oportunities04news12challenges34middleeastfocus24bioethicscontentsanddevelopmentsoverseasmedicalcare

04 NEWS

A round up of regional and international news

and developments

08 PARTNERSHIPOPORTUNITIESPublic Private Partnerships in Health Tourism

12 CHALLENGES Trends and Challenges in Medical Tourism

18 REGULAR COLUMNSlips and Tips, by Dr. Sanjiv Malik

20 HEALTHCARE MARKETINGGlobal Marketing Strategies for emerging trends

24 BIOETHICSMedical Tourism - Proceed with Caution

26 HEALTHCARE INSURANCEOverseas Medical Care Has Become an Option

for Employers

34 MIDDLE EAST FOCUSUAE: Can it share a slice of the pie?

CONTENTS HealtHcare travel MAGAzINE ISSUe 01 2008

08

26

12

34

20

24

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

Contents

FOREWORD ISSUE 01 2008

EDITOR Jenna Wilson Tel: +971 4 336 51 [email protected]

ADVERTISING SALES John Suzara Tel: +971 4 336 [email protected]

PUBLISHING DIRECTOR Simon Page [email protected]

DESIGN & LAyOUT Andreas Schmidt [email protected]

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

This publication may not be reproduced or transmit-ted in any form in whole or in part without the writ-ten consent of the publishers.

© Publications International Ltd. 2006Healthcare Travel magazine is published 4 times a year. For subscription information visit www.arab-healthonline.com and follow the link.

HEALTHCARE TRAVEL MAGAzINE IMPRINT

Foreword

HealtHcare has long seemed one of the

most local of all industries. Yet beneath the

bandages and emergency rooms, globalisa-

tion is thriving. The reading of x-rays and the

outsourcing of record keeping is already a

multi-billion dollar business. Hospitals and

clinics in the developed world are making a

habit out of recruiting nurses and physicians

from the developing world. The next growth

area for the industry is the flow of patients in

the other direction – known as “medical tour-

ism” – which is on the threshold of a dramat-

ic boom.

Travelling abroad for medical treatment is

one of the latest and biggest trends. Tens of

millions of middle-class Americans are unin-

sured or underinsured and soaring healthcare

costs are pushing them and cost-conscious

employers and insurers to look abroad for

cheaper healthcare. As such, the Healthcare

Travel industry is growing at 15 to 20 percent

annually and it is estimated that total gross

medical tourism revenues will rise from $56

billion today to $100 billion by 2012.

Under the guiding theme of “the Globalisa-

tion of Healthcare”, the Healthcare Travel

magazine aims to bring together all aspects

of medical travel in one publication keeping

you up-to-date with the development of this

growing sector. Time and money provide the

main incentives for seeking healthcare outside

the patient’s country. I hope you enjoy read-

ing this issue of Healthcare Travel magazine

and I welcome your comments, ideas and sug-

gestions.

Jenna Wilsoneditor

» SingapORE’S CliniCal serviCes are exCellent, with internationally aCCredited FaCilities and renowned physiCians. Beyond merely Being trained in the Best Centers internationally, singapore’s doCtors are well known and respeCted in the mediCal world «

H e a l t h c a r e T r a v e l M a g a z i n e | I s s u e O n e 2 0 0 8 | 3

news | MIDDLE EAST

President of Private Hospital Association

(PHA) Fawzi Hammouri was quoted as saying

that: “Jordan is the only country in the Middle

East that generates more income than what it

spends on health.” Jordan’s medical tourism

revenues in 2007 exceeded US$1 billion, he

added.

According to a study prepared by the PHA,

over 250,000 patients from around 84 Arab and

foreign countries were treated in Jordanian pri-

vate hospitals, clinics and medical centers last

year.

Iraqi patients treated by Jordan’s private med-

ical sector amounted to 45,000 in 2007, while

Palestinians and Sudanese trailed with around

25,000 patients from each country.

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

citizens, 1,200 British citizens and 400 Canadi-

an citizens sought medical treatment in the

kingdom last year.

Hammouri noted that treatment expenditures

in Jordan are only 25 percent of the cost in the

U.S., which include airline tickets and the pa-

tient’s stay in addition to site-seeing tours. «

“We Have a department here establishing

this,” he said. “We’ll be ready to start receiv-

ing patients coming here with their families,

whether for plastic surgery, knee replace-

ments or cardiovascular. We have so many

hospitals, with John Hopkins, Harvard, some

of the biggest names in the world are here

doing work,” he added.

Al-Budoor acknowledged that in the past the

Middle East would never have been considered

a destination for medical tourists, but the situa-

tion for the UAE had changed completely.

“People would go to London for shopping

with their families and receive a check up or

undergo a small operation. Now Dubai is

ready for this,” he said. “We have so much to

offer now, with certified hospitals from inter-

national agencies,” he added.

Health tourism is a global phenomenon

that is allegedly worth $50 billion annually

depending on who you talk to. The actual

size of the industry is up for discussion. This

is but one of many issues in an area of medi-

cine that is attracting a huge amount of at-

tention.

These issues are set to be discussed at the

Healthcare Travel Exhibition & Congress 2008

to be held at the Al Bustan Rotana Hotel in

Dubai from November 2-4. Sietske Meerloo,

Marketing Manager at IIR Middle East indicat-

ed that the event is expected to provoke

some heated debate.

“There are so many issues relating to medi-

cal tourism, and because the area is develop-

ing so quickly it’s becoming essential that

hospitals, insurers and policy makers, to name

a few work together closely to streamline

processes to cater to this market,” she said.

“We’re expecting a great deal of debate at

the event, and hopefully we’ll see some prac-

tical solutions adopted for many of these is-

sues,” she added.

Medical tourism is already proving to be

highly competitive with developing nations

offering cheap, quality healthcare. The Minis-

try of Health in the UAE believes it can find a

niche in this market and has endorsed the

Healthcare Travel Exhibition & Congress 2008

in which it’s participating.

“I’m really happy to see IIR [highlighting]

medical tourism for the first time,” Al-Budoor

said. “We have so many hospitals ready to re-

ceive patients from abroad,” he concluded. «

Jordan Tops Region As Medical Tourism Hub

UAE all set to attract medical tourism

The World Bank medical tourism experts ranked Jordan number one in the Arab region and the

fifth in the world as a medical tourism hub, quoted China’s Xinhua news agency.

DUBAI – The Ministry of Health in the UAE is at the forefront of developing the necessary infra-

structure to attract medical tourists. That’s according to Nasser Khalifa Al-Budoor, the Assistant

Undersecretary for International Relations and Health Affairs at the UAE Ministry of Health.

news MIDDLE EAST

» JORDan IS A MODERN COUNTRy, WITH A GOOD INFRASTRUCTURE, A THRIVING BUSINESS «

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

in a HealtH Promotion Center at Inha

University Hospital in Incheon recently they

had a comprehensive checkup, including x-

rays and blood tests.

They were among 29 Americans whose

two-week trip to Korea included a medical

program jointly developed by the LA branch

of Korea Tourism Organization (KTO) and an

LA-based travel agency Aju Tours.

Although some individual foreigners have

visited Korea for medical treatment, this was

the first group of tourists to come to Korea

on a ``medical tourism’’ package.

The report stated that the government and

some hospitals are joining hands to promote

medical tourism programs, capitalizing on

reasonable prices and quality medical skills,

especially in cosmetic surgery and other treat-

ments.

The results carried out on the patients take

four days to process. Patients can check on-

line at the hospital’s English language Web

site, or receive them by post.

The group also received skin care treatment

at Anacli Dermatology-Plastic Surgery Clinic in

Gangnam, southern Seoul. Doctors from the

clinic consulted them at their hotel the previ-

ous evening to prepare for treatment. Sixteen

of them received superficial peeling, which

cost $200 each.

Medical tourism in Korea is at an initial

stage. The program for the American tourists

came after KTO and six hospitals offered a

promotional presentation in Los Angeles last

month to medical tourism coordinators and

travel agencies.

In 2007, 16,000 foreigners visited Korea for

medical tourism, and 20,000 are expected this

year, the report said. «

American Tourists Check in for CheckupA group of Americans visited South Korea not only to go shopping

and traveling but to receive high-quality, state-of-the-art medical

treatment at relatively lower costs reports the Korean Times.

news | ASIA

news ASIA

in 2007, the hospital

received over 140,000

patients from around

the world with 19% of

them coming from the

Gulf states, a senior

official was quoted as saying.

So far this year, the hospital has received

18,226 patients from the UAE and 3,152 from

Oman. The number of Qatari patients reached

3,046, a growth of 107% compared to last

year.

Thailand is a popular destination for medi-

cal tourism. “The main benefits of health

tourism include getting the opportunity to

travel to an exotic destination and reaping big

monetary savings,” the official said.

Dr Michael Moreton, deputy director, Bang-

kok Referral Centre, said that Arab patients

sought treatment for cases ranging from

check-up to surgery, heart problems and can-

cer to rehabilitation. According to him, the

hospital has established an Arabic service cen-

tre to cater to Arab patients. «

Thailand lures Arab patients THAILAND - The number of Qatari patients seeking treatment in Thailand rises significantly dur-

ing the summer months of June to August. This year their number has grown by over 100%

compared to last year, Bangkok Hospital Medical Centre officials told Gulf Times.

» in 2007, 16,000 FOREIGNERS VISITED KOREA FOR MEDICAL TOURISM «


international patient traffic to Mayo Clinic

has rebounded since 2001 to almost pre-9/11

levels, Mayo officials say.

In 2000 and 2001, Rochester saw about

2,100 Middle Eastern patients arrive each year.

By 2006, that number had been cut in half to

about 1,000.

Mayo Clinic currently is attracting almost

1,500 patients a year here from the Middle East,

says Brent Phillips, the international administra-

tor for Rochester.

“My sense is we’re having a strong year and

we’ll be very close to where we before 9/11,”

he says.

And the growth is giving a financial boost to

the Rochester hospitality industry, and to hotels

like the Kahler Grand Hotel and Bridgestreet

Broadway Plaza.

International patients bring $30 million to

$50 million into Rochester each year, according.

And Rochester accounts for 10 percent of all

international visitors coming into Minnesota

each year, he says.

“They (international Mayo Clinic patients) are

very important to us,” says Bruce Fairchild of

Kahler’s parent Sunstone Properties. “The dollar

is down, and it makes buying medical care and

staying here less expensive. That may be help-

ing us.”

Sunstone recently expanded a-hotel-within-

in-a-hotel -- The International -- on two floors

of the Kahler. It is targeted for the high-income

international traveler. The president of Iraq

stayed there during three recent visits, including

last month when he was in town for heart sur-

gery.

The return of the international patients also is

helping keep Broadway Plaza -- Rochester’s tall-

est building -- fully occupied.

“We’ve grown year over year from 5 to 10

percent,” says John Beltz, the plaza’s general

manager. “About a third of our overall business

comes from outside the U.S.”

While Middle Eastern patients are often the

most visible on Rochester streets, Mayo officials

point out that the area with the highest number

of patients coming to Mayo Clinic is Canada.

The Middle East is the second largest source. «

Middle Eastern patient numbers rebound in Rochester

USA | news

USA news

“medical tourism is a small but growing

trend among American patients, and it’s un-

clear at this time whether the risks outweigh

the benefits,” said AMA Board Member J.

James Rohack. “Since this is uncharted wa-

ters, it is our hope that the AMA’s new guid-

ance on medical tourism will benefit patients

considering traveling abroad for health care.”

In 2006, an estimated 150,000 Americans

received health care overseas, and nearly half

of the procedures were for medically neces-

sary surgeries. The emergence of medical

tourism is in part a response to the rising cost

of health care in the U.S., which puts needed

health care out of reach for many, particularly

those without health care coverage.

“We need to address the cost of care in the

U.S. and cover the uninsured so that every

American who needs health care can get it

right here at home,” said Dr. Rohack. “Until

there is significant action at home, patients

with limited resources may turn elsewhere for

care. It is important that U.S. patients have

access to credible information and resources

so that the care they receive abroad is safe

and effective.”

The new AMA principles call for all medical

care outside of the U.S. to be voluntary. They

address financial incentives, insurance cover-

age for care abroad and care coordination.

The principles also call for patients to be

made aware of their legal rights prior to trav-

el and to have access to physician licensing

and facility accreditation information prior to

travel.

“For those patients considering medical

tourism, the new AMA principles are an im-

portant starting point for consideration be-

fore making the decision to go abroad for

health care,” said Dr. Rohack.

To ensure that insurance companies and

others that facilitate medical tourism adhere

to the new principles, the AMA will introduce

model legislation for consideration of state

lawmakers. «

AMA provides first ever guidance on medical tourism UNITED STATES - To ensure the safety of patients considering traveling abroad for medical care,

new guiding priciples on medical tourism were adopted this summer by the American Medical

Association’s (AMA) annual policy-making meeting. The nine principles are the first-of-its-kind,

and outline steps for care abroad for consideration by patients, employers, insurers and third-

parties responsible for coordinating travel outside of the U.S.


london is Well establisHed as a centre

that attracts international patients for a range

of healthcare treatments. The value of the over-

seas patient market to London hospitals in 2007

is estimated to exceed £200m, which is divided

between 10 large private and charity owned

hospitals, and the private patient units at a simi-

lar number of leading NHS hospitals including

Great Ormond St, The Brompton, UCLH and

The Marsden. The majority of these patients

come from the GCC region, mainly funded by

overseas patients offices, with some patients

funded by other government agencies such as

the military, large employers, or paying for their

own treatment. This article explores how some

NHS Trusts and some private companies are re-

sponding to changes in the market.

The overseas market is clearly changing.

Countries such as Germany are taking a larger

slice of the overseas patient market, as increas-

ingly privately owned hospitals in Germany are

looking for additional sources of revenue to sat-

isfy their shareholders. Hospitals in India and

Thailand are increasingly attracting health tour-

ists for higher volume surgical procedures. Per-

haps the greatest changes are in the markets

from where overseas patients are traditionally

drawn – developments in these countries such

as Dubai healthcare city, or The Royale Hayat

women’s hospital in Kuwait (managed by Inter-

health Canada) are reducing the need to travel

abroad to receive high quality treatment, and

are in fact aspiring to attract their own inbound

health tourists to the region.

Another significant change has occurred in

the NHS in England (which is governed sepa-

rately from the NHS in other UK countries),

which is having an impact on the market. All

NHS hospitals in England, including leading Lon-

don teaching hospitals, are becoming ‘Founda-

tion Trusts’. On the one hand, this gives these

organisations much greater management au-

tonomy from the department of health, which

has been welcomed by managers and is part of

a larger drive to decentralise and localise NHS

planning and management in the UK. Howev-

er, in agreeing to this decentralisation of power,

politicians wanted measures to ensure that

these NHS hospitals focused on their core busi-

ness – treating NHS patients – and have capped

the amount of private patient revenue that NHS

Foundation Trusts can earn directly to the same

percentage that they earned in 2003, limiting

their potential to grow private patient revenue.

This legislative change is perhaps less of an is-

sue for trusts with very large and well estab-

lished private patient units, although it does

limit their scope for further growth. It is proving

to be more of a problem for trusts with very

limited private revenue historically, who wish to

grow.

Apart from this new regulatory constraint on

NHS trusts, these organisations have historically

faced a squeeze on capital funding, and have

often had to prioritize investments in their NHS

wards ahead of investment in private facilities.

Consequently, some of these private units are

now looking dated.

A new public private partnership model is

emerging, that will allow some of these units to

compete on the international stage. By leasing

Public Private partnerships in Health Tourism

By hugh risebrow, Ceo interhealth Canada Uk

» HOSpiTalS IN INDIA AND THAILAND ARE INCREASINGLy ATTRACTING HEALTH TOURISTS FOR HIGHER VOLUME SURGICAL PROCEDURES «

FeatUre | PRIVATE PARTNERSHIPS


PRIVATE PARTNERSHIPS | FeatUre

their private patient unit to a private sector hos-

pital operator, the foundation trust does not di-

rectly invoice the patient or payer, and manages

to bypass the regulatory constraint on directly

earned private patient income.

There are a number of other advantag-

es to this model for patients, doctors,

the NHS Foundation Trust, and the pri-

vate hospital operator:

• The private operator will generally invest

their own capital to upgrade facilities to a

standard that is competitive internationally

• The private operator will have marketing

skills as part of their core competency, and

will be more successful at attracting patients

• Business processes, clinical pathways,

and non clinical services can be re-engi-

neered to better meet the higher expecta-

tion of private patients, as well as the dif-

ferent needs of payers and clinicians in

private practice

• The NHS Trust can focus on their core

business of treating NHS patients, and

leave the non-core activities associated

with private patients to their private sector

partner. Financially it is attractive for the

NHS Trust, who receive a guaranteed rental

income, income from use of facilities such

as operating theatres and diagnostics, and

usually some form of profit share.

• The medical consultants whose NHS

practice is at the same hospital site usually

strongly prefer the convenience of treating

their private patients on the same site as

their NHS patients

• Expensive equipment can be used for

both NHS and private patients, making cer-

tain investments possible that wouldn’t

otherwise have been viable

• Private patients often prefer to be treat-

ed at a private unit on an NHS site, such

that they have the full multi-disciplinary

team back-up, and range of NHS facilities

and resources should they need them

To date, HCA are now managing oncology serv-

ices at a private patient unit at UCLH. Inter-

health Canada have been awarded a contract

to manage and expand a private patient unit at

a leading specialist NHS hospital, and expect to

announce this in January 2009. There have been

two further public procurements advertised, and

Interhealth Canada have had informal discus-

sions with a further eight NHS trusts who are

interested in exploring the concept.

Interhealth Canada’s vision is to develop 6-10

such partnerships with NHS Trusts over the next

5 years. The preference is for partnerships with

trusts that have one or more areas of tertiary

expertise w here they have international recog-

nition, and to develop units with 20-40 private

beds, capable of £15m+ revenues pa, with typi-

cally a 60-40 split of UK to International pa-

tients. Interhealth Canada’s view is that patients

from the Middle East and elsewhere will increas-

ingly only travel for complex tertiary procedures,

and will want to travel to internationally recog-

nised clinical centres. Their expectations in terms

of non clinical services will also be very high –

they will want a 5 star hotel environment with a

range of peripheral services including airport

transfers and accommodation for their family

arranged by the hospital operator as part of a

package.

Interhealth Canada’s view is that these types

of partnerships will provide a service that is very

attractive to international patients and paying

organisations. They will combine world leading

medical skills in internationally renowned NHS

teaching hospitals, with high quality services

that patients will expect from a leading private

sector operator.

Interhealth Canada will use their existing of-

fices in the Middle East to support the market-

ing of these services. Much of this will involve

bringing clinicians from the UK hospitals to

meet clinicians from referring facilities and over-

seas patient organisations in the Middle East to

establish relationships and develop clinical con-

fidence. A further development in the longer

term may be to establish satellite clinics within

the GCC region, which will be supervised clini-

cally by the NHS teaching hospital in the UK.

Moorfields Eye Hospital is one NHS trust that

has boldly taken the step of establishing itself in

Dubai Healthcare City, whilst other trusts may

prefer to do this with a joint venture partner. «

For more information about visiting

the Healthcare Travel Congress log

on to www.healthcare-travel.com or

call +971 43364021


tHe flagsHiP facility of the group, Pantai

Medical Centre (PMC), Kuala Lumpur, is a 330

bedded facility, with about 150 consultant

specialists covering almost all major special-

ties.

It is strategically located amidst lush green-

ery in the affluent neighbourhood of Bangsar,

home to a sizeable expatriate population and

just a stone’s throw away from nation’s capital,

Kuala Lumpur. It is also located near to KL Sen-

tral, the integrated transportation hub of the

capital and the transfer point for major rail

systems including the KLIA Ekspres which pro-

vides a non-stop journey between the city and

airport in just 28 minutes.

PMC is steadfast in the delivery of afford-

able services that are technologically appropri-

ate, with emphasis on quality, innovation and

health promotion, through its caring staff and

its sophisticated centres of excellence. Wheth-

er one seeks critical or non-urgent medical

treatment, PMC is able to offer value for mon-

ey services with its highly trained and experi-

enced medical personnel. In addition, consul-

tant specialists of the hospital are highly

specialised in the medical disciplines they rep-

resent, majority with recognised post-graduate

qualifications and fellowships from the UK,

USA and Australia.

Furthermore, the facility is also complement-

ed by the latest healthcare amenities and

equipments such as an advanced Linear Accel-

erator – the Elekta Synergy System, which al-

lows IMRT, IGRT, SRT and TBI; the latest model

of angiography machine – Phillips Allura,

which is capable of performing 3D coronary

angiogram, 3D radiological procedures as well

as stent boosts; and the Toshiba 64 Multi-slice

CT Scanner to further support and enhance

cardiac imaging and diagnostic procedures.

Being in a harmonious and multi-ethnic

country, the medical personnel in PMC are

able to converse fluently in English and collec-

tively able to speak various Asian languages.

A wide choice of foods are available including

Asian and international cuisines, with adher-

ence to “halal” standards in food preparation.

As a key provider of healthcare to the expa-

triate community in the capital and to enhance

appeal to international patients, Pantai’s Inter-

national Ward, the first Medical Ward and

Lounge in Malaysia specially dedicated to for-

eign patients and expatriates was officially

launched on the 25th September 2007. It of-

fers a range of in-hospital accommodations

and has an international lounge on the same

floor, providing club floor facilities to patients

and their guests. International patients are also

able to benefit from the personalised services

provided by the Pantai International Call Cen-

tre - a medical referral centre for foreign pa-

tients, which offers support services such as

medical referrals and appointments, travel and

accommodation, currency exchange, transfer

from airport and hotel, visa extensions, inter-

preter services, tour of the facility and other

patient related assistance.

Through many years of experience in provid-

ing quality healthcare to Malaysians, the expa-

triate community and international patients in

the region, PMC has working relationships

with most major insurance companies, both

domestically and internationally – such as Pru-

dential, Great Eastern, AIA, William Russell,

BUPA International, CIGNA and others.

The hospital was awarded the IS0 9001:2000

Quality Certification and Malaysian Society for

Quality in Health (MSQH) accreditation, which

is a member of the International Society for

Quality in Health Care (ISQua) and the Accred-

itation Federation Council. Other achieve-

ments of the hospital include winning the Su-

perbrands Malaysia Award in 2005 and an

Asian Hospital Management Award in 2006. In

pursuit of continuous improvement in quality

and safety of patient care, PMC is currently

working towards obtaining accreditation by

Joint Commission International (JCI). «

pantai Hospitals, one of the premier hospital groups in asia pantai hospitals, one of the premier hospital groups in asia, currently operate 9 hospitals in malaysia and are managed by pantai holdings sdn Bhd. the share-holders are khazanah nasional, the national sovereign Fund of malaysia and parkway holdings of singapore.

advertisement FeatUre | SINGAPORE

» THROUGH MANy yEARS OF ExPERIENCE IN PROVIDING qUALITy HEALTHCARE TO MALAySIANS «


INTRODUCTIONTraveling to seek medical care is thousands of

years old. People have been traveling across

the globe in search for cures for any imagin-

able illnesses. In ancient Greece, people have

used thermal and mineral waters for bathing

and their health for many thousands of years.

This was well incorporated in the practices at

the “Asclepeia” which were built near mineral

based thermal springs. The Arabs built on the

knowledge of the Greece and established a

phenomenal success of medicine. Baghdad and

other cities had large hospitals that cater to all

type of people seeking care from around the

world.

After the Arabs, the West took the lead and

established modern medicine. Starting from

the 19th century until recently, people from

around the developing world were traveling to

Europe to seek medical care. Post September

11th and due to visa limitations, many Arab

patients seeking care in the US started to shift

their destinations to Europe and the Far East.

For example and according to a Qatari news-

paper, many patients from Qatar are traveling

to Thailand’s Bangkok Hospital for medical

treatment. This regional trend was inline with

a greater global trend that was underway.

People from the West especially US, UK, Cana-

da, and Germany are seeking care in develop-

ing countries such as Brazil, Mexico, Costa

Rica, Turkey, Thailand, and India for procedures

such as dental surgery, plastic surgery, hip re-

placement, and even heart surgery. Many

countries such as India and Thailand saw this

as a real opportunity and an economic driver.

Governments in those countries invested and

promote their medical tourism industries.

To provide some numbers of the size of the

industry, it’s estimated that in 2007, 750000

Americans would travel abroad to seek medi-

cal care. On a global level it’s estimated that

health tourism is worth US$513 billion.

So what are the reasons that make people

travel thousands of miles away from their

homes to get medical treatment? Is cost or is it

quality or love of travel? Would this half a tril-

lion-dollar industry continues to grow and

what we can learn from it in the Middle East

and the UAE to build a medical tourism hub in

this region. The next section tries to address

these questions.

Trends and Challenges in Medical Tourism

By dr. ahmad okasha, healthcare Business development manager, oracle, dubai, Uae

FeatUre | CHALLENGES IN MEDICAL TOURISM


CHALLENGES IN MEDICAL TOURISM | FeatUre

WHy MEDICAL TOURISM NOW?COST SAVING

The cost of medical care has reached outra-

geous levels that are fueled by many factors

such as bureaucracy and cost of medical mal-

practice insurance. For instance, a simple cal-

culation of cost comparisons of unilateral hip

replacement in the United States of America,

Costa Rica, and India reveals a cost advantage

of more than 70%. Dr. Arnold Milstein, med-

ical director of the United States based medi-

cal group Pacific Business Group, told a U.S.

Special Committee on Aging in 2006 that the

typical combined hospital and doctor’s charg-

es for operations in “technologically advanced

hospitals in lower-wage counties such as Thai-

land were 60 to 85% lower than charges in

the US hospitals. Another study in the UK

done by European Research Specialists re-

vealed that UK patients could save up to 80%

by traveling abroad to undergo surgery and

medical treatment. The big advantage in cost

saving between the US, UK, and developing

countries makes it appealing for cash pay-

ment patients as well as insurance companies

to consider the seeking medical care in devel-

oping countries such as Costa Rica and India

even after adding travel related costs.

SPEED AND CONVENIENCE

When patients have to wait long time for cer-

tain procedures such as Canada and the UK,

they will consider medical care in developing

countries even thought if they have to bear

additional costs. For instance, many Canadi-

ans are travelling to Cuba to seek medical

care. Apollo Hospitals in India is attracting pa-

tients from the UK through prior arrange-

ments with the UK PUBA health insurance

company.

In other cases such as plastic surgery or

dental surgery, which is not covered by many

insurance companies, patients from the US

and the West are finding it less expensive and

convenient to travel abroad to seek care to

places such as Brazil.

TOURISM ASPECT

Getting away form the stresses of home and

work can be much better and more relaxing

way to recover from an operation. Many peo-

ple find it more convenient to combine medi-

cal care with travelling to exotic destinations.

According to a survey of European travel mar-

ket, the top five considerations for medical

travel in Europe were: Scenery, the climate,

cost of travel, and cost of accommodation.

This illustrates that the when people consider

medical travel, the tourism aspect plays sig-

nificant role(4). Thailand, which has built its

tourism industry, is leveraging its tourism des-

tination to build a medical tourism industry.

THE NEW GLOBAL CITIzEN

A new global citizen whose life and work

transcends borders is emerging. The transfor-

mation of the global economy towards a

knowledge economy in which experience and

knowledge can cross borders based on the

best opportunities available. Many people no

longer live exclusively in their country of ori-

gin. This trend will likely increase in Europe,

the Middle East, North America, and East

Asia. As people become increasingly mobile

for both temporary and permanent work as-

signments, they require a global healthcare

model that provides care for them wherever

they are. The global citizens can search the

best treatments available and where they will

be provided. Individuals are seeking outside

their present healthcare systems for better an-

swers, and are willing to travel and pay for

them. This trend is creating millions of global

citizens. These global citizens For instance,

they may be working for a year in the US and

then go back home to India for summer vaca-

tion. Along the same line in the Middle East,

some insurance companies are offering

» Many CANADIANS ARE TRAVELLING TO CUBA TO SEEK MEDICAL CARE «


people the choice to seek performs surgeries

in their home countries such as Lebanon in-

stead of the United Arab Emirates for instance

to save cost and be close to their extended

families.

TRENDS AND CHALLENGES IN MEDICAL TOURISMGLOBALIzATION OF HEALTHCARE

The globalization of health care is underway.

Globalization is happening in many industries.

The healthcare industry is catching up with

banking, insurance, and other service oriented

industries. Not only those brands that are

major specialized teaching hospitals focused

on education such as John Hopkins, Cleveland

Clinic, and Mayo Clinic jump on the global

expansion wagon, but also other non teach-

ing hospitals. Recently, a Dallas based Chris-

tus Health, a non-for-profit Catholic system

with more than 40 hospitals has recently

opened hospitals in Mexico to serve not only

Mexican residents living on the US borders,

but also US citizens coming from the US.

The biggest driver of the growth of medical

tourism and globalization of the health mar-

ket is what happening in the US market and

how the US insurers and hospitals react to

this trend. The promise of a growing medical

tourism market has prompted Mexican busi-

nessman Carlos Slim, the second richest man

on earth according to Forbs Magazine, to

build hospitals catering to US baby boomer in

partnership with Grupo Star Medica.

Another example was in 1992 when the

Dallas based International Hospital Corp (IHC)

opened the fist of its 10 hospitals throughout

Brazil, Costa Rica, and Mexico. The main fo-

cus of the Dallas-based hospital system was

to offer high quality care that had long

prompted residents of Latin America to travel

to the US. “Over the last couple of years, the

reverse has been happening,” said Joseph

Bracie, president of Centralized services for

IHC. US patients started to come to the hos-

pital locations in Latin America. According to

Barcie, 11% of the IHC patients now fall in

the category of medical tourists. 66% of

those patients are from the US.

Recently, Blue Cross and Blue Shield of

South Carolina indicated that they would cov-

er certain medical travel claims. It has estab-

lished a managed-care network of foreign-

based hospitals called Companion Global

Healthcare in which ParkwayHealth of Singa-

pore is one of the providers participating in

the network and offering surgical procedures

such as joint replacement, cardiac surgery,

and cancer treatment at pre-negotiated rates.

Would this trend continue? It’s difficult to

predict now. The jury is still out. There are

several challenges to the growth of medical

tourism on a global scale. The first is conti-

nuity of care and the second is legal aspect

and where liability fall in cases of medical

malpractice or injury to patients. The third

challenge is brain drainage of nurses and spe-

cialists from rural and less developed areas to

highly specialized medical centers who are at-

tracting international patients. The fourth

challenge is that as countries are focusing on

medical tourism and attracting international

patients, they are diverting resources from

public health and preventive care resources.

HEALTHCARE FINANCING

Healthcare is influenced to a large extent by

the way it’s financed. How insurance compa-

nies would impact medical tourism is still to

be seen. In one hand, many global healthcare

insurance companies are financing selected

medical travel for patients seeking care out-

side their home counties. As indicated earlier,

Blue Cross and Blue Shield of South Carolina

has extended its coverage to include Interna-

tional Hospitals in Singapore. How many in-

surance companies in the US, the biggest

buyer market of healthcare would pursue

suite will impact the rate of change in medi-

cal tourism.

According to British Medical Journal, the

NHS does not fund British patients to go to

India. It has told Indian hospitals that it can-

not refer UK patients because flying time to

India exceeds the three hours limit set for

transferring patients. This is not the case with

Commercial health insurance companies such

as PUBA, the UK medical insurance company,

which approves hospitals in India such as The

Escorts Heart Institute.

A recent study published in the US indicat-

ed that traditional insurance plans discrimi-

nate explicitly or implicitly against treatment

abroad.

qUALITy AND ACCREDITATION

In order to medical tourism to grow and satis-

fy the requirements of patients and insurers,

hospitals have to provide a minimum level of

quality done by third party agencies such as

accrediting agencies. Accreditation agencies

such as Joint Commission International (JCI)

Accreditation Canada, and the Australian

Council on Healthcare Standards are expand-

ing globally and providing this mission.

Recently, more than 140 hospitals have

been accredited by the JCI. Furthermore, the

JCI has updated its international version by is-

suing a new standard that focuses on patient

safety.

The issue for accreditation will be for na-

tions to agree on accreditation standards. Not

all hospitals that are marketing themselves to

international patients will be JCI accredited.

LEGAL ASPECT

As indicated earlier, with the continuous

growth of medical tourism, patients need to

feel secure and protected. Where does the li-

ability fall in case of a medical error? Does it

fall on the hospital, the doctor or the insur-

ance agency that covered patients for their



CHALLENGES IN MEDICAL TOURISM | FeatUre

medical travel? Would providers who are

treating US patients or UK patients find them-

selves pulled to court cases in the US in cases

where US patients find themselves entitled to

go to a court. Even though previous legal cas-

es against Middle Eastern hospitals were not

successful such as Jeha v. Arabian American

Oil Co., and Gibbon v. American University of

Beirut(6), still many US lawyers would seek

every step and process of the care to find a

way to bring the jurisdiction to a US court.

Hospitals would treat US patients need to be

prepared to defend against clever lawyer and

sometimes sympathetic judges. International

hospitals must work together with the sup-

port of their countries to agree on a legal

framework that address that issue of malprac-

tice and medical mistakes. If this is not re-

solved and if also US patients started to go to

court, many international hospitals will limit

the number of US patients treated at their in-

stitutions. Therefore, a legal framework for

medical travel under the WHO is essential.

CONTINUITy OF CARE

So what happens when a patient travels and

undergoes a surgery? The optimum outcome

is the surgery is successful, and the patient

travels back home. The Patient stills need to

see a physician and care practitioners for fol-

low up. Would the medical history investiga-

tions be with the patients or would it be at

the treating hospital? The international hos-

pital that treated the patient needs to coordi-

nate follow-up and post surgery care with

physicians and hospitals in the patient home

country. Hospitals in the travel destination

and the home country need to share medical

information, treatment protocols, medication

history, lab results, and follow up visits to en-

sure best outcomes. This is also useful for the

international hospital since it provides out-

comes data to provide feedback on the best

treatment protocols and process.

HOW TO POSITION yOUR HOSPITAL FOR THE FUTURE?Countries in the Middle East have a long way

to go to establish themselves as medical tour-

ism hubs. In the Middle East, one can classify

two types of countries that have the potential

to be medical hubs. The first are the Gulf Co-

operating Council countries with long-term

strategy and plenty to spend on building in-

frastructure and promoting medical tourism.

One can cite two countries that are building

their medical tourism capabilities. The first is

the UAE in which, I believe is on its way to

becoming a center for medical tourism. The

second one is Bahrain, which announced its

intention to build a medical tourism city.

The second type of countries are those that

have built excellent medical institutions and

have high caliber physicians and healthcare

professionals, but lack the financial resources

to build their legal, quality, and marketing to

promote medical tourism at the international

level. One can cite Lebanon and Jordan as ex-

amples of these countries.

So what can learn from international initia-

tives in building medical tourism? I believe

any country focusing on medical tourism

should address the following:

ATTRACTING SUPER STAR

SPECIALISTS

The healthcare industry is still led by physi-

cians. A high-caliber specialist is like a super

star. If you give this star a qualified team and

the state-of-the-art technology he/she excels

to a high level of success and becomes a mag-

net for patients from the region and the

globe. Patients are willing to travel thousands

of miles to be treated by a famous surgeon or

specialist. In addition, there are a body of lit-

erature that supports the role of specialists

versus primary care physicians in certain spe-

cialties such as cardiology and its impact on

increasing the volume of patient care.

» PATIENTS are willing to travel thoUsands oF miles to Be treated By a FamoUs sUrgeon or speCialist «

» COunTRiES IN THE MIDDLE EAST HAVE A LONG WAy TO GO TO ESTABLISH THEMSELVES AS MEDICAL TOURISM HUBS «



The more a surgeons or a specialist practices

certain procedures the better outcomes he/

she will get. This is the “practice makes per-

fect” rule in healthcare. I believe as the out-

comes of the spcialist improve so the volume

of patients he/she attracts. Thus specialists

with a record of high volume of certain proce-

dures are important pillars to having a medi-

cal tourism program.

CREATING LOCAL BRANDS

Once a famous specialist is in house and has a

high caliber medical team to support him, a

hospital can build a local and then a regional

healthcare brand in order to attract interna-

tional patients and insurance companies.

Corporate brand development, image build-

ing, and reputation need to be taking into

consideration when building such a brand.

Borrowing from the success of regional brands

such as Emirates Airlines, Aramco, and

EMAAR, the local healthcare market can use

similar marketing strategies to build health-

care brands. King Faisal Specialist Hospital,

Dubai Healthcare City, American University of

Beirut Hospital, and American Hospital of Du-

bai are among potential local healthcare

brands that have a high potential of becom-

ing regional brands then going global.

INTEGRATING MEDIAL AND LEISURE

PACKAGES

The GCC countries as well as Middle Eastern

countries in general are building their tourism

industry. Billions of dollars are being spent to

develop the tourism industry. The UAE is

heavily investing in building hotels, theme

parks and other entertainment facilities. In

addition, the UAE has been successful in of-

fering attractive touristic packages. It’s ex-

pected that in 2008, more than 8 million visi-

tors will make the UAE their tourist

destination. GCC countries can differentiate

themselves and leverage these investments to

offer attractive medical travel packages that

include staying in luxury hotels, visiting the

parks, and enjoying safari rides in addition to

medical care.

SMART HIRING AND DEVELOPING LO-

CAL TALENTS

The healthcare industry is an experienced

based industry, which relies heavily on high

experienced, licensed, and talented profes-

sionals. Special type of skills and attitude in

addition to technical qualifications are impor-

tant to build successful medical tourism capa-

bilities. A cheerful positive nurse who’s cultur-

ally knowledgeable and trained to deal with

patients from diverse cultures is as crucial as a

highly technically trained nurse. This applies

to all other allied healthcare professionals and

front office staff. Careful screening and re-

cruitment of the right skills is essential.

Along the same line, providing training to

local students and incorporate some hospita-

bility aspects such as dealing with diverse cul-

tures is needed. I believe that the GCC coun-

tries such as the UAE, Oman, and Bahrain are

experienced with developing their hospitality

capabilities. For instance, it’s estimated that

there are residents from more than 80 differ-

ent nationalities living in the UAE. This creates

an environment where people have to deal

with different cultures on a daily basis.

DEVELOPING THE LEGAL

ENVIRONMENT

In order to develop medical tourism, Middle

East countries need to build their legal and

malpractice laws in order to protect patients,

build a reputation of having a safe medical

care industry and to protect their hospitals

from being drawn to courts in the US or the

West. As stated earlier and since medical er-

rors may happen. Not all of these medical er-

rors are due to human errors. Lawyers from

the US or the Western countries may use all

possible legal means to move the cases to the

their countries where judges may be more

sympathetic to their claims.

Medical tourism is a journey that is worth

taking. This journey cannot be rushed. There

are many elements that need to be considered

in order to build a successful medical tourism.

Countries that invest and develop their medi-

cal tourism capabilities will reap huge bene-

fits. Countries that either rush into medical

tourism or do not take the necessary steps

will find themselves overtaken by other near-

by medical tourism hubs. «

References available on request ([email protected])


every culture has its stories of great divides,

and how those distances were crossed using

passion and tenacity, and with the loyalty of

trusted friends.

In today’s world of global healthcare, the di-

vides are different. They are divides of medical

and facility quality, divides between patient

and employee culture, language and expecta-

tions, and of course the great divides of dis-

tance a patient may travel to your facility.

Within your own organizations there are di-

vides between the administration and the doc-

tors. Divides between medical staff and patient

relations staff. Further divides all along the

continuum of care you strive to provide, to-

gether with your external partners such as

travel agents or overseas consulates.

Then, at the end of the fiscal year, there

may be a divide in the bottom line, between

what your accountant says and what owner-

ship or shareholders desire. Operational effi-

ciency must be planned, worked toward con-

sistently, and met, or else the purse strings will

be strained and may not reach across the bud-

get gaps.

Or perhaps you are planning a new facility

or service to serve the growing healthcare

market. What are the divides between what

the market wants and what you plan to pro-

vide?

These are some of the themes we shall be

exploring in future columns. Each of these and

many other scenarios present dangers of slip-

ups. I will offer tips to help you avoid misfor-

tunes.

To really grasp the opportunities presented

by global healthcare, we must go across each

great divide with every bit of courage, strength

and smarts as our storied predecessors. We

must put forth effort to bring the distances to-

gether and meet our goals. We must learn the

tips to avoid the slips.

In my background as a doctor of Ophtha-

mology, I saw divides in the healthcare avail-

able to rural peoples. I initiated programs and

performed more than 1,000 cataract surgeries

free of charge.

In my background as regional director of a

chain of 5 hospitals for Max Healthcare in In-

dia, I saw divides in each facility among staff

and medical professionals and ownership.

In the successful medical travel initiatives

created during my time at Max, I saw foreign

patients travel great distances for care they

could otherwise not afford, or quality of care

they could not receive in their own country.

In my travels to numerous conferences

throughout the world, I have met people who

did not see the divide in front of them, even as

another step would have sent them slipping

into that gulf. I met others who saw the gulf,

but did not have the tips on how to get across

that distance.

That is the purpose of this column. We shall

have a dialogue between myself and you, Dear

Reader, and go across those divides together.

We seek to bridge the gaps in operations, in-

ternal and external branding, marketing, cus-

tomer service and cross-cultural expectations.

The only way to do this is with tenacity, pas-

sion, and appropriate loyalty.

Together, we shall travel those distances and

find the best solutions to close the gaps. I wel-

come your companionship on these journeys

together, as we will ultimately show how bet-

ter patient outcomes are achieved by our com-

mitments to bridge the divides.

This dialogue will work best with your ques-

tions and comments to this magazine, or to

me directly at [email protected].

We shall see examples not only from the

world of healthcare, but also from the worlds

of consumer brands. They have been learning

the lessons of global markets far longer than

we health practitioners.

Next month we shall begin by exploring slips

and tips in “customers desire, we misfire” (the

gap between what customers want and what

hospitals deliver). I hope you will join me in

these great adventures, as we cross the many

great divides. «

Dr. Sanjiv Malik, MS, MBA is Chairman of Medical Qi,

Inc., a healthcare consulting and representation firm.

He was formerly Regional Director of Max Healthcare

in India and has acted as consultant to many health-

care initiatives around the globe. Contact Dr. Malik at

[email protected]

Slips & Tips

across the great Divide

By dr. sanjiv malik, ms, mBa

gaps exist in every part of healthcare, but with passion and tenacity we can bridge those gaps

FeatUre | REGULAR COLUMN

regular Column


ask anyone in town to name the best hospi-

tal in Dubai, and the answer would be the

American Hospital Dubai. A landmark in the

city, The American Hospital Dubai (AHD), is a

143 bed acute care, general medical / surgical

hospital was established in 1996 and has prov-

en itself to be a leader among private and

medical centers in the Emirate.

The Hospital was planned, designed, built

and equipped to meet American Standards of

Healthcare. The hospital operates to these

standards and all its physicians are North

American Board Certified or of equivalent

Western training programs, such as those in

the United States, the United Kingdom and

Canada. Catering to quality medicine, Ameri-

can Hospital Dubai is the first hospital in the

Middle East to be accredited by the Joint Com-

mission International Accreditation (JCIA); a

subsidiary of the United States based Joint

Commission on Accreditation of Healthcare

organizations (JCAHO).

Despite the expensive mandate, “AMERI-

CAN HOSPITAL DUBAI is committed to provid-

ing the highest quality patient care by meeting

American and International accredited stan-

dards”, says Richard Larison, CEO.

The hospital has been recognized as a lead-

er in primary, secondary and increasingly ter-

tiary care in the UAE for the past eleven years.

It has built this reputation by insuring the fin-

est hospital facilities, the latest technology and

the recruitment of US / Western qualified and

trained physicians.

The hospital has developed several areas of

expertise: Heart, Total Joint Replacement, Dia-

betes, Neurosciences, GI Services, Cancer,

Emergency Medicine, Pediatrics and Obstet-

rics.

Construction is already well under way for

the hospital’s new seven-storey tower. It is

projected to be completed in February 2010

and will include 8 state-of-the-art operating

rooms, 47 ICU beds, 178 patient beds, a new

Radiation Therapy Center, an expanded Re-

gional Center for Diagnostic and Interventional

Radiology, and a Reference Laboratory. All of

this will allow AHD to continue to meet the

healthcare needs of the people of Dubai, UAE

and the region.

“With a dedication to continual quality im-

provement and growth, AHD is committed to

expand its present services and introduce

new centers of excellence”, concluded Rich-

ard Larison. «Tel: +9714 336 7777, www.ahdubai.com

AMERICAN HOSPITAL | advertisement FeatUre

American Hospital Dubai: quality American Standard Healthcare in the Middle Eastthe american hospital dubai provides quality, cost effective, american standard healthcare to meet the

needs of dubai and the surrounding gulf states through comprehensive primary, secondary and tertiary

care services on an inpatient, outpatient and referral basis.

» THE aMERiCan HOSpiTal WAS PLANNED, DESIGNED, BUILT AND EqUIPPED TO MEET AMERICAN STANDARDS OF HEALTHCARE «


HoW HealtHcare Providers make use of

this trend, is a question which will top the

popularity charts in the global healthcare in-

dustry. To find the answers, you do not have

to look far. Strategic marketing principles are

as relevant to healthcare as they are to any

other industry.

The product life cycle, if we could have one,

for Medical Value Travel, will show that the

concept is about to hit the growth phase.

Maybe it already has. According to an esti-

mate, over a million people travel to 28 differ-

ent countries for medical treatment. The num-

bers are likely to rise owing to a number of

factors.

At this juncture, examining the various strat-

egies that the industry players can deploy be-

comes critical. The following are the strategic

lines that the players can follow and attain

sustained growth for themselves:

MOVE FIRSTIt is a foregone conclusion that the competi-

tion will intensify as the concept grows fur-

ther. Everyone will want to jump on to the

bandwagon and earn extra dollars. It is already

happening. At this juncture, therefore, the

first movers’ advantage becomes important.

For medical travel business, according to me,

first movers’ advantage cannot be gained un-

less the forces extraneous to your business are

supportive of you. For example, you may be

the best suited hospital for international pa-

tients, but the visa laws in your country ensure

that the potential medical traveller gets a

good run around before he gets the visa. In

another country the visa laws may be simple

but the political instability may raise questions.

All in all, traveller friendly countries with great

hospital facilities and stable economic and po-

litical conditions are more likely to gain the

first mover’s advantage.

SKIMMINGAnother feature of the early growth phase is

that the price elasticity of demand is less. In

other words, the markets are less sensitive to

price. If Thailand is a bit more expensive than

India but is more convenient and offers better

quality, more people will go to Thailand than

India [and they are going too]. In any case, in

a high involvement service as healthcare, peo-

ple will not always decide on price alone.

Skimming can be an option in the early growth

phase. This essentially means that you can

charge a decent premium for your services as

the category grows further.

The profits thus made can be used in creat-

ing a highly differentiated brand. This exercise

will stand you in good stead when the con-

cept enters the maturity stage.

EARLy ADOPTERSAnother driver for growth in emerging trends

is the ability of the players to locate ‘early

adopters.’ Some people will take on to a new

concept more easily than others. An estimate

puts a figure of 17% as the percentage of

people who can be labelled as ‘early adop-

ters.’ Finding them and winning them over will

spell the difference between winners and lag-

gards in the category. For some hospitals, 50

million or so uninsured Americans seem to be

a lucrative market. It may make more sense to

approach the ‘early adopting’ segments out of

these 50 million and win them over.

EDUCATEA lot of information and education needs to

be provided in the early growth stage. People

would want to know a lot more about the

service category. This is where medical travel

planners, web-sites, published articles, videos,

testimonials will play a very vital role. The

whole idea of travelling abroad for treatment,

its benefits, safety issues, legal issues, number

of people already receiving international treat-

ment, cost involved, etc. needs to be told to

Global marketing strategies for emerging trends

By vivek shukla, healthcare marketing Consultant, [email protected]

FeatUre | HEALTHCARE MARKETING

as the world rapidly moves towards becoming a global village, new unforeseen trends are

arising. amongst many firsts, we are seeing, for the first time, a lot of people travelling from their

home countries to other parts of world for medical treatment. this practice is not new, but the

magnitude of the trend and its potential has caught the eye of many industry watchers.


HEALTHCARE MARKETING | FeatUre

the segments you are targeting.

India may still be a country of snake charm-

ers for many people in North America. So,

unless people are educated about India, its

medical facilities, its economy, price structures,

expertise, etc. they want not want to board

the plane just as yet.

Unless they are educated about the concept

of medical value travel and how it benefits

them, they are less likely to plunge in.

DEFRAGMENTATIONAny new market will defragment with the

times to come. The entire world your target

market will divide. You may find yourself ca-

tering only to the Middle Eastern market. Fur-

ther, as the market matures further, you may

only find yourself providing orthopaedic solu-

tions to the Saudi and UAE patients. The point

is, growing markets divide as they mature. You

have to take your call sooner or later regard-

ing your manoeuvre. Categories divide. So the

service providers should be clear as to which

way they will go as and when that happens.

BARRIERS TO PURCHASEFor medical travel there are many barriers.

These barriers can be categorized into psycho-

logical [going to a different country], logical

[quality of clinical outcomes], economical [in-

surance not covering treatment abroad or lo-

gistical [visa not easily available]. The idea for

the players is to work incessantly towards low-

ering/eliminating these barriers. How far the

industry grows before it starts to mature and

finally decline will depend upon how well the

barriers to purchase medical treatment abroad

are lowered. A significant barrier at the

present moment is the legal cover that pro-

vides security to mistreatment abroad. A

standard international law for medical treat-

ment will significantly help reduce this barrier.

INNOVATEThe faster the category of medical value travel

grows, the more important it is for the players

to innovate. Ones who will innovate and be-

come different will be the ones who will get

ahead, and stay ahead. Rigid providers who

resist change will become as extinct as dino-

saurs. Getting accredited with an internation-

ally accepted quality organization is one exam-

ple of innovation. Changing your operations

to meet the needs of international patients is

another innovation. Ensuring that the interna-

tional patient gets his home cuisine, watches

his home movies, gets his instructions in his

home language through a translator, etc. are

some basic innovations required.

BUILD LOyALTyAs the initial growth phase starts gaining more

pace, competition will intensify. If you have

built loyalties with the patients who used your

services, you will be bailed out much more

easily and will be able to ward off much of

competition. Medical travel is done for elec-

tive treatment and it is mostly one time treat-

ment that is imparted. How do you build a

loyalty with a onetime customer is a big ques-

tion. Well, he may never come back. But he

can send a few people across. If you ensured

his continuity of care and kept in touch with

him long after he has left your borders, chanc-

es are that he will recommend you to others.

Easier said than done; but worth trying never-

theless.

CREATE BARRIERSWith every other person ready to jump on to

the band wagon, it sometimes becomes nec-

essary to create entry barriers for others. Cre-

ating exclusive partnerships with insurance

companies, medical travel planners and even

international governments can create barriers

for others to enter. A big tertiary care teaching

hospital in India has an exclusive tie up with

the Bhutan government to provide tertiary

care services to its citizens. Even though the

hospital is far from the India - Bhutan border,

the hospital serves scores of patients every

year.

All said and done, we are in exciting times

when it comes medical value travel. This may

be the beginning of an era that may see a

huge transformation in the way healthcare is

being sought and provided.

All you have to do is keep a close watch and

create clear advantage for yourself by stand-

ing apart from the rest of the pack. «

More information on the Global Healthcare

Marketing conference can be found at

www.healthcare-travel.com To register to

attend, please call +971 43364021


cmc Has been cHosen by Johns Hopkins

Medicine International to be one of its affiliate

reputable medical institutions around the

world. To achieve the goal of serving as a cent-

er of excellence for Lebanon and the surround-

ing region, CMC in Beirut has achieved a long-

term collaboration with Johns Hopkins

International in the United States.

ONE-STOP CAREVirtually all medical services a patient might

need – doctor visits, testing, surgery, and hos-

pital care- are all available “under one roof” at

CMC. The hospital, provides all the essential

health services required through a person’s life

time: These range from simple diagnostic tests

to the most complex surgeries in Neurosurgery,

cardiothoracic, spine surgery etc...

Oncology, Heart, Eye, ENT, Colorectal and

Digestive diseases are among the centers of

excellence at Clemenceau Medical Center.

CMC also houses specialized departments

for renal diseases, urology, as well as women’s

health clinic, fertility and IVF, children depart-

ment, new born intensive care unit, in addition

to a plastic surgery center.

NEW TREATMENTS AND TECHNOLOGyCMC continuously pushes the boundaries to

offer the most advanced options. Patient Care

and safety are always priorities when selecting

equipment, thus, only the best breed of equip-

ment from reputable manufacturers have been

selected. Amongst other things, CMC offers a

completely film-less digital medical imaging

environment, and has built and equipped the

most modern Operating Theaters in the world,

complemented by advanced laparoscopy and

OR automation systems.

TOP DOCTORSCMC chooses doctors carefully based on their

educational background, their medical skills,

and their ability to work together. Our doctors

are with extensive experience in treating every

kind of illness, many are international experts.

CMC supports doctors by providing the best

personnel, facilities and technology to help

them deliver the best care to every patient eve-

ry day.

PREMIER ExECUTIVE HEALTH CHECKCMC offers the Premier Executive Health Check

program, a thorough determination of your

health status with customized wellness pro-

gram for your continued health and well-be-

ing.

This program is designed to target, reduce,

and eliminate health risks through early detec-

tion and counseling of lifestyle-related prob-

lems.

THE INTERNATIONAL PATIENT SERVICESThis includes a complete scope of services for

patients visiting the hospital from outside Leb-

anon. A multilingual staff is available to coor-

dinate all aspects of a patient’s stay, such as

the management of medical consultation and

hospital admission, travel and hotel arrange-

ments for patients and their families including

an air ambulance depending on the distance

and the condition of the patient, assistance in

choosing the right doctor, processing of sec-

ond medical opinion, and remote consultations

via telemedicine, if needed.

CLEMENCEAU MEDICINE INTERNATIONAL (CMI)CMI is an organization whose main duty is the

advancement and spread of the Clemenceau

Medicine’s mission of patient care both region-

ally and internationally. CMI has dedicated

itself to improving patient safety and quality of

medical care, providing assistance in managing

performance and applying the world’s best

practices in the Middle East.

For these reasons, CMI offers a wide array

of services that range from healthcare consult-

ing to clinical services development. Through

its proficient services, CMI strives to foster

partnerships with international organizations

and help them excel regionally and serve as

examples of excellence internationally. «

Clemenceau Medical Center and its Affiliation

in a constantly evolving world of high-end technology and research, it was a matter of sheer

necessity to establish a regional state-of-the-art medical facility with global reach and support.

Clemenceau medical Center (CmC), in affiliation with the prominent and pioneering Johns hop-

kins medicine international, is an ultra-modern medical institution located in the epicenter of

Beirut. our aim is to provide quality healthcare services within a supportive and compassion-

ate environment in both a timely and cost-effective manner, in a 5 star setting environment for

patients from lebanon and the middle east.

advertisement FeatUre | CLEMENCEAU MEDICAL CENTRE


FeatUre | BIOETHICS

WHat do a HiP rePlacement, a facelift and

a free vacation for your partner have in com-

mon? A lot, if one is embarking on a medical

tourism jaunt. A combination of market dy-

namics and increased globalization has helped

create this new industry which combines re-

quired and/or elective surgery with vacation-

like amenities. The numbers are compelling.

The actual numbers of those participating in

off-shore operations are noteworthy for their

size as well as the variability of the estimates,

which range from 500,000 to 150,000 U.S.

citizens per year. The lack of verifiable numbers

is the first tip- off that medical tourism may be

infused with a bit of the wild west, or in this

case, East. Drawn by the $11,000 cardiac pro-

cedure versus the heart stopping US rate of

$130,000 or a spinal fusion with a price tag of

$5,500 versus a back breaking US bill of

$62,000, patients and more importantly, insur-

ers, are heading beyond the pale for surgery.

However, the allure of inexpensive medical

care may not be quite enough to get your aver-

age cubicle worker with an unstamped pass-

port on an airplane for a hip replacement. The

tipping point may be the perks, which include

airfare and lodging for patient and partner, a

bump up to first class and some additional va-

cation time. Insurance companies are facilitat-

ing the shift of outsourced medical care. The

biggest names in insurance, Cigna, Aetna and

Blue Cross, are either contemplating or imple-

menting off-shore treatments for required and

elective surgeries as a matter of economics. It’s

Medical Tourismproceed with Caution

By Colleen lyons

» MANy DEvElOping COunTRiES ARE BANKING ON TOURISM TO HELP BUILD A SUSTAINABLE ECONOMy «


cheap. As the median age of the population

rises upwards, along with the costs to care for

an aging yet unhealthy population, insurers are

looking for ways to elongate the dollar.

In addition many developing countries are

banking on tourism to help build a sustainable

economy and play in the global market. Gov-

ernments, businesses and healthcare providers

in India, Thailand, Mexico, Israel, New Zealand,

Costa Rica and Turkey are collaborating with

the medical tourist providers to attract patients

and their currency. In the West, these countries

have historically evoked exotic imagines of un-

reachable allure. Yet, the appearance of finan-

cial savings and efficiencies has made strange

bedfellows of sutures and seductive travel.

Those who have reservations about making

reservations for going abroad to be sliced, su-

tured and sent home are prudent. Price does

not always equal costs and there are a few

points to be considered before a ‘buy and fly”

operation. One such consideration is informed

consent, the full disclosure of surgical risks,

complications and recovery expectations. In-

formed consent in the West is difficult- parsing

the medical jargon, common language use, and

grade-level appropriateness are familiar chal-

lenges. Non-western cultures may place less

importance on ensuring a fully informed patient

and the language differences lend themselves

to hi-jinks.

Beyond informed consent is the issue of post-

operative complications. What may be a routine

complication can take on a menacing twist

when one is thousands of miles from home

without the assistance of friends and family to

interpret the medical milieu and translate the

language. Hospital-based staph infections, for

example, are pernicious. What if a stay is pro-

longed indefinitely? If one does trot home on

schedule, recovery may not be calibrated for a

long, often truncated, flight home. As a result,

unanticipated complications may arise en route

or at home. Then what? Is the patient going

to be inclined to get back on the plane? Prob-

ably not.

Now we come to another significant issue:

legal remedy. Americans are singular in their

propensity to seek legal remedy when medical

complications arise. Yet off-shore law suits for

medical malpractice will be the rare occurrence

and not de rigueur as it is in the US. With

these considerations as part of the cost/benefit

analysis, the bloom may be a bit off of the

rose.

From a policy perspective, the issues are larg-

er, the first of which is certification. The inter-

national medical tourism guidelines and stan-

dards set by the American Medical Association

and the International Society for Quality in

Health Care which certifies 170 +/- hospitals

around the world offer little comfort. For start-

ers, how are the standards monitored, audited

and updated? Are there corollary environmen-

tal standards for air, water and food safety?

The powerful Food & Drug Administration

(FDA) has difficulty managing safe food and

drugs- tomatoes and Heparin come to mind.

How can an AMA imprimatur, which does not

have legal authority, provide assurance of sus-

tained quality and safety?

McKinsey & Co., estimates that 500,000

-700,000 Americans might go off-shore for

medical care if insurers cover some or all of the

bill and that savings may top $20 billion a year.

The first issue is that if insurers sniff the aroma

of cost savings, a la managed care, the patient’s

option to stay home or jet-set may be off the

table. The venue may be mandated. In addition,

if these cost savings become imbedded in the

balance sheet- and the talk track to Wall Street-

the luxuries and incentives will go the way of

house calls. On a macro level, a significant eco-

nomic and social shift will occur if half-million

procedures shift out of the medical system in

the US. The effects are far reaching and may

further exacerbate the issues associated with

the marginal and uninsured.

While medical tourism does have some fine

attributes- there are many positive anecdotes-

we must proceed with caution and consider the

spectrum of implications affecting patients, so-

ciety and the economy. «

Ms. Lyons is a bioethicist and principal with Ethical

Stability for Sustained Prosperity.

Sources:

By JoNel Aleccia MSNBC

updated 8:41 a.m. ET, Mon., June. 30, 2008

Art Caplan

By Alex Davidson , updated 5:40 p.m. ET, Thurs., Dec.

13, 2007

» WE MuST pROCEED WITH CAUTION AND CONSIDER

THE SPECTRUM OF IMPLICATIONS AFFECTING PATIENTS,

SOCIETy AND THE ECONOMy «

BIOETHICS | FeatUre


FeatUre | HEALTHCARE INSURANCE

tHe number of americans traveling over-

seas for health care is rising steadily, climbing

to between 600,000 and 1 million last year, ac-

cording to some estimates. Although a recent

paper produced by McKinsey Consulting sug-

gested a much lower estimate, most experts

agree that the number certainly will increase in

the future. And human resource executives

who design benefit plans for self-insured em-

ployer groups will have a definite say in deter-

mining the rate of acceleration.

The medical travel industry – I prefer the

terms “medical travel” or “global health care”

over “medical tourism” since most patients

travel abroad for the express purpose of un-

dergoing medical treatment and not sightsee-

ing – began to take off in recent decades as

Americans sought cosmetic procedures over-

seas at a fraction of the U.S. costs. Now, with

47 million Americans lacking health insurance

and millions more underinsured, patients are

exploring overseas options for medically neces-

sary surgeries such as cardiac bypass, heart

valve replacement, hip and knee replacement,

hysterectomy and others.

The initial attraction for these globetrotting

patients is the low cost, and many save 80 to

85 percent off U.S. prices. But the level of ser-

vice and five-star hospitality they receive is

equally impressive in most cases … and con-

verts most medical travelers returning to the

U.S. into flag-waving diplomats of this alterna-

tive.

While the desire for cosmetic work launched

the medical travel industry and a lack of insur-

ance coverage for many Americans fed it, I be-

lieve the next wave in demand will be fueled

by employee benefit plan administrators who

include a global health care option in their

benefit packages.

Companion Global Healthcare Inc., based in

Columbia, S.C., was established last year to

streamline access to overseas care for the

members of a large commercial health plan in

South Carolina who choose to travel abroad

for treatment. This 1.5 million-member health

plan knew South Carolinians were traveling to

Southeast Asia and other destinations for sur-

gery, so we decided to make it easier for their

members and provide assistance on a value-

added basis. While member service was the

initial driver behind Companion Global Health-

care, the company also is available to assist the

uninsured, and to contract with other insur-

ance companies and self-insured groups inter-

ested in offering a global surgery option.

Employers are the ultimate payers for most

health care under the current U.S. system, and

we at Companion Global Healthcare are con-

stantly fielding questions from human resource

brokers and others who shape benefit struc-

ture about how a global health care benefit

works.

For example, we are hearing from employer

groups who say they might consider waiving

the $2,000 deductible in an employee’s medi-

cal plan if the employee chooses to undergo

surgery at one of our network hospitals over-

seas. Other incentives are possible, too, such

as employers covering the cost of travel.

Employers are the key as to whether this

trend continues to gather momentum.

Overseas Medical Care Has Become

an Option for Employers

By david Boucher

president and Chief operating officer

Companion global healthcare inc.


HEALTHCARE INSURANCE | FeatUre

THE ‘PERFECT STORM’ DRIVING THE TRENDThe factors that have led to the heightened in-

terest in medical travel are many, but the rela-

tively high cost of treatment in developed

countries is by far the most obvious. For many

surgical procedures, the cost is 50-80 percent

less at all of the hospitals in Companion Global

Healthcare’s overseas network than for the

same procedure performed at a U.S. facility.

Lower labor costs overseas and the fact that

medical malpractice suits are a rarity help keep

costs in check.

While the low cost is the attention-grabber

for most patients who travel outside the U.S.

for care, those patients are often just as im-

pressed by the superior hospitality they are af-

forded at facilities in Thailand, Singapore, Tur-

key, Costa Rica and other places. Throw in the

ease and affordability of international travel,

and you begin to see how the pace of global

health care is picking up.

Of course, going hand-in-hand with the af-

fordability factor is the substantial number of

uninsured and underinsured people in this

country, who have utilized overseas facilities in

larger numbers than those with comprehensive

health insurance.

Even those with insurance are considering

the overseas option in increasing numbers, and

that is a surprise to some.

Skeptics often ask me, “Why would a mem-

ber of a commercial payer with a $500 deduct-

ible spend $1,500 for a plane ticket and en-

dure a 25-hour flight to go to Thailand or India

for care?” Well, most probably wouldn’t.

When we launched Companion Global

Healthcare, we simply wanted to offer another

alternative that reflects our ongoing commit-

ment to help members seek the services they

want at competitive prices. We certainly did

not envision long lines of our members at the

airport waiting for flights to far-away locales so

they could have knees and hips replaced.

But what about the person with a high-de-

ductible plan? Or the person who has insur-

ance but is not covered for a procedure due to

a pre-existing condition? Or the patient who

needs a specialized procedure not performed

frequently in the United States, such as hip re-

surfacing? Those are the people going abroad

already, and now we have groups asking about

tapping into the Companion Global Healthcare

network and considering incentives for em-

ployees who choose surgery abroad.

Another factor contributing to the growth in

global health care has to do with the aging of

the U.S. population.

According to USA Today, during each hour

of 2008, 365 Americans will turn 62 years old,

and more than half will accept early retirement

from Social Security. Many, however, will no

longer have health care benefits from their

previous employer and will not be eligible for

Medicare for three more years. Clearly, their

Social Security income will not cover traditional

insurance products, and all of this will come at

a time when many of these new retirees are in-

curring substantial expenses. So while the Sil-

ver Tsunami is helping fuel the demand side of

the medical cost equation in the U.S., the ac-

celerating shortage of health care workers in

the States is pressuring the supply side.

Treatment overseas may not be the total an-

swer for this population, but I do believe it will

be an option for many.

IS OVERSEAS CARE qUALITy CARE?Year-over-year growth in international patient

care is approaching 25 percent in some coun-

tries, including Thailand, Singapore and India.

Colleagues in Mexico and Costa Rica say their

numbers of patients from the U.S. are up well

over 50 percent vs. 2007. This could not hap-

pen unless patients there received high-quality

care.

The number of foreign hospitals that have

earned accreditation from the international

arm of The Joint Commission, the group that

accredits U.S. hospitals, has increased from 87

in mid-2006 to more than 170. What’s more,

many of the physicians who practice at these

international facilities are U.S. board-certified.

As we expand our network of overseas hos-

pitals, Companion Global Healthcare will con-

sider adding only facilities certified by the Joint

Commission International (JCI) that we believe

have comparable technology and subscribe to

the same high standards of care as the best

U.S. facilities.

Although Companion Global Healthcare is

aggressive in seeking new network members –

we hope to expand our overseas network from

the current 10 to perhaps 15 hospitals – we

are also conservative when it comes to risk.

Many critics of medical travel suggest that a

few well-publicized deaths or serious injuries in

this business could arrest the trend. And while

those could happen at any hospital –


FeatUre | HEALTHCARE INSURANCE

every patient responds to anesthesia different-

ly, for example – we want to be able to miti-

gate that risk as much as possible.

We have been impressed with the transpar-

ency exhibited by many international hospitals

with regard to quality and patient satisfaction,

as well as price.

Several indices have become the back-

bone of the “quality transparency” drift in

the United States, including:

• Number of cases per procedure

• Average length of stay per procedure

• Mortality and hemorrhage rates

• Post-surgical infection rates

• Patient-satisfaction scores

While Web-enabled data available to the pub-

lic for some of these indicators is sparse, at

best, for U.S. facilities, many foreign hospitals

such as Bumrungrad International in Thailand,

Parkway in Singapore, and CIMA in Costa Rica

readily make this data available.

Price transparency also is more common

among overseas hospitals than with those in

the United States, with many offering prices

for all-inclusive packages prior to service. Un-

der this approach, the consumer is more em-

powered and informed as the health care-buy-

ing experience becomes more like shopping for

other goods and services.

LIMITATIONS OF GLOBAL HEALTH CAREWhile I believe strongly that the care delivered

by JCI-accredited facilities is on par with U.S.

hospitals and that a global care option is at-

tractive to millions of Americans, I am quick to

add that traveling outside this country for sur-

gery is not for everyone.

The trend of Americans utilizing overseas fa-

cilities has formidable limitations.

First, many Americans will not consider trav-

eling abroad for fear of surgical complications,

questions concerning whether their primary

physician will see them for after-care following

their return to the United States, and limits on

medical malpractice claims in some foreign

countries.

Also, not every surgical procedure is appro-

priate for global travel. Certainly, emergency

operations and organ transplants will be ex-

cluded from widespread consideration in the

near term. Basically, for a U.S. resident to con-

sider surgery outside this country, the proce-

dure should be costly, one that can be sched-

uled well in advance, and one with consistent,

complication-free outcomes.

Some of our members have expressed con-

cerns about continuity of care following a pro-

cedure in a foreign hospital. A few wonder

whether their primary care physician might re-

fuse to treat them for any post-surgical com-

plications once they return home. While we

would encourage members to use their prima-

ry care physician if they have one, we have

contracted with a group of health clinics to

provide prepaid, after-care consultations for

patients following surgery overseas.

COMPANION GLOBAL HEALTHCARECompanion Global Healthcare was established

to put together a network of JCI-accredited

hospitals outside the United States, and then

to serve as a one-stop shop for those who

choose treatment at one of the network facili-

ties – helping clients schedule appointments,

make travel arrangements, transfer their medi-

cal records and more.

As stated above, Companion Global’s initial

mission was to assist members of the large

South Carolina insurance plan, but for the past

year, the company has been working with ben-

efits brokers, employer groups and limited ben-

efit insurance administrators who want to add

a global option to their benefit plans in a more

structured way.

Several self-insured employers, for example,

have added Companion Global’s network and

service offerings directly to their benefit plans,

and then listed specific medical procedures

that their employees may elect to have per-

formed at one of the network hospitals. All of

the employers have announced plans to share

any savings with the employee as well. For ex-

ample, the employers might waive any deduct-

ibles or co-payments the employee would nor-

mally pay. Some employers even offer to pay

air fare for the employee and a companion.

In the next year, we fully expect some of

these employees who select the overseas op-

tion to return to work and share their positive

experiences. With that, the trend toward

health care globalization will continue to gain

steam. «

More information on the Global Healthcare

Marketing conference can be found at

www.healthcare-travel.com To register to

attend, please call +971 43364021

» COLLEAGUES IN MExICO AND coSta rIca SAy THEIR NUMBERS OF PATIENTS FROM THE U.S. ARE UP WELL OVER 50 PERCENT VS. 2007 «


SINGAPORE MEDICINE | advertisement FeatUre

eacH year, more than 400,000 patients trav-

elled to Singapore specifically for healthcare,

and many others sought wellness and health-

care services while on the island for other rea-

sons. They come from all over the world for

clinical services ranging from complex, high-

end cancer treatment down to the simplest of

general practice care.

While other destinations provide good clini-

cal services in a tourist-friendly environment,

Singapore’s healthcare system is ranked by the

World Health Organization as Asia’s very best.

There are as many healthcare facilities in Singa-

pore accredited by the Joint Commission Inter-

national (the most common measure of health-

care service excellence) than all the other major

Asian destinations – India, Thailand, Malaysia,

Philippines – put together. Singapore’s doctors

are not just trained in the best centres world-

wide but are internationally respected for their

research and expertise. Technology is up-to-

date but carefully selected for safe and effec-

tive treatment. Some – like the bodyfat Ultra-

Shape and the complete neurosurgical

BrainSuite – are the first deployments in the

world.

The excellent clinical services are backed up

by leading-edge research in facilities like the

Biopolis, a purpose built biomedical research

hub with researchers from both the public and

private sectors. Through basic, translational and

clinical research, Singapore’s doctors not only

provide good, tested treatments to their pa-

tients but create new ones as well. Many world

and Asian firsts happen in Singapore, from the

beginnings of the test-tube babies to the

“tooth-in-eye” operation that makes the blind

see again - small wonder then that Singapore is

also the regional hub for medical conferences

and professional training.

Much is sometimes made of Singapore’s rela-

tively higher prices. But that’s relative. The dif-

ference is often not large and what prices one’s

health, one’s life anyway? And higher prices do

not always translate to higher total costs for

the traveling patients when better outcomes

lead to a shorter stay and an earlier return

home. In any case, Singapore’s average bill siz-

es are published regularly by the Ministry of

Health, providing feedback to the local and in-

ternational patients on healthcare costs. Clini-

cal outcome indicators, such as survival rates

for childhood leukaemia and cataract surgery,

are similarly published for public scrutiny; such

is the increasing desire of the medical commu-

nity to be open and transparent with the pa-

tient and the community.

All major healthcare facilities have Interna-

tional Patient Liaison Services to look after the

language, travel, accommodation and leisure

needs of patients and their family members,

ensuring a comfortable stay for all.

A city well-known for its international repre-

sentations like the Singapore Girl, Changi Air-

port and the world’s busiest seaport, Singa-

pore’s cosmopolitan community welcomes

travellers from all parts of the world.

English is widespread, crime is low, security

is high, transport is convenient, Singapore is a

tourist’s dream destination. There is little need

to say more about the touristy aspects of medi-

cal travel beyond the destination tagline –

Uniquely Singapore, Beyond Words – since Sin-

gapore welcomed more than 10.3 million

discerning tourists last year. That’s more than

twice the total resident population of the whole

island state!

Ultimately, medical travellers do not want to

go where there are uncertainties about the

quality of care or the safety of blood, rumours

of wars and bombs, social antagonism or dis-

trust, or any concerns for the safety and com-

fort for themselves and their accompanying

persons. Singapore is the one destination

where patients will have no such fears, and

can find peace of mind when their health really

matters. «For more information on medical travel to Singapore visit

www.singaporemedicine.com

Singapore: More Than Just a World Class Healthcare Destination

if any place on earth can be called the ultimate healthcare destination today,

singapore is it, with more than 400,000 people making a trip each year.

» EngliSH IS WIDESPREAD, CRIME IS LOW, SECURITy IS

HIGH, TRANSPORT IS CONVENIENT, SINGAPORE IS A

TOURIST’S DREAM DESTINATION «


UK paediatric brain injury specialist extends help to the Middle East

with more than 20 years experience in providing care, therapy and

support to children with acquired brain injury, the Children’s trust

is expanding its help to families from the middle east

advertisement FeatUre | CHILDREN’S TRUST TADWORTH

nearly five years ago The Children’s Trust

began offering brain injury rehabilitation to

children from the Middle East – helping a

young boy from Qatar.

Left minimally conscious and with a serious

brain injury following a road traffic accident,

the boy came to the UK with his family for

treatment. He was admitted to The Children’s

Trust for its specialist therapy, nursing care and

medical input, where he had a programme tai-

lored to his needs. Upon discharge he had re-

gained many of his skills and was able to at-

tend the Trust’s on-site school for 52-week

residential special education.

Since then the Trust has been strengthening

its links with the Middle East and has helped

many other children from the region.

The Children’s Trust started the UK’s first res-

idential rehabilitation service for children with

acquired brain injury in 1985. It is still the UK’s

largest centre and has purpose-built specialist

facilities and an extensive team of profession-

als to help each child.

Children come to the Trust having acquired a

brain injury from causes such as road traffic ac-

cidents; encephalitis; brain tumour; cardiac ar-

rest; a fall; stroke or meningitis.

Due to increasing demand, the Trust is open-

ing in 2009 a new residential rehabilitation

centre featuring the latest technology, and a

multi-sensory hydrotherapy centre. It means

The Children’s Trust can help even more chil-

dren.

The Trust’s interdisciplinary team includes

doctors; nurses; carers; physiotherapists; occu-

pational therapists; psychologists; speech and

language therapists and teachers. Its consult-

ant neuro-developmental paediatrician is re-

sponsible for medical care, supported by an as-

sociate specialist in paediatrics and doctors in

training.

On-site clinics and individual assessments are

also available through the Trust’s extensive net-

work of specialists, from neurology to epilepsy

and dentistry.

The Children’s Trust works closely with other

specialist children’s medical providers including

Great Ormond Street Hospital and Adden-

brooks Hospital, and is within easy access of

London.

The Trust is able to help some of the most

profoundly disabled children and those with

complex health needs, and provides opportuni-

ties for therapy, education and leisure not

available in a hospital. It can also provide fol-

low-up advice and treatment strategies for

long-term care.

The Children’s Trust is also there to help the

child’s family. Interpreters are provided for the

duration of the child’s daytime sessions and

can be accessed outside of these times if nec-

essary. Families are helped to find local accom-

modation during their child’s stay and an advo-

cate is available to offer support. The Trust has

good working relationships with embassies to

support a child’s placement.

Salim is one example of the benefits of The

Children’s Trust’s rehabilitation service. He was

admitted to the Trust following three opera-

tions to remove a brain tumour. Totally physi-

cally dependant, he needed help in all aspects

of his daily living.

After a six month placement at the Trust,

Salim was able to sit up, stand and walk short

distances unaided. He also regained much of

his speech and returned with his family to the

UAE. Physiotherapy in particular played an im-

portant role, encouraging his movements and

helping him regain his cognitive skills. Each

member of the interprofessional team played

an important role, helping Salim learn to be in-

volved in his activities of daily living and com-

municate with others.

Salim’s parents believe he benefitted greatly

from his stay at the Trust and are grateful for

the treatment and care he received. He is now

attending the Centre of Human Services in

Sharjah, which provides care for children with

special needs. He recently returned to The Chil-

dren’s Trust for a follow-up reassessment and

continues to do well. «

For more information about The Children’s Trust or how

to refer a child please contact Bob Butler at enquir-

[email protected] or telephone +44 1737

365847 and quote reference HCTM1.

www.thechildrenstrust.org.uk


املركز غادرت وقد بغيبوبة. م�صابة ال�صغرية فاطمة و�صلت

والدها يتذكر وجهها. على االبت�صامة وتبدو اأ�صهر ت�صعة بعد

الطويلة. ال�صهور اإبراهيم خالد

فاطمة كانت عاتقي. على ال�صغرية ابنتي حياة م�صئولية اأحمل كنت �صنغافورة، اإىل الطائرة ا�صتقللنا عندما

غيبوبة، يف دخلت قد حينها فاطمة كانت للغاية. مري�صة وكانت فقط، �صنوات ثالث العمر من تبلغ حينها

معدودة. اأ�صبحت قد العامل هذا يف اأيامها واأن تنجو، لن باأنها الأطباء واأخربين

advertisement FeatUre | PARKWAy GROUP

دكتور اآجن مع ال�صغرية فاطمة

وعندما ات�صلت ب�صنغافورة و�صاألت عن العالج، وجدت

اأخربوين بلدي يف الأطباء ولكن اأمل. بارقة هناك اأن

واأتذكر كبرًيا. خطًرا متثل �صوف بالطائرة الرحلة باأن

ال�صماح اأ�صتطيع ل »اإنني يل قال حينها الطبيب اأن

بذلك، فهي لن تنجو من هذه الرحلة.

اأن اأفعل؟ وعندما �صاألت »فماذا على

اأنت تتحمل اأن عليك يكون »�صوف الطبيب اأجاب

امل�صئولية.

وكانت عاتقي. على امل�صئولية واأخذت فعلت، وقد

الأطول الطائرة هي ق�صيناها يف التي �صاعات ال�صبع

يعتنون وممر�صة طبيب هناك كان وقد حياتي. يف

اأنا منت وقد الرحلة. طوال هادئة كانت التي بفاطمة

حافلني الرحلة �صبقا اللذان اليومان كان فقد الآخر،

للغاية، حيث كان علي ترتيب العديد من الأمور.

حياتي يف راأيتها التي املناظر اأجمل من كان وقد

يف الهبوط ممر اإىل الطائرة نافذة من نظرت عندما

واأنا�س الإ�صعاف �صيارات راأيت كما �صنغافورة.

امل�صاعدة. لتقدمي م�صتعدين

باأن و�صعرت م�صتعدون«، »اإنهم لنف�صي قلت عندها

العبء الواقع على كاهلي مل يعد بنف�س الثقل. وبعد اأن

لتاأدية الأ�صخا�س اأولئك هرع الطائرة، من نزلنا

عملهم.

اإعطاوؤها قد مت كان الطائرة، من فاطمة اإخراج وقبل

وعند لها. ميكانيكي تنف�س جهاز و�صع ومت مهدئًا

باأخذ العمل فريق قام الطائرة، �صلم اآخر اإىل الو�صول

تكد ومل الإ�صعاف �صيارة اإىل الطائرة من فاطمة

اإىل و�صلوا حتى اأظن ما على دقائق 10 مت�صى

امل�صت�صفى.

يف و�صولنا وكان اأخرى. �صيارة يف تبعناهم وقد

ذلك م�صم�س حار. وكان يوم الظهرية يف بعد ما فرتة

لنا. اأمل جديد بالن�صبة مبثابة

انبثاثي من نوع »ويلم«، كانت فاطمة تعاين من ورم

الأطفال له يتعر�س الكلى �رسطان من نوع وهو

اأحال قد بلدي يف املوجود اجلراح وكان اأحياًنا.

فاطمة اإىل طبيب يف �صنغافورة، وهو الدكتور اأجن بنج

تيام، وذلك لأنها كانت تعاين من ورم كبري للغاية يف

كان اأنه لدرجة للغاية كبرًيا الورم كان وقد ال�صدر.

بنف�س الرئتان تعمل مل ولذا، اليمني. اإىل القلب يدفع

املفرت�صة. الكفاءة

كان ال�رسطان ينمو ب�رسعة كبرية.

لعملية اإخ�صاعها هو الأطباء فعله �صيء اأول وكان

الورم بع�س ل�صتئ�صال حماولة يف جراحية

ال�رسطاين. ولكن عندما حدث ذلك، وقام الأطباء بفتح

ال�صدر، بداأ الورم يف النزف ب�صدة.

اأخذ الأطباء عينة �صغرية من الن�صيج. ويف النهاية،

يعني هذا هل بال�صدمة. وزوجتي اأنا �صعرت وعندها

اأن اجلراحة قد ف�صلت؟

فما الذي يبقى بعد ذلك؟

الثالثة املرة هي هذه كانت نفعل؟ اأن ن�صتطيع ماذا

اإىل �صنغافورة. التي ناأتي فيها

وعندما غادرنا اأخربونا باأن الأمر اأ�صبح على ما يرام

واأنه لي�س هناك ما يدعو للقلق. فقد ذهب ال�رسطان.

وبعد للغاية«. حمدوًدا »ن�صاًطا هناك اأن واأخربونا

اإىل بلدنا. ذلك باأ�صهر قليلة عدنا

مل نكن نعرف ماذا ميكن اأن نتوقع.

بدرجة الأوعية »منت�رس يف الورم اأن الأطباء قال لقد

كبرية«. واأنه ميكن اأن ينزف يف احلال.

قبل بالفعل ينزف كان الورم اأن اأخربونا اإنهم بل

اإجراء اجلراحة.

مل يكن باأيدينا حينها �صوى اأن جنل�س يف احلجرة، ومل

نتكلم فلم يكن هناك ما يقال.

من يقرب ما يوم كل تنزف فاطمة ال�صغرية كانت

300 ملليلرت من الدم؛ قطرات وقطرات من الدم تخرج

اأننا �صوى �صيئًا نفعل ومل ال�صغرية. طفلتي ج�صد من

اإىل بع�صنا. جل�صنا يف احلجرة ن�صلى ونبكي وننظر

الأيام، جل�س اأحد بالياأ�س. ويف ي�صعرون الأطباء كان

معنا الدكتور اأجن وقال:

»اإن اخليار الوحيد هو متابعة العالج الكيميائي.« وقد

اإخ�صاع اأثناء الكيميائي العالج اإجراء اأن لنا اأو�صح

حالة يف كما ال�صناعي، التنف�س جلهاز املري�س

املر�صى فهوؤلء للغاية. النادرة الأمور من فاطمة،

العالج يتحملوا اأن من اأ�صعف الغالب يف يكونون

نظًرا وفاتها يف يت�صبب قد ذلك اأن كما الكيميائي.

كان الكيميائي. العالج عن الناجتة العدوى خلطر

يكن »مل اأجن الدكتور قال كما ولكن كبرًيا اخلطر

اآخر. اأمامنا خيار

املوت بني الختيار اختيار- اأمامي كان بالطبع

ال�صغرية لفتاتي احلياة اخرتت ولكنني واحلياة.

بركوبي قبل من خاطرت كما ذلك اأجل من وخاطرت

الطائرة.

اأطباء ثالثة من املكون الفريق ياأتي كان يوم، وكل

ينظرون اإىل اجلداول وي�صجلون كمية الدم املتدفق من

خالل من الكمية نف�س با�صتبدال يقومون ثم ال�صدر

اإخ�صاع �صغريتي فاطمة لعملية نقل دم.

النخفا�س. املفقود يف الدم بداأت كمية اأ�صبوع، وبعد

ال�صحية جيدة الثالث، كانت حالتها الأ�صبوع وبحلول

ال�صناعي. التنف�س جهاز عن لف�صلها يكفي مبا

اأن ا�صتطاعت كما ا�صتيقظت. الوقت، ذلك وبحلول

تراين.

بهاتفي لعبت اأنها هو فعلته �صيء اأول كان وقد

فوتوغرافية �صورة راأت عندما وتب�صمت املحمول

اأذين ثقبت قد زوجتي وكانت عليه. ال�صغري لأخيها

فاأعدنا عمرها. من الأول العام بلغت عندما فاطمة

عن ف�صلها مت عندما ال�صغري الذهبي قرطها اإليها

جهاز التنف�س ال�صناعي. ول زلت اأذكر تالألوؤ القرط يف

اإلينا وتبت�صم. تلتفت اأذنها عندما كانت

تتح�صن اأ�صهر، ثمانية مدار وعلى يوم، كل نراها كنا

يت�صاءل ال�رسطان حجم وكان النزيف، فقل حالتها.

امل�صح �صور خالل من ذلك علمنا وقد – با�صتمرار

ال�صوئي الذي كان يجريه الأطباء.

وكل ليلة، كنا نعود اإىل �صقتنا بجوار امل�صت�صفى، ناأخذ

وكانت امل�صت�صفى. اإىل اأخرى مرة ونعود نحتاجه ما

على اإليها الو�صول ميكن بحيث جًدا قريبة ال�صقة

بع�س يف اأجرة �صيارة ن�صتقل كنا كما القدمني

الأحيان.

اأخربونا الأطباء لأن نظًرا قرب عن البقاء نريد وكنا

من« »بالرغم الورم »انفالت احتمالية هناك اأن

ل�صتئ�صال ثانية عملية باإجراء قاموا لذلك، العالج«.

املتقل�س. الورم

انتهى »لقد زوجتي: يل قالت عندما ذلك كان وقد

وا�صرتت خرجت وقد الآن.« جيدة بحالة اإنها الأمر.

التي الأوىل املرة هي هذه كانت للجميع. احللوى

اأراها ت�صحك فيها ب�صوت مرتفع لقرتة طويلة.

وقد ا، اأي�صً الأطباء اأعني يف البهجة راأيت اأنني كما

الأجنحة! الفرحة جميع عمت

»اإن اأجن الدكتور يل قال حينما اأذكر زلت ول

الطفولية الأعمال بتلك وتقوم جتري لها م�صاهدتي

اأن اأخربين كما يومي!«. يف به اأ�صتمتع ما اأكرث هي

%15 من يقرب ما اإىل ت�صل فر�صة لديها فاطمة

التعلق اأحاول مل ولكنني البلوغ. مرحلة اإىل للو�صول

بالأمل كثرًيا.

�صغريتي واأحمل اأ�صتيقظ �صباح، كل ويف والآن،

اأطعمة ماكدونالدز للخارج لتناول الطعام. وهي حتب

يوم كل معها وجبة اأتناول وكنت للت�صوق. والذهاب

بها نخرج الآن ونحن رغبتها. هي تلك كانت اإذا

كاٍف ب�صكل الآن قوية تعد مناعتها لأن نظًرا للت�صوق

ميكنها من اخلروج.

والذهاب اخلروج الآن ن�صتطيع تتخيل؟ اأن ميكن هل

الطبيب اأخربنا حني يف الأطفال لعب حمالت اإىل

10 هذه – انظر! اأمل. هناك لي�س اأنه قباًل املحلي

بها قمنا التي اجلولت اأثناء ا�صرتيناها قد دميات

هناك.

وقد ات�صلت يف بلدي بذلك الطبيب املحلي، ومل ي�صتطع

ت�صيح واأنها احلياة، قيد على تزال ل اأنها الت�صديق

اإليه. وجتري وتتحدث

جيدة �صهيتها اأن كما والتلوين. املل�صقات حتب وهي

للغاية.

و�صوف نعود للوطن. و�صتلتحق فاطمة باملدر�صة. فهي

مل تلتحق باملدر�صة حتى الآن.

ل وهذا طبيبة. ت�صبح اأن تريد اأنها والدتها وتعتقد

يعنيني كثرًيا، فكل ما اأريده هو اأن اأراها ت�صحك.

يف ويعمل عاًما 35 العمر من يبلغ اإبراهيم، خالد

العمر من تبلغ عايدة، زوجته البرتول. �صناعة جمال

من يبلغ ابن فاطمة، جانب اإىل ولديهما عاًما. 29

يف �صنغافورة جميًعا غادروا وقد واحًدا. عاًما العمر

العا�رس من �صهر مايو.


tHe Pack of Profiteers is led by India,

China and Thailand, all with their individual

assets and short -comings. The numbers talk

for them self: 1.2 million patients travelled to

India for healthcare while another 1.1 million

medical tourists travelled to Thailand in 2007.

India’s biggest asset has been its numerous

Western trained English speaking doctors. It

also has some of the worlds largest corporate

hospital chains. A report from the Confedera-

tion of Indian Industry and McKinsey has pre-

dicted that up market tertiary care hospitals in

India could generate up to $2bn (£1.1bn;

€1.7bn) in revenue through health tourism by

the year 2012.

China with its liberal policy with organ re-

trieval and donation has become the top

choice for liver and kidney transplants, even

though the international community does

chastise it for the lack of transparent medical

practices.

Thailand, the perfect tourist destination has

come up with a rich blend of American trained

accredited establishments and an eclectic mix-

ture of Thai Hospitality. Also with a permissive

culture, it is sought by many for rehabilitation

and respite care.

Unfortunately the Middle East remains a net

exporter of patients rather than a net importer.

This scenario is changing, but the pace is too

slow.

The Middle East in the last few years has be-

come a brand ambassador for opulence and

luxury. Dubai, Abu Dhabi and Doha are taking

the tourism industry by storm. The whole

landscape is changing with the emergence of

these super cities. Museums, retail space,

theme parks, and business parks are coming

up all over. The demographics are changing as

well. Gone are the days when it was the haven

for adventurous Westerners and industrious

Indians. Now it is a playground for the rich and

uaE: Can it share

a slice of the pie? By anshul govila, sheikh khalifa medical City, Uae

FeatUre | MIDDLE EAST FOCUS

40.4 Billion dollars is the projected size of the medical tourism industry in the

year 2012. From Bombay to Bagota people are lining up to take a jab at this fruit.

But will the UAE get a slice of this pie. Maybe, maybe not.


MIDDLE EAST FOCUS | FeatUre

famous, more so in the years to come. Such

periods in history, when new cities are being

created and previous ones re-defined come far

and few.

Unfortunately, the healthcare picture does

not reflect the same confidence. Though the

hospitality industries standards have been at

par or in some cases better than international

standards, the healthcare industry cannot

boast the same. Few hospitals are true con-

noisseur hubs where health and hospitality are

both at their prime. New hospital chains are

trying to address this issue. These establish-

ments often find themselves lacking in talent

when it comes to bringing the hospitals up to

steam. Accreditation, infrastructure cost, short-

age of paramedics and attrition of staff all get

in the way. Further, the effort required to un-

ravel the logistics of healthcare is humongous.

It requires the steady hand of a seasoned play-

er.

This is where there is a clear and present

need for the Middle East Entrepreneurs to

partner with its not so distant brother in arms,

India.

Several Indian Hospital chains are today JCIA

accredited. The Corporate hospitals in India

have also made a reputation to be lean opera-

tors, keeping operating budgets slim and mar-

gins high. This is a lesson the UAE hospitals

still have to learn.

This need is mutual. Indian hospitals are also

looking out for expansion in to the Middle East

too. The infrastructure cost and licenses are

what keeps them away. This is an obvious area

for synergy between the two regions.

UAE today has the capability to address the

shortcomings of its large Indian neighbor.

The market in India still lacks the panache to

lure the celebrity patient. It lacks the depth of

luxury and the perfection in service, both of

which the Middle East offers. The medical

tourism market in India still caters to those un-

fortunate few who have either found a similar

health care solution too expensive in their

country or have found the waiting period dis-

mally long. Patients tend to come for these

reasons rather than by choice.

Also the Indian story comes unstuck with

the current social turmoil. Bomb scares have

wreaked havoc in the Indian tourism industry.

The already unwell are not wiling to take their

chances.

Then there has been the odd case where a

medical tourist has caught a communicable

disease while on the subcontinent. Though

these cases may be far and few, the fears are

not unfounded.

The NHS in the UK and some other health

care providers have sited the distance involved

in traveling to India as hazardous for their pa-

tients and hence refused to reimburse medical

tourist. Acting as a major hub for several direct

Trans Atlantic and European carriers Dubai and

Abu Dhabi can escape this incrimination too.

From time immemorial the Middle East has

been a market at cultural and economic cross-

roads. The end of the silk route-the sea link to

Africa. It has always profited from its unique

geo presence. This is yet another industry

which is beckoning to be explored by the Mid-

dle East entrepreneur.

Fair winds are blowing for those few who

are ready to lift the anchor. «

» unFORTunaTEly THE MIDDLE EAST REMAINS A NET

ExPORTER OF PATIENTS RATHER THAN A NET IMPORTER «


SingHealth – Singapore’s largest healthcare group

singapore health services (singhealth) is singapore’s largest healthcare group with 3 JCi-

accredited hospitals – singapore general hospital, kk women’s and Children’s hospital and

Changi hospital; 5 national specialty Centres focusing on treatment and care for Cancer,

heart, eye, neuroscience and dental; and a network of primary healthcare clinics.

advertisement FeatUre | SINGHEALTH

COMPREHENSIVE MULTIDISCIPLI-NARy CAREWith a wide range of 42 clinical specialties and a

faculty of 1000 internationally qualified medical

specialists, SingHealth institutions offer integrat-

ed care in a multidisciplinary setting.

Well-equipped with advanced diagnostic and

medical treatment technology, SingHealth insti-

tutions offer pioneering treatments in a wide

range of medical procedures.

LEADING EDGE MEDICAL CARESingHealth’s flagship hospital, Singapore General

Hospital (SGH) is Singapore’s largest acute terti-

ary hospital and a national referral centre for the

specialties of Plastic Surgery and Burns, Haemo-

tology, Renal Medicine, Nuclear Medicine and

Pathology.

SGH is also home to the world’s first integrat-

ed neuroscience centre, the Khoo Teck Puat-NNI

Integrated Neuroscience Centre. Offering cut-

ting-edge treatment in the neurosciences, the

Centre integrates the latest in healthcare tech-

nology to offer timely information and treat-

ments that enable clinicians to perform compli-

cated surgeries in less time and with better

patient outcomes.

SGH has made its mark with pioneering treat-

ments including the world’s first unrelated cord

blood stem cell transplant and first cord blood

transplant for Thalassaemia Major patients and

the world’s first modified jaw advancement tech-

nique for treatment of Obstructive Sleep Apnoea

and Asia’s first unicompartmental arthroplasty.

Another leading hospital in the SingHealth

group is Singapore’s only tertiary hospital spe-

cialising in the medical care of women and chil-

dren. KK Women’s and Children’s Hospital (KKH)

is a major referral centre for high risk obstetrics,

gynaecological oncology, urogynaecology, neo-

natology, paediatrics, paediatric bone-marrow

transplants and paediatric open-heart surgery.

Amongst the series of firsts chalked up by

KKH - it was the first hospital in the world to of-

fer the first FDA-approved phosphor plate com-

puted radiography for mammography combined

with computer-aided detection to detect breast

cancer. It was also the first in the region to per-

form MR-guided focused ultrasound ablation for

the treatment of fibroids.

Another leading edge SingHealth hospital is

the Changi General Hospital, located only 10

minutes from Singapore’s international airport.

Offering a full range of medical services, the

hospital excels in Sports Orthopaedics, General

Surgery, Obstructive Sleep Apnoea and Gastro-

enterology.

PIONEERING TREATMENTSThe 5 national specialty centres of the Sing-

Health group are tertiary referral centres provid-

ing specialised treatment for patients in Singa-

pore and the region. As national referral centres,

they lead the way not only with highest level of

medical care but also with pioneering treat-

ments.

National Cancer Centre Singapore, a national

and regional one-stop specialist centre housing

Singapore’s largest pool of oncologists, offers

the latest therapies including mini transplants

and targeted therapies designed to maximise

outcomes while minimising undesirable side ef-

fects.

Outcomes for many treatments, including

head and neck cancers and liver cancer are

comparable to the best institutions worldwide

National Heart Centre Singapore is Singapore’s

designated national centre for cardiovascular

medicine. It is the first heart centre outside of

the USA and in Asia to receive Joint Commission

International (JCI) accreditation. It is the largest

cardiovascular specialty group in Singapore,

treating complex cases requiring specialised care

from other hospitals in Singapore and region.

Outcomes for treatments, including percuta-

neous transluminal coronary angioplasty and

coronary artery bypass grafting surgery are com-

parable with international benchmarks.

Singapore National Eye Centre, a designated

national centre for ophthalmological services is

one of the leading transplant centres in the

world offering new advanced LK techniques,

stem cell transplants and Osteo-Odonto Kerato-

prosthesis (OOKP) surgery, a radical and complex

eye operation.

It is a world pioneer in conjunctival stem cell

transplant, a technique of growing one’s own

stem cells to treat conditions such as chemical

injuries, severe contact lens overwear and Ste-

ven-Johnson’s Syndrome.

National Neuroscience Institute is the national

specialist centre for treatment of neurological

diseases. The centre is well-equipped to provide

patients with high quality care in the areas of

neurodiagnostics, neurology, neurosurgery and

neuroradiology. National Dental Centre Singa-

pore, Singapore’s referral centre for specialist

oral healthcare offers comprehensive, integrated

care for the full spectrum of, from simple to

complex, dental needs.

INTERNATIONAL PATIENTSSingHealth’s extensive experience and expertise

makes it a logical choice for international pa-

tients seeking high quality multidisciplinary med-

ical care.

Interested parties wishing to collaborate in fa-

cilitating International Patient Care at our insti-

tutions, please contact jaryll.chan@singhealth.

com.sg or [email protected] «

At the National Cancer Centre Singapore, the latest

image-guided technology in radiation oncology en-

hances cancer treatment.


oportunities04news12challenges34middleeastfocus24bioethicscontentsanddevelopmentsoverseasmedicalcare

Documents

healthcare travel industry

cheaper healthcare

aspects of medical travel

soaring healthcare costs

medical world h e

medical treatment

medical tourism

r e t r