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Health and Wellness Market Health and Wellness Market Dynamics and Opportunities in Dynamics and Opportunities in

the Caribbeanthe CaribbeanMay 9, 2006 IDB Meeting

Private Investment Opportunities In The Caribbean Health And Wellness Sector

Dr. Leroy Miller

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Questions of the DayQuestions of the Day

Market OpportunitiesMarket OpportunitiesWhat are the market opportunities for the health and What are the market opportunities for the health and wellness sector in the Englishwellness sector in the English--speaking Caribbean?speaking Caribbean?

Next StepsNext StepsHow can we facilitate the marketHow can we facilitate the market--driven driven development of the health and wellness sector in the development of the health and wellness sector in the Bahamas, Barbados, Guyana, Jamaica and Trinidad Bahamas, Barbados, Guyana, Jamaica and Trinidad and Tobago?and Tobago?

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Purpose: catalyze and leverage private sector led development Purpose: catalyze and leverage private sector led development of the Caribbean Health and Wellness Marketof the Caribbean Health and Wellness Market

IDBIDBRepresentatives of Region 3Representatives of Region 3Private Sector Department (PRI)Private Sector Department (PRI)InterInter--American Investment CorporationAmerican Investment CorporationMultilateral Investment Fund (MIF)Multilateral Investment Fund (MIF)

Civil SocietyCivil SocietyTourism, Healthcare andTourism, Healthcare and

EducationalEducationalorganizations organizations and associationsand associations

Caribbean Public SectorCaribbean Public SectorRepresentatives of Bahamas, Barbados, Representatives of Bahamas, Barbados, Guyana, Jamaica, Guyana, Jamaica, Trinidad andTrinidad andTobagoTobago

Private Return on InvestmentDevelopment Mandate

Market Opportunities and Next Steps

Private Sector Investors Private Sector Investors and Partnersand Partners

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An integrated health and wellness An integrated health and wellness market strategymarket strategy

Eldercare

Alternative Health

Telehealth

Medical Tourism

Healthcare Education

Strategic Entry

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Situation AnalysisSituation Analysis

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Health and Wellness Products and Services are a Major Health and Wellness Products and Services are a Major Opportunity for the EnglishOpportunity for the English--Speaking CaribbeanSpeaking Caribbean

Aging population driving global Aging population driving global demand for health and wellness demand for health and wellness services and productsservices and productsCurrent healthcare spending in Canada, Current healthcare spending in Canada, US and UK totals $2.3 trillionUS and UK totals $2.3 trillionUS alone will spend $4 trillion or 20% US alone will spend $4 trillion or 20% of GDP within 10 yearsof GDP within 10 yearsGrowing use of alternative and Growing use of alternative and complementary health services and complementary health services and herbal remediesherbal remediesTelehealth Services growingTelehealth Services growingWorldwide demand for healthcare Worldwide demand for healthcare professionalsprofessionals

Barbados, Bahamas, Guyana, Jamaica, Barbados, Bahamas, Guyana, Jamaica, Trinidad and Tobago Trinidad and Tobago

EnglishEnglish--speakingspeakingHigh cultural affinity with markets in High cultural affinity with markets in North America and UKNorth America and UKProximity to North AmericaProximity to North AmericaClimateClimateBioBio--Diversity in marine life and Diversity in marine life and tropical rain foreststropical rain forestsTelecommunications services Telecommunications services improvingimprovingWorldWorld--Class Reputation for Empathy Class Reputation for Empathy and Clinical Excellence of Caribbean and Clinical Excellence of Caribbean healthcare professionalshealthcare professionals

Market Drivers Caribbean Competitive Advantages

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Potential Benefits of Health and Potential Benefits of Health and Wellness Sector for the CaribbeanWellness Sector for the Caribbean

More Jobs for Women More Jobs for Women andand Men Men High value added employmentHigh value added employmentExpansion and Diversification of EconomyExpansion and Diversification of EconomyEconomic incentive to protect environmentEconomic incentive to protect environmentImprove health and wellness servicesImprove health and wellness servicesImprove health and wellnessImprove health and wellnessTransition to a knowledgeTransition to a knowledge--based economybased economy

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Primary Challenge (and Opportunity?) for Primary Challenge (and Opportunity?) for Development of Health and Wellness Market Development of Health and Wellness Market

in the Caribbeanin the Caribbean

Brain Drain

Migration of Skilled Healthcare Personnel out of

Caribbean

U.S.U.S.

CanadaCanada

UKUK

Rest of Rest of WorldWorld

In U.S. alone – Shortage of one million nurses within 5 years

Worldwide Demand for Healthcare Professionals

Migration of Healthcare

HR into Caribbean from India

and Philippines

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Demand for Nurses in U.S. will accelerate Demand for Nurses in U.S. will accelerate Shortage in CaribbeanShortage in Caribbean

29%23227925Total

53%11322125Trinidad and Tobago

16%34216St. Vincent

4%18409St. Lucia

26%50192St. Kitts

23%5682457Jamaica

37%245667Guyana

4%16432Grenada

6%11177Dominica

21%192930Barbados

18%56320Antigua

% Vacancies

# of Vacancies

# of Registered Nurses PostsCountry

Source: Judith Smith Richards, Director, Human Resource Management & Development in the Ministry of Health, Jamaica, “Managed Migration of Nurses”; and U.S. Dept of Health and Human Services, Bureau of Health Professions, July 2002

Nurse Vacancy Rate in Caribbean Currently 29% U.S Nurse Shortage will

grow from 200,000 to nearly 1 million nurses

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Shortage of Healthcare Professionals Shortage of Healthcare Professionals not limited to Nursesnot limited to Nurses

Source: Pan American Health Organization (PAHO)

Nurses by Country in Last Available Year (Ratio per 10,000 Inhabitants)

78.5 73.4

23.8

51.2

16.528.7

8.6

0102030405060708090

U.S

.

Can

ada

Bah

amas

Bar

bado

s

Jam

aica

Trin

idad

an

d To

bago

Guy

ana

Physicians in Last Available Year (Ratio per 10,000 Inhabitants)

22.518.9

16.713.7

8.5 7.5

2.6

0

5

10

15

20

25

U.S

.

Can

ada

Bah

amas

Bar

bado

s

Jam

aica

Trin

idad

an

d To

bago

Guy

ana

Dentists in Last Available Year (Ratio per 10,000 Inhabitants)

5.4 5.7

2.51.9

0.8 0.90.4

0

1

2

3

4

5

6

U.S

.

Can

ada

Bah

amas

Bar

bado

s

Jam

aica

Trin

idad

an

dTo

bago

Guy

ana

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Educational Services, Healthcare and Business Educational Services, Healthcare and Business Services Fastest Growing Employment Sectors in U.S.Services Fastest Growing Employment Sectors in U.S.

Average Annual Rate of Change in Number of Jobs in the U.S.

2004-2014

2.9% 2.7%2.5%

1.6%1.2%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

Educationalservices

Health careand socialassistance

Professionaland business

services

Leisure andhospitality

Average forAll U.S.IndustrySectors

Average Annual Rate of Change in Number of Jobs in the U.S.

1994–2004

3.9%

3.0%2.7%

2.1%

1.2%

0.0%0.5%1.0%1.5%2.0%2.5%3.0%3.5%4.0%4.5%

Educationalservices

Professionaland

businessservices

Health careand socialassistance

Leisure andhospitality

Average forAll U.S.IndustrySectors

Job Growth 1994 to 2004

Source: BLS

Job Growth 2004 to 2014

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How to Plug the Brain Drain How to Plug the Brain Drain andandDevelop Health and Wellness in the Develop Health and Wellness in the

Caribbean?Caribbean?

Right now public healthcare universities and colleges of Right now public healthcare universities and colleges of the Caribbean are unintentionally training for export the Caribbean are unintentionally training for export ––with taxpayer moneywith taxpayer moneyChallenges to the Caribbean health and wellness sectorChallenges to the Caribbean health and wellness sector

More exits than entries of skilled professionalsMore exits than entries of skilled professionalsImpact on healthcare for the people of the Caribbean?Impact on healthcare for the people of the Caribbean?

How do we leverage market forces and develop world How do we leverage market forces and develop world class health and wellness products and services in the class health and wellness products and services in the Caribbean?Caribbean?

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Potential Strategy for Development of Potential Strategy for Development of Caribbean Health and Wellness SectorCaribbean Health and Wellness Sector

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Knowledge-based Entry Strategy

Create World Class Healthcare Training and Educational Facilities in the Caribbean

The Caribbean becomes the Global Destination for the Education of World Class Healthcare Professionals

Graduatesremain in the Caribbean or fulfill world-wide Demand

Leverage Scale:Students and Staff from the Caribbean, Diaspora, Asia, Africa, Europe, Latin America, North America

Prep Caribbean Students in Primary and Secondary School for Healthcare Professions

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Graduateswith Globally Recognized Credentials

Healthcare Education and Student Loan ModelHealthcare Education and Student Loan ModelWith Crossborder Loan EnforcementWith Crossborder Loan Enforcement

Public or PrivateWorld Class Healthcare Educational Institutions in the Caribbean

Employment in Caribbean Public Sector Healthcare(No interest loan with 10% principal reduction per year)

Public Private Partnership Student loan fund

Cross Border Loan Administrator

Student Loan Voucher

Employment in Caribbean Private Sector(low interest loan with 5% principal reduction per year)

Out-Migration (high interest loan repaid within 3 years)

Leverage Scale:Students from the Caribbean, Diaspora, Asia, Africa, Europe, Latin America, North America

Clinical Public Service Incentive

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Magnets for Employment in the Caribbean:Magnets for Employment in the Caribbean:Telehealth and Eldercare ServicesTelehealth and Eldercare Services

TelehealthTelehealthTelephonic and Telephonic and teleconferenced health teleconferenced health servicesservices

Opportunity to serve a Opportunity to serve a large and growing demand large and growing demand in North America and the in North America and the UKUKNatural Caribbean Natural Caribbean advantages in cultural and advantages in cultural and linguistic affinitieslinguistic affinities

EldercareEldercare““Caribbean EscapeCaribbean Escape””

Family Respite and Eldercare Family Respite and Eldercare with real Caribbean with real Caribbean HospitalityHospitalityPartnerships with North Partnerships with North American and UK nursing American and UK nursing facilitiesfacilities

Concierge Eldercare Concierge Eldercare CompanionsCompanionsFacilities for the Caribbean Facilities for the Caribbean parents and relatives of the parents and relatives of the Diaspora (funding through Diaspora (funding through remittances)remittances)

Remote monitoring and assistance for chronically ill and the elderly

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Telehealth Services Telehealth Services Telephonic Nursing ExampleTelephonic Nursing Example

Caribbean-Based Telephonic Nursing Center(200 nurses with Headsets,

Broadband Computers and VOIP)

Outbound Calls

Patients in North America with Chronic Conditions (Diabetes, Hypertension, CHF,

COPD…)

PAYORSHealth Insurance Companies, Medicare and Medicaid

(in order to avoid the high cost of hospitalizations)

Disease Management Companies

Who Pays for this?

Caribbean Patients with Chronic Conditions (Diabetes,

Hypertension, CHF, COPD…)Mortality Rate from Diabetes Mellitus

in Last Available Year (per 100,000 pop)

94.5

70.0

57.5

36.6 32.925.2 23.7

0.010.020.030.040.050.060.070.080.090.0

100.0

Trin

idad

an

dTo

bago

Bar

bado

s

Jam

aica

Bah

amas

Guy

ana

U.S

.

Can

ada

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Diaspora is a Natural Market for Diaspora is a Natural Market for Caribbean EldercareCaribbean Eldercare

Caribbean Diaspora in the U.S.

301,790n/an/aThe Bahamas

279,254n/a52,172Barbados

1,088,644164,738197,398Trinidad & Tobago

765,283 162,425n/aGuyana

2,731,832716,513553,827Jamaica

Country Population (2005 est)

Ancestry and Living in the U.S. (2000)

Place of Birth and Resident in the U.S. (2000)

Source: U.S. Census

Eldercare for returning Diaspora and as remittance-financed care for parents and family members in the Caribbean

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Magnets for Employment in the Caribbean:Magnets for Employment in the Caribbean:CaribbeanCaribbean BrandedBranded

Health and Wellness Health and Wellness ProductsProducts & & ServicesServices

ProductsProductsCaribbean herbal remedies and Caribbean herbal remedies and pharmaceutical preparationspharmaceutical preparationsBioBio--Prospecting (Caribbean Prospecting (Caribbean Intellectual Property)Intellectual Property)Water Products ($90 billion Water Products ($90 billion industry, bottled water)industry, bottled water)

ServicesServicesCaribbean Spas and Hydrotherapy Caribbean Spas and Hydrotherapy (black water, salt ponds, healing (black water, salt ponds, healing ponds, mineral spas)ponds, mineral spas)Holistic and Alternative Holistic and Alternative Treatments (depression, pain, Treatments (depression, pain, cancer, AIDs, Alzheimers, cancer, AIDs, Alzheimers, Substance Abuse) Substance Abuse) EcoEco--Tourism with Caribbean Tourism with Caribbean Organic Herbal Farming (pick Organic Herbal Farming (pick your own tea)your own tea)

SMB Marketing Cooperative; Financing of medium sized JVs and start-ups; Micro-Loan Fund for entrepreneurs and start-ups, “Encyclopedia of Caribbean Herbal Remedies and Alternative Health Services”; Standards and Certification Study for Alternative Health Facilities and Products in the Caribbean”

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Potential DemandPotential Demand for for Caribbean Alternative HealthCaribbean Alternative HealthServicesServices: Nearly 75% of U.S. Adults have used : Nearly 75% of U.S. Adults have used

Complementary and Alternative MedicineComplementary and Alternative Medicine

Source: U.S. National Institutes of Health, CAM Survey, 2004

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U.S. Market Shows Strong Potential U.S. Market Shows Strong Potential for Caribbean Herbal for Caribbean Herbal ProductsProducts

Source: U.S. National Institutes of Health, CAM Survey, 2004

Rate of Use Among U.S. Adults who Use Natural Products-Top 10 Natural Products -

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Magnets for Employment in the Caribbean:Magnets for Employment in the Caribbean:Medical (Healthcare) TourismMedical (Healthcare) Tourism

Strong competitors in Strong competitors in Medical TourismMedical Tourism

$2.2 billion medical tourism $2.2 billion medical tourism market in India within 5 years market in India within 5 years (McKinsey Report)(McKinsey Report)Thailand operating a 5,000 bed Thailand operating a 5,000 bed private medical tourism hospitalprivate medical tourism hospitalCuba, Costa Rica, Hungary, Cuba, Costa Rica, Hungary, Lithuania, Turkey, Israel, Jordan, Lithuania, Turkey, Israel, Jordan, South Africa, MalaysiaSouth Africa, Malaysia…………

Caribbean Medical Tourism a Caribbean Medical Tourism a nascent marketnascent market

Current market dynamic: Current market dynamic: outbound overwhelms inboundoutbound overwhelms inboundLack of international branding and Lack of international branding and international accreditationinternational accreditationNiche market opportunities in Niche market opportunities in cutting edge treatments (stem cell, cutting edge treatments (stem cell, cancer, AIDs, Alzheimers) and in cancer, AIDs, Alzheimers) and in Diaspora dental surgery?Diaspora dental surgery?

Regional opportunities?Regional opportunities?Staffing?Staffing?High Quality and Low Cost Elective

Surgeries and Procedures outside of Home Country

High and Low Quality and High Total Cost Elective Surgeries and Procedures

International portability of healthcare insurance?

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Caribbean Health and Wellness Caribbean Health and Wellness StrategyStrategy

Caribbean Branded Health and Wellness Products

and Services

Entry

Create World-Class Healthcare Training and Educational Facilities in the Caribbean

Telehealth and Eldercare Services

Grow Magnets for Employment and Economic Development in the Caribbean

World-Class Health and Wellness Professionals, Standards, Accreditation and Quality

Medical Tourism

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Challenges to Private Investment in the Challenges to Private Investment in the Caribbean Health and Wellness SectorCaribbean Health and Wellness Sector

Application process for medical licensing of Application process for medical licensing of international medical practitioners in the Caribbean?international medical practitioners in the Caribbean?Incentives and business climate for private investment Incentives and business climate for private investment in healthcare education institutions?in healthcare education institutions?Visa requirements for international students to enroll in Visa requirements for international students to enroll in public and private healthcare education institutions?public and private healthcare education institutions?Global accreditation of health and wellness Global accreditation of health and wellness professionals and institutions?professionals and institutions?Telecom services to enable international telehealth Telecom services to enable international telehealth competitiveness and online healthcare education?competitiveness and online healthcare education?Perception of Crime?Perception of Crime?

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Your Thoughts and ProposalsYour Thoughts and Proposals

Market OpportunitiesMarket OpportunitiesWhat are market opportunities for the health and What are market opportunities for the health and wellness sector in the Englishwellness sector in the English--speaking Caribbean?speaking Caribbean?

Next StepsNext StepsHow can we facilitate the marketHow can we facilitate the market--driven driven development of the health and wellness sector in the development of the health and wellness sector in the Bahamas, Barbados, Guyana, Jamaica and Trinidad Bahamas, Barbados, Guyana, Jamaica and Trinidad and Tobago?and Tobago?

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Private Investment Opportunities In The Caribbean Health And Wellness Sector

May 9, 2006 AgendaMay 9, 2006 Agenda

A Private Sector Perspective on the Health A Private Sector Perspective on the Health and Wellness Market in the Caribbean and Wellness Market in the Caribbean (15 minutes each)(15 minutes each)

Richard Rakowski, Partner, Kidd & Richard Rakowski, Partner, Kidd & CompanyCompanyDavid Bythewood, Esq, South David Bythewood, Esq, South Eleuthera ProjectEleuthera ProjectDr. Henry Lowe, Chair, Blue Cross of Dr. Henry Lowe, Chair, Blue Cross of JamaicaJamaica

IDB: Who we are and how we can support IDB: Who we are and how we can support private sector investment private sector investment

PRI, IIC and MIF (10 minutes each)PRI, IIC and MIF (10 minutes each)Country Panel Country Panel –– how we can assist health how we can assist health and wellness sector investment and wellness sector investment

Bahamas, Barbados, Guyana, Jamaica, Trinidad and Bahamas, Barbados, Guyana, Jamaica, Trinidad and Tobago (6 minutes each)Tobago (6 minutes each)

Investment Working GroupsInvestment Working GroupsThree Working GroupsThree Working Groups

Healthcare EducationHealthcare EducationTelehealth/EldercareTelehealth/EldercareWellness and Alternative HealthWellness and Alternative Health

What are the Market Opportunities and What are the Market Opportunities and Next Steps?Next Steps?(five minutes or less for each panelist)(five minutes or less for each panelist)

Reports from Working Groups Reports from Working Groups (10 minutes for each group rapporteur)(10 minutes for each group rapporteur)

IDB Wrap up and closing CommentsIDB Wrap up and closing Comments

Opportunity Overview Morning

Catalyze InvestmentAfternoon

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AppendixAppendix

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There is a Shortage of Health Care There is a Shortage of Health Care Workers Magnified by Global InequitiesWorkers Magnified by Global Inequities

Source: December 2004 WHO report: Addressing Africa’s Health Workforce, cited in: “Efforts under way to stem ‘brain drain’ of doctors and nurses”, Bulletin of the World Health Organization, February 2005, available at: http://www.who.int/bulletin/volumes/82/8/en/

Health Workers Density By Region

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Job Growth in the U.S.Job Growth in the U.S.

1.21.2100.0100.0100.018,927.616,366.4164,539.9145,612.3129,245.9Total for all BLS Industry Sectors

1.6 2.1 8.9 8.6 7.8 2,214.7 2,379.3 14,693.8 12,479.1 10,099.8 Leisure and hospitality

For Comparison

2.7 2.7 11.2 9.7 8.4 4,294.9 3,275.3 18,482.1 14,187.2 10,911.9 Health care and social assistance

2.9 3.9 2.2 1.9 1.5 898.1 871.6 3,664.5 2,766.4 1,894.8 Educational services

2.5 3.0 12.8 11.3 9.4 4,566.2 4,239.8 20,979.9 16,413.7 12,173.9 Professional and business services

2004–

2014

1994–

20042014200419942004–

20141994–2004201420041994

Average annual rate of change

Percent distributionChangeThousands of jobs

Industry sector

Source: BLS

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Selected Examples of Medical Selected Examples of Medical Tourism Market SizeTourism Market Size

$20 million350 (Est. )3500 (2000)Cuba

Target of 1 million foreign patients by 2012

80% from Indonesia and Malaysia

150,000 (2001)Singapore

$103 million (2001)< 10%100,000 (2001)Malaysia

2005: $330 million (est)$1.1 b to $2.1b by 2012

~10%150,000 (2004)Projections of 1 million+ (2012)

India

2005: $350 million70,000 (2004) (Bumrungrad)

350,000 (2004) (Bumrungrad)Thailand

Revenues from Medical Tourism

Number of European and N. American Med Tourists

Number of Medical TouristsCountry

Sources: Economist, British Medical Journal, Medical Devices & Surgical Technology Week, Company websites, Advertising Age, Tourism Review International, Bloomberg, IBS estimates.

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Number of Potential Medical Number of Potential Medical Tourists from Canada, U.K. and U.S.Tourists from Canada, U.K. and U.S.

195,00010%1,950,000Total

40,00010%400,000U.S.

80,00010%800,000U.K.

75,00010%750,000Canada

Number of Potential Medical Tourists for Elective Surgery

Barrier Multiplier

Number of Patients with Difficult Access to Elective Surgery ( on waiting lists or uninsured needing surgery)

Country of Origin

Source: International Business Strategies estimates.