Medical Travel Today

THIS WEEK IN MEDICAL TRAVEL TODAY
Volume 2, Issue 23
by Amanda Haar, Editor

We may be wrapping up the summer months here in the States, but it feels like medical travel is just heating up worldwide.

From a comment issued by the International Medical Travel Association regarding accreditation to the latest research brief on the industry as a whole from the National Center for Policy Analysis, virtually every aspect of the field is currently under discussion and review by a variety of stakeholders.

In this issue, we touch upon these topics as well as newly developed group medical tours, all-new insurance products for in vitro fertilization (IVF) treatments abroad -- and we even get Ruben Toral’s perspective on the similarities between medical travel and the auto industry (!).

As always, we welcome your thoughts and story ideas.

Cheers,

Amanda Haar, Editor
ahaar@cpronline.com

International Medical Travel Association: Accreditation Agencies with Standardized Infrastructure and Oversight Ensure Quality Care, Patient Safety

Washington, DC – The International Medical Travel Association (IMTA; www.intlmta.org), a not-for-profit association representing the broad and diverse interests of medical travelers and the medical travel industry, has issued a position statement urging organizations and individuals offering accreditation or certification to closely examine their services and infrastructure. The IMTA sets forth its view that it is neither sufficient nor professionally respectable for an organization to simply declare itself a grantor of accreditation while lacking the requisite infrastructure and oversight.

“We believe that with patient safety at stake, accreditation standards and processes must be vetted by internationally recognized accreditation organizations and government agencies,” says Steven Tucker, M.D., president of the IMTA and a leading U.S. board-certified medical oncologist. “The emergence of trade groups and others declaring themselves as quality accreditors or certification authorities not only threatens the integrity of existing organizations, but also creates market confusion at a time when global outsourcing of medical care is a growing phenomenon.“

IMTA advocates that all international hospitals and other healthcare institutions be held to high standards, whether through a country’s own regulatory system or through internationally accepted standards set by recognized accreditation authorities, such as the Joint Commission International (JCI) and others.

According to healthcare quality expert Sharon Kleefield, Ph.D,Harvard Medical School, “Without tested standards and strict regulation for competent and independent surveys, accreditation becomes meaningless, and patients go unprotected. The international healthcare community must work toward creating and enforcing such standards of accreditation.”

Over the years, patients, practitioners, payers, and governments have come to associate accreditation with a trusted and tested body of professionals and regulations, designed to protect healthcare consumers and professionals alike. As patients travel across borders, accreditation of hospitals must continue to offer a minimum baseline level of quality and safety assurance.

Increasingly, many countries and health ministries have developed their own sets of quality and safety standards, thereby maintaining local accreditation oversight. Typically, they seek guidance from accreditation organizations with proven international experience, including but not limited to the United States, Canada, and Australia.
Accreditation organizations have specific internal requirements and processes, including:

“As a result of IMTA’s efforts, we are seeing a trend of would-be ‘accreditors’ deploying more appropriate terminology,” says Tucker. “Those who wish to provide accreditation services in the future need to know there are rules to follow.”

About The 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 organization funded by membership dues and programs.

From Price to Quality to Innovation – How Asia Changes the Game in Cars and Healthcare
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.
Toral shares his perspectives on the growing industry with Medical Travel Today on a monthly basis.

Cars and healthcare. For some reason, I see a lot of similarity in these two very different industries. The idea that I can equate medicine with manufacturing perplexes many and ever angers some, but there are some interesting parallels between the two.
The first is how Asian car manufacturers changed the game by evolving from the price leader to the quality leader to the innovator. From the lowly Datsun came the Honda Civic then the Toyota Prius. Japanese manufacturers entered on price; gained respect and market share on quality; and now lead through innovation. You don’t buy a Toyota Prius because it is cheap; you buy it because it makes you feel good. Toyota changed the game from selling a car to selling environmental awareness – not something that Hummer understands.

Asian hospitals are essentially doing the same thing in the U.S. healthcare market. They are attracting U.S. medical tourists on price, delivering on quality, and wowing on service. Look at Bumrungrad International’s new outpatient clinic – the design is changing the way a hospital looks and feels. That’s important to people. U.S. healthcare is over-engineered – building the healthcare equivalent of an SUV, while Asian hospitals are starting to offer the Civic.

The second is how U.S. car manufacturers, like General Motors (GM), are competing and winning in Asia by adopting distinctly Asian tactics. GM announced last week that it was expanding its manufacturing facilities in Thailand to meet rising demand for its cars and trucks in Asia and the Middle East. In Asia, GM is making money -- $128 million in the first half of 2008 alone. Back in Detroit, GM is in a death spiral of restructuring, falling sales, layoffs, and a record $10 billion dollar loss. How can GM compete in Toyota’s backyard and thrive when they are getting their lunch eaten in the United States?

Because in Asia, G M is quietly reinventing itself as a profitable producer of small, environmentally friendly cars that use South Korean technology, Japanese production techniques, and Thai labor. GM is competitive in Asia because they changed their thinking, business model, and focus. GM broke out of their big engine, U.S. centric, vertically integrated model into a light engine, global platform using strategic partners. These Asian-built GM cars are what the company should be building in Flint, one could argue.

Like autos, one of the big opportunities in healthcare is in new product and network development through partnerships. Methodist International, a subsidiary of Methodist Hospital Systems out of Houston, Texas, has signed a management agreement with Emaar Properties, one of the world’s largest property developers, to build and manage 100 hospitals and medical centers in the Middle East over the next decade. Dr. Lynn Schroth, the CEO of Methodist International, is positioning the brand to become a “global healthcare leader with a global network of hospitals.”

World-class medical institution partners with world-class property developer to serve world-class cities in high growth markets. Now that’s smart.

Globalization is forcing healthcare to look at the world differently. It doesn’t matter if you are producing cars or computers, the market will always favor the low-cost producer of quality goods and services. GM’s experience suggests that Asia is a tough competitor but an even more attractive partner. It’s probably time U.S. healthcare looked at a trade-in.

Trish J. Taylor
Founder, New Life Agency

Medical Travel Today (MTT):Tell me a bit about the New Life Agency…how long you’ve been around, what’s the agency’s focus, and your role?

Trish Taylor (TT): The New Life Agency (NLA) has been around for more than a decade. We exclusively service the assisted reproductive technology industry. We’re the only company specializing in Assisted Reproduction Insurance as a Lloyd's of London cover holder and underwriter.

We provide policies for intended parents, surrogates, egg donors, and all the professionals involved in the industry of assisted reproductive technology. That includes IVF clinics, IVF doctors, and the OB/GYNS involved.

I’m the president and founder of NLA. Prior to starting NLA I was the co-founder of one of the largest surrogacy and egg donor companies in the United States. It was through that experience that I recognized the need for a specific type of insurance for this high-risk community of people.

Our largest policy and greatest need is through the surrogacy bodies we cover. Quite often, these people don’t have access to a major medical policy. That’s because surrogates have a 30 percent higher claims rate than typical deliveries. That’s because there are more multiple pregnancies with surrogates, higher risks, and the potential for increased complications. Over time, the major insurance companies looked at their actuarial data and simply dropped them.

All of our claims are serviced by New World Administrators (NWA). We started NWA three years ago to exclusively service our claims.

Because of the high risk and number of claims, one of our priorities at NLA is to educate IVF doctors, the surrogates, and patients. We feel it’s very important for them to understand that there is over-fertilization taking place. In the case of the IVF doctors, they don’t see the deliveries. They don’t appreciate the stresses and complications that multiple births can cause. The surrogate’s body is experiencing more damaging claims due to over-fertilization.

In addition to surrogates, we also insure egg donors. There can be complications for egg donors, and there are many weeks of medication prior to the harvesting. We provide policies for the intended parent or parents to cover those complications.

MTT: How did you become interested in medical travel, and what’s the fit for NLA?

TT: I went to a third-party administrator convention (Health Care Administrators Association) in San Francisco in July of 2008. That was a huge eye-opener. I was very surprised to hear IVF and infertility even mentioned at the convention.

I perked right up and began asking, “What’s going on? Why are they talking about this?”
It had really only been since January or the end of last year that I began hearing of people reaching out to international doctors for IVF treatments. Most of the reputable surrogacy agencies are against it. Of course there’s the financial impact on them, but there’s also the concern about what’s going on abroad.

More recently, we at NLA started hearing that the egg donor agencies are looking for egg donors abroad. They are advertising and using the medical doctors, but they have no access to insurance policies because most policies are restricted to the United States.
In the past, I’ve simply said “no way” because we didn’t know there were reputable providers or provider networks. Up until this event in San Francisco, we didn’t know that quality existed or that there are actual hospitals and doctors who have the credentials and are trained. In many cases, they’re providing better care there than you can get here.
Right now, we’re the only one in the world that exclusively insures this market. The possibility of opening coverage up to other countries is extremely exciting to me.

MTT: What product or products are you considering offering?

TT: There are more than 40,000 infertility cases discovered each year in the United States. The problem is not going away. The procedures aren’t getting cheaper, and the elements involved in IVF aren’t going to become less expensive. The intended parents (or parent) are going to go abroad where they can get an IVF procedure at 1/3 the price—plus you get free airline tickets.

We’re looking to create a package for the industry that covers those individuals.
We now know the quality is there, the savings are there, and the care is there. We want to make it a better option for those individuals and couples.

MTT: What obstacles do you see to creating and selling such a product?

I think the biggest thing is fear on the part of both clients and the industry.
Clients need to be educated on the safety and quality of care. As I said before, a focus for NLA is education.

Personally speaking, just a few months ago, I was saying “no way” to a medical travel option, plus my carrier wasn’t going to cover it.

We always try to give our clients a choice, so if there’s a demonstration of a desire from our industry to choose this option, it would be silly not to create the product to back them up.

MTT: Do you have a timeframe in mind for its creation?

TT: Well, I have to tell you that in the typical insurance world where things move at a snail’s pace, NLA adjusts and shapes its policies like a Ferrari. If we can prove the risk ratio in this international market, it could be by the end of next year.

It’s really a matter of presenting to our carrier and digging in to see who these people are. We’re a Lloyd’s cover holder. There’s no one else outside our company other than the carrier who backs our policies. They’ve entrusted us in this market because we have a proven ratio with them. As long as we can support a product through actuarials, we have their backing.

So once we prove this one, as I believe we will, it won’t take long to bring to market.

About Trish Taylor
Trish Taylor is president and founder of New Life Agency, Inc. and New World Administrators, Inc., with a strong track record of creating niche businesses and product development.

Ms. Taylor has directed her time of more than 15 years to the assisted reproduction community, co-Founding the world’s largest surrogacy agency, Growing Generations, LLC, and egg donor agency, Fertility Futures, LLC. Ms. Taylor understood the risk and need for this market and created her current companies. She has successfully designed and underwritten policies for the assisted reproduction technology industry, paying claims on millions of dollars of assisted reproduction issues.
She can be reached at trish@newlifeagency.com or through www.newlifeagency.com

INDUSTRY NEWS

Medical Tourism: Health Care Free Trade
Brief Analysis #623
By Devon Herrick

Reprinted with the permission of the National Center for Policy Analysis. The story originally appeared online at http://www.ncpa.org/pub/ba/ba623/

Global competition in healthcare is allowing more patients from developed countries to travel for medical reasons to regions once characterized as “third world.” Many of these “medical tourists” are not wealthy, but are seeking high quality medical care at affordable prices. To meet the growing demand, entrepreneurs are building technologically advanced facilities in India, Thailand, Latin America, and elsewhere, and are hiring physicians, technicians, and nurses trained to American and European standards to run them.

How Patients Obtain Treatment Abroad.
Patients usually coordinate their treatment through medical travel intermediaries. These services often employ doctors and nurses to assess the medical efficacy of procedures and help select physicians and hospitals. Some services are affiliated with specific medical providers and send patients exclusively to those hospitals. Currently, the treatment networks of most U.S. health insurers do not include foreign providers. But, since six million people a year worldwide are expected to travel for medical care by 2010, that is quickly changing.

More Health Plans Cover Medical Travel.
BlueShield of California has a health plan, Access Baja, designed for Americans and Mexicans who choose to receive medical care in northern Mexico. In 2007, BlueCross BlueShield of South Carolina established Companion Global Healthcare, a network of foreign-based hospitals that includes internationally accredited medical facilities in Singapore, Thailand, Turkey, Costa Rica, and Ireland.

Denver-based BridgeHealth International also has a provider network of offshore hospitals, clinics, and physicians. It works with insurers and employer health plans to facilitate workers’ treatment abroad. Insurers Aetna and Cigna both report growing interest in medical tourism among employers. Mercer Health, an employee benefits consulting firm, is helping several Fortune 500 employers use medical travel to help stem the rising cost of employer-provided medical coverage.
Indeed, a report by the International Foundation of Employee Benefit Plans found that 11 percent of employer health plans surveyed now cover medical travel.

Treatment Abroad Costs Less.

Fees for treatments abroad range from one-half to as little as one-fifth the price in the United States, depending upon the destination country and type of procedure performed. For example:
Apollo Hospital in New Delhi, India, charges $4,000 for cardiac surgery, compared to about $30,000 in the United States.

A rhinoplasty (nose reconstruction) procedure that costs only $850 in India would cost $4,500 in the United States. [See the figure.]

Magnetic resonance imaging (MRI) in Brazil, Costa Rica, India, Mexico, Singapore, or Thailand costs from $200 to $300, compared to more than $1,000 in the United States.

Why Treatment Abroad Costs Less.
There are many reasons why medical costs are lower abroad.

Lower Labor Costs. In the United States, labor costs equal more than half of hospital operating revenue, on the average. Yet, Indian physicians often earn only 40 percent as much, and many Indian nurses earn only one-tenth as much as their American counterparts.

Less Third-Party Payment. In the United States, patients spend only 13 cents out-of-pocket for every dollar they spend on healthcare; insurers or government pay the rest. In countries with growing, entrepreneurial medical markets, patients pay more out-of-pocket. For instance, local patients pay out-of-pocket for 51 percent of healthcare in Mexico and 78 percent in India. Consequently, providers must compete for patients based on price.

Limited Malpractice Liability. Malpractice litigation costs are lower outside the United States. American physicians in some specialties pay more than $100,000 annually for liability insurance, while a physician in Thailand spends about $5,000 per year.

Price Discrimination. Medical suppliers often charge customers in lower income countries less than customers in higher income countries for the same product or service. As a result, hospitals in developing countries pay much lower prices for medical supplies, equipment, and drugs than do hospitals in rich countries. For instance, wholesale prices for the artificial joints and other equipment used in hip replacements are much less in India than in the United States.

Measuring Quality.
Many healthcare providers in developing countries meet U.S. health quality standards. In fact, more than 120 hospitals abroad are accredited by the Joint Commission International (JCI), an arm of the organization that accredits American hospitals participating in Medicare. Moreover, many foreign hospitals hire physicians who are U.S. board-certified or have internationally respected credentials. And many of the physicians were trained in the United States, Australia, Canada, or Europe.

Obstacles to Medical Tourism.
Outdated laws and regulations create barriers to medical tourism. For example, the federal Employee Retirement Income Security Act (ERISA) could make it difficult for U.S. providers to offer financial rewards to willing medical tourists without being exposed to increased liability risk. State laws that require doctors to be licensed in the state where the patient receives treatment are another problem. Such laws prevent medical tasks from being performed by providers in other states or countries.

What Public Policy Changes Are Needed?
The first step for state and federal policymakers is to understand that global competition in healthcare will benefit U.S. consumers by reducing costs and improving quality through competition. But other action is also needed.

Modernize State Licensing Laws. Medical licensing laws should be brought into the information age, where distance (or country) is irrelevant in procuring many medical services. Foreign physicians who meet standard criteria should be considered licensed if their skills have been evaluated and approved for inclusion in an insurer’s network.

Allow Financial Incentives. Insurers and employer-sponsored health plans should be able to offer financial incentives for seeking care abroad, much as they do currently for medical services within their network, without facing increased liability risks. Legislation such as ERISA should not penalize providers who offer lower cost treatment options for patients willing to travel overseas for care.

Lead by Example. Federal and state government should lead by example, by allowing Medicare and Medicaid programs to send willing patients abroad. Medicare would particularly benefit from cost savings since it pays for a large volume of orthopedic and cardiac procedures.

Conclusion.
As more insured patients begin to travel abroad for low-cost medical procedures, medical tourism will result in sorely needed competition in the American healthcare industry.

Devon Herrick is a senior fellow with the National Center for Policy Analysis.

Med Tours International Offers the First Ever Group Medical Tour
Med Tours International is inviting people to join them for the first ever Group Medical Tour.

This trip is for anyone who has ever considered having surgery abroad but was afraid to travel alone. Now patients can have the surgery they need at a fraction of the cost (usually 50 to 80 percent below U.S. costs), while enjoying the added benefits of traveling with a group of people in a similar situation to an exotic and exciting destination.

Medical Group Travel differs from other group tours in the sense that one size does not fit all. Individual attention and care to your personal situation is not sacrificed in the planning. This is a custom-tailored medical tour.

In addition to having access to world-class doctors and outstanding care, patients will be escorted by our U.S.-based staff with first-hand knowledge of India and also of having the experience of being a patient there. Other patients on the tour will be a wonderful support system for those traveling alone, and if you are traveling with a companion, the support of other patient’s companions will ensure that you are not alone while your loved one is in the hospital. They will also provide an opportunity to have company for activities.

Your health care facilitator will consult with you prior to making these arrangements and attend to every detail. You will be assisted with everything from getting your medical records to obtaining your visa and setting up a teleconference with your doctor through the follow-up consultation in the United States.

Agreement Allows Companion Global Healthcare Clients to Choose India

Columbia, S.C. – Clients of medical travel company Companion Global Healthcare Inc. can add India to their list of possible destinations for obtaining surgery and other medical care at a fraction of the U.S. cost.

The state-of-the-art Wockhardt Hospitals in Mumbai and Bangalore, both accredited by the Joint Commission International (JCI) and affiliated with Harvard Medical International, have become the first two facilities in India accepted into Companion Global Healthcare’s network of overseas hospitals, Companion Global Healthcare President David Boucher announced today.

Companion Global Healthcare, which helps self-insured employers and individuals access lower-cost healthcare overseas, now has affiliations with 10 hospitals located in India, Costa Rica, Singapore, Thailand, Turkey, and Ireland. All of the hospitals hold the prestigious JCI accreditation, and all have completed Companion Global Healthcare’s extensive credentialing process.

Wockhardt (www.WockhardtHospitals.net) has established a special division to serve international patients. The Mumbai and Bangalore facilities offer a variety of procedures, including hip replacement, hip resurfacing, knee replacement, cardiac surgeries, and spinal surgery. Their physicians in these specialties are backed by new-generation technology and nursing care. Private rooms in the hospitals are equipped with computers, high-speed Internet access, televisions, and DVD players.

“A self-insured company can save tens of thousands of dollars if just one of its employees elects to have surgery at a fully credentialed Companion Global Healthcare network facility, and the employee can save thousands in out-of-pocket costs,” Boucher said. “The addition of Wockhardt Hospitals to our network gives our clients more outstanding options if they are considering going abroad for care.”

“International patients have experienced from our services excellent clinical outcomes with personalized care at highly affordable costs,” Wockhardt Hospitals CEO Vishal Bali said. Over the past 18 years we have built an evolved healthcare system in India that matches global benchmarks in patient care.

“We are extremely proud of our JCI accreditation and our affiliation with Harvard Medical International, which gives us access to Harvard Medical School’s experience and expertise in patient care.”

About Companion Global Healthcare
Companion Global Healthcare (www.CompanionGlobalHealthcare.com), headquartered in Columbia, S.C., provides assistance to clients who travel to its network hospitals around the world, serving as a single launch point for appointments, travel arrangements, case management, assistance with claims filing, and help in arranging follow-up care in the United States.

The company serves uninsured and underinsured individuals, as well as employers and insurance companies that have included the Companion Global Healthcare network in their benefit plans. All BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina members have access to Companion Global Healthcare’s services.

BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina Inc., both headquartered in Columbia, S.C., are independent licensees of the Blue Cross and Blue Shield Association.

Companion Global Healthcare is a separate company that does not offer BlueCross BlueShield of South Carolina or BlueChoice HealthPlan products. Companion Global Healthcare is solely responsible.

Research and Markets Releases “Asian Medical Tourism Analysis (2008-2012)”

International markets research firm Research and Markets has just released a new report on the Asian medical tourism market. The following overview provides key facts, findings, and players featured in the report. The complete table of contents as well as ordering information can be found here.

The report, “Asian Medical Tourism Analysis (2008-2012)”, provides an insight into the Asian medical tourism market. The past, present and future potential of the five biggest Asian markets - India, Thailand, Singapore, Malaysia and Philippines - have been analyzed, and both statistics and trends regarding market size, tourist arrivals, infrastructure, accreditations, cost and success and risk factors have been thoroughly discussed in the report.

Asia represents the most potential medical tourism market in the world. In 2007, the region generated revenues worth US$ 3.4 Billion, accounting for nearly 12.7% of the global market. The report draw the fact that the ageing population, particularly in the developed world, is increasing rapidly, putting an extra demand on an already overburdened health infrastructure, thus creating huge opportunities in the Asian medical tourism market.

The report also acknowledges the fact that the five Asian markets covered have vast differences in terms of cost, infrastructure, human resources, patient perceptions, competencies and level of government support. Thus, it provides valuable information to clients looking to venture into these markets and helps them to devise strategies while going for an investment/partnership in these markets.

For the purpose of this report, the Asian medical tourism market has been defined as the aggregate of medical tourism markets in Thailand, Singapore, India, Malaysia and Philippines.

Key Findings

More than 2.9 Million patients visited Thailand, India, Singapore, Malaysia and the Philippines for medical tourism in 2007.
Thailand’s low cost and scenic beaches have enabled it to become the largest medical tourism market in Asia; however, an unstable political environment and occurrence of another epidemic such as bird flu can restrain its growth.
Healthcare costs are considerably high in Singapore as compared to other Asian destinations. The country, however, boasts of an infrastructure and resources that in some cases are even better than those in the west.
India, with its low cost advantage and emergence of several private players, represents the fastest growing market. The country’s questionable sanitary perceptions in the west are, however, a major roadblock for growth.
Malaysia and Philippines, both relatively new players in the medical tourism market, are expected to grow strongly in the next five years.
A number of employers and health insurance firms in developed countries have now started looking at medical tourism to reduce their surging healthcare expenditure.
The Asian medical tourism market is expected to grow at a CAGR of 17.6% between 2007 and 2012.

Key Issues & Facts Analyzed

Evaluation of past, current and future market trends.
Market study by segment and country.
Discussion about the major drivers of the Asian medical tourism market.
Analysis of the opportunities created by the market.
Analysis of the major challenges faced by the market.
Competitive landscape of the market.

Key Players Analyzed
This section provides the overview and key facts of prominent players in the Asian medical tourism markets, such as Apollo, Bumrungrad, Raffles, Parkway Health and St. Luke’s Medical Center.

Research Methodology Used
Information Sources
Information has been sourced from books, newspapers, trade journals, and white papers, industry portals, government agencies, trade associations, monitoring industry news and developments, and through access to more than 3000 paid databases.

Analysis Methods
The analysis methods include ratio analysis, historical trend analysis, and linear regression analysis using software tools, judgmental forecasting, and cause and effect analysis.

Even Healthcare Can Be Outsourced
Nationally syndicated opinion columnist Froma Harrop of the Providence Journal recently devoted a piece to the subject of medical tourism. The story begins:

Is “medical tourism” — Americans’ going abroad for cheaper treatments — good or bad? The answer is “yes.” It’s both. But one thing is for sure: Medical tourism is here to stay.
To read the complete story, click here.

Noteworthy Feature Story in The Economist
The August 14, 2008, print edition of The Economist featured an interesting story on the globalization of the healthcare. To read the story, go to economist.com and search for the story “Operating Profit.”

DESTINATION

Inflation's Threat to Medical Tourism
By Robin Elsham

Does anybody write down treatment costs anymore in anything but pencil? So figures can be quickly erased and revised.

Various factors have combined recently to fuel double-digit rates of increase in treatment costs at many destinations, sometimes over mere weeks.

A recent client was stupefied by the spiraling cost of care. The quoted price for a hysterectomy surged 22 percent in two jumps over three months. (No other details can be divulged under terms of a confidentiality agreement.)

Far from being an isolated case, cost increases of that magnitude have not been uncommon. Commodity-driven inflation, exchange rate volatility, and strong economic growth in major medical tourism destinations have prompted foreign hospitals in many areas to hoist prices.

But the pace and scale of the price increases pose a disturbing question. Have the recent increases been an unusual, brief phenomenon? Or are they a harbinger of more to come?
The future of medical tourism—by destination, by service provider, by procedure -- depends on the answer.

If treatment price increases slow with the expected drop-off in global inflation, the startling increases of recent months will be viewed as a brief price tsunami -- simply, evidence of volatility in global markets generally this year.

But what if global inflation retreats only temporarily, or remains stubbornly high in any country now popular as a medical travel destination? How long would it take for price inflation to erode, even obliterate, the appeal of traveling there for healthcare?

It's a mathematical certainty that given highly variable inflation rates, over time the financial attractiveness of traveling from a low-inflation nation to a high-inflation country for cheaper healthcare will diminish. At some point, the financial appeal (the savings) disappears completely. The danger of recent inflation levels is that process could unfold faster than widely understood.

To appreciate just how quickly, take the example of how greatly U.S. domestic prices changed over two seven-year periods. During the high-inflation period between 1974 and 1980, annual U.S. inflation ranged from 4.9 percent to 13.3 percent and averaged 9.37 percent. The result: what cost $100 in 1974 rose to $185.81 by 1980, a near doubling. Now compare that with the increase in prices over the low-inflation period between 1997 and2003. During that seven-year stretch, U.S. annual inflation ranged from 1.6 percent to 3.4 percent and averaged 2.18 percent. What cost $100 in 1997 cost only $116.33 in 2003.

The difference between average inflation rates of 9.4 percent and 2.2 percent over seven-year stretches meant a difference of 69.5 percentage points (85.81-16.33) in the scale of price increases over the two periods.

The same effect now threatens to unfold regarding the arbitrage in international healthcare costs. Instead of two periods, the impact would be evident in the rapid narrowing of price differences between national healthcare markets: between the cost of care in medical tourism destinations plagued by high inflation, and the steadier rates of care in medical travelers' home nations.

Look at current rates of inflation around the world and imagine the impact on the price competitiveness of the competing medical tourism destinations if current rates were sustained.

*Medical Value Traveler Home Countries*
	U.S.	5.6%	(July)
	Britain	4.4%	(June)
	Canada	3.1%	(July)

*Major Medical Value Travel Destinations*
	Brazil	6.4%	(July)
	Costa Rica	14.2%	(July)
	India	12.1%	(July)
	Malaysia	7.7%	(June)
	Mexico	5.4%	(July)
	Panama	9.6%	(June)
	Philippines	12.2%	(July)
	Singapore	7.5%	(June)
	South Korea	5.9%	(July)
	Taiwan	5.9%	(July)
	Thailand	9.2%	(July)

The primary causes of the recent worldwide acceleration in inflation are well known: big increases in global commodity prices powered in large part by rapid economic growth in China and India, as well as Brazil and Russia. Fast growth in the four so-called BRIC countries is fueling steady, strong growth in demand for commodities, particularly food and fuel.

In recent weeks global inflation has shown signs of coming off the boil, as commodity prices slid back from historic highs amid evidence of a slowdown in global economic activity. The world's four largest economies -- the United States, Japan, the euro zone, and United Kingdom -- now all are in jeopardy of slipping into recessions, caused in part by the damage inflicted on consumer spending, corporate profits, and employment by surging prices and operating costs.

The price of oil has now dropped nearly a quarter from the record high of $147 a barrel reached in early July. After rising to a record $1,100 per metric ton in May, the price of rice -- a food staple throughout the developing world -- has dropped 40 percent to the $600 to $700 range. Global prices for wheat, copper, palm oil (used to produce cooking oil), and a host of other commodities have also declined substantially.

Nonetheless, many factors point toward the global economy experiencing persistent high inflation well into the future. And those forecasts are based solely on known and predictable factors (e.g. projections of supply and demand over time for oil, natural gas, iron ore, etc). It's inevitable, however, that commodity prices will also be whipped by unpredictable events (i.e. droughts and floods in major food production areas, war in the Middle East causing the price of oil to skyrocket.)

As recent experience has shown, when global business costs accelerate, global healthcare costs quickly follow suit. What's poorly understood—or at least seldom acknowledged—is how cost increases vary by locality. It's how effectively any country responds to inflation that could separate the winners from the losers among competing service destinations in the future.

To help anticipate the impact, here are a couple of factors to bear in mind:

Disparate rates of inflation will first affect the global market for low-cost medical services. Where the savings is modest to start, the impact of globally-driven inflation is certain to cramp, and even destroy, the financial incentive behind traveling for those treatments.
The rate at which service destinations are affected will depend on how price competitive they are now. For example, hospitals in northern Mexico, which engage in shadow pricing -- closely tailoring their rates to maintain a modest discount to prices north of the border -- must react more quickly and often to inflation-driven changes on both sides of the border.
For corporate healthcare benefits administrators sizing up the global hospital market with an eye toward creating an international hospital network, thought should be given to how pricing is likely to change over time by country. Inflation is an important factor to consider, so thought ought to be given to distinguishing between inflation-prone and inflation-resistant economies. Characteristics of inflation-prone economies: particularly fast growth rates, fiscal deficits (national governments running big deficits), and weak and unstable central governments (who curry support through profligate spending.)

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

According to the National Coalition on Health Care, roughly half a million Americans sought medical care abroad in 2006, 40 percent of which were dental tourists.

As a fast-growing trend, U.S. patients are crossing the border and flying overseas for dental procedures scheduled between sightseeing trips and spa appointments.
Countries like Hungary, Mexico, Thailand, and Costa Rica have emerged as hotspot destinations for dental tourism. The following chart compares prices of certain dentals procedures in these countries to costs in the United States:

Although these countries are on the top of the list for dental tourism, countries such as Singapore, India, Panama, and Turkey, among others, have started offering dental procedures to Americans looking to travel abroad for care.

Before traveling anywhere for dental tourism, the American Dental Association (ADA), advises patients to check with the health department or ministry in the destination country to see what national guidelines are in place for dentists.

The ADA website also has an International Dental Associations section, where patients can contact dental associations in any country. Visit http://www.ada.org/ada/organizations/international.asp, to find contact information and a Web site link to the selected country’s association.

Always remember to ask the qualification and schooling of the dentist you will be seeing. Also, if you are booking your trip through a medical tourism company, ask a representative if you can speak to a patient who has already used their services, or for a customer testimonial.

MedTrava to Sponsor The Medical Travel Road Show in Kick-off Locations Dallas and Austin, Texas

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

Austin, Texas – August 21, 2008 –As the medical tourism industry continues to grow in popularity, healthcare companies have begun to sponsor medical conferences to help increase consumer awareness and understanding of this new trend. MedTrava (www.medtrava.com), a Texas-based medical travel company dedicated to helping patients obtain high-quality, affordable, offshore healthcare in India, recently announced their sponsorship of The Medical Travel Road Show in Dallas and Austin.

“The Medical Travel Road Show is excited to be working with a company of MedTrava’s status and reputation,” states Skip Brickley, CEO of Transmarx, LLC, one of the country's premier conference and trade show producers. “As a leading medical tourism company, MedTrava is a valuable sponsor, and we look forward to working with them.”

The Medical Travel Road Show, a medical tourism expo focused on bringing healthcare information and advice to the masses, features exhibits on medical tourism, healthy living, free health screenings, and more. The show brings together hospitals, providers, medical travel experts, spas, and wellness centers from around the world to offer health education and guidance.

“Given the rising cost of healthcare in the United States, more and more Americans are choosing to travel overseas for their medical treatment. Heart surgery, total hip resurfacing, knee replacements, gastric bypass, dental, and cosmetic surgery are all popular treatments being sought overseas” says Poonam Dhawan, founder and CEO of MedTrava. “With the emergence of 5-star hospitals, with highly qualified doctors, and savings of over 60 to 80 percent, it’s no surprise that nearly a million medical travelers are already heading overseas for treatment. We are excited to sponsor The Medical Travel Road Show, which offers a one-stop venue for consumers to get insight into the medical tourism process, global providers, and international patient experience,” she adds. “Not only consumers, but companies evaluating medical travel will benefit from this first of a kind expo.”

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 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.

About MedTrava
As one of India’s top medical tourism companies with offices in Texas, Hawaii, Bangalore, and New Delhi, The MedTrava Group is dedicated to empowering individuals and organizations in their effort to receive the highest quality healthcare at the most affordable costs. MedTrava connects clients to a network of leading medical experts and facilities, and their hand-selected, rigorously pre-screened, internationally accredited network allows clients to save as much as 70 percent over the cost of comparable procedures in the United States. Visit www.medtrava.com

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”

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

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