Medical Travel Today

THIS WEEK IN MEDICAL TRAVEL TODAY
Volume 2, Issue 10
by Amanda Haar, Editor

We open this issue with a conversation with Ken Getz, a senior research fellow at the Tufts Center for the Study of Drug Development and the Center for Information & Study of Clinical Research Participation, a non-profit organization focused on raising public awareness and literacy for clinical research. This conversation was particularly interesting for all the parallels one could draw between the evolution of medical travel and clinical trials. We anticipate checking in with Ken again in the future to learn how his industry is shaping up and what lessons we might learn that would benefit our own industry’s development and growth.

We continue our conversation with Ira Nissel of IMS Global Services begun last issue, this time taking a look at his company’s partnership with multiple hospitals in Israel and their IVF services.

We’re also happy to include excerpts from a letter that we received from Robert Kramer, M.D. of Dallas, Texas highlighting his concerns about the industry and healthcare in general. Our publisher Laura Carabello also offers her perspective on international healthcare standards.

SPOTLIGHT

A conversation with Ken Getz, a senior research fellow at the Tufts Center for the Study of Drug Development and founder of the Center for Information & Study of Clinical Research Participation

Ken Getz, Tufts Center for the Study of Drug Development and the Center for Information & Study of Clinical Research Participation

Medical Travel Today recently had the opportunity to talk with Ken Getz, a senior research fellow at the Tufts Center for the Study of Drug Development (CSDD). In addition to his role at Tufts, Getz also runs the Center for Information & Study of Clinical Research Participation (CISCRP), a non-profit organization focused on raising public awareness and literacy for clinical research.

Our conversation was interesting as it brought to light the many commonalities in the global evolution of clinical research and medical travel. We’re grateful to Mr. Getz for sharing his insight and will continue to pay close attention to his industry and the lessons we can learn from it.

MTT:First, tell us a bit about how you got involved in clinical research.

Ken Getz (KG): My background is in management economics, psychology and the sciences. I worked in management consulting for seven years assisting mostly pharmaceutical and biotech companies in the area of research and development.

After that, I started a publishing company called CenterWatch. When the opportunity presented to sell it, I did and went on to join Tufts and start CISCRP.

The one consistent thread through all of these experiences has been clinical trials. Even while in college I participated in clinical trials. When working in consulting, I helped a company build departments and modify clinical trial practices.

MTT: Over the past few years we've all witnessed the astounding growth and acceptance of medical tourism as a viable option for consumers. How do you see or expect to see this new global approach influence the way medical trials are currently conducted?

KG: Interestingly, a lot of this has already taken place. In recent years we’ve seen a tremendous movement in clinical trials (FDA regulated studies) activity across the globe.

Today almost half of all clinical trials are being placed in investigative sites in many parts of the world outside the US.

What we’re seeing now is a proliferation of companies conducting clinical testing globally. Some of the companies are absolutely huge—think big pharmaceutical companies —and others are quite small, from specialty pharmaceutical and biotechnology companies to manufacturers of herbal remedies and dietary supplements. What they’re all taking advantage of is regions where there are high volumes of treatment-naïve patients and well-trained staff to run trials. India, China, Eastern Europe, and Latin America in particular are proving popular for trials.

What’s interesting is how the clinical trials industry and the travel medicine industry are both seeking the same types of markets—a willing consumer base and well-trained staff.

MTT: Is there potentially an opportunity for a clinical trial involving patients coming back?

It’s difficult to speculate or project but I suppose it’s a possibility.

However, you have to consider the current climate and pressure points in clinical trials. For example, as the proportion of patients getting involved in clinical trials come from regions outside the US, there’s a growing pressure in the US to limit the number of trials abroad. Some people feel by going abroad we’re denying US patients access to the trials.

Now what could also happen is that as American patients realize the specific clinical trial they need is not available in the US or in their part of the country, they may choose to travel to gain access. That’s essentially what’s happening in your industry, although getting the treatment at a given cost is the driver. It’s largely the same process.

We’re also seeing early signs of forces that may prompt biopharmaceutical companies to scale back the amount of clinical trials taking place overseas. Initially research sponsors moved some of their clinical trials overseas for economic reasons— they offer faster enrollment, and lower labor and operating costs.

But as the medical professionals in these regions begin to realize they can earn more then they traditionally received the economic advantages will begin to wane. Relative costs will approach parity with those of US and Western European investigators. We may see placement of clinical trials abroad begin to parody with US based trials. This is 7 to 10 years out, but that’s what we need to be thinking about now.

MTT: Do you feel that medical tourism supports or hinders the work you do in any way?

KG: I see the big drivers of clinical research and medical travel being largely the same.

As consumers get savvy about treatments available only in certain markets, they begin to take more proactive and aggressive measures to gain access to these treatment..

For example a patient currently getting an asthma treatment approved two years ago could find out about a study of an experimental treatment that is potentially safer and more effective. A physician could approach them to participate and the patient could either be compensated or receive a subsidy.

You could see the same thing happening abroad. A physician could essentially recruit you and you would participate either by travel or through the internet.

I think the industries work well in parallel. I don’t see one really hurting the other. If anything, as more people get familiar with the notion of traveling abroad for medical related reasons—be it a clinical trial or a surgery—it’ll make them more comfortable with the idea of traveling.

MTT: Your industry is particularly good at sharing information through forums, etc. What do you think the professionals in medical tourism could learn from that approach? What practices you think they should consider to increase consumer confidence and understanding?

Well to be honest, neither the pharmaceutical or biotech industries have done a particularly good job of engaging the public. Public education simply hasn’t existed and without that, public trust has deeply eroded.

I think what the medical travel industry can learn from the clinical trials industry. First and foremost, it is essential—especially with the widespread use of the Web—to put in a concerted effort to engage and educate the public. Public outreach and education cannot be overly promotional. It must be credible, and respectful. You really can’t sugar coat the realities in the honest pursuit of trust.

Unfortunately, this is not the approach that the pharmaceutical industry took and, as we’ve discovered, it takes a lot more effort to reverse the erosion of public trust than it does to build it honestly up front.

One of the other things that pharmaceutical companies did wrong is that its conferences and communications have been very insular. The industry engaged research professionals but to a far lesser extent medical professionals. This hasn’t helped to increase either acceptance or awareness.

If I were in your position, I’d seek to engage stakeholders. I’d host speakers’ bureaus and lectures at medical schools and start talking to physicians. Plus, I’m a big fan of grassroots outreach efforts. If you look at the ciscrp.org Website, you’ll see the types of public media programs we do. And we do these because we’ve found they work.

PERSPECTIVES

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

Ira Nissel, CEO
IMS Global Limited

Editor’s Note:In our last issue of Medical Travel Today, we began a conversation with the founder and CEO of IMS Global Limited (www.medicaltourismforyou.com). In this issue we continue that conversation beginning with a look at how and why the company works with all the medical centers in Israel plus the specific services it offers related to IVF.

MTT: Ira, I understand that IMS maintains relationships with all the major medical centers in Israel rather just one or two. That sounds challenging and it’s certainly a different approach than others are taking. What can you tell us about it.

Ira Nissel (IN): Yes, you’re right, we do work with 18 medical centers here in Israel. It keep us busy but it’s not complicated. First of all, Israel is very small compared the United States so we’re not talking about working with people hundreds of miles away. And we’re here, which is not something every medical travel organization can say. We’re pulling people here, to our community, our neighborhoods. It’s not a push that you have to manage from long distance.

Getting to the ‘why,’ there are a lot of reasons we operate this way.

First, patients sometimes request a specialist that only works in one specific medical center. We need to have that relationship.

And then you’ve got patients who request not a specific specialist, but a specific medical center.

Obviously, each medical center has its own strength. We maintain relationships with all of them so when we have a patient who needs a particular type of care, we can provide it. We always want to be able match a patient’s need with the most appropriate facility physician.

The different centers also vary in terms of the types of amenities they offer. Some have apartments or hotels. If someone’s traveling with family, having that kind of proximity is important.

But on the business side of things, we want to be the gateway to all of Israel’s best. Best physicians, best medical centers, best technology, and so on. The only way to do that is to work with everyone because you never know where the next best will emerge.

MTT:In addition to patient care, IMS offers quite a few professional business services to doctors, medical centers, and various public and private entities. Tell us about that.

IN: Yes, we do quite a bit on the business side of things.

A big area is our International Consultations and Second Opinions Program (CSO). Working with three leading medical centers here in Israel, we offer on-site programs to foreign medical centers and clinics. Our partner physicians actually travel to the patient, wherever they are, to provide a second opinion. This is better for the patient and the physician. This way they both have a better sense of what’s needed and the patient doesn’t have to travel more than necessary.

We also have a Surgical Program. In this case, we send physicians to provide not a second opinion, but actual care to patients who, for whatever reason, can’t travel.

But we also bring doctors to Israel, as well. Our Doctors Training Program offers a wide range of innovative training programs for medical practitioners from around the world. For example, Israel’s Center for Medical Simulation is one of the most sophisticated centers of its kind. Here, doctors can participate in more than 60 types of simulation-based courses. It’s really quite something.

We also have a Technical Transfer service. IMS works with foreign medical centers or clinics that want to establish specialized units within their facilities. We work with them to get it designed, developed, equipped, and we’ll even help train the staff on the technology. We’ve done plastic surgery operating theaters, burn units, trauma centers, and other types of care facilities. It works very well.

MTT:In our last conversation you told us about pediatric care through IMS. If you will, please tell us about one of your other specialty areas: fertility.

IN: This is a big and important area for us. Did you know that the world’s second IVF baby was actually born in Israel. I say that so you can appreciate that this is not a new technology for us. Israel is truly a world leader in IVF treatment. We have some of the world’s best specialists and facilities right here. IN fact, Israel has more fertility clinics per capita than any other nation. There are 24 recognized facilities offering a full range of medical and surgical interventions for addressing everything from Polycystic Ovarian Syndrome, endometriosis, genetic issues, recurrent miscarriages, and other things.

Plus, the countries policies are very attractive to many people. Both married and single women, up to age 45, are permitted virtually unlimited IVF attempts. And that’s not just for a first baby, but for all subsequent babies as well.

For women age 45 to 51, they can also get treatment but with donated ova. Right now there are no waiting lists.

But it’s not all done through IVF. We also employ ICSI (intracytoplasmic sperm injection). Between these two methods, we are able to help most infertile couples conceive and have their own child. It’s really special.

Editor’s Note:In our next issue, we’ll continue our conversation with Ira and learn more about Pediatric care through IMS Global Limited.

About Ira Nissel

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

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

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

BridgeHealth International, Inc. Announces Acquisition of Medical Tours International, Expands Capabilities for Global Medical Tourists

DENVER, Co. – February 13, 2008 -- BridgeHealth International, Inc., a premier health care service provider with a focus on serving businesses for the delivery of international medical care, today announced it had purchased the assets of Medical Tours International (MTI), the nation's leading professional organization serving North Americans, Canadians and residents of other nations seeking medical care in foreign countries. MTI president and CEO Stephanie Sulger, RN, MS, CIPC, a pioneer and recognized thought-leader in medical tourism, will become vice president of BHI's Consumer Division. Visit www.medicaltoursinternational.com or www.bridgehealthintl.com.

"MTI's sophisticated processes and reputation for excellent coordination of medical travel will enhance BridgeHealth's commitment to serving customers seeking medical treatment abroad," says Victor Lazzaro, Jr., CEO of BHI which primarily serves health plans, insurance carriers, employers, third party administrators, and individuals accessing benefits via voluntary benefits plans, health card programs or Consumer Directed HealthCare Plans (CDHP). "Stephanie is a recognized spokesperson in the medical tourism marketplace and adds significant industry and clinical expertise to our management team."

Sulger is a U.S. Registered Nurse who specialized in operating room nursing and staff management until 2002 when she founded MTI. To date, MTI has assisted in the procedure arrangements and travel for several thousand patients seeking dental and surgical procedures in specialties such as orthopedics, neurosurgery, general surgery, cosmetic surgery, GYN, urology, cardiac and vascular surgery and stem cell transplants.

MTI nurse coordinators and health care professionals have arranged medical procedures at health care facilities throughout Costa Rica, Brazil, Panama, Mexico, Singapore, Thailand, and India. Hallmarks of their service portfolio are a commitment to patient safety and dedication to offering patients affordable and timely options for accessing medical care outside the United States.

Sulger designed the MTI Traveling Patient Information Packet which provides patients with information and education about their individual procedure prior to leaving the United States, as well as detailed documents regarding travel arrangements. Additionally, she helped develop the International Patient Identifier (IPED) device used to house patient information and reduce the risk of medical errors resulting from lost records or communication errors such as transcription and translation mistakes.

Sulger serves on the Board of Advisors of Consumer Health World and consults with major U.S. health insurance organizations, hospitals, individual practices and hotels on revenue-generating, value-based products for the medical tourism industry. As the hands-on owner of the earliest medical travel company in the U.S., she brings significant industry knowledge to BHI and is quoted widely in high profile U.S. media. A graduate of the Samaritan Hospital School of Nursing, Troy, NY, Sulger holds a B.S. from Iona College, New Rochelle, NY, and an M.S. from Long Island University at West Point, New York.

Expressing confidence in BHI's business-to-business platform, Sulger says, "BHI's senior management team represents decades of business experience coupled with extensive understanding of health care operations -- the ideal combination of talent and expertise required for success in the growing global medical tourism industry. As individuals, they care about patients, and as a focused business unit, they recognize the valuable role of nurses in delivering quality patient care."

BHI arranges cost effective care, easy access, and travel to key destinations where the physicians and medical facilities are of the highest caliber and have Joint Commission International (JCI) – or equivalent – accreditation. BHI's all-inclusive, transparent pricing plan spans surgery/procedure costs, airfare, lodging, transfers and a full concierge service, and their programs integrate seamlessly with conventional health benefits plans to simplify the medical travel process for patients, employers, and payers alike.

About BridgeHealth International, Inc.
Founded in 2007 and positioned as a leader in the medical tourism industry, BridgeHealth International, Inc. (BHI) maintains a worldwide network of physicians and accredited hospitals, offering priority customer service, significant savings on high value medical procedures, and outcome-based measurement systems. BHI primarily serves health plans, insurance carriers, employers, third party administrators, and individuals accessing benefits via voluntary benefits plans, health card programs or Consumer Directed HealthCare Plans (CDHP), as well as consumers seeking medical travel options. Visit www.bridgehealthintl.com or www.medicaltoursinternational.com

A panel has been set up by the Public Health Ministry to assess how plans to make Thailand a regional medical hub will effect the healthcare system - because many top medical specialists have jumped to the private sector in recent years.

The trend is particularly worrying because medical schools have reportedly lost some of their most valuable teachers to private medical facilities.

"If top medical experts really leave medical schools, grave damage is inflicted on the country's healthcare system. The government spends a lot of time and money to produce a capable medical expert," Dr Thinnakorn Noree said.

Thinnakorn heads the Human Resources for Health Research and Development Office.

In 2003, the government led by Thaksin Shinawatra launched a project to turn Thailand into a regional medical hub.

Thinnakorn said: "On the one hand, the project attracts about Bt50 billion each year for the country. But on the other hand, the Public Health Ministry and state authorities are worried about human resources available to them [given doctors shifting to the private sector]."

"This problem has been discussed for a long time but until now there has been no research or study established to get deep into the information."

He said Privy Councillor Kasem Wattanachai would chair the panel and convene its first meeting next Monday (Feb 11).

The exodus of doctors from the public hospitals to private hospitals has been blamed on the medical hub project, according to the ministry's study. Lower pay at state facilities plus greatly increased workloads on medical staff because of the introduction of the Bt30 health system - which caused a huge jump in the number of hospital visits - have also played a role.

However, data relating to the "brain drain" is scant. That's why the Public Health Ministry wants to conduct a study to try to gauge possible impacts from the predicament.

The first phase of the medical hub project was implemented in the five years to 2008. A sub-panel from the national health office will conduct a study to evaluate this and try to assess effects from implementation of the next phase.

The medical hub project includes three facets that aim to boost medical services such as sickness prevention, spa services and Thai massage. It also promotes Thai herbal medicine products.

A health ministry study estimates these projects have generated Bt200 billion over the past five years from medical services provided to millions of foreign patients who come to Thailand to take advantage of the lower cost of medical treatments available here.

Private hospitals in Thailand benefited most from these projects, the study found. And some private hospitals started marketing strategies based on packaged services targeted more towards foreign patients.

The relatively competitive price, high quality services and excellent hospitality contributed to a rapid influx of foreign patients.

The study forecasts that by 2015 up to eight million people will seek outpatient services here, plus 400,000 will seek medical treatment as patients in private hospitals.

Some 176 to 303 physicians will be needed to cater for this demand, which is equivalent to 23-24 per cent of the country's private doctors or 9-12 per cent of total doctors in the country.

"We expect this will draw a large amount of physicians into the private sector, and cause a shortage of medical workers in the public hospital system," Thinnakorn said.

Senior health officer Viroj Tangcharoensathient said future studies should focus on how to increase the supply of doctors and nurses needed to cope with the demand from medical tourism.

They should also review the financial and non-financial incentives for medical staff in the rural public sector in order to improve its effectiveness and sustainability.

The capacity for medical staff to work in private practice and part-time at state facilities should also be explored.

Medical Tourism Magazine, the official publication of the Medical Tourism Association has released its second issue of the Medical Tourism Magazine. This new issue has a special focus on Indian Healthcare and gives unique insight as to the quality of care available in India.

Medical Tourism Magazine is available in both print and electronic versions and is free for subscribers in both versions. Current and future versions will address important issues affecting the Medical Tourism industry and have a primary focus on the quality of healthcare available at leading international hospitals. Each issue of the medical tourism magazine covers the world as a whole, but also features an inside focus on one specific country or topic. Other topics covered in each issue include:

The magazines is currently distributed to several thousand industry professionals employed at international hospitals, international health insurance carriers in the Middle East, US, UK and Canada, healthcare providers throughout the world, the travel industry, as well as directly to potential medical tourism patients considering going overseas for surgery, and others interested in the industry. The magazine is also distributed to a majority of the health plans that administer self-funded employer health plans in the U.S.

Medical Tourism Magazine is currently accepting ideas for stories, articles, authors and input for the magazine. If you would like to submit an article or story idea or would like your hospital or country featured in our magazine please contact us at renee@medicaltravelauthority.com.

The Medical Tourism Association is producing a documentary on Medical Tourism called Angels Overseas. This documentary will provide significant insight into the high quality of care that international hospitals provide to foreign patients. The Medical Tourism Association plans to produce complete series of documentaries showing foreign patients from the UK, Canada, US, Middle East, and Asia traveling to other countries for healthcare and life saving surgeries. Angels Overseas is the first in the series and follows American patients overseas for health care to Latin America and Asia. The documentary shows the honest truth of what a foreign patient can expect when traveling overseas to a foreign country for medical tourism. The Association is working to have the documentary made available to the public through a TV Network station and also on DVD.

To view a preview of the Medical Tourism Documentary, please click on the link. (Note: the video may take several minutes to load).

If you are a hospital or medical tourism company interested in being featured in the series, please contact renee@medicaltravelauthority.com.

Columbia , S.C. - Clinica Biblica Hospital, a general hospital in San Jose, Costa Rica , that holds the prestigious Joint Commission International (JCI) accreditation, has joined Companion Global Healthcare Inc.ƒs network of overseas hospitals, Companion Global Healthcare announced today.

Network inclusion means Clinica Biblica (www.ClinicaBiblica.com) can provide surgical and other medical treatment to Companion Global Healthcare clients at pre-negotiated, in-network rates. The addition of Clinica Biblica brings the number of hospitals in the Companion Global Healthcare network to four, and the company plans to add more facilities.

“We’re excited about joining forces with Companion Global Healthcare and allowing people to see the quality of care available at Clinica Biblica Hospital,” said Brad Cook, director of Clinica Biblica’s international department.

“Clinica Biblica offers the latest in technology to our individual clients and members of our employer groups who choose to travel abroad for health care,” said David Boucher, Companion Global Healthcare’s assistant vice president of health care services. “ Costa Rica is only a short flight from the United States, and Clinica Biblica offers our clients affordable, all-inclusive rates.”

Companion Global Healthcare (www.CompanionGlobalHealthcare.com), based in Columbia , S.C. , offers streamlined access to JCI-accredited medical facilities that provide services at rates substantially lower than many U.S. hospitals. The company was established in 2007 to serve as a single launch point for appointments, information, travel services, case management and follow-up care in the United States.

All BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan of South Carolina members have access to Companion Global Healthcare’s network hospitals for select surgical procedures. Companion Global Healthcare also serves the uninsured, and contracts with insurance companies and employer groups that wish to include an overseas option in their health benefit plans.

In addition to Clinica Biblica, Companion Global Healthcareƒs network includes Anadolu Medical Center in Istanbul, Turkey; Bumrungrad International Hospital in Bangkok, Thailand; and Blackrock Clinic of Dublin, Ireland.

For more information about Companion Global Healthcare, call 1-800-906-7065. BlueCross BlueShield of South Carolina and BlueChoice HealthPlan members can learn more about Companion Global Healthcare by visiting the „Discounts and Added Values section of www.SouthCarolinaBlues.com. 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.

When 500+ hospital and health care leaders from around the world gathered at the recent International Medical Tourism Conference at Consumer Health World, the subject of accreditation incited a United Nations-style debate that pitted foreign leaders against a delegation of Americans. At issue was the subject of hospital accreditation, with many foreigners questioning the imposition of a requirement that all facilities become accredited by the Joint Commission International (JCI), the international arm of the American-based Joint Commission.

Many argued that requiring the JCI stamp of approval was yet another example of American colonialism, and simply a further case in point of Ugly American strong arm tactics to impose our beliefs on the rest of the world. After all, there are other accreditation arms such as ISQua which many regard as even more rigorous than the JCI. Further, JCI accreditation is an expensive, time-consuming undertaking.

This latest round of criticisms results from the growth of medical tourism, the practice of US citizens traveling outside our borders for medical care, albeit the exact number of medical tourists is in question. According to a report from the National Center for Policy Analysis, an estimated 500,000 citizens exercised this option, seeking quality care and treatment at lower costs. That number is expected to increase dramatically as the nation’s employers, health plans, insurers and other payers – as well as individuals – look to foreign health care providers for quality care and treatment that can also lower health care costs. Throw in a week’s recuperation at a high-end spa or some exotic travel without extra expense and it is understandable why so many people find medical tourism an attractive option.

The core question for Americans is, “What is the level of care outside the US and how can we determine the safety and quality of this care?” Surely, the lure of visiting foreign lands and combining one’s vacation or recuperation with a needed medical procedure must be tempered by a determination of the quality of such care. Clearly, Americans have come to rely upon the standards set by the Joint Commission and fully expect that those proffered by the JCI will also be reliable. It is not a question of imposing our standards on others; rather it’s a matter of trusting the home grown accreditation body as the most reliable judge of hospital quality.

So it is not without basis that many medical tourism companies, health plans and other benefits payers would look to JCI accreditation as the standard bearer of high quality. It is what we know and have faith in– and yes, it is reserved only for those facilities that meet certain standards of excellence.

If foreign providers are seeking to attract Americans as cash-paying patients, they may be well-advised to undergo the processes of JCI accreditation. While there may be others that are equal to – or even supersede – the JCI principles, we are not yet familiar enough with those entities. Given time, American health care consumers will seek out the best value and the highest quality. Right now, JCI-accredited institutions appear to be our best bet.

Editor’s Note: After reading our last issue, Robert Kramer, M.D. of Dallas, Texas felt compelled to share his concerns about the medical travel industry and more specifically, about the values of our system.

We’re grateful to Dr. Kramer for taking the time to write and welcome other readers to share their views on this important topic.

As a physician, I read the interviews with great interest and came away with a disturbing fact. Nowhere, until you get to Ira Nissel and IMS Global, does anyone stress anything but cost savings. Sure, the quality of care by a US-trained physician in India or Korea might be at the level that can be obtained at home, but after care, the possibility of severe complications and need for further intervention are never mentioned. What has been the hallmark of exceptional care for the 50 years I have been a physician has been the continuity of care, a fact that doesn't seem to exist in our "cost savings at any cost" mentality. Knowing your patient, having developed a mutually beneficial relationship over many years, immediately provides the treating physician... that provides an incalculable benefit to that patient's care.

What happens to a person who has a liver or heart transplant overseas, comes home in stable condition, but suddenly goes into acute rejection? Does he get on a plane back to where the surgery was performed, or does he then see a doctor who has never seen him, might have different thoughts on treatment, and has no real-time opportunity to discuss it with the original surgeon?

Add this to the fact that the physician suddenly thrust into the therapeutic mix, might be averse to get involved since he or she was never able to be the doctor on the case. How would you, as a physician, feel if you got a call saying that I was in India for my heart transplant, but now that I am home, you need to take care of me because I now have complications? I might just say "Sorry, I can't or won't help you. I don't want to be responsible if anything further goes wrong. I will probably get sued."

Ira Nissel's efforts are the only patient sensitive ones in your entire article and interviews. And it is because his work is to provide care for those children who would otherwise not be able to receive it. To put his work in the same category of your other interviewees does him a great disservice.

Can we ever return to the time when doctors follow the following rules: Do the right thing to the right patient for the right reason in the right place at the right time and for the right price?

Robert I. Kramer, MD FAAP
Clinical Professor of Pediatrics and Pulmonology (ret)
UT Southwestern Medical Center
Dallas, Texas

New Zealand is a first world English speaking country that has a very accountable and transparent medical system. New Zealand boasts a sophisticated tourism infrastructure that means patients can access 5-star luxury hotels as well as recuperate in areas of stunning natural beauty and tranquility.

Auckland ’s relative proximity to the West Coast of the US is also a positive attribute as it takes only a 12-14 hour non-stop flight from the major cities of the west coast of both the USA and Canada. In other words, you wake up and you’re there.

“New Zealand is possibly the ideal place for the North American medical traveler” say Dr Edward Watson, founder of Medtral New Zealand. “We are a first world, English speaking country, able to provide world class surgical care at an extremely competitive cost with a culture very similar to that of North America”.

Surgical packages to New Zealand including all flights, accommodation and expected medical costs, aftercare (physiotherapy and nursing care) and contingency insurance (to cover serious adverse events) are often 25-40% the cost of the medical procedure alonein the USA.

Dr Watson explains, “We have some of the lowest healthcare costs in the western world due partly to government regulation but we believe the quality of the private hospitals and surgeons we use, and their surgical outcomes are the equal of any western country including the USA.”

Annually approximately 600-850 overseas patients are treated in New Zealand. Many are sourced from the Pacific Islands where New Zealand has agreements in place with Pacific Island governments to treat cardiac and surgical burns patients from the Islands but also the USA, Canada. UK, and Southeast Asia.

The medical system in New Zealand is based on the British system and is very similar to other first world Commonwealth countries like Canada, Australia and the UK. It has been ranked by the Commonwealth Fund ( New York) as one of the best medical systems in the world to treat its population.

The public system in New Zealand is paid for by government taxes and is free to all New Zealanders which does create some degree of waiting time. The private system shares the same medical specialists as the public system but uses completely different facilities.

New Zealand is able to keep the cost of medical care low by developed countries standards because it operates a true ‘no-fault’ compensation medical system. While doctors can be liable for gross negligence the system is based on government-funded compensation which compensates patients both for medical accidents be they a potential risk of having an operation or the fault of the doctor. Compared with a medical malpractice system, the New Zealand system offers more-timely compensation to a greater number of injured patients and more-effective processes for complaint resolution and provider accountability.

Medtral New Zealand offers access to a large range of world class surgical treatments as well as in vitro fertility treatment services and interventional cardiology.

A product unique to Medtral New Zealand is Contingency Insurance. This covers the patient during their stay in New Zealand for any unexpected complication that may arise from surgery. Like most western countries while such events are uncommon if they do occur they can be very serious both physically and financially for the patient. Medtrals contingency insurance enables the further treatment and rehabilitation (included prolonged hospitalization, intensive care treatment and repeat surgery) of the patient so that they can return home when appropriate as deemed by their treating physician. This insurance is standard for all Medtral New Zealand’s packages

Through Medtral New Zealand, patients have access to two of New Zealand’s premier private hospitals: Mercy Hospital and Ascot Integrated Hospital. Combined as a network they form New Zealand ’s largest private surgical facility with 22 surgical theatres

Both hospitals have internationally recognized quality accreditation as conferred by the International Society of Quality in Healthcare (ISQua). Both are reviewed regularly both Quality Health New Zealand (the New Zealand equivalent of JCI and a member, like JCI, of ISQua) as well as the Ministry of Health.

Currently these hospitals treat between 300-400 overseas patients per year mainly from the neighboring Pacific islands ( Fiji, Samoa, Tahiti, Tonga) Canada and the USA.

The European Commission is to hold a workshop on e-health management, organized by the ePractice.eu portal – the EC’s web service for the professional community of eGovernment, eInclusion and e-health practitioners.

The workshop will be facilitated by e-health experts and will be introduced by a high-level keynote speaker, still to be confirmed.

Three different e-health cases will be introduced briefly, before the workshop divides into three breakout sessions in which each case is explored in further detail. A number of core issues and questions will be discussed throughout the day.

Making up the three cases will be the Macro government level, centered on Britain’s NHS service, Hospital Catalonia in Spain will look at the institutional hospital level, and a separate presentation will look at the clinical to patient level, focusing on electronic patient records.

The aim of the workshop is to review IT management issues with a core focus on e-health.

It is geared to two sets of people - those with a particular interest in e-health and those with a general interest in public services and their use of information and communication technologies.

Especially welcome are health service managers and executives, public sector officials, civil servants, ICT managers, designers and implementers.

Key questions relating to e-health and IT implementation will be discussed. These are:

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

- Building World Class Capability for Consumer Centric Service — International

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

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

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

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

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

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

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

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

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

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

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

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

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

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