about trashing U.S. healthcare or anything like that.

We live here in South Carolina. We did not know really what to expect over there, Jeff. We were just incredibly surprised by what we found.

It sounds like we’ve had some similar experiences. When I went overseas for dental work I was a little nervous and concerned and I came back as an evangelist for it in some ways. I didn’t write my book as a proselytizer -- I tried to write it objectively -- but I certainly had a life-changing experience.

That was the experience we had, absolutely. When I returned from Bangkok I had the opportunity to talk to some of the senior staff at BlueCross BlueShield of South Carolina

… We tend to seek out Blue Ocean instead of fighting out in the marketplace, fighting over the same fixed customer base. We’re always looking to see how we can expand the base -- how we can make markets. So that was how we started to look at the whole globalization of healthcare -- we began to enumerate benefits that really offered the opportunity to create a market.

So -- fast forward to the beginning of this year -- we are, as all Blue plans are, an independent licensee of the Blue Cross Association and we are prevented from contracting with out-of-state hospitals … and obviously, Bangkok and Singapore and other places are out of state. So we formed a company, Companion Global Healthcare Inc., as a subsidiary for what we are doing in this area … and we’ll give it several years and see where it goes. We own and operate Companion Life Insurance Co. and we have had, for over twenty years, the Companion Property and Casualty Co. The Companion name is at the top of our building.

So you’ve got some branding on that already.

You bet. We’ve owned several “Companion” companies over the years, so we have a little bit of leverage there. So what we’ve done now is we’ve partnered with World Access. (World Access, a member of the global Mondial Assistance Group, is a leading provider of travel insurance, international healthcare, and assistance products.)

World Access provides travel agency services, case management services for those patients interested in traveling abroad, and they will coordinate with the provider care community to get the member there as quickly as reasonably possible and make sure they can get good care. They have a contracted network of air ambulances at their fingertips as well.

That, we felt, offered several advantages -- World Access is a known entity amongst the commercial insurance and business world. We really felt like they would do a great job, being part of one of the biggest companies in the world. They have their own travel agency. We could have partnered locally but these folks … well, for example, if they have a patient who is seeking to travel to have a knee replaced, who can’t afford a business or first class ticket to Thailand, what they will try to do is work with the member and say “If you can delay your trip by one day, we can get you bulkhead seating on all legs of your flight” … they would naturally think in those terms, in terms of working with the customer as a patient.

I was curious about the relationship with Companion Global and how you were doing this because I talked to a lot of the people who have gotten into this as a business. And it is apparent that these companies have to start creating some value and start figuring out how to scale what they do, because when the Blues get into this they’re not going to be doing it for 100 people a year. They’re going to scale it up and perhaps blow the little companies out of the water.

Of course, that’s critical, being able to scale … our parent company manages call centers and large claims operations. These are some of our core competencies.

But we really felt like in the early offing we would subcontract out to people (World Access) who really knew what they were doing in International travel markets and not try to replicate it.

In our next issue, David Boucher talks about the marketing approach that Companion Global brings to medical tourism … and says: “ That’s where medical travel is going --small steps are getting our organization to where we’re envisioning we would be between now and the January 1 benefit cycle.” (top of page)

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PERSPECTIVES:
Health hazards of travel: WHO weighs in

By Stephanie Sulger RN, MS, CIPC
(First of Two Parts)
Copyright©2007

With the introduction of much larger, lighter planes flights of 15 hours or more will become commonplace. More patients will be traveling by air on these long haul flights to destinations offering medical care and surgeries.

Each of us has a role in reducing the risks associated with Deep Vein Thrombosis (DVT). Using what we already know about prevention, medical travel and tourist companies need to educate themselves and their clients about reducing the risks of venous blood clot formation.

World Health Organization: Health Hazards of Travel

The World Health Organization (WHO) has published its Phase 1 on the health hazards of travel. The purpose of the first phase, called the WRIGHT Project, was to confirm that the risk of venous thromboembolism (VTE - blood clots in the veins) is increased by air travel, to assess the size of the risk, and to evaluate the impact of other factors.

Key findings of the project include:

•  The risk of VTE roughly doubles with flights greater than 4 hrs and increases with longer flights or repeated flights within a short period of time.

•  Overall, the risk of VTE is about 1 in 6,000 healthy individuals, but is primarily concentrated in those with hypercoagulable conditions, those using birth control pills, and/or those with other risk factors such as obesity, extremes of height (less than 5'2" or greater than 6'2"), older age, and cardiovascular disease. Note that a hypercoagulable condition is a biochemical abnormality that increases clotting risk.

•  The VTE risk is greatest immediately following the flight, but persists for several weeks afterwards.

•  The risk also exists for other forms of travel, but travel-related immobility may carry a greater risk than non-travel immobility such as sitting in a movie marathon..

The link between venous blood clot formation and air travel is not new. The diagnosis was first put forward by Homan in1954 when he reported a case of a doctor who developed deep vein thrombosis after a long haul flight.  Homan, also a physician, went on to postulate that any activity that involved immobility for a long length of time would predispose to the development of deep vein thrombosis (DVT).

According to The Mayo Clinic anyone can develop blood clots (VT) and subsequent pulmonary embolism (PE) — together known as venous thromboembolism (VTE) and the following factors, including prolonged sitting or lengthy bed rest, increases your risk:

Certain surgical procedures. Especially likely to cause blood clots are hip or knee replacements, some obstetric or gynecological procedures and extensive abdominal operations.

Some medical conditions. Certain cancers, especially pancreatic, ovarian and lung cancers can increase levels of substances that help blood clot, and chemotherapy further increases the risk. Menopausal women with a history of breast cancer who are taking tamoxifen or raloxifene also are at risk. High blood pressure and cardiovascular disease make clot formation more likely, as does having an inflammatory bowel disease such as ulcerative colitis or Crohn's disease.

Being overweight. Researchers aren't certain why weighing more than normal increases the risk of blood clots, but one theory links the formation of clots to leptin, a hormone produced by fat cells in the body. People who are overweight have more leptin-producing cells than slender people do, and so may be more prone to develop clots.

Pacemakers or venous catheters. Having a pacemaker or catheter — a soft, flexible tube — in a central vein makes the formation of clots more likely.

Pregnancy and childbirth. Pulmonary embolism is the most frequent cause of death associated with childbirth. Some women who have pregnancy-related venous thromboembolism also have an inherited clotting disorder.

Birth control pills. Estrogen in birth control pills can increase clotting factors in your blood, especially if you smoke or are overweight. On the other hand, the risk of clots from birth control pills is small compared with the risks associated with pregnancy.

Family history. Having a personal or family history of venous thromboembolism increases the risk of blood clots. More than half the cases of VTE are the result of an inherited clotting disorder.

Smoking. For reasons that aren't well understood, tobacco use predisposes some people to blood clot formation, especially when combined with other risk factors.

Editor’s Note: Stephanie Sulger RN, MS, CIPC, is CEO of HYPERLINK Medical Tours International in Cold Spring, N.Y. In Part 2 of this article, in the next issue of Medical Travel Today, Sulger talks about what medical travelers and providers can do to reduce the risk of DVT.
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Medical Tourism Association Launches as Definitive Voice of the Industry

West Palm Beach, FL – Sept. 4 – Some of the nation’s recognized leaders in the burgeoning industry of medical tourism, the practice of traveling abroad for treatment, today announced the creation of the first US-based international Medical Tourism Association (MTA), a not-for-profit organization comprised of top international hospitals and clinics, leading medical tourism companies, employers and benefits payers, as well as key influencers worldwide. MTA’s mission is to promote positive and stable growth of medical tourism internationally, to set credentialing standards for hospitals and medical tourism companies, and to increase the awareness and utilization of overseas hospitals for Americans. Visit www.medicaltravelauthority.com.

“Hundreds of thousands of Americans are now traveling out of the country for care that spans elective medical and dental procedures to life-saving cardiac surgery, stem cell transplantation, in-vitro fertilization and dozens of routine or specialized interventions,” says Jonathan Edelheit, inaugural president of MTA and vice president of OptiMed Health/United Group Programs, Inc. “With heightened interest and increased public confidence in the quality of care delivered abroad, US insurance carriers, employers and other benefits claims payers are now offering a medical tourism option.”

MTA endeavors to protect the reputation of reputable hospitals, providers and other stakeholders worldwide who maintain appropriate levels of quality healthcare and comply with standards. The organization will also create an internal network to facilitate the flow of information between hospital members regarding fraudulent practices or other important issues impacting medical tourism.

“We are establishing a comprehensive, credible resource for American citizens to access information on medical tourism, identify hospitals and providers, and learn about their outcomes,” explains Edelheit. “As a preeminent voice for the industry, the MTA is also positioned to address inquiries from government agencies, legislators, employers and insurers.”

MTA is developing minimum US-based credentialing standards for participating hospital members. Based upon these criteria, Americans will be able to make informed choices regarding the most appropriate venues for their individual medical needs.

To further enhance connectivity and communications between international hospitals and US-based insurers and claims payers, MTA is also promoting a single gateway for electronic data interchange (EDI), healthcare transactions and claims.

‘We encourage all stakeholders in medical tourism, affiliated industries and related technologies to join the MTA in its mission to serve the American public,” adds Edelheit, noting that the organization will publish a magazine and produce a television documentary. “Together, we can generate awareness of the quality and economic value of going abroad for quality healthcare and build credibility for foreign hospitals. As a unified, combined voice, we expect this industry to flourish and meet the needs of citizens who want to take advantage of services outside the U.S. borders.”

The MTA Advisory Board includes:

• John F. P. Bridges, PhD., assistant professor, Johns Hopkins Bloomberg School of Public Health
• Jonathan Edelheit, vice president, OptiMed Health/United Group Programs, Inc.
• Brad Cook, benefits director, Hospital Biblica Clinica, Costa Rica
• Laura Carabello, principal, CPR Communications, publisher of Medical Travel Today newsletter
• Robert K. Krone, MD, president & CEO, Harvard Medical International, Boston
• Mary Ann Keough, professor, Eastern Washington University, Washington
• Dale C. Van Demark, Esq.; Kevin Ryan, Esq., Epstein Becker & Green, PC, Washington DC law firm specializing in medical tourism
• Thomas Johnsrud, senior consultant, North America, Parkway Hospital, Singapore
• Renee-Marie Stephano, Esq.
• Ruben Toral, marketing director, Bumrungrad Hospital

“Several factors have led to the recent increase in the popularity of medical travel and the need for a medical tourism organization,” concludes Edelheit. “The high cost of health care along with a growing number of uninsured Americans, the ease and affordability of international travel, and improvements in technology and standards of care in many countries of the world have all contributed to this surge. Increasingly, Americans are traveling abroad for essential health care services such as cancer treatment, orthopedic surgery, or brain and transplant surgery, with elective services such as cosmetic surgery and dental care still commanding significant interest.”

To learn more about membership in the MTA, visit www.medicaltravelauthority.com or email info@medicaltravelauthority.com.
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ISSUES AND ANSWERS:
Medical Tourism and legal liability

Editor’s Note: Among the more intriguing and challenging questions associated with Medical Tourism are those having to do with liability. What rights do patients have? What liability do providers or medical tourism companies have, particularly in regard to the court system in the United States? Medical Travel Today asked Joseph McMenamin, a partner at the law firm of McGuireWoods in Richmond, Va. to give an overview of the legal issues involved in the industry.

McMenamin was a university-trained internist and a practicing emergency physician before being admitted to the bar. He holds medical (1978) and law (1985) degrees from the University of Pennsylvania, and served a straight medicine residency (1978-1981) at Emory University and Grady Memorial Hospital in Atlanta before joining McGuireWoods in 1985. His practice areas include: Pharmaceuticals and Medical Products; Health Care; Toxic Torts; E-Commerce; and Insurance.

By Joseph McMenamin
Copyright©2007

Reportedly, 150,000 Americans per year are seeking treatment abroad, a number said to be increasing at a rate of 15-20 percent per year.  Those without insurance, or those seeking procedures that may not be covered, such as cosmetic surgery, are among those most likely to find the concept appealing.  In some instances employers are providing insurance through carriers willing to cover these costs.

 The reason is clear:  Medical tourism could provide a means to lower health care expenditures.  For a host of reasons, care in foreign countries is usually much cheaper than it is in the United States.  We have the latest and most expensive technology here; for some conditions, state-of-the art devices and procedures may not be necessary.  In countries where physicians are generally employees, especially of a collectivized system, salaries are typically lower than compensation for physicians here. 

 The complex, elaborate administrative mechanism we have erected in the U.S., a creature of our mixed public/private approach, is unique to our country.  Layers of administrative personnel, reams of paperwork (or its electronic equivalent), and associated costs are not needed elsewhere.  The costs of defensive medicine, which add billions to health care expenditures in the U.S., become unnecessary where physicians have no reason to see each patient as a potential adversary. 

 These differences are enough to make care abroad significantly cheaper than it is here, even when travel costs are factored in – indeed, sometimes even when care is provided in a luxury setting.  Given the burden U.S. employers shoulder in bearing the cost of health care, it is scarcely surprising that at least some companies are willing to send employees abroad for some procedures.

 We must recognize, however, that cheaper care that is also inferior care may be penny-wise and pound-foolish.  If avoidable complications arise after a procedure, all the savings derived from doing it elsewhere may prove illusory.  More important, lives may be needlessly lost or serious harms inflicted unnecessarily. 

 By no means is this observation an indictment of foreign health care.  There are excellent hospitals abroad, often staffed with highly capable, well-trained personnel.  On the other hand, some American facilities could stand a bit of improvement.

 But the risk is real.  It is no accident that people of means travel from all over the world to be seen at the Mayo Clinic.  Nor is it mere avarice that explains why foreign doctors flock to our shores for training and, often, the opportunity to practice. American medicine, while expensive, is world-class. Hence, the decision to seek care abroad should not be made lightly.

 The legal issues attendant to medical tourism are challenging. That which comes first to mind is professional liability. Under existing law, however, such exposure is largely limited to participating foreign providers.  American matchmaking companies, which help U.S. patients find and travel to foreign hospitals and clinics, are generally not health care providers themselves, and so by definition are incapable of medical malpractice. 

 An imaginative patient might be willing to assert that a foreign provider is the agent, actual or ostensible, of an American matchmaking company, but this theory would probably founder because doctors must and do exercise independent medical judgment and are not under the control of the matchmaker.  To address any concerns on this score, the matchmaker could easily develop a disclaimer and have its client sign a document negating an agency relationship. 

 There could be exceptions to this general rule.  If a company tried to ascertain whether a particular patient was healthy enough to make the trip, it might be accused of providing a form of diagnostic service and hence accepting some liability exposure.  If a middleman claims it can help an American patient “find the right provider,” or were it to actively promote specific foreign centers, it might be exposed to consumer fraud claims.  Most such companies, however, avoid offering such services.  As a result, they probably do not face much risk of professional liability exposure under existing law.

 It is unlikely that a patient claiming injury from treatment abroad will be able to hail the foreign doctor or hospital into an American court.  Plaintiffs’ counsel will of course labor long and hard to achieve this very result.  But unless the foreign hospital has explicitly courted U.S. business, as by advertising here, for example, most U.S. courts would probably find they lack jurisdiction to entertain such a claim.  Even advertising in the U.S. would not necessarily lead a court to conclude it has jurisdiction to entertain a claim.  Compensation, if available at all, will thus probably be available only in foreign jurisdiction and will be stingy by US standards.

 Hence, Americans seeking care abroad should probably assume that, in event of a maloccurrence, the likelihood they would realize a large, U.S.-style recovery is probably remote.

Mr. McMenamin can be reached at can be reached at jmcmenamin@mcguirewoods.com

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BOOK REVIEW:
U.S. healthcare indicted, hospitals abroad lauded

Who Killed Healthcare? By Regina Herzlinger, DBA. 240 pages. McGraw-Hill, June 1, 2007.

 Regina E. Herzlinger, DBA, is Nancy R. McPherson Professor of Business Administration at the Harvard University Graduate School of Business Administration, Boston, where she was the first woman to gain tenure.

By Laura Carabello
Copyright©2007

No holds barred – Regina Herzlinger masterfully strips away any notion that those responsible for the death of our healthcare system will be exonerated.

She weaves a thoroughly entertaining and informative account of the culprits, leaving consumers to wonder why they have not already taken charge of the crime scene.

In her condemnation of the U.S. general hospitals, Dr. Herzlinger rightfully points to their bloated costs and propensity for making deadly mistakes.  There is no conjecture, just the facts.

Short of offering an outright directive to abandon these institutions in favor of foreign-run hospitals, she carefully substantiates to American consumers the value of traveling out of the country for medical care.  Her support for medical tourism is evident, with a clear-cut cost comparison between U.S. hospitals and those in India or Thailand where the prices are as low as 10 percent of those in America.

Herzlinger heaps praise on foreign healthcare settings for their ability to deliver value, the result, she says, of innovative organizational structures, not simply lower wages.

She takes this support a step further, articulating the fact that institutions outside of our borders, “…provide better value at a much lower cost, even after allowing transportation.”  Herzlinger’s perspectives are drawn from on-site visits to hospitals abroad, not merely hearsay – another piece of credible evidence to support consumer confidence in foreign locales.

Kudos to the Professor for touting the managerial innovations that enhance productivity in foreign hospitals; for complimenting their transparent price policies that provide consumers with up-front information on the cost of care; and for citing their willingness to even publish results.

An eye-opener for readers may be Herzlinger’s recitation regarding one Indian hospital which claims, for example, that its mortality rate from open-heart surgery is one 0.2 percent more than the U.S.-based Cleveland Clinic, while it performs three times the number of open-heart procedures.

Proponents of medical tourism will applaud her characterization of global health services as lower cost and high quality.  Herzlinger’s high regard for the benefits of globalized services is obvious:  these services, she says, enable developing countries to minimize the massive capital investments that healthcare facilities require; reduce the waiting times and the capacity pressures in single-payer countries; and are typically cheaper than similar services in developed countries.

In Thailand, she reiterates, costs are one tenth of those in the United States.

For stakeholders in the growing medical tourism industry, Herzlinger’s book is a must read.  By describing the frailties and failures that persist here, she lays out a marketing blueprint for foreign destinations.

Those who find her blunt criticisms too hard to swallow – namely, “our big greedy hospitals and their overpaid politically manipulative executives,” Herzlinger’s commentary will hopefully be the catalyst for change. 

In the interim, she says that these guilty parties, “may soon find themselves with big empty waiting rooms and depleted bank accounts.”

Amen, Professor Herzlinger.  Case closed.

Laura Carabello is a principal of CPR Communications, the publisher of Medical Travel Today. She can be reached at: lcarabello@cpronline.com (Top of Page)

Editor's Note: This newsletter is for informational purposes only and should not be construed as medical advice.

NEWS IN REVIEW:

Interview with Maggi Ann Grace, author of State of the Heart
World Healthcare Blog, David Williams
In 2004 Howard Staab found out he would need surgery to repair a failing heart valve. Unfortunately for Howard he was uninsured. Unable to afford the $200,000 cost for the surgery in North Carolina, but too well off for Medicaid, Howard didn’t know what to do …

More Americans seeking foreign health care
Houston Chronicle, United States 
A recent study by the University of Texas Medical Center in El Paso estimated that more than 20 million US-Mexico border crossings are made for health care ...

Hospitals adapting to foreign needs
The Star Online, Malaysia
In 2005, Malaysia drew 230,000 foreigners into the country for health/medical tourism, generating a revenue of about RM151mil. The number grew to 297,000 in 2006 …(Editor’s Note: See also related stories, list at: The Star Online archives.)

Passport to Cheaper Health Care?
Good Housekeeping, October issue
You can have surgery for less than half the price, but only in countries where you wouldn't drink the water. Is "medical tourism" a brilliant solution — or a too-risky business?

Ah, Cuba: sun, cigars and hip replacements
Macleans.ca, Canada
Daren Jorgenson, founder and "chief idea officer" of Choice Medical Services, has sent some 200 Canadians and Americans on medical tourism excursions to the island for services including drug rehabilitation, hip replacement, eye surgery and breast ...

Adventures in Medical Travel
Kiplinger.com, Washington, D.C.
Americans head overseas for five-star care at Motel 6 prices.
Returning from vacation with a tummy tuck and a tan isn't unusual anymore. But a flat stomach and a face untouched by time aren't the only physical improvements people are seeking abroad. A growing number of patients head overseas for more-serious procedures, such as hip replacements, heart bypasses and kidney transplants.

Tour operators key in medical tourism
INQ7.net By Cris Evert Lato Cebu City, Philippines - The role of tour operators is crucial in making the medical tourism industry in Cebu known worldwide, a tourism expert said Monday.

Tourism players need to link with health sector - expert
Sun.Star, Philippines
In promoting Cebu as the health and wellness capital of the Philippines, tourism stakeholders are encouraged to diversify its tour packages...

Medical tourism’s no longer a pep pill
Economic Times, Bangalore, India
Medical tourism in India may not be as booming as the industry makes it out to be. And even as hospitals try to woo patients from the developed countries, many still prefer to go for yoga and ayurveda, which is more a part of leisure and not ...
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