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Contents

CONTENTS

Healthcare Travel Magazine

ISSUE 01 2008

12

08

20

04 NEWS A round up of regional and international news and developments

24 BIOETHICS

08 PARTNERSHIP OPORTUNITIES

Medical Tourism - Proceed with Caution

Public Private Partnerships in Health Tourism

12 CHALLENGES

26 HEALTHCARE INSURANCE

Trends and Challenges in Medical Tourism

Overseas Medical Care Has Become an Option for Employers

18 REGULAR COLUMN

34 MIDDLE EAST FOCUS

Slips and Tips, by Dr. Sanjiv Malik

UAE: Can it share a slice of the pie?

20 HEALTHCARE MARKETING Global Marketing Strategies for emerging trends

24 34

26 This publication may not be reproduced or transmitted in any form in whole or in part without the written consent of the publishers. Š IIR Middle East 2008


Foreword

»

Singapore’s clinical services are excellent, with internationally accredited facilities and renowned physicians. Beyond merely being trained in the best centers internationally, Singapore’s doctors are well known and respected in the medical world «

Healthcare Travel Magazine IMPRINT EDITOR Jenna Wilson Tel: +971 4 336 51 61 jenna.wilson@iirme.com

ADVERTISING SALES John Suzara Tel: +971 4 336 5161 john.suzara@iirme.com

PUBLISHING DIRECTOR Simon Page simon.page@iirme.com

DESIGN & Layout Andreas Schmidt as@stadtrand-design.de

PRINTED BY Zabeel Printing Press P.O. Box 5143 Dubai, UAE Tel: +971 4 262 61 71

This publication may not be reproduced or transmitted in any form in whole or in part without the written consent of the publishers. © Publications International Ltd. 2006 Healthcare Travel magazine is published 4 times a year. For subscription information visit www.arabhealthonline.com and follow the link.

FOREWORD Healthcare has long seemed one of the most local of all industries. Yet beneath the bandages and emergency rooms, globalisation is thriving. The reading of x-rays and the outsourcing of record keeping is already a multi-billion dollar business. Hospitals and clinics in the developed world are making a habit out of recruiting nurses and physicians from the developing world. The next growth area for the industry is the flow of patients in the other direction – known as “medical tourism” – which is on the threshold of a dramatic boom. Travelling abroad for medical treatment is one of the latest and biggest trends. Tens of millions of middle-class Americans are uninsured or underinsured and soaring healthcare costs are pushing them and cost-conscious employers and insurers to look abroad for cheaper healthcare. As such, the Healthcare Travel industry is growing at 15 to 20 percent annually and it is estimated that total gross medical tourism revenues will rise from $56 billion today to $100 billion by 2012.

ISSUE 01 2008

Under the guiding theme of “the Globalisation of Healthcare”, the Healthcare Travel magazine aims to bring together all aspects of medical travel in one publication keeping you up-to-date with the development of this growing sector. Time and money provide the main incentives for seeking healthcare outside the patient’s country. I hope you enjoy reading this issue of Healthcare Travel magazine and I welcome your comments, ideas and suggestions.

Jenna Wilson Editor

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NEWS | Middle East

NEWS MIDDLE EAST

»good Jordan is a modern country, with a infrastructure, a thriving business « Jordan Tops Region As Medical Tourism Hub The World Bank medical tourism experts ranked Jordan number one in the Arab region and the fifth in the world as a medical tourism hub, quoted China’s Xinhua news agency. President of Private Hospital Association

over 250,000 patients from around 84 Arab and

The study also shows that more than 1,800 U.S.

(PHA) Fawzi Hammouri was quoted as saying that: “Jordan is the only country in the Middle East that generates more income than what it spends on health.” Jordan’s medical tourism revenues in 2007 exceeded US$1 billion, he added. According to a study prepared by the PHA,

foreign countries were treated in Jordanian private hospitals, clinics and medical centers last year. Iraqi patients treated by Jordan’s private medical sector amounted to 45,000 in 2007, while Palestinians and Sudanese trailed with around 25,000 patients from each country.

citizens, 1,200 British citizens and 400 Canadian citizens sought medical treatment in the kingdom last year. Hammouri noted that treatment expenditures in Jordan are only 25 percent of the cost in the U.S., which include airline tickets and the patient’s stay in addition to site-seeing tours. «

UAE all set to attract medical tourism DUBAI – The Ministry of Health in the UAE is at the forefront of developing the necessary infrastructure to attract medical tourists. That’s according to Nasser Khalifa Al-Budoor, the Assistant Undersecretary for International Relations and Health Affairs at the UAE Ministry of Health.

“We have a department here establishing this,” he said. “We’ll be ready to start receiving patients coming here with their families, whether for plastic surgery, knee replacements or cardiovascular. We have so many hospitals, with John Hopkins, Harvard, some of the biggest names in the world are here doing work,” he added. Al-Budoor acknowledged that in the past the Middle East would never have been considered a destination for medical tourists, but the situa-

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tion for the UAE had changed completely. “People would go to London for shopping with their families and receive a check up or undergo a small operation. Now Dubai is ready for this,” he said. “We have so much to offer now, with certified hospitals from international agencies,” he added. Health tourism is a global phenomenon that is allegedly worth $50 billion annually depending on who you talk to. The actual size of the industry is up for discussion. This is but one of many issues in an area of medicine that is attracting a huge amount of attention. These issues are set to be discussed at the Healthcare Travel Exhibition & Congress 2008 to be held at the Al Bustan Rotana Hotel in Dubai from November 2-4. Sietske Meerloo, Marketing Manager at IIR Middle East indicated that the event is expected to provoke some heated debate.

“There are so many issues relating to medical tourism, and because the area is developing so quickly it’s becoming essential that hospitals, insurers and policy makers, to name a few work together closely to streamline processes to cater to this market,” she said. “We’re expecting a great deal of debate at the event, and hopefully we’ll see some practical solutions adopted for many of these issues,” she added. Medical tourism is already proving to be highly competitive with developing nations offering cheap, quality healthcare. The Ministry of Health in the UAE believes it can find a niche in this market and has endorsed the Healthcare Travel Exhibition & Congress 2008 in which it’s participating. “I’m really happy to see IIR [highlighting] medical tourism for the first time,” Al-Budoor said. “We have so many hospitals ready to receive patients from abroad,” he concluded. «


NEWS | ASIA

NEWS ASIA

» In 2007, 16,000 foreigners visited Korea for medical tourism «

American Tourists Check in for Checkup A group of Americans visited South Korea not only to go shopping and traveling but to receive high-quality, state-of-the-art medical treatment at relatively lower costs reports the Korean Times. In a Health Promotion Center at Inha University Hospital in Incheon recently they had a comprehensive checkup, including xrays and blood tests. They were among 29 Americans whose two-week trip to Korea included a medical program jointly developed by the LA branch of Korea Tourism Organization (KTO) and an LA-based travel agency Aju Tours.

Although some individual foreigners have visited Korea for medical treatment, this was the first group of tourists to come to Korea on a ``medical tourism’’ package. The report stated that the government and some hospitals are joining hands to promote medical tourism programs, capitalizing on reasonable prices and quality medical skills, especially in cosmetic surgery and other treat-

ments. The results carried out on the patients take four days to process. Patients can check online at the hospital’s English language Web site, or receive them by post. The group also received skin care treatment at Anacli Dermatology-Plastic Surgery Clinic in Gangnam, southern Seoul. Doctors from the clinic consulted them at their hotel the previous evening to prepare for treatment. Sixteen of them received superficial peeling, which cost $200 each. Medical tourism in Korea is at an initial stage. The program for the American tourists came after KTO and six hospitals offered a promotional presentation in Los Angeles last month to medical tourism coordinators and travel agencies. In 2007, 16,000 foreigners visited Korea for medical tourism, and 20,000 are expected this year, the report said. «

Thailand lures Arab patients THAILAND - The number of Qatari patients seeking treatment in Thailand rises significantly during the summer months of June to August. This year their number has grown by over 100% compared to last year, Bangkok Hospital Medical Centre officials told Gulf Times. In 2007, the hospital received over 140,000 patients from around the world with 19% of them coming from the Gulf states, a senior official was quoted as saying. So far this year, the hospital has received 18,226 patients from the UAE and 3,152 from Oman. The number of Qatari patients reached 3,046, a growth of 107% compared to last year.

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Thailand is a popular destination for medical tourism. “The main benefits of health tourism include getting the opportunity to travel to an exotic destination and reaping big monetary savings,” the official said. Dr Michael Moreton, deputy director, Bangkok Referral Centre, said that Arab patients sought treatment for cases ranging from check-up to surgery, heart problems and cancer to rehabilitation. According to him, the hospital has established an Arabic service centre to cater to Arab patients. «


USA | NEWS

USA NEWS

AMA provides first ever guidance on medical tourism UNITED STATES - To ensure the safety of patients considering traveling abroad for medical care, new guiding priciples on medical tourism were adopted this summer by the American Medical Association’s (AMA) annual policy-making meeting. The nine principles are the first-of-its-kind, and outline steps for care abroad for consideration by patients, employers, insurers and thirdparties responsible for coordinating travel outside of the U.S. “Medical tourism is a small but growing trend among American patients, and it’s unclear at this time whether the risks outweigh the benefits,” said AMA Board Member J. James Rohack. “Since this is uncharted waters, it is our hope that the AMA’s new guidance on medical tourism will benefit patients considering traveling abroad for health care.” In 2006, an estimated 150,000 Americans received health care overseas, and nearly half of the procedures were for medically necessary surgeries. The emergence of medical tourism is in part a response to the rising cost of health care in the U.S., which puts needed health care out of reach for many, particularly

those without health care coverage. “We need to address the cost of care in the U.S. and cover the uninsured so that every American who needs health care can get it right here at home,” said Dr. Rohack. “Until there is significant action at home, patients with limited resources may turn elsewhere for care. It is important that U.S. patients have access to credible information and resources so that the care they receive abroad is safe and effective.” The new AMA principles call for all medical care outside of the U.S. to be voluntary. They address financial incentives, insurance coverage for care abroad and care coordination.

The principles also call for patients to be made aware of their legal rights prior to travel and to have access to physician licensing and facility accreditation information prior to travel. “For those patients considering medical tourism, the new AMA principles are an important starting point for consideration before making the decision to go abroad for health care,” said Dr. Rohack. To ensure that insurance companies and others that facilitate medical tourism adhere to the new principles, the AMA will introduce model legislation for consideration of state lawmakers. «

Middle Eastern patient numbers rebound in Rochester International patient traffic to Mayo Clinic has rebounded since 2001 to almost pre-9/11 levels, Mayo officials say. In 2000 and 2001, Rochester saw about 2,100 Middle Eastern patients arrive each year. By 2006, that number had been cut in half to about 1,000. Mayo Clinic currently is attracting almost 1,500 patients a year here from the Middle East, says Brent Phillips, the international administrator for Rochester. “My sense is we’re having a strong year and we’ll be very close to where we before 9/11,” he says. And the growth is giving a financial boost to the Rochester hospitality industry, and to hotels like the Kahler Grand Hotel and Bridgestreet Broadway Plaza. International patients bring $30 million to $50 million into Rochester each year, according.

And Rochester accounts for 10 percent of all international visitors coming into Minnesota each year, he says. “They (international Mayo Clinic patients) are very important to us,” says Bruce Fairchild of Kahler’s parent Sunstone Properties. “The dollar is down, and it makes buying medical care and staying here less expensive. That may be helping us.” Sunstone recently expanded a-hotel-withinin-a-hotel -- The International -- on two floors of the Kahler. It is targeted for the high-income international traveler. The president of Iraq stayed there during three recent visits, including last month when he was in town for heart surgery. The return of the international patients also is helping keep Broadway Plaza -- Rochester’s tallest building -- fully occupied. “We’ve grown year over year from 5 to 10

percent,” says John Beltz, the plaza’s general manager. “About a third of our overall business comes from outside the U.S.” While Middle Eastern patients are often the most visible on Rochester streets, Mayo officials point out that the area with the highest number of patients coming to Mayo Clinic is Canada. The Middle East is the second largest source. «

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FEATURE | Private Partnerships

Public Private Partnerships in Health Tourism By Hugh Risebrow, CEO Interhealth Canada UK London is well established as a centre that attracts international patients for a range of healthcare treatments. The value of the overseas patient market to London hospitals in 2007 is estimated to exceed £200m, which is divided between 10 large private and charity owned hospitals, and the private patient units at a similar number of leading NHS hospitals including Great Ormond St, The Brompton, UCLH and The Marsden. The majority of these patients come from the GCC region, mainly funded by overseas patients offices, with some patients

funded by other government agencies such as the military, large employers, or paying for their own treatment. This article explores how some NHS Trusts and some private companies are responding to changes in the market. The overseas market is clearly changing. Countries such as Germany are taking a larger slice of the overseas patient market, as increasingly privately owned hospitals in Germany are looking for additional sources of revenue to satisfy their shareholders. Hospitals in India and Thailand are increasingly attracting health tour-

»increasingly Hospitals in India and Thailand are attracting health tourists

for higher volume surgical procedures «

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ists for higher volume surgical procedures. Perhaps the greatest changes are in the markets from where overseas patients are traditionally drawn – developments in these countries such as Dubai healthcare city, or The Royale Hayat women’s hospital in Kuwait (managed by Interhealth Canada) are reducing the need to travel abroad to receive high quality treatment, and are in fact aspiring to attract their own inbound health tourists to the region. Another significant change has occurred in the NHS in England (which is governed separately from the NHS in other UK countries), which is having an impact on the market. All NHS hospitals in England, including leading London teaching hospitals, are becoming ‘Foundation Trusts’. On the one hand, this gives these organisations much greater management autonomy from the department of health, which has been welcomed by managers and is part of a larger drive to decentralise and localise NHS planning and management in the UK. However, in agreeing to this decentralisation of power, politicians wanted measures to ensure that these NHS hospitals focused on their core business – treating NHS patients – and have capped the amount of private patient revenue that NHS Foundation Trusts can earn directly to the same percentage that they earned in 2003, limiting their potential to grow private patient revenue. This legislative change is perhaps less of an issue for trusts with very large and well established private patient units, although it does limit their scope for further growth. It is proving to be more of a problem for trusts with very limited private revenue historically, who wish to grow. Apart from this new regulatory constraint on NHS trusts, these organisations have historically faced a squeeze on capital funding, and have often had to prioritize investments in their NHS wards ahead of investment in private facilities. Consequently, some of these private units are now looking dated. A new public private partnership model is emerging, that will allow some of these units to compete on the international stage. By leasing


Private Partnerships | FEATURE

their private patient unit to a private sector hospital operator, the foundation trust does not directly invoice the patient or payer, and manages to bypass the regulatory constraint on directly earned private patient income. There are a number of other advantages to this model for patients, doctors, the NHS Foundation Trust, and the private hospital operator: • The private operator will generally invest their own capital to upgrade facilities to a standard that is competitive internationally • The private operator will have marketing skills as part of their core competency, and will be more successful at attracting patients • Business processes, clinical pathways, and non clinical services can be re-engineered to better meet the higher expectation of private patients, as well as the different needs of payers and clinicians in private practice • The NHS Trust can focus on their core business of treating NHS patients, and leave the non-core activities associated with private patients to their private sector partner. Financially it is attractive for the NHS Trust, who receive a guaranteed rental income, income from use of facilities such as operating theatres and diagnostics, and usually some form of profit share. • The medical consultants whose NHS practice is at the same hospital site usually strongly prefer the convenience of treating their private patients on the same site as their NHS patients • Expensive equipment can be used for both NHS and private patients, making certain investments possible that wouldn’t otherwise have been viable • Private patients often prefer to be treated at a private unit on an NHS site, such that they have the full multi-disciplinary team back-up, and range of NHS facilities and resources should they need them

To date, HCA are now managing oncology services at a private patient unit at UCLH. Interhealth Canada have been awarded a contract to manage and expand a private patient unit at a leading specialist NHS hospital, and expect to announce this in January 2009. There have been two further public procurements advertised, and Interhealth Canada have had informal discussions with a further eight NHS trusts who are interested in exploring the concept. Interhealth Canada’s vision is to develop 6-10 such partnerships with NHS Trusts over the next 5 years. The preference is for partnerships with trusts that have one or more areas of tertiary expertise w here they have international recognition, and to develop units with 20-40 private beds, capable of £15m+ revenues pa, with typically a 60-40 split of UK to International patients. Interhealth Canada’s view is that patients from the Middle East and elsewhere will increasingly only travel for complex tertiary procedures, and will want to travel to internationally recognised clinical centres. Their expectations in terms of non clinical services will also be very high – they will want a 5 star hotel environment with a range of peripheral services including airport transfers and accommodation for their family arranged by the hospital operator as part of a package. Interhealth Canada’s view is that these types of partnerships will provide a service that is very attractive to international patients and paying organisations. They will combine world leading medical skills in internationally renowned NHS teaching hospitals, with high quality services that patients will expect from a leading private sector operator. Interhealth Canada will use their existing offices in the Middle East to support the marketing of these services. Much of this will involve bringing clinicians from the UK hospitals to meet clinicians from referring facilities and overseas patient organisations in the Middle East to establish relationships and develop clinical confidence. A further development in the longer term may be to establish satellite clinics within the GCC region, which will be supervised clini-

cally by the NHS teaching hospital in the UK. Moorfields Eye Hospital is one NHS trust that has boldly taken the step of establishing itself in Dubai Healthcare City, whilst other trusts may prefer to do this with a joint venture partner. «

For more information about visiting the Healthcare Travel Congress log on to www.healthcare-travel.com or call +971 43364021

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advertisement feature | SINGAPORE

Pantai Hospitals, one of the premier hospital groups in

Asia

Pantai Hospitals, one of the premier hospital groups in Asia, currently operate 9 hospitals in Malaysia and are managed by Pantai Holdings Sdn Bhd. The shareholders are Khazanah Nasional, the National Sovereign Fund of Malaysia and Parkway Holdings of Singapore.

» Through many years of experience in providing quality healthcare to Malaysians The flagship facility of the group, Pantai Medical Centre (PMC), Kuala Lumpur, is a 330 bedded facility, with about 150 consultant specialists covering almost all major specialties. It is strategically located amidst lush greenery in the affluent neighbourhood of Bangsar, home to a sizeable expatriate population and just a stone’s throw away from nation’s capital, Kuala Lumpur. It is also located near to KL Sentral, the integrated transportation hub of the capital and the transfer point for major rail systems including the KLIA Ekspres which provides a non-stop journey between the city and airport in just 28 minutes. PMC is steadfast in the delivery of affordable services that are technologically appropriate, with emphasis on quality, innovation and health promotion, through its caring staff and its sophisticated centres of excellence. Whether one seeks critical or non-urgent medical treatment, PMC is able to offer value for mon-

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«

ey services with its highly trained and experienced medical personnel. In addition, consultant specialists of the hospital are highly specialised in the medical disciplines they represent, majority with recognised post-graduate qualifications and fellowships from the UK, USA and Australia. Furthermore, the facility is also complemented by the latest healthcare amenities and equipments such as an advanced Linear Accelerator – the Elekta Synergy System, which allows IMRT, IGRT, SRT and TBI; the latest model of angiography machine – Phillips Allura, which is capable of performing 3D coronary angiogram, 3D radiological procedures as well as stent boosts; and the Toshiba 64 Multi-slice CT Scanner to further support and enhance cardiac imaging and diagnostic procedures. Being in a harmonious and multi-ethnic country, the medical personnel in PMC are able to converse fluently in English and collectively able to speak various Asian languages.

A wide choice of foods are available including Asian and international cuisines, with adherence to “halal” standards in food preparation. As a key provider of healthcare to the expatriate community in the capital and to enhance appeal to international patients, Pantai’s International Ward, the first Medical Ward and Lounge in Malaysia specially dedicated to foreign patients and expatriates was officially launched on the 25th September 2007. It offers a range of in-hospital accommodations and has an international lounge on the same floor, providing club floor facilities to patients and their guests. International patients are also able to benefit from the personalised services provided by the Pantai International Call Centre - a medical referral centre for foreign patients, which offers support services such as medical referrals and appointments, travel and accommodation, currency exchange, transfer from airport and hotel, visa extensions, interpreter services, tour of the facility and other patient related assistance. Through many years of experience in providing quality healthcare to Malaysians, the expatriate community and international patients in the region, PMC has working relationships with most major insurance companies, both domestically and internationally – such as Prudential, Great Eastern, AIA, William Russell, BUPA International, CIGNA and others. The hospital was awarded the IS0 9001:2000 Quality Certification and Malaysian Society for Quality in Health (MSQH) accreditation, which is a member of the International Society for Quality in Health Care (ISQua) and the Accreditation Federation Council. Other achievements of the hospital include winning the Superbrands Malaysia Award in 2005 and an Asian Hospital Management Award in 2006. In pursuit of continuous improvement in quality and safety of patient care, PMC is currently working towards obtaining accreditation by Joint Commission International (JCI). «


FEATURE | Challenges in Medical Tourism

Trends and Challenges in

Medical Tourism

By Dr. Ahmad Okasha, Healthcare Business Development Manager, Oracle, Dubai, UAE Introduction Traveling to seek medical care is thousands of years old. People have been traveling across the globe in search for cures for any imaginable illnesses. In ancient Greece, people have used thermal and mineral waters for bathing and their health for many thousands of years. This was well incorporated in the practices at the “Asclepeia” which were built near mineral based thermal springs. The Arabs built on the

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knowledge of the Greece and established a phenomenal success of medicine. Baghdad and other cities had large hospitals that cater to all type of people seeking care from around the world. After the Arabs, the West took the lead and established modern medicine. Starting from the 19th century until recently, people from around the developing world were traveling to Europe to seek medical care. Post September

11th and due to visa limitations, many Arab patients seeking care in the US started to shift their destinations to Europe and the Far East. For example and according to a Qatari newspaper, many patients from Qatar are traveling to Thailand’s Bangkok Hospital for medical treatment. This regional trend was inline with a greater global trend that was underway. People from the West especially US, UK, Canada, and Germany are seeking care in developing countries such as Brazil, Mexico, Costa Rica, Turkey, Thailand, and India for procedures such as dental surgery, plastic surgery, hip replacement, and even heart surgery. Many countries such as India and Thailand saw this as a real opportunity and an economic driver. Governments in those countries invested and promote their medical tourism industries. To provide some numbers of the size of the industry, it’s estimated that in 2007, 750000 Americans would travel abroad to seek medical care. On a global level it’s estimated that health tourism is worth US$513 billion. So what are the reasons that make people travel thousands of miles away from their homes to get medical treatment? Is cost or is it quality or love of travel? Would this half a trillion-dollar industry continues to grow and what we can learn from it in the Middle East and the UAE to build a medical tourism hub in this region. The next section tries to address these questions.


Challenges in Medical Tourism | FEATURE

Why medical tourism now? Cost saving The cost of medical care has reached outrageous levels that are fueled by many factors such as bureaucracy and cost of medical malpractice insurance. For instance, a simple calculation of cost comparisons of unilateral hip replacement in the United States of America, Costa Rica, and India reveals a cost advantage of more than 70%. Dr. Arnold Milstein, medical director of the United States based medical group Pacific Business Group, told a U.S. Special Committee on Aging in 2006 that the typical combined hospital and doctor’s charges for operations in “technologically advanced hospitals in lower-wage counties such as Thailand were 60 to 85% lower than charges in the US hospitals. Another study in the UK done by European Research Specialists revealed that UK patients could save up to 80% by traveling abroad to undergo surgery and medical treatment. The big advantage in cost saving between the US, UK, and developing countries makes it appealing for cash payment patients as well as insurance companies to consider the seeking medical care in developing countries such as Costa Rica and India even after adding travel related costs.

convenient to travel abroad to seek care to places such as Brazil.

Tourism Aspect Getting away form the stresses of home and work can be much better and more relaxing way to recover from an operation. Many people find it more convenient to combine medical care with travelling to exotic destinations. According to a survey of European travel market, the top five considerations for medical travel in Europe were: Scenery, the climate, cost of travel, and cost of accommodation. This illustrates that the when people consider medical travel, the tourism aspect plays significant role(4). Thailand, which has built its tourism industry, is leveraging its tourism destination to build a medical tourism industry.

The new global citizen A new global citizen whose life and work transcends borders is emerging. The transfor-

mation of the global economy towards a knowledge economy in which experience and knowledge can cross borders based on the best opportunities available. Many people no longer live exclusively in their country of origin. This trend will likely increase in Europe, the Middle East, North America, and East Asia. As people become increasingly mobile for both temporary and permanent work assignments, they require a global healthcare model that provides care for them wherever they are. The global citizens can search the best treatments available and where they will be provided. Individuals are seeking outside their present healthcare systems for better answers, and are willing to travel and pay for them. This trend is creating millions of global citizens. These global citizens For instance, they may be working for a year in the US and then go back home to India for summer vacation. Along the same line in the Middle East, some insurance companies are offering

Speed and convenience When patients have to wait long time for certain procedures such as Canada and the UK, they will consider medical care in developing countries even thought if they have to bear additional costs. For instance, many Canadians are travelling to Cuba to seek medical care. Apollo Hospitals in India is attracting patients from the UK through prior arrangements with the UK PUBA health insurance company. In other cases such as plastic surgery or dental surgery, which is not covered by many insurance companies, patients from the US and the West are finding it less expensive and

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FEATURE | Challenges in Medical Tourism

people the choice to seek performs surgeries in their home countries such as Lebanon instead of the United Arab Emirates for instance to save cost and be close to their extended families.

Trends and challenges in medical tourism Globalization of Healthcare The globalization of health care is underway. Globalization is happening in many industries. The healthcare industry is catching up with banking, insurance, and other service oriented industries. Not only those brands that are major specialized teaching hospitals focused on education such as John Hopkins, Cleveland Clinic, and Mayo Clinic jump on the global expansion wagon, but also other non teaching hospitals. Recently, a Dallas based Christus Health, a non-for-profit Catholic system with more than 40 hospitals has recently opened hospitals in Mexico to serve not only Mexican residents living on the US borders, but also US citizens coming from the US. The biggest driver of the growth of medical tourism and globalization of the health market is what happening in the US market and how the US insurers and hospitals react to this trend. The promise of a growing medical tourism market has prompted Mexican businessman Carlos Slim, the second richest man on earth according to Forbs Magazine, to build hospitals catering to US baby boomer in partnership with Grupo Star Medica. Another example was in 1992 when the Dallas based International Hospital Corp (IHC) opened the fist of its 10 hospitals throughout Brazil, Costa Rica, and Mexico. The main focus of the Dallas-based hospital system was to offer high quality care that had long prompted residents of Latin America to travel to the US. “Over the last couple of years, the reverse has been happening,” said Joseph Bracie, president of Centralized services for

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IHC. US patients started to come to the hospital locations in Latin America. According to Barcie, 11% of the IHC patients now fall in the category of medical tourists. 66% of those patients are from the US. Recently, Blue Cross and Blue Shield of South Carolina indicated that they would cover certain medical travel claims. It has established a managed-care network of foreignbased hospitals called Companion Global Healthcare in which ParkwayHealth of Singapore is one of the providers participating in the network and offering surgical procedures such as joint replacement, cardiac surgery, and cancer treatment at pre-negotiated rates. Would this trend continue? It’s difficult to predict now. The jury is still out. There are several challenges to the growth of medical tourism on a global scale. The first is continuity of care and the second is legal aspect and where liability fall in cases of medical malpractice or injury to patients. The third challenge is brain drainage of nurses and specialists from rural and less developed areas to highly specialized medical centers who are attracting international patients. The fourth challenge is that as countries are focusing on medical tourism and attracting international patients, they are diverting resources from public health and preventive care resources.

Healthcare Financing Healthcare is influenced to a large extent by the way it’s financed. How insurance companies would impact medical tourism is still to be seen. In one hand, many global healthcare insurance companies are financing selected medical travel for patients seeking care outside their home counties. As indicated earlier, Blue Cross and Blue Shield of South Carolina has extended its coverage to include International Hospitals in Singapore. How many insurance companies in the US, the biggest buyer market of healthcare would pursue

suite will impact the rate of change in medical tourism. According to British Medical Journal, the NHS does not fund British patients to go to India. It has told Indian hospitals that it cannot refer UK patients because flying time to India exceeds the three hours limit set for transferring patients. This is not the case with Commercial health insurance companies such as PUBA, the UK medical insurance company, which approves hospitals in India such as The Escorts Heart Institute. A recent study published in the US indicated that traditional insurance plans discriminate explicitly or implicitly against treatment abroad.

Quality and Accreditation In order to medical tourism to grow and satisfy the requirements of patients and insurers, hospitals have to provide a minimum level of quality done by third party agencies such as accrediting agencies. Accreditation agencies such as Joint Commission International (JCI) Accreditation Canada, and the Australian Council on Healthcare Standards are expanding globally and providing this mission. Recently, more than 140 hospitals have been accredited by the JCI. Furthermore, the JCI has updated its international version by issuing a new standard that focuses on patient safety. The issue for accreditation will be for nations to agree on accreditation standards. Not all hospitals that are marketing themselves to international patients will be JCI accredited.

Legal Aspect As indicated earlier, with the continuous growth of medical tourism, patients need to feel secure and protected. Where does the liability fall in case of a medical error? Does it fall on the hospital, the doctor or the insurance agency that covered patients for their


Challenges in Medical Tourism | FEATURE

» Patients are willing

to travel thousands of miles to be treated by a famous surgeon or specialist «

medical travel? Would providers who are treating US patients or UK patients find themselves pulled to court cases in the US in cases where US patients find themselves entitled to go to a court. Even though previous legal cases against Middle Eastern hospitals were not successful such as Jeha v. Arabian American Oil Co., and Gibbon v. American University of Beirut(6), still many US lawyers would seek every step and process of the care to find a way to bring the jurisdiction to a US court. Hospitals would treat US patients need to be prepared to defend against clever lawyer and sometimes sympathetic judges. International hospitals must work together with the support of their countries to agree on a legal framework that address that issue of malpractice and medical mistakes. If this is not resolved and if also US patients started to go to court, many international hospitals will limit the number of US patients treated at their institutions. Therefore, a legal framework for medical travel under the WHO is essential.

Continuity of care So what happens when a patient travels and undergoes a surgery? The optimum outcome is the surgery is successful, and the patient travels back home. The Patient stills need to see a physician and care practitioners for follow up. Would the medical history investigations be with the patients or would it be at the treating hospital? The international hospital that treated the patient needs to coordinate follow-up and post surgery care with physicians and hospitals in the patient home country. Hospitals in the travel destination and the home country need to share medical information, treatment protocols, medication history, lab results, and follow up visits to ensure best outcomes. This is also useful for the international hospital since it provides outcomes data to provide feedback on the best treatment protocols and process.

How to position your hospital for the future? Countries in the Middle East have a long way to go to establish themselves as medical tourism hubs. In the Middle East, one can classify two types of countries that have the potential to be medical hubs. The first are the Gulf Cooperating Council countries with long-term strategy and plenty to spend on building infrastructure and promoting medical tourism. One can cite two countries that are building their medical tourism capabilities. The first is the UAE in which, I believe is on its way to becoming a center for medical tourism. The second one is Bahrain, which announced its intention to build a medical tourism city. The second type of countries are those that have built excellent medical institutions and have high caliber physicians and healthcare professionals, but lack the financial resources to build their legal, quality, and marketing to promote medical tourism at the international

level. One can cite Lebanon and Jordan as examples of these countries. So what can learn from international initiatives in building medical tourism? I believe any country focusing on medical tourism should address the following:

Attracting super star specialists The healthcare industry is still led by physicians. A high-caliber specialist is like a super star. If you give this star a qualified team and the state-of-the-art technology he/she excels to a high level of success and becomes a magnet for patients from the region and the globe. Patients are willing to travel thousands of miles to be treated by a famous surgeon or specialist. In addition, there are a body of literature that supports the role of specialists versus primary care physicians in certain specialties such as cardiology and its impact on increasing the volume of patient care.

» Countries in the Middle East have a

long way to go to establish themselves as medical tourism hubs «

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FEATURE | Challenges in Medical Tourism

The more a surgeons or a specialist practices certain procedures the better outcomes he/ she will get. This is the “practice makes perfect” rule in healthcare. I believe as the outcomes of the spcialist improve so the volume of patients he/she attracts. Thus specialists with a record of high volume of certain procedures are important pillars to having a medical tourism program.

Creating local brands Once a famous specialist is in house and has a high caliber medical team to support him, a hospital can build a local and then a regional healthcare brand in order to attract international patients and insurance companies. Corporate brand development, image building, and reputation need to be taking into consideration when building such a brand. Borrowing from the success of regional brands such as Emirates Airlines, Aramco, and EMAAR, the local healthcare market can use similar marketing strategies to build healthcare brands. King Faisal Specialist Hospital, Dubai Healthcare City, American University of Beirut Hospital, and American Hospital of Dubai are among potential local healthcare brands that have a high potential of becoming regional brands then going global.

Integrating medial and leisure packages The GCC countries as well as Middle Eastern countries in general are building their tourism industry. Billions of dollars are being spent to develop the tourism industry. The UAE is heavily investing in building hotels, theme parks and other entertainment facilities. In addition, the UAE has been successful in offering attractive touristic packages. It’s expected that in 2008, more than 8 million visitors will make the UAE their tourist destination. GCC countries can differentiate themselves and leverage these investments to offer attractive medical travel packages that include staying in luxury hotels, visiting the parks, and enjoying safari rides in addition to medical care.

Smart hiring and developing local talents The healthcare industry is an experienced based industry, which relies heavily on high experienced, licensed, and talented professionals. Special type of skills and attitude in addition to technical qualifications are important to build successful medical tourism capabilities. A cheerful positive nurse who’s culturally knowledgeable and trained to deal with

patients from diverse cultures is as crucial as a highly technically trained nurse. This applies to all other allied healthcare professionals and front office staff. Careful screening and recruitment of the right skills is essential. Along the same line, providing training to local students and incorporate some hospitability aspects such as dealing with diverse cultures is needed. I believe that the GCC countries such as the UAE, Oman, and Bahrain are experienced with developing their hospitality capabilities. For instance, it’s estimated that there are residents from more than 80 different nationalities living in the UAE. This creates an environment where people have to deal with different cultures on a daily basis.

Developing the legal environment In order to develop medical tourism, Middle East countries need to build their legal and malpractice laws in order to protect patients, build a reputation of having a safe medical care industry and to protect their hospitals from being drawn to courts in the US or the West. As stated earlier and since medical errors may happen. Not all of these medical errors are due to human errors. Lawyers from the US or the Western countries may use all possible legal means to move the cases to the their countries where judges may be more sympathetic to their claims. Medical tourism is a journey that is worth taking. This journey cannot be rushed. There are many elements that need to be considered in order to build a successful medical tourism. Countries that invest and develop their medical tourism capabilities will reap huge benefits. Countries that either rush into medical tourism or do not take the necessary steps will find themselves overtaken by other nearby medical tourism hubs. « References available on request (jenna.wilson@iirme.com)

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FEATURE | Regular Column

Regular Column

Slips & Tips By Dr. Sanjiv Malik, MS, MBA

Across the Great Divide Gaps exist in every part of healthcare, but with passion and tenacity we can bridge those gaps could otherwise not afford, or quality of care they could not receive in their own country. In my travels to numerous conferences throughout the world, I have met people who did not see the divide in front of them, even as another step would have sent them slipping

Every culture has its stories of great divides, and how those distances were crossed using passion and tenacity, and with the loyalty of trusted friends. In today’s world of global healthcare, the divides are different. They are divides of medical and facility quality, divides between patient and employee culture, language and expectations, and of course the great divides of distance a patient may travel to your facility. Within your own organizations there are divides between the administration and the doctors. Divides between medical staff and patient relations staff. Further divides all along the continuum of care you strive to provide, together with your external partners such as travel agents or overseas consulates. Then, at the end of the fiscal year, there may be a divide in the bottom line, between what your accountant says and what ownership or shareholders desire. Operational efficiency must be planned, worked toward consistently, and met, or else the purse strings will be strained and may not reach across the budget gaps. Or perhaps you are planning a new facility or service to serve the growing healthcare

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market. What are the divides between what the market wants and what you plan to provide? These are some of the themes we shall be exploring in future columns. Each of these and many other scenarios present dangers of slipups. I will offer tips to help you avoid misfortunes. To really grasp the opportunities presented by global healthcare, we must go across each great divide with every bit of courage, strength and smarts as our storied predecessors. We must put forth effort to bring the distances together and meet our goals. We must learn the tips to avoid the slips. In my background as a doctor of Ophthamology, I saw divides in the healthcare available to rural peoples. I initiated programs and performed more than 1,000 cataract surgeries free of charge. In my background as regional director of a chain of 5 hospitals for Max Healthcare in India, I saw divides in each facility among staff and medical professionals and ownership. In the successful medical travel initiatives created during my time at Max, I saw foreign patients travel great distances for care they

into that gulf. I met others who saw the gulf, but did not have the tips on how to get across that distance. That is the purpose of this column. We shall have a dialogue between myself and you, Dear Reader, and go across those divides together. We seek to bridge the gaps in operations, internal and external branding, marketing, customer service and cross-cultural expectations. The only way to do this is with tenacity, passion, and appropriate loyalty. Together, we shall travel those distances and find the best solutions to close the gaps. I welcome your companionship on these journeys together, as we will ultimately show how better patient outcomes are achieved by our commitments to bridge the divides. This dialogue will work best with your questions and comments to this magazine, or to me directly at drmalik@medicalqi.com. We shall see examples not only from the world of healthcare, but also from the worlds of consumer brands. They have been learning the lessons of global markets far longer than we health practitioners. Next month we shall begin by exploring slips and tips in “customers desire, we misfire” (the gap between what customers want and what hospitals deliver). I hope you will join me in these great adventures, as we cross the many great divides. «

Dr. Sanjiv Malik, MS, MBA is Chairman of Medical Qi, Inc., a healthcare consulting and representation firm. He was formerly Regional Director of Max Healthcare in India and has acted as consultant to many healthcare initiatives around the globe. Contact Dr. Malik at drmalik@medicalqi.com


American Hospital | Advertisement feature

American Hospital Dubai:

Quality American Standard Healthcare in the Middle East

The American Hospital Dubai provides quality, cost effective, American standard healthcare to meet the needs of Dubai and the surrounding Gulf states through comprehensive primary, secondary and tertiary care services on an inpatient, outpatient and referral basis. Ask anyone in town to name the best hospital in Dubai, and the answer would be the American Hospital Dubai. A landmark in the city, The American Hospital Dubai (AHD), is a 143 bed acute care, general medical / surgical hospital was established in 1996 and has proven itself to be a leader among private and medical centers in the Emirate. The Hospital was planned, designed, built and equipped to meet American Standards of Healthcare. The hospital operates to these standards and all its physicians are North American Board Certified or of equivalent Western training programs, such as those in the United States, the United Kingdom and Canada. Catering to quality medicine, American Hospital Dubai is the first hospital in the Middle East to be accredited by the Joint Commission International Accreditation (JCIA); a subsidiary of the United States based Joint Commission on Accreditation of Healthcare organizations (JCAHO). Despite the expensive mandate, “AMERICAN HOSPITAL DUBAI is committed to providing the highest quality patient care by meeting American and International accredited standards”, says Richard Larison, CEO. The hospital has been recognized as a leader in primary, secondary and increasingly tertiary care in the UAE for the past eleven years. It has built this reputation by insuring the finest hospital facilities, the latest technology and the recruitment of US / Western qualified and trained physicians. The hospital has developed several areas of expertise: Heart, Total Joint Replacement, Diabetes, Neurosciences, GI Services, Cancer, Emergency Medicine, Pediatrics and Obstetrics. Construction is already well under way for the hospital’s new seven-storey tower. It is projected to be completed in February 2010 and will include 8 state-of-the-art operating rooms, 47 ICU beds, 178 patient beds, a new

Radiation Therapy Center, an expanded Regional Center for Diagnostic and Interventional Radiology, and a Reference Laboratory. All of this will allow AHD to continue to meet the healthcare needs of the people of Dubai, UAE and the region.

“With a dedication to continual quality improvement and growth, AHD is committed to expand its present services and introduce new centers of excellence”, concluded Richard Larison. « Tel: +9714 336 7777, www.ahdubai.com

» The American Hospital was planned,

designed, built and equipped to meet American Standards of Healthcare «

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FEATURE | healthcare marketing

Global marketing strategies for emerging trends By Vivek Shukla, Healthcare Marketing Consultant, mail@vivekshukla.com

As the world rapidly moves towards becoming a global village, new unforeseen trends are arising. Amongst many firsts, we are seeing, for the first time, a lot of people travelling from their home countries to other parts of world for medical treatment. This practice is not new, but the magnitude of the trend and its potential has caught the eye of many industry watchers.

India but is more convenient and offers better quality, more people will go to Thailand than India [and they are going too]. In any case, in a high involvement service as healthcare, people will not always decide on price alone. Skimming can be an option in the early growth phase. This essentially means that you can charge a decent premium for your services as the category grows further. The profits thus made can be used in creating a highly differentiated brand. This exercise will stand you in good stead when the concept enters the maturity stage.

Early Adopters How healthcare providers make use of this trend, is a question which will top the popularity charts in the global healthcare industry. To find the answers, you do not have to look far. Strategic marketing principles are as relevant to healthcare as they are to any other industry. The product life cycle, if we could have one, for Medical Value Travel, will show that the concept is about to hit the growth phase. Maybe it already has. According to an estimate, over a million people travel to 28 different countries for medical treatment. The numbers are likely to rise owing to a number of factors. At this juncture, examining the various strategies that the industry players can deploy becomes critical. The following are the strategic lines that the players can follow and attain sustained growth for themselves:

Move First It is a foregone conclusion that the competition will intensify as the concept grows fur-

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ther. Everyone will want to jump on to the bandwagon and earn extra dollars. It is already happening. At this juncture, therefore, the first movers’ advantage becomes important. For medical travel business, according to me, first movers’ advantage cannot be gained unless the forces extraneous to your business are supportive of you. For example, you may be the best suited hospital for international patients, but the visa laws in your country ensure that the potential medical traveller gets a good run around before he gets the visa. In another country the visa laws may be simple but the political instability may raise questions. All in all, traveller friendly countries with great hospital facilities and stable economic and political conditions are more likely to gain the first mover’s advantage.

Skimming Another feature of the early growth phase is that the price elasticity of demand is less. In other words, the markets are less sensitive to price. If Thailand is a bit more expensive than

Another driver for growth in emerging trends is the ability of the players to locate ‘early adopters.’ Some people will take on to a new concept more easily than others. An estimate puts a figure of 17% as the percentage of people who can be labelled as ‘early adopters.’ Finding them and winning them over will spell the difference between winners and laggards in the category. For some hospitals, 50 million or so uninsured Americans seem to be a lucrative market. It may make more sense to approach the ‘early adopting’ segments out of these 50 million and win them over.

Educate A lot of information and education needs to be provided in the early growth stage. People would want to know a lot more about the service category. This is where medical travel planners, web-sites, published articles, videos, testimonials will play a very vital role. The whole idea of travelling abroad for treatment, its benefits, safety issues, legal issues, number of people already receiving international treatment, cost involved, etc. needs to be told to


healthcare marketing | FEATURE

the segments you are targeting. India may still be a country of snake charmers for many people in North America. So, unless people are educated about India, its medical facilities, its economy, price structures, expertise, etc. they want not want to board the plane just as yet. Unless they are educated about the concept of medical value travel and how it benefits them, they are less likely to plunge in.

Defragmentation Any new market will defragment with the times to come. The entire world your target market will divide. You may find yourself catering only to the Middle Eastern market. Further, as the market matures further, you may only find yourself providing orthopaedic solutions to the Saudi and UAE patients. The point is, growing markets divide as they mature. You have to take your call sooner or later regarding your manoeuvre. Categories divide. So the service providers should be clear as to which way they will go as and when that happens.

Barriers to Purchase For medical travel there are many barriers. These barriers can be categorized into psychological [going to a different country], logical [quality of clinical outcomes], economical [insurance not covering treatment abroad or logistical [visa not easily available]. The idea for the players is to work incessantly towards lowering/eliminating these barriers. How far the industry grows before it starts to mature and finally decline will depend upon how well the barriers to purchase medical treatment abroad are lowered. A significant barrier at the present moment is the legal cover that provides security to mistreatment abroad. A

standard international law for medical treat-

easily and will be able to ward off much of

ment will significantly help reduce this barrier.

competition. Medical travel is done for elective treatment and it is mostly one time treatment that is imparted. How do you build a loyalty with a onetime customer is a big question. Well, he may never come back. But he can send a few people across. If you ensured his continuity of care and kept in touch with him long after he has left your borders, chances are that he will recommend you to others. Easier said than done; but worth trying nevertheless.

Innovate The faster the category of medical value travel grows, the more important it is for the players to innovate. Ones who will innovate and become different will be the ones who will get ahead, and stay ahead. Rigid providers who resist change will become as extinct as dinosaurs. Getting accredited with an internationally accepted quality organization is one example of innovation. Changing your operations to meet the needs of international patients is another innovation. Ensuring that the international patient gets his home cuisine, watches his home movies, gets his instructions in his home language through a translator, etc. are some basic innovations required.

Build Loyalty As the initial growth phase starts gaining more pace, competition will intensify. If you have built loyalties with the patients who used your services, you will be bailed out much more

Create Barriers With every other person ready to jump on to the band wagon, it sometimes becomes necessary to create entry barriers for others. Creating exclusive partnerships with insurance companies, medical travel planners and even international governments can create barriers for others to enter. A big tertiary care teaching hospital in India has an exclusive tie up with the Bhutan government to provide tertiary care services to its citizens. Even though the hospital is far from the India - Bhutan border, the hospital serves scores of patients every year. All said and done, we are in exciting times when it comes medical value travel. This may be the beginning of an era that may see a huge transformation in the way healthcare is being sought and provided. All you have to do is keep a close watch and create clear advantage for yourself by standing apart from the rest of the pack. ÂŤ More information on the Global Healthcare Marketing conference can be found at www.healthcare-travel.com To register to attend, please call +971 43364021

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Advertisement feature | Clemenceau Medical Centre

Clemenceau Medical Center and its Affiliation

In a constantly evolving world of high-end technology and research, it was a matter of sheer necessity to establish a regional state-of-the-art medical facility with global reach and support. Clemenceau Medical Center (CMC), in affiliation with the prominent and pioneering Johns Hopkins Medicine International, is an ultra-modern medical institution located in the epicenter of Beirut. Our aim is to provide quality healthcare services within a supportive and compassionate environment in both a timely and cost-effective manner, in a 5 star setting environment for patients from Lebanon and the Middle East. New Treatments and Technology

anon. A multilingual staff is available to coordinate all aspects of a patient’s stay, such as

CMC continuously pushes the boundaries to offer the most advanced options. Patient Care and safety are always priorities when selecting equipment, thus, only the best breed of equipment from reputable manufacturers have been selected. Amongst other things, CMC offers a completely film-less digital medical imaging environment, and has built and equipped the most modern Operating Theaters in the world, complemented by advanced laparoscopy and OR automation systems.

the management of medical consultation and hospital admission, travel and hotel arrangements for patients and their families including an air ambulance depending on the distance and the condition of the patient, assistance in choosing the right doctor, processing of second medical opinion, and remote consultations via telemedicine, if needed.

Top Doctors CMC has been chosen by Johns Hopkins Medicine International to be one of its affiliate reputable medical institutions around the world. To achieve the goal of serving as a center of excellence for Lebanon and the surrounding region, CMC in Beirut has achieved a longterm collaboration with Johns Hopkins International in the United States.

CMC chooses doctors carefully based on their educational background, their medical skills, and their ability to work together. Our doctors are with extensive experience in treating every kind of illness, many are international experts. CMC supports doctors by providing the best personnel, facilities and technology to help them deliver the best care to every patient every day.

One-Stop Care Virtually all medical services a patient might need – doctor visits, testing, surgery, and hospital care- are all available “under one roof” at CMC. The hospital, provides all the essential health services required through a person’s life time: These range from simple diagnostic tests to the most complex surgeries in Neurosurgery, cardiothoracic, spine surgery etc... Oncology, Heart, Eye, ENT, Colorectal and Digestive diseases are among the centers of excellence at Clemenceau Medical Center. CMC also houses specialized departments for renal diseases, urology, as well as women’s health clinic, fertility and IVF, children department, new born intensive care unit, in addition to a plastic surgery center.

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Premier Executive Health Check CMC offers the Premier Executive Health Check program, a thorough determination of your health status with customized wellness program for your continued health and well-being. This program is designed to target, reduce, and eliminate health risks through early detection and counseling of lifestyle-related problems.

The International Patient Services This includes a complete scope of services for patients visiting the hospital from outside Leb-

Clemenceau Medicine International (CMI) CMI is an organization whose main duty is the advancement and spread of the Clemenceau Medicine’s mission of patient care both regionally and internationally. CMI has dedicated itself to improving patient safety and quality of medical care, providing assistance in managing performance and applying the world’s best practices in the Middle East. For these reasons, CMI offers a wide array of services that range from healthcare consulting to clinical services development. Through its proficient services, CMI strives to foster partnerships with international organizations and help them excel regionally and serve as examples of excellence internationally. «


FEATURE | Bioethics

By Colleen Lyons

Medical Tourism

Proceed with Caution What do a hip replacement, a facelift and a free vacation for your partner have in common? A lot, if one is embarking on a medical tourism jaunt. A combination of market dynamics and increased globalization has helped create this new industry which combines required and/or elective surgery with vacationlike amenities. The numbers are compelling. The actual numbers of those participating in off-shore operations are noteworthy for their size as well as the variability of the estimates, which range from 500,000 to 150,000 U.S. citizens per year. The lack of verifiable numbers is the first tip- off that medical tourism may be infused with a bit of the wild west, or in this case, East. Drawn by the $11,000 cardiac procedure versus the heart stopping US rate of $130,000 or a spinal fusion with a price tag of $5,500 versus a back breaking US bill of $62,000, patients and more importantly, insurers, are heading beyond the pale for surgery. However, the allure of inexpensive medical care may not be quite enough to get your average cubicle worker with an unstamped passport on an airplane for a hip replacement. The tipping point may be the perks, which include airfare and lodging for patient and partner, a bump up to first class and some additional vacation time. Insurance companies are facilitating the shift of outsourced medical care. The biggest names in insurance, Cigna, Aetna and Blue Cross, are either contemplating or implementing off-shore treatments for required and elective surgeries as a matter of economics. It’s

Âť

many developing countries are banking on tourism to help build a sustainable economy ÂŤ

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Bioethics | FEATURE

cheap. As the median age of the population rises upwards, along with the costs to care for an aging yet unhealthy population, insurers are looking for ways to elongate the dollar. In addition many developing countries are banking on tourism to help build a sustainable economy and play in the global market. Governments, businesses and healthcare providers in India, Thailand, Mexico, Israel, New Zealand, Costa Rica and Turkey are collaborating with the medical tourist providers to attract patients and their currency. In the West, these countries have historically evoked exotic imagines of un-

unanticipated complications may arise en route or at home. Then what? Is the patient going to be inclined to get back on the plane? Probably not. Now we come to another significant issue: legal remedy. Americans are singular in their propensity to seek legal remedy when medical complications arise. Yet off-shore law suits for medical malpractice will be the rare occurrence and not de rigueur as it is in the US. With these considerations as part of the cost/benefit analysis, the bloom may be a bit off of the rose.

»

we must proceed with caution and consider the spectrum of implications affecting patients, society and the economy « reachable allure. Yet, the appearance of financial savings and efficiencies has made strange bedfellows of sutures and seductive travel. Those who have reservations about making reservations for going abroad to be sliced, sutured and sent home are prudent. Price does not always equal costs and there are a few points to be considered before a ‘buy and fly” operation. One such consideration is informed consent, the full disclosure of surgical risks, complications and recovery expectations. Informed consent in the West is difficult- parsing the medical jargon, common language use, and grade-level appropriateness are familiar challenges. Non-western cultures may place less importance on ensuring a fully informed patient and the language differences lend themselves to hi-jinks. Beyond informed consent is the issue of postoperative complications. What may be a routine complication can take on a menacing twist when one is thousands of miles from home without the assistance of friends and family to interpret the medical milieu and translate the language. Hospital-based staph infections, for example, are pernicious. What if a stay is prolonged indefinitely? If one does trot home on schedule, recovery may not be calibrated for a long, often truncated, flight home. As a result,

From a policy perspective, the issues are larger, the first of which is certification. The international medical tourism guidelines and standards set by the American Medical Association and the International Society for Quality in Health Care which certifies 170 +/- hospitals around the world offer little comfort. For starters, how are the standards monitored, audited and updated? Are there corollary environmental standards for air, water and food safety? The powerful Food & Drug Administration (FDA) has difficulty managing safe food and drugs- tomatoes and Heparin come to mind. How can an AMA imprimatur, which does not have legal authority, provide assurance of sus-

tained quality and safety? McKinsey & Co., estimates that 500,000 -700,000 Americans might go off-shore for medical care if insurers cover some or all of the bill and that savings may top $20 billion a year. The first issue is that if insurers sniff the aroma of cost savings, a la managed care, the patient’s option to stay home or jet-set may be off the table. The venue may be mandated. In addition, if these cost savings become imbedded in the balance sheet- and the talk track to Wall Streetthe luxuries and incentives will go the way of house calls. On a macro level, a significant economic and social shift will occur if half-million procedures shift out of the medical system in the US. The effects are far reaching and may further exacerbate the issues associated with the marginal and uninsured. While medical tourism does have some fine attributes- there are many positive anecdoteswe must proceed with caution and consider the spectrum of implications affecting patients, society and the economy. «

Ms. Lyons is a bioethicist and principal with Ethical Stability for Sustained Prosperity. Sources: By JoNel Aleccia MSNBC updated 8:41 a.m. ET, Mon., June. 30, 2008 Art Caplan By Alex Davidson , updated 5:40 p.m. ET, Thurs., Dec. 13, 2007

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FEATURE | Healthcare Insurance

By David Boucher President and Chief Operating Officer Companion Global Healthcare Inc.

Overseas Medical Care Has Become an

Option for Employers

The number of Americans traveling overseas for health care is rising steadily, climbing to between 600,000 and 1 million last year, according to some estimates. Although a recent paper produced by McKinsey Consulting suggested a much lower estimate, most experts agree that the number certainly will increase in the future. And human resource executives who design benefit plans for self-insured employer groups will have a definite say in determining the rate of acceleration. The medical travel industry – I prefer the terms “medical travel” or “global health care” over “medical tourism” since most patients travel abroad for the express purpose of undergoing medical treatment and not sightseeing – began to take off in recent decades as Americans sought cosmetic procedures overseas at a fraction of the U.S. costs. Now, with 47 million Americans lacking health insurance and millions more underinsured, patients are

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exploring overseas options for medically necessary surgeries such as cardiac bypass, heart valve replacement, hip and knee replacement, hysterectomy and others. The initial attraction for these globetrotting patients is the low cost, and many save 80 to 85 percent off U.S. prices. But the level of service and five-star hospitality they receive is equally impressive in most cases … and converts most medical travelers returning to the U.S. into flag-waving diplomats of this alternative. While the desire for cosmetic work launched the medical travel industry and a lack of insurance coverage for many Americans fed it, I believe the next wave in demand will be fueled by employee benefit plan administrators who include a global health care option in their benefit packages. Companion Global Healthcare Inc., based in Columbia, S.C., was established last year to

streamline access to overseas care for the members of a large commercial health plan in South Carolina who choose to travel abroad for treatment. This 1.5 million-member health plan knew South Carolinians were traveling to Southeast Asia and other destinations for surgery, so we decided to make it easier for their members and provide assistance on a valueadded basis. While member service was the initial driver behind Companion Global Healthcare, the company also is available to assist the uninsured, and to contract with other insurance companies and self-insured groups interested in offering a global surgery option. Employers are the ultimate payers for most health care under the current U.S. system, and we at Companion Global Healthcare are constantly fielding questions from human resource brokers and others who shape benefit structure about how a global health care benefit works. For example, we are hearing from employer groups who say they might consider waiving the $2,000 deductible in an employee’s medical plan if the employee chooses to undergo surgery at one of our network hospitals overseas. Other incentives are possible, too, such as employers covering the cost of travel. Employers are the key as to whether this trend continues to gather momentum.


Healthcare Insurance | FEATURE

THE ‘PERFECT STORM’ DRIVING THE TREND The factors that have led to the heightened interest in medical travel are many, but the relatively high cost of treatment in developed countries is by far the most obvious. For many surgical procedures, the cost is 50-80 percent less at all of the hospitals in Companion Global Healthcare’s overseas network than for the same procedure performed at a U.S. facility. Lower labor costs overseas and the fact that medical malpractice suits are a rarity help keep costs in check. While the low cost is the attention-grabber for most patients who travel outside the U.S. for care, those patients are often just as impressed by the superior hospitality they are afforded at facilities in Thailand, Singapore, Turkey, Costa Rica and other places. Throw in the ease and affordability of international travel, and you begin to see how the pace of global health care is picking up. Of course, going hand-in-hand with the affordability factor is the substantial number of uninsured and underinsured people in this country, who have utilized overseas facilities in larger numbers than those with comprehensive health insurance. Even those with insurance are considering the overseas option in increasing numbers, and that is a surprise to some. Skeptics often ask me, “Why would a member of a commercial payer with a $500 deductible spend $1,500 for a plane ticket and endure a 25-hour flight to go to Thailand or India for care?” Well, most probably wouldn’t. When we launched Companion Global Healthcare, we simply wanted to offer another alternative that reflects our ongoing commitment to help members seek the services they want at competitive prices. We certainly did not envision long lines of our members at the airport waiting for flights to far-away locales so they could have knees and hips replaced. But what about the person with a high-deductible plan? Or the person who has insurance but is not covered for a procedure due to a pre-existing condition? Or the patient who needs a specialized procedure not performed frequently in the United States, such as hip resurfacing? Those are the people going abroad already, and now we have groups asking about tapping into the Companion Global Healthcare network and considering incentives for employees who choose surgery abroad. Another factor contributing to the growth in global health care has to do with the aging of the U.S. population. According to USA Today, during each hour

of 2008, 365 Americans will turn 62 years old, and more than half will accept early retirement from Social Security. Many, however, will no longer have health care benefits from their previous employer and will not be eligible for Medicare for three more years. Clearly, their Social Security income will not cover traditional insurance products, and all of this will come at a time when many of these new retirees are incurring substantial expenses. So while the Silver Tsunami is helping fuel the demand side of the medical cost equation in the U.S., the accelerating shortage of health care workers in the States is pressuring the supply side. Treatment overseas may not be the total answer for this population, but I do believe it will be an option for many.

IS OVERSEAS CARE QUALITY CARE?

in mid-2006 to more than 170. What’s more, many of the physicians who practice at these international facilities are U.S. board-certified. As we expand our network of overseas hospitals, Companion Global Healthcare will consider adding only facilities certified by the Joint Commission International (JCI) that we believe have comparable technology and subscribe to the same high standards of care as the best U.S. facilities. Although Companion Global Healthcare is aggressive in seeking new network members – we hope to expand our overseas network from the current 10 to perhaps 15 hospitals – we are also conservative when it comes to risk. Many critics of medical travel suggest that a few well-publicized deaths or serious injuries in this business could arrest the trend. And while those could happen at any hospital –

Year-over-year growth in international patient care is approaching 25 percent in some countries, including Thailand, Singapore and India. Colleagues in Mexico and Costa Rica say their numbers of patients from the U.S. are up well over 50 percent vs. 2007. This could not happen unless patients there received high-quality care. The number of foreign hospitals that have earned accreditation from the international arm of The Joint Commission, the group that accredits U.S. hospitals, has increased from 87

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FEATURE | Healthcare Insurance

» Colleagues in Mexico and Costa Rica say

their numbers of patients from the U.S. are up well over 50 percent vs. 2007 «

every patient responds to anesthesia differently, for example – we want to be able to mitigate that risk as much as possible. We have been impressed with the transparency exhibited by many international hospitals with regard to quality and patient satisfaction, as well as price. Several indices have become the backbone of the “quality transparency” drift in the United States, including: • • • • •

Number of cases per procedure Average length of stay per procedure Mortality and hemorrhage rates Post-surgical infection rates Patient-satisfaction scores

While Web-enabled data available to the public for some of these indicators is sparse, at best, for U.S. facilities, many foreign hospitals such as Bumrungrad International in Thailand, Parkway in Singapore, and CIMA in Costa Rica readily make this data available. Price transparency also is more common among overseas hospitals than with those in the United States, with many offering prices for all-inclusive packages prior to service. Under this approach, the consumer is more empowered and informed as the health care-buying experience becomes more like shopping for other goods and services.

LIMITATIONS OF GLOBAL HEALTH CARE While I believe strongly that the care delivered by JCI-accredited facilities is on par with U.S.

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hospitals and that a global care option is attractive to millions of Americans, I am quick to add that traveling outside this country for surgery is not for everyone. The trend of Americans utilizing overseas facilities has formidable limitations. First, many Americans will not consider traveling abroad for fear of surgical complications, questions concerning whether their primary physician will see them for after-care following their return to the United States, and limits on medical malpractice claims in some foreign countries. Also, not every surgical procedure is appropriate for global travel. Certainly, emergency operations and organ transplants will be ex-

cluded from widespread consideration in the near term. Basically, for a U.S. resident to consider surgery outside this country, the procedure should be costly, one that can be scheduled well in advance, and one with consistent, complication-free outcomes. Some of our members have expressed concerns about continuity of care following a procedure in a foreign hospital. A few wonder whether their primary care physician might refuse to treat them for any post-surgical complications once they return home. While we would encourage members to use their primary care physician if they have one, we have contracted with a group of health clinics to provide prepaid, after-care consultations for patients following surgery overseas.

COMPANION GLOBAL HEALTHCARE Companion Global Healthcare was established to put together a network of JCI-accredited hospitals outside the United States, and then to serve as a one-stop shop for those who choose treatment at one of the network facilities – helping clients schedule appointments, make travel arrangements, transfer their medical records and more. As stated above, Companion Global’s initial mission was to assist members of the large South Carolina insurance plan, but for the past year, the company has been working with benefits brokers, employer groups and limited benefit insurance administrators who want to add a global option to their benefit plans in a more structured way. Several self-insured employers, for example, have added Companion Global’s network and service offerings directly to their benefit plans, and then listed specific medical procedures that their employees may elect to have performed at one of the network hospitals. All of the employers have announced plans to share any savings with the employee as well. For example, the employers might waive any deductibles or co-payments the employee would normally pay. Some employers even offer to pay air fare for the employee and a companion. In the next year, we fully expect some of these employees who select the overseas option to return to work and share their positive experiences. With that, the trend toward health care globalization will continue to gain steam. « More information on the Global Healthcare Marketing conference can be found at www.healthcare-travel.com To register to attend, please call +971 43364021


Singapore Medicine | Advertisement feature

Singapore: More Than Just a World Class

Healthcare Destination

If any place on earth can be called the ultimate healthcare destination today, Singapore is it, with more than 400,000 people making a trip each year.

Each year, more than 400,000 patients travelled to Singapore specifically for healthcare, and many others sought wellness and healthcare services while on the island for other reasons. They come from all over the world for clinical services ranging from complex, highend cancer treatment down to the simplest of general practice care. While other destinations provide good clinical services in a tourist-friendly environment, Singapore’s healthcare system is ranked by the World Health Organization as Asia’s very best. There are as many healthcare facilities in Singapore accredited by the Joint Commission International (the most common measure of healthcare service excellence) than all the other major Asian destinations – India, Thailand, Malaysia, Philippines – put together. Singapore’s doctors are not just trained in the best centres worldwide but are internationally respected for their research and expertise. Technology is up-todate but carefully selected for safe and effective treatment. Some – like the bodyfat UltraShape and the complete neurosurgical BrainSuite – are the first deployments in the world. The excellent clinical services are backed up by leading-edge research in facilities like the Biopolis, a purpose built biomedical research hub with researchers from both the public and private sectors. Through basic, translational and clinical research, Singapore’s doctors not only provide good, tested treatments to their pa-

»

English is widespread, crime is low, security is high, transport is convenient, Singapore is a tourist’s dream destination « tients but create new ones as well. Many world and Asian firsts happen in Singapore, from the beginnings of the test-tube babies to the “tooth-in-eye” operation that makes the blind see again - small wonder then that Singapore is also the regional hub for medical conferences and professional training. Much is sometimes made of Singapore’s relatively higher prices. But that’s relative. The difference is often not large and what prices one’s health, one’s life anyway? And higher prices do not always translate to higher total costs for the traveling patients when better outcomes lead to a shorter stay and an earlier return home. In any case, Singapore’s average bill sizes are published regularly by the Ministry of Health, providing feedback to the local and international patients on healthcare costs. Clinical outcome indicators, such as survival rates for childhood leukaemia and cataract surgery, are similarly published for public scrutiny; such is the increasing desire of the medical community to be open and transparent with the patient and the community. All major healthcare facilities have International Patient Liaison Services to look after the language, travel, accommodation and leisure needs of patients and their family members,

ensuring a comfortable stay for all. A city well-known for its international representations like the Singapore Girl, Changi Airport and the world’s busiest seaport, Singapore’s cosmopolitan community welcomes travellers from all parts of the world. English is widespread, crime is low, security is high, transport is convenient, Singapore is a tourist’s dream destination. There is little need to say more about the touristy aspects of medical travel beyond the destination tagline – Uniquely Singapore, Beyond Words – since Singapore welcomed more than 10.3 million discerning tourists last year. That’s more than twice the total resident population of the whole island state! Ultimately, medical travellers do not want to go where there are uncertainties about the quality of care or the safety of blood, rumours of wars and bombs, social antagonism or distrust, or any concerns for the safety and comfort for themselves and their accompanying persons. Singapore is the one destination where patients will have no such fears, and can find peace of mind when their health really matters. « For more information on medical travel to Singapore visit www.singaporemedicine.com

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Advertisement feature | children’s trust tadworth

UK paediatric brain injury specialist extends help to the Middle East With more than 20 years experience in providing care, therapy and support to children with acquired brain injury, The Children’s Trust is expanding its help to families from the Middle East

Nearly five years ago The Children’s Trust began offering brain injury rehabilitation to children from the Middle East – helping a young boy from Qatar. Left minimally conscious and with a serious brain injury following a road traffic accident, the boy came to the UK with his family for treatment. He was admitted to The Children’s Trust for its specialist therapy, nursing care and medical input, where he had a programme tailored to his needs. Upon discharge he had regained many of his skills and was able to attend the Trust’s on-site school for 52-week residential special education. Since then the Trust has been strengthening its links with the Middle East and has helped many other children from the region. The Children’s Trust started the UK’s first residential rehabilitation service for children with acquired brain injury in 1985. It is still the UK’s largest centre and has purpose-built specialist facilities and an extensive team of professionals to help each child. Children come to the Trust having acquired a brain injury from causes such as road traffic accidents; encephalitis; brain tumour; cardiac arrest; a fall; stroke or meningitis. Due to increasing demand, the Trust is opening in 2009 a new residential rehabilitation

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centre featuring the latest technology, and a multi-sensory hydrotherapy centre. It means The Children’s Trust can help even more children. The Trust’s interdisciplinary team includes doctors; nurses; carers; physiotherapists; occupational therapists; psychologists; speech and language therapists and teachers. Its consultant neuro-developmental paediatrician is responsible for medical care, supported by an associate specialist in paediatrics and doctors in training. On-site clinics and individual assessments are also available through the Trust’s extensive network of specialists, from neurology to epilepsy and dentistry. The Children’s Trust works closely with other specialist children’s medical providers including Great Ormond Street Hospital and Addenbrooks Hospital, and is within easy access of London. The Trust is able to help some of the most profoundly disabled children and those with complex health needs, and provides opportunities for therapy, education and leisure not available in a hospital. It can also provide follow-up advice and treatment strategies for long-term care. The Children’s Trust is also there to help the child’s family. Interpreters are provided for the duration of the child’s daytime sessions and can be accessed outside of these times if necessary. Families are helped to find local accom-

modation during their child’s stay and an advocate is available to offer support. The Trust has good working relationships with embassies to support a child’s placement. Salim is one example of the benefits of The Children’s Trust’s rehabilitation service. He was admitted to the Trust following three operations to remove a brain tumour. Totally physically dependant, he needed help in all aspects of his daily living. After a six month placement at the Trust, Salim was able to sit up, stand and walk short distances unaided. He also regained much of his speech and returned with his family to the UAE. Physiotherapy in particular played an important role, encouraging his movements and helping him regain his cognitive skills. Each member of the interprofessional team played an important role, helping Salim learn to be involved in his activities of daily living and communicate with others. Salim’s parents believe he benefitted greatly from his stay at the Trust and are grateful for the treatment and care he received. He is now attending the Centre of Human Services in Sharjah, which provides care for children with special needs. He recently returned to The Children’s Trust for a follow-up reassessment and continues to do well. «

For more information about The Children’s Trust or how to refer a child please contact Bob Butler at enquiries@thechildrenstrust.org.uk or telephone +44 1737 365847 and quote reference HCTM1. www.thechildrenstrust.org.uk


‫‪Advertisement feature | Parkway Group‬‬

‫و�صلت فاطمة ال�صغرية م�صابة بغيبوبة‪ .‬وقد غادرت املركز‬ ‫بعد ت�سعة �أ�شهر وتبدو االبت�سامة على وجهها‪ .‬يتذكر والدها‬ ‫خالد �إبراهيم ال�شهور الطويلة‪.‬‬ ‫عندما ا�ستقللنا الطائرة �إىل �سنغافورة‪ ،‬كنت �أحمل م�سئولية حياة ابنتي ال�صغرية على عاتقي‪ .‬كانت فاطمة‬ ‫حينها تبلغ من العمر ثالث �سنوات فقط‪ ،‬وكانت مري�ضة للغاية‪ .‬كانت فاطمة حينها قد دخلت يف غيبوبة‪،‬‬ ‫و �أخربين ا لأطباء ب�أنها لن تنجو‪ ،‬و �أن �أيامها يف هذا العامل قد �أ�صبحت معدودة‪.‬‬ ‫حالتها‪ .‬فقل النزيف‪ ،‬وكان حجم ال�رسطان يت�ضاءل‬ ‫با�ستمرار – وقد علمنا ذلك من خالل �صور امل�سح‬ ‫ال�ضوئي الذي كان يجريه الأطباء‪.‬‬ ‫وكل ليلة‪ ،‬كنا نعود �إىل �شقتنا بجوار امل�ست�شفى‪ ،‬ن�أخذ‬ ‫ما نحتاجه ونعود مرة �أخرى �إىل امل�ست�شفى‪ .‬وكانت‬ ‫ال�شقة قريبة ج ًدا بحيث ميكن الو�صول �إليها على‬ ‫القدمني كما كنا ن�ستقل �سيارة �أجرة يف بع�ض‬ ‫الأحيان‪.‬‬ ‫نظرا لأن الأطباء �أخربونا‬ ‫وكنا نريد البقاء عن قرب ً‬ ‫�أن هناك احتمالية «انفالت الورم «بالرغم من»‬ ‫العالج»‪ .‬لذلك‪ ،‬قاموا ب�إجراء عملية ثانية ال�ستئ�صال‬ ‫الورم املتقل�ص‪.‬‬ ‫وقد كان ذلك عندما قالت يل زوجتي‪« :‬لقد انتهى‬ ‫الأمر‪� .‬إنها بحالة جيدة الآن‪ ».‬وقد خرجت وا�شرتت‬ ‫احللوى للجميع‪ .‬كانت هذه هي املرة‪ ‬الأوىل التي‬ ‫�أراها ت�ضحك فيها ب�صوت مرتفع لقرتة طويلة‪.‬‬ ‫أي�ضا‪ ،‬وقد‬ ‫كما �أنني ر�أيت البهجة يف �أعني الأطباء � ً‬ ‫عمت الفرحة جميع الأجنحة!‬ ‫وال زلت �أذكر حينما قال يل الدكتور �أجن «�إن‬ ‫م�شاهدتي لها جتري وتقوم بتلك الأعمال الطفولية‬ ‫هي �أكرث ما �أ�ستمتع به يف يومي!»‪ .‬كما �أخربين �أن‬ ‫فاطمة لديها فر�صة ت�صل �إىل ما يقرب من ‪%15‬‬ ‫للو�صول �إىل مرحلة البلوغ‪ .‬ولكنني مل �أحاول التعلق‬ ‫كثريا‪.‬‬ ‫بالأمل ً‬ ‫والآن‪ ،‬ويف كل �صباح‪� ،‬أ�ستيقظ و�أحمل �صغريتي‬ ‫للخارج لتناول الطعام‪ .‬وهي حتب �أطعمة ماكدونالدز‬ ‫والذهاب للت�سوق‪ .‬وكنت �أتناول وجبة معها كل يوم‬ ‫�إذا كانت تلك هي رغبتها‪ .‬ونحن الآن نخرج بها‬ ‫كاف‬ ‫نظرا لأن مناعتها تعد قوية الآن ب�شكل ٍ‬ ‫للت�سوق ً‬ ‫ميكنها من اخلروج‪.‬‬ ‫هل ميكن �أن تتخيل؟ ن�ستطيع الآن اخلروج والذهاب‬ ‫�إىل حمالت لعب الأطفال يف حني �أخربنا الطبيب‬ ‫املحلي قب ًال �أنه لي�س هناك �أمل‪ .‬انظر! – هذه ‪10‬‬ ‫دميات قد ا�شرتيناها �أثناء اجلوالت التي قمنا بها‬ ‫هناك‪.‬‬ ‫وقد ات�صلت يف بلدي بذلك الطبيب املحلي‪ ،‬ومل ي�ستطع‬ ‫الت�صديق �أنها ال تزال على قيد احلياة‪ ،‬و�أنها ت�صيح‬ ‫وجتري وتتحدث �إليه‪.‬‬ ‫وهي حتب املل�صقات والتلوين‪ .‬كما �أن �شهيتها جيدة‬ ‫للغاية‪.‬‬ ‫و�سوف نعود للوطن‪ .‬و�ستلتحق فاطمة باملدر�سة‪ .‬فهي‬ ‫مل تلتحق باملدر�سة حتى الآن‪.‬‬ ‫وتعتقد والدتها �أنها تريد �أن ت�صبح طبيبة‪ .‬وهذا ال‬ ‫كثريا‪ ،‬فكل ما �أريده هو �أن �أراها ت�ضحك‪.‬‬ ‫يعنيني ً‬ ‫عاما ويعمل يف‬ ‫خالد �إبراهيم‪ ،‬يبلغ من العمر ‪ً 35‬‬ ‫جمال �صناعة البرتول‪ .‬زوجته عايدة‪ ،‬تبلغ من العمر‬ ‫عاما‪ .‬ولديهما �إىل جانب فاطمة‪ ،‬ابن يبلغ من‬ ‫‪ً 29‬‬ ‫عاما واح ًدا‪ .‬وقد غادروا جمي ًعا �سنغافورة يف‬ ‫العمر ً‬ ‫العا�رش من �شهر مايو‪.‬‬

‫ماذا ن�ستطيع �أن نفعل؟ كانت هذه هي املرة الثالثة‬ ‫التي ن�أتي فيها �إىل �سنغافورة‪.‬‬ ‫وعندما غادرنا �أخربونا ب�أن الأمر �أ�صبح على ما يرام‬ ‫و�أنه لي�س هناك ما يدعو للقلق‪ .‬فقد ذهب ال�رسطان‪.‬‬ ‫و�أخربونا �أن هناك «ن�شاطً ا حمدو ًدا للغاية»‪ .‬وبعد‬ ‫ذلك ب�أ�شهر قليلة عدنا �إىل بلدنا‪.‬‬ ‫مل نكن نعرف ماذا ميكن �أن نتوقع‪.‬‬ ‫لقد قال الأطباء �أن الورم «منت�رش يف الأوعية بدرجة‬ ‫كبرية»‪ .‬و�أنه ميكن �أن ينزف يف احلال‪.‬‬ ‫بل �إنهم �أخربونا �أن الورم كان ينزف بالفعل قبل‬ ‫�إجراء اجلراحة‪.‬‬ ‫مل يكن ب�أيدينا حينها �سوى �أن جنل�س يف احلجرة‪ ،‬ومل‬ ‫نتكلم فلم يكن هناك ما يقال‪.‬‬ ‫كانت ال�صغرية فاطمة تنزف كل يوم ما يقرب من‬ ‫‪ 300‬ملليلرت من الدم؛ قطرات وقطرات من الدم تخرج‬ ‫من ج�سد طفلتي ال�صغرية‪ .‬ومل نفعل �شيئ ًا �سوى �أننا‬ ‫جل�سنا يف احلجرة ن�صلى ونبكي وننظر �إىل بع�ضنا‪.‬‬ ‫كان الأطباء ي�شعرون بالي�أ�س‪ .‬ويف �أحد الأيام‪ ،‬جل�س‬ ‫معنا الدكتور �أجن وقال‪:‬‬ ‫«�إن اخليار الوحيد هو متابعة العالج الكيميائي‪ ».‬وقد‬ ‫�أو�ضح لنا �أن �إجراء العالج الكيميائي �أثناء �إخ�ضاع‬ ‫املري�ض جلهاز التنف�س ال�صناعي‪ ،‬كما يف حالة‬ ‫فاطمة‪ ،‬من الأمور النادرة للغاية‪ .‬فه�ؤالء املر�ضى‬ ‫يكونون يف الغالب �أ�ضعف من �أن يتحملوا العالج‬ ‫نظرا‬ ‫الكيميائي‪ .‬كما �أن ذلك قد يت�سبب يف وفاتها ً‬ ‫خلطر العدوى الناجتة عن العالج الكيميائي‪ .‬كان‬ ‫كبريا ولكن كما قال الدكتور �أجن «مل يكن‬ ‫اخلطر‬ ‫ً‬ ‫�أمامنا خيار �آخر‪.‬‬ ‫بالطبع كان �أمامي اختيار‪ -‬االختيار بني املوت‬ ‫واحلياة‪ .‬ولكنني اخرتت احلياة لفتاتي ال�صغرية‬ ‫وخاطرت من �أجل ذلك كما خاطرت من قبل بركوبي‬ ‫الطائرة‪.‬‬ ‫وكل يوم‪ ،‬كان ي�أتي الفريق املكون من ثالثة �أطباء‬ ‫ينظرون �إىل اجلداول وي�سجلون كمية الدم املتدفق من‬ ‫ال�صدر ثم يقومون با�ستبدال نف�س الكمية من خالل‬ ‫�إخ�ضاع �صغريتي فاطمة لعملية نقل دم‪.‬‬ ‫وبعد �أ�سبوع‪ ،‬بد�أت كمية الدم املفقود يف االنخفا�ض‪.‬‬ ‫وبحلول الأ�سبوع الثالث‪ ،‬كانت حالتها ال�صحية جيدة‬ ‫مبا يكفي لف�صلها عن جهاز التنف�س ال�صناعي‪.‬‬ ‫وبحلول ذلك الوقت‪ ،‬ا�ستيقظت‪ .‬كما ا�ستطاعت �أن‬ ‫تراين‪.‬‬ ‫وقد كان �أول �شيء فعلته هو �أنها لعبت بهاتفي‬ ‫املحمول وتب�سمت عندما ر�أت �صورة فوتوغرافية‬ ‫لأخيها ال�صغري عليه‪ .‬وكانت زوجتي قد ثقبت �أذين‬ ‫فاطمة عندما بلغت العام الأول من عمرها‪ .‬ف�أعدنا‬ ‫�إليها قرطها الذهبي ال�صغري عندما مت ف�صلها عن‬ ‫جهاز التنف�س ال�صناعي‪ .‬وال زلت �أذكر تلأل�ؤ القرط يف‬ ‫�أذنها عندما كانت تلتفت �إلينا وتبت�سم‪.‬‬ ‫كنا نراها كل يوم‪ ،‬وعلى مدار ثمانية �أ�شهر‪ ،‬تتح�سن‬

‫دكتور �آجن مع ال�صغرية فاطمة‬ ‫وعندما ات�صلت ب�سنغافورة و�س�ألت عن العالج‪ ،‬وجدت‬ ‫�أن هناك بارقة �أمل‪ .‬ولكن الأطباء يف بلدي �أخربوين‬ ‫كبريا‪ .‬و�أتذكر‬ ‫ب�أن الرحلة بالطائرة �سوف متثل‬ ‫خطرا ً‬ ‫ً‬ ‫�أن الطبيب حينها قال يل «�إنني ال �أ�ستطيع ال�سماح‬ ‫بذلك‪ ،‬فهي لن تنجو من هذه الرحلة‪.‬‬ ‫وعندما �س�ألت «فماذا على �أن �أفعل؟‬ ‫�أجاب الطبيب «�سوف يكون عليك �أن تتحمل �أنت‬ ‫امل�سئولية‪.‬‬ ‫وقد فعلت‪ ،‬و�أخذت امل�سئولية على عاتقي‪ .‬وكانت‬ ‫ال�سبع �ساعات التي ق�ضيناها يف الطائرة هي الأطول‬ ‫يف حياتي‪ .‬وقد كان هناك طبيب وممر�ضة يعتنون‬ ‫بفاطمة التي كانت هادئة طوال الرحلة‪ .‬وقد منت �أنا‬ ‫الآخر‪ ،‬فقد كان اليومان اللذان �سبقا الرحلة حافلني‬ ‫للغاية‪ ،‬حيث كان علي ترتيب العديد من الأمور‪.‬‬ ‫وقد كان من �أجمل املناظر التي ر�أيتها يف حياتي‬ ‫عندما نظرت من نافذة الطائرة �إىل ممر الهبوط يف‬ ‫�سنغافورة‪ .‬كما ر�أيت �سيارات الإ�سعاف و�أنا�س‬ ‫م�ستعدين لتقدمي امل�ساعدة‪.‬‬ ‫عندها قلت لنف�سي «�إنهم م�ستعدون»‪ ،‬و�شعرت ب�أن‬ ‫العبء الواقع على كاهلي مل يعد بنف�س الثقل‪ .‬وبعد �أن‬ ‫نزلنا من الطائرة‪ ،‬هرع �أولئك الأ�شخا�ص لت�أدية‬ ‫عملهم‪.‬‬ ‫وقبل �إخراج فاطمة من الطائرة‪ ،‬كان قد مت �إعطا�ؤها‬ ‫مهدئ ًا ومت و�ضع جهاز تنف�س ميكانيكي لها‪ .‬وعند‬ ‫الو�صول �إىل �آخر �سلم الطائرة‪ ،‬قام فريق العمل ب�أخذ‬ ‫فاطمة من الطائرة �إىل �سيارة الإ�سعاف ومل تكد‬ ‫مت�ضى ‪ 10‬دقائق على ما �أظن حتى و�صلوا �إىل‬ ‫امل�ست�شفى‪.‬‬ ‫وقد تبعناهم يف �سيارة �أخرى‪ .‬وكان و�صولنا يف‬ ‫فرتة ما بعد الظهرية يف يوم م�شم�س حار‪ .‬وكان ذلك‬ ‫مبثابة �أمل جديد بالن�سبة لنا‪.‬‬ ‫كانت فاطمة تعاين من ورم انبثاثي من نوع «ويلم»‪،‬‬ ‫وهو نوع من �رسطان الكلى يتعر�ض له الأطفال‬ ‫�أحيا ًنا‪ .‬وكان اجلراح املوجود يف بلدي قد �أحال‬ ‫فاطمة �إىل طبيب يف �سنغافورة‪ ،‬وهو الدكتور �أجن بنج‬ ‫تيام‪ ،‬وذلك لأنها كانت تعاين من ورم كبري للغاية يف‬ ‫كبريا للغاية لدرجة �أنه كان‬ ‫ال�صدر‪ .‬وقد كان الورم‬ ‫ً‬ ‫يدفع القلب �إىل اليمني‪ .‬ولذا‪ ،‬مل تعمل الرئتان بنف�س‬ ‫الكفاءة املفرت�ضة‪.‬‬ ‫كان ال�رسطان ينمو ب�رسعة كبرية‪.‬‬ ‫وكان �أول �شيء فعله الأطباء هو �إخ�ضاعها لعملية‬ ‫جراحية يف حماولة ال�ستئ�صال بع�ض الورم‬ ‫ال�رسطاين‪ .‬ولكن عندما حدث ذلك‪ ،‬وقام الأطباء بفتح‬ ‫ال�صدر‪ ،‬بد�أ الورم يف النزف ب�شدة‪.‬‬ ‫ويف النهاية‪� ،‬أخذ الأطباء عينة �صغرية من الن�سيج‪.‬‬ ‫وعندها �شعرت �أنا وزوجتي بال�صدمة‪ .‬هل هذا يعني‬ ‫�أن اجلراحة قد ف�شلت؟‬ ‫فما الذي يبقى بعد ذلك؟‬ ‫‪32 | H e a l t h c a r e T r a v e l M a g a z i n e | I s s u e O n e 2 0 0 8‬‬


FEATURE | Middle East focus

UAE: Can it share

a slice of the pie? By Anshul Govila, Sheikh Khalifa Medical City, UAE

40.4 Billion Dollars is the projected size of the Medical Tourism Industry in the year 2012. From Bombay to Bagota people are lining up to take a jab at this fruit.

But will the UAE get a slice of this pie. Maybe, maybe not. The pack of profiteers is led by India, China and Thailand, all with their individual assets and short -comings. The numbers talk for them self: 1.2 million patients travelled to India for healthcare while another 1.1 million medical tourists travelled to Thailand in 2007. India’s biggest asset has been its numerous Western trained English speaking doctors. It also has some of the worlds largest corporate hospital chains. A report from the Confederation of Indian Industry and McKinsey has predicted that up market tertiary care hospitals in India could generate up to $2bn (£1.1bn; €1.7bn) in revenue through health tourism by the year 2012. China with its liberal policy with organ retrieval and donation has become the top choice for liver and kidney transplants, even though the international community does chastise it for the lack of transparent medical practices. Thailand, the perfect tourist destination has come up with a rich blend of American trained accredited establishments and an eclectic mixture of Thai Hospitality. Also with a permissive culture, it is sought by many for rehabilitation and respite care. Unfortunately the Middle East remains a net exporter of patients rather than a net importer. This scenario is changing, but the pace is too slow. The Middle East in the last few years has become a brand ambassador for opulence and luxury. Dubai, Abu Dhabi and Doha are taking the tourism industry by storm. The whole landscape is changing with the emergence of these super cities. Museums, retail space, theme parks, and business parks are coming up all over. The demographics are changing as well. Gone are the days when it was the haven for adventurous Westerners and industrious Indians. Now it is a playground for the rich and

34 | H e a l t h c a r e T r a v e l M a g a z i n e | I s s u e O n e 2 0 0 8


Middle East focus | FEATURE

famous, more so in the years to come. Such periods in history, when new cities are being created and previous ones re-defined come far and few. Unfortunately, the healthcare picture does not reflect the same confidence. Though the hospitality industries standards have been at par or in some cases better than international standards, the healthcare industry cannot boast the same. Few hospitals are true connoisseur hubs where health and hospitality are both at their prime. New hospital chains are trying to address this issue. These establishments often find themselves lacking in talent when it comes to bringing the hospitals up to steam. Accreditation, infrastructure cost, short-

shortcomings of its large Indian neighbor. The market in India still lacks the panache to lure the celebrity patient. It lacks the depth of luxury and the perfection in service, both of which the Middle East offers. The medical tourism market in India still caters to those unfortunate few who have either found a similar health care solution too expensive in their country or have found the waiting period dismally long. Patients tend to come for these reasons rather than by choice. Also the Indian story comes unstuck with the current social turmoil. Bomb scares have wreaked havoc in the Indian tourism industry. The already unwell are not wiling to take their chances.

»

Unfortunately the Middle East remains a net exporter of patients rather than a net importer « age of paramedics and attrition of staff all get in the way. Further, the effort required to unravel the logistics of healthcare is humongous. It requires the steady hand of a seasoned player. This is where there is a clear and present need for the Middle East Entrepreneurs to partner with its not so distant brother in arms, India. Several Indian Hospital chains are today JCIA accredited. The Corporate hospitals in India have also made a reputation to be lean operators, keeping operating budgets slim and margins high. This is a lesson the UAE hospitals still have to learn. This need is mutual. Indian hospitals are also looking out for expansion in to the Middle East too. The infrastructure cost and licenses are what keeps them away. This is an obvious area for synergy between the two regions. UAE today has the capability to address the

Then there has been the odd case where a medical tourist has caught a communicable disease while on the subcontinent. Though these cases may be far and few, the fears are not unfounded. The NHS in the UK and some other health care providers have sited the distance involved in traveling to India as hazardous for their patients and hence refused to reimburse medical tourist. Acting as a major hub for several direct Trans Atlantic and European carriers Dubai and Abu Dhabi can escape this incrimination too. From time immemorial the Middle East has been a market at cultural and economic crossroads. The end of the silk route-the sea link to Africa. It has always profited from its unique geo presence. This is yet another industry which is beckoning to be explored by the Middle East entrepreneur. Fair winds are blowing for those few who are ready to lift the anchor. «

H e a l t h c a r e T r a v e l M a g a z i n e | I s s u e O n e 2 0 0 8 | 35


Advertisement Feature | SingHealth

SingHealth

– Singapore’s largest healthcare group

Singapore Health Services (SingHealth) is Singapore’s largest healthcare group with 3 JCIaccredited hospitals – Singapore General Hospital, KK Women’s and Children’s Hospital and Changi Hospital; 5 National Specialty Centres focusing on treatment and care for Cancer, Heart, Eye, Neuroscience and Dental; and a network of primary healthcare clinics.

Comprehensive Multidisciplinary Care With a wide range of 42 clinical specialties and a faculty of 1000 internationally qualified medical specialists, SingHealth institutions offer integrated care in a multidisciplinary setting. Well-equipped with advanced diagnostic and medical treatment technology, SingHealth institutions offer pioneering treatments in a wide range of medical procedures.

Leading Edge Medical Care SingHealth’s flagship hospital, Singapore General Hospital (SGH) is Singapore’s largest acute tertiary hospital and a national referral centre for the specialties of Plastic Surgery and Burns, Haemotology, Renal Medicine, Nuclear Medicine and Pathology. SGH is also home to the world’s first integrated neuroscience centre, the Khoo Teck Puat-NNI Integrated Neuroscience Centre. Offering cutting-edge treatment in the neurosciences, the Centre integrates the latest in healthcare technology to offer timely information and treatments that enable clinicians to perform complicated surgeries in less time and with better patient outcomes. SGH has made its mark with pioneering treatments including the world’s first unrelated cord blood stem cell transplant and first cord blood transplant for Thalassaemia Major patients and the world’s first modified jaw advancement technique for treatment of Obstructive Sleep Apnoea and Asia’s first unicompartmental arthroplasty. Another leading hospital in the SingHealth group is Singapore’s only tertiary hospital specialising in the medical care of women and children. KK Women’s and Children’s Hospital (KKH) is a major referral centre for high risk obstetrics, gynaecological oncology, urogynaecology, neonatology, paediatrics, paediatric bone-marrow transplants and paediatric open-heart surgery. Amongst the series of firsts chalked up by KKH - it was the first hospital in the world to of-

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fer the first FDA-approved phosphor plate computed radiography for mammography combined with computer-aided detection to detect breast cancer. It was also the first in the region to perform MR-guided focused ultrasound ablation for

Singapore National Eye Centre, a designated national centre for ophthalmological services is one of the leading transplant centres in the world offering new advanced LK techniques, stem cell transplants and Osteo-Odonto Kerato-

the treatment of fibroids. Another leading edge SingHealth hospital is the Changi General Hospital, located only 10 minutes from Singapore’s international airport. Offering a full range of medical services, the hospital excels in Sports Orthopaedics, General Surgery, Obstructive Sleep Apnoea and Gastroenterology.

prosthesis (OOKP) surgery, a radical and complex eye operation. It is a world pioneer in conjunctival stem cell transplant, a technique of growing one’s own stem cells to treat conditions such as chemical injuries, severe contact lens overwear and Steven-Johnson’s Syndrome. National Neuroscience Institute is the national specialist centre for treatment of neurological diseases. The centre is well-equipped to provide patients with high quality care in the areas of neurodiagnostics, neurology, neurosurgery and neuroradiology. National Dental Centre Singapore, Singapore’s referral centre for specialist oral healthcare offers comprehensive, integrated care for the full spectrum of, from simple to complex, dental needs.

Pioneering Treatments The 5 national specialty centres of the SingHealth group are tertiary referral centres providing specialised treatment for patients in Singapore and the region. As national referral centres, they lead the way not only with highest level of medical care but also with pioneering treatments. National Cancer Centre Singapore, a national and regional one-stop specialist centre housing Singapore’s largest pool of oncologists, offers the latest therapies including mini transplants and targeted therapies designed to maximise outcomes while minimising undesirable side effects. Outcomes for many treatments, including head and neck cancers and liver cancer are comparable to the best institutions worldwide National Heart Centre Singapore is Singapore’s designated national centre for cardiovascular medicine. It is the first heart centre outside of the USA and in Asia to receive Joint Commission International (JCI) accreditation. It is the largest cardiovascular specialty group in Singapore, treating complex cases requiring specialised care from other hospitals in Singapore and region. Outcomes for treatments, including percutaneous transluminal coronary angioplasty and coronary artery bypass grafting surgery are comparable with international benchmarks.

International Patients SingHealth’s extensive experience and expertise makes it a logical choice for international patients seeking high quality multidisciplinary medical care. Interested parties wishing to collaborate in facilitating International Patient Care at our institutions, please contact jaryll.chan@singhealth. com.sg or ims@singhealth.com.sg «

At the National Cancer Centre Singapore, the latest image-guided technology in radiation oncology enhances cancer treatment.


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