Medical Travel Today

THIS WEEK IN MEDICAL TRAVEL TODAY
Volume 2, Issue 9
by Amanda Haar, Editor

This has been an exciting month for me. In the past two weeks I’ve had the privilege to speak and work with some of the most important thought leaders in several different areas of healthcare.

In this issue’s Spotlight, you’ll read a conversation I had with two senior principals at Noblis Center for Health Innovation, an influential organization that cited medical tourism as one of the top ten trends that will shape healthcare in the coming year. In Issues and Answers, you’ll find part one of a two-part series on the legal issues surrounding medical tourism as seen by Renee-Marie Stephano of the Medical Tourism Association. Plus, our Perspectives section features some fascinating predictions for medical tourism by the highly regarded Ruben Toral.

We’re grateful to these individuals for sharing their time, thoughts and vision with us. If you have a perspective you’d like to share or some ideas on other topics to cover in the future, we’re all ears.

SPOTLIGHT

A conversation with John Vitalis and Barbara Cox of the Noblis Center for Health Innovation

John Vitalis, Senior Principal, Noblis Center for Health Innovation

Barbara Cox, Senior Principal and Service Line Leader, Noblis Center for Health Innovation

When the Noblis Center for Health Innovation (www.noblis.org/healthcare), a highly regarded organization that assists both public and private sector organizations achieve their missions through strategy, facility planning, information management and performance innovation, released its list of forecast trends for healthcare, we here at Medical Travel Today were excited to see medical tourism on the list.

We contacted John Vitalis, a Senior Principal at Noblis, and his colleague Barbara Cox, a Senior Principal and Service Line Leader for information management, and asked if they might be willing to talk with us about what specifically drove them to include the industry on their list for the first time — and what they see for the future.

They graciously accepted and offered the following observations about what the future might hold for consumers, clinicians, and businesses involved in the field.

MTT: We’re obviously very excited to know that our industry has caught your attention and that you see it to potentially have great influence on management and delivery in the future. Can you tell us specifically what factors prompted you to include it on your trends list?

John Vitalis (JV): There were really three main reasons for its inclusion on our list.

First was the growth of the industry. We’ve observed a significant increase in growth, particularly in the number of US citizens traveling abroad for care.

Barbara Cox (BC): Yes, and the sheer number of sales people we’re running into at conferences and in healthcare facilities who are actively recruiting patients to travel abroad is something we’ve never seen before.

The whole notion of travel abroad for healthcare has become so widely accepted that you’ll even see a box on customs slips asking you if your reason for travel involved medical care.

JV: That’s right. The second reason is the number of prestigious healthcare organizations that have established a position in the marketplace or are seeking to do so, is really noteworthy. We’re talking about really prestigious providers such as Duke, Johns Hopkins, and Harvard Medical International. Each is seeking to find a way to operate in the emerging international arena.

BC: We’re seeing proposals coming in the door quite regularly for various things from planning facilities abroad, to finding new ways in which they might handle their process side to allow for more international care relationships. Plus, there’s the whole technical side of things. Organizations are asking what they need to do in order to communicate effectively across borders. And that communication goes beyond data sharing to overcoming cultural differences about how you communicate, when you communicate, and what’s appropriate to share.

The whole way these organizations are looking at international healthcare has shifted dramatically. In the eighties, organizations sought out people from abroad to come to the US for care. Now it’s about establishing entities in those other countries to provide care. Some of this will be accomplished by building facilities, some through partnerships or contracted facility management, or by providing clinicians.

JV: The third thing is the number of very important issues that must be considered by both the organizations and patients as they consider embarking on international healthcare.

MTT:Going back to your second point, regarding the various organizations looking for ways to grow in the market, it sounds like companies are going about it in many different ways. Have you seen one way that’s proving particularly effective?

BC: No, not really. How an organization goes about embarking on this type of international growth is largely dependent upon the culture of the organization, where they are in maturity in terms of handling international relationships, and where they want to be in the long run.

MTT:Turning back to look at the United States, how is medical tourism changing the face of American healthcare in the future?

JV: Based upon what we’ve seen in terms of trends and data, medical tourism will definitely continue to grow. The reasons are plentiful — the rising cost of healthcare, growing market opportunities internationally, opportunities to expand the footprint, and more employer interest -- particularly on the part of small employers.

Also, as more people engage in it and share their experiences and money savings, others will begin to see it as a viable alternative to care.

BC: I agree. The truth is, competition drives healthcare. The interest from different organizations toward cost will increase competition. US providers are going to have to take a long hard look at how they are providing services.

As for health plans, they are definitely looking to offer different services. They’re going to start offering different products that include medical tourism. Some may even provide incentives to members based upon cost reduction. It may be in the form of a rebate or a discount or something else, but they’re definitely looking for ways to push members in that direction.

MTT:Do you see care on the local level being affected?

JV: Most providers won’t be directly impacted. Most simply don’t see themselves as competing globally. They’re more concerned about competing with the hospital across town. The major academic centers will be the ones most concerned. They’re the ones already operating in that arena and with market share to lose.

It’s possible some local providers might find themselves losing referrals if they’re in a market with organizations that practice globally. Patients, payers and employers are going to be looking for alternatives and they might feel that to some degree.

BC: The major players who will be focusing globally will be working with their providers – they may even transplant doctors across the globe to ensure a standard of care is adopted across the world under their umbrella.

MTT:Let’s talk about those organizations that will be seeking to operate internationally. What are the kinds of things that they’ll need to be alert to or sensitive to consider?

BC: Clinical organizations that are providing services abroad are going to have to understand how to process the local currency. You’d think that everyone should know how to do that, but when you look back at when the first businesses went global, this was the first issue they had to contend with and it was a real obstacle to getting business going.

The other big area of concern is cultural issues. We need to be thinking about when a patient goes abroad, they need to be educated on what to expect. They need to know if they’ll have to stand in a line. The care is going to be different. They’ll need to know that and they’ll need to know how to interact with the people in a different culture.

For example, I was going to Tokyo for business and had scheduled a dinner with a group of business people. Before going, I had to learn how to interact with this group of people in this particular setting. There was the question of when to sit, who to talk to, when to get up, and so forth. And that’s just for dinner. Imagine the education that will be needed to undergo a major operation!

MTT:What new types of related business or services might you expect to see evolve as the industry grows?

JV: In terms of new businesses or services, I think we can expect to see growth in the areas of international facility planning and construction. We’re currently handling requests for proposals to assist companies looking to go global. Some are already to the phase of looking at architecture needs. Some are still in the strategy phase. We’re helping them look at whether or not going global is an appropriate response to a competitive threat or if it’s in line with their larger corporate goals.

I also think we’re going to see an increase need for more staff resource planning and retention.

In the past, US providers have relied heavily upon individuals trained in other countries. You’re likely to see more of those clinicians choosing to stay at home and graduates of US medical schools may opt to practice abroad. This could have a very negative and serious impact on the labor supply of critical clinicians.

BC: In terms of growth opportunities, I see telemedicine as a big one. You’re going to see more consultations from afar taking place as organizations try and connect with each other. I think we can also expect to see health plans offering telemedicine as part of their new products.

Additionally, there’s a significant new sales channel arm being created. As mentioned before, we’re seeing more and more people promoting services here in the US. They’re reaching out to both employers and health plans.

I think we can also expect to start seeing provider organizations begin offering concierge services for patients. By handling their travel accommodations, their transportation in the area they’ve traveled to, etc., they make it both easier for the client and they ensure that everything is appropriate to the type of care needed or received by the patient.

MTT:What are your biggest concerns or cautions about the industry?

JV: The whole issue of privacy and security of patient data is of major concern across the board in the US. When you take it across borders, you then have to ask who has access to my personal health records? How can you guarantee it’s secure?

We really need to be prepared to address threats, both real and perceived, regarding patient data.

For providers and organizations setting up practice or partnerships abroad, I think it’s critical that they have a crystal clear understanding of the legal requirements of the country where they are providing care. They need to understand the requirements and balance them with US requirements.

BC: I also think there’s some concern on the patient safety aspect. In the US, there’s a huge emphasis on the number of errors that occur in a facility, the number of infections, and so on.

When traveling abroad, the standards of care for patients are more important. We need to consider the type of travel that will occur and the patient’s condition. Furthermore, are the standards of care where they’re headed the same as our own?

What we don’t want is the incident rates in US to rise related to problems of care received abroad when the patients return.

I think we also need to begin managing patient expectations. People, especially those who have never been abroad before and now find themselves going for the first time for a medical procedure, don’t know what to expect. We’ll need to rely upon the people making recommendation for travel abroad to make the effort to provide that education to patients. Otherwise, the feedback on the experience could be greatly negatively impacted -- not to mention patient recovery.

However, if we think about it as an opportunity, there are a number of content providers that provide information on procedures. We could see those content providers or others creating new content that will explain specifically what’s going to happen to you when you travel abroad, specific to different countries, and so forth.

JV: Credentialing, of course is a big concern. Patients will be looking for some assurances from the JCI or elsewhere, that the quality of care is as good or better than here in the US. The credentialing process will provide that assurance that the standards of care are what’s expected and desired.

MTT:Thank you both for your time and insight. It’s been most informative and best of luck with efforts to help your clients grow internationally.

My introduction to medical tourism came about four years ago when, as outside legal counsel for a national Third Party Administrator (which administers health insurance plans for both self funded employers and insurance companies), I was asked to take a look at the liability involved in sending people overseas for healthcare. My initial reaction was, “Why would you want to send anyone overseas for healthcare when we have a perfectly good healthcare system right here with state of the art equipment and the best medical schools money can buy?”

When it was explained to me that over 50 million people were uninsured and that employers were canceling health plans because they had become so unaffordable, needless to say I was shocked. What in the world has happened to our country that we are sending people overseas for care? The more I learned about the high quality of care, affordable prices and in some cases, more experienced surgeons with procedures unavailable in the U.S., the more I was intrigued. As I evaluated the legal arena of this industry, I came up empty handed. Literally, there is no case law on this phenomenon. That is not only a good thing, but a great thing. Preventative law is my expertise. My litigation background has shown me one valuable lesson for the average client. Avoid litigation at all costs. It is costly, it is time consuming, and it rarely is extremely successful. What is never considered when evaluating the true amount of a successful “win” is the emotional costs, the value of time lost, and the toll it takes on the parties involved, their families, and their careers.

So when I was asked to speak at a medical tourism conference in Goa, India, I was excited to have the chance to share “preventative law” with others. What are the risks? How do I avoid litigation? If I am sued, what are my defenses and how do I defend myself before getting sued? First, it was necessary to explain the American Legal System for anyone to have an idea of what those risks are.

As more patients travel abroad for healthcare, the probability increases that a patient will have an adverse result. In the United States, we are a litigious country and access to the court system for plaintiffs is extremely easy. Therefore, an adverse result generally will result in litigation against all parties involved in the care of or arrangement of care for the patient. This is just how our system is. Attorneys may be liable for legal malpractice if they do not bring the claim against the proper responsible party.

The U.S. Court System is comprised of federal courts and state courts and even if a claim is brought in Federal Court, state law shall apply in claims of medical malpractice or negligence. Each state has its own legislative laws and case laws. Judges interpret these laws. If there are no state laws, common law applies, which affects the outcomes of the cases in various ways. What is the law in one state is not necessarily the law in another state and outcomes can vary even in different counties of the same state. Of course then you have judicial interpretation of preceding case law and the application of the facts applicable to the current case that leads to unpredictable outcomes. Finally, there is no case precedent for the global healthcare context in the U.S. and the results of a particular claim are speculative.

It is this speculative approach that evaluates theories of liability and the possibility of whether a particular claim could be brought against a particular defendant in a particular set of circumstances that this column addresses. Putting into place some cost-effective risk reduction measures is worthwhile and does not outweigh the financial reward of attracting American patients overseas for healthcare.

So what is the incentive for an attorney to bring a legal claim against a foreign defendant in the U.S.? In the first place, the incentive for patients to bring action against a foreign hospital provider in a U.S. Court is very high because U.S. Courts and juries award high judgments and attorneys look for “deep pockets” to pay for injuries. It is typical for attorneys in the U.S. to bring a claim against any party involved in the adverse result. This may include the physician, the hospital and the medical tourism company that arranged the travel. Often times, because defending cases in the U.S. is expensive as each party is responsible for their own attorneys’ fees, an attorney is able to achieve a settlement from the foreign defendant as a matter of convenience and cost savings to the foreign defendant. This is considered the win-win approach for many attorneys who would like to avoid long, costly litigation when in the end it is uncertain whether a judgment received in a U.S. Court could even be enforced against the foreign defendant.

This being said, it is in the best interest of the foreign provider to take steps to assess and reduce risk and make every effort to defend itself on the jurisdictional ground so even if a claim is brought against it, the case may be dismissed because the U.S. Court does not have the authority over the foreign defendant.

In order for a plaintiff (patient – claimant) to bring a claim (legal action) against an overseas hospital, the plaintiff needs to establish through his attorney and his legal complaint that the U.S. Court has “jurisdiction” over the hospital. This means the U.S. court must somehow have authority to impose liability upon the hospital. Jurisdiction may be established in various ways. The most common way is through “personal jurisdiction.” Personal jurisdiction means authority over the person (or entity) regardless of location. This means the U.S. court would have authority over the hospital regardless of where they are located.

How does this happen? How could a U.S. Court have any authority over a hospital located overseas? In an attempt to attract international patients, hospitals advertise through direct marketing, indirect marketing and internet marketing to increase the number of patients they attract overseas. Through advertising, hospitals or medical travel companies may be establishing what is perceived to be “business operations” in the U.S., thereby exposing themselves to legal jurisdiction within a particular state in the U.S. or many states. Many hospitals open U.S.-based liaison offices to handle American patients going overseas to their hospitals for care. Does an office in the U.S. establish jurisdiction in the state where the office is located? If a foreign Defendant creates a U.S. based corporation, it exposes itself to jurisdiction in the state where the corporation is incorporated and also the state where its principal place of business is located.

In the U.S., we have what is known as Long Arm Statutes. Long Arm Statues permit courts to exercise personal jurisdiction over nonresident defendants who “transact business” or “regularly solicit business” in a particular state. States may use these long arm statutes to attempt to impose jurisdiction on a foreign defendant. Affiliating with U.S. physicians for continuum of care may affect jurisdiction. Case law now finds jurisdiction in situations involving internet marketing depending on the amount of interaction the plaintiff and defendant have through a particular website.

Medical Tourism Companies located in the U.S. referring patients to a foreign provider may expose the provider/hospital to jurisdiction within the state where the medical tourism company solicits business. Case law varies on this issue. For example, in the case of McLenithan v. Bennington Community Health Plan, a New York Appellate Court held it had jurisdiction over a Vermont physician because he “interjected himself” into the NY service economy by contracting with a NY HMO that consisted of NY residents. Similarly, a U.S. Court could find that it has jurisdiction over a foreign physician or hospital because, as part of a network of providers of the U.S. based medical tourism company, the foreign doctor “interjected” himself into the state service economy.

What about theories of liability? There are various theories of liability that exist in some states that may be used in the context of medical tourism. Medical tourism plaintiffs will likely attempt to hold a medical tourism company liable for including a foreign provider in their network that the plaintiff alleges is negligent under a theory of liability called negligent referral. It is possible that a medical tourism company could be held liable for placing physicians in their networks of providers that they knew or should have know were substandard, had insufficient backgrounds to be performing certain procedures, or had questionable backgrounds. If with the exercise of some due diligence the medical tourism company could have found out a physician was not up to par and did not, it could be held liable.

What about foreign hospitals? In some states, hospitals have been found liable for negligently hiring or negligently retaining incompetent physicians or for failing to adequately supervise them. This form of liability is referred to as corporate negligence. What if there is no other theory of liability under which a plaintiff could recover for damages? A state court may decide to hold a hospital liable under this theory if the plaintiff has no other theory of liability under which to recover in a foreign court, asserting jurisdiction in the U.S.

This idea of “no other adequate recovery” will be covered in Part II of this column. Also to be covered will be more theories of liability for both hospitals and medical tourism companies, the idea of public policy, defenses to jurisdiction and prophylactic measures to litigation in the U.S.

Remember, this column is for the purpose of awareness, and not meant to scare or deter anyone from attracting American patients. If you exercise the highest quality of care and take appropriate measures to protect yourself, this industry will produce win-win scenarios for everyone.

Renée-Marie Stephano is General Counsel and Director of the Medical Tourism Association, Inc., an international non-profit organization that serves international healthcare providers and medical travel facilitators in the global healthcare industry. Renée-Marie is an attorney licensed to practice law in the states of Florida, Pennsylvania and New Jersey and has a background in litigation and health law. She is also Editor of the Medical Tourism Magazine, a monthly journal serving the global healthcare industry by free subscription at www.medicaltravelauthority.com. Renée-Marie may be reached at Renee@medicaltravelauthority.com.

PERSPECTIVES

Predictions for 2008, by Ruben Toral

Ruben Toral is a recognized leader in medical tourism and healthcare globalization. Formerly Group Marketing Director for Bumrungrad International, Toral is widely recognized as one of the driving forces behind medical tourism and Bumrungrad’s position as the world’s premier medical tourism destination. Now owner and operator of a healthcare marketing company, Mednet Asia Ltd., Toral has extensive healthcare experience.

Medical Travel Today recently asked Toral if he would be willing to share his perspectives on the growing industry with our readers. He kindly accepted and his contributions will appear on a monthly basis beginning in this issue with his predictions for 2008.

Ruben Toral, CEO and Founder
of Mednet Asia Ltd.

Predictions for 2008

Ruben Toral, Chairman of the Global Care Summit and CEO of Mednet Asia

1. The term “Medical Tourism” will be replaced by “Global Care”. While catchy and frequently used by the media to describe people traveling from developed countries to developing countries for lower cost surgical procedures, the fact is that the term “medical tourism” was not universally liked or accepted, especially by many in the international provider community, because it simply did not reflect the reality of cross border care.

“Global Care” recognizes that globalization is significantly changing the way healthcare is bought, sold and delivered around the world. Medical tourism and medical travel are only small parts of this larger globalization process that will lead to more innovation, more choice and more direct consumer involvement. Information technology and the web are flattening the world we live in and healthcare will be just one more industry that will be flattened in the process.

Healthcare is changing. Today, someone sitting in their home can use the web to access information about their specific disease condition, contact a doctor or hospital halfway around the world for treatment options and prices, and book their appointments and travel on line. That’s consumer driven choice and this will ultimately lead to more choice, better access and affordability.

2. Insurance companies will develop new ‘global choice’ care plans. These plans will offer a global provider network consisting of top quality international medical centers in Asia, Europe and Latin America for customers who want the option to travel overseas for specific medical services in exchange for lower premiums, co-pays and deductibles.

The real opportunity with these global choice plans is to bring the under-insured, the self-insured and small businesses back into health plan coverage by making it more affordable. Individuals and corporations alike are looking for more options, and right now the insurance industry is focused on selling a high cost, premium product which is beyond the reach of tens of millions of their customers. By adding new products that take advantage of global network of providers that can provide surgical services at 50%-80% cost savings, the insurance industry has a real opportunity to grow their customer base.

Aetna, Blue Cross, United, Mercer and Tower Perrins are among the many blue chip companies looking at options or deploying initiatives to offer a wider range of choice to their customers. They are moving cautiously; however, as no one wants to be the ‘bleeding edge’ of this movement, but healthcare costs will ultimately have a greater impact on corporate and household budgets than even the price of oil.

3. US providers will begin to look overseas for new business and expansion opportunities. US healthcare providers are beginning to understand that global care is a two way street and they have a ‘world of opportunity’ beyond their borders.

US healthcare providers, by and large, have viewed medical tourism as a threat to their industry. The prospect of tens or hundreds of thousand of Americans traveling overseas for lower cost medical care is not appealing to the AMA, the AHA, politicians and unions. But the US is a recognized center of excellence in medicine, research, technology and education, and the global market opportunities are seemingly endless for US providers that are willing to venture beyond their shores.

Take GM and the auto industry as an example. For decades, GM ruled the roost in the automobile industry, focusing virtually all of its resources on designing big cars for the US market until the oil crisis hit and Japanese manufacturers started to enter the market with more innovative models. GM struggled for decades to adapt. At first they denied the trend, and later they fought against it, but ultimately they understood that they needed to change and focus on developing products for a global market using a global platform. Today, GM makes money in China – not Detroit – because Asia is a higher growth lower cost environment.

The same lesson applies to US healthcare providers. Healthcare is a growth business, particularly in developing markets like India and China, where demand far exceeds supply. By acting smart, US healthcare providers can take a page out of the automotive playbook and begin developing global research and development, education and treatment platforms internationally using their vast experience and brand power.

IMS Global Limited: A Three-Part Series on World-Class Care in Israel

Ira Nissel, CEO
IMS Global Limited

Editor’s Note:Israel has been getting a lot of good press lately as an emerging medical destination. Medical Travel Today decided to take a closer look at this destination and at one company in particular: IMS Global Limited, www. medicaltourismforyou.com which represents leading medical centers in Israel including:

Assuta Medical Center
Assaf Harofeh Medical Center
Atidim Medigroup Hospital
Chaim Sheba Medical Center
Dana Children's Hospital
Edith Wolfson Hospital
Hadassah Hospital
Herzliya Medical Centers
Lowenstein Hospital Rehabilitation Center
National Institute for Rehabilitation of the Brain Injured
Rabin Medical Center
Rambam Medical Center
Ramat-Aviv Medical Center
Sapir Medical Center, Meir Hospital
Shaare Zedek Medical Center
Schneider Children's Medical Center
Soroka Medical Center
Tel-Aviv Sourasky Medical Center

Less than a year old, IMS is working hard to redefine medical travel for consumers and establish itself as a true medical services company in ways that reach well beyond traditional medical travel.

In our discussions with the company’s CEO and founder, Ira Nissel, we found there was a lot to tell. And so, this is the first part of a three part series to explore how he got started, how he’s seeking to define and establish Israel as a destination, including key areas for care.

MTT: First, thank you for agreeing to speak with us. Let’s start with some background information. How long have you been involved in medical tourism and how did you initially get involved?

IN: I guess it all started back in 2004 when I was in Turkey setting up an emergency response business. In addition to running the business, I was also looking into two niche markets: children and severe burns. There really wasn’t anywhere for people to get this kind of care in Turkey. So I started looking into options to send Turkish citizens to Israel. At some point, someone suggested to me that I really ought to look into establishing a medical tourism company to facilitate coming to Israel for medical procedures.

The idea was intriguing, but I knew I needed more information before trying to start something. So I spent the next two years doing research and focusing on how I envisioned setting up a company. I spent a lot of time building relationships with Israel’s 18 internationally recognized medical centers, university hospitals and private clinics , figuring out how we’d connect and what services they could provide at a truly world-class level.

One thing I recognized was that this needed to be and to look first and foremost like a medical company rather than a tourism or travel company. In fact, I dislike that term of medical tourism. I think it minimizes what’s really taking place and does nothing to build consumer understanding or confidence that they’re getting—or should be getting— quality care.

Add to that the fact that for many people, especially psoriasis patients, traveling to Israel for medical care means going to the Dead Sea. In setting up the business, I knew I would have to reprogram people’s percepts of what kind of care you can get in Israel.

The truth is, Israel has some of the finest medical care available in the world. In fact, one of the medical centers in Israel that IMS represents was named one of the top ten centers for care in the world by Newsweek.

MTT:You opened your doors eight months ago. How are things going and how do you think you’ve done in terms of setting new expectations for patients?

IN: Well, we’re taking on a lot of patients. We’ve got a network of offices, partners and affiliates in sixteen countries (our channel partners in these countries range from Ministries of Health, Private clinics and small boutique medical centers, key opinion leaders in domestic medicine, travel agents and even the Israeli embassy send referrals to IMS when a local citizen comes in to get information about medical care in Israel) and I think we’re taking the right approach to handling patient care and expectations. We really control the entire patient experience.

For example, this program is on the commercial side of IMS, we have our country partners arrange for at least 20 patients to see a doctor and then fly the doctor in for a weekend consultation. This side of the business is less interesting to the average person, maybe our potential partners would be interested but… we do this to a) strengthen IMS’s image and presence in that particular country b) we make money and the whole process is relatively inexpensive c) we screen patients before they come so we don’t take terminally ill patients who we cannot treat d) psychologically it helps us overcome the questions of why the patient should come to Israel.

And I should mention that’s one of the things that is unique about Israel and IMS: we’re in the enviable position of pulling people into Israel for care. We’re able to provide an extra level of care (TLC, up-close and personal, family oriented) because this is where we live and operate. We’re not pushing patients abroad and try to make arrangements long distance. We’re bringing people here; we’re getting them the care and everything else they need to make their stay as comfortable, enjoyable and memorable as possible. You know, we speak the language, we know the right people, and we’re here to solve any issues before they really become issues.

In that way, we’re also becoming a medical tourism company for other medical tourism companies. We’re able to help them solve problems they can’t solve themselves.

From a business perspective, we think this also helps establish us as a medical services company and not just a medical travel organization

MTT: On your Web site you feature four key areas of care: Pediatrics, Fertility/infertility, Adult advanced Medicine and Women’s Health. I’d like to begin with Pediatrics. What can you tell us about what you’re doing in this specialty area?

IN: Sure. This is a really big area for us and Israel. Due to the small population, Israel has excelled in child care and fertility. We work with four internationally accredited pediatric medical centers in Israel along with two other reputable medical centers who have developed children’s departments. Because of the caliber of care they offer, we get referrals from all over—Asia, Africa, Europe, Turkey, Jordan, Belarus, Moldavia, Ethiopia, Ukraine, the US, and other places. The level of care we provide, many of the countries I mentioned simply don’t have. One of the Children’s medical centers is the largest in the Middle East receiving children from Iraq, Iran and even Pakistan! Another works with the WHO and FDA consulting on infectious diseases.

Part of our success is that we’re the only medical service firm providing multidisciplinary, comprehensive care solely to children. The centers we work with are focused on children and only children. The technologies they’re using, the approaches they’re taking, the treatments they’re applying, are all designed specifically to care for children. They’re not adapting things from adult care to child care. This is what they do. And they’re the best pediatric specialists that Israel has to offer.

Editor’s Note: In our next installment we will take a closer look at the client services side of IMS and Fertility.

About Ira Nissel
Ira Nissel is the founder and CEO of IMS Global, Inc., a global health care firm specializing in medical travel to Israel (www.medicaltourismforyou.com). Prior to founding IMS, Nissel honed his blend of business acumen and altruism as part of an emergency response system in Istanbul, Turkey. In that capacity, he established and served as general manager of Nexus Health and Technology, Inc., an organization that provided front-line relief services for the elderly, children, and foreign citizens, among others. In only its second year, Nexus numbered more than 3,000 members and had revenues exceeding $1.3 million.

Previously, Nissel served as the Corporate Director of Business Development & Sales for InkSure, Inc. (INKS), an OTC forensic security technology firm with headquarters in Israel and the US, and worked for several international companies specializing in security technologies and products.

Nissel can be reached at: ira.nissel@medicaltourismforyou.com.

11% of Organizations Pay Expenses Related to Medical Tourism
Survey reveals the breadth of health care benefit offerings

Brookfield , Wisconsin —Health Care Benefits: Eligibility, Coverage and Exclusions, a new survey published by the International Foundation of Employee Benefit Plans, looks at health care coverage of employees and dependents, and provides details on covered health care benefits.

"Due to the rising costs of health care benefits, employers are challenged to find a balance between cost-effective care and the level of benefits needed to successfully recruit and retain valuable workers,” said Julie Stich, Senior Information/Research Specialist at the International Foundation. “Employers need to regularly look at the benefits they offer to make sure they're reasonable yet current and competitive."

Key Survey Results

Employees Eligible for Health Care Benefits

Almost all, 99.7%, of surveyed respondents (corporations, public employers and professional service firms) offer health care benefits to full-time employees and 49.9% cover part-time employees.

Dependents Eligible for Health Care Benefits

Nearly all, 99%, of the responding organizations cover adopted and biological children, while 74% cover stepchildren and 42% cover foster children.
A large majority, 92%, cover opposite-sex spouses, while 37.5%, cover same-sex unmarried domestic partners, 30% cover opposite-sex unmarried domestic partners and 28.8% cover same-sex spouses.

Health Care Services Covered

More than 98% cover: emergency room visits for life-threatening conditions, inpatient hospitalization coverage, inpatient and outpatient surgery, inpatient and outpatient physician visits, imaging and lab services, and intensive care services.
Medical tourism, a relatively new approach that involves an individual traveling to another country to seek medical care, is covered by 11% of surveyed organizations.

Complementary and Alternative Medicine Providers and Therapies Covered

Most respondents, 80.5%, cover chiropractic care expenses and about one-third, 33.5%, cover acupuncture or acupressure.

The survey also asked respondents about covered diagnostic tests, health care benefit exclusions, and additional coverage areas including inpatient and outpatient mental health services, annual physical exams, prenatal care, adult flu vaccinations, weight control surgery, smoking cessation programs, laser vision-correction procedures, organ transplants and health coaching.

Health Care Benefits: Eligibility, Coverage and Exclusions contains 22 sample health care policies and summary plan descriptions. The survey reflects responses from 400 U.S. corporate benefit managers, professional service providers, public employers and multiemployer plans.

Health Care Benefits: Eligibility, Coverage and Exclusions is 417 pages and is available in print (with the sample collection on CD-ROM) or CD-ROM. The survey costs $131 (I.F. Members $52). Order a copy online at www.ifebp.org/books.asp?6412 or call (888) 334-3327, option 4. Item #6412.

The International Foundation of Employee Benefit Plans is a nonprofit educational association serving the employee benefits and compensation industry. Total membership includes more than 35,000 individuals representing over 8,300 trust funds, corporations, public employee groups and professional advisory firms in the United States and Canada.

The agenda for the First Economic Times Medical Value Travel Forum to be held in Mumbai on January 23, 2008 has been announced. The theme of the conference is integrated ecosystem for consumer centric services and better value. Top decision makers from leading hospitals, tourism boards, travel and tourism industry medical assisting industries, alternative medicine centers, health and insurance providers, medical supply chain, IT industry, and respected industry analysts will be on hand to address important issues. Key sessions at the conference include:

To view a complete agenda and for registration information, email Suchita Tuli at suchita.tuli@timesgroup.com

The agenda has been set for Medical Tourism Asia 2008. Scheduled to take place March 25-28, 2008 at the Rasa Sentosa Resort in Singapore, this year’s event will feature more than 20 respected speakers addressing a variety of topics related to the rapidly growing market. Topics addressed will include issues related to both the public and private sectors, healthcare organizations and the travel sector, potential partnerships between players such as hotel chains, property developers, airlines, insurance companies, financial institutions, and more. Medical Tourism Asia 2008 will feature leaders from Asian and International Healthcare Providers:

Site Tour A: Khoo Teck Puat Neuro-Navigation Integrated Operating BrainSUITE :The World's First Digitally Integrated Neuroscience Centre

Site Tour B: Visit to The National Liver Transplant Programme Facilities at National University Hospital

Take advantage of our early-bird savings today and reap the benefits of attending the ONLY medical travel event you need to attend this year. To register, please call +65 65143180 or email rita.parasurum@ibcasia.com.sg

MyHealthGuide Source: Self-Insurance Institute of America, Inc. (SIIA), 1/16/08, www.SIIA.org

The Self-Insurance Institute of America, Inc. (SIIA) has scheduled a new international conference in Barcelona, Spain on June 10-12, 2008.

SIIA's Global Self-Insurance & Alternative Risk Transfer Executive Forum will highlight self-insurance and alternative risk transfer (ART) opportunities that are emerging on multiple continents. An internationally stellar cast of business leaders will lead seminars at the Hilton Barcelona Hotel.

This new stand-alone conference comes on the heels of a successful international track of educational sessions incorporated as part of the organization's most recent National Educational Conference & Expo, held last year in Chicago.

"Alternative risk transfer including self-insurance now comprise the majority of all property-casualty and employee benefits coverage plans in the U.S. and we expect that to expand to the rest of the world," said SIIA President Dick Goff in announcing the Barcelona conference. "In addition to a splendid educational and business development opportunity, attendees will have the opportunity to explore one of the world's richest cultural and historic centers," Goff added.

SIIA's International Committee has worked to develop a seminar program that will appeal to risk managers and professional service providers throughout the world. The committee members represent seven nations in North and South America, Europe, the Middle East and Asia.

"The emergence of seamless global communications technologies have enabled us to work together as easily as if we were present in the same room," said Committee Chair Brij Sharma, CEO of Tela-Sourcing, Inc. of Baltimore, and owner of a TPA in India.

"Our objective for the Barcelona conference program was to introduce self-insurance/ART strategies and coverage concepts to people throughout the world and to provide SIIA members access to markets and service resources that are available in other countries," Sharma said. "The conference represents a true global collaboration."

Global risk management leaders that will appear at SIIA-Barcelona include the following:

Interview with Josef Woodman, author of Patients Beyond Borders, Available Online Now

If any of these questions are of concern to you, you’ll want to listen to a recent interview with Josef Woodman, author of Patients Beyond Borders available at http://www.938live.sg/programming.aspx?Editorial_Id=9045 . In addition to these topics, Woodman speaks about these issues and more concerning patients’ choices of an overseas hospital or clinic.

For more in-depth discussion and thought leadership practitioners’ views and advice, join Josef Woodman and Asia’s healthcare CEOs leading the march in global healthcare at the Medical Travel World Congress 2008, Kuala Lumpur, Malaysia, 25-28 February 2008 (Crowne Plaza Mutiara KL).