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CONTENTS
All Content Copyright ©2007 From the Editor: This week in Medical Travel Today, by Jeff Schult, editor and author of Beauty from Afar... PRESS RELEASES Medical Tourism and Healthbase Help Canadian Bid Goodbye to her Chronic Back Pain Michigan's First Medical Tourism Company Offers Global Health Care Options |
THIS WEEK IN MEDICAL TRAVEL TODAY (Vol. 1, Issue 2): In the wake of the extremely well-received first issue of Medical Travel Today, I got a call from a fellow in the public relations business asking me what sort of submissions we're looking for. The answer I gave him, I'm sure, is a variation of one he has heard countless times before. We want to know everything, but we're very choosy about what we print. I want our newsletter to be full of, well ... actual news, and by that, I mean I want it packed with information, articles and informed opinions on medical travel about which I was previously unaware. By all means, I said, send us your press releases. But be aware that we're rather choosy. From a journalistic point of view, Medical Tourism is a story with global sweep and scale; telling it in a newsletter, in biweekly installments, requires some editorial discretion. And In addition, we of course include Part Two of our conversation with David Boucher of Blue Cross/Blue Shield of South Carolina and Companion Global Healthcare, and the challenges the companies face in offering medical travel options; and Part Two of Medical Tours International CEO Stephanie Sulger giving perspectives on the World Health Organization's initial look at safety issues for medical travelers. We also provide links to the most top medical travel news and events from around the world. As a reminder, we encourage letters to the editor and will consider submitted articles for publication. We got quite a lot of feedback on Issue 1 and almost all of it was congratulatory, the sort of stuff we'd show our moms but don't really need to publish. 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. Jeff Schult, Editor SPOTLIGHT: South Korea and Emerging Medical Travel Nations -- A Snapshot By Josef Woodman Last week, I had the singular opportunity to visit several of South Korea’s international hospitals, (along with 30 or so other participants from Japan, China and the U.S.), as part of a familiarization tour sponsored by government health and tourism interests there. The four days were grueling, and took us to five cities and a South Korea has targeted Japan, China and North America as its target markets. In July of this year, the Korea Health Industry Institute (KHIDI) established the Council for Korea Medicine Overseas Promotion (CKMP), which carries 27 participating centers, including Severance Hospital, a 2000-bed treatment, research and educational facility -- the world’s largest JCI-accredited hospital. The bad news is that while South Korea boasts excellent healthcare infrastructure country-wide, as well as a roaring economy, medical travel challenges loom large, particularly language and culture barriers. Most physicians and administrators do not have a command of English (or Chinese or Japanese for that matter), signage isn’t multilingual, and neither are most of the hospitals’ Web sites, to name a few impediments. The good news is that South Korea isn’t trying to re-invent the medical travel wheel, and appears to be moving fast to catch up. During the course of the weeklong event, other established health travel destinations were openly discussed, most frequently Singapore. No surprises here. By any quality assurance measure I can imagine, Singapore is the gold standard of medical travel. 35 hospitals (14 JCI-accredited, the most of any country in Asia) serve more than 400,000 international patients annually. Centralized government oversight allows for collaboration among otherwise competitive hospitals and networks. Research and education are well integrated into the treatment infrastructure. Likewise, hospitality and tourism agencies work with health ministries to ensure a seamless travel experience. Partnerships have been forged with established US and European hospitals, such as Johns Hopkins and Harvard Medical International. English is universally spoken. Thus, much can be learned from Singapore and, refreshingly, the country wants to see other countries in the region succeed. A rising tide carries all boats, and Singapore has a unique rationale for wanting to attract medical travelers that fits well with a region strong in healthcare infrastructure. The South Koreans are smart to emulate this benchmark. Durin While most of the international hospitals we queried provided excellent medical care (and could back it up with accreditation, physicians credentials, number of surgeries performed, success rates, etc.), we found wide discrepancies on the hospitality side. In some of the world’s most renowned international hospitals — including dozens which had spent good time and money establishing International Patient Centers, gaining JCI accreditation and the like -- our phone calls and email inquires went unanswered, our repeated requests for specific treatment information were neglected, and language barriers loomed large, despite promotional assurances otherwise. When reflecting upon the tide of new and hopeful entrants into the medical travel arena (e.g. Korea, Panama, Philippines, Taiwan, Vietnam), fellow participants and I debated the minimum criteria required for an up-and-coming nation to successfully participate in the contemporary medical travel arena. We came up with the following:
To successfully implement a medical travel program, a hospital, clinic, or hospital network must have:
--Managed by a consumer-driven, service-savvy, pr-savvy executive, not some retiring surgeon the hospital wants to put out to pasture. --The ability to respond promptly and adequately to patient inquiries or inquiries from health travel planners and travel agencies. --Excellent working relationship with all appropriate departments within the hospital --Partnerships with hotels, resorts, spas and in-country travel facilitators; tour and excursion information for companions or visiting family members. --An efficient system of gathering, processing and transposing medical records from foreign patients --A program for managing patient recuperation and recovery. --An efficient exit documentation process, where patient, upon leaving the hospital is furnished all invoices, lab reports, physical therapy recommendations, and prescriptions, et al. --A process for communicating seamlessly with the patient’s hometown physicians or surgeons should post-op complications arise. Can South Korean medical travel compete with the likes of India, Thailand, Singapore and Malaysia? Time will tell. If its medical hospitality can match the quality of healthcare offered, it’s reasonable to expect that South Korea could, within the next three to five years, become one of the half-dozen leading world medical travel destinations. The devil is in the details, though, and South Korea — as well as any emerging participant — would be well-advised to look to the leading medical travel destinations for counsel on how it’s done right. In this regard, imitation is the sincerest form of flattery, and the medical travel world would be well served by a quantum leap in consumer care and medical hospitality worldwide. Notes on a health screening--Asia style: My travels over the past three years have taken me to hospitals and clinics in Mexico, Cuba, Costa Rica, Singapore, India, Thailand and Malaysia, and I’ve had dental work done abroad on three occasions. I had always been interested in the highly touted health screenings offered abroad, particularly the legendary Well-man” and executive screenings offered throughout SE Asia. When visiting Inha University Hospital in Incheon (the port town near Seoul with the International Airport of the same name), I was rather casually invited to participate in a health screening. Thinking of the typical American-style check up, I accepted. What followed was as surprising as it was impressive. In the span of a couple hours, I was hustled in and out of a dizzying number of tests and screens, including:
Unbelievably, they also had me scheduled for a GI endoscopy (I declined due to the anesthesia required) and a PET-CT scan (also declined due to the additional hour wait). My results were given to me the next day, and I understand they will be soon posted on a secured page on Inha’s website, including the MRI, for use as I see fit. Cost for a full health screening is U.S. $1600, including the MRI. Once I recovered somewhat from this unexpected whirlwind, I reflected that of the 20 or so physical checkups I’ve undergone in my 55 years, I have never received a vision check, and auditory check or an EKG, let along an MRI. During my vision exam, I struck up a conversation with a mid-30ish woman from Palatine, Illinois, who was there with three girlfriends. They were all uninsured, and had decided to pay for their vacations with the differential savings realized from the health screening. Afterwards they were heading to the beach. I asked her how it was going, and she replied “so far so good.” I think the same can be said of the Korean entry into the medical travel arena, and I for one hope to welcome them into the community in the near future. Josef Woodman is the author of Patients Beyond Borders: Everybody's Guide to Affordable, World-Class Medical Tourism. He can be reached via e-mail at: jwoodman@patientsbeyondborders.com. BlueCross BlueShield of South Carolina has Companion for Overseas (Continued from last issue) A Conversation with
By Jeff Schult One of the questions I had, you almost answered (in Part 1) and it surprised me a little. I was going to ask what obstacles you had overcome internally? I assume there were some objections and it sounds like from the top down you guys “got it.” Absolutely, we really have. And I think the NBC piece (NBC News, May 15, 2007) helped a bit. NBC interviewed me, and indicated that we are one of the first companies to get involved in this … so that really helped to confirm that we were on the right track. So there weren’t really any internal barriers. It’s just that when you try to explain, “Here’s where this thing may go …” … well, certainly, I get a few people raising eyebrows, saying, “ Like, what are you, crazy? Exactly. They may not come out and say it -- because I think I have a pretty decent track record for making things work outside the box -- but we’ll see. What we’re doing now, Jeff, is our 1.5 million members have access to these options, for Bumrungrad … as an affinity program. There are enough other folks that have gone out and started services for which they’re trying their best to get covered members to do this, to go overseas. We have attempted just the opposite -- leveraging an existing membership base. How does it work as a value-add for the patient? Why would a patient choose it? They wouldn’t. First, personally, we know a number of folks around the country -- the estimates are 600,000 to a million people last year -- have elected to go abroad for surgery. If you just pro-rate the numbers of the 80,000 American patients that received services at Bumrungrad last year, about 1,200 were from Well they probably wouldn’t. But we needed to go through this first step of what we consider an iterative process for a few reasons, primarily to raise member awareness. We are surprised at the amount of press that this has received and that helps to raise consumer awareness as well … but also, it has helped us to open dialogue with staff from various payers who actually shape benefit structure. We have had requests from multiple human resource brokers, companies that work with different employer groups I get calls from That’s how this trend will continue to gain momentum. . Here’s an example, the CEO of a prospective group hears about Companion Global Healthcare and medical tourism on National Public Radio back in February and begins to ponder the financial impact of waiving the $2,000 deductible in his employee’s medical plan if they choose to receive expensive surgical services at Bumrungrad. So that was great, and there are ways to do that and make it attractive or compelling .. 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. It sounds like the market and the demand shape what you offer. Exactly, we need to be market-driven….and we’re starting to have groups ask questions. We began advertising in a few media outlets, notably United Airlines’ Hemisphere magazine. So we have begun to strategically position a few ads which focus on both patients and HR directors. So you guys haven’t sent a patient yourself? Correct. I just wanted to make sure. I was pretty sure that was the case. That did kind of amuse me as far as a lot of the press went. “OK, are they actually doing this yet?” Yet I think it’s a very big thing and I think it’s a tipping point for medical tourism. You bet. We’re neither surprised nor discouraged about the limited patient traffic thus far. . But remember that our website (www.CompanionGlobalHealthcare.com) has received over 200,000 hits now in just about five months. I think it’s interesting the way you’re rolling it out. We’re just starting to do some advertising now. And I’ve spent a little bit of time this week developing a plan focused on stimulating specific patient interest. We have spent much of our organization’s early life been building infrastructure – we’re only 3 ½ months old. So we’re trying to follow up on every single market lead if we can. You’re doing a good job of answering all my questions before I ask them. Have international hospitals been ringing your phone? Have you gotten that kind of reaction? Yes they have. Off the hook. I thought so. I’ve been on the phone a lot. I went to visit a couple of hospitals in Although we are aggressive in seeking other opportunities we are also conservative when it comes to risk. Many critics of medical travel suggest that it’s only going to take one or two maladventures in this business to arrest the trend. And that could happen even with the best hospitals and care. Every patient responds to anesthesia differently. We want to be able to mitigate that risk as much as we can. I’ve heard it suggested in the media that other insurers and HMOs and the like are looking very closely at medical tourism and that some of them will be following suit very soon. Would you care to venture some speculation on that? Not really -- it’s hard to tell. Healthcare is a local phenomenon and it’s hard to know what’s going on in other states. When people ask me, “Is this going to happen?” I tend to say, well, certainly based on the cost differential and the reputation for quality, You bet, and that’s what I think. I’ve heard … that some of the senior staff at other commercial payers recently visited Bumrungrad and other high-quality international hospitals. The popular media has helped this whole process, and again, it has come from sources with pretty good reputations like 60 Minutes, Good Morning America, Newsweek, The Economist … they’ve all run pieces. Some of the media have really educated themselves. If you looked at stories about this 4 or 5 years ago, it was all about crazy people going overseas. I think it was 2004-05 when some media people starting looking at this and figured out it was for real. And I think it’s just a matter time before any company in a margin-sensitive sector says, “We’re going to take a look into this; we’re going to put a global surgical option into our benefit plan and we’ll see where it goes.” One other question -- do you deal JCI accreditation as a prerequisite for overseas hospitals as far as the American market? We’re only going to contemplate JCI accreditation within network. Part of the reason is that a certain percentage of American consumers recognize the Joint Commission as a trusted stamp of approval, that’s number one; number two is that there’s an increased comfort level that the Joint Commission has been involved in giving the medical staff and the hospital’s credentialing process their blessing. I recall as a hospital CEO the whole healthcare credentialing process is something the Joint Commission takes very seriously and we are comforted by that. PERSPECTIVES: Health hazards of travel: WHO weighs in (Part 2) (Editor’s Note: This is the second of two parts on the World Health Organization Phase 1 report on the hazards of travel, written by Stephanie Sulger RN, MS, CIPC, CEO of Medical Tours International in Cold Spring, N.Y. In the last issue of Medical Travel Today, she covered the health hazards of travel – principally, the risk of VTE, blood clots in the veins. In this issue, Sulger writes about what patients, hospitals and providers can do to reduce the risk of VTE and discusses what is next at WHO. Subscribers can read Part 1 in Issue 1 at the www.medicaltraveltoday.com archives page.) By Stephanie Sulger RN, MS, CIPC How do you, as a medical traveler, reduce your risk of blood clot formation?
In Hospital Steps that Reduce the risk of DVT
How would you know if you had a blood clot (DVT)? In most cases of DVT, the clots are small and do not cause any symptoms. The body is able to gradually break down the clot and there are no long-term effects. And, in the event of a blood clot occurring during a flight, symptoms may not appear until between five and seven days later. DVT may cause pain and swelling in one or both legs, or less commonly, in an arm. There may also be tenderness in the affected area, and an increase in skin temperature (compared to the unaffected limb). Signs and symptoms include:
When a DVT forms high up in the leg (ileofemoral vein), the superficial, surface veins may become visible over the thigh and hip areas as well as over the lower abdomen. These are not always a sign of a DVT, but if you experience them, you should seek medical advice. Signs and Symptoms of Pulmonary Embolism (PE) Because a DVT can be present without symptoms, medical travelers should be aware of the signs and symptoms of a clot that has traveled to the lungs. The symptoms of a blood clot that has traveled to the respiratory system (PE for pulmonary embolism) vary from very mild to very intense according to the location and size of the clot. Symptoms may include:
Have someone get help immediately if you experience any of these symptoms. WHO: Next Steps Phase ll of the WRIGHT Project will try to identify effective preventive measures that reduce the risk of blood clot formation in travelers. Depending upon those findings, airlines may be asked to take measures to reduce a flyer’s risk of predictable surgical complications such as increasing seat pitch to increase leg room in economy seating. Medical travelers can address the preventable risk factors of blood clot formation such as obesity, smoking, dehydration and immobility and consult with a physician before traveling abroad for surgery. Editor's Note: Stephanie Sulger RN, MS, CIPC, is CEO of Medical Tours International in Cold Spring, N.Y. Medical Tourism Magazine to Launch
This will be the first magazine devoted to the issues facing international hospitals, educating both consumers and companies looking to involve themselves in medical tourism.The magazine will cover issues and topics such as:
The magazine will also be the industry’s simplest way for advertisers to broadcast their message online and in print internationally and at a very low cost. Advertising costs range from $500 - $2,000 which is almost 1/5th of what other magazines charge.The magazine publishers are looking for individuals to participate, sponsor or provide editorial content. They would like to see all aspects of the industry get involved! Request a media package for advertising or request information regarding editorial opportunities from the editor at ReneeStephano@aol.com. For free online subscriptions, send a request to info@medicaltravelauthority.com. ISSUES AND ANSWERS: Editor's Note: Dr. Michael Horowitz has been researching medical tourism and international medical travel since 2005 in collaboration with Professor Jeffrey Rosensweig, Director of the Global Perspectives Program, Goizueta Business School, Emory University. He is the author of several articles on medical tourism and has given professional presentations on this subject. A graduate of the University of Miami School of Medicine, Dr. Horowitz practiced Cardiothoracic Surgery for more than 15 years. He has an MBA from Goizueta Business School of Emory University. Dr. Horowitz is currently forming a consultation practice devoted to researching, analyzing and providing valuable information and critical insights about medical tourism and international medical travel.By Michael D. Horowitz, MD, MBA The most common reason that American patients consider traveling to other countries for medical care is for low cost. This article explains the reasons why care in many medical tourism destinations is so much more affordable than equivalent services in the United States and other industrialized countries. There are three major factors that make it possible for patients from industrialized nations to receive health services in developing nations at affordable prices:
To remember these easily, note that they all begin with the letter M (as in The most important factor in the affordability of medical tourism is the disparity in the level of economic development between the patient’s country of origin and the destination where care is provided. Patients maximize the value of their money when they choose to have health care in countries that are economically disparate from the country where they live – up to a point. This is why developing countries are such popular medical tourism destinations. But if a country is too poor, then it will be impossible to provide adequate services to attract and serve foreigners. To really understand why economic issues are so pivotal in low cost offshore health care, we need to consider a nation’s gross domestic product, currency exchange rates, and foreign exchange markets. These are very important, but a bit technical, so I will address them separately in the second part of this article. Management activities contribute substantially to the reduced price of medical services in medical tourism destinations where hospitals and other health care providers are able to purchase labor and supplies at much less cost. In the United States, health care organizations are required to collect and analyze information on myriad things. Although some of this is certainly important for patient care, documentation and reporting requirements consume an unimaginable amount of employee time and energy. However, in many medical tourism destinations, there is much less bureaucratic burden for physicians and hospitals. Paradoxically, the drive to achieve and maintain accreditation from organizations such as JCI and ISO will increase documentation requirements for such offshore facilities. However, because employee wages are relatively low in developing countries, the cost of fulfilling these requirements is less onerous. Health care providers in the United States have enormous expenses related to patient billing and collection, particularly when insurance companies are involved. Reduction in insurance payments to providers has been so aggressive that many find it difficult to cover the cost of caring for patients in certain situations. In many medical tourism destinations, patients pay for care at the time service is provided. Although the fees are lower, providers have no costs related to billing and collection and they are protected from unilateral insurance denials and payment cuts. The medicolegal environment in medical tourism destinations also contributes to lower costs. Providers have huge savings in premiums for professional liability insurance. Reportedly, the insurance premium for a heart surgeon in New Delhi is less than 5% of that in New York. Also, there is little pressure on providers to engage in defensive medical care and documentation. In Part 2 of this article we will focus our attention on the macroeconomic underpinnings of medical tourism.Dr. Horowitz can be reached at michael_horowitz@mac.com Editor's Note: This newsletter is for informational purposes only and should not be construed as medical advice. |
Traveling blues in Bumrungrad The ugly facts behind beauty tourism COUNTER VIEW: Move from medical tourism to medicine A novel tourism concept Interview with Milica Bookman, author of Medical Tourism in Developing Countries Uninsured Americans traveling to Panama for health care |
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By Jeff Schult, Editor
dozen hospitals, medical universities and research centers throughout the country. Our first-hand experiences, and follow-up research, indicated that Korea is yet another potentially successful Asian contender for providing high-quality, low-cost care to international medical travelers.
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. This is Part 2; for Part 1, please see our last issue on the archive page at 
West Palm Beach, FL (Oct. 3) -- The Medical Tourism Association, a non-profit corporation, will lbegin publishing "The Medical Tourism Magazine," the organization's official monthly journal, at the end of October 2007. The publication will be an in-depth advisor on medical travel, free to subscribers. 
Money). Furthermore, when placed alphabetically, these factors are listed in the order of importance in terms of their impact on prices.