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SPOTLIGHT
Steven Tucker

Dr. Steven Tucker, president and medical director, IMTA

At the recent Consumer Health World conference in Las Vegas, The International Medical Travel Association (IMTA) debuted its American presence. Medical Travel Today recently had the opportunity to talk with the IMTA’s president and medical director, Dr Steven Tucker, MD (USA), FACP (USA) about this development, their plans for growth within the U.S. and other countries, as well as his perspective on the industry as a whole.

Medical Travel Today (MTT): Very exciting news about your U.S. presence. Can you tell us a bit about what drove the decision to establish that presence and what your intents for growth in the U.S. might be?

Steve Tucker (ST): As I see it, there are currently three types of medical travel taking place: regional medical travel, travel to centers of excellence, and most recently medical travel from North America to other destinations such as Asia and South America. All these patients are seeking high quality care at a better price point.

Recall that medical travel is not a new concept. For years, people have been traveling from Europe, Asia, the United Kingdom, and so on to other destinations for medical and dental care abroad. But now, there’s an increased awareness of medical travel in the U.S. for obvious reasons.

The International Medical Travel Association (IMTA) is an international body, and we need a strong presence in all countries. Because of the growing interest in the U.S., it seemed to us to be the next logical beachhead for expanding our outreach.

Plus, as part of our mission, we need to find as many common touch points as possible with medical travel players across the world. There are so many emerging players in the U.S. that it also made it a great choice.

As an aside, and this is a personal opinion, global medical travel, unlike the U.S. medical system, presents an opportunity to make the healthcare industry work like it should: a system where physicians and providers can determine their value in an open and transparent environment; an environment where patients have opportunities for choice in the medical services they receive; and a reduction, and in some cases a complete elimination, of the number of third-party payors involved.

When you have that, you have a very real value proposition. And when it’s done well, everyone is satisfied with the quality services provided and received.

MTT: Do you have any plans for establishing a presence in other countries?

ST: Not at the moment. We have not established a timeline for creating a presence in another continent or country.

Part of our reason for choosing the United States was that so many of our constituents are either interested in North America or have been approached by potential North American partners.

Ultimately, we need to spend more time in Europe and South America. And we’ll get there. But growth for growth’s sake really isn’t a part of our mission.

We’re a young organization and strictly run through volunteerism. We need to make sure we’re a sustainable association so we can continue down the path of our ‘patient first’ approach and keep moving our constituents in that direction. Plus, we’re really looking to connect people who need each other. The globalization of health-care services is happening, and we need a body around it to make sure it stays at the highest level. That’s what we’re trying to do. That’s our focus.

MTT: How large is the IMTA at this time and what regions or countries do the members represent?

ST: Right now we’re at around 35 members, although we expect that number to double in next six months. Our goal is to reach 100 members by 2009. As for where they’re from, if you asked me six weeks ago I would have told you most were from Southeast Asia. But now we represent Southeast Asia, some European countries, the U.S., and South and Central America. Our biggest increase has definitely come from the U.S. and Mexico.

MTT: What are you doing or planning to do to attract members and growth in South and Central America as well as Europe?

ST: Central and South America is on our radar for a lot of reasons.

First, there is something like 50 million Spanish-speaking Americans.
Second, Mexico and South America have quality services, and they fully understand travel and needs of medical travelers. Add to that the fact they are contiguous to the U.S., and they are doing what’s needed to drive medical travel. Of course this is all driven by the frustrations Americans have with access to the U.S. health-care system.

Americans spend more than anyone else in the world on health care and yet the dissatisfaction rate is incredibly high.

Other countries are simply doing it better on many levels. Around the world, they are providing just honest-to-goodness care—doctors who call their patients, attentive nurses, and great care. When an American patient has that kind of interaction, they are shocked. It’s simply a level of care they are not used to. Honestly, they’re shocked.

As for our approach to these markets, we’re a little more laissez faire about membership. Right now we are interested in networking key players and new players. We don’t have an aggressive media program, and we’re not “out there” marketing. But we’re also not being a wallflower either. We’re an association that’s interested in people and businesses who are interested in what we are doing. We’re not looking to simply drive membership numbers. We’re interested in the quality of our members and the quality of services and value we bring to them as members.

We’ve got some serious regional players—Parkway, Bumrungrad, Wocroft—and I expect we’ll see more like that coming on board soon.

MTT: Coming off of the Vegas conference and the IMTA’s U.S. debut, what are your thoughts on the future of the industry both short- and long-term?

ST: The industry of “medical tourism” itself is not going away. Call it what you will – globalization, medical travel, or outsourcing -- the industry is health-care delivery, plain and simple. All that’s changing is that people are willing to travel greater distances or can now travel with greater ease than in the past to access the best medical care.

In the short-term, there will most certainly be an increase in the number of medical travelers. We’re going to see more and more. The recent McKinsey report indicated the numbers are small for intensive and complex inpatient surgeries, but they defined the population of their research very specifically and only looked at that population. They didn’t consider, for example, the 400,000 people traveling to Singapore from Indonesia, for routine care and mid-level procedures. The McKinsey definition of medical traveler was very tight, very specific. But still you cannot deny that these other cases constitute the bulk of medical travel.

But even with their small number, they concluded that the potential is huge. Now use a larger, and what I think is a more accurate, denominator in that equation and it’s not just huge; it’s a staggering number of medical travelers.

In what I’ll call the mid-short term, say five to ten years, I do think you’ll see a decrease in the industry. Around the world, we should be able to create better health-care services in those locations from which people are currently departing.

Take Vietnam. Right now a majority of their health care is exported. But give it another five years and they’ll be able to provide a higher quality of care. Many of those patients won’t go abroad for care. They’ll have as good or better care options close to home.

Over in the U.S., I suspect we’ll see a reduction in the cost of care. After the system breaks, and it will, we’ll see a shift toward transparency on the finance side of health care. That transparency will lead to change.

We’ll see big decreases in the cost of care. It could be as much as fifty percent depending upon procedures, especially for electives.

I’m a big believer that people value products and services most when they pay directly for them. Conversely, people don’t appreciate a service or product when it has no perceived cost to them. American patients clearly need to re-evaluate their sense of quality care. I believe that’s definitely going to happen. Patients will begin to appreciate a famous quote from Warren Buffet, and that is “Price is what you pay. Value is what you get.”

 

PERSPECTIVES

Editor’s Note: The following is a slightly different viewpoint: a patient’s perspective.

We sat down this week with Jane Schaeffer of North Bennington, Vermont. She recently returned from India where she had a hip resurfacing performed. Jane was kind enough to share with us how she came to be a medical tourist and her reflections on the experience. It’s our hope that a patient’s perspective will provide you with some valuable insight into consumer expectations, research habits, and priorities.

To look at Jane Schaeffer today, navigating the steps in her home surrounded by two energetic standard poodles, one would hardly believe that the 64-year-old traveled to India and underwent a hip resurfacing procedure just five weeks ago.

For Schaeffer, who owns and operates The Yoga Place in Bennington, VT, the decision to become a medical tourist emerged out of frustration with the limits placed on her care options here in the U.S, as well as a fierce determination to maintain her mobility and flexibility as long as possible.

“The problem really began six years ago when I was bike riding on vacation,” says Schaeffer. “I sat down after the ride and then couldn’t get back up. When I returned home I ran through all the MRIs and diagnostics and was told I had a compressed disc impinging on the nerves in my spine.”

Schaeffer lived with that diagnosis for some time until she went for a Thai massage. The therapist noted that the tightness she was displaying wasn’t consistent with a back problem—but rather an issue with the hip. He suggested she have a hip x-ray.
Schaeffer contacted her physician who ordered the x-ray and quickly discovered a bone-on-bone issue in her hip. His suggestion: full hip replacement.

Determined to make the best choice for her body (and her livelihood), Schaeffer turned to the Internet for more information. It was there that she learned about hip resurfacing.

“It immediately seemed like a better option,” she says. “As a yoga teacher, I need my flexibility. With a hip replacement you simply can’t go back. In addition to being less invasive, resurfacing looked like a better way for me to keep that flexibility.”

It was during these early Internet searches that Schaeffer first started to learn of her options abroad.

“In one of my Google searches I came across a Web site called www.surfacehippy.info and another called http://health.groups.yahoo.com/group/indiaresurfacinghippies. I dove deeper into those sites and found out the plusses and minuses of resurfacing versus replacement. That information pretty much sealed the decision for me about the procedure. It was also during those searches that I first found out they were doing hip resurfacing with great success and regularity in India,” says Schaeffer.

The next step was to discuss the idea of hip resurfacing versus hip replacement with her doctor. Initially, he resisted but finally conceded that she was a “young 64,” and resurfacing did present a better option. However, due to Schaeffer’s osteopenia, he was concerned that the Birmingham Hip Replacement (BHR) used in resurfacing would not be strong enough for her situation and that he might need to do a hip replacement anyway. He explained to Schaeffer that this was the only option as the Modified BHR, a device recommended for people with high risk of fracture (e.g. people with osteopenia), has not been approved by the FDA in the U.S., and thus was not available. When she threw out the idea of traveling abroad for the procedure, he was less receptive.

“He didn’t come out and slam it,” says Schaeffer, “but it was clear he wasn’t for it.”

A trip to Rutland, VT, for a second opinion on the procedure yielded an even lower opinion of medical travel.

“That doctor was downright disdainful of India,” exclaims Schaeffer. “He said, ‘I wouldn’t let my mother go to India. What if you crash? What if you need blood?’ His attitude made me cranky. Add to that, he didn’t do hip resurfacing, only hip replacements, and was really pushing me to a procedure I frankly didn’t want.”

Frustrated and admittedly cranky, Schaeffer turned back to the Internet for more information and advice. Searching for places where hip resurfacing was the norm and not the exception, she found a medical travel company. She also read about a physician who had performed over 1,000 resurfacings: Dr. Vijay Bose.

“At that point I was very intrigued,” admits Schaeffer. “Plus, I’ve done a lot of travel in Asia and had friends from the West Coast and Hawaii who had gone to Bangkok for care. The idea of going to India wasn’t that big of a stretch for me.”

Schaeffer took a chance and contacted the medical travel company to learn more about her options.

“They not only got back to me immediately,” says Schaeffer, “They had a doctor call me. That really impressed me.”

The coordinator requested her x-rays, which they then had digitized and sent to a physician in Brussels and, oddly enough, to Dr. Bose in Chennai, India. They kept her apprised of the process regularly by phone. “Those touch points made me feel very comfortable and cared for even though they weren’t technically caring for me yet,” explains Schaeffer.

In a few days she had feedback from both physicians. The Brussels physician turned down the case due to Schaeffer’s past history with kidney stones. Dr. Bose, however, was a “yes.”

“I did check out another company I learned of on the Internet. Planethospital.com had come up a couple of times in discussion groups and so on so I gave them a call,” says Schaeffer. “However, I was put off that they wanted money right off the bat for digitizing the x-rays. Of course, I already had them digitized so I sent them those, and they told me they’d send them to some newly trained doctors in Mexico. I wasn’t thrilled about the doctors being so new, but I was willing to see what they had to say. But the truth is, they simply didn’t respond in a very timely manner. At that point I knew where I’d go, it was just a question of if I’d go.”

Schaeffer took a few days to consider the decision and, as she puts it, “look for reasons not to go.” She couldn’t come up with any.

In very short order she had found a friend to travel with her for the procedure and set about making her arrangements.

“Luckily, I had frequent-flier miles I was trying to use up. The travel company was perfectly fine with that and worked with me to bring all the rest of the arrangements in line with what I was handling,” says Schaeffer. That included hotel arrangements, post-care stay, transportation to and from the hospital, and so on. “I felt completely cared for and that was before I even arrived,” laughs Schaeffer.

Schaeffer and her companion chose to arrive two days in advance of the scheduled surgery to do some sightseeing. “I even had help with that,” adds Schaeffer.

On the day of the surgery, Schaeffer arrived at Apollo Hospital in Chennai. Naturally a bit nervous, she proceeded through a very crowded lobby and onto an even more crowded elevator.

“It wasn’t the usual airy atrium with a coffee cart and a grey lady like we’re used to here,” she explains. “It was a bit intimidating but, once I reached the Platinum Ward where all the medical tourists stay, I felt more, well, at home.”

She met with Dr. Bose who, upon looking at her x-ray, recognized she didn’t need the modified Birmingham device but rather just an ordinary BHR.

“This was a relief,” says Schaeffer, “but even more of a relief was the fact that they simply deducted the cost of the modified device and related procedure from my bill. I didn’t have to do any paperwork or file something. That was really great.”

Schaeffer’s procedure went extremely well. Throughout the pre- and post-op she reports having been well-attended to and closely monitored by Dr. Bose who came by at least twice a day.

“The doctors are very present at Apollo,” says Schaeffer, “All of my medical needs were attended to by a trained physician,” including the changing of her wound dressings and the physical therapy she received twice a day. She notes, “It was extremely comforting.”

Meanwhile, Schaeffer’s travel companion was also quite happy with the arrangement.

“She stayed in the bed next to mine and got a lot of reading done. We were both very well fed, and she never had to go far to get advice on where to run errands or have a cigarette. The fact that she was welcomed and not seen as a nuisance is certainly different than it might have been here in the U.S.”

After seven days, Schaeffer was moved to a nearby resort to continue healing and prepare for the journey home.

“It went very smoothly. Even though I was in pain, I was in pain in a very nice place and the resort, Ideal Beach Resort, is totally set up for patients like myself,” she adds. “Plus, the travel coordinator gave me a six-week protocol of PT to follow and I was able to do it on my own and feel some ownership in my recovery.”

Five weeks later, Schaeffer is home and preparing to resume teaching yoga classes. Her recovery has gone extremely smoothly, and she hasn’t had reason to contact her local physician.

“Any questions I have I e-mail to Dr. Bose, and I always have an answer within 24 hours. Always.”

When asked how the individuals and companies involved in her experience might improve it in the future, she hesitates. Then with complete confidence says, “I can’t think of a thing. It was all so straightforward and uncomplicated. The entire procedure was $8,000 inclusive of all charges. There was no pharmacy bill, no x-ray bill, and no diagnostic bill that came floating in later. That was great!”

As for whether or not she would do it again, Schaeffer responds with an emphatic, “Absolutely, YES. I’d even go as someone’s companion if it would make them feel more at ease and confident. I have absolutely no regrets.”

 

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INDUSTRY NEWS

StarHospitals.net Announces Patient Airfare Sponsorship Campaign
Individuals will be awarded round-trip airfare to the hospital of their choice within the Star Hospitals network for medical care

Ontario, Canada – May 23, 2008 – Star Hospitals.net (www.starhospitals.net), a North American healthcare service, announced today that it is sponsoring American and Canadian patients to travel overseas for a necessary medical procedure at a participating facility in the Star Hospitals network in India, Singapore and Thailand. Individuals will be able to choose the hospital that best suits their medical needs, and Star Hospitals will provide an economy class, round-trip ticket from a major airport.

Following a diagnostic evaluation and the selection of a physician, teleconferencing is available for patients to discuss treatments with their overseas surgeon prior to travel. To finalize travel arrangements to the appropriate hospital, Star Hospitals.net staff will coordinate passports and visas, book flights and hotel rooms, arrange transportation from the airport, and complete hospital registration.

A random drawing to select recipients will be held at the end of June, 2008. In order to be considered, individuals can send an email to mbarbosa@cpronline.com.

Patients wishing to take advantage of this opportunity must be uninsured or underinsured and meet the following criteria:

• 45 years of age or older
• Visit www.starhospitals.net for a list of procedures available.
• Patients must be traveling for a “major” surgery such as orthopedic (hip or knee replacement or resurfacing), cardiac (angioplasty or cardiac bypass surgery), neurosurgery (brain tumors, spine, head or neck surgery), bariatric (Lap band surgery, gastric bypass surgery). Patients seeking minor, noninvasive procedures will not be considered.
• Patients must be open to media coverage.
• Patients must be able to travel for surgery by October 31, 2008.

“We understand that many people are interested in medical tourism, but may have some constraints regarding participation,” states Kumar Jagadeesan, vice president of Star Hospitals.net. “Our goal is to help people discover the benefits of medical travel as well as the quality of our services, which include the first call center operated entirely by doctors, physician assistants, paramedics, physiotherapists and other medical professionals.”

For further information please call toll free: 1-888-STAR-012 or visit www.starhospitals.net.

About Star Hospitals.net
Star Hospitals is a North American health care service offering affordable and timely treatment abroad through a network of hospitals throughout India, Singapore and Thailand. For more information please visit www.starhospitals.net or call 1-888-STAR-012.

 

U.S. Risk Launches MedTour Pro for Medical Tourism Industry

U.S. Risk Underwriters, a subsidiary of U.S. Risk Insurance Group, Inc., launched a new professional liability product for the medical tourism industry called MedTour Pro.

MedTour Pro is designed for medical tourism professionals who arrange for people to obtain medical services outside of the United States. Coverage is for damages caused by any actual or alleged negligent act, error, or omission by the insured while providing or arranging for these medical tourism services.

"We are the first to market with a product specifically built for the fast-growing medical tourism industry," said Art Seifert, president of U.S. Risk Underwriters. "MedTour Pro will be followed by a suite of products designed specifically to cover the risks inherent in the dynamic new industry, predicted to generate $100 billion in revenue by 2012."

MedTour Pro has been developed in concert with the Medical Tourism Association and written with an A.M. Best "A" rated carrier on a claims-made basis. Limits are offered up to $1 million with a minimum premium of $2,225. Excess over the $1 million limit is available.

Source: U.S. Risk Insurance Group,
www.usrisk.com

ICRI Health Offers a Masters in Medical Tourism

ICRI Health, a division of Institute of Clinical Research (India), India's premier institution in clinical research studies, has applications now available for a two-year, full-time Masters in Medical Tourism.

The course promises to prepare students for a rewarding career in Medical tourism.
Program content includes courses in:

Management Process and Organization Behavior
Business Economics
Marketing of Medical Tourism
Healthcare Industry perspectives
Alternative Therapies in Medical Tourism
Insurance Regulations and Management
Healthcare Laws and Regulations
Tour Operations Management
Business and Social Ethics
Empathetic Communication Skills
Net-working & MIS Skills

The program begins from August 11, 2008.

For more information, contact: enquiry@icriindia.com.

Some U.S. Hospitals Try to Draw Foreigners with Flat-rate Care
The Wichita Eagle, Wichita, KS

Escalating health care and insurance costs are driving many Americans overseas for medical care, but some U.S. hospitals—including at least one in Wichita—are aiming to bring foreign patients here by offering deeply discounted rates.

At the forefront are physician-owned hospitals, whose managers say they have the efficiency and flexibility to charge extremely low rates and still come out ahead. They call it “reverse medical tourism.”

Galichia Heart Hospital treated its first out-of-country patient last month, a Canadian who needed a hip replacement and was willing to pay cash instead of waiting months—or even years—for what is considered elective surgery in Canada.

"They treated us like gold," said Alberta farmer Roy Newman, whose father, Richard Newman, 73, underwent the surgery April 4 in Wichita.

The Newmans paid $14,000 for a hip replacement, a procedure that averages $41,000 in the U.S., according to Vimo.com, a cost comparison site.

"People say $14,000 sounds like a lot of money, but for the pain he was in it's not that much," Roy Newman said. "We had a great experience. Dad's totally rejuvenated."

The rate race

The medical tourism market is valued at about $20 billion annually with an estimated 150,000 Americans traveling abroad for medical services in 2006, according to industry figures.

The appeal is paying substantially lower costs—up to 75 percent less—at internationally accredited hospitals. A hip replacement in Asia, for example, runs about $12,000, according to medical tourism facilitators.

Some U.S. hospitals say they can challenge those numbers.

Physician-owned hospitals, not typically saddled with layers of bureaucracy, are better equipped to operate at peak efficiency and offer comparatively low rates, said Molly Sandvig, executive director of Physician Hospitals of America, which represents 148 hospitals nationwide.

"The reason our hospitals are efficient—the reason they cost less, frankly —is we know what our charges are, where the money is going," Sandvig said.

"Our goal is not to make a gigantic profit. Our goal is to offer services in the most efficient way possible while still being able to stay in business."

Entering the fray

Galichia officials stunned the industry in February when they announced they would charge a flat fee of $10,000—undercutting traditional hospital charges by at least $25,000—for one of the most common types of open-heart surgery and still make money.

Charging flat fees for other common procedures was the next logical step, chief executive Steve Harris said.

Hoping to tap into countries such as Canada that have overburdened government-run health care systems, Galichia is marketing guaranteed flat rates for orthopedic surgery, electrophysiology procedures such as pacemakers, certain open-heart surgeries, and general surgery.

"We can create a market, an opportunity for patients to come here at reasonable costs and have high-quality medical care," Harris said. "I think it could eventually be ten percent of our business."

Other Wichita hospitals, such as the physician-owned Kansas Spine Hospital, are considering the potential.

Chief Operating Officer Thomas Schmitt said the idea reflects an evolving trend toward greater consumer involvement and transparency that eventually will transcend national boundaries and traditional markets.

"The challenge is to make sure, given the physical distance, that we're able to effectively do the presurgical analysis and patient assessments necessary to make sure patients receive the excellent care they deserve," he said.

Targeting patients

Galichia is marketing to Canadians with local ads and through clearing houses such as those run by Rick Baker, a Canadian who founded Timely Medical Alternatives and North American Surgery. His companies connect clients with U.S. specialty hospitals that agree to perform certain surgeries at low, contracted rates.

He sends patients to hospitals in Oklahoma City, Phoenix, Washington state, Buffalo, New York, Maine, and Wichita. He has called Galichia's price guarantee "remarkable."

"For the most part, we can match, sometimes beat, and always come very close to prices offshore," Baker said.

"With these prices, there's no reason whatsoever anybody should assume the risks of going offshore. Why travel to the other side of the world to save $1,000?"

Galichia has about a half-dozen Canadian or uninsured, cash-paying Americans scheduled for surgery next month.

In addition, the hospital has caught the interest of medical tourism companies, including Wichita entrepreneur Frank Mitchell's American Medical Outsourcing, which promises patients 50 to 80 percent savings at its partner hospitals in India.

Mitchell, who went live with his business in January, said he's happy to work with U.S. hospitals that are willing to charge discounted rates comparable to India. When he heard that Galichia was charging $10,000 for heart bypass surgery, he called them.

"The ultimate goal is to help people and get them the medical attention they need," he said. "I'm definitely all for doing it internally.

"It just makes a lot more sense to me time-wise. And flying to India—you're saving $1,000 a plane ticket right there."

What employers want

Mitchell sees potential in directly targeting employers, which can realize significant savings by contracting with hospitals that charge discounted flat rates.

Galichia officials have heard from several employers interested in the flat-rate concept, including East Coast supermarket chain Hannaford Bros. Co., which employs 26,000 people and insures 10,000 of them.

Peter Hayes, Hannaford's director of associate health and wellness, said Galichia's willingness to negotiate low, flat rates is appealing. On January 1, the company added a benefit that pays 100 percent of costs if an employee has a hip or knee replaced in Singapore.

Aetna, its insurance carrier, complied, albeit grudgingly at first, Hayes said.

"The issue becomes either we're going to have a market solution to health care or a governmental solution, so a part of this was very deliberate—let's change the (national) conversation," Hayes said.

"I think the ultimate end game is that it really creates a very competitive market for high-quality care."

 

Insurance Company Includes Global Network Option in Limited Benefit Plans

Columbia, S.C. - BasicPlus Health Insurance of Roswell, Ga., recently announced that it has entered into an agreement with Companion Global Healthcare Inc. of Columbia, S.C., to include a network of accredited, overseas hospitals in its most popular limited benefit health insurance plans.

The agreement means those enrolled in BasicPlus' FlexMed (for employers) and BasicPlus (for individuals) limited benefit plans have the option of seeking surgery and other covered services at hospitals in Companion Global Healthcare's network. All of the network's hospitals hold the prestigious Joint Commission International (JCI) accreditation, and all offer a range of services at rates lower than those typically charged in the United States.

FlexMed and BasicPlus members treated overseas will receive Companion Global Healthcare's concierge medical travel services, including assistance with scheduling appointments and arranging travel.

Chuck Green, CEO of BasicPlus, said, "Since our members have fixed benefit maximums, the inclusion of Companion Global Healthcare's option into our products allows members to limit their out-of-pocket payments while availing themselves to JCI-accredited hospitals in foreign locations."

"To our knowledge, this is the first fully insured, limited benefit product with a global health care benefit included," said Robert Rhodes, chief operating officer of TCC of South Carolina, the third-party insurance administrator that supports the BasicPlus product line. "This arrangement will help FlexMed and BasicPlus members dramatically stretch their limited benefit plan dollars."

Companion Global Healthcare President David Boucher said his company's network of overseas hospitals is a helpful addition for limited benefit plans.

"While many limited benefit plans provide coverage for basic health care, most would cover only a small portion of the bill for a lengthy inpatient hospital stay in the United States," Boucher said. "Treatment at a JCI-accredited hospital overseas will be an attractive, more affordable option for many policyholders."

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DESTINATION

Malaysia
By Robin Elsham

Several weeks ago, the Philippines was described here as the global health-care destination most likely to exceed expectations. Now the focus turns to Malaysia, an altogether different story: a medical destination in jeopardy of badly under-performing expectations.

In fact, it has been for five years now.

In 2001 about 100,000 foreigners sought treatment at Malaysian hospitals, generating revenue of 150 million ringgit, up from 39,000 foreign patients and 90 million ringgit in revenue three years earlier. That growth pace prompted then Health Ministry parliamentary secretary, S. Sothinathan, to say in early 2003: "We have set a target of 400 million ringgit (U.S. $124 million) in revenue (from medical tourism) within a few years, and 2.2 billion ringgit (U.S. $684 million) by 2010."

Since then, Malaysia's medical tourism industry has continued to develop but at nothing like that projected rate. And Malaysia's earnings from medical tourism now pale in comparison to those of neighboring Singapore and Thailand, the result of woeful marketing.

Recently the New Straits Times, Malaysia's most respected newspaper, published figures showing an estimated 386,000 foreigners traveled to Malaysia last year for hospital care, producing revenue of 265 million ringgit. That reflected a nearly three-fold increase in patients and a 176 percent jump in revenue since 2001. But it still put Malaysia far below the trend-line required to hit the Health Ministry's 2010 targets.

So what did Malaysia do? It quietly adopted new target figures for 2010 far below the earlier numbers. It's now striving to attract one-fourth as much in revenue, yet still crowing about its success. In 2010, Malaysia "could well rake in as much as 584 million ringgit from treating some 849,000 foreigners," the New Strait Times reported recently, citing estimates issued by the Association of Private Hospitals of Malaysia (APHM).

Although that revenue projection is just a quarter of the sum ballyhooed five years earlier, the tone of news reports—both domestic and international—about Malaysia's potential as a global health-care destination remains every bit as upbeat. Comments made by leading Malaysian health-care industry officials remain just as jaunty. It's as though medical value travel to Malaysia remains right on track, hurtling forward.

The reality, though, is that at this point, Malaysia is primarily attracting foreign patients from just one country, neighboring Indonesia. And efforts to expand that pool of foreign patients by marketing Malaysia as an appealing treatment destination suffer greatly from inattention and insincerity. How else can you explain the PR wreckage that awaits any visitor to the APHM website (www.hospitals-malaysia.org)?

The APHM is an organization representing the 224 private hospitals throughout Malaysia, including the 35 listed by the Health Ministry as medical tourism destinations. Yet anyone who goes to the APHM website in search of that list, or other information about Malaysia's leading private hospitals, finds instead instant turnoffs like a five-year-old message explaining "Malaysia has successfully contained SARS."

The website actually directs attention to the worst regional public health scare the country has experienced in living memory! And to what purpose, given the fact that the cause of Sudden Acute Respiratory Syndrome (SARS), which in 2003 killed 840 people, most in East and Southeast Asia, was quickly identified and the threat contained and ended. There has not been a SARS infection or death in five years.

Yet click on "Health Tourism" on the APHM website home page, and the first entry you see, written in red, is the rhetorical question, "Is Malaysia a safe travel & tourism destination?" (By clicking an adjoining button, you're taken to a page that explains no more than 1-in-10 people infected with the SARS virus dies. "It must be noted that about 90% of SARS victims recover and only 5-10% succumb to it.")

Elsewhere under "Health Tourism," the calendar of events is for 2007. The "In the News" link brings up only three articles, all from 2003.

Unfortunately, the APHM website isn't atypical. It's emblematic of the Malaysian attitude and approach to medical tourism. Episodic, ambivalent, and sort of interested as long as catering to foreign patients requires no extra effort.

It's telling that 70 percent of the foreign patients treated at Malaysian hospitals last year came from Indonesia. The official national languages of Indonesia and Malaysia are essentially the same and mutually intelligible. Malay cuisine contains many dishes common in Indonesian cooking as well. Even much of the genetic history of Indonesians is familiar to Malaysian physicians. They're experienced in treating their own indigenous Malay population, who are closely related to the Javanese and Sundanese, the two dominant ethnic groups of Indonesia.

Yet a large portion of the remaining 30 percent of foreign patients treated at Malaysian hospitals last year came from Europe, pointing to Malaysia's appeal to medical travelers from further afield.

To significantly increase that traffic, Malaysia must get serious about marketing itself. If it does, Malaysia truly will have great potential to become one of the most attractive treatment destinations in the world. The nature of its appeal can be summed up in just seven words: Singapore-type patient experience at Thai prices.

Malaysia resembles no country more than Singapore, which is not surprising since the island of Singapore is situated like a fingernail at the tip of the Malayan peninsula, and was bound to Malaysia through most of the nearly 250-year period of British colonial rule of the region. For eight years after independence, Singapore was also part of the Malayan Federation, eventually tossed out—or it withdrew, depending on which version of history you read—to become a tiny independent country. Yet by history, customs, traditions, values, and the phenomenal ethnic mixing of their societies, Malaysians and Singaporeans remain national siblings.

That background is essential to understanding the appeal of Malaysia as a medical travel destination, since it means in many ways the differences in medical care now offered in both countries are differences of degree, not of type. Overall, Singapore is wealthier, so it has more money to invest on health care. And, as is widely known, Singapore is targeting medical tourism as a national economic policy, guaranteeing government/private sector support of every kind. So the hospitals in Singapore caring for foreign patients tend to be newer and packed with even more of the very latest medtech equipment.

On the human side, the people staffing hospitals in Singapore and Malaysia are remarkably similar in educational background, training, temperament, disposition, and appearance. This is natural, given that these are two peoples born of the same womb. Even 43 years after splitting in two, it's hard to distinguish whether someone is Malaysian or Singaporean without asking.

So operationally, the nature and quality of medical care provided in top Malaysian hospitals compares well with Singapore standards, which are recognized as among the highest in the world.

In terms of pricing though, Malaysian hospitals are significantly cheaper. In fact they offer treatment at rates similar to Thailand’s. The excellent Gleneagles Medical Centre in Penang, the famous resort island off the northwestern coast of peninsular Malaysia, offers hip resurfacing for $12,000. The APHM website says hip replacement surgery generally costs $15,000 to $20,000, total knee replacement $15,000 to $18,000, liposuction $5,000 to $8,000, colonoscopy $700 to $1,000, and a CT scam $500 to $1,000.

Given similar pricing, many English-speaking medical travelers might be persuaded to choose care in Malaysia over Thailand for other compelling reasons.

Significantly, English is so widely spoken in Malaysia as to be the de facto national language. It's certainly the inter-communal language of choice. Malaysia is composed of three major ethnic groups—Malays, Chinese, and Indians—each with their own mother tongues. While the government has succeeded in forcing all Malaysians to learn Malay, in everyday life it's English that's commonly spoken when Malaysians of different ethnic backgrounds meet. In Malaysian hospitals virtually all staff members—from physicians and nurses to administrators and business office personnel to cafeteria workers and janitorial staff—speak English effortlessly.

Malaysia is also a safe, orderly country with excellent urban infrastructure: well-maintained roads, sleek highways, a highly reliable power grid, and a spotlessly clean and efficient gateway in Kuala Lumpur International Airport. Built at a cost of $3.5 billion and opened just 10 years ago, KLIA is located 35 miles (57 kilometers) outside the capital. A single-purpose high-speed rail line (the KLIA Ekspres) links the airport to the KL City Air Terminal in central Kuala Lumpur in just 28 minutes, making arrival and departure a breeze.

As a tourist destination, Malaysia is one of the most popular countries in the Asia-Pacific region. No nationality travels that region more widely and frequently than the Australians, making their preferences one of the best gauges of any Asia-Pac country's relative appeal. And Malaysia routinely tops surveys of Australians' favorite travel destination in the Asia-Pacific region.

For all these reasons and more, Malaysia would actually have been my first choice as a country likely to surprise the most people by becoming a thriving medical tourism destination. But at this point, the Malaysians seem determined to prevent that from ever happening.

Robin Elsham is the managing director of Patients With Passports, an international health-care arranger based in suburban St. Paul, Minnesota. He can be contacted at robin.elsham@patientswithpassports.com.