Medical Travel Today

THIS WEEK IN MEDICAL TRAVEL TODAY
Volume 2, Issue 21
by Amanda Haar, Editor

Greetings,

Earlier this month the Medical Tourism Association (MTA) issued a press release (see PERSPECTIVES) announcing the creation of an accreditation program.

The release caught the attention of many in our industry, including Rick Johnson, senior online editor of HealthLeaders Media. Johnson published a piece on July 22, 2008, that raised some serious questions about both the value of the accreditation and the qualifications of the MTA as an accrediting body.

Representatives of the MTA did not respond to Johnson’s initial queries regarding the story but did follow up with him after its publication (see second item, PERSPECTIVES). Since that time Johnson has published additional excerpts of his conversation with representatives of the MTA.

Accreditation is serious business. In the same way that consumers benefit from an understanding of a hospital or provider’s qualification through a JCI or ISQua accreditation, there’s no question that they would benefit from a fair and objective assessment of patient services.

However, we must all be clear in stating our intentions and expressing our understanding of the goals of others. Creating confusion or distrust in the minds of consumers as well as our colleagues does absolutely nothing to further the reputation of the industry.

As always, we welcome your comments, story ideas, and press releases.

Cheers,

Amanda Haar, Editor
ahaar@cpronline.com

The Medical Tourism Association Announces Medical Tourism Accreditation Program

San Francisco, Calif., July 15, 2008 --(PR.com)-- Medical Tourism Accreditation.

The Medical Tourism Association announces “Medical Tourism Accreditation Program.” Information on accreditation is available at the new Medical Tourism Association website at www.MedicalTourismAssociation.com.

The Medical Tourism Association has launched “accreditation” to ensure the safety and overall positive results for patients traveling from one country to another. “Having the right processes and procedures in place to assist international patients has a direct correlation to better surgical outcomes for those patients,” stated Renée-Marie Stephano, Chief Operating Officer of the Medical Tourism Association. The accreditation for Medical Tourism Programs is critical to help patients, employers, and insurance companies identify which hospitals have the highest quality of care and the right processes and procedures in place to ensure patient safety during their entire patient experience. As the industry grows, there is a greater need to assure that hospitals, clinics, recovery centers, and facilitators entering the medical tourism industry have the proper patient management procedures to manage the patient experience before they begin their journey until well after they return home. These procedures should include proper communication, transparency in quality and pricing, informed consent, appropriate aftercare, and continuity of care once the patient returns home. The Medical Tourism Association Accreditation is not an identification of the quality of the surgeons or the facility outcomes, rather it focuses on the international patients’ services and protocols currently being utilized and marketed to foreign patients, allowing patients, employers, and insurance companies the ability to identify those organizations that are qualified to receive patients who are looking for specific medical tourism services.

The accreditation system will focus on the “medical tourism” aspect and is not intended to accredit quality or to replace any accreditation system. This new MTA Accreditation system “complements” existing accreditation systems currently in place.

International patients may have special needs and requirements different than domestic patients. Hospitals, clinics, and facilitators need to be able to accommodate different cultures, religions, language barriers, and other requirements. It is reasonable for patients to request and be provided with this information easily.

An accreditation panel made up of an international committee of healthcare experts will review each application and perform due diligence, investigation, and research to determine if the organization meets the standards and criteria of accreditation. Organizations that qualify will be given the “Medical Tourism Accreditation Logo” so that patients, employers, and insurance companies can be aware of the availability of certain services.

Updated 7/23/08—Any healthcare executive who has been through the rigors of international accreditation knows the course should be deliberately plotted—not only to ensure successful accreditation, but also because the method itself of measuring against quality and safety standards holds real value for the organization and its patients.

Just as no healthcare facility should take a slapdash approach to earning accreditation, no organization should claim to be an accrediting body without fully realizing and communicating its goals and standards to salient stakeholders. The Medical Tourism Association last week launched a new accreditation program "to ensure the safety and overall positive results for patients traveling from one country to another."

On its face, an accreditation program sounds like a fine idea for hospitals, clinics, recovery centers, and facilitators in the medical travel industry. This brand of accreditation could give medical travelers a degree of comfort that their healthcare experience will meet quality standards and provide continuity of care.

Renee-Marie Stephano, chief operating officer of the Medical Tourism Association, is quoted in the release as saying, "Having the right processes and procedures in place to assist international patients has a direct correlation to better surgical outcomes for those patients."

The prepared statement goes on to note that this new accreditation program will focus only on "medical tourism" and is not intended to accredit quality or replace any accreditation system; instead it complements existing accreditation systems that an organization might currently have in place.

I told David Jaimovich, MD, chief medical officer for the Joint Commission International, about the Medical Tourism Association's new program. He didn't have any inside knowledge of the association's plans but said that he thinks the Medical Tourism Association will find starting an accreditation program from scratch to be a daunting task. For example, he says it takes JCI about six months just to revise its existing standards. "It takes significant effort," he says. "Outsourcing these things is hard to do . . . to ensure quality."

In a phone interview yesterday, Stephano says the MTA's accreditation program should not be compared to the JCI or any other accreditor of healthcare quality. "We're working with establishing standards and best practices for medical tourism companies, for hotels, clinics, and hospitals specifically in the area of international patient services, which includes facilitation services, communication services, and informed consent forms," says Stephano. "It is procedural and does not involve at all infection rates, quality indicators, or anything that the JCI or any other accreditation system is doing."

I went to the Medical Tourism Association's website to see if I could find specific details about its standards and process for granting accreditation to medical travel organizations, but I came away with more questions than answers. A page about the accreditation program was easy enough to find on the site, but it amounts to a sales pitch about the "benefits of accreditation" without many specifics. A link that says it will take me to a list of MTA-accredited organizations claims the list will be available soon.

Stephano told me that the listing is blank because the MTA has not yet begun accrediting organizations. But the accreditation standards have been finalized, and she expects to publish them on the Medical Tourism Association's website within two weeks.

A member of the association's quality committee says the MTA's leadership never shared plans to roll out an accreditation program. The committee had been working on developing core measures for safety, quality, and patient outcomes, but nothing has been finalized, says the committee member.

Sharon Kleefield, M.A., Ph.D., told me she was approached by Stephano last fall to join the MTA's quality committee. Kleefield is a Harvard University faculty member who has worked with international systems to develop quality metrics. She says she was surprised to read about the Medical Tourism Association's new accreditation program in the press release and on the association's website.

"I'm unaware that they have the expertise and resources to build the required infrastructure," says Kleefield. "You can't just declare that you're going to be an accreditor."

Stephano says Kleefield and others have been working on the association's "quality indicator project," which is completely separate from its accreditation project. She says that in order to receive accreditation, medical tourism organizations must complete a detailed application and interview process. MTA's evaluators, under contract with the association, must then determine whether the applicant requires a site visit. If organizations do not meet the MTA's standards, the association "will work with them to help them develop what they need to develop to achieve accreditation," Stephano says.

Although the concept of medical tourism certification is a good one that could promote industry best practices and help ease barriers to medical travel, the announcement of this accreditation program -- without releasing specifics -- is at best premature. When the details are published, it will be up to the healthcare industry to decide whether this program measures up.

In next week's HealthLeaders Media Global, I will share more from my interview with Stephano. She answered many of my questions about the association's new accreditation program, including:

Jim Arriola
President, Sekure Healthcare

Recently, Forbes magazine featured a story on a partnership between CHRISTUS Muguerza and Sekure Healthcare with the IntelHealthGroup.

The partnership is noteworthy in that it allows Sekure Healthcare members to utilize their insurance benefits at CHRISTUS Muguerza Alta Especialidad Hospital in Monterrey—Mexico's first hospital accredited by the Joint Commission International.

For its role in the partnership, IntelHealthGroup will facilitate medical travel for Sekure Healthcare Members, a service it has been providing to cross-border healthcare travelers for the past year.

Dr. Jamie Zozaya
IntelHealthGroup

Medical Travel Today recently had the opportunity to speak with Jim Arriola, Sekure Healthcare, and Dr. Jaime Zozaya, IntelHealthGroup, about this unique partnership and its origins.

Medical Travel Today (MTT):While this news of your partnership is late-breaking, I suspect it’s been a long-time in the making. Can you tell us how it came about?

Jim Arriola (JA): You’re right. Jaime and I have known each other for the past twelve years, and I had a great comfort level with him. His reputation in the industry is simply stellar. When Jaime approached me with this opportunity in the fall of 2007, I didn’t hesitate.

MTT: So Jaime, you initiated the relationship?

Jaime Zozaya (JZ): Yes. We (IntelHeatlh) had been facilitating cross-border care for two years prior to this partnership.

Originally, the company was created to provide consultancy services for the healthcare sector in Mexico, with just one business unit focused on medical travel.

However, we started to recognize the needs of Latin American patients coming from Miami to Mexico for care. We thought it was important to establish a specific process that reviewed all the quality and safety problems for patients so that they’d be assured of a good experience and the best quality care.

You see, there are a lot of care brokers out there, but brokers don’t assure that patients are getting the right service. We decided to make a formal review of physician credentials and ask hospitals to comply with some specific requirements, including:

Credentialed and certified physicians
Hospitals certified by the National Health Council (an independent council that stems directly from the office of the Mexican President)

We then started to review the infrastructure in Mexico and sought partnerships with the larger hospitals, the first of which was CHRISTUS Muguerza. CHRISTUS Muguerza is the clear leader in Mexico and the first JCI-accredited hospital. Working with them was both natural and essential.

We now have relationships with hospitals in Mexico City, Guadalajara, Monterrey, and along the border.

As all this was coming together, I started talking with Jim about what we were doing.

JA: Right. Tangentially, Sekure had an interest in medical travel. Our main focus is providing affordable healthcare coverage to employers. When you’re looking for low cost plans geared primarily toward low-wage earners, cross border care becomes very important not only because of cost savings but also because of cultural considerations.

I had been watching the trend of medical travel for quite a while and felt that the additional benefit of a JCI facility in Mexico would really help to differentiate us from other cross-border coverage plans. Plus, it’s clearly going to be of growing interest to employers.

We’ve had a lot of medical travel companies come to us seeking a partnership, but we selected IntelHealthGroup for a number of reasons.

First, Jaime is a medical doctor, not a travel agent. Second, he’s consulted with a lot of hospitals and has good relationships with the Mexican officials. We obviously wanted to work with folks who are in good standing with the highest authorities in Mexico. And, finally, because of his high integrity and ethics, I know he will always do what’s best for the patients

The importance of this for Sekure is to be the first health coverage program to connect with CHRISTUS Muguerza. We wanted to be first in the market to have a program in place…there are a lot of employers interested in this kind of access to Mexico. The vast majority of the Hispanic market segment is perfectly fine with the idea of going to Mexico for healthcare. For this segment, JCI isn’t that important. However, it is important to the non-Latino consumer segment. With CHRISTUS Muguerza, we’ve got it covered.

You know, there’s been a lot of medical travel going to the Far East. But honestly,
on the economics and quality side, I think Mexico is the sleeping dragon of medical travel.

It has the proximity to the United States working for it -- plus, the emerging medical clusters that Jaime is working on in Baja, Monterrey, Campeche, and so forth. As it starts going from fragmented “mom and pop” health centers to integrated quality institutions, it’s going to grow very big. The opportunity is enormous.

JZ: I agree, but I also think that in order for Mexico to make the most of this opportunity, Mexico as a country has to articulate to all the players inside the health sector the need to standardize the services. That’s essential to becoming a good choice for the United States and Canada.

Right now, the government isn’t really focused on it. There have been big discussions between hospitals and companies such as mine. But so far, the government doesn’t understand the concept. For them, health is first a social issue and then a market opportunity.

I’ve been spending a lot of time talking with the government. The tourism counsel is reviewing the concept, and I hope that in less than a year they’ll be fully involved in the process.

We really need to recognize it as an economic issue and then we need the structure to execute. We need to create and establish our main players in the health sector so that we can really seize the opportunity.

JA: I think the big thing that’s going to rocket Mexico into becoming an important medical travel destination is approval of stem cell therapies. This is going to be huge. You’re going to see a lot of people from the United States becoming much more open to the notion of medical travel both for cost savings and for procedures not presently available in the United States.

About Jim Arriola

Jim Arriola is the CEO and president of Sekure Healthcare. Sekure Healthcare provides healthcare coverage solutions to employers who cannot afford comprehensive, major medical insurance. A West Point graduate, Arriola has an M.B.A. from National University and a Masters Degree in Human Resources from Chapman University. He has more than 15 years experience in the healthcare market and has worked with business leaders, government officials, and regulators on both sides of the border. He was a former creator and director of Blue Shield’s cross border health plans. He can be reached via email at:Jarriola@MySekure.com

About Jaime Zozaya

Jaime Zozaya, M.D., is the general director of IntelHealthGroup S.C. Prior to his current role, he served as the president and chairman of the board DeBBioM, a company that specialized in Biopharmaceutical Services. He can be reached by email at: jaime.zozaya@intelhealthgroup

INDUSTRY NEWS

Swiss Re's Commercial Insurance Launches Medical Travel Insurance Offering

OVERLAND PARK, Kan., July 22 /PRNewswire/ -- Swiss Re's Commercial
Insurance announced today they now recognize medical travel coverage as
part of their existing stop-loss offering. Employer stop-loss is available
in all 50 states and the District of Columbia through Westport Insurance
Corp., a member of the Swiss Re Group, which underwrites the company's stop-loss products.

"By recognizing medical travel coverage offered by our self-funded
stop-loss employer client base, we facilitate the availability of
top-quality healthcare at more affordable levels than is possible in the
United States," says Matt Leming, vice president and sales leader within Swiss Re' s Commercial Insurance division.

A dramatically growing number of uninsured and underinsured U.S.
patients are traveling to countries with high-quality hospitals and staffs
that offer services at costs often significantly lower than those available
in the United States. Heart by-pass surgeries by highly trained surgeons in India may
cost only $10,000 as opposed to $130,000 in the United States. (TIME, "Outsourcing
Your Heart," May 21, 2006). Similarly, high quality hip replacements and
other major medical procedures can also cost far less in selected countries
overseas than in the United States.

Swiss Re has selected WorldMed Assist (http://www.worldmedassist.com) as the
third-party medical logistics provider to manage its medical travel option.

"WorldMed Assist is honored to have been selected by Swiss Re to
provide logistical assistance for clients utilizing their medical travel
benefits. This is another opportunity to fulfill our mission of improving
lives by helping patients receive high quality medical treatment at
international facilities at affordable prices," said WorldMed Assist CEO
Wouter Hoeberechts. "This agreement is new to the U.S. marketplace. Swiss Re
will be the first carrier to recognize medical travel coverage on a
national basis."

WorldMed Assist, as Swiss Re's medical logistics provider, will ensure
that strict standards for the level of care offered by the medical staff,
the hospital, clinic, and any recuperative care facilities are followed.
Selected medical facilities will have to meet the criteria of the Joint
Commission International (JCI) and/or an equivalent accreditation.

Coverage will be coordinated with the employer's primary policy and
with the patient's primary physician in the United States. For more information about
Employer Stop-Loss or to be directed to a licensed agent, contact Swiss Re
at 1-866-266-0902.

"This non-traditional alternative will create a win-win situation for
both our self-funded policyholders and their employees. We believe this is
one way to address rising healthcare expenditures in the marketplace," says
Leming. "When our program is fully utilized, it will enable our
policyholders to cover their employees more completely and at less cost. It
will also allow employers to offer another quality network and more choice
to their employees".

First Opportunity for U.S. Consumers to Explore Medical Travel: The Medical Travel RoadShow Debuts in Six U.S. Cities

RICHMOND, VA, DALLAS, Texas, and AUSTIN, Texas, July 23, 2008 -- U.S. residents will have their first look at the vast array of options for accessing high quality medical care at significantly lower costs when the Medical Travel RoadShow makes its first stops in six cities hosting Your Health Expos www.themedicalroadshow.com:

- Saturday, Sunday, October 25-26, 2008, Hilton DFW Lakes, Dallas, Texas
- Saturday, Sunday, November 1-2, 2008, Renaissance Hotel, Austin, Texas
- Saturday, Sunday, December 6-7, 2008, Hyatt Regency Crystal City,
Arlington, VA
- February 21-22, 2009, Sheraton Mart Airport, Miami, Fla.
- February 28-March 1, 2009, Orlando, Fla., location TBD
- May 8-9, 2009, Marriott Hotel & Marina, San Diego, Calif.

"Medical tourism is an important trend and top-of-mind for U.S. healthcare consumers," states Skip Brickley, director of The Medical Travel RoadShow and Your Health Expos, citing a recent Deloitte study showing that nearly 40 percent said they would travel outside the country for medical treatment if the quality was comparable and the cost was cut in half. "Texas was a logical location to kick-off this year-long schedule of medical travel and consumer health expos based upon the high level of interest among Texans for traveling to nearby destinations in Central and South America as well as Asia, New Zealand, Israel, and other countries for documented high-quality care at a fraction of U.S. costs."

Brickley explains that hospitals, providers, medical travel experts, spas, and wellness centers throughout the world will be on hand to offer education and guidance.
"This is the first series of shows to showcase these types of participants, and we look forward to meeting residents from all the states on our consumer health tour," says Brickley. "A key component will be providers who perform cosmetic and elective procedures, since these surgeries are generally not covered by health plans."

These tours are focused on helping consumers find affordable healthcare solutions, and traveling overseas for medical care is a safe and high-quality option for all U.S. consumers. Brickley says that Americans are ready to take advantage of the benefits of medical travel and anxious to learn more about the latest developments in health and wellness. Attendees will have the opportunity to take part in a wide range of health and wellness activities, including personal visits with medical travel facilitators and providers; free health screenings; meetings with on-site personal trainers; and opportunities to learn more about healthy eating.

"These expos are designed to meet the needs of all age groups and will be particularly valuable for those who do not have sufficient health insurance," says Brickley. "There will be a wealth of resources on hand to help people discover their options for specialty care, including orthopedic, cardiac, dental, bariatric, and cosmetic surgery. Today, Americans are also interested in opportunities to access care that is not available in the United States, such as stem cell transplantation, organ transplants, as well as lower cost in-vitro fertilization (IVF). People are amazed that these options now exist."

Expo visitors can also take advantage of health screenings, including blood pressure and cholesterol testing, disease management counseling, healthy nutrition, fitness, and exercise coaching. Giveaways and prize drawings will supplement the informational and educational experience.

Steven Tucker, M.D., president of the International Medical Travel Association (www.imta.org) and a leading U.S. board-certified medical oncologist, adds, "As the fast-growing sectors of global healthcare and medical travel begin to influence patient choices, there are often more questions than answers. Your Medical Travel & Health Expos are designed to address every aspect of this important topic and provide a venue for better understanding of healthcare and the growing number of medical care options around the world."

Registration for the expos will soon be active. For general questions or assistance with registration, please contact Willie Moreno at 804.266.7422 ext. 7408 or willie@transmarx.com. Admission to Your Medical Travel & Health Expo is $5.00 per person when pre-registering online at www.themedicalroadshow.com.

About Your Medical Travel & Health Expo
Your Medical Travel & Health Expos are organized to provide consumers nationwide with information about traveling outside the United States for quality medical care at a fraction of the cost. Expos will be held throughout 2009 in cities nationwide. Visit www.themedicalroadshow.com.

IHTSDO Launches New Global Effort to Build Essential Health Terminology Toolset
Tools to Benefit 9 Member Nations and Other SNOMED CT Users

Copenhagen, Denmark– The International Health Terminology Standards
Development Organisation (IHTSDO) announced today a global effort to improve access to tools needed to develop, maintain, and enable the use of SNOMED CT in health systems around the world. This effort is part of an Open Health Tools Charter Project jointly sponsored by IHTSDO, the National Health Service in England, and Australia’s National e-Health Transition Authority.

"Having accurate and reliable health information when and where needed saves lives and
saves time," says Jennifer Zelmer, IHTSDO’s chief executive officer. "By working with
partners from around the world, IHTSDO hopes to increase access to standards-based
solutions that enable the safe exchange of health information in a privacy-sensitive manner."

IHTSDO Sources SNOMED CT Workbench
IHTSDO announced today that it is seeking proposals for the supply and maintenance of a SNOMED CT multi-lingual modular workbench that will host terminology editing, translation, mapping, and other applications. Open Health Tools (OHT) is managing this process on behalf of IHTSDO. Open source solutions will be encouraged, but any offerings will be assessed on their own merits.

The SNOMED CT workbench is part of IHTSDO’s on-going efforts to enable broader access to, and use of, standardized clinical terminologies worldwide. Already, nine countries (Australia, Canada, Denmark, Lithuania, Sweden, New Zealand, the Netherlands, the United Kingdom, and the United States) have joined together to support the on-going development and maintenance of SNOMED CT and related standards, sharing the costs on a sliding scale based on national income and making the standards freely available in their jurisdictions. IHTSDO also offers free access to SNOMED CT in countries that are not yet members for qualifying research projects and on humanitarian or charitable grounds.

IHTSDO Provides SNOMED CT Free to Participating Software Developers
IHTSDO also announced that software developers who are building open source tools using SNOMED CT through an OHT Charter Project can now access the terminology at no cost. All software created by OHT will be freely available to anyone, anywhere, under a commercially friendly open source license (the Eclipse Public License). Health service
organizations and software companies will be able to use the OHT technology to build
products and systems that will interoperate with other OHT-based products to facilitate
information exchange.

"The challenge for a standards development organization such as the IHTSDO is to
encourage widespread adoption of its standards within the health sector. Open Health Tools provides an opportunity to engage with the software development community to accelerate this uptake by developing open source tools and component libraries that meet their needs and those of IHTSDO Members," states Karen Gibson, deputy chair of IHTSDO and chair of the IHTSDO Technical Committee.

Making it easier to develop robust and interoperable health information systems is a shared goal for all of the partners in this project. “We envision a worldwide health information interoperability platform and tools that will allow patients and their care providers to have access to vital, reliable, and secure medical information as required. We anticipate that this will help contain the growth in healthcare costs and will save lives and improve the quality and safety of care provided to citizens across the globe,” explains Skip McGaughey, executive director of Open Health Tools.

About International Health Terminology Standards Development Organization
(IHTSDO) The IHTSDO (International Health Terminology Standards Development Organisation) and its members seek to improve the health of humankind by fostering the development and use of suitable standardized clinical terminologies, notably SNOMED CT, in order to support the safe, accurate, and effective exchange of health information. The IHTSDO is an international organization, established as a Danish not-for-profit association. Copies of the recently issued Request for Information/Request for Proposals can be accessed at https://ihtsdo.projects.openhealthtools.org.

About SNOMED CT
SNOMED Clinical Terms™ (SNOMED CT™) is a standardized terminology that can be used as the foundation for electronic health records and other applications. For example, different clinicians often use different terms to describe the same concept. SNOMED CT contains more than 310,000 unique concepts and more than 1.3 million links or relationships between them that ensure that this information is captured consistently, accurately, and reliably across the health system. The terminology is used in more than 40 countries around the world. SNOMED CT was originally created by the College of American Pathologists by combining SNOMED RT and a computer-based nomenclature and classification known as Clinical Terms Version 3, formerly known as Read Codes Version 3, which was created on behalf of the United Kingdom’s Department of Health and is Crown copyrighted.

About Open Health Tools
Open Health Tools (OHT) is an open source community with a vision of enabling a
ubiquitous ecosystem where members of the health and information technology (IT) professions can collaborate to build interoperable systems that enable patients and their professional healthcare providers to have access to vital and reliable medical information at the time and place it is needed. IHTSDO is a founding member of OHT.

Patients Beyond Borders Taiwan Edition Launches in Taipei

Text Box: Taipei, TAIWAN—29July 2008:Healthy Travel Media and Taiwan Task Force on Medical Travel(TTFMT) jointly announce the launch of the Patients Beyond Borders Taiwan Edition, to be published in English for international distribution 29 July 2008, at theMedical Tourism North Asia Conference in Taipei.
Supported by the Taiwan government, hospitals, and related private organizations, the 304-page guidebook offers an in-depth overview of Taiwan’s 19 international hospitals, selected health travel agents, nearby recovery and guest accommodations, and area travel information.

"Located centrally between Tokyo and Hong Kong and with some of the best healthcare in Asia, Taiwan receives visitors from more than 30 countries throughout the region and the world,” says Healthy Travel Media CEO Josef Woodman. “The recent move by the Taiwan government to permit regular flights between Taiwan and China will attract an even greater number of visitors to the island.”

Taiwan’s prices for procedures are on par with leading healthcare providers in Singapore, Malaysia, and Thailand, and patients can receive 30-80% discounts on a wide array of treatments. Newly JCI-accredited hospitals, such as Min Sheng Healthcare in Taoyuan and Wan Fang Hospital in Taipei, provide additional comfort to international medical travelers.

“As our reputation as an international healthcare leader grows, we are pleased to offer the Patients Beyond Borders Taiwan Edition to a growing market of medical travelers,” says Dr. Mingyen Wu, CEO, Taiwan Task Force on Medical Travel and Secretary General of TNHCA. “Readers will see the vast diversity of medical facilities, treatments, and services offered throughout Taiwan.”

About Healthy Travel Media
Healthy Travel Media, an independent imprint based in Chapel Hill, NC, publishes books on medical, health and wellness travel.

About Taiwan Task Force on Medical Travel
The Taiwan Task Force on Medical Travel was launched in Oct. 2007 to position Taiwan as a global leader of five-star medical travel destinations. For more information contact SherineKuo, nhca04@gmail.com or visit http://medicaltravel.org.tw.

DESTINATION

Changes in air travel certain to cause major changes in medical tourism industry

By Robin Elsham

The global market for medical tourism is being reshaped by factors the industry has long ignored: the travel aspect .Massive changes are occurring in the global airline industry with major ramifications for the medical value travel industry.

Soaring ticket prices, route reductions and restructuring, and deteriorating convenience and service quality are combining to undermine the appeal of flying anywhere for healthcare.

What's more, the cost and aggravations of flying today are certain to only get worse. The reason: the airline industry has barely begun to introduce the sweeping changes required to restore profitability in the face of the soaring cost of fuel -- airlines' number one expense. Despite repeatedly raising fares over the past year, fuel costs have risen even more, nearly doubling by June before easing somewhat the past month.

The U.S. airline industry is expected to post losses for 2008 of nearly $10 billion, just short of the record $11 billion in losses booked in 2002. The U.S. airline industry lost more money that year than the industry had cumulatively made throughout its entire existence.

Soaring fuel costs and ticket prices have depressed passenger numbers, pushing many carriers into the red. Many airlines are responding by downsizing their fleets and reconfiguring their route networks to better match supply with demand and airfares with higher operating costs.

Particularly in the U.S. market, the focus is on reducing seat capacity to enable carriers to raise ticket prices even more. "If airline ticket prices fully reflected current fuel prices, by common estimate the industry would have to be 20 percent smaller," The Wall Street Journal reported recently. Now, virtually all major U.S. airlines are moving to shed capacity (see details below.)

In addition to boosting ticket prices, the capacity cutbacks will also result in fewer flights overall and fewer direct flights, especially on long international routes. Passengers will find they need to pay more, yet find it often takes longer to get where they are going even without problems. When problems do occur, the inconvenience caused to passengers is likely to be more severe.

The thrust of the coming changes is to force more passengers to take connecting flights on smaller aircraft to insure most flights operate at or near capacity. Airlines are replacing big planes with smaller ones to fly with fewer empty seats.

So for passengers experiencing flight delays or cancellations caused by weather, equipment breakdowns, or other factors, missing connections will often be more of a nightmare. Finding empty seats on later flights will be more difficult, and travelers flying the greatest distances will see the problem compounded by more stops along the way.

Nearly a third of U.S. domestic flights did not arrive on time during the January-March quarter this year, due to delays, flight cancellations, or diversions.

Would-be medical travelers living in or near the smallest U.S. cities, and medical tourists drawn to seek care at the most distantly located destinations (meaning hospitals in Asia), will be most affected.

Some U.S. medical travelers have already found their journeys complicated by the need to drive to more distant airports. Some 100 airports in the United States that had commercial airline services last year do not have them today, according to David Castelveter, a spokesman for the Air Transport Association.

Many more medical travelers are going to find it more difficult to get from home to a U.S. airport offering international connections to their healthcare destination abroad. That's because the number of direct flights within the United States is set to dwindle. "Of the 50,000 city pairs served by the U.S. airline industry, only 3 percent can sustain direct point-to-point service. If you want to fly to and from most places in America, you'll need your own plane—or a legacy carrier's hub and spoke system," The Wall Street Journal's Business World columnist Holman W. Jenkins, Jr., wrote in June.

Overseas travel will be affected even more greatly by these routing changes, with the most severe impact on service to destinations more than 12 hours away by air.

Airlines charge 20 percent more for the convenience of flying nonstop. But due to soaring ticket prices causing a drop-off in passenger traffic, flights of more than 12 hours are particularly vulnerable to fuel prices. On flights of more than 15 hours, the economics get even more precarious.

"A passenger on a 15-hour flight uses more fuel for each mile of the trip than someone on an eight-hour flight, but the airfare per mile generally doesn't rise proportionately," according to a recent news report on ultra-long-haul flights.

"Flying 18 hours in one hop could double the cost of flying the same route with three stops. To fly that far, a plane needs lots of fuel onboard, and to carry all that fuel, it needs even more fuel."

Today only a handful of distant city pairs generate sufficient high-paying traffic to support direct flights. Among the thousands of intercontinental flights worldwide, barely two dozen are longer than 15 hours.

But a majority of these flights serve four destinations in South and Southeast Asian now among the most popular destinations for North Americans traveling overseas for medical care: Singapore, Malaysia, Thailand, and India.

Singapore Airlines has significant first- and business-class traffic on the world's longest scheduled route -- about 18 hours from Singapore to Newark airport. And Continental Airlines generates sufficient premium traffic on its 16-hour nonstops between Newark and two major medical tourism destinations in India—Delhi and Mumbai.

But Thai Airways recently announced it will end its 17-hour Bangkok-New York direct service, and scale back direct service between Los Angeles and Bangkok.

But not all airlines are shedding capacity. There are airlines in South America, Europe, Asia, and especially the Persian Gulf that are expanding.

In the Gulf, Etihad Airways of Abu Dhabi, Dubai's Emirates Airlines, and Qatar Airways are expanding. So too are discount carrier Ryanair, Air France-KLM, and Deutsche Luthansa in Europe; Singapore Airlines, Malaysian Airlines, Hong Kong-based Cathay Pacific Airways, South Korea-based Asiana Airlines, and China Air in Asia; and LAN Airlines of Chile.

"Before we get to a new world order, we're going to have a period of new world disorder," says Henri Courpron, who works for Seabury Group, an airline-restructuring consultant.

These changes in the global airline industry have major ramifications for the medical tourism industry. Among the most significant (or most likely):

The effect overall will be to make traveling anywhere by air for healthcare less appealing. The "hassle factor" will discourage more people from even considering the option.

The soaring cost of air travel will diminish the appeal of traveling abroad for the lowest-cost procedures. Much dental work and the lowest-cost sorts of hospital and cosmetic surgery procedures are dwindling in appeal because the cost of travel represents such a significant proportion of the total expense when performed abroad.

The greater the distance, the less appealing the destination will be. In addition to the already deeply rooted concern with travel time, the coming changes will disproportionately increase the hassle and cost of getting to the most distant healthcare destinations. "In the world of triple-digit oil prices, distance costs money," says Jeff Rubin, chief economist at CBIC World Markets in Toronto.

Conversely, greater patient traffic will flow to destinations the least distance away, and/or to those offering the most direct air connections.

And the importance of patient care arrangers, or so-called medical concierge services, will increase as both medical travelers and foreign healthcare providers (hospitals, dental clinics, and cosmetic surgery centers) seek help from travel professionals. Medical travelers, both individuals and self-insured companies, which have introduced a global care option for employees, will recognize the need for expert help in making smart travel arrangements—and for quick help when problems occur while traveling. And foreign service providers will recognize a need for help in selling their service to populations averse to flying anywhere.

Downsizing plans announced by major carriers.

U.S. airlines:
American Airlines, the largest U.S. carrier, said it plans to reduce capacity by as much as 12 percent in the fourth quarter, and to remove at least 75 of the 954 planes in its fleet and that of its regional American Eagle operation.

United Airlines, the second-largest U.S. carrier, said it will ground 100 planes of its 460-plane fleet, and close its discount subsidiary, Ted, to cut capacity by 11 to 12 percent.

Delta Air Lines, the third-largest U.S. carrier, plans to trim its domestic capacity by 11 percent in the 4th quarter and take out of service 70 planes from its fleet of 580 aircraft, along with as many as 70 flown by its regional affiliates.

Continental, the nation's fourth largest carrier, said it will reduce its domestic capacity by 11 percent this fall.

Northwest Airlines said it will cut its domestic flight schedule by 5 percent this fall, and take 15 to 20 planes out of service.

- US Airways, the 7th largest U.S. airline, said it plans to cut is domestic mainline capacity by 6-8% in the fourth quarter, and slash capacity in 2009 a further 7-9%.

AirTran, a U.S. budget airline based in Orlando, plans to cut seats by 5 percent starting in September.

Virgin America, a discount airline, said it will cut seat capacity about 10 percent in the fall by reducing flight frequencies on some routes.

A number of U.S. airlines have recently failed. Indianapolis-based ATA Airlines and Honolulu-based Aloha Airlines ceased operations and filed for bankruptcy in April. In May, Minneapolis-based charter flight operator Champion Air shut down, and Sun Country Airlines reduced its pilot workforce by nearly a third.

Non-U.S. airlines:
Air Canada said it will cut capacity 7 percent beginning this autumn.

Qantas Airways said it aims to cut total capacity by 5 percent. Changes will affect 11 routes and more than 50 weekly flights.

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

Thailand is known for its tranquil beaches, lush rain forests, and superb cuisine, but for some tourists the country offers another added attraction: sex-change surgery.

One of the top 10 procedures bringing foreign patients to Thailand, sexual reassignment surgery (SRS), also known as sex change or gender reassignment surgery, is the alteration of a person's genitals and other physical characteristics to that of the opposite gender. Individuals suffering from gender identity disorder will often elect to undergo SRS to change their physical body to match their gender identity.

SRS is a costly, highly-involved elective procedure. In the United States male-to-female reassignment surgery averages between $5,000 to $30,000, including the accompanying cosmetic procedures. Female-to-male reassignment surgeries are much more involved, and thus, more expensive. Average total cost currently falls between $50,000 to $80,000. Because much of the expense is not covered by insurance, many people are traveling abroad for procedures.

Dr. Tawisak Labchitkuson of ThaiMed (www.thaimed.com) notes, “I evaluate patients from six major health care centers for sex change in Bangkok, Thailand. In total, there are about 10 to 15 cases per week and 60 to 90cases per month.”

“Patients travel from around the world,” says Tawisak, “but mainly come from—in order—the United States, Australia, Japan, Korea, Philippines, China, Italy, Iran, Israel, African countries, New Zealand, Vietnam, Singapore, Indonesia, and France.”

He adds, “I believe America is the leading nationality because the society there is more open to transgender surgery than other societies. However, that is quickly changing. Additionally, American patients have higher levels of treatment, including psychiatrists or psycho-therapists, to assist in taking care and preparing them for the surgery.”

SRS is serious business, often taking six hours to perform and requiring fifteen days of hospitalization and numerous counseling sessions. Many hospitals throughout Thailand perform the procedures and many of their physicians are recognized as the world’s best.

Mike Brennan, CEO of ThaiMed, says, “I believe the number one reason that patients travel to Thailand is price. Including all medical, hotel, and travel cost, it is often less expensive than having the procedure alone back home. Couple that with privacy and a higher level of medical care, and Thailand has become a major destination.”

But Brennan adds, “There are some disadvantages that have recently become a factor. The value of the dollar has decreased, making the surgery and hotel cost not the bargain it once was. When we first started the baht was 42 to $1 U.S. Dollar. Now it is nearly 30 Baht to $1 U.S. Dollar. This may not seem like a huge difference, but it is when your entire trip may cost 300,000 Thai Baht.”

“We assist our patients in getting the best exchange rate to increase the potential amount of savings,” says Brennan, “and try to offer ways to decrease the cost of their overall trip.
With rising oil cost, we look closely at airline ticket prices. Most likely oil prices will fall, and airlines are always working to make air travel more affordable.”

Individuals investigating Thailand as a destination for SRS will have to do a bit of homework as it is “an offence under the laws of The Kingdom of Thailand” for Thai doctors to advertise openly on the Internet or in other general publications. However, most centers are happy to provide information regarding the center’s qualifications and the experience and credentialing of its surgeons upon request.

Prospective patients will also want to inquire about the center’s requirements for SRS. While requirements vary from one institution to the next, they typically include being of legal age to make surgical decisions in their homeland, 6 to12 months of continuous hormonal therapy, 6 to12 months of successful continuous full-time real life experience in the acquired gender, a formal diagnosis of gender identity disorder or gender dysphoria, no serious medical conditions, and letters of recommendation from both physicians and mental health practitioners.

Anyone intending to include sightseeing as part of their “trip of a lifetime” will want to make sure they build it into the front half of their itinerary as mobility is quite restricted post-surgery.

Texans First in the Nation to Explore Opportunities for Medical Travel: Your Medical Travel & Health Expo Debuts in Dallas and Austin, TX

Saturday, October 25 through Sunday, October 26, 2008
Dallas, Texas, Hilton DFW Lakes

Saturday, November 1 through Sunday November 2, 2008
Austin, Texas, Renaissance Hotel

DALLAS, Texas/AUSTIN, Texas —August, 2008—Texas residents will have the first look at the growing array of options for accessing high quality medical care at significantly lower costs when the first consumer-focused medical travel expos debut in the Lone Star State: Your Medical Travel & Health Expos:
Saturday, Sunday, October 25-26, 2008, Hilton DFW Lakes, Dallas, Texas;
Saturday, Sunday, November 1-2, 2008, Renaissance Hotel, Austin, Texas.

“Texas is a logical location to kick-off this year-long schedule of medical travel consumer expos, based upon the high level of interest among Texans who either pay their own medical bills or seek procedures not covered by their medical insurance,” states Skip Brickley, CEO of Transmarx, LLC, one of the country's premier conference and trade show producers. “Traveling to nearby destinations such as Central and South America, Asia, New Zealand, and Israel, means documented high quality care at a fraction of U.S. costs. Hospitals, providers, medical travel experts, spas, and wellness centers throughout the world will be on hand to offer education and guidance. It is the first show of its kind and all participants look forward to meeting Texas residents.”
Brickley adds that Americans are ready to take advantage of the benefits of medical travel and anxious to learn more about the latest developments in health and wellness. Attendees will have the opportunity to take part in a wide range of health and wellness activities, including personal visits with medical travel facilitators and providers; free health screenings; meetings with on-site personal trainers; and opportunities to learn more about healthy eating.
“There will be a wealth of resources on hand to help people discover their options for specialty care including orthopedic, cardiac, dental, bariatric, and cosmetic surgery,” says Brickley. “Today, Americans are also interested in opportunities to access care that is not available in the U.S. such as stem cell transplantation, organ transplants as well as lower cost in-vitro fertilization (IVF). People are amazed that these options now exist.”

Expo visitors can also take advantage of health screenings including blood pressure and cholesterol testing, disease management counseling, healthy nutrition, fitness and, exercise coaching. Giveaways and prize drawings will supplement the informational and educational experience.
Registration for the Dallas and Austin expos will soon be active. For general questions or assistance with registration, please contact Willie Moreno at 804.266.7422 ext. 7408 or willie@transmarx.com. Admission to Your Medical Travel & Health Expo is $5.00 per person when pre-registering online at www.themedicalroadshow.com. Bloggers, go to blog.themedicalroadshow.com.

About IMTA
The International Medical Travel Association is a global organization of stakeholders in the international medical travel industry, representing leading health care providers, medical travel facilitators and related industry service providers around the world. IMTA supports the development of international industry standards and best practices that promote and advance medical quality, safety, and transparency for the international patient, and that preserve and protect the doctor-patient relationship. IMTA, www.intlmta.org, is a not-for-profit association funded by membership dues and programs.

Asia’s biggest landmark healthcare congress – Global Health Conference (GHC) 2009—Announces Its Agenda: How Should Future Models in Healthcare Delivery be Re-Tooled to Handle Disease Management?

Disease management will directly impact the future models of care. But what shape and form these models will take is of question. Will we see more of specialized hospitals? If so, where will they be located? How will innovative ‘disruptive’ technologies help the future healthcare cities and hospitals cater to and deal directly with new disease management?

The future of healthcare delivery lies mostly in disease-based intervention programs. The healthcare cities and hospitals of the future will greatly benefit from a clearer understanding of how to effectively integrate disease management into future facilities and core competencies to be built.

Another contributing factor that will shape future care models is the growing number of highly valued patients globally – many of whom are crossing international borders in search of quality care and access. How should hospitals convert their centers of excellence to cater to this growing sector? How can they adequately build capacity and expertise to ensure they are able to meet new and growing demands?

Leaders in global healthcare will be tackling these issues head-on at Asia’s biggest landmark healthcare congress, GHC 2009, which will feature two co-located events, “Healthcare Cities & Hospitals of the Future” and “Crossing International Borders” (February 23-26, 2009, Singapore).

Attn: Ms Catherina Koh
Conference Director
Magenta Global Pte Ltd
DID: (65) 6391 2539
Email: catherina.koh@magenta-global.com.sg with subject code “GHC-MTT”

World Medical Tourism & Global Health Congress in September in San Francisco. For More Information on the Congress visit www.MedicalTourismCongress.com.

Healthcare Travel Congress set to tackle major issues in medical tourism industry
Text Box:

DUBAI - Major issues relating to the $50 billion global medical tourism industry are to be discussed by international experts in Dubai this autumn at the world’s first global congress dedicated to the subject. Healthcare Travel Exhibition & Congress 2008 will take place at the Al Bustan Rotana Hotel in the emirate from November 2-4, and organizers have revealed there has been unprecedented interest from medical professionals and institutes across the world looking to participate.

“It’s been simply overwhelming the caliber of people wanting to take part in the event,” says Sietske Meerloo, marketing manager at IIR Middle East. “Medical tourism is one of the fastest growing industries in the health and tourism sector, and because of Dubai’s position as a global hub, everyone knows that the Healthcare Travel exhibition in November is the place where deals will get done.” She adds, “We’re seeing big names and less well known health providers in the industry from all over the world signing up to take part.”

Medical tourism is expected to become a $100 billion dollar industry within the next four years, and countries in developing parts of the world are increasingly looking at ways to adapt their health systems to attract business.

However, the phenomenon of patients crossing borders to receive treatment in foreign lands for any type of condition one cares to imagine is not without risk.
Issues are being addressed as quickly as patients are being treated. These issues can range from whether small private clinics in Thailand have received appropriate international accreditation to treat foreign patients to whether there’s a negative impact on a local health service’s ability to treat local patients.

Meerloo indicated the healthcare travel event is the ideal platform to address these issues and generate solutions to them. “Obviously there are huge networking opportunities for participants, but a major element of the event is to address the major issues,” she says. “Whether it’s international accreditation or bioethics, healthcare travel is all about tackling these issues head-on.”

Although there are many issues to be discussed, the positive outlook for the medical tourism industry is apparent. It’s an exciting time for the sector, and as more countries offer their services to foreign patients and more insurance firms enter the market, the range of treatments on offer becomes broader.

This fact hasn’t been lost on the United Arab Emirates (UAE), which is keen to boost the number of foreign patients already visiting the country. Nasser Khalifa Al-Budoor, the assistant undersecretary for International Relations and Health Affairs at the UAE Ministry of Health, suggested the country is set to become a popular destination for health tourists.

“We don’t have exact figures on the number of people coming for treatment yet, but numbers are increasing for health tourism,” he says. “They trust our clinics for treatment. We have a good product with good pharmacies. The cost of medication and treatment is high, and people looking for lower costs are now coming to Dubai,” he added.

For further information please contact:
Peter Donnelly
Science Correspondent
Life Science Division
IIR Middle East
T: +971 4 407 2743
M: +971 50 429 7105
peter.donnelly@iirme.com