Medical Tourism Blog

There are now a record 47 million Americans without health insurance, while the percentage of children without insurance rose for a second consecutive year, according to newly realeased US Census Bureau data. The comparison:

• The number of people without health insurance coverage rose from 44.8 million (15.3 percent) in 2005 to 47 million (15.8 percent) in 2006.
• The number of uninsured children increased from 8 million (10.9 percent) in 2005 to 8.7 million (11.7 percent) in 2006.

Source : US Census Bureau Press Releases and you can see the detailed census data here. Naturally, the media is all over this data, and you can expect more than a few congressional hearings on this matter. We'll be following this issue closely, and report live on gab fests from Capitol Hill. Expect medical tourism to crop up somewhere in the hearings, and let's see whether they pile on it or embrace it as a way out of the mess. I mean, if they can outsource intelligence gathering, what's healthcare for a few million Americans?

Marketplace talkradio has posted the audio of a story which attests that Americans are breaking the law to go to Cuba for healthcare. Helen Palmer: "Sam" is 63, a self-employed carpenter who can't afford health insurance. He hurt his shoulder and is heading to Havana for surgery to get it fixed.
Sam: Here in the states it would run from $12,000-$20,000. Over there it runs about $4,000 plus my airfare.
Sam will save $6,000 — and get a vacation. Because of the U.S. embargo, he's flying via Canada. He knows he's breaking the law but hopes his government would understand...

I think Michael Moore is about to get piled on for touting Cuba's supposedly impressive healthcare....

Helen Loveless, writing for This is Money, UK, talks about Britons heading to Hungary and other destinations for getting their teeth fixed. Emily Mayer is one of the many British dental tourists to have travelled to Hungary. Having suffered from severe gum disease for several years, Emily, 46, had lost several teeth and many others were loose..... Over the next six months, Emily, an artist from Kenninghall, Norfolk, had all her teeth replaced with implants. The total cost was about £20,000 - about a third of what it would have been in the UK. Emily says, 'I was so conscious of the state of my teeth. Having this treatment has changed my life. Not only did the clinic take really good care of me, but I have also saved a huge amount of money.'

Bloomberg has a business news story which says that Fortis Healthcare is to set up a 950-Bed hospital in India. The hospital will be modeled along the lines of the U.S.- based Cleveland Clinic and Mayo Clinic, Rajen Ghadiok, director of medical operations at Fortis Group. Fortis gets about 8 percent of its revenue from treating foreign patients. "Medical tourism is on everyone's mind,'' Ghadiok said. "The greater advantage is that cost-wise we'll be competitive.''

On Sept. 6th, Dr. David Vequist, University of the Incarnate Word, San Antonio, TX, will present a paper on medical tourism, focused on forecasting future trends from the data. This paper is part of the sixth annual international smart-sourcing conference at the Hilton Resort, Atlantic City, NJ. I got in touch with Dr. Vequist, and asked him to provide an overview of what his paper will be about. He was kind enough to provide a snapshot, with statistics and a brief analysis. Dr. David Vequist in his own words:

---

What I have done is this paper is to report on the state of medical tourism from various news sources and journals from the past several months to summarize the current trends in this industry. I summarized the articles and categorized them in terms of countries being visited and procedures being performed. In addition, I used the data collected to forecast what some of the future trends for medical tourism will be in the near future.

I collected data pulled from the last several months of RSS feeds from Yahoo. I received news feeds, almost daily, from any articles that mentioned Medical Tourism in the content. I then categorized the collected data based on the countries and procedures mentioned in the news articles.

This is what I found and what I think will be happening in the near future.


In the articles I reviewed, I found that SE Asia countries (including India - which was the most frequently mentioned country) made up the most frequently mentioned region for medical tourism (as expected). However, it appears that there are several trends present in the data including, the frequency of Latin American countries being found in news reports regarding medical tourism. Countries like Mexico and Costa Rica are increasing seeming to attract medical tourists particularly for Dental and Cosmetic Surgery. Another trend I found was that Cosmetic Surgery (which used to be the main staple of the medical tourism movement) appears to be taking a back-seat to traditional medical procedures like General Surgeries (e.g., hip replacement surgery) and Heart/Cardiac Care (e.g., angioplasty). In addition, there appears to be a trend of healthcare procedures (e.g, hip replacement, heart procedures, cosmetic surgery, dentures, etc.) being marketed towards the aging baby-boomer populations in the USA (which, when you look at the population demographic trends [in the US ] is not very surprising).

I am recommending that further research be undertaken that uses RSS feeds to validate this research methodology and the findings of this study.

---

Thank you Dr. Vequist, for sharing this valuable information and analysis with us. Stay tuned in the coming week for a post with some stunning statistics regarding medical tourism in Tijuana, Mexico.

Because these news bulletins qualify more for the wierd news section than for medical tourism. First up is Lululemon Athletica, a company which manufactures 'yoga wear', including eco-friendly yoga mats and a lot of other kinds of wear. Seems they're sponsoring 'Yoga on the Hill' sessions in Ottawa, Canada. These sessions have it seems, created a buzz, and people are ready to go to the mat for 'Ottawa on the Hill' yoga sessions and a spot of tourism. Let's just call it Yoga tourism. Lululemon being a company with dozens of offices in North America and Canada, a $200 million IPO, and an inhouse stretch fabric formula called Luon, I sent an email to their spokesperson, asking for a few clarifications, including how the company came to be named 'lululemon' and asking if they have any advice regarding clothing wear for medical tourists. No reply as yet.

Also, some nail biting news from the Netherlands with Alain-Raymond van Abbe, Director of the Institute for Pathological Onychophagy claiming to have a treatment for curing nail biters.
"So many have applied — there are about 2 million Dutch people who admit to being biters, about 6 million in Britain — that he is booked up until December. Until recently sufferers were subjected to foul-tasting creams, hypnosis or acupuncture. Dr van Abbe's patented device — the Preventor — comes with a bit of psychobabble but relies mostly on the simple but effective method of not allowing gnashers to come into contact with nails."

And this takes the cake. "The run back lasted 10 minutes before the guide screamed "stop". All three stopped. An elephant appeared in the bush in front of them. It was trumpeting loudly. The guide then screamed "run". He gave no indication in which direction the parties should run. The plaintiff ran. She remembers falling down. She was unable to outrun the elephant. She went under a bush. The elephant caught up with her..."
If you're on an African safari, come face to face with an angry elephant, and your tour guide screams 'run', you better be able to outrun the tour guide.

Lastly ( this is not nutty news ), the AOS insurance company in Barbados is offering malpractice insurance cover for the medical tourism industry. "New insurance coverage is now available to protect individuals should medical malpractice occur while seeking healthcare services in a foreign country.....AOS has also developed a group version of the PMMI product called GMMI (Group Medical Malpractice Insurance) to be used in the growing group insurance market. This product will provide a much needed level of security that before now was missing for the medical tourist."

I checked out their website. I sent them an email. No reply. For the record, I didn't find the website too impressive, and something about the whole setup seems a bit out-of-tune for an insurance company. According to their online premium calculator, if you opt for a dental implant ( anywhere/worldwide ), and you purchase PMMI cover worth $100,000 from AOS Insurance, it costs you $45. Doesn't seem too much of a risk to invest $45 into insurance cover. Still, can't say I know much, or anything, about them, so please use your own common sense.

Update 1 : A few news links came up, which I thought were print worthy, but not enough to merit a new post. First up, Phil Galewitz, writing for the Palm Beach Post, writes about people going abroad for elective surgery. "In Costa Rica, a nose job costs $1,600 compared to $3 ,000 in the U.S.. A face-lift costs $2,100 in Costa Rica, compared to $4,000 in the U.S."
On balance, the article is fairly interesting, until one reaches down to the comment section, where an anonymous lawyer lets rip against Galewitz. "A nose job costs $3000 in the States??? Who did you do your research with - a vet??? I cannot believe the irresponsibility of this little vignette....Your headline should be “Want to tempt fate, go to a 2d or 3d world country to get your surgery on the cheap!...1st, Costa Rica is “not overseas” - it is just south of the US border IN CENTRAL AMERICA. 2d, have you ever been to Costa Rica - I have and I need to tell you that the standards of hygeine at these “surgical retreats” aimed at the naive surgical tourist trade (predominately from the US) is SUBPAR at best (as are the credentials of the majority of medical staff you’ll find at these centers)."

Press TV reveals where the royals from the middle east travel to for medical treatment. "Kuwait's Emir Sheikh Sabah has had a surgery in the US, as more Arab officials and leaders are undergoing various surgeries abroad."

Marianne Mattera of Medpage Today publishes a survey of 456 American physicians, who say they would wish patients a "bon voyage" if they want to travel overseas for expensive surgery or treatment not available in the U.S.

Update 2 : Oxford business Group publishes an interview with Dr Ahmed Mubarak Al-Marques, Chairman, General Authority for Health Services (GAHS) of Abu Dhabi. "According to a statement issued by Sheikh Rahmatulah, a representative for the Middle East Tourism Authority, approximately 62,000 UAE nationals alone sought medical treatment in Thai hospitals in the first seven months of 2006, resulting in a large loss of revenue for local hospitals."

Couple of weeks back, we interviewed Brian Gooch, JCI consultant, who explained how he helps international hospitals plan and prepare for JCI accreditation. Today, we bring you Karen H. Timmons, president and chief executive officer of Joint Commission Resources, Inc. (JCR) and Joint Commission International (JCI).

Under her leadership, JCI is developing an international collaborative network to improve patient safety. Ms. Timmons is also the primary liaison with the World Health Organization (WHO) and is a past board member and Treasurer for the International Society of Quality Assurance (ISQua).

---

Question : ISO also concentrates on organization-related standards. How does JCI add to that, specifically in terms of standards related to patients, and their safety?
Karen Timmons : We believe that JCI’s combination of patient- and organization-centered standards helps assure that all aspects of a patient’s journey through a health care organization are as safe and of favorable quality as possible. JCI’s standards also account for proper education, not only of caregivers, but of the patients they treat and the too-often-forgotten patients’ families. Accreditation is a risk-reduction activity. By compliance with standards, organizations are in fact performing to “evidence-based” practices and have a greater likelihood of good outcomes, with less risk to patients.

Patient-focused standards are included in seven chapters of our current hospital standards manual: “Access to Care and Continuity of Care”; “Patient and Family Rights”; “Assessment of Patients”; “Care of Patients”; “Anesthesia and Surgical Care”; “Medication Management and Use”; and “Patient and Family Education”. Health Care Organization Management Standards are covered in six chapters: “Quality Improvement and Patient Safety”; “Prevention and Control of Infections”; “Governance, Leadership, and Direction”; “Facility Management and Safety”; “Staff Qualifications and Education”; and “Management of Communication and Information”.

Question : JCI is a subsidiary of the Joint Commission, which accredits U.S. Hospitals. What are the differences in the standards for U.S. hospitals and those outside? Is the bar set lower, or do you need to take into consideration other factors?
Karen Timmons : With the release of the 3rd edition of the JCI Hospital Standards in July 2007 (effective 1 January 2008), our most comprehensive and stringent to date, JCI’s standards are different from, but comparable to, Joint Commission standards. Our standards account for countries’ and regions’ specific legal, religious, and cultural factors, whereas The Joint Commission’s standards reference United States federal requirements (such as the National Fire Protection Association’s and others). We consider JCI’s standards to be optimal, achievable criteria for organizations dedicated to improving the quality of patient care, ensuring a safe environment, and continually working to reduce risks to patients and staff.

Question : JCI accreditation is purely voluntary and there are currently approximately 130 hospitals which are JCI accredited. Do you think that this is limiting the impact that you are having on improving standards of hospitals worldwide? Do you think hospitals which cater to international patients need a little prodding to get themselves accredited?
Karen Timmons : JCI’s accreditation process is indeed voluntary. We launched JCI’s international accreditation program in 1999 in response to the increasing global demand for valid external evaluation of health care quality and safety.

To date, more than 130 organizations have achieved JCI accreditation and the numbers are growing at a rate that exceeds our forecasts. JCI standards are viewed as the international health care standards and their impact is significant and lasting.

Additionally, JCI has working public-private partnerships with a number of Ministries of Health and other governmental and non-governmental agencies across the globe in which JCI standards are serving as the foundation for national accreditation programs. The most recent example of this type of arrangement is our agreement with the People’s Republic of China’s Ministry of Health, in which JCI is assisting the Ministry in improving the safety and quality of patient care through a series of initiatives in Chinese hospitals, clinics, laboratories, and other health care settings. JCI is helping create strategies to further strengthen qualifications and training of hospital staff, as well as collaborating with medical facilities, research institutes, and non-governmental organizations to establish standards-based guidelines for blood safety, medication management and information management.

Question : I understand you review accreditations once in three years. What happens if a hospital adds a new specialty in between, with new staff and new equipment? Do you have agreements in place to make it necessary for the hospitals to either stick to the standards, or request an emergency review of the new facilities?
Karen Timmons : We require that organizations notify us in writing within 30 days of any significant changes to their organization or facility during the course of their 3-year accredited status. If and when that happens, JCI schedules what we call an “extension survey”—a survey that makes certain that this new “extension” of an organization’s service meets JCI standards.

Question : I take it that JCI accreditation involves implementing changes in the way that the hospitals and their staff treat and manage patients, in addition to infrastructural requirements. Do you provide them with any help for that, or just explain the requirements?
Karen Timmons : When an organization approaches JCI about accreditation, they are given the following:
a) One of our brochures, describing JCI accreditation process
b) A list of for-purchase publications and education conferences, including the JCI accreditation manuals and other accreditation- or patient safety–related publications, audio conferences, etc.
c) Web links, including a link to the most recent JCI standards applicable to their organization
If an organization requests more technical assistance, we provide it by giving the organization a phone number to contact the international consulting division of Joint Commission Resources. We do that because of our self-imposed “firewall” between JCI’s accreditation and consulting; accreditation cannot and will not know which organizations seek or use JCI consultants and JCI consultants do no know an organization’s accreditation status prior to a public announcement is made. That division works completely independently of JCI’s accreditation operations; neither organization is aware of the other’s clientele (until an organization is publicly acknowledged as accredited). Although consultants may assist an organization with preparing for JCI accreditation, consultation in itself is by no means a required or even recommended step in the accreditation process.

Question : What information about an accredited hospital can a prospective patient expect to get from JCI? You must be collecting a lot of data from each hospital on a regular basis. So if someone contacts JCI regarding a particular hospital, what would you be saying to them?
Karen Timmons : We envision a time when JCI will provide an international service similar to The Joint Commission’s Quality Check Web portal (http://www.qualitycheck.org/), a wide-ranging guide to the 15,000 Joint Commission-accredited health care organizations and programs in the United States. As JCI continues to grow, we see that sort of quality-monitoring service as a patient-centric priority. Today, though, we are able to tell prospective patients who contact JCI whether or not a health care organization is accredited or not.
Question : Are you seeing an improvement recently in the numbers of hospitals applying for JCI accreditation? If so, why?
Karen Timmons : As I described earlier, we have seen an upswing in interest in JCI accreditation, and we believe that the surge in interest is an indication that our message is being heard by a larger audience. Eight years into its existence, JCI is becoming more widely known around the world as an accreditor of choice. We believe our patient-centric focus is a big part of the growing acceptance of JCI everywhere, in addition to the growing consensus across borders that there is a business case for patient safety. More and more, patients are taking control over their searches for quality health care, and the stamp of approval that JCI accreditation provides is becoming a “gold standard” for knowledgeable patients and care givers alike.

Question : Does JCI get involved in partnerships or collaborations? Do you have any programs other than accreditation which deal with improving health care and patient safety?
Karen Timmons : JCI has several patient-safety collaborations separate from its accreditation activities, including the following:

WHO Collaborating Centre for Patient Safety. Since its launch in August 2005, the World Health Organization (WHO) Collaborating Centre for Patient Safety has been building an international network to identify, evaluate, adapt and disseminate patient safety solutions worldwide. A WHO collaborating centre is “a national institution designated by the Director-General of the World Health Organization to form part of an international collaborative network carrying out activities in support of WHO's mandate for international health work and its programme priorities.”3 This specific Collaborating Centre, a cooperative endeavor of WHO, JCI, and The Joint Commission, is operationalized by The Joint Commission International Center for Patient Safety (see below) through the establishment of a collaborative network of leaders in developing, transitional, and developed countries, who are helping to identify health care safety needs and match these with known best practices and solutions. Specific projects of the Collaborating Centre include the following:

Patient Safety Solutions. Announced in May 2007, the basic purpose of the Patient Safety Solutions is to guide the redesign of care processes to prevent inevitable human errors from actually reaching patients. The Solutions include any system design or intervention that has demonstrated the ability to prevent or mitigate patient harm stemming from health care processes. Solutions disseminated by the Collaborating Centre are evidence-based, presented in a standard format, and will be updated at regular intervals. The inaugural Patient Safety Solutions address the following issues:
· Look-alike, sound-alike medication names
· Correct patient identification
· Hand-over communications
· Correct procedure at the correct body site
· Control of concentrated electrolyte solutions
· Medication accuracy
· Catheter and tubing misconnections
· Needle reuse and injection device safety
· Hand hygiene

Additional solutions for 2008 release are currently under development.

High 5s. Drawn from a broader set of patient safety solutions, the overall goal of the initiative is to achieve significant, sustained, and measurable reduction or elimination of five highly prevalent patient safety problems in selected hospitals in each country over a five-year period (hence “High 5s”). The High 5s build on the partnership established by the Commonwealth Fund with Australia, Canada, New Zealand, the United Kingdom, and the United States, and the more recent expansion of this international program to include Germany and the Netherlands. These solutions are the following:
· Prevention of patient care hand-over errors
· Prevention of wrong-site, wrong-procedure, wrong-person surgical errors
· Prevention of continuity of medication errors
· Prevention of high concentration drug errors
· Promotion of effective hand hygiene practices

In March 2005, The Joint Commission and JCR announced the establishment of the Joint Commission International Center for Patient Safety, a virtual organization which leverages the expertise, resources, and knowledge of the Joint Commission and JCR toward its mission of continuously improving patient safety in all health care settings. The Center does the following:
. Collaborates with other leading patient safety organizations around the globe to achieve its goals, including the identification, development and sharing of patient safety solutions
. Serves as a credible source of valid and meaningful information and education about patient safety
. Engages patients, families, practitioners, and providers in improving patient safety
. Advocates for public policy that promotes patient safety
. Conducts research related to patient safety

Q & A with Dr. Jason CH Yap, Director, Healthcare Services, Singapore Tourism Board. Dr. Yap is a public health physician with nearly two decades in healthcare services and currently part of the SingaporeMedicine multi-agency initiative to promote and streamline services offered by Singapore's healthcare providers to international medical travelers.

Dr. Yap is highly suited to be the public face of Singapore's medical tourism not only because of his background which includes stints as the IT Director for the National Healthcare Group and before that with Singapore's Ministry of Health, but also because he sees himself as a product of Singapore's medical travel facilities, considering that his mother traveled from Malaysia to Singapore specifically for his birth.

---

Question: Dr. Yap, you are the Director of Healthcare Services with the Singapore Tourism Board. I hope that is correct. So are your duties, and those of your office, tilted more towards healthcare or tourism? Or are you specifically handling medical tourism?
Dr. Yap: Yes, the designation is correct.

First and foremost, STB’s focus goes beyond mere “medical tourism”. We prefer to call it Medical Travel. While many do go on “medical holidays” where healthcare offerings are combined with leisure activities, a great many others travel solely for healthcare. Therefore, what STB takes care of are medical travelers.

Unlike our major competitors, Singapore has an unusual reason for being in the medical travel industry. While the revenue from international patients is naturally welcome in a country that has had to rely on international trade for its national survival, the reality is that Singapore would make more money investing its resources in other directions. However, the national imperative to make and maintain Singapore as an international medical hub arises from the need to look after its own citizens and residents.

Through the decades of strong economic growth, Singapore has invested in its own healthcare system and created one of the best healthcare systems in the world. Singapore sent its doctors overseas to train in the best international centers. These doctors eventually return to upgrade and improve local healthcare services to be on par with where they had trained. All the major healthcare networks are JCI-accredited and Singapore accounts for some one-third of all JCI-accredited healthcare facilities in Asia.

However, with a small population of only 4.5 million residents, Singapore finds it increasingly difficult to sustain the many subspecialties, to maintain the many high-end services and to afford the technology. Thus, the effort to draw international patients is to maintain a critical mass of patients. Ironically, and unlike other countries, Singapore seeks foreign patients in order to serve local patients.

The Singapore Tourism Board (STB) plays an instrumental role to develop and maintain Singapore as a medical hub, not only for international patients, but for medical conferences and training, healthcare consultancy, regional and international headquarters of healthcare organisations, manufacturing of pharmaceuticals and medical devices, etc. STB’s main role is in international marketing and the development of people-oriented services for medical travelers.

Question: What advantages does Singapore hold, for a medical tourist, as compared to countries like Thailand or India?
Dr. Yap: There are several reasons why medical travelers choose Singapore as their choice healthcare destination.

The first and foremost reason is simply that, it is Singapore. Singapore is known for its excellence, efficiency and effectiveness. Having the best international airport, the best airline, and the busiest port in the world, these accolades are evidence of Singapore’s world-class standards and achievements.

The clinical services in Singapore emphasize excellence, safety and trustworthiness, with internationally accredited facilities and renowned physicians trained in the best centers in the world. In 2000, the World Health Organization ranked Singapore’s healthcare system as the sixth best in the world and the best in Asia, and Singapore accounts for one-third of all JCI-accredited facilities in Asia. Beyond international certifications, the quality of healthcare is also seen in published clinical indicators. Many healthcare institutions in Singapore publish their success rates on their corporate websites, and these rates are comparable to, if not exceeding, international standards.

Singapore is a true multi-faceted regional medical hub, not only for patients’ services but also as a meeting place for medical professionals for conferences and training, as a base for healthcare consultancy and operations management, and as the centre for research and clinical trials.

Cost is an important consideration for many international patients. For instance, an angioplasty costs approximately US$57,000-83,000 for an uninsured patient in the United States, whereas in Singapore, it costs only US$13,000, similar to the costs at other major Asian medical travel destinations. So even after factoring in travel and accommodation expenses of the patient and their accompanying persons, the cost savings are still considerable. On top of the affordability, patients in Singapore are assured of world-class treatment and high clinical outcomes.

Finally, Singapore is an international city which welcomes people of all cultures. The Singapore Changi International Airport is connected to some 180 cities in the world, making it highly accessible. Transport and accessibility within the country is equally easy and convenient. English is the first language of education and business. The people in Singapore enjoy high security and low crime. As Singapore is a multi-racial and multi-culturally accommodating city, patients of all race and creed will not find it difficult to meet people in Singapore who speak their language or share their religion.

Ultimately, the medical traveler seeks peace of mind. They do not want to go where there are uncertainties about the quality of care or the safety of the blood, rumors of wars and bombs, government or social unrest, natural disasters, or any concerns about safety for themselves and their families. Singapore is one destination where medical travelers will have no such fears, where they can enjoy peace of mind when their health really matters.

Question: Approximately how many international patients does Singapore receive annually, from which parts of the world, and what are the most sought after treatments by these patients? How much growth is Singapore expecting in this area in the next year and beyond?
Dr. Yap: Based on exit surveys conducted of international patients, out of the nearly 10 million visitors to Singapore in 2006, approximately 410,000 or four percent travelled specifically for healthcare. These patients did not come alone. Approximately 89,000 persons accompanied them on their visits. Another 56,000 received healthcare incidentally when on visits for other purposes. In total, some 555,000 international visitors to Singapore in 2006 were involved in some aspect of medical travel.

The majority of our medical travelers come from the established markets of Indonesia, Malaysia and Brunei, but the list of countries that patients now come from have gone up tremendously in the past half-decade. Singapore continues to be a favored destination for our established markets. Readers Digest in a 25,000-reader survey found that their readers ranked Singapore only after USA as most favored healthcare destination, even ahead of Europe. Consider how the number of healthcare visitors grew from 320,000 in 2004 to 410,000 in 2006, a 28% increase. Some of that increase is accounted by gradual increases in numbers from the relatively stable, established markets, but the remainder is from the rapidly growing markets in ASEAN, the Middle East, South Asia, Russia, etc.

Singapore offers a wide spectrum of healthcare services ranging from health screening and cosmetic surgery to complex specialty care such as ophthalmology, orthopedic surgery, cardiology, cardiothoracic surgery, obstetrics and gynecology, neurology, neurosurgery and oncology amongst others.

Categorically, international patients come to Singapore for four main types of healthcare. They come for essential healthcare where the care is not available in their own country, affordable healthcare where the care is available but not affordable, quality healthcare where the care available locally is or is perceived to be of inferior quality, and premium healthcare where traveling for healthcare is seen as a luxury and adds prestige to the traveling person.

The most significant reason for patients coming to Singapore from the surrounding regions such as Indonesia, Malaysia, IndoChina and India, is for quality healthcare. Many also come for essential healthcare, in particular, complex heart, brain, lung, liver and orthopedic surgeries, organ transplantations, as well as cancer care where their home countries just do not have a similarly high level of medical sophistication, whereas patients from the United Kingdom come to Singapore to avoid long waiting times for surgeries like hip replacements.

For visitors from the United States who usually come to Singapore for orthopedic surgeries and cardiology, the biggest motivation is the cost savings for high quality healthcare, as patients can receive US-standard health care from JCI-accredited healthcare facilities and internationally known doctors at a fifth of the price back home or less.

In total, some 555,000 international visitors to Singapore in 2006 were involved in some aspect of medical travel. Thus, medical travel is a very big market. Singapore hopes to attract at least 1 million medical travelers to Singapore every year starting from 2012.

Question: The Singapore Government seems to be much more involved in promoting medical tourism and getting the various agencies to coordinate in order to provide a better experience for visiting patients. Is this a conscious effort, or is it just the way you do things?
Dr. Yap: While many other countries and regions announce their plans to “go into medical tourism”, Singapore has been quietly doing it all along. The “Whole of Government” approach to supporting Singapore’s international medical travel industry is evident in the SingaporeMedicine initiative.
SingaporeMedicine is a multi-agency government-industry partnership to develop and maintain Singapore as a medical hub and international patient destination. It is led by the Ministry of Health, and supported by three government agencies: the Economic Development Board which develops industry capabilities, the International Enterprise Singapore which fosters regionalization by Singapore’s local health care players, and the Singapore Tourism Board which manages international marketing and associated people-oriented services.
The government agencies work with the local and international healthcare and medical travel industries to ensure that patients are well taken care of. Where there are issues affecting other government agencies (e.g. visas), there is a government-wide consensus and effort to balance the different needs to achieve the best solutions.
Most important of all, as mentioned in Q1, the main motivation behind the government supporting medical travel is that Singapore needs to have patient volumes to maintain the clinical subspecialty expertise, and to gain economies of scale for its technology.
So yes, it is a conscious effort by the government to ultimately provide and sustain the level of clinical expertise and medical care that Singaporeans have since become used to.

Question: We recently interviewed Dr. Milica Bookman, who is doing research on the effect of medical tourism on developing countries. Not to say that Singapore is a developing country, but is medical tourism having any effect on healthcare you offer to your own citizens? If so, could you elaborate on that?
Dr. Yap: As emphasized in Q1, Singapore needs foreign patients in order to serve its own patients.

Question: Please tell us a bit more about Singaporemedicine (Singaporemedicine.com), its mission and activities.
Dr. Yap: Activities undertaken by SingaporeMedicine partners include: Media familiarization trips for international journalists

Participation in healthcare conferences and tradeshows in key and emerging overseas markets such as Indonesia, Malaysia, India, Bangladesh, the Middle East, Russia, and more recently, the United States.

Intensified market development, business development and product development programmes by the Singapore healthcare providers through the support of SingaporeMedicine.

SingaporeMedicine is also working closely with medical institutions to improve international patient support through the provision of international patient liaison services, translation and interpretation services as well as foreign language signages to meet the diverse needs of foreign patients.

Question: We're seeing some employers and insurers showing interest in medical tourism in the U.S. What do you think about medical tourism as an industry? What's the potential? What changes do you see in the near future?
Dr. Yap: The Medical Tourism market is currently valued at US$20 billion annually. Some of these dollars is perhaps hype but the market is obviously significant whatever the actual numbers. These numbers are expected to double by 2010.

The world has flattened for many industries like manufacturing and software engineering, where many companies have gone to China and India respectively. We expect to see the flattening of the world (as in Thomas Friedman’s book) finally reach the healthcare world. Today people in many countries and regions find that the healthcare in their own locality is not accessible, affordable, adequate or acceptable. With the relative ease and low costs of travel today, patients will travel in search of better healthcare.

The medical travel industry has grown in several waves. Initially, there was the local/proximate movements of people to nearby countries for better healthcare, for example, Singapore has been serving the peoples of Indonesia, Malaysia, Brunei and the rest of the ASEAN region long before the term “medical tourism” was ever coined. The people started moving farther afield when they found that they, as consumers, had the ability to choose, which was when individual, often uninsured, Americans started looking to Asia for lower cost healthcare.

The next wave is waiting, when corporate entities realise that, just they can source worldwide for manpower and means of production, they can also start looking overseas for healthcare for their manpower. When corporations, for example in the US and the developed world, started sending their staff around the world for the best and the most affordable healthcare, then truly the world would be flat indeed.

Question: The main worry about medical tourism is that there's no legal recourse in case things go wrong when you opt for surgery abroad. There is realistically very little chance of a successful and timely malpractice suit in most countries promoting medical tourism. What is the status of Singapore, in this regard?
Dr. Yap: Patients travelling for healthcare should by and large be seeking reliable and safe healthcare, and legal proceedings should ideally be a low probability event. Given the excellent clinical outcomes and assured quality of healthcare in Singapore, the chances of patients having to seek legal recourse are significantly lower as compared to other healthcare destinations. However, medicine being what it is, it is not possible to rule out completely the possibility of mishaps and other untoward events. Legal suits related to healthcare services delivered in Singapore would generally be contested in Singaporean law courts. The legal system in Singapore is well known for its impartiality and reliability. In 2004, the Political and Economic Risks Consultancy (PERC) rated Singapore's judicial system as the best in Asia, ahead of Hong Kong and Japan. It also ranked Singapore as the top in consistency of application of laws. In addition, Singapore's legal system has been praised by the International Monetary Fund and the Economic Intelligence Unit. Therefore, the medical traveler can be assured of fairness in the rare event that legal action is appropriate.

---

That was Dr. Jason Yap, Director, Healthcare Services, STB. The main advantage Singapore has is that things work efficiently, and on time. A medical tourist in Singapore gets the same, if not better, level of care, at a fraction of the price, has legal recourse which is fair and quick, and best of all, you have the option of recuperating with a great post surgical vacation in Singapore. And an indicator of their efficiency is the fact that the SingaporeMedicine website can be accessed in five languages - English, Chinese, Arabic, Indonesian and Vietnamese. That shows how consumer friendly they are, and how far they are willing to go to attract and satisfy medical tourists. Stay tuned for more interviews.

Neil Osterweil, Senior Associate Editor for Medpage today, takes an in-depth look at the scope o medical tourism, experimental medical procedures, organ transplants, risks involved in having surgery abroad, and his article also features extensive comments from Maggi Grace ( see interview ), whom he calls 'the enthusiast'. I prefer firebrand, but let's not quibble over words.



Also, AZCentral profiles Americans who are trying to immigrate to Mexico?? Yes, that's right!