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Medical Tourism

August 15, 2008 By: Mark Rogers Travel Agent

Agents have a potential gold mine in booking U.S. citizens into hospitals abroad

Americans are living longer than ever before, but at the same time they’re facing challenges presented by out-of-control medical costs and inadequate health insurance. Increasing numbers of U.S. citizens are traveling abroad to avail themselves of Asian and Latin American hospitals and medical centers, for treatments that range from something as simple as getting your teeth whitened, to procedures as major as hip replacement surgery.

This relatively new market is here to stay, and can be profitable for agents, similar to booking honeymoons or dream trips of a lifetime. Honeymooners and dreamers want every detail to be perfect, and reaching out to travel agents is all part of the plan. Similarly, if a person is planning to go to a foreign country for medical treatment, the expertise of a knowledgeable travel agent can make or break their decision to go.

According to the most recent census data, 47 million Americans have no health insurance, and 120 million are under-insured. The Commonwealth Fund, a New York-based healthcare research organization, recently issued a report saying nearly half the working-age population of the U.S. risks being financially devastated if confronted with the need to pay for major surgery, either because they have no insurance or inadequate insurance.

Medical Destinations
Some of the major players in this niche in Asia are India, Malaysia, Singapore, Thailand and the Philippines, while destinations in Latin America that are attracting a major share of the market include Argentina, Brazil, Costa Rica, Mexico and Panama.

The India Tourist Board reports that approximately 500,000 medical tourists go to Asia annually. Of this number, India receives 200,000. Medical tourism to India has been growing at 30 percent a year for the past three years, and experts estimate that, by 2012, medical tourism will be a $1 billion industry in India. Presently, the lion’s share of medical tourists traveling to India come from the Middle East, although the U.S. accounts for 10 to 15 percent of the total. It’s clear that it’s a cost-driven decision for many patients. For example, heart surgery can cost $60,000 in the U.S., but might cost $8,000 in India. When you add travel for two, and perhaps a recuperative or holiday stay, you’re still paying a fraction of what the cost would be in the U.S.

parkway health singapore

Parkway Health in Singapore

According to the Singapore Tourism Board, the number of international patients traveling to Singapore for medical care is increasing by about 20 percent each year. Based on exit surveys conducted of international visitors to Singapore in 2006, 410,000 visitors traveled to Singapore specifically for healthcare. Blue Cross Blue Shield recently inked a deal with Singaporean company Parkway Health, which owns three first-class hospitals in Singapore. Through this deal, American patients will have access to pre-negotiated, in-network rates that are dramatically lower than those typically charged at hospitals in the U.S. There is increasing interest for U.S. healthcare insurance providers to evaluate lower-cost options overseas as alternative healthcare services. It is estimated that $200 billion of U.S. healthcare can be exported.

“Thailand offers tremendous value for money spent, and the facilities and doctors are some of the best in the world,” says Santi Chudintra, director Western USA, Central and South America, Tourism Authority of Thailand. Chudintra advises patients to be sure to allow sufficient recovery time based on the severity of the procedure being done before planning to continue on vacation or fly back home.

“Travel agents are the facilitators for getting medical work done, [but] they are not involved with medical decisions or procedures,” says Chudintra. “For more serious operations, there should be a doctor here in the U.S. that will work as [a] liaison with the Thai doctors.”

The National University Dental Hospital in Seoul, Korea

National University Dental Hospital in Seoul, Korea

“The medical field in Korea is highly advanced and is considered on-par with leading medical facilities in the U.S.,” says Jennifer Goger, marketing coordinator, Korean Tourism Organization–Los Angeles. Goger recommends that agents take fam trips to medical facilities so they can acquire firsthand experience with the facility. “The Korean Tourism Organization is currently working with travel agents and tour operators to promote groups of medical tourists within the Korean community with hopes of expanding these efforts,” she says. Recently, a group of medical tourists traveled to Inha University Hospital and Arumdaun Nara Beauty Clinic to experience pioneer medical tourism programs for mainstream U.S. travelers. Interested agents can contact Goger at 323-634-0280, ext. 227 or [email protected].

“Medical travel is more than just normal tourism with a sprinkling of healthcare,” says Dr. Jason Yap, director of healthcare services for the Singapore Tourism Board. “The stakes are higher and unwary patients can get hurt.” Yap notes that it’s obvious that the choice of doctor or facility is important, but there are other factors to consider. “Agents should also think beyond the healthcare component, as there are cases of patients with excellent clinical results having memorable trips for the wrong reasons—their companion being mugged, or they’re shocked at the poverty and squalor of some countries.”

Yap points to Singapore as a country that gets medical travel right. “Singapore’s clinical services are excellent, built up through decades of strong economic growth and careful health manpower and services development, with many international accolades, including being ranked the best healthcare system in Asia,” says Yap. “Singapore is open, convenient to get to, safe and secure, and a great leisure destination in its own right.”

A Patient’s Story

When knee-replacement surgery proved to be too expensive at home in the U.S., 52-year-old Nancy Hoskins from Corpus Christi, Texas, made the 24-hour journey to Singapore from her home. Hoskins’ knee never recovered after an accident that left her with torn cartilage. Doctors in Texas recommended a total knee replacement. But without any medical insurance, the cost of surgery and hospitalization would set her back more than she wanted to spend. She chose Singapore after reading about the destination’s medical capabilities, high level of expertise and low infection rates on U.S.-based medical tourism company Med Journeys’ website. After receiving detailed pre-surgical instructions and information from her Singaporean physician, Dr. Ang, via Med Journeys, Hoskins was ready to make the long flight.

Shortly after her arrival, new X-rays indicated a “knock knee” deformity, what was medically termed a valgus knee. But that was not the main problem. There was also a big hole in her proximal tibia that had developed as a result of long-standing arthritis. The surgery would therefore not be as straightforward as the doctors had hoped. To get her knee implant straight, Dr. Ang decided on computer-navigated surgery to improve accuracy and get it as perfectly aligned as possible. Three days after her two-and-a-half-hour surgery, under the close watch of a physiotherapist, Hoskins was out of bed walking.

Hoskins was discharged after five days, and stayed in Singapore for two more weeks for follow-ups and to monitor for complications and infections.

“Dollar for dollar, it was really affordable, [and] the quality of healthcare in Singapore is up to world-class standards,” says Hoskins.

What makes the story all the more remarkable is the fact that Hoskins is a registered nurse.

“Latin America and Mexico are extremely popular among U.S. tourists for this form of travel simply because these regions are so close to the U.S. border and therefore have many doctors that are U.S. certified,” says Willie Moreno, director of operations and registration for the Latin America division of Transmarx. Transmarx is a company that helps organize medical tourism consumer and trade shows throughout the U.S.

In Central and South America, Moreno points to Panama and Costa Rica as the two most popular medical tourism destinations among U.S. travelers, whereas Monterrey is among the most popular Mexico destinations for medical tourism, as it is home to the acclaimed Christus Muguerza Internacional Hospital.

“Places throughout the world like Singapore, India and Latin America are not considered Third World anymore in regard to medical facilities,” Moreno says. “In fact, some of the hospitals in Mexico and the doctors there are even better than some in the U.S.”

Pana-Health is a group of specialists that includes the best health professionals of Panama, most of whom are also U.S. certified professionals. In Panama and Costa Rica, travelers will come for procedures ranging from heart to reconstructive knee surgeries, while Brazil remains one of Latin America’s most popular destinations for plastic surgeries. Moreno notes that soon-to-be emerging Latin America destinations in this field include El Salvador, Guatemala and Argentina.

“In the Caribbean, the top medical tourism destination by far is Puerto Rico,” says Moreno. “This destination has a major advantage in this niche, because patients from the U.S. are obviously still considered U.S. citizens here, since Puerto Rico is a commonwealth of the U.S. This is extremely important when it comes to a patient’s concerns of possible lawsuits or malpractice suits in the event of a botched surgery.”

Moreno says his company is aggressively seeking the attendance of more travel agents at medical tourism events and is also looking to pursue partnerships with agents in arranging medical travel. Agents can reach Moreno at 804-266-7422, ext. 7408 or [email protected].

Where the Agent Comes In
“Booking travel for someone headed overseas for medical care is altogether different than booking vacation or business travel,” says Robin Elsham, managing director of U.S.-based Patients With Passports, a medical care arranger that works to identify travel agents who are able to provide expert travel planning to the eight foreign countries where the company arranges medical and dental care. “All the established international medical care arrangers view themselves as medical services companies, not as niche-oriented travel agencies. Their focus is riveted on the medical aspect of the client journey, and arranging travel is incidental to that process.” Agents can contact Elsham at 651-554-0290 or [email protected].

In Elsham’s view, the international medical care arrangers are finally recognizing the importance of expert travel planning. “For example, in planning the U.S. return of a heart-bypass surgery patient from a far-flung destination like India, it’s vital to know which airports to avoid to minimize the chance of missed connections,” says Elsham.

Elsham notes that patients shouldn’t automatically assume any destination or region is best for them. Identifying the most appropriate destination for any individual requires an understanding of factors in five areas:

* The procedure they need done
* Their physical condition
* Financial resources
* Previous international travel experience
* Personal preference

Elsham notes that Latin America is typically a preferred destination for less expensive procedures because of its proximity to the U.S. “The less expensive a procedure is, the greater the proportion travel costs comprise of the total cost,” she says. “But since Asian destinations like the Philippines provide care for substantially less than most Latin American providers, it can be less expensive on a total cost basis to travel to the Philippines rather than Mexico or Panama.”

What Lies Ahead?
The medical tourism field is an expanding one, and there are sure to be many changes as it continues to grow.

“Today, with increasing globalization, the borders are crumbling, and patients, professionals, healthcare providers and payers are all reaching out around the world,” says Yap. “Besides patients and professionals, it is probably only a matter of time before there are multinational corporations for clinical services, much as there is today for IT and finance.”

“The number of destinations drawing U.S. medical travelers is certain to expand,” adds Elsham. “In years past, most media reports focused on Americans traveling to India and Thailand. More recently, stories are appearing about the appeal of countries like Singapore for hospital care, and nearer to home, of Costa Rica for dental care and cosmetic surgery.”

Elsham notes that as interest in medical tourism grows and Americans become more knowledgeable about the wider range of options, they will travel to many other countries, such as Brazil and Argentina for cosmetic surgery, or Eastern Europe for dental care.

“But the appeal of rival locations is going to be heavily influenced by the rising cost of air travel,” she says. “In fact, entire categories of healthcare treatments—those costing the least—may no longer be appealing to medical value travelers. Skyrocketing travel costs could wipe out the financial appeal of flying anywhere for any but the most expensive dental procedures, or for the least expensive cosmetic surgery procedures.”

Additional Reporting by Joe Pike


Getting it Right

“There are many misperceptions about medical tourism,” says Robin Elsham, managing director of U.S.-based Patients With Passports. “One is that medical tourism would not be valuable to any American with health insurance. For people who have health insurance with large deductibles and co-pays of 15-20 percent, they can often save thousands of dollars by traveling abroad for surgery and paying the entire cost themselves, as opposed to just their portion of the cost of surgery in the U.S.”

Elsham also notes that because surgery costs so much less abroad, especially in countries like India and Thailand, there’s a tendency to believe that the care must be inferior.

“In fact, Americans who travel abroad for surgery often end up receiving superior care for this simple reason,” she says. “When people have surgery domestically, they typically have the surgery performed at a conveniently located hospital with an acceptable reputation in their community. The result is average, or even sub-standard care. But as soon as somebody decides to travel abroad for surgery, they set in motion a process that typically leads them to a super-specialty hospital abroad—a facility more comparable to the Cleveland Clinic or Mayo Clinic than to a city hospital here. The result is superior care, yet at a cost of 30-90 percent less than in the United States.”

“One misperception out there is that there are many excellent healthcare destinations in the world—actually, there aren’t that many,” says Dr. Jason Yap, director of healthcare services for the Singapore Tourism Board. “Some countries have announced national programs and many have marketed themselves as great destinations, but few really deliver.”

Yap points to the example of patients having successful surgeries but bad experiences overall because of poor service or unsafe city streets. “Beyond excellent, safe and trustworthy clinical services, affordable costs and good customer service, patients need a warm and non-threatening environment, cultural acceptance, ease of travel, safety for themselves and their families, and even opportunities for recreation and shopping for their travel companions,” he says.

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