final country strategy medical tourism belize

Confidentiality: Private Date: September 17, 2012

ANALYZING THE POTENTIAL OF THE MEDICAL TOURISM SECTOR FOR INVESTMENT PROMOTION – BELIZE

Final Sector Strategy

All rights reserved. The information herein is confidential and the recipient will not disclose it to third parties without the written permission of BELTRAIDE

ANALYZING THE POTENTIAL OF THE MEDICAL TOURISM SECTOR FOR INVESTMENT PROMOTION - BELIZE


Confidentiality Private Status Proposal Author Massimo Manzi

Reviewers Approver(s) Copy to Mario Alberto Umaña Mario Alberto Umaña

Diego Morais Diego Morais

BELTRAIDE BELTRAIDE

Ishmael Quiroz Ishmael Quiroz





Table of contents

Executive Summary………………………………………………………….4

Overview………………………………………………………….………..…5 Project Objectives……………………………………………………………..……….……5

Project Scope…………………………………………………………………………...……5

Sector Strategy: Developing Medical Tourism in Belize……………….….6 1. Introduction…………………………………………………………………………..….7

1.1 Medical tourism in the context of the National Development Plan……………..7

1.2 Medical tourism: a global industry………………………………………………9

2. Strategic analysis of the medical tourism industry prospects……………………….11

2.1 Medical tourism clusters. Benchmarking………………………………………11

2.2 Services and Pricing. Benchmarking…………………………………………..14

2.3 Investment Incentives. Benchmarking…………………………………………15

2.4 Medical tourism in Belize: SWOT Analysis…………………………………...17

2.5 Competitive advantage positioning…………………………………………….17

2.6 Mapping of the Sector………………………………………………………….19

2.7 Technical Assessment of the Preparedness, Readiness and Competitiveness of the Healthcare and Tourism Sector………………………………………………...20

2.8 List of Private Stakeholders……………………………………………………25

2.9 Linkages between the healthcare sector and the tourism sector………………..27

3. Sector development strategy…………………………………………………………..33

3.1 Key components for a successful country strategy…………………………….33

3.2 Public Policies supporting Healthcare Clusters……………………………......34

3.3 Commitment of the private sector……………………………………………...36

3.4 The Strategy: Three Components for a Three Stages process…………………37

4. Action plan for the implementation of the strategy………………………………….41





4.1 Legal framework……………………………………………………………….41

4.2 Risks mitigation: ¨Belize Safe Destination for Medical Travelers Program¨….44

4.3 Cluster structuring……………………………………………………………...47

4.4 Human Resources………………………………………………………………47

4.5 Capacity Building………………………………………………………………49

4.6 Foreign Investments……………………………………………………………50

4.7 Role of the Government………………………………………………………..52

5. Communication and marketing strategy……………………………………………..54

5.1 List of procedures………………………………………………………………54

5.2 Most appropriate geographic territories to be targeted………………………...55

6. Final Recommendations……………………………………………………………….56

ANNEXES…………………………………………………………...………58

Acronym List……………………………………....……………………......64

End of Document





Executive Summary Medical tourism is a growing industry as a result of high cost of care and problems to provide timely attention in developed country. Countries willing to be part of this global economic opportunity have to provide a trustable, quality and coordinated value proposal including not only healthcare procedures but also specialized transportation, recovery and accommodation services.

The development of a medical tourism industry in Belize is consistent with both the Long Term National Development Framework for Belize – HORIZON 2030¨ and the National Sustainable Tourism Master Plan for Belize 2030.

As a result of a competitiveness diagnostic, SWOT analysis and benchmarking, Belize showed accounting with a number of competitive advantages that put the country in a good position to become a medical tourism destination. Those are proximity to the US, being an English speaking country, branding as a top natural tourism destination, famous retirement destination, experience with dental tourism.

Medical tourism is not just a business opportunity for a group of clinics and hospitals. Medical tourism is a country opportunity of development for a wide range of SMEs: from transportation companies to tour operators, from hotels to restaurants.

This means that the sector strategy requires a broad approach and a comprehensive action plan where both the public and the private sector have to play a key role. The first by setting the rules and making sure everybody get benefits from the initiative and the latter by working together putting aside individualism and promoting fair competition.

The Belizean way to develop medical tourism consists of a ¨three components strategy¨: a Local Healthcare Capacity Improving Program; Human resources development; Foreign Investments in New Medical Tourism Projects. On the other hand, the strategy will be developed by ¨stages¨ where variables are the type of investment projects to be expected, degree of participation of existing clinics and hospitals, level of involvement of foreign doctors.

The implementation of the proposed action plan will require Governmental help and international cooperation in terms of consultancy, financial and technical assistance. But, the first, essential step, is to structure a medical tourism cluster, by promoting the creation of a private, independent body (BELHEALTH), closely supported by the Government, to achieve the important goals of representation of country`s interest to become a medical tourism destination; Self regulation; International promotion; Training; Linkages among sectors; Sector´s Competitiveness.





Overview In 2009 BELTRAIDE initiated an Organizational Evaluation to assess and benchmark the organization against similar Investment and Trade Promotion Organizations in the region. This assessment constitutes a starting point for analyzing the institution, presents a detailed organizational analysis, including recommendations for improving strategic leadership, financial management, human resources management and development, monitoring and evaluation, Information Technology (IT) services, organizational communications, among others. Nevertheless, the assessment lacks an implementation plan, and a solid analysis and recommendations on the operation of its three main functional areas (export promotion, investment attraction, and SME development) and comparisons to regional and international best practices. The Government of Belize has entered into a Technical Cooperation Agreement with the Inter-American Development Bank to access resources under the Compete Caribbean Program to refocus BELTRAIDE’s investment attraction efforts towards key sectors that will drive economic growth in the country

Project Objectives The objective of this consultancy is to develop a comprehensive sector strategy and implementation plan for investment promotion in the medical tourism sector.

The sector strategy will include the specific trade and investment development profiles, which clearly identify, quantify and assess the resources and advantages of the sector as targets for direct investment.

This consultancy will include the detailed articulation of the unique selling points for the sector and the development of marketing collaterals to be used in supporting the marketing effort.

Project Scope The scope of this consultancy is to identify the potential of Belize to be a medical tourism destination and to attract foreign direct investments in this field, and to define an adequate blueprint to achieve the agreed common goals.





Sector Strategy: Developing Medical Tourism in Belize The development of a sector strategy includes several necessary steps aiming to make sure the program is based on an in depth analysis of the country and the specific sector competitiveness, and on agreed values and vision.

The cycle that follows is a practical guide to the single phases that brought to the draft of a Sector Strategy and to the following steps such as cluster structuring and implementation.





1 Introduction

1.1 Medical tourism in the context of the National Development Plan A strategy to include medical tourism among the key sectors for the economy in Belize is totally consistent with the ¨Long Term National Development Framework for Belize – HORIZON 2030¨.

As mentioned in the Report …¨Economic resilience suggests that that there is a strong, well financed business sector operating at a high degree of efficiency and producing quality goods and services and in the context of Belize´s natural resource based economy, environmental sustainability is key to sustainability of economic development¨.

Particularly, when mentioning the priority economic goals to be achieved by the year 2030, it mentions, among others:

• Sustainable, profitable and expanded responsible tourism in a well developed

services sector exporting to the rest of the world. • Strong well performing micro small and medium enterprise sector, with strong

credit unions playing a key role in financing. • A strong work force and corps of entrepreneurs created by an education system

that nurtures entrepreneurs and local talents and provides training relevant to Belize´s development needs.

And when mentioning the strategic actions at different levels to be included, it specifically mentions:

• Develop a support system for small business that goes beyond financing to

include market information, management support, planning advice etc. • Give greater opportunities for women´s and youth employment and job creation • Implement policies and provide incentives to support the creation of new

industries. • Support community driven initiatives that encourage local enterprise development

especially community, agro-tourism and overnight tourism initiatives. • Engage the tourism sector in developing real solutions to the crime situation. • Promote and facilitate the identification and development of new sectors

The development of an industry like medical tourism represents a concrete contribution to the achievement of the mentioned goals, for the following reasons:





• It diversifies the tourism industry and the offer of services to the world; • Since the majority of clinics are small and medium, medical tourism represents a

great opportunity for SMEs in Belize; • It also offers a job opportunity for many women involved in the healthcare and

tourism sector (nurses, patients assistants, tourism personnel, among others) and young people studying or willing to study a medical career.

Additionally, the National Sustainable Tourism Master Plan for Belize 2030 (NSTMP) identifies in the specialization in ¨niche market segments¨ one of the key elements of the Vision 2030.

The development of medical tourism can support developing some of the strategic approaches to achieve the goals of the NSTMP:

• Experiential Quality Enhancement: a stronger private medical sector will improve

the capacity of the country to provide a better emergency response; • Empowerment of Stakeholders: the majority of healthcare providers are small and

medium enterprises which will be the one leading the national effort on medical tourism;

• Proactive Solution to Funding Sources: the type of local/foreign model to promote medical tourism in the country will be an excellent source of successful partnerships and investment attraction;

Finally, the objectives of the National Tourism Marketing Macro-Program can be better achieved with the development of medical tourism as a niche market for Belize:

• Position Belize as a World Class tourism destination: a proper development of a

medical tourism industry in Belize is able to improve the positioning of the country as international destination for different types of tourists;

• Increase tourism intensity: medical travelers spend on average 12 days or more in the country in order to properly recover from surgery or other medical/dental procedures;

• To enhance local income generation potential: medical tourists spend on average 5 to 6 times more than a traditional tourist (leisure, vacation);

• To optimize cost/benefit ratio of marketing actions: since an international patient generates much more revenue to the country than other kinds of visitors, the return of each dollar invested in medical tourism is much higher than for other niches.





1.2 Medical tourism: a global industry Medical Tourism is defined as the phenomenon of people traveling from one country to another for medical intervention based upon the perceived personal value.

The reasons why people are travelling for care depends on the country they live as well as personal situations. Nevertheless, there are four main drivers of medical tourism:

1. Affordability

Typically, the research of more affordable healthcare services is related with the case of Americans without a medical insurance (uninsured) or insufficient coverage (under insured); but, it is also related with people looking for esthetic/elective procedures (esthetic dentistry, plastic surgery) not covered by any insurance and where the best procedure at the best cost is a global phenomenon.





2. Accessibility

A number of countries accounting with a public health system, mainly in the developed world, is facing a challenge to provide prompt healthcare to its citizens. It is the case of countries like Canada and the majority of European nations, where an ageing population is generating long waiting lists in certain specialties.

People with the capacity of paying for quicker care started to travel to other countries to look for surgeries like orthopedics, urology, and gynecology, among others.

3. Availability

Regulatory reasons are making impossible for certain patients receiving a necessary or desired medical treatment.

It is the case for ¨In Vitro Fertilization¨ in Costa Rica, pushing citizens of this country to travel to Panama or Colombia to receive the desired procedure.

4. Quality

Even if quality is always at the top of the list of any person travelling for care, in many cases the lack of the desired level of quality care or medical specialization is the reason for individuals from countries with insufficient healthcare offer to travel abroad.

South American that travels to Centers of Excellence like the Mayo Clinic, Cleveland Clinic or The Houston Medical Center.

In terms of the directions that patients can take, there are three different types of medical travels that have been identified:

Affordability Accessibility Availability Quality

Perception of Tourism

(experience) Value





2 Strategic analysis of the medical tourism industry prospects

2.1 Medical tourism clusters. Benchmarking Benchmarking is a necessary tool that will allow identifying best practices and establishing a competitive positioning of Belize. An appropriate Benchmarking will include the analysis of country cases able to generate useful information for Belize.

•  Patients traveling out of a country Outbound

• Patients coming into a country Inbound

• Patients traveling within a country Intrabound

COSTA RICA MEXICO GUATEMALA

VALUE PROPOSAL

Strategic location; Political and economic stability; Quality of Life; Accredited hospitals; Trained professionals; eco tourism destination

Location; Retirement living destination; tourism destination; high quality healthcare and state-of-the-art technology

Proximity to the US; State of the art Medical Infrastructure; Competitive prices; Timely Attendance; Spring-like climate; Cultural heritage; Cosmopolitan Atmosphere; Tourist activities; Learn new skills; Hospitality

HEALTHCARE OFFER

3 JCI accredited hospitals; 30 AAAASF and AAAHC accredited ambulatory surgery facilities

7 JCI accredited hospitals;

National accreditation by the Secretary of Health

No internationally accredited healthcare facilities





Particularly, the following three countries have been selected taking into consideration the indicated reasons

• MEXICO

o Close to Belize, attracting patients from Belize

o Retirement living destination

o Famous destination for sun and beach tourism

o Proximity to the US

o Cruise tourism destination

SECTOR`S ORGANIZATION

PROMED with support of Costa Rican Tourism Authority and PROCOMER

Medical tourism declared of national interest

States individual initiatives (Baja California, Mexicali, Chihuahua, Nuevo León, DF, Tamaulipas, Sonora, Jalisco, Guanajuato). Attempt of the Secretary of Tourism and Health to unify efforts

INGUAT-PRONACOM

AMCHAM

AGEXPORT

Lack of agreement on a common country strategy

BRANDING Quality Healthcare and Nature within your reach

¨Mexico te hace sentir bien¨ (Mexico makes you feeling well)

Quality and Safety at affordable prices

MAIN MARKETS

United States; Canada United States (Southern States); Mexican residents in the US

Main Markets: United States; Central America; South of Mexico; Belize; Europe

Potential Markets: Canada: The Caribbean; Panama; Colombia; Taiwan; Russia

MAIN FIGURES

36.000 medical tourist in 2010; (100.000 projected by 2015)

288$ millions (7.000$ per patients). 40% dental; 15% plastic; 45% other surgeries and preventive medicine

122$ millions

102.000 medical tourists

1.200$ per patient

47$ millions

1.500 international patients





• GUATEMALA

o Close to Belize, attracting patients from Belize

o Famous destination for Mayan culture

o Lack of accredited healthcare facilities

• COSTA RICA

o Small country

o Retirement destination

o Famous destination for eco tourism

o Medical schools recognized by NCFMEA (US Department of Education)

o Majority are small clinics

The results of the Benchmarking to be taken into consideration for the development of a successful sector strategy in Belize are the following:

• A combination of general competitive advantages of each country, specific

healthcare aspects and tourism attractions forms the value proposal of all analyzed countries. A proposal based on the ¨experience¨ of having a procedure done in the beautiful country of untouched nature would be the recommended value proposal.

• Internationally accredited facilities are the base of Costa Rican and Mexican strategy. It is not the case for Guatemala, where ¨non standardized¨ quality healthcare and affordable prices represent an indivisible concept. The Belize´s way will have to include a multiple phase program aiming to achieve international accreditation for its hospitals in the medium term. In the short term, there seems to be the opportunity to have small ambulatory facilities (mainly dental facilities) accredited in a 6 to 8 months time.

• Costa Rica and several States of Mexico have created joint public-private partnerships in order to better represent the interest to promote their places as medical tourism destinations. A strong medical tourism cluster seems to be one of the key of the success of those destinations





2.2 Services and pricing. Benchmarking

Medical Procedure USA Colombia Costa Rica Mexico Guatemala

Heart Bypass $144,000 $14,802 $25,000 $27,000 $18,400

Angioplasty $57,000 $4,500 $13,000 $12,500 $11,800

Heart Valve Replacement $170,000 $18,000 $30,000 $18,000 $18,000

Hip Replacement $50,000 $6,500 $12,500 $13,000 $12,500

Hip Resurfacing $50,000 $10,500 $12,500 $15,000 $11,500

Knee Replacement $50,000 $6,500 $11,500 $12,000 $12,500

Spinal Fusion $100,000 N/A $11,500 $12,000 $16,800

Dental Implant $2,800 $1,750 $900 $1,800 $920/ $1,750

Lap Band $30,000 $9,900 $8,500 $6,500 $7,500

Breast Implants $10,000 $2,500 $3,800 $3,500 $2,900

Rhinoplasty $8,000 $2,500 $4,500 $3,500 $3,700

Face Lift $15,000 $5,000 $6,000 $4,900 $5,800

Hysterectomy $15,000 N/A $5,700 $5,800 $4,500

Gastric Sleeve $28,700 $7,200 $10,500 $9,995 $12,500

Gastric Bypass $32,972 $9,900 $12,500 $10,950 $14,500

Liposuction $9,000 $2,500 $3,900 $2,800 $2,000

Tummy Tuck $9,750 $3,500 $5,300 $4,025 $5,600

Lasik (both eyes) $4,400 $2,000 $1,800 $1,995 N/A

Cornea (both eyes) N/A N/A $4,200 N/A N/A

Retina N/A N/A $4,500 $3,500 N/A

IVF Treatment N/A N/A $2,800 $3,950 $7,000





2.3 Investment Incentives. Benchmarking

COUNTRY BENEFICIARY SECTOR

TYPE OF INCENTIVES

REQUIREMENTS

Mexico Medical tourism or healthcare services not defined as priority sector

Costa Rica Healthcare services excluded from free trade zones incentives (medical equipment exempted of import duties by law)

Guatemala Medical Tourism Projects in Free Trade Zones

Import duties and sales taxes exemption on all materials, machineries, equipment necessary to operate

Exemption on Corporate Tax for 12 years

No specific requirements

El Salvador Specialized Healthcare Services provided by Hospitals to Non Resident Patients (general medicine and dentistry are excluded)


Exemption on Corporate Tax

Municipal Taxes Exemption

Minimum Investment of 10.000.000US$ for facilities providing surgery procedures or 3.000.000US$ when not providing surgery procedures

To be installed outside Metropolitan Areas

Offering services only to patients with a national or international medical insurance

Colombia Healthcare Services installed in Free Trade Zones

Import duties and sales taxes exemption on all materials, machineries, equipment necessary to

Minimum Investment and Employment generation (min. 2,6 millions US$ and 500 jobs; max 23,79 millions US$ or more and 150 jobs)





operate

Lower Corporate Tax 15% (normal 33%)

Achieving national accreditation in 3 years

Achieving international accreditation in 5 years

Panama Specialized Health Services Providers installed in Free Trade Zones


Exemption on Corporate Tax applied to the amount of services offered to non residents

Hiring Panamanian workers (except specialized personnel);

Providing training;

Starting investment in one year from approval;

Initiating operation two years after approval;

No minimum investment (250.000US$ to open a Free Trade Zone)





2.4 Medical tourism in Belize: SWOT Analysis

2.5 Competitive advantage positioning Benchmarking and SWOT analysis allow identifying the competitive advantages to Belize as a medical tourism destination.

These advantages include: • Geographic location with its proximity to the US, in the middle of the

Americas; • Being an English speaking country is a great competitive advantage above

any other Latin American destination for medical travels. And not only the language but also a cultural affinity with North America and the UK;

•  -Competition from Mexico and Guatemala

• New medical tourism projects in the Caribbean

• Migration of health workers

• FDI attraction for health and wellness related projects

• Training local doctors through joint ventures with foreign doctors

• Belizeans living abroad (one million)

• Lack of accredited healthcare facilities

• Shortage of health professionals in certain areas

• Lack of a medical school for clinical training

•  Lack of medical equipment maintenance providers

•  -High costs of utilities

• English speaking doctors and nurses

• Retirement destination (more than 8000 Americans living in Belize)

• Brand of natural tourism destination (almost 200.000 tourists from US and Canada)

• Experience with dental tourism

• Strategic location STRENGTH WEAKNESSES

THREATS OPPORTUNITIES





• Belize is a renowned natural tourism destination, very well positioned in North America, a place where Americans want to go;

• The country is home of a large North American and European community of retirees; these people represent not only affluent potential buyers of healthcare but also and mainly a group of effective promoters of medical tourism services in Belize; QRP program is a great incentive program to attract more of those buyers and promoters;

• Cruise ships passengers and crew as well as a couple of committed medical tourism facilitators has allowed Belize to build some kind of experience in dental tourism, creating the bases for an expansion in terms of number of international patients and specialties.





2.6 Mapping of the Sector

Human resources

• Existing capacity (Basic Indicators 2010) •  241 Physicians •  469 Nurses •  126 Lab Technicians •  41 dentists (2012)

•  Future capacity •  200 doctors training outside Belize (150 in Cuba and 50 in other countries)

•  25/40 graduated nurses per year

Academic •  4 Offshore Medical Schools •  1 Nursing and Allied Health School

Healthcare

•  4 private hospitals (Belize Medical Associates, Universal, Northern Medical Specialty Plaza Orange Walk, Loma Luz)

•  1 Tertiary Public Hospital (Karl Heusner Memorial Hospital) able to offer services to medical tourists (separate building)

• Ambulatory facilities (with potential to export according to BMDA) •  10 dental •  3 dermatology •  3 ophthalmology

Investment projects

• The Placencia •  Sanctuary of Belize •  Stem Cells Project in San Pedro

•  Facility in San Pedro (local/foreign capital)

Tourism

•  5-‐6 DMO (Tour Operators) with the capacity of properly developing medical tourism programs

•  2/3 Hotels with international standards in main destinations for MT (BC, San Pedro, Placencia)

• Airlines ]lying to Belize: American Airlines, US Airways, United, Taca, Delta

• Cruise Lines (265 calls in 2012)

Wellness

•  Royal Wellness-‐ Belize City • Captain Morgan Retreat – San Pedro

•  Secret Garden-‐ Placencia • Black Orchid Spa-‐ San Pedro •  Las Terrazas-‐ San Pedro • Chaa Creek-‐ Cayo • Escape Day Spa-‐ San Pedro • Kaana-‐ Cayo • Healing Touch Day Spa-‐ Caye Caulker

Supporting services

•  Insurance providers (Atlantic Insurance, ING=medical tourism product, RF&G Insurance, ICB through Lloyd of London=malpractice)

• Banks





2.7 Technical Assessment of the Preparedness, Readiness and Competitiveness of the Healthcare and Tourism Sector

2.5.1 Healthcare Sector The following observations are based on site visits, interviews, and conversations conducted with Medical Directors and Staff from September 2-8, 2012 by both the consultant and a technical adviser on patient safety and quality (Mr. Tom Terranova, MA, Director of Legislative & External Relations for the American Association for the Accreditation of Ambulatory Surgery Facilities AAAASF).

The on-site visits conducted during the second mission trip were not as comprehensive as official accreditation surveys; as such the observations should be taken as a basic assessment to the readiness of facilities. The findings herein consider only factors that would affect the ability to achieve accreditation; they do not pertain to wider observations on health care and medical tourism.

Challenges for accreditation in Belize have been classified into three broad categories:

1. Impediments are national challenges that do not necessarily prevent facilities from

achieving accreditation but nevertheless create an environment that is not necessarily conducive to achieving accreditation.

2. Structural Barriers are system-wide conditions that could prevent facilities from achieving accreditation; these conditions are outside of the control of any individual facility.

3. Observed Deficiencies are deficiencies that would need to be corrected in order to obtain accreditation and are within the facility’s power to correct.

2.7.1.1 Impediments • Education: Relatively few medical professionals in Belize are board certified or

have fellowship training in any given specialty largely due to the lack of any medical education institutions or programs. This is merely a concerning impediment rather than a serious institutional blockage because there is nothing that prohibits physicians or other medical personnel from seeking additional training or specialization. It is unlikely that many of the existing physicians will seek additional fellowship training for the purposes of international accreditation, perhaps incoming physicians will be more likely to elect to do so. Belize may elect to import foreign physicians to supplement the shortage of internationally acceptable supply, under an acceptable, broadly agreed scheme that fits into a national vision of medical tourism industry development.





• Licensing: Belize lacks a re-certification process, which is critical to the accreditation process in that it assures ongoing professional competency and ethical conduct. Accreditation standards do not explicitly address re-certification per se, however it is doubtful that the accreditation committee and international patients would consider Belizean clinics to be adequate without such a process. Without ongoing re-certification, which usually includes Continuing Medical Education or Continuing Education Units, the accreditation organization would need to collect and assess the units. This is not something that agencies do. The proposed Medical Act is aimed at this very concern, which should assure agencies that medical professionals undergo sufficient oversight to provide relative confidence in their quality and ethical behavior on an ongoing basis.

• Support personnel: There are no trained and qualified bio-medical technicians in

Belize. Accreditation requires that facilities utilize a biomedical technician to perform all maintenance and diagnostic testing of all equipment according to manufacturer’s instructions. All facilities have indicated that they import the biomedical tech from either the US or Guatemala to conduct regularly scheduled maintenance, at great cost. Of greater concern to the accreditation process is how facilities handle emergency equipment repairs. In some cases facilities indicated that they absorbed any costs to bring the foreign techs in, while others mentioned that they do what they need to do to keep machines working including using non-certified personnel to perform repairs. Accreditation would necessitate that facilities ALWAYS import the technician for any repairs, a high cost option, or establish qualified personnel in Belize.

2.7.1.2 Structural Barriers • Access to hospitals: This is a national barrier to international accreditation for

nearly every location in Belize outside of Belize City. Although there are health care facilities throughout the country, all 3 general hospitals with an Intensive Care Unit are concentrated in Belize City. All facilities outside of Belize City visited on the trip are far too remote, considering the country’s transportation infrastructure, to satisfy the requirement that the accredited facility and any recovery hotels be located within 30 minutes of a hospital to which a patient in jeopardy can be transferred. Given distance, speed restrictions (enforced via bumps), and road conditions, the country appears to have two options to provide hospital coverage to the rest of the country. Belize must build more new hospitals or make reliable air transport available at the site of surgery. With the reduction of British forces in Belize, the only company providing limited air transportation is the Belize Emergency Response Team (BERT). Their flights are severely limited in that they





do not fly in inclement weather or in the evening. Without new capabilities it will be difficult to accredit facilities in other towns.

2.7.1.3 Observed Deficiencies

Six site visits included a tour of the operating suite. Here are the main findings:

Sterility: During on-site visits, facilities generally displayed at least one of several issues concerning the maintenance of sterility:

• 3 displayed a potential issue with the flow of used surgical supplies and equipment post-surgery

• 1 had an operable sink in the Operating Room • 1 does not appear to be appropriately sealed from the outside and environmental

hazards • At least 2 have surfaces (floors, ceilings) that would not satisfy international

standards • 2 clinics stored surgical supplies and equipment in open hallways that might not

sufficiently protect packs from unintentional opening or contamination • At least 1 facility did not utilize spore testing to ensure sterility of equipment

sterilized in the autoclave • 1 may not be using test strips often enough • 1 facility is not capable of a clear physical separation of clean and dirty equipment

without a significant remodeling effort

Secure Operating Suite: International accreditation requires that the OR suite is physically distinct from the rest of the ambulatory care facility and sufficiently bars entry by unauthorized personnel.

• 1 facility had an Operative Room that opens directly into a public hallway; the Operating Suite is not entirely self-contained.

• 1 facility had a separate surgical suite but did not appear to have adequate controls in place to ensure that unauthorized personnel could not access the suite

• At least 3 facilities had inadequate scrub area either located outside of a secure operating suite or in a heavily trafficked area

OR Equipment: Standards require that OR equipment and machines are properly cleaned and maintained. Although none of the site visits indicated that these machines were not properly cared for, in some cases the age and appearance of much of the equipment means that the facility would need to demonstrate that the equipment is safe and has been properly maintained.





Exposure Controls: Accreditation mandates that protocols be instituted and followed that protect personnel from hazardous exposures depending on their roles in the facility. Such hazards may include needle-sticks, bodily fluids, radiological material, etc.

• 2 facilities appeared to have inadequate radiology protection

Explosives and Combustibles: Facilities must assure adequate safety for explosive and combustible materials.

• At least 1 facility stored compressed gas tanks inappropriately, not secured to the wall, which exposes patients and staff to potential dangers

• 2 facilities use centrally housed piped gases but did not include the central storage location in the tour of the facility, without inspecting those rooms it is impossible to judge the appropriateness of the facility’s storage methods

• In general although most facilities had fire extinguishers most appears to possibly have too few

Patient Signage: Accreditation requires a certain level of patient interaction and information via signage such as emergency exits signs as well as patient bill of rights (either posted or provided in writing). During the on-site visit, no facilities showed a posted patient bill of rights, it is uncertain if the facility provides one in writing before care.

Time constraints during the site visits prevented a detailed review of OR and PACU equipment to ensure that all patient monitoring equipment was always present. Experience and data indicate that the most commonly cited deficiencies, particularly in a new country of operation, concern paperwork such as protocols, patient charts, narcotics and anesthesia logs, and personnel records. It would be particularly important to reinforce the importance of detailed record keeping to the accreditation process.

In order to provide a complete picture, this report considers areas in which visited facilities did not demonstrate deficiencies. Belizean facilities generally demonstrated strength in the following areas.

a) Narcotics Oversight: Each facility that had an operating theater keeps narcotics properly

locked in secure storage, records narcotics in a log, the medical record, and anesthesia record, and exercises tight control over issuing narcotics from pharmacy to the OR to administration of drug to the patient. All facilities also conduct review of narcotics inventory by multiple personnel.





b) Path Report Review: All facilities indicate appropriate review of imaging and pathology reports by the operating physician and communication of findings with patients. The path reports are also included in the patient record.

c) Director Involvement: Every facility director was intimately involved in the operation of the facility.

d) Clean and Safe General Environment: Although some facilities may want to update and

renovate their public areas for the purposes of marketing to international patients, most of the facilities visited displayed sufficiently clean, safe and appealing environment to pass an accreditation survey.

e) Sufficient Backup: Every facility with an operating theater, except one (which the

doctor admitted could not be used for international patients) possessed sufficient generator backup to protect the operating suite from a loss of power.

f) Sharps and Red Waste Disposal: All facilities complied with typical OSHA standards

for storage and disposal.

g) PACU Care: Each facility kept the patient under the supervision of the anesthesia

provider, operating physician, or other appropriate personnel until discharged into the care of a responsible adult.

2.5.2 Tourism Sector Lack of adequate hotel infrastructure around existing hospitals in places like Belize City, Orange Walk or in areas of future development like Belmopan, is probably the main limitation in terms of tourism services.

Not necessarily the type of accommodation for international patients has to be a 5 stars hotel, since small boutique hotels are sometimes a better options in terms of personalized, warm care.

Nevertheless, the quality of infrastructure and key services like restaurants, common areas are a big challenge for the majority of hotels observed in the mentioned cities.

Places like Placencia and San Pedro seem to be better prepared in terms of hotels infrastructure.





2.5.3 Additional considerations on Competitiveness There seems to be challenges in terms of cost competiveness related with certain elements often reported by private stakeholders:

1. Costs of medical devices. The lack of a national importer of medical devices is

increasing the costs of buying medical technology and giving maintenance to it.

2. High Costs of utilities. A system designed to serve a small population but in a low density country makes the access to important services for clinics and hospitals like electricity and water very costly.

2.8 List of Private Stakeholders The following is the list of the main private stakeholders that have been identified and involved in the process of designing a sector strategy for medical tourism industry in Belize.

These stakeholders and other have to be taken into account in the process of cluster structuring and implementation of the work plan.

1 AMCHAM Belize

2 Belize Tourism Industry Association BTIA

3 Belize Chamber of Commerce and Industry

4 Belize Medical and Dental Association BMDA

5 Karl Heusner Memorial Hospital KHMH

6 Belize Diagnostic Center Leslie Street Belize City, BELIZE TEL: + 501-224-5778 Email: [email protected] Http://www.belizediagnostic.com

7 Belize Medical Associates St. Thomas Street Belize City, BELIZE TEL: + 501-223-0303 Email: [email protected] Http://www.belizemedical.com

8 Bethesda Medical Center Santa Rita Road Corozal District Belize Tel: 501-422-3000 Fax: 501-422-3198

9 La Loma Luz Hospital Santa Elena Cayo District, Belize Tel: 501-804-2985/824-2087





10 Northern Medical Specialty Plaza Orchid Street Orange Walk Town Orange Walk District Belize Tel: 501-302-3708 Fax: 501-322-2320

11 Belize Healthcare Partners. Corner Chancellor and Blue Marlin Aves., Belize City. 223/7870. www.belizehealthcare.com.

12 The Carlton Clinic [email protected]

13 The Placencia Group [email protected]

14 Anne Kuffner ESCAPE ARTIST [email protected]

15 Offshore Medical/Dental Services Box 107 Corozal, Belize Tel/Fax: 619-615-2345 [email protected]

16 Medical University of the Americas 1000 Coconut Drive (P.O. Box 127), San Pedro, Ambergris Caye tel. 501/226-3744 fax 501/226-3835 e-mail [email protected] www.mua.edu.bz

17 St. Luke's University School of Medicine P.O. Box 557 Belmopan, Cayo tel. 877-545-8537 e-mail [email protected] www.stluke.edu.bz

18

InterAmerican School of Medical Science Corozal Town US Information Office: 10 N Post St. Suite 642 Spokane, WA 99201-0705 tel: 509-838-0592 or 877-DOCSTUDY fax509-456-7449 [email protected] www.interamericanschool.com

19 QUALITY OF LIFE SURGERY Dr. Joel Cervantes [email protected]

20 Dental Center (Dr. Habet) 2604 Mercy Lane Belize City District: Belize 501-223-6500 Fax: 501-223-6501

21 San Carlos Medical-Dental Center 28 Pescador Drive San Pedro District: Ambergris Caye 501 226 2918 Fax: 501 226 2918

22 Minnesota Dentistry 4 Miles North Of San Pedro San Pedro District: Belize 206-2526

23 Balaam Eco Adventures Oscar Castaneda Owner & Director 620-1811 Belmopan [email protected] www.balaamecoadventuresbz.com/main/

24 Los Pinos Medical Clinic, San Pedro, Dr. Teresa Damera

25 Dr. Giovanni Solorzano, San Pedro





26 Buttonwood Bay Medical Center

27 Blue Creek Clinic

28 Hoy Eye Clinic

29 University of Belize

30 Sanctuary of Belize

2.9 Linkages between the healthcare sector and the tourism sector Even if the core service of the medical tourism offer is healthcare, it is important to understand that the experience of the medical travelers has to be seen as a complete package where the international patient receives a number of different services before and after the surgery. Both sectors have to work together and commit on high quality and patient safety standards in order to provide a successful, stress-free experience.

Tourism sector is highly beneficiated by the development of medical tourism for a number of reasons:

1. Longer stays. A medical tourist stays in the country on average 12 days

representing a source of attractive long stays both for hotels and specialized recovery facilities;

2. More revenues. It is estimated that a medical tourist spends 5 to 6 more times than other types of tourists. On average 30% of the total spending is dedicated to tourism activities (accommodation, transportation, tours, leisure, restaurants, souvenirs)

3. No seasons. The decision of a patient to undergo a medical or dental procedure is not related to specific periods of the year. So medical tourism represents a way of attracting new visits to the country all the year round.

4. Less competition. If almost every country competes with each other to attract leisure tourists, medical tourism is a specialized niche where a more reduced number of destinations compete to attract patients from more developed countries.

5. Value chain. The number of services provided to medical travelers is very high not only including accommodation and transportation but also tours, shopping, souvenirs, pharmacy, restaurants, wellness and SPAs.

6. No mature product. Medical tourism is not a mature product since it is still in its consolidating phase. This opens important opportunities when considering global trends like an aging population (baby boomers), a growing demand for elective procedures (aesthetic) and increasing healthcare costs in countries like the US pushing corporations to look for saving options overseas.





2.9.1 The Role of Hotels and Recovery facilities

Hotels have to play an active role in the consolidation of a medical tourism industry in Belize.

They have to work to prepare themselves to attend a very different type of guest: the patient. It involves adapting infrastructure, offering new specialized services to medical tourists (special diets, nursing support, concierge assistances), training personnel to better meet with the needs and expectations of people recovering from a surgery or a dental procedure (CPR training, emergency response).

On the other hand, hotels have to support the country strategy of promoting a new niche by proactively providing information to all their guests about the possibilities Belize is offering in terms of medical and dental treatments. It demands an innovative approach to generate interest in new services offered in the country, understanding that ¨medical motivation¨ is able to make tourists returning to the country.

Package

Transparent Pricing; Services

Modifications

Dietary/ Menu; Privacy; Nursing Support;

Entertainment

Tourism / Concierge

Translators; Personalized

Services; Appropriate

Tourism; Transportation

Communication

Sensitizing Staff;

Communicatio Training;

Coordinated Emergency Response

Promotion

Provide information

about medical services





In terms of infrastructure requirements there are basic elements to be taken into account:

1. Homelike and Therapeutic Environment

• Give spaces a homelike, rather than institutional, size and scale with natural light and views of the outdoors.

• Create a warm reassuring environment by using a variety of familiar, non-reflective finishes and cheerful, varied colors and textures, keeping in mind that some colors are inappropriate and can disorient or agitate impaired residents

• Provide each resident a variety of spatial experiences, including access to a garden and the outdoors in general.

• Promote traditional residential qualities of privacy, choice, control, and personalization of one's immediate surroundings

• Encourage resident autonomy by making their spaces easy to find, identify, and use

• Provide higher lighting levels than typical for residential occupancies

2. Cleanliness and Sanitation

• Adequate and highly visible toilet rooms in key locations near spaces where residents congregate

• Proper detailing of such features as doorframes, casework, and finish transitions to avoid dirt-catching and hard-to-clean crevices and joints

• Effective ventilation, which may need to exceed nominal design levels.

3. Accessibility

Some patients may have ambulatory limitations, and will require the assistance of canes, crutches, walkers, or wheelchairs. To accommodate these residents, all spaces used by them, both inside and out, should:

a. Comply with the requirements of the Americans with Disabilities (ADA) or similar national legislation

b. Be designed so that all spaces, furnishings, and equipment, including storage units and operable windows, are easily usable by residents in wheelchairs.

c. Be equipped with grab bars in all appropriate locations.





d. Be free of tripping hazards.

e. Be located on one floor if feasible, preferably at grade. If residents' bedrooms must be located on more than one floor, then elevators have to be provided

4. Security and Safety

• Use of non-reflective and non-slip floors to avoid falls.

• Control of access to hazardous spaces.

• Provision of secure spaces to safeguard facility supplies and personal property of residents and staff.

• CPR trained personal

• Emergency plan

• Agreement with ambulance services

• Agreement with a nearby hospital

2.9.2 The Role of Travel Agents and Tour Operators Travel agents and tour operators have to play a transcendental role of linkages between health and tourism sector.

They are the ones called to materialize the necessary cooperation between both sectors in specific packages to be offered both nationally and internationally.

Also, they offer concierge, transportation, tours and assistance services that make more complete, stress-free and organized the experience of the international patient in Belize. They meet the patient at the airport; they transfer him to hospitals, clinics and back to hotels; they offer tours and activities that add value to the patients` experience (shopping, museums, city tours).

Quality requirements for tour operators are more related to the way they choose providers than specific standards applying to them directly. The commitment to only include healthcare and tourism companies complying with international standards is essential.

In addition to that, certain few specific elements do have to be taken into account by tour operators:

• CPR training for drivers and guides; • Accessible transportation units;





• Proper disinfection of fleet; • Emergency protocols

But one of the key roles for travel agents and operators is to support the country strategy to promote Belize as a medical tourism destination.

These companies can help increasing the number of international patients buying medical tourism package by providing information and offering packages to tourists visiting the country for other reasons.

2.9.3 Wellness and Medical Tourism Wellness Tourism refers to trips aiming at a state of health featuring the harmony of the body, mind and spirit, self-responsibility, physical fitness, beauty care, healthy nutrition, relaxation, meditation, mental activity, education, environmental sensitivity and social contacts as fundamental elements.

The motivation to travel is different from medical tourism: normally wellness is not the main reason to travel but an attraction that combines with a general need of spending a relaxing vacation by the beach or in the mountain.

Different also are the quality requirements for SPAs and resorts offering this type of services. Very important is to establish the limit between a non-invasive, wellness treatment and a medical procedure even if performed outside a traditional clinic.

Commitment on Quality and Patient`s safety

Coordinate Appropriate Aspects of Travel

Increase Patients Referrals

Tourists visiting the country for other reasons New visits to the country for health reasons





Day spas for example typically offer traditional non-invasive beauty treatments such as facials, body massages, reflexology, aromatherapy, etc.

Medical spas offer invasive and non-invasive aesthetic procedures under the full-time, on-site supervision of a licensed health care professional, such as chemical peels, laser hair removal, varicose vein removal, collagen replacement therapy, among others in a spa-like setting.

This means that when we enter into the medical arena, SPAs have to comply the same quality and patient´s safety requirements than traditional ambulatory facilities.

All that said, without a doubt there is an interesting linkage between medical and wellness tourism to be exploited, mainly for countries like Belize, accounting with excellent, luxury, wellness resorts offering from typical SPA services to alternative, Mayan, herbs treatments.

Marketing promotion on a country level and specific packages offered by tour operators are called to find an attractive balance of both activities in order to generate value to Belize as destination for international patients.

Finally, it is important to take into consideration the growing demand of corporations in the US of wellness, preventive and rehabilitation programs part of a strategy to reduce healthcare costs and decrease absence from work as consequence of addictions, mental illnesses, stress and burn out phenomena.





3 Sector development strategy

3.1 Key components for a successful country strategy Each country faces different challenges when deciding to develop a new industry. Particularly, when it is up to medical tourism, the strategy to implement will depend from the specific situation of the healthcare, tourism and related services providers.

Nevertheless, according to the existing experience of countries, regions, and cities that decided to develop a comprehensive strategy on medical tourism, it is possible to identify certain components that contribute to a successful result.

Quality, patient safety and continuing medical education must be the common denominator of every action, initiative and activity in this field.

Common values and a shared vision have to be the fundamental building blocks of the plan.

Nevertheless, without a close partnership between public and private sector it is unlikely to experience an organized, participative, and timely development of the industry. The Government is called both to implement an adequate legal framework allowing the industry to operate properly and to make sure the strategy to be neutral, independent, not favoring specific interests but promoting equal opportunities to everybody.





3.2 Public Policies supporting Healthcare Clusters In the process of consolidating a new industry the Government can influence all main determinants of competitiveness. Clearly government can influence the supply conditions of key production factors, demand conditions in the home market, and competition between companies.

1. Input conditions are human resources, physical resources, knowledge resources, capital resources and infrastructure. Specialized resources are often specific for an industry and important for its competitiveness. Specific resources can be created to compensate for factor disadvantages. Examples of public policies influencing input conditions in healthcare clusters are:

• Policies promoting quality and quantity of specialists, technicians and nurses.

• Fiscal incentives to R&D projects in biomedical areas

• Infrastructure Development (airports, docks)

• Emergency response system composed of land ambulances, air ambulances, and helicopters, including the need for airports to stay open 24/7 in case of

CONTEXT FOR FIRM, STRATEGY

AND RIVALRY

• Health labor force regulation (licensing)

• Fiscal incentives for hospitals and clinics

• Focused policies on medical services export promotion and FDI attraction

• Intellectual Property Rights Protection (R&D in biomedicine)

DEMAND CONDITIONS

• Regulations on quality standards for tourism and healthcare companies willing to be promoted

RELATED AND SUPPORTING INDUSTRIES

• Policies in favor of productive supply-chain (medical devices, pharmaceuticals, etc.)

• Negotiations with insurance companies and financial institutions

• Promotion of ¨Healthcare Cities¨ (specific areas where healthcare providers interact and innovate)

INPUT CONDITIONS

• Policies promoting quality and quantity of specialists, technicians and nurses.

• Fiscal incentives to R&D projects in biomedical areas

• Infrastructure Development (airports, docks, emergency system)





emergencies. A public-private system and the participation of insurance companies assuming the risk of the operation is a possibility to be taken into consideration.

2. Demand conditions in the home market can help companies create a competitive

advantage, when sophisticated home market buyers pressure firms to innovate faster and to create more advanced products than those of competitors. Examples of public policies influencing demand conditions in healthcare clusters are:

• Regulations on quality standards for tourism and healthcare companies willing to be promoted

3. Related and supporting industries can produce inputs, which are important for

innovation and internationalization. These industries provide cost-effective inputs, but they also participate in the upgrading process, thus stimulating other companies in the chain to innovate. Examples of public policies influencing related and supporting industries in healthcare clusters are:

• Policies in favor of productive supply-chain (medical devices, pharmaceuticals, etc.)

• Negotiations with insurance companies and financial institutions

• Promotion of ¨Healthcare Cities¨ (specific areas where healthcare providers interact and innovate)

4. Firm strategy, structure and rivalry constitute the fourth determinant of

competitiveness. The way in which companies are created, set goals and are managed is important for success. But the presence of intense rivalry in the home base is also important; it creates pressure to innovate in order to upgrade competitiveness. Examples of public policies influencing firm strategy, structure and rivalry in healthcare clusters are:

• Health labor force regulation (licensing)

• Fiscal incentives for hospitals and clinics

• Focused policies on medical services export promotion and FDI attraction

• Intellectual Property Rights Protection (R&D in biomedicine)





3.3 Commitment of the private sector The private sector has to support the country project on medical tourism by committing on three main elements:

• Quality • Fair competition • Uniformity of message

A strategy based on quality means availability to submit providers to external, independent, international scrutiny. This is the best way to establish who´s entitled to be included in the official portfolio of medical tourism in Belize to be promoted either by BTB or BELTRAIDE.

A common goal to attract a higher number of international patients imply for all private stakeholders to work together in favor of the destination; but no cooperation among different providers is possible if not based on fair competition, understanding that the country comes first and marketing to drive interested medical tourists to Belize to a specific package only as a second step.





3.4 The Strategy: Three Components for a Three Stages process The Strategy for developing a successful Medical Tourism Industry in Belize has to be SUSTAINABLE and INCLUSIVE.

It cannot be just the excuse to formalize one specific investment project but it should be a long-term strategy to create new jobs and new business opportunities to Belize and Belizeans.

In this sense, foreign investment must be a tool, a necessary tool to develop a new industry according to the priorities, goals and model established by the Government of Belize. FDI has to be at the service of Belizeans objectives and not FDI using Belize to materialize its objectives.

Of course, Foreign Investors have to be offered the necessary conditions, incentives and security to trust in Belize and its intention to seriously develop and support the Medical Tourism Industry.

The proposed model is a mixed model, based on the cooperation between local and foreign doctors, where investors’ objectives are independently established and pursued but where local and foreign health professionals jointly operate medical tourism projects.

Medical Tourism will have to be an opportunity for Belize to increase its medical preparation and expertise and where foreign investors commit in helping the country achieving these objectives as the counterpart for the opportunity and incentives offered by the country of Belize.

3.4.1 Three Components of the Strategy The Country Strategy will be based on three main components each of one needing specific implementation activities.

A comprehensive Sector Strategy will have to take into consideration the reality of the country, the specific sensibilities involved but also the overall interest and need for the country to look for new wealth, business and employment opportunities.

The balance has to be a ¨Belizean way¨ as the result of a broad consultation as the one that has been developed during the first and second mission of the consultant to the country.

This process has been, to certain extent, the context for BMDA to include political issues (as the approval of a Medical and Dental, a Pharmacy and a Nursing Act) not necessarily, entirely related with the scope of the consultancy. Certain aspects, like the need for a more transparent medical licensing process and the inclusion of a recertification model do are related with the scope of making of Belize a competitive medical tourism destination; but





other aspects, like the possibility to account for an autonomous Medical Council, have to be part of a separate, direct negotiation between the medical community and the Government of Belize, particularly the Ministry of Health.

That said, the following strategy is considered as giving appropriate answers to major concerns and properly promoting a sustainable development model of the medical tourism industry.

Local Healthcare Capacity Improving

Program

• Technical and ]inancial assistance to existing clinics and hospitals

Human resources

development • Training and continuing education programs

Foreign Investments in New Medical Tourism Projects

•  Foreign Capital with foreign-‐local participation





The three components of the strategy are:

1. Local Healthcare Capacity Improving Program

A structured technical and financial assistance program to support existing clinics and hospitals to achieve International Quality and Patients Safety Standards

2. Human resources development

The promotion of training and continuing education programs and initiatives in order to improve the level of preparedness and specialization of Belizean healthcare and tourism sector.

3. Foreign Investments in New Medical Tourism Projects

The attraction of Foreign Capital to develop new state-of-the-art medical tourism projects where foreign and local health professionals interact, operate and exchange experiences under a model already in place in the country at hospitals and clinics that regularly invite foreign professionals to jointly offer local patients more curative options than the ones currently available in Belize.

3.4.2 Three Stages of the Strategy Existing conditions in the country, the time needed to achieve significant results in healthcare related programs, actual trends in the medical tourism arena, imply the sector strategy to see a development on ¨stages¨ where variables are the type of investment projects to be expected, degree of participation of existing clinics and hospitals, level of involvement of foreign doctors.





STAGE 1 (1-‐2 years) • Foreign Investments in Innovative Medical Tourism Projects (stem cells, anti aging, fertility) • Foreign practitioners performing non available surgeries and providing training opportunities to local profesionals • Local cllinics performing phase 1 procedures in clinics in process of accreditation • Technical and ]inancial assistance to local operations

STAGE 2 (2-‐3 years) • Initial Accredited local capacity • Foreign/local practitioners • Incentives to Belizean Nurses and Doctors to return to Belize • Foreign Investments in more complex, comprehensive medical tourism projects

STAGE 3 (+5 years) • Signi]icant Accredited local capacity • Signi]icant Specialized local offer of practitioners • Foreign Investments in Specialized medical tourism projects





4 Action plan for the implementation of the strategy

4.1 Legal framework

4.1.1 Institutionalization of Medical Tourism • Declaration of National Interest for Medical Tourism Industry

o Creation of a National Commission on Medical Tourism § Composition

• Representative of the Medical Tourism Cluster (BELHEALTH)

• Ministry of Health • BTB • Ministry of Tourism • BELTRAIDE • Ministry of Trade • Belize Medical and Dental Association

§ Role of the National Commission on MT • Developing a National Plan of Promotion of the Medical

Tourism Industry in Belize • Approving International Accrediting Bodies • Providing approval of Implementation Plans of Medical

Tourism Projects about local professionals involvements and national convenience

• Developing a National Seal of Quality for Medical Tourism Providers to enhance quality and where to include different components of a ¨Belize Safe Destination for Medical Travelers¨ program

§ Executive Secretariat • An Executive Secretariat will be created in order to represent

to ¨One Stop Shop¨ for every company willing to receive guidance in terms of requirements to comply, financing and technical assistance opportunities, training, promotional activities. Each one of the components of the National Commission on Medical Tourism will provide the necessary funds in order to





4.1.2 Quality Assurance • International Ethical-Scientific Committee

o Creation of an International Ethical-Scientific Committees to analyze convenience of Medical Research Projects presented to the Government for approval and to protect human beings involved in the research projects. International participation in Committees is strongly recommended when complex issues like stem cells or other innovative research projects are presented for approval in Belize. This will legitimize decisions taken by the Government and reduce external pressures from interested parties like foreign regulating authorities. A fee for project will be established in order to finance review process. The Committee will have the power to suspend investigation at every stage when patient’s rights are at stake. For this reason the Committee will have to perform periodic inspections.

o Important elements of Ethical-Scientific Committees are: § Independency from researcher and sponsor; § Made up of at least 5 members; § Both genders representation; § With a member coming from the non-scientific community

o The strengthening of the existing Committee in the Ministry of Health represents an option instead of creating a new entity. This will imply including international experts in the committee and providing it with the necessary resources to operate, through the fee to be paid by the sponsor of the research project.

• Minimum Requirements for Medical Tourism companies

o A regulation of Ministry of Health, Tourism and Trade on Medical Tourism

will establish mandatory minimum requirements for clinics, hospitals and tourism providers willing to be internationally promoted by BTB, BELTRAIDE and other Governmental agencies:

§ Hospitals • National licensing • All health professionals licensed • Holding the specialty needed to perform the surgery • JCI or similar (approved by MT Commission)

§ Ambulatory facilities • National licensing • All health professionals licensed





• AAAASF or AAAHC or similar (approved by MT Commission)

§ Hotels • No more than 30 minutes from an hospital • Having protocols in place to respond to emergencies • Providing ambulance service

§ Tour Operators and Transportation companies • CPR training of all guides and drivers • Having protocols in place to respond to emergencies

• Revision of Medical and Dental Act

o National Medical Professionals Licensing § Including Continuing Medical Education as a necessary requirement

to maintain licensing.

o Foreign Medical Professionals Licensing. Basic and additional requirements: § Certificate of Good Conduct § A copy of physician’s Medical License § A copy of physician’s Board Certificate (or appropriate

documentation for specialization for the country, fellowship training documentation, or diplomas indicating specialty training)

§ Fee to practice in Belize (designated to a Continuing Medical Education Fund)

§ Obligation of providing social service for one day per month. The Ministry of Health will be in charge a making the necessary arrangements in cooperation with regional health managers, according to the specific needs.

• Revision of Licensing of Clinics and Hospitals § Minimum requirements have to be established in the following

categories, depending on the area of practice: • Human resources • Infrastructure • Equipment • Documentation

§ When foreign doctors are involved in the clinics or hospitals, a mandatory involvement of local physicians in their operation must be granted. A detailed plan on the involvement and educational opportunities provided to local physicians will be reviewed by the MT Commission, which will provide to the Medical Council its





binding opinion. The clinic or hospital will have the possibility to present a new plan according to the suggestion of the MT National Commission.

4.1.3 Competitiveness • Investment Incentives

o Fiscal Incentive Program specifically offered to new local and international healthcare or medical tourism projects, as well as to remodeling, renovations, annex buildings projects of existing facilities.

o Incentives should at least include § Import Duties and Sales Tax exemption on all necessary materials,

machinery and equipment to operate o Some countries are also offering exemption on corporate taxes for a number

of years to medical tourism investors. Even if considered not essential for a country to be attractive as destination for medical tourism investments, limited tax breaks could be taken into consideration by the Government in order to provide the Belizean private healthcare industry with higher level of competitiveness.

• Brain return o Incentives to Belizeans healthcare professionals willing to return to Belize

(extension of QRP Program to Belizeans living abroad) • Statistics

o Inclusion in Arrival Record Format of Health and Wellness as an option in question N.13 ¨Purpose of Visit¨. This will help the country monitoring and measuring the advances of the country strategy on medical tourism.

4.2 Risks mitigation: ¨Belize Safe Destination for Medical Travelers Program¨

The fundamental components for a National Program to offer a safe experience to medical tourists to Belize are the following:





• Malpractice and General liability Insurance

o Hospitals and clinics have to account with General Liability coverage. It would be part of the Seal of Quality to be developed by the Medical Tourism Commission

o Doctors have to account with Malpractice Liability coverage. It would be part of the Seal of Quality to be developed by the Medical Tourism Commission

• Complications insurance

o All patients travelling to Belize should be offered a Travel and Medical Complications Coverage to reduce responsibilities when travel related accidents and complications related to medical practice (and not due a malpractice)

• Dispute settlement

o In addition to the existing protection through the Belizeans Judicial System, the country has to offer a Mediation, Conciliation and Arbitration Instance to solve

• Emergency Response System

• Follow Up Network

• International arbitration

• General liability – professional – complication coverage

• Quality standards

LIABILITY of commercial

partners

RESPONSIBILITY of the providers and Insurance

coverage

EMERGENCY RESPONSE

and CONTINUUM

OF CARE

CONCILIATION AND

ARBITRATION clause





eventual conflicts between patients and providers, or commercial partners and providers

• International Accreditation

o The compliance of International Accreditation requirements (as the one to be included in the Medical Tourism Order) not only represents a strategic decision of the country to enhance quality standards on health and tourism services but also limits the liability of commercial partners to Belize (like insurance companies, self funded employers, facilitators) when intentionally driving patients from other countries to Belize

The Role of International Accreditation in the Global Healthcare Industry

As Americans seek care in other countries, they look for reassurance that health care organizations abroad meet certain quality and safety standards they have come to expect. Therefore, hospitals and clinics abroad who hope to attract Americans to their institutions have been seeking International accreditations such as Joint Commission International, AAAASF or AAAHC, because they demonstrate to the international community that the hospital or the clinic has voluntarily sought an independent review of its commitment to safety and quality, and has met standards that contribute to good patient outcomes.

Why an International Accreditation for Belizeans Healthcare providers?

Patients’ Perspective: Legitimizing Medical Travel • Patients too often have been referred to as customers

o Reframes the situation as a business transaction not healthcare o Patients want to be the focus of care not a target for revenue

• Lingering suspicion of quality for out-group patients o Skeptical of care in developing economies o Native patients tend to trust care in their country more o Websites about Belize indicate “decent” healthcare but suggest seeking care in

Mexico, Guatemala, or back in the US o International patients’ biggest anxiety is the quality of the healthcare provided

Providers’ Perspective: Compete Internationally • Establish a global level of safety through accreditation

o Data indicates equivalent safety in accredited clinics regardless of locale o More participants associate the location with quality and safety

• Lets patients focus on the destination and cost saving o Patients may opt for treatment in a more desirable location o Medical travel can be inbound or outbound o Total cost of care, travel, and additional leave compared to domestic care





• Emergency Transportation o Patients` safety throughout the whole experience of an international patient in

Belize necessarily needs a reliable emergency transportation system to make sure a patient can be safely, quickly and with the support of qualified health professionals, moved to equipped hospitals. Transportation can be by land, air or sea depending on the location of the medical tourism provider.

• Follow Up Network

o Providing continuity of care when patients go back to their home countries is one of the key elements to offer a safe experience to people visiting Belize for care. This service can simply be the result of a commercial alliance with hospitals, group of doctors (why not Belizeans doctors living in the US) or other healthcare services providers

4.3 Cluster structuring • Creation of a specialized private, independent agency recognized by the

Government: BELHEALTH. This agency will be representing the specific interest of the country to become a leading destination for medical tourism. It will be a self -regulating, training facilitation and country promotion entity made up of chambers, medical and dental private institutions, tourism companies, universities, banks, insurance companies and any other organization directly or indirectly related and interested in the development of medical tourism in Belize. It will have a representative in the National Commission of Medical Tourism.

• Involvement of related services: o Airlines (negotiations of special rates and additional services to medical

tourists) o Banks (financing to clinics to improve their standards of quality) o Insurance (specific products for medical tourism: general liability,

malpractice, complications coverage)

4.4 Human Resources In order to improve the preparedness of the country as leading medical tourism destination there are necessary actions to take in term of technical training and medical education:





• Technical Training

o ITVET will be invited to include specific programs in its portfolio. Private Universities and other Technical Institutes will support the strategy. The focus will be on the following topics:

§ Emergency protocols for Hotels, Tour operators § Bio-Medical Devices maintenance § CPR for tour guides (Concierge), drivers and hotel personnel § Bio-infectious waste management § Marketing and Customer Service to health personnel

o New profiles. Universities and Technical Institutes are invited to open new

courses to form the following new profiles

§ Medical Concierge (a specialized tour guide managing basic medical knowledge, CPR and First Aid training, marketing and sales basics, customer service. This is the person attending patients throughout the whole process in Belize. He offers his services to medical tourism facilitators, clinics and hospitals, tour operators)

§ International Patients Manager (a managerial profile in charge of International Patients Programs both in healthcare facilities or hotels and recovery centers dedicated to medical tourism. Among necessary skills: marketing and sales; insurance; legal issues; basic medical knowledge; customer service)

• Medical Education

o Belize needs a Medical School and Teaching Hospital offering clinical training in order to increase its capacity to generate the number and quality of health professionals the country needs. It could be a joint effort between a local University, the Government and a foreign Academic institution

o Development of a Cooperation Program with foreign Medical Schools in order to promote the level of training of Belizeans doctors. Alliances with Schools and Hospitals in the US or Europe are preferable to achieve country goals. Alliances with countries like Mexico and Costa Rica can also be taken into account.

§ Alliances could include a joint investment in creating a Medical School in Belize; negotiation by the Ministries of Education and Health of special rates and scholarships for Belizeans willing to study medicine abroad; affiliations between Belizeans Universities





and Hospitals, and Foreign Medical Schools and Hospitals in order to provide fellowships and training opportunities to Belizeans.

o The number of specialists in the country can be increased with the mentioned Fund for Fellowships outside Belize that can receive additional money from the Government, International Banks, and International Cooperation.

4.5 Capacity Building In order to increase local capacity to provide excellent levels of healthcare a comprehensive capacity building program is necessary. It involves providing financial and technical assistance to hospitals, clinics, recovery hotels and other related services providers to comply with International Standards of Accreditation.

Private Banks, International Bank, Cooperation Agencies should be involved to create specific programs for this industry. Elements to be included are the following:

• Bio-Medical technology improvement • Infrastructure • Safety protocols and environment • International Patients Department • Regulatory, legal, responsibility issues

Some potentially available options are:

o IDB Technical Capacity Building and Financial Assistance programs for

local hospitals and clinics, like FINPYME CARIBBEAN and other ad hoc programs

o New IDB/BTIA ¨Improving Small Business Competitiveness in the Tourism Industry¨ project specifically focused on small hotels, transportations companies, tour operators willing to enter medical tourism market

o EXIM Bank (Financing of Medical Devices manufactured in the US) o CARIBBEAN EXPORT Development Agency





4.6 Foreign Investment

4.6.1 Potential target investors to be prioritized As far as Investment Promotion is concerned, the main targets of BELTRAIDE Strategy will be the following:

• Doctors (individuals and groups) • Hospitals Groups • Real Estate Developers • Retirement Communities Operators • Investment Funds specialized in long term assisted living projects (for example

members of the National Investment Center for the Senior Housing & Care Industry NIC)

• Hotel Chains specialized in Hospitality in Health

United States and Canada can be considered the main areas where to focus the Investment Attraction Strategy.

Mexico and at some point Guatemala are also an interesting source of investments, mainly on the side of Doctors and Hospitals willing to open a subsidiary in Belize. Mexican Hospitals located in States like Nuevo Leon (Monterrey) for the problems facing with security issues might be a priority target.

4.6.2 Specific Geographic Areas for New Investments in Medical Tourism It is important to consider that the investor is the one taking the decision about how, where and when. Cost of land, accessibility, strategic partnerships are some of the elements that could intervene in the decision of the investor (local or foreigner).

Nevertheless, objective considerations like accessibility, existing health and tourism capacity, available infrastructure, determine the existence of areas with a higher potential to be designated as medical tourism centers:

• Belmopan

o The capital city, protected from hurricanes, home of Government and Embassies personnel, strategic platform to visit Western and Southern tourism attractions. It would be an ideal location for a Teaching Hospital, focused also on international patients.





• San Pedro o Important tourist destination, with an important offer of accommodation

solutions, already home of small clinics and hosting different projects to create medical tourism centers.

• Placencia o High-end tourism destination, soon connected to the world by an

international airport, home of amazing retirement resorts, It is an ideal destination for state-of-art medical facilities providing healthcare services to retirees and medical tourist.

• Belize City o Already home of 80% of the existing medical and dental capacity, connected

by the main international airport, destination for cruise ships. It is the ¨ready to go¨ destination for medical tourists to Belize if and only if existing clinics and hospitals commits with increasing their quality standards and engage in a remodeling process to make their facilities more attractive to international patients

But again, this shouldn´t be a reason for not supporting existing or future projects in different areas. Areas like Santa Elena, Orange Walk, Corozal and Blue Creek have shown the interest of developing medical tourism project and the Government should be committed to support them when complying with quality and patients safety standards.

4.6.3 Types of prospected investments Belize is likely to receive the following type of investments, related with medical tourism and retirement living:

• Fully integrated resorts with medical SPAS, dental clinics, recovery retreats and

long term assisted living residential opportunities • Specialized Centers in Alternative Medicine (stem cells, cancer therapies, anti

aging, rehab) • Continuing Care Retirement Communities • Teaching Hospital in the areas of Belize City or Belmopan • Necessary major investments

o Cruise ships dock (it will allow a safer logistic to passengers willing to go through more invasive procedures)

o International Airport in Placencia (it will accelerate the development of a retirement and healthy living cluster around a group of projects focused on retirement living and medical tourism)





4.7 The Role of the Government Implementing a comprehensive strategy on medical tourism will imply the participation of a number of public institutions related in some way with this industry.

Once the strategy has been reviewed and approved it is important to formalize this commitment with a Declaration of Public Interest of Medical Tourism and assigning a representative in each institutions in charge of being the contact point and responsible for the follow up of any issue related with medical tourism.

Nevertheless, it is necessary that one specific institution, in this case BELTRAIDE, as the official counterpart to COMPETE CARIBBEAN, to take the lead of the whole process of developing a medical tourism industry in Belize, until a proper and exclusive dedicated Executive Secretariat to be in operation.

• Investment promotion • Corporate Buyers strategy

BELTRAIDE

• Country promotion (consumers) • Quality assurance of tourism services BTB

• Licensing of clinics and hospitals MINISTRY OF HEALTH

• Licensing of health professionals MEDICAL COUNCIL

• Incentives MINISTRY OF TRADE

• Technical training (technicians, CPR, medical equiments maintenance) ITVET • Promotion through the Embassies and Consulates

MINISTRY OF FOREIGN AFFAIRS





About the Role of BELTRAIDE as responsible for the follow up of the implementation process of medical tourism work plan, there are certain elements of high importance to be taken into account:

1. Communication

The Country Strategy of Medical Tourism shall be properly marketed within the country to key stakeholders and the society.

For example, it is important to present the strategy on ¨Medical Tourism¨ not as just an investment opportunity but as a country development opportunity where foreign investment to be only one of its components and where the main goal is providing Belize with new business, job and educational opportunities.

2. Expertise

BELTRAIDE will have to develop specific expertise in the medical tourism industry by participating at international conferences, receiving specific training, organizing specific activities and seminars in the country.

It is important to designate an officer or group of officers as responsible for this area, taking into consideration the particularities of the industry.

3. Relationship with the Private Sector

Since it represents a new sector to BELTRAIDE it is important to establish a closer relationship with private stakeholders like doctors, clinics, hospitals, medical groups, tourism providers like tour operators, hotels and transportation companies.

A specific communication tool could be developed (newsletter) in order to provide useful information about trends, events, training opportunities and industry providers.





5 Communication and marketing strategy The communication and marketing strategy for Belize`s medical tourism industry will have three main components:

1. A FDI Attraction Strategy aiming to attract investments to the medical tourism

industry 2. An Export Promotion Strategy focused on key industry players like insurance

companies, self funded employers, affinity groups, doctors groups, retirement associations

3. A Consumer focused Marketing Strategy aiming to position Belize as a destination to improve general health conditions: ¨Be smart, Feel Better, Belize¨

5.1 List of procedures Considering the existing capacity of the country in terms of quality, experience and patient’s safety, the approach in terms of Export Promotion and Country Marketing will have to be based on different phases.

Stage 1

Dentistry Dermatology Ophtalmology Gastroenterology Laparoscopy Preventive Medicine Phyisical Rehab Anti aging Wellness •  SPA •  Traditional treatments

Stage 2&3

Spine Surgery General Surgery Gynecology Orthopedic Surgery Bariatric Surgery Plastic Surgery Rehabilitation from addictions Fertility treatments





It is understood that in terms of Investment Promotion there will be the possibility that the investors, considering their areas of expertise, to promote projects in different areas that the ones identified according to local, existing capacity.

5.2 Most appropriate geographic territories to be targeted The Export Promotion Strategy and Consumer Focused Strategy will be focused on the geographical areas where Belize account with a competitive advantage and that can generate the major flow of patients.

Proximity, direct flights connections, origin of tourists visiting Belize, situation of healthcare in home countries are some of the elements that make the country very attractive for medical travelers proceeding from:

1. United States 2. Canada

Concerning the US, States with direct flights to Belize like Georgia, Florida, Texas, North Carolina should be the first destinations to be targeted by promotion authorities of Belize.

UNITED STATES

EUROPE •  UK

CANADA





Additionally, Europe seems to be a potential market for Belize considering its history and the number of tourists’ arrivals from countries like the United Kingdom, Germany, Netherlands, France and Italy.

The strategy to attract medical tourists from Europe will have to be different from the one focused on North America. Particularly, packages offered to European medical travellers will have to be focused on elective-esthetic procedures combined with non invasive-wellness and tourism activities that justify a longer travel and add value to the experience considering the competition from nearer, regional competitors like East Europe and Turkey.

There is a potential opportunity with smaller Caribbean Islands that doesn`t account with a quality healthcare offer. The possibility to attract patients from these places, and to compete with other destinations like Colombia, Barbados and Jamaica, largely depends on the possibility to provide an easy and affordable access to Belize in terms of flights connections.

6. Final recommendations Establishing a medical tourism industry will need moving to the next two important steps:

1. Cluster structuring, and 2. Implementation

During both phases, external help in terms of consultancy, financial and technical assistance are important to really transform a strategy into reality.

The first step, that is transcendental to secure a proper, organized and continuity in implementation is cluster structuring, hopefully promoting the creation of a private, independent body (BELHEALTH), closely supported by the Government, to achieve the following goals:

• Representation of country`s interest to become a medical tourism destination

• Self regulation

• International promotion

• Training opportunities

• Networking

• Competitiveness

• Public-private partnership





On the other hand, it is essential to define the public entity in charge of coordinating the effective implementation of the Strategy. BELTRAIDE, thanks to its experience in dealing with private stakeholders, foreign investors and promotional activities is recommended to take lead of the follow up of the strategy in close cooperation of other main entities part of the Medical Tourism National Commission like BTB and Ministry of Health.

In this sense, BELTRAIDE would be the recommended agency to act as catalyst during the initial phase until an Executive Secretariat of the National Commission on Medical Tourism is fully into force.





ANNEXES

A) Matrix of Action Plan Legal Framework

Objective Action Type Owner

Institutionalization Declaration of National Interest of the Medical tourism Industry Legislation

Cabinet (Ministries of Health, Tourism and Trade)

Quality Assurance Ad-hoc International Ethical-Scientific Committee Regulation Ministry of Health

Quality Assurance Minimum Requirements for Medical Tourism companies Regulation Ministries of Health,

Tourism and Trade

Quality Assurance Revision of Medical and Dental Act Legislation Ministry of Health

Quality Assurance Revision of Licensing for Clinics and Hospitals Legislation Ministry of Health

Quality Assurance Creation of a National Seal of Quality for Medical Tourism Coordination MT Commission and

Private Sector

Competitiveness Investment Incentives Regulation Ministry of Trade

Competitiveness Brain Return Regulation Ministry of Tourism

Competitiveness Statistics Regulation Ministry of National Security

Risks Mitigation Objective Action Type Owner

Malpractice and General Liability Insurance

Development of a Specific Insurance product to be offered to Doctors and Clinics

Coordination MT Commission with Private Sector

Complications insurance

Inclusion in Medical Tourism Packages of a Complications Coverage


Dispute settlement Inclusion in Inform Consents and Contracts an International Arbitration clause


International Accreditation

Inclusion as mandatory requirement for clinics and hospitals willing to be

Regulation Ministries of Health, Tourism and Trade





promoted internationally

Emergency Transportation

Implementation of a nationwide emergency response system

Coordination Ministries of Health and Tourism with Private Sector

Follow Up Network Implementation of a Follow Up network in the US and Canada Coordination MT Commission with

Private Sector Cluster Structuring

Objective Action Type Owner

Private Sector Organization

Creation of a private, independent, non-profit organization representing sector´s interest in medical tourism

Coordination BELTRAIDE with Private Sector

Involvement of related services

Generation of alliances with related services providers, necessary to achieve a proper implementation of action plan

Coordination BELTRAIDE with Private Sector

Human Resources Objective Action Type Owner

Technical Training

Design of specific training courses for Health and Tourism companies and professionals

Coordination Ministry of Education with Private Sector

Technical Training

Design of new technical programs for new profiles needed in the medical tourism industry

Coordination Ministry of Education with Private Sector

Medical Education Opening of Medical Schools for Clinical Training in Belize Coordination

Ministries of Health and Education with Private Sector

Medical Education Establishment of Partnerships and Alliances with Foreign Medical Schools

Coordination Ministries of Health and Education with Private Sector

Medical Education Creation of a Medical Fellowships Fund Regulation Ministry of Health

Capacity Building Objective Action Type Owner

Financial and Technical Assistance

Design of Projects and Establishment of Alliances in order to provide financial and technical assistance to local healthcare and tourism

Coordination

BELTRAIDE with Private Sector and Local and International Banks





providers interested in medical tourism

Foreign Investment Objective Action Type Owner

Foreign Investment Strategy

Development and Implementation of a FDI Strategy for the medical tourism sector in Belize

Coordination BELTRAIDE

Communication and Marketing Objective Action Type Owner

Communication and Marketing Strategy

Development of a National Country Promotion Strategy on Medical Tourism

Coordination MT Commission





B) Flow Chart of Medical Tourism Services

PATIENT

Services providers

In the country

Transportation

Emergency

Tour operators

Rent a car

Arlines

Accomodation

Hotels

Apartments

Recovery centers

Healthcare

Hospitals and clinics

Pharmacies

Leisure

Tours

Souvenirs

Cultural activities

Restaurants

Outside the country

Drivers

Facilitators

Insurance

Employers

Logistic Travel agencies

Airlines

Medical services

Family doctor

Follow up provider

Industry providers

Medical devices Financial services

Non ]inancial services

Academy

Emergency response





C) Guidelines for a follow up project to provide financing and technical assistance to the MT sector

Overview

The successful implementation of the sector strategy on medical tourism requires the establishment of an effective Public-Private Partnership. Particularly, there is the need to create a dedicated agency to facilitate the implementation of the proposed action plan and promotional strategy.

Since the majority of companies involved in the medical tourism industry are micro, small and medium enterprises (MSMEs) like medical and dental offices, small clinics, bed and breakfast hotels, and small tour operators, it is necessary to provide them with financing and technical assistance in order to achieve a international standards of accreditation.

The focus of the Sector Strategy is a ¨Belizean Way¨ to the internationalization of healthcare services providing mechanisms like a Fellowships Funds, mandatory Social Service for foreign practitioners that will help in the medium term enhancing access to basic services.

Target companies • Clinics and local practitioners willing to start a process of international accreditation

in order to start offering services to international patients; • Small hotels and other tourism providers (transportation, tour operators) willing to

convert their operations for offering specialized services to medical tourists (¨recovery centers¨, medical concierges, medical tourism facilitators)

Components • A credit line specific to private clinics and medical practitioners for investment in

equipment, infrastructure and accreditation costs • Technical Assistance for these beneficiaries in skills and marketing training as well

as training in standards and accreditation • Technical support to small hotels and other tourism providers to convert their

operations for offering specialized services to medical tourists • Consultancy to establish a private, independent, nonprofit agency to represent the

specific interest of the country to become a leading destination for medical tourism.

Counterparts to the financing institution • BELTRAIDE Belize Trade and Investment Development Service (institutional

counterpart) • BMDA Belize Medical and Dental Association (healthcare component)





• BTIA Belize Tourism Industry Association (tourism component)

Credit line fundamentals (preferable) • Significantly lower interest rates than available in commercial banks • Grace period of 2 years until the medical tourism program to be fully in operation

Content of the technical assistance • Healthcare

o ABC of medical tourism o Importance of the certification and of quality systems o International standards of certification o Safety requirements for healthcare providers (General Environment;

Operating Room Environment; Recovery Room Environment; General Safety in the Facility; Fluids and Medications; Medical Records (Appropriateness of Patient); Quality Assessment, Quality Improvement; Personnel (Quality of Practitioner); Anesthesia

o How to design a medical tourism program in your hospital/clinic o International buyers of Healthcare o Marketing and Sales of healthcare services

• Tourism o ABC of medical tourism o Management, planning and implementation systems o Provision of services o Adverse events o Preventive management and corrections o Quality and Safety requirements for tourism providers o How to create a medical tourism package o Marketing and Sales in medical tourism

Entry profiles • Healthcare

o Commitment to enter into a process of international accreditation o Being a facility with an Intensive Care Unit or being located in an area

where a facility with an ICU can be reach in less than 30 minutes • Tourism

o Demonstrated interest in offering services to medical tourists o Being located in an area where a facility with an ICU can be reach in less

than 30 minutes





Acronyms and abbreviations

AAAASF = American Association for Accreditation of Ambulatory Surgery Facilities

AAAHC = Accreditation Association for Ambulatory for Ambulatory Healthcare

BELTRAIDE = Belize Trade and Investment Development Service

BTB = Belize Tourism Board

BTIA = Belize Tourism Industry Association

CPR = Cardiopulmonary Resuscitation

EXIM = Export-Import Bank of the United States

FDI = Foreign Direct Investment

IDB = Inter-American Development Bank

ITVET = Institutes for Technical and Vocational Education and Training

JCI = Joint Commission International

MT = Medical Tourism

NIC = National Investment Center for the Senior Housing & Care Industry

OR = Operating Room

OSHA = Occupational Safety and Health Administration (OSHA)

PACU = Post-Anesthesia Care Unit

QRP = Qualified Retirement Program

SME = Small and Medium Enterprises

SWOT = Strength Weaknesses Opportunities Threats

US = United States of America

End of document

final country strategy medical tourism belize

Documents

medical tourism sector

private sector

healthcare sector

sector development strategy

medical tourism clusters

marketing strategy

private date

medical travelers program