Medical tourism : special insights with emphasis on

the Gulf region

Prof. Tawfik A. M. KhojaMBBS, DPHC, FRCGP, FFPH,FRCP (UK)

Director General - GCC

International Medical Tourism CongressAmman – Jordan, 12-13 Shaban 1436H / 30 – 31 May, 2015

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The medical Tourism Industry

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Medical tourism is becoming increasingly popular.

Medical tourism presents important concerns and challenges as well as potential opportunities.

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There is a compelling need for all parties involved in healthcare to become familiar with medical tourism and to understand the economic, social, political, and medical forces that are driving and shaping this phenomenon.

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The medical tourism marketplace consists of a growing number of countries competing for patients by offering a wide variety of medical, surgical, and dental services.

Medical Tourism Destinations

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Medical Tourism Destinations

Asia / Middle East

The Americas Europe Africa Other

China Argentina Belgium South Africa Australia

India Brazil Czech Republic Tunisia Barbados

Jordan Canada Germany Cuba

Colombia Hungary Jamaica

Malaysia Costa Rica Hungary

Singapore Ecuador Latvia

South Korea Mexico Lithuania

Philippines United States Poland

Taiwan Portugal

Turkey Romania

United Arab Emirates

Russia

spain

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Medical tourists are presently traveling to faraway countries for cosmetic surgery, dental procedures, bariatric surgery, assisted reproductive technology, ophthalmologic care, orthopaedic surgery, cardiac surgery, organ and cellular transplantation, gender reassignment procedures, & even executive health evaluations.

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Several highly developed nations including Belgium, Canada, Germany, and Italy are attracting foreign patients under the banner of medical tourism, offering sophisticated modern care with careful attention to patient preference, service, and satisfaction.

For patients from countries where a governmental healthcare system controls access to services, the major reason to choose offshore medical care is to circumvent delays associated with long waiting lists.

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National health programs do not typically pay for cosmetic surgery and similar type services; therefore, patients from Canada and the United Kingdom desiring these procedures pursue medical tourism for the same economic reasons as those from the United States.

Patients also travel to offshore medical destinations to have procedures that are not widely available in their own countries.

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Some patients, particularly those undergoing plastic surgery, sex change procedures, and drug rehabilitation, choose to go to medical tourism destinations because they are more confident that their privacy and confidentiality will be protected in a faraway setting.

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The insurance industry has become an active participant in medical tourism. In the USA, Blue Cross Blue Shield sells insurance policies that enable or encourage patients to have expensive surgical procedures at low-cost offshore medical facilities.

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The informed patients shop outside the organized medical system to find services that are affordable, timely, or simply available.

Physicians and hospitals in medical tourism destinations recognize that they must provide high-quality careto develop a sustainable competitive advantage inthe international marketplace.

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Medical tourism carries some risks that locally-provided medical care does not.

Exposure to diseases without having built up natural immunity can be a hazard for weakened individuals, specifically with respect to gastrointestinal diseases (e.g. Hepatitis A, amoebic dysentery, paratyphoid) which could weaken progress and expose the patient to mosquito-transmitted diseases, influenza, and tuberculosis.

Risks

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The quality of post-operative care can also vary dramatically, depending on the hospital and country, and may be different from US or European standards. Also, traveling long distances soon after surgery can increase the risk of complications.

Long flights and decreased mobility associated with window seats can predispose one towards developing deep vein thrombosis and potentially a pulmonary embolism.

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Also, health facilities treating medical tourists may lack an adequate complaints policy to deal appropriately and fairly with complaints made by dissatisfied patients.

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Differences in healthcare provider standards around the world have been recognised by the World Health Organization, and in 2004 it launched the World Alliance for Patient Safety. This body assists hospitals and government around the world in setting patient safety policy and practices that can become particularly relevant when providing medical tourism services.

If there are complications, the patient may need to stay in the foreign country for longer than planned or if they have returned home, will not have easy access for follow up care.

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Receiving medical care abroad may subject medical tourists to unfamiliar legal issues.

The limited nature of litigation in various countries is one reason for the lower cost of care overseas.

While some countries currently presenting themselves as attractive medical tourism destinations provide some form of legal remedies for medical malpractice, these legal avenues may be unappealing to the medical tourist.

Should problems arise, patients might not be covered by adequate personal insurance or might be unable to seek compensation via malpractice lawsuits.

Legal issues

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There can be major ethical issues around medical tourism. For example, the illegal purchase of organs and tissues for transplantation had been methodically documented and studied in countries such as India, China, Colombia and the Philippines. The Declaration of Istanbul distinguishes between ethically problematic "transplant tourism" and "travel for transplantation".

Ethical issues

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Medical tourism centered on new technologies, such as stem cell treatments, is often criticized on grounds of fraud, blatant lack of scientific rationale and patient safety. However, when pioneering advanced technologies, such as providing 'unproven' therapies to patients outside of regular clinical trials, it is often challenging to differentiate between acceptable medical innovation and unacceptable patient exploitation.

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Africa and the Middle EastJordan

Jordan through their Private Hospitals Association, managed to attract 250,000 international patients accompanied by more than 500,000 companions in 2012, with a total revenues exceeding 1B US$. Jordan won the Medical Destination of the year award in 2014 in the IMTJ Medical Travel Awards.

Destinations

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AmericasBrazil

In Brazil, Albert Einstein Hospital in São Paulo was the first JCI-accredited facility outside of the US, and more than a dozen Brazilian medical facilities have since been similarly accredited. B

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Canada

Canada has entered the medical tourism field.

In comparison to US health costs, medical tourism patients can save 30 to 60 percent onhealth costs in Canada.

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Mexico

US doctors point out that the Mexican legal system makes it almost impossible to sue Mexican doctors for malpractice.

Some clinics may also offer alternative medicine therapies that have been proven ineffective or are banned in the United States.

The Mexican government hasshut down some of thesein recent times.

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United States

A McKinsey and Co. report from 2008 found that between 60,000 to 85,000 medical tourists were traveling to the United States for the purpose of receiving in-patient medical care.

The same McKinsey study estimated that 750,000 American medical tourists traveled from the United States to othercountries in 2007(up from 500,000 in 2006).

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Hong Kong

All 12 of Hong Kong's private hospitals have been surveyed and accredited by the UK's Trent Accreditation Scheme since early 2001.

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India

Medical tourism is a growing sector in India. India’s medical tourism sector is expected to experience an annual growth rate of 30%, making it a $2 billion industry by 2015.

An estimated 150,000 of these travel to India for low-priced healthcare procedures every year.

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Singapore

Singapore has a dozen hospitals and health centers with JCI accreditation.

In 1997 (published 2000), the World Health Organization ranked Singapore's health care system sixth best in the world and the highest ranked system in Asia.

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Thailand

Thailand has 37 JCI-accredited hospitals.

The Ministry of Public Health plays an important role in developing healthcare to promote scientific based education.

The Thai government has placed a more important role in public health programs for its citizens.

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France

British NHS patients have been offered treatment in France to reduce waiting lists for hip, knee and cataract surgery since 2002. France is a popular tourist destination but also ranked the world's leading health care system.

The French National Authority for Health (HAS) issues high-level quality requirements for French health care, with which clinics and hospitals must comply in order to be accredited.

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Germany

Costs for medical treatment in Germany are commonly 50% of those in the USA.

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Price is not the only determining factor when it comes to choosing a destination. Networks, history and relationships may also explain a great deal about the success of particular destinations.

The destinations of medical tourists are typically based on geo-political factors.

Medical tourists from the Middle East typically go to Germany and the UK due to existing ties, while Hungary attracts medical tourists from Western Europe owing to its proximity.  

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 Dubai – UAE  Dubai is preparing to roll out medical tourism packages covering procedures from spots medicine to cosmetics surgery.

Despite rapidly rising room rates across the emirate, analytical believe the city’s health offering will draw medical tourists from around the world.

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The Dubai Health Authority (DHA) will seek applications which would hospitals in the emirate to participate in medical tourism packages recreational activities for accompanying family members.

Medical tourism, which relies on affordable quality treatment, is also dependent on ancillary services such as hotels and recreational infrastructure.

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While Dubai is becoming more expensive for hotel guests, it is perceived as having an edge over other medical tourism destinations such as Lebanon, known as a cosmetic surgery hub. Bangkok or New Delhi, in terms of security, shopping and leisure activities.

“Dubai is counting on its brand and its additional attractions plus the relatively shorter commuting times from its core target markets”.

Dubai still appears competitive when compared with more traditional medical tourism destinations such as Switzerland, Germany and the UK.

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Still, the number of medical tourists to Dubai has been rising despite the city becoming a more expensive option.

In 2012, an estimated 107,500 medical tourists came for treatment at Dubai’s 23 hospitals, five day surgery facilities and 1,181 clinics.

The figure is growing at a compound annual growth rate of 15 per cent, said DHA in February.

The top source markets include Russia, Qatar, Kuwait, Saudi Arabia, the UK, India and Pakistan.

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Dubai is initially targeting wellness and preventive care treatment, including orthopaedic and sports medicine, plastic surgery, ophthalmology, dental procedures and full-body check-ups.

“Dubai in general is attuned to providing therapies in beauty and often quick-fix health issues such as gastric banding and liposuction,

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The making of a world-class healthcare destination is complex.

We consider a variety of factors, including:

Government and private sector investment in healthcare infrastructure.

Demonstrable commitment to international accreditation, quality assurance, and transparency of outcomes.

International patient flow. Potential for cost savings on medical

procedures.

Why these destinations?

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Political transparency and social stability. Excellent tourism infrastructure. Sustained reputation for clinical excellence. History of healthcare innovation and

achievement. Successful adoption of best practices and

state-of-the-art medical technology. Availability of internationally-trained,

experienced medical staff.

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Cosmetic surgery Dentistry (general, restorative, cosmetic) Cardiovascular (angioplasty, CABG,

transplants) Orthopedics (joint and spine; sports

medicine) Cancer (often high-acuity or last resort) Reproductive (fertility, IVF, women's health) Weight loss (LAP-BAND, gastric bypass) Scans, tests, health screenings and second

opinions.

What are the top specialties for medical travelers?

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Finding the answer to this question can be challenging, as estimates and forecasts vary widely among world's the top research firms.

Patients Beyond Borders' editors define a medical traveler : as anyone who travels across international borders for the purpose of receiving medical care.

How big is the market?

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We believe the market size is USD 38.5 - 55 billion, based on approximately eleven million cross-border patients worldwide spending an average of USD 3,500-5,000 per visit, including all medically-related costs, cross-border and local transport, inpatient stay and accommodations. We estimate some 1,200,000 Americans will travel outside the US for medical care this year (2014).

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Yes…The world population is aging and becoming more affluent at rates that surpass the availability of quality healthcare resources.

In addition, out-of-pocket medical costs of critical and elective procedures continue to rise, while nations offering universal care are faced with ever-increasing resource burdens.

Patients are forcing to pursue cross-border healthcare options either to save money or to avoid long waits for treatment.

We estimate the worldwide medical tourism market is growing at a rate of 15-25%, with rates highest in North, Southeast and South Asia.

Is the market growing?

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Using US costs across a variety of specialties and procedures as a benchmark, average range of savings for the most-traveled destinations:

Brazil: 20-30% Costa Rica: 45-65% India: 65-90% Malaysia: 65-80% Mexico: 40-65% Singapore: 25-40% South Korea: 30-45% Taiwan: 40-55% Thailand: 50-75% Turkey: 50-65%

How much can be saved?

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Countries & numbers of hospitals with Joint Commission International accreditation in August 2013

Country Number of accredited hospitals

Bahrain 1

Jordan 9

Kuwait 2

Qatar 5

Kingdom of Saudi Arabia 42

United Arab Emirates 39

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Tourism is Kingdom of Saudi Arabia's second largest source of income after oil, generating approximately US$ 13.8 billion annually, and it is the third largest source of employment. Income from international travel and tourism to Kingdom of Saudi Arabia is predicted to reach US$ 63.7 billion by 2019. In Kingdom of Saudi Arabia, religious tourism is the heart and soul of all tourism.

Medical tourism in Kingdom of Saudi Arabia

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Currently, Kingdom of Saudi Arabia is investing intensively in its health system, most of the financing coming from Government bodies, which places a continuous strain on the Government.

With 386 hospitals, 54 724 hospital beds and 55 000 physicians, a successful health care infrastructure is well on its way to being fully established.

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Most doctors in Saudi hospitals have been trained in western countries with well-known, trustworthy training systems, which may attract patients from abroad.

The recent trend of obtaining accreditation from the Joint Commission International resulted in more than 40 accredited hospitals by August 2012. Although accreditation is not designed to attract more patients from abroad but rather to upgrade national health facilities, this will develop more trust among foreign patients choosing a hospital.

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Surveys and research suggest that most foreign patients coming to Kingdom of Saudi Arabia have a spiritual life and regard their spiritual and physical health as equally important.

Merging religious and medical tourism

With proper arrangements, patients (especially those for elective surgery) could be offered medical or surgical treatment packaged with religious tourism, such as visits to holy places for prayers or Umrah.

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Moreover, All Muslims believe that ALLAH hears their prayers and grants health in the holy places, and they believe that spiritual activities in the holy places boost their healing process. Many old patients with terminal stage diseases or geriatric problems would like to spend time in the holy places duringtreatment.

The spiritual element is an essential component of palliative and end-of-life care.

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Underestimation of the country's potentialThe authors consider that the main problem in the emergence of Kingdom of Saudi Arabia as a hub of medical tourism is that it is neglected by the Government and the private sector, which underestimate the importance of medical tourism. Major medical tour operators are of the opinion that Kingdom of Saudi Arabia has not made a significant mark in the inbound medical tourism business. 

Barriers to medical tourism in Kingdom of Saudi Arabia

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The authors suggest that the relevant authorities should make a consolidated, joint effort to build a long-term plan and infrastructure for medical tourism.

Difficult documentation and visa processesIt is difficult to acquire a medical visa for a number of reasons. A delay in acquiring a visa is unfavourable in the case of medical ailments, when one of the first priority of patients is early diagnosis and treatment. This delay cannot be reduced until the Government recognizes the importance of medical tourism and makes special arrangements and policies for this activity.

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Insufficient informationAlthough many milestones have been achieved in the concept of E-health, special attention is required for foreign patients intending to obtain medical care in Kingdom of Saudi Arabia. This includes clear-cut information from the medical unit to which the patient wishes to go. Special information portals should be dedicated solely for this purpose, and a more efficient national health information system should be set up, from which the international community could also benefit.

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Poor cooperation between medical tour operators and medical unitsStrong partnerships with medical tour operators are of key importance, as these organizations are not only specialized in travel services but can also assist in related services before and throughout a trip. Depending on the agreements with medical units, they can take on most of the burden of scheduling appointments, booking hotels and providing assistance in getting a medical visa.

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Inadequate marketing

As Kingdom of Saudi Arabia's neighbours are emerging giants in medical tourism, Kingdom of Saudi Arabia should undertake a well-planned, continuous, worldwide publicity campaign through sources such as the Internet, social media and print and e-media.

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Identify specific areas for medical tourismAlthough providing all types of medical services is a fascinating target, focusing on a few areas first and mastering them would be more commercially practical in establishing a position. For example, Thailand has focused on gender defining and cosmetic surgery, China on stem cell treatments, India on alternative medicine, bone-marrow transplant, cardiac bypass surgery and eye surgery. Kingdom of Saudi Arabia must explore which field its hospitals should focus on.

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Identify the target populationAs mentioned earlier, certain populations are attracted more to certain locations. This might be due to a similar ethnic and racial background: Taiwan attracts mainly Chinese patients, Jordan mainly Arabs from the Middle East and North Africa, and India and Pakistan mainly South-East Asians. Kingdom of Saudi Arabia has the edge, in that it can attract not only patients from Gulf Cooperation Council, Middle Eastern and North African countries but also, if packaged with religious tourism and wisely advertised, the entire Muslim world.

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Make policy and legal issues easy and systematicLegal regulations and laws related to medical tourism, visa issuance, medical tour operators, private sector involvement, health insurance, medico-legal aspects of malpractice and related issues should be revised and clear enough for the convenience and safety of incoming patients. The ministries of health, tourism and information should initiate comprehensive, multi-ministerial efforts.

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Kingdom of Saudi Arabia has good potential for becoming a hub of medical tourism in the region. It has most of the infrastructure and facilities with high standards, many of which are already accredited internationally. The unique position of the Kingdom in religious and archaeological history and its political stability give it advantages over competitors in the field. Having learnt lessons from the achievements of neighbouring countries, it is now time that Kingdom of Saudi Arabia become motivated and initiate a well-planned, long-term plan for the medical tourism industry. The current era of global economic turmoil is the right time to take advantage of medical tourism and reduce the heavy dependence of the country on oil.

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Today’s health challenges require a new way of working based on : - shared leadership; - aligning root causes and- strategy and measureable results.

It is believed that innovative collaborations produce innovative solutions for healthier communities.

SUCCESS IS

COLLABORATION AMONG COUNTREIS AND SHARING

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LEADERSHIP & INNOVATIONIN MEDICAL TOURISM

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Thank you for your

kind attention

داعيا4 الله سبحانه لي ولكمبدوام الصحة والعافية والرضوان