THIS WEEK IN MEDICAL TRAVEL TODAY
Volume 5, Issue 15
by Amanda Haar, Editor

Greetings,

This week's issue has been a fascinating one to compile for several reasons.

First, two interviews, which were featured in the last issue, continue by offering insight into legal issues as well as employer perspectives related to medical travel. Both are very worthwhile and I encourage readers to check them out. In addition, we're pleased to feature a conversation between our publisher Laura Carabello and Ali Moussavi, CEO of Global Health Voyager, the first publicly traded medical tourism facilitator in the United States.

In addition, a couple of newswire stories highlight the intersection of medical travel and hospitality. It's interesting to watch how the two industries learn to borrow and align themselves with each other. I have no doubt that in time the line between the two will become seamless in ways we can't even imagine at this point.

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

Cheers,

Amanda Haar, Editor
ahaar@cpronline.com

SPOTLIGHT: Ali Moussavi, Global Health Voyager (GHV)

Medical Travel Today (MTT): How did you get started in this medical travel sector?

Ali Moussavi (AM): Since 1992 -- in one capacity or another -- I have been involved with small, growing publicly traded companies in the United States and abroad.

When the opportunity presented itself for me to become the CEO of such a company as NT Media, which is in the business of owning Internet real estate, I took it. Now, here we are with www.globalhealthvoyager.com as a subsidiary of NT Media.

MTT: Can you describe the core mission of Global Health Voyager?

AM: The core mission of Global Health Voyager is to provide exceptional healthcare delivered by highly qualified surgeons and advanced state-of-the-art facilities at a fraction of the cost of traditional healthcare services in the United States.

Our vision is to be recognized as the premier global healthcare company by current and potential patients, employers and our shareholders.

MTT: What inspired you to launch Global Health Voyager?

Medical tourism had been an option for primarily the wealthy and fortunate who were seeking the best in quality care, primarily in the United States and Western Europe.

In recent years, other countries worldwide have expanded their knowledge, expertise, technology and infrastructure in healthcare to meet — and at times surpass — these high-quality standards originated in the United States and Western Europe. These countries have become direct competitors by offering such high-quality care at low prices.

In addition to the satisfaction that affordable healthcare brings to the masses, I also noticed an opportunity to introduce medical travel to small and mid-size employers, both under and uninsured citizens.

MTT: Do you have programs for affluent travelers?

AM: Yes. Global Health Voyager also provides opportunities for affluent patients, providing access to top-tier providers and advanced medical technologies including stem cell treatments, anti-aging and rejuvenation procedures; in-vitro fertilization; rehabilitation programs (i.e., alcohol and drug addiction).

Affluent medical travelers are not as concerned with price as they are with access to Centers of Excellence and “the best-of-the-best” providers in every category. They are also seeking the highest levels of customer service and best-in-class touring opportunities.

For rehab programs, there are special concerns regarding privacy. These individuals need to be assured that their arrangements are completely discreet.

Wealthy patients are in a special category, and we will handle their arrangement with the utmost discretion.

MTT: What distinguishes Global Health Voyager from other medical travel professionals?

AM: As the first publicly traded medical tourism facilitator in the United States, we pride ourselves on providing top-tier service and excellence in quality for all hospitals, clinics, and physicians that we present to patients.

We recognized an opportunity to provide a business-to-business model, to serve private insurers specifically with more than 200 employees and to also serve individuals.

We would like to bring this growing opportunity to the attention of the investing public.

Cost of healthcare in the United State will continue to rise for years to come. Our stock creates a significant opportunity for investors to have access to a pure play in the medical travel space.

MTT: Why are your initiatives important in the industry?

AM: We will build a globally recognized and reputable brand that will help the medical travel industry meet its growth potential.

Currently, there is still a lot of skepticism toward medical travel; primarily, because of the fragmented nature of the industry and lack of recognition among industry leaders. We plan to change that.

MTT: Can you describe your unique roll-up strategy, the size of target acquisitions, and their geographic locations?

AM: We noticed a huge opportunity in consolidating the fragmented facilitators within the medical tourism industry in the United States. Our strategy is to roll-up well-established facilitators within the United States through a national brand presence that will help propel marketing and earning potential.

MTT: Did you see changes in the medical travel marketplace in the past year?

AM: The democratization of healthcare has established standardized evaluation methods and quantifiable benchmarks for international patient care, making the timing of this offering attractive to the global investment community.

In the last year, private insurers and employers have come to realize the significant cost savings and the comparable quality and safety of medical travel. Now, medical travel is regarded as a competitive benefit for plan members and company employees.

MTT: What criteria do you have in choosing medical travel destinations?

AM: We have a number of stringent internal criteria that we set for the travel destinations, but the primary concern is quality of care and safety.

Comparable standards of care to the top U.S. hospitals and clinics are very important. We seek to align with medical institutions that are reputable and carry one of numerous international accreditation credentials.

MTT: Are you finding that more insurance companies are open to medical travel?

AM: Absolutely! Every day, we find growing interest. We believe that payers are going to be playing a major role in the evolution of medical travel.

MTT: Do you think that employers will begin sending patients out of the country? Do you think they will begin to include international medical benefits into programs for their employees?

AM: Yes and yes. It is already happening and the numbers are picking up.

While there are no credible statistics available, our path is set: at the end of the day, it is a matter of a value proposition, which makes it very easy for both employers and employees to understand.

MTT: Do you think the U.S. government will ever start outsourcing healthcare to other countries?

AM: No – but it remains to be seen.

As we mentioned before, a value proposition cannot be ignored. But a review of the healthcare payment challenges facing government -- such as Medicare – shows the potential. Perhaps, some Medicare Advantage programs can be enticed to run a pilot program.

MTT: How does Global Health Voyager intend to market its medical travel programs? What are you doing to reach employers, payers, intermediaries and patients to let them know about the availability of services?

AM: Our overall marketing plan will include all traditional media outlets as well as all available online marketing tools.

On the business-to-business side, we are depending upon conferences and our growing industry relationships.

We believe it is important not to lose sight of medical travel as an evolving and growing industry. As far as GHV goes, we plan to position ourselves to be nimble enough to take advantage of all of these opportunities.

MTT: Do you think domestic hospitals are responding to the competitive threats from less expensive options outside the United States – Asia, Caribbean Islands, Central and South America or India?

AM: No, not really.

But, we have seen some partnerships and collaborative efforts between U.S.-domestic medical institutions and some of their reputable peers in these global destinations. More are likely to come to fruition over time.

About Global Health Voyager

Global Health Voyager (GHV) is a subsidiary of NT Media Corp. of California, Inc. (OTCBB: NTMI). A U.S.-based full-service medical tourism facilitator, Global Health Voyager (GHV) extends its vast worldwide network of highly accredited facilities and providers to patients seeking healthcare, surgical, dental and wellness procedures. GHV is a one-stop medical tourism resource, providing consumers, employers, payers and other intermediaries the ability to choose and access information about a wide array of destinations, hospitals, procedures and services from one convenient location. Through established relationships with international providers, GHV has already done the groundwork to verify the accreditation and experience of the provider organizations. Visit www.globalhealthvoyager.com.

About Ali Moussavi

Mr. Ali Moussavi has been a Director of the NT Media Corp. of California, Inc since April 17,
2001 and Chief Executive Officer, President and Acting Chief Financial Officer since June 30,
2005. He principally is responsible for identifying and structuring international opportunities
and partnerships. Prior to joining the Company, Mr. Moussavi, had a career in Investment
Banking, focusing on capital raising, mergers and acquisitions, and International Business
Development. Mr. Moussavi has substantial experience and knowledge in global expansion
and for over the past five years, has acted as corporate advisor to several U.S. companies,
structuring financial and business reorganization plans and assisting in the expansion of their
consumer and/or investment base to the European and Asian continents. Mr. Moussavi’s
experience in creating online media destinations and connections with medical facilitators is
pivotal in the Companies venture in the medical tourism industry. Mr. Moussavi holds a BA
from New York University.

ali@globalhealthvoyager.com

SPOTLIGHT: Andrew Webber, National Business Coalition on Health, PART II

Andrew Webber, National Business Coalition on Health

MTT: Do you think we could be cost-competitive with places like India, the lowest end in terms of cost, to South America which is probably 50 percent of the cost? Do you think we’ll ever get to that stage?

AW: Maybe not strictly in dollars, but if you packaged our significant potential – high quality, competitive pricing, convenience, family support, follow-up care – we could produce a high-value equation at home.

Candidly, I don’t think that folks would want to travel across the globe just for healthcare services if they knew high-value services were available in their own community -- unless, of course, it’s been their lifetime dream to visit India, which now that I think about it has been one of mine.

MTT: I don’t disagree with you.

AW: That’s where our focus of attention needs to be, I would argue.

MTT: What if — and this is strictly what if — you had a disease or one of your employees or colleagues had a particular condition that would benefit from a procedure that couldn’t be accessed here in the United States — i.e., stem cell?

AW: We’re talking about a procedure that for whatever reason is not done here in the United States, that is not Food and Drug Administration- approved or what?

MTT: Not FDA approved or is going through its approval, but is not there yet. I am specifically pointing to stem cell because a lot of people travel outside the United States for stem cell.

AW: So, this would be a non-covered service outside the employer’s benefit coverage?

MTT: Employers may not reimburse it, but did you know that people are accessing it in large numbers?

AW: I’m sure people are accessing it, but employers are surely not making it part of their benefit coverage.

MTT: What if -- again, strictly what if -- you are covered under an HSA or you could dictate wherever you wanted to go?

Let’s say you found out that in China, for example, they were doing a stem cell procedure that might reverse your condition, such as psoriatic arthritis, or another auto-immune disease. Would you travel and do you think it’s something that employers should look at, if an employee opted to do so?

AW: I’ve never been in that situation, and I can’t even begin to fathom how I would feel if I were diagnosed with a rare disease and went looking for a cure.

So, it’s a free country and if individuals want to spend their own dollars chasing a cure without clear evidence or probability of success, who am I to say that’s wrong.

MTT: People at end-of-life situations will do or try anything.

AW: Personally, I like to look at evidence. I like to look at probability, and I would hope that even toward the end of my life, I or my loved ones would factor in all those issues including traveling across the world and spending significant dollars before making a decision.

MTT: People travel all over the world just to tour and see the sights. Travel has become faster and easier, so I think they are more amenable to traveling for medical care.

AW: I’m sure that’s true and it all comes down to individual choice, particularly if someone’s own money is on the line.

But again, I’m not sure I’d make that decision with my own dollars unless I had confidence that there was more than just a possibility for improvement. I would be looking for an evidenced-based probability that the intervention could help me.

MTT: Right, and there is that evidence by the way, so it’s an interesting point.
Let me switch to something else: What do you think would be the tipping point for employers? What quality benchmarks do you think they are looking for to make a decision to send a patient either to the next state, across the country or maybe even out of the country? What is the quality measurement that you think they would find most comfortable?

AW: I think it’s the combination of quality and cost.

I think if they were able to review quality data including comparative mortality rates, infection rates, and readmission rates – all relative to other medical centers or hospitals – that would support the decision. Employers would also want to see comparative pricing information.

Again, the value equation: cost and quality information.

MTT: So it’s “Show me the data?”

AW: Yes, show me the data, show me the quality data, cost data and show me risk adjusted to population and the patient outcome and process results that have been achieved relative to regional and national benchmarks.

Thankfully, we’ve made some real progress on measuring quality and what can’t happen is to go back to the managed care days when performance was, at least in perception, defined by lower cost.

In fact, I would strongly argue that for public and provider acceptance, quality measures must be the leading indicator of performance with total costs then added to the equation. Let’s not get into trouble again with the public, perceiving that cost-containment trumps quality.

MTT: So, if the quality was the same and the cost to the employer was 50-60 percent less — and the employee was interested in accessing care with no co-pay or no out of pocket expenses — would this be acceptable?

AW: We believe in reference pricing, but you said the key thing: holding quality constant.

So I’m a believer and supporter of reference pricing, for something like lab tests or a colonoscopy where there isn’t significant quality variation. I’m very comfortable with the Safeway model of reference pricing for colonoscopies and saying to employees, “You pay the difference between the average cost of the service and anything your own provider charges.”

MTT: Right and that’s a good message too.

AW: Yes, it’s a very good message. I think the American people have to be ready for that conversation.

MTT: I do, too, and that’s what medical travel is all about.

AW: Agreed, assuming we have the complete information on cost and quality to measure total value.

MTT: Including reporting outcomes?

AW: Yes, that’s right --cost and quality outcomes.

MTT: So, what if the Leapfrog Group came out with International quality measures? Do you think that would raise the comfort level of employers?

AW: Well, if Leapfrog’s hospital-quality measures are a part of the total quality assessment, then yes, we would be supportive.

MTT: So you’re not surprised to learn that they are looking at international quality standards?

AW: Sounds good; I did not know that.

MTT: So, the international community has to get that message, would you agree?

AW: Particularly on the quality side of the value equation. As we learned from the managed care wars, lower costs alone cannot carry the day.

MTT: And did you know that there are health plans offering a full range or international benefit packages?

AW: Does not surprise and fits with more health plans developing high performance provider networks here at home.

Another thought relative to medical travel is that growing acceptance of this model creates a sort of wake up call to our domestic medical community. And as a representative of the business community, I think that competition can be a good thing in terms of motivating the provider community here in the states to become more value-based.

MTT: I agree. Let’s say that healthcare reform kicks in and access to care is compressed, like in Canada. Will people travel?

AW: I learned a long time ago not to predict the impact of major health legislation, so time will tell. I’m just hoping that the employer community will continue to be a major force and participant in health and healthcare.

I will say this: our access problem in the United States is not related to hospital-based acute care services and medical travel. Our access-to-care issues relate more to our under investment in primary care, which is another weakness of our overall delivery system in combination with higher costs.

On the flip side, we have a surplus of specialists and hospitals in many communities which often is a driver of supply induced demand and higher per capita costs.

So a long term, sustainable strategy to get us to higher value healthcare is to transform our delivery system and move in the direction of prevention, primary care and chronic care management. Let’s keep individuals well and manage chronic disease in an ambulatory setting and, by so doing, prevent high-cost hospitalizations and re-admissions. That’s where the real healthcare cost savings can be found and individuals will be happier, even if they miss out on some foreign travel.

About Andrew Webber

Andrew Webber joined the National Business Coalition on Health (NBCH) as president and CEO in June of 2003. NBCH is a national, not-for-profit, membership organization of 53 purchaser-led business and health coalitions dedicated to improving health and transforming healthcare, community by community. Webber oversees all association activities including value-based purchasing programs, government and external relations, educational programs, member communications and technical assistance, and research and evaluation.

Webber sits on the Board of Directors of the National Quality Forum and the combined Bridges to Excellence and Prometheus Payment organizations. He is a principal of the Hospital Quality Alliance and the Quality Alliance steering committee, and NBCH is a member of the Ambulatory Quality Alliance and the Patient-Centered Primary Care Collaborative. Webber is also a member of the Purchaser/Business Advisory Councils for the National Committee for Quality Assurance and the Joint Commission for the Accreditation of Healthcare Organizations, and the eHealth Initiative.

Mr. Webber is a past vice president for external relations and public policy at the National Committee for Quality Assurance. In this role, Webber directed all government relations activities and outreach efforts to the employer and consumer communities. Previous positions include senior associate for the Consumer Coalition for Quality Health Care and executive vice president for the American Medical Peer Review Association (renamed the American Health Quality Association). Webber started his health policy career in 1978 as an employee of the Washington Business Group on Health (renamed the National Business Group on Health), rising to the position of vice president for public policy.

Webber is a frequent speaker and lecturer on health policy issues. He is a graduate of Harvard University.

About the National Business Coalition on Health
NBCH is a national, non-profit, membership organization of 53 purchaser-led business and health coalitions, representing more than 7,000 employers and 25 million employees and their dependents across the United States. NBCH and its members are dedicated to value-based purchasing of healthcare services through the collective action of public and private purchasers. For additional information, visit: www.nbch.org.

SPOTLIGHT: I. Glenn Cohen, Harvard Law School, Petrie-Flom Center for Health Law Policy,

I. Glenn Cohen , a ssistant professor, Harvard Law School; co-director, Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics

Biotechnology, and Bioethics, PART II

I. Glenn Cohen, assistant professor, Harvard Law School; co-director, Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics

MTT: Do you think this is a time bomb that’s ticking away? Is there likely to be case law or any examples of malpractice in the international marketplace to test what is going on?

GC: Yes, I mean it will happen eventually.
The U.S. patient faces a lot of obstacles to collecting damages from a foreign provider. But, there are some things that foreign providers are doing that will make it more likely they will be suitable in the United States.

Let me give you an example that I was told about during a recent hospital tour in South Korea. One of the hospitals has a nurse affiliated with a hospital in New York, and is ready to do initial screenings on patients in the United States. I think that’s the kind of relationship that’s more likely to subject the foreign provider to jurisdiction in the United States.

It is the kind of thing that they are doing in the United States. Chances are, one of these providers will be doing something like that and will be subject to U.S. jurisdiction in court. Then, there will be the question of whether the hospital can get the case dismissed on another ground; either there’s no merit to it or it will come under the doctrine known as “forum non-conveniens,” which asks the court to dismiss the case because this is not a convenient place to hold a trial – the evidence is elsewhere, among other things.
Eventually, I think we’re going to get a case where, in fact, a suit will be maintained in the United States and makes it to trial and a judgment. When cases get that far along, the hospital has a large incentive to settle, but if they don’t, I think we will eventually get a case that holds a foreign provider liable.

My own guess is that the actual case law that develops won’t be all that different from what we have domestically. It will probably apply to foreign law, but it won’t be that different from the way things are analyzed.

Let me take a step back, in terms of a procedure and the way things develop and are maintained in the U.S. courts regarding applying foreign law. It seems unlikely that there will be a lot of the tortuous activity actually occurring in the United States, so as I discuss in my Iowa Law Review article under choice of law principles, a U.S. court will likely apply Thai, Indian or Korean law in the U.S. court. And the patient may, -- in the end -- win, and there will be a judgment against a foreign provider. I think that’s likely to occur at some point.

MTT: In that case, how likely do you think it would be that the patient would actually collect?

GC: There would be a number of factors.

One: the foreign facility, after losing at that point, would have a strong incentive not to make the collection difficult.

I think the facility may have a strong public relations incentive to want to pay up. The other thing is that to get personal jurisdiction in the United States, it’s likely that the foreign facility is doing something in this country; like an office or something. If that’s the case, it’s possible the court will attach those assets to satisfy the judgment.

So if you’re running a little office where you have a nurse in the United States, it may be that you attach the furniture or the computers or whatever to satisfy the judgment. My guess is that if a case gets that far along, foreign providers have an incentive to try and get the case dismissed and everything up until that stage.

Once it gets up to that stage — just for public relations alone — they’re probably not going to fight too hard on the collection. But, I don’t know. It probably depends upon the size of the foreign provider and how much business they want to do going forward.
I will say, California thought this through. It has authorized some Mexican-based HMOs to sell some insurance plans providing services in Mexico, but in return has required the insurers to consent to personal jurisdiction in the United States. They must also continuously review the quality of Mexican providers and publish an advisory statement on healthcare in Mexico among other things.

As I discuss in more depth in my Iowa Law Review article, if a U.S. state wants to get ahead of this and is worried, it could require that foreign providers consent to jurisdiction in the United States — or at least consent to arbitration and also make available how a judgment can be collected.

If we’re worried about this, each U.S. state or the federal government can get ahead of this problem and try to solve it before it actually occurs.

MTT: Are you referring to a California HMO that offers coverage in the Baja?

GC: This is actually the opposite. These are Mexican-based HMO’s.
For the California-based HMOs Baja coverage, it’s easy because it is California-based and if there’s going to be jurisdiction over it in California; there are plenty of assets in California.

California initiated this program in 1998, but then expended it in 2004. The state allowed Mexican-based HMOs to sell insurance plans that provide services in Mexico. At the outset, it was only to Mexican nationals living in California, and then to non-Mexican citizens later in 2004; although that expansion technically expired in 2008, so I am not sure what the current status is.

In order for these Mexican-based HMOs to have the privilege of selling insurance in California, the government pulled them aside and said, “Listen, if you are going to provide services to Californian patients, you must subject yourself to jurisdiction in the California courts. At the end of the day, you can’t say, ‘I’m sorry – you can’t sue me for whatever goes wrong.’”

So, they gave on the one hand, and then needed this authorization to allow the Mexican-based HMOs to sell products to U.S. patients. In order to do that, they got a concession from them that they would basically consent to jurisdiction in California.

MTT: How does this differ from the accidental medical tourist who happens to be touring in France or Spain or anywhere in the world and needs medical care -- and it’s botched. Does that differ from the patient who intentionally travels for medical care?

GC: It does in a few ways.

One way is in terms of the patient who travels to France and gets botched there. The chance of recovery in the United States is even less, except if they go to a facility that has a huge presence — like the sister organization of an American facility.

Usually, this is called “specific in-personam personal jurisdiction,” which means that jurisdiction has to be predicated upon a tie that has to be related to the thing that is being sued. So, in the case of the regular medical tourist, there are possible ties to the foreign provider concerning advertising/recruiting in the United States — sort of reaching into the United States is the image.

In the kind of case mentioned, where there happens to be a foreign facility sitting there, it may not have any ties to the United States. Even if it does have ties, they tend to be unrelated to the actual touring that occurred because it’s not like they did anything that brought this patient to them.

So, in that case, the accidental tourist is going to have a harder time suing in the United States than the active intentional medical tourist, assuming that the foreign provider in that case has made some attempt to reach out to this patient.

MTT: Since the United States is a major destination for medical tourism – I think it is rated among the top three destinations -- do foreigners have rights to sue hospitals and providers here if the case is botched?

GC: Absolutely. They can absolutely bring suit in the United States.

MTT: Do they?

GC: I’ve seen a few cases involving foreign patients who’ve sued in the United States. I haven’t seen a lot, but this is something that I have not systematically reviewed, so I cannot speak authoritatively.

Certainly, they have the incentive to do so because U.S. law tends to be more remunerative than most home state laws, and these jury and discovery rules are also very attractive. If there are going to be suits anywhere, it’s a good idea to sue in the United States, all things being equal. We are on the generous end in terms of medical malpractice.

MTT: Would they likely hire a U.S.-based attorney?

GC: Yes. I would think it advisable to have somebody here that is well experienced at medical malpractice in that particular state.

MTT: Are there any additional words of advice that you would give to our readers?

GC: One thing is how the Affordable Care Act (the Obama health reform) is going to change the dynamics of the market for them – that might be interesting.

What I tell people is that while the number of uninsured individuals is going to decrease, it’s not going to go completely away, even if the Act is completely implemented in 2019. The Congressional Budget Office estimated that there would be about 23 million non-elderly that will still be uninsured. Of those, many of them — about one third — will be undocumented aliens and many of them will be from Mexico.

In the uninsured market, there will be a decrease in the total size of the market and an increase in the people who are going to Mexico; a favorite destination for undocumented individuals from that region.

The uninsured market is going to contract, but it is unclear how large. It will likely depend upon how good the insurance has to be to satisfy the Secretary of Health and Human Services in terms of the mandate. It’s possible the uninsured market will stay the same or grow a little bit if the mandate leaves a lot of people underinsured.

I also think the insured market is likely to increase because now there will be much more demand for lower cost insurance products. It’s possible that the HHS secretary will use her discretion -- she has been delegated a lot of discretion to determine what kind of a plan will satisfy the insurance mandate.
Theoretically, she could use that discretion in a way that rules out insurer-prompted medical tourism plans. Thus far, however, she hasn’t shown any inclination to do so I do think there’s a chance that the medical travel market will increase.

There also isn’t case law on how facilitators are going to be treated for medical malpractice purposes. As I discuss in the Iowa Law Review paper, there’s a chance that facilitators are going to be treated under a more friendly status than HMOs in medical malpractice lawsuits.

I expect facilitators will be better off in terms of the substance of medical malpractice law that they face. On the other hand, facilitators are much more likely to be subject to jurisdiction in federal courts and have suits maintained against them in federal courts because they have many more contacts with the United States.

So, I do think there’s a difference that cuts both ways. On one hand, there are more likely to be lawsuits against facilitators than physicians in foreign facilities. On the other hand, they’re more likely to be judged by a more favorable standard than the foreign doctors and foreign facilities.

MTT: Do you put travel agents into that bucket?

GC: Probably not.

A travel agent who operates in the United States is likely to be subject to a lawsuit here, that much is clear. Whether they’re going to be sue-able on the medical malpractice theory depends, I think, a little bit on how they hold themselves out and what they actually do.

If an agent arranges travel for a patient to go abroad and harm results not from the travel, but from the delivery of medical services, I think it would be hard to sue the agent.

On the other hand, if a facilitator is brokering, arranging and handling the back-and-forth with a foreign hospital, then I think it’s more likely to be subject to potential liability.

MTT: If an illegal alien accesses care in the United States, do they have rights to sue for malpractice?

GC: As far as I know, yes.

The fact is an illegal alien hasn’t given up their medical malpractice liability rights; it’s the same as if someone ran someone over in a car or a toaster exploded. Patients don’t lose rights just because they are undocumented aliens.

About I. Glenn Cohen
Glenn Cohen, assistant professor and co-director of the Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics at Harvard Law School, a leading expert on the intersection of bioethics (also called “medical ethics”) and the law as well as health law. He also teaches civil procedure. From Seoul to Krakow to Vancouver, Cohen has spoken at legal, medical and industry conferences around the world and his work has been covered on PBS, NPR, in the Boston Globe and through several other media venues.

Cohen’s current projects relate to reproduction/reproductive technology and medical tourism – the travel of patients who reside in one country to another for medical treatment. His past work has included projects on end-of-life decision-making, Food and Drug Administration regulation, research ethics and commoditization.  

His award-winning academic work has appeared in the Stanford, Southern California, Minnesota, Iowa, and Hastings law reviews; the Harvard Journal of Law and Negotiation; the Harvard Journal of Law and Technology; the Food and Drug Law Journal; the Journal of Law, Medicine and Ethics; and the Hastings Center Report.
Prior to joining the faculty, Cohen served as a clerk to Chief Judge Michael Boudin, U.S. Court of Appeals for the 1st Circuit. He also served as an appellate attorney for the U.S. Department of Justice, Civil Division, Appellate staff, where he led counsel in more than 12 circuit court cases and represented the government in the Supreme Court, in conjunction with the Solicitor General's office. Immediately before joining the faculty, he was a fellow at the Petrie-Flom Center.

Cohen has published two papers on medical tourism, “Protecting Patients with Passports: Medical Tourism, Medical Tourism and the Patient-Protective Argument,” 95 Iowa Law Review 1467 (2010), available for free download at http://ssrn.com/abstract=1523701; and “Medical Tourism: The View from 10,000 Feet,” 40 Hastings Center Report, March-April, 11 (2010), available for free download at http://ssrn.com/abstract=1650616 

Special to Medical Travel Today: Scott Frankum: Value Innovation in High-Volume
Hospitals – Part II

In our last issue, we were pleased to present Part I of Scott Frankum's exploration of why High-Volume Focus Hospitals could define health travel’s future. This week, he
continues with an examination of well-documented model of value-innovated medicine. Please address questions to: TheWellReport@gmail.com

MEDICAL TRAVEL―A Broader Search for Value
Second in a Series on Value-Innovated Medicine

A Re-Cap
The first installment of this report on the potential impact of High-Volume Focus Medicine (HVFM) looked for commonality between the original pioneer ― Shouldice Hospital in Canada, and Narayana Hrudayalaya (NH) ― a fast growing model in India and the Cayman Islands. The models have common pre-conditions for the development of value-innovated pricing, outcomes and experiences. The comparison also led to a working definition for High-Volume Focus Hospitals (HVFHs).

Aravind Eye Hospital
This week I’ll add a preliminary conclusion from analyzing India’s Aravind Eye Hospital,
another well-documented model of value-innovated medicine. So far, Aravind Eye Hospitals conform to the pre-conditions and working definition for HVFHs. A high level of conformity increases the likelihood that value-innovated medicine is reproducible, especially when the examples range across three distinct categories of surgeries performed in different environments.

By any measure, Aravind has a patient population that is so broad as to be unprecedented. The unexpectedly diverse patient audience leads me to consider whether diversity characteristic are present at Shouldice and NH as well, in which case we’ll add super-broad patient populations to the working definition of value-innovated medicine. I’ll try to have some answers with the concluding installment.

Floating Layers
Physical, cultural, administrative, and economic distance are layers related to health travel, which float independently on top of a search for medical treatment. These layers create a framework for mapping the additional effort required of medical travelers.

Each layer is also a way to understand the extra value health travelers can gain (and conversely, the extra value the industry needs to deliver) on a health travel journey.

The customer evaluation goes something like: Health Travel Benefits must be greater than or equal to (≥) Price + Burden. This simple formula allows us to depict an industry demand curve that incorporates the extra effort and rewards affecting medical travelers.

Health Travel at Shouldice
Most Shouldice Hospital patients are from the Province of Ontario, but approximately ten percent of patients arrive from the U. S. and 114 other countries.

Shouldice’s spokesman and Director of Business Development, Daryl Urquhart, writes that the hospital’s evergreen allure comes from word-of-mouth, practice longevity, confidence in surgical outcomes and a lifetime guarantee on hernia procedures.

The Effect of Insurance on Patient Numbers
When The Harvard Business School case on Shouldice was written in the 1980’s, international patients made up about 42% of the hospital’s patients. The story of what happened to precipitate the decrease from 42% international patients to 10% may be the only data we have on the effect of insurance on international health travel numbers.

Mr. Urquhart writes that until around 1983, Medicare and private insurance both reimbursed Shouldice for normally scheduled hernia surgeries on U.S. patients. Around then, a U. S. Senator went to Shouldice as a patient and publicly praised the care he received. A wave of “Buy American” Medicare and private insurance changes ensued, and both stopped paying for Canadian surgeries, except in unusual circumstances. Once the U. S. stopped normal reimbursement for care at Shouldice, the number of U. S. patients declined rapidly.

Urquhart writes,” If Medicare and private insurers covered cross-border health care… Shouldice Hospital would see a return to higher volumes of cases from the US.”

The Road to Narayana Hrudayalaya
NH has a broader patient base than any I could have imagined before starting this research. By 2008, 450,000 medical tourists had come to NH from more than 25 countries. Currently, twenty percent of NH’s patients come from outside the country and another large group travels from within India, making NH the most popular medical value travel destination in India. Clearly, NH makes globalized health care work.

The hospital’s social justice policies broaden the definition of who may qualify as a medical traveler. Non-paying patients from Pakistan, Bangladesh, Burma and Africa together with subsidies for 40% of patients demonstrate NH’s goal to help the underserved.

The World Noticed
Devi Shetty, MD is Chairman of NH. He tells me the story of being invited to the United
Kingdom recently to meet with National Health Service (NHS) policy makers at the House of Commons.

He writes, “The United Kingdom does not really require twenty-two heart hospitals. All the country needs is a maximum of two to three heart hospitals in two or three locations. Patients can easily travel from one part of the country to another part, in less than five hours. If the UK consolidates procedures like heart operations, joint replacements and organ transplants in a few centers across UK, first of all their costs will go down significantly. The results will get better and the efficiency will be the best.”

Governments Already Voted
You’ll recall from the first installment that national and regional governments in Slovenia,
Cayman Islands, India and the UK are creating strategies or making policy decisions around value-innovated medicine.

Will the UK Make the leap to HVFHs and domestic health travel? Would value-innovated medicine jump-start the cross-border initiative in the European Union? How far would the cross- border queue extend for value-innovated UK heart surgeries? The rumbling sound you hear is a line forming at the Chunnel ticket booth, now.

First One In
So, what happens to customer preferences in regard to health travel when NH in the Cayman Islands opens? Or, when Slovenia launches the first all-Da Vinci robotic high-volume bariatric hospital, offering $3500 gastric sleeve surgeries with top medical outcomes and experiences that patients prefer?

I think HVFM will drive development and that the demand curve for health travel will look like this.

Which Path Will Development Take?
Value-innovated pricing, outcomes and experiences allow HVFM to leap-frog over legacy competition and drive how health travel unfolds.

In this graphic, X = Customer Burden (time, complexity, unknowns and price) from low to high. The X axis is a stand-in for the (physical, cultural, administrative and economic distance) layers of considerations that medical travel adds to the normal search for medical treatment. Y = Overall Quality (medical outcomes, favorable experiences, savings, simplicity & confidence). The Y axis is a stand-in for the extra value health travelers can gain.

Three Scenarios
These three scenarios propose what customer demand might look like in regard to health travel and value-innovated medicine. There is simple segmentation for cross border / time aspects

Scenario 1 represents today’s health travel demand curve where there is a linear
relationship between overall quality and customer burden, with a cross-border inflection
point. It assumes patients are comparing nearby traditional hospital medicine to other
traditional hospitals, at longer distances.

Scenario 2 projects the health travel demand curve for market entry of High-Volume
Focus Hospitals competing with traditional hospitals. In other words, it depicts the
demand curve for traditional vs. value-innovated medicine.

You’ll see that the curve may dip at first because of the need to market the new services,
explain the paradox of value-innovated medicine and get to volume. Then, the demand
curve rises really fast and flattens at the international border, where customer burden
spikes.

Research on value innovation shows that new entrants can charge up to 70% of the
previous value equation and still take market share. Consequently, once value-innovated
medicine enters a market, the utility of Scenario 1 fades permanently as demand shifts
into Scenario 2.

Scenario 3 projects a demand curve for patients comparing one HVFH to other, value-
innovated health care. It is likely that real, overall quality will be at par between two
value-innovated offerings. Consequently, small gains in outcomes will draw fewer
patients to take on additional burden for decreasing gains.

Diminishing returns will shift customer preferences from apples-to-apples value comparisons toward other tangibles like convenience and amenities ― as well as toward
intangibles like brand.

The Path of Progress
The factors below determine which customers become patients and the velocity of health travel adoption. I close by focusing on the direct impact of medical travel marketing, which I believe is the single biggest problem health travel has.

Direct Factors
Marketing & Sales Cycle
The Key Customer
Customer Centeredness
Insurance
First Mover Advantages

Secondary Factors
Tele-Health and Distance Medicine
Technology
Unilateral Offerings vs. Bi-Lateral Offerings
Getting to Volume

Good Intentions.
Many global health care marketers utilize “Announcement / Awareness” marketing which lives mostly on the Internet. A small number of companies put effort and resources toward helping customers through the Sales Cycle’s other stages of Interest, Evaluation, Trial and Adoption.

Fewer still truly support customers after-the-sale, or are sophisticated enough to affect the speed of the adoption curve with marketing levers for Relative Advantage, Compatibility, Complexity/Simplicity, Observability and Trialability. Worse, the good web content swims in a dirty sea of undifferentiated websites that pull us all down.

Bad Results.
The only way a company can draw customers with general information and a beginner’s gloss is if the site already ranks on the first two pages of Google search results. Everyone else should figure out a different plan. The way to prosper in our maturing environment is to communicate how your offering is greater than or equal to (≥) Price + Burden.

When health travel marketing fails, it hurts all of us. I want to walk you through why I believe that announcement marketing actually creates confusion and risk that works against attracting patients ― indeed, why I believe it causes customers to stay away in droves.

The formal explanation is that bad marketing creates a Power Law which pushes an adoption curve from a normal distribution into a Pareto distribution, (also known as the 80/20 phenomenon). The practical reason is that customers don’t stand a chance of being able to evaluate what to do or whom to trust with fewer than 30 hours of research. What customer in their right mind wants to do that? The practical effect is that we suppress 80% of the gross market size.

The Way Forward
Poor marketing choices and the dirty sea of undifferentiated sites cause the industry to see only 20% of the customers it would serve with professionalized marketing. The best way to correct the Power Law (and recover the suppressed 80%) is for countries, regions, hubs and individual firms to introduce smarter, more disciplined marketing ― starting with setting a unifying
strategy.

About Scott Frankum
Scott Frankum is an author, analyst, blogger, speaker and creative director with a master’s of business administration in global management. He helps consumers become highly informed patients and smart healthcare shoppers. He helps governments, businesses and high-potential start-ups find growth through analysis, innovation and impact. His new book, “The Well Report ― How to Shop for Hip Surgery,” publishes in August.

TheWellReport@gmail.com
https://twitter.com/TheWellReport
www.TheWellList.com

Copyright © 2011, Scott Frankum. All Rights Reserved.

PERSPECTIVES

A letter to a Student of Medical Tourism from Constantine Constantinides

Editor's Note: In our last issue, we presented Part I of "A letter to a Student of Medical Tourism” by Dr. Constantine Constantinides, of Health Care Cybernetics. We're pleased to present the conclusion below.

Treatment Abroad and Internal Medical Tourism
…and the effect of economic recession

Once more, Simplistic Thinking was heralding the explosion of Treatment Abroad as a result of the economic recession (because people would not be able to afford the expensive treatment at home – e.g., the USA).
The scoffing of this simplistic thinking (by some, including me) was met with derision by those with a vested interest in receiving patients from abroad.
But of course, the doubters, basing their doubts on deeper knowledge and understanding of how health consumers behave (both in good and in bad economic times), were proven right.
The “Treatment Abroad” activity did not increase. In fact, it dropped noticeably because people simply put off going abroad (or even locally) for treatment.
Our Health Tourism Watch, which closely monitors, documents and analyses information (available in the public domain) and intelligence (obtained from privileged information sources) indicates that the phenomenon of Medical Treatment Abroad is leveling off (never mind the continued predictions by the usual suspects that by 2012, the “abroad” version of Medical Tourism will be a trillion-dollar market).
What we are also seeing is an increase in Internal Medical Tourism (movement within the country) at the expense of Medical Tourism Abroad (see the USA).

Every Tourism Destination is a Health Tourism Destination
…and every tourist/traveler is a Health Tourist

Besides the “West’s revenge” backlash phenomenon, (where once “source countries” are now becoming “destinations”), with the ht8 Concept and approach to Destination Development, every Tourism Destination can become a Health Tourism Destination – even if it is only in the Boutique Health Tourism category.
And for the same reason, with ht8, every tourist/traveler is a potential Health Tourist.
It needs to be remembered that “Health Tourism” is the catch-all term for health-related services in 8 Segments.

Just as we were celebrating Globality
…we are seeing Regionality

Just as we were celebrating Globality (I am a staunch champion and supporter of Globalization “done right”), and, when certain pundits were beginning to replace the term “Healthcare” with “Globalized Care,” we are, in fact, seeing Regionality (regional preferences based on cultural and socio-economic factors - see “Market Segmentation - and Stratification,” above).

The Best Medical Tourism Destination
…and the Health Tourism Perception Index

So, is there such a thing as “the” Best Medical Tourism Destination?
The clear answer is “no” – unless one lays down a set of universally accepted (and undisputed) criteria.
Such a set of criteria, which would reveal “the” best Medical Tourism Destination does not exist – and cannot exist. This is because people choose a Destination for different reasons using a different set of criteria.
Nevertheless, Destinations can be rated and graded (like something which the rating agencies, e.g., Moody’s and Standard & Poor’s do for countries, financial institutions and companies).
We have come up with the Health Tourism Perception Index, which is a compound “pillared” and “Sliding Scale” Index that ensures equity (by comparing “likes with likes”). "Absolute Rankings" are given considerably less prominence than "Same-Criteria Rankings."
Same-Criteria rankings are based on the consideration of a self-selected set of factors (sub-indices and Index Pillars).

“Have to” vs. “Want to”
Given the choice, “want to” will always trump “have to.”

“Medical Tourism,” as understood by most people today, is all about “have to.”

Have to because I cannot afford the alternative
• Have to because of the long “waiting list”
• Have to because it is not available in my country

But as we have seen, competition steps in and deals with inefficiencies and “friction”.
And the industry will always aim to give the market what it “wants” – and provide it “where” it wants.
This, of course, in no way means “the end of Medical Tourism.”
It just means that Medical Tourism – like Tourism – will become a “want to” activity.
We already see Health Tourism including Medical Tourism as a lifestyle choice.

The Role of the Medical Tourism Facilitation Profession
…and the need for constant re-invention

The Medical Tourism Facilitation Profession is loved and hated.
Today, the profession is operating in crisis mode. Many facilities have gone out of business, some exist merely as a static website (stuck at 2009 or 2010), others are there if and when they are needed and a few remain viable businesses, but aiming to diversify just in case.

Consumer Fears and Reservations
What do consumers fear and make them weary and mistrustful of Facilitators?
The following are some of the identified consumer concerns:

• Added Cost
• Restriction of choice
• Clash of Interest (Facilitator serving the interests of the Provider)

Provider (e.g., Hospital) Fears and Reservations
What do the Health Service Providers/Hospital Owners fear and make weary and mistrustful of Facilitators?

• Added Cost
• Management / Administration Difficulties
• Reflection of Facilitator Behavior (when bad) on the Provider/Hospital

With the introduction of the Scheme, nothing will change with regards to Discretionary (some refer to them as Elective) Health Services.

I participated in and contributed to the EU Commission Consultation on EU Cross-Border Healthcare (2006 – 2007).

At the time, and subsequently at several conferences, I pointed out a number of stumbling blocks – and suggested how they may be converted to stepping stones - to allow the proposed scheme to work.

The Directive has now been voted into Law. The Commission and the architects of the Scheme expect all EU Member Countries to be ready to allow the scheme to operate smoothly by 2013 (in my view, “wishful thinking”).

By the way, in 2011, we saw the founding of the European Cross-Border Healthcare Organization (I am an Executive Board Member). It has a broad agenda, which includes acting as an observatory, a think-tank, advisory and lobbying organization.

So, how many EU citizens are likely to take advantage of this “benefit?”
Those closely involved with the subject and scheme talk about something like 1–3 percent of those entitled.

All things being equal, people prefer their treatment as close to home as possible.

Of course, for some, things are not equal, and services outside their home are obviously better.

But let us not forget that it will be the public sector which will be the primary player – and, generally, there is no spare capacity (empty beds and underemployed doctors) in Public Sector Hospitals – in any of the EU Member States. So patients from other EU Countries are not likely to be welcomed with open arms.

We are still not sure if and how the Private Sector will be allowed to play – and play profitably. The private sector will be willing to provide “capacity” and services – if there is profit to be made. But this is doubtful, since the dispatching country will only reimburse as much as the patient would have cost them back home at a Public Sector Hospital (and generally this cost is underestimated).

INDUSTRY NEWS

Miami Herald Report: ‘Inspector General Blasts International Marketing Program of Jackson Health System’
 
An investigation by the county’s inspector general concluded that Jackson was spending millions of dollars on international marketing efforts without knowing how many patients the program attracted.
The Miami-Dade Office of the Inspector General released an 82-page report Thursday strongly condemning some practices of the company that until last spring ran Jackson Health System’s international marketing program; particularly questioning the value of government hospitals spending millions of dollars to attract foreign patients.

To continue reading, click here.

TFP|Ryder Healthcare Wins First Project in China

Terry Farrells & Partners (TFP) and Ryder Architecture are joining forces to follow new opportunities in the burgeoning healthcare market in China, and have just announced their inaugural commission for a International Medical and Healthy City in Northeast China. Under the collaborative title TFP|Ryder Healthcare, the two firms will draw on Ryder Architecture’s extensive project base in healthcare and TFP’s experience in China to realize this world-class medical treatment platform and medical tourism resort.
Due to be completed in 2020, the new complex will incorporate a gene granulocyte treatment centre, a stem cell transplantation centre, an organ transplantation centre and a granulocyte bank into a major acute hospital building. Additional structures will include a recuperation and convalescence center and areas for aged care and residential communities, with eco-tourism, residential, culture and entertainment facilities.
Speaking on the joint venture, Paul Bell, director at Ryder Architecture and previously of TFP in Hong Kong, said, “We are confident our informed and holistic approach to sustainable healthcare design will offer real benefits to projects in China, Hong Kong and the wider Southeast Asia region providing an integrated service from the earliest strategic planning stages through to the intelligent operation of facilities.”

Cleveland Clinic Hotel on Main Campus Undergoes ‘Wellness’ Renovation

Banking on a continuation of the medical tourism trend, a hotel on Cleveland Clinic‘s main campus is undergoing a multimillion-dollar renovation that’ll transform it into a “wellness hotel.”
The InterContinental Suites Hotel's nine-month-long renovation project is scheduled to wrap up this week and will create what appears to be Ohio’s only wellness hotel associated with a hospital. The new build-out involves several typical aspects of a hotel renovation including improvements to the lobby, public spaces, guest rooms and fitness center, the addition of soft lighting, soothing music and a muted color palette. The difference is that nearly all 162-room InterContinental’s changes are done with the intention of helping guests enhance health and wellness.

To continue reading, click here.

Mixed-Use Concept of Hotels Bridging Healthcare Gaining Ground

Udel.edu -- Hospitals and luxury are two words that just don’t seem to go together. Or do they?  In a recent trend where medical recovery meets the comfort of a luxury hotel, the idea of "hotels bridging health care," or H2H, is gaining ground. 

A mixed-use concept, H2H creates a new and innovative business model for entrepreneurs to fulfill the unmet needs of certain patients and their families in a hygienic, complementary and friendly environment that provides quality accommodations, upscale treatments and state-of-the-art wellness centers for recovery.

To continue reading, click here.

Wellness Tourism Worldwide Issues Part I of 4WR: Wellness for Whom, Where and What? Report

Editor's Note: Dr. Laszlo Puczko, Wellness Tourism Worldwide's managing director, and his colleague, Camille Hoheb, reached out this week and shared news that Part I of their 4WR: Wellness Travel 2020 research report is complete. By way of background, Wellness Tourism Worldwide (WTW) is an international trade alliance comprised of wellness and tourism-related businesses, organizations and institutions based on the domains of well-being and quality of life.
WTW's research project is aimed at forecasting the state of wellness tourism by 2020 in three categories: who (consumers), where (countries offering wellness tourism products) and what (types of wellness tourism products). 4WR collected information from 140 stakeholders at wellness, tourism, spa and healthcare industries in more than 50 countries worldwide.
 
The report is divided into two sections: Part I describes the current status of wellness tourism, and Part II  offers industry perceptions and trends predicted to shape wellness tourism by 2020 (Part II will be published on Aug. 19, 2011).

We're grateful to WTW for making Phase I of the report available to our readers. To view it, click here: http://www.wellnesstourismworldwide.com/news.html

Hotwire for Surgery

Washingtonpost.com — he hotel bed that is empty tonight can never be sold again. That insight led Hotwire to create a disruptive model that has given travelers great deals on hotel rooms. It turns out there are “beds” and “suites” of a different variety - Surgical Suites/Beds - that have a similar phenomena. Just as top hotels rarely are 100 percent booked and can earn incremental revenue from otherwise empty beds; top surgical facilities have a similar dynamic. That insight led National Surgery Network to develop a national marketplace for surgical procedures. 

To continue reading, click here.

E. Idaho Woman Healthy again after Foreign Surgery

NECN.com — Heather Cody is proof that you really can turn back the clock.
Two years ago, the 45-year-old counselor was a different woman. She looked tired, worn thin by years of chronic hip pain. She couldn't dance, or at least not for very long. Even simple day-to-day tasks were exhausting.

She used a cane to help her get around.

Cody, now 47, looks younger than she did back then. The fatigue has left her smile. She dances. She hikes and skis.

The cane is gone.

"This is really the old Heather. This is the Heather I knew," said Julie Thompson, a longtime friend of Cody who is herself a mental health counselor. "Just being able to see somebody reconnect to their healthy self — it's a miracle."

The turning point in Cody's life was hip-replacement surgery, a procedure in 2009 that took her on a three-week journey to New Zealand. Like many Americans, the cost of such a major medical intervention in this country was a huge obstacle. Cody said the surgery in the United States would have cost between $50,000 and $80,000.

"I was thinking, 'Maybe I'll just sell my house,' or, 'I don't know what I'm going to do,'" said Cody.

Then, she found a company in New Zealand that quoted her just $23,000 for the same operation, plus a plane ticket and lodging there. For Cody, the decision was a no-brainer.

"It was a little adventure," she said of her trip. "In some ways, I think it took (away) the pain of going into surgery. You know, I got distracted by the excitement of doing something new."

While reliable statistics are elusive on how many Americans turn to medical tourism in search of cheaper treatment in foreign lands, it's clear that the service has become a viable industry in a growing number of countries. Thailand, Hungary, India and Israel are just a few of the nations whose clinics have stepped into the niche created by the United States' spiraling healthcare costs.

These nations offer thousands of dollars in savings and tantalizing tourism opportunities for treatment that is often comparable with what's available in this country.

But the practice isn't without drawbacks. One problem medical tourists face is the difficulty of continuing care after a major procedure, such as a hip replacement or cataract surgery.

Cody said her doctor wasn't really engaged in her recovery, and so she has stopped seeing him.

"It's a disappointment and a worry," she said. "But I don't feel like I'm at risk really. I feel like I could get help if I need it."

Other complications that can arise from medical tourism include the difficulty of dealing with a foreign country's legal system in case something goes wrong during an operation.
Recovery from surgery wasn't a walk in the park. Cody experienced significant muscle pain; an upgrade from her bone-grinding, pre-surgery pain, but pain nonetheless. She couldn't walk without crutches or drive for six weeks.

Then, almost from one day to the next, she said, the pain went away. She still avoids high-impact activities like jogging and downhill skiing, but dancing, cross-country skiing and hiking are all possible and even enjoyable.

"She's an inspiration to anybody that knows her: her ability to surpass the limits of the system," said Thompson. "Her story is an example to other people that there are options out there. You just have to think outside the box."

Doing It the Marketing Way

Expresshealthcare.in — Tune into a radio or pick up any newspaper, health magazine or even take note of huge hoardings lined up on city junctions; a ton of ads are likely to speak of the best of care provided at their hospitals. Moreover, these days, many hospitals are updating logos, altering the visual look of their communications, changing positioning lines and giving facelifts to facilities. All these activities indicate that marketing has finally hit the radar for the healthcare delivery segment in the United States. Hospitals in India have now come to believe that marketing their services is crucial to their financial success. Their marketing efforts are maturing to the point that patients are coming to terms with hospital marketing. It is interesting to note that Indian hospitals these days are investing heavily in marketing. The Apollo group, Fortis group, Manipal hospitals, L H Hiranandani and Kokilaben Dhirubhai Ambani are a few hospitals and groups that have taken advantage of this tool to drum up business. Industry analysts note that these hospitals have achieved an increasing positive return on investment (ROI) over a period of time. Apart from increased ROI, effective marketing has given hospitals the opportunity to earn a competitive advantage over their competitors.

To continue reading, click here.

World-Class Hospital to Open in Barbados to Serve Global Medical Tourism Market

PRNewswire — Invest Barbados today announced that a new world-class hospital will be built on the site of the former St. Joseph Hospital as part of a long-term development program that will also bring several specialty treatment centres, biotechnology research companies and patient accommodation facilities to the country in the next five years. 

"This exciting initiative brings a national asset back into productive use in a way that will generate foreign exchange, international investment and tax revenue, as well as  employment and skills training and technology transfer," said Wayne Kirton, CEO of Invest Barbados. 

"Our role is to support what is, we believe, the most respected healthcare brand in the world -- board-certified American physicians -- and we believe that Barbados has the quality of life, educational facilities and technological resources to enable us to achieve our strategic goals as quickly as possible," said Dr. Paul Angelchik, a plastic surgeon from Phoenix, Ariz. and CEO of AWC. 

"We have been particularly impressed by the prudence and sophistication that the Government of Barbados has demonstrated in considering our proposal," said Robert Priddy, AWC president. "We intend to work with its officials closely in the years ahead to meet the interests not only of our physician-members, but also of the people of Barbados."

Registered as a Barbadian corporation, American World Clinics expects to attract investors from the United States, Canada and the United Kingdom interested in the potential of medical tourism. The primary market for AWC's hospital and care services and facilities in Barbados will be patients from the UK and North America, but treatment will also be available to Barbadians and other international clients seeking private medical and surgical care.

The project will bring numerous benefits to Barbados, Kirton said.  The estimated construction and equipment cost of the first phase of foreign investment is approximately BDS$92 million, providing jobs for about 200 Barbadians.

Once operations begin, approximately 230 persons will be employed at the facility in a range of job categories. AWC has pledged to hire locally whenever possible.

The development will generate the equivalent of BDS$200 million per year in foreign exchange during its first few years, according to conservative estimates, with that figure rising steadily over the longer term.

"Of equal importance for the future of our country is the opportunity for Barbadian healthcare professionals to work alongside leading U.S. surgeons in employing the latest medical techniques and equipment to improve patient outcomes,” said the Hon. Donville Inniss, minister of health in Barbados.

"While medical care will primarily be delivered by U.S. physicians and healthcare specialists, Barbadian professionals will be able to collaborate with them on a daily basis in working with patients. These professional partnerships, as well as the introduction of new research and specialty care facilities to our infrastructure, will provide significant benefits in terms of both technology and skills transfer."

He added that AWC will work with public health officials to ensure that the facility's operations will not have a negative effect on the number of local healthcare professionals available to serve Barbadians' need.

In addition, Kirton pointed out that the estimated tourism value of patient visits will be in excess of BDS$50 million per year for accommodation, food and beverages, taxi services, car hires and other related goods and services.

AWC's initial hospital facility will offer a wide range of services including urologic surgery, orthopedic surgery, bariatric surgery, ENT surgery, general and gynecologic surgery, ophthalmic surgery, dental surgery, plastic surgery, dermatological treatment and medical research. Specialty centers for neuroscience, cardiology and oncology will be developed in conjunction with the main AWC hospital facility.

The main facility will include:

• 12 operating rooms
• 50 inpatient/overnight beds capable of swing capacity to support critical care needs
• 20 outpatient, pre- and post-operative exam rooms
• A separate cosmetic dentistry area
• Diagnostics, radiology and laboratory facilities
• A wellness, spa and recuperative component.

Over the next five years, as part of the program, branches of internationally known specialty treatment centres from the United States as well as several medical equipment and biotechnology research companies are expected to open. Patient and family accommodation facilities will also be developed.

It is expected that the hospital will be accredited by the Joint Commission International, which provides the gold standard in healthcare accreditation services to hospitals around the world. 

In return for AWC's construction and operation of the facility, the Government of Barbados will lease the property for a period of 25 years, with an option to renew for a further 25 years.

In order to meet international hospital construction and design standards required for accreditation, AWC's advisors have determined that none of the existing structures on the St. Joseph hospital site are suitable for use. The project will, as a result, require substantial environmental research and planning and capital investment prior to the start of operations, and will be subject to Barbados Town and Country Planning approval.

For a related story, click here.

Bumrungrad International Hospital to Release Patients Beyond Borders® Focus On™

Top medical tourism destination offers patients choice in affordable medical care

Chapel Hill, NC – 19 July 2011: Patients Beyond Borders® announces the official release of FOCUS ON: Bumrungrad International Hospital, a 32-page digital edition profiling the renowned Asian destination that has treated more international patients than any other.

Located in the heart of Bangkok, Thailand, this award-winning healthcare campus boasts many of Thailand’s top doctors, including physicians trained at Johns Hopkins, the Cleveland Clinic, Stanford, MD Anderson, and the Mayo Clinic. More than 200 have been US board-certified.

Established in 1980, Bumrungrad’s main facility now measures 1 million square feet and houses a 554-bed tertiary-care hospital, advanced imaging department, ISO-certified laboratory, clinical research center, and medical heliport. The hospital offers 30 specialty centers and has the resources and capacity to meet all patient needs on one campus, within days rather than weeks. During the past decade, more than 3 million patients from 190 countries have traveled to Bumrungrad for its combination of medical quality, efficiency, value, and Thai hospitality, making it one of the world’s most popular destinations for medical travelers.

“With costs averaging 50–80% less than comparable treatments in the US and with a 90% satisfaction ranking in recent Gallup polls, it is easy to see why so many healthcare consumers are making the trek to Thailand,” says Josef Woodman, author of Patients Beyond Borders. “I have personally been a patient at Bumrungrad International, and the experience is comparable to the best healthcare and service to be found in North America or Europe.”

Bumrungrad was the first hospital in Asia to receive Joint Commission International (JCI) accreditation (in 2002) and was reaccredited in 2005, 2008, and 2011. International medical coordinators, multilingual customer service staff, airport reception services, and a variety of ethnic food options are among the innovations Bumrungrad offers the international patient.

Patients Beyond Borders FOCUS ON: Bumrungrad International Hospital will provide healthcare consumers worldwide with in-depth information on the hospital’s top specialties and doctors, achievements, accreditation, signature services, patient experiences, and travel information.

“We are gratified to be partnering with Patients Beyond Borders to produce this new digital-format publication,” says Kenneth Mays, senior director of Hospital Marketing and Business Development for Bumrungrad International. “Patients Beyond Borders is the bible for medical travelers, so it’s only natural that we should collaborate on this important resource for international patients who want to make smart and informed healthcare decisions.”

Produced by the research and editorial team of Patients Beyond Borders, the FOCUS ON series features a 32- page full-color digital brochure and eBook highlighting the world's leading internationally accredited hospitals and specialty centers in a fully searchable, dynamic, consumer-friendly format. Published under the Patients Beyond Borders brand, the series offers healthcare consumers detailed information on specialties, procedures, costs, and travel planning from the most recognized, trusted information source in international medical travel.

FOCUS ON: Bumrungrad International will be accessible from a variety of sources, including the Patients Beyond Borders website, Bumrungrad’s website, Kindle, GoogleEditions and other eBook readers, iPhone and other mobile devices, medical, business, and reference libraries worldwide, and all popular social networks.

 UPCOMING EVENTS

Second Annual Health 2.0 Europe Conference to Explore Impact of Web 2.0 Technology on European Healthcare

Event in Berlin, Germany, Oct. 27-28, 2011, will explore user-generated healthcare in a boundary-less online world and connecting patients and providers in diverse systems

Berlin, Germany, July 14, 2011– Health 2.0 Europe, a conference dedicated to how Web 2.0 tools, data and social media are transforming healthcare systems in Europe, announced that its second annual event will take place Oct. 27-28, 2011, in Berlin. Co-hosted with partner K.I.T. Group, this second edition will reconvene leaders and stakeholders in the Health 2.0 community for a day-and-a-half of technology demos, networking and brainstorming.

Health 2.0 Europe 2011 will present the latest thinking about content, search & communities, data utility layer and analytics, provider and consumer tools for care management, and financing, mobile devices, smartphones and ‘unplatforms’ in a European context. In particular, the conference will address what a “boundary less” online world means for consumers and physicians working in different healthcare systems. Technologies that are shaping the future of European healthcare will be featured in live demonstrations, along with special videos, keynotes and interactive sessions. In addition, during Launch!, a signature part of all Health 2.0 conferences, start-ups will demo innovative technologies. The call for speakers is open.

“Doctors, patients, and healthcare organizations are adopting a new generation of online and mobile technologies, and are fundamentally changing the way healthcare works,” said Indu Subaiya, co-chairman and CEO of Health 2.0. “This is particularly fascinating with Europe, given each country’s different system, language and methods.”

“We’re thrilled to be bringing Health 2.0 Europe to Berlin. And we’ll again be contrasting and contextualizing the best of European health technology,” said Matthew Holt, co-chairman of Health 2.0.

“Health 2.0 is more than a conference: it is a network, a community, and a complementary suite of activities tailored for the Health 2.0 community,” said Pascal Lardier, international director at Health 2.0.

First held in San Francisco in 2007, the annual Health 2.0 conferences are rapidly expanding to other continents as the use of web and mobile technologies in health grows worldwide. Its inaugural European event was held in Paris in April 2010 and attracted more than 500 attendees. Future conferences are planned for India and China, all featuring Health 2.0’s unique format.

 3rd International TEMOS Conference
HEALTHCARE ABROAD & MEDICAL TOURISM
 
November 20 - 23, 2011
Cologne / Germany

This year’s location for the 3rd International Temos Conference from 20 – 23 November 2011 will be the Mercedes Benz Center in Cologne, one of the most interesting and up-to-date Conference locations in Cologne. Enjoy the combination of Temos Conference high class speakers and the atmosphere of 125 years German high class car design. We are pleased to again carry out the Conference in cooperation with the German Aerospace Center, DLR.

Further information about the Advisory Board, program and exhibition will be published soon on www.temos-conference.com.

Early bird rates are available until 31 July 2011. 

Main topics:
– Medical Tourism I: case management & importance of non-medical services
– Medical Tourism II: state-of-the-art medicine & upcoming topics
– Germs, viruses & Co: “unrequested passengers” of Medical Tourism
– Insurers perspective: treatment abroad
– Repatriation by air: requirements for/of hospitals, insurances and assistances
– Quality Management: standards for international patient treatment
– Telemedicine in Medical Tourism: mission – vision – proven applications
 
Social program:
– November 20: Welcome Reception at Mercedes Benz Center
– November 21: Conference Dinner at Rheinterrassen
– November 22: Visit of Christmas Market in Cologne
Registration fee includes participation in Welcome Reception and Conference Dinner.

 
Information about this event and the preliminary program is now available on the TEMOS Conference Website.

Dates for Center for Medical Tourism Research 2012 Conference Announced

The Center for Medical Tourism Research has announced it's 2012 conference will take place in
San Antonio, TX on February 13-15. Keynote speaker will be Dr. Tricia Johnson from Rush University.

Dr. Johnson is the co-PI for the $500,000 (USD) U.S. Department of Commerce grant to study inbound medical tourism to the U.S. and also is the co-author of the recent book "The Future of Healthcare: Global Trends Worth Watching"

She will be sharing the initial results of her study with our conference participants.

A call for papers will be issued soon.

To submit your job posting or a description of your desired position ahaar@cpronline.com. Please keep text to 100 words or less.