HealthAbroad.net: Point of View

Finally, some meaty data on traffic and financial forecasts…
THAILAND

2004: Medical tourists - 600,000; Revenue - 20 billion Baht

2006 (expected): Medical tourists - 1000,000; Revenue - 27.5 billion Baht

Source: Thailand’s Health Ministry

Of Bumrungrad 400,000 foreign patients in 2005, the largest group - 70,000 - was from the UAE, where the cost of healthcare is high! Before 9/11, they would go to Europe/USA, but now they are shifting their attention to Thailand.
INDIA

Currently draws 150,000 medical tourists/year; industry is growing by 30%/year; expected to generate at least USD 2.2 billion by 2012.

MALAYSIA

2005: Medical tourists - 200,000

2010: Expected to generate USD 590 million

Have you ever fallen for one of those “sun, sand and surgery” ads? Come on, admit it, no one’s looking
I certainly have!

“The first thing a doctor tells you after a procedure is, ‘Don’t go in the sun, don’t swim, don’t go in the sand, don’t drink and don’t over-exert yourself.”
– overheard at a recently concluded medical tourism conference in Pattaya, Thailand

Already? and we thought the buzz arount MHTI had just started.

At the recently concluded Diagnostics of Medical Travel conference in Pattaya, Thailand, experts recommended the formation of an international regulatory body and an advertising code of conduct. That’s all very well, but what good would an international regulatory body do when most (all?) hospitals are regulated by their national regulatory bodies?

What’s more interesting are the spending stats attributed to medical tourists at this conference: “health tourists spent an average of US$362 per day compared to US$144 for leisure travellers.” That’s a huge difference! It would be interesting to know the source of this data: which countries does this include, what is the average period of stay and what are the most common surgeries?

Another interesting statistic to come out of this conference is the estimated size of the medical tourism industry in Malaysia: USD 40 million at present. We know that Malaysia has been pushing aggressively to garner a larger-pie of medical tourists coming to SE Asia, and specifically to woo them away from Singapore.

With Singapore getting its act together as well–Singapore’s Tourism Board already has a Director of Healthcare Services– this will be an interesting contest.

There are 48 million uninsured adults aged 19 to 64 in the US. This news is going to make the MHTI in Asia, Eastern Europe and other low-cost healthcare destinations really happy. It’s a tragedy though.

Here’s the full article:

SAN FRANCISCO (MarketWatch) — The problem of getting and keeping affordable health insurance affected substantially more middle-income workers in 2005 as more went without coverage, according to a new report.

Among working adults with annual incomes of $20,000 to $40,000, 41% were uninsured for at least part of the past year, up from 28% who were at least temporarily without coverage in 2001, according to a survey of 4,350 people from The Commonwealth Fund, a research group in New York.

Low-income Americans typically face the biggest challenge with health insurance, and the trend of more moderate-income people losing it is “worrisome,” said Sara Collins, senior program officer for the Commonwealth Fund.

“Forty-thousand dollars a year is by no means a low-wage job,” she said.

The numbers also show that in the U.S. population as a whole there were 32 million who were uninsured at the time of the survey, and 82% of those had been uninsured for a year or longer. Among the 16 million who had insurance at the time of the poll but had spent some time without coverage in the past year, about one-fourth had at some point been uninsured for a year or longer, Collins said.

Several factors in the last few years have combined to make it tougher for moderate-income families to hold onto their health plans. Wage growth has been stagnant and the percentage of employers — especially small firms — offering coverage has been falling, said Gary Claxton, vice president of the nonpartisan Kaiser Family Foundation in Washington.

“Health-insurance costs have been going up so much faster than income, it’s not surprising that difficulty in getting access to health benefits and keeping them would be going up the income scale,” he said.

Of the estimated 48 million uninsured adults age 19 to 64 in the country, 67% were in families where at least one person was working full time, according to the report.
Increased cost-sharing where workers are on the hook for more out-of-pocket spending on deductibles, copays and premiums has put health care out of reach for more people, Collins said. And those on their own without job-based plans often find the individual market unaffordable or inaccessible, especially if they have preexisting conditions, she said.

“Premiums might be quite high or they might not be covered at all,” she said. “Because of the underwriting issue, it makes that market problematic for people looking for alternatives.”

About 6% of those surveyed had individual insurance.

Medical debt burdens
Household financial problems associated with health care are on the rise as well. One in five adults, including insured and uninsured, currently has medical debt being paid off over time, the survey said. About 44% of those with medical debt reported it was $2,000 or more.

The majority of Americans don’t use enough health care to get them in such a bind, Claxton said. “In any given year, 20% of people account for 80% of the costs.”
But for those who do end up needing hospital and other expensive care, the bills can be a hardship, especially if they have a bare-bones health plan or no insurance at all, he said.
“When you look at some of the policies now where the out-of-pocket limit might be in the $6,000 to $8,000 range for a family, it’s not that hard to get there.”

Collins agreed. “One really interesting finding is this affected both uninsured people in lower-income and higher-income households. Rates of debt were actually highest among those with higher incomes,” she said, adding that 60% of adults with income of at least $40,000 have problems with medical bills or accrued debt.

More than half of uninsured adults said they had medical-bill problems. Of those, 49% used their entire savings to pay it off, according to the survey. The need to pay medical bills prevented two of five from shelling out for basic necessities such as food, heat or rent.

Care of teeth and oral health often take a hit when insurance disappears. The portion of uninsured adults who had a dental exam in the past year was 35%, half the rate of those with coverage.

The consequences of going without health insurance often lead to a downward spiral of poorer health and costly care, Collins said.

Almost six in 10 adults with chronic illnesses who spent time uninsured in the past year didn’t fill or skipped their medications because they couldn’t afford them, the study said.
They also were more than twice as likely to go to an emergency room or hospital for care of those chronic conditions than people with health coverage, with 35% of uninsured people with conditions such as asthma or diabetes visiting an emergency room or staying in the hospital overnight compared with 16% of those insured all year who had a chronic condition.

People with gaps in coverage also tended to go without recommended cancer, cholesterol and blood-pressure screenings more often, according to the report.

We’ve officially gone ‘live’ today! See our Press Release.

The Palo Alto, California based Institute for the Future (IFTF) has issued a timely warning about the dark side of medical tourism. It takes a lot of searching amongst the generally-glowing articles about the MHTI to find stories that highlight the dark underside of this high-growth industry that is attracting its share of racketeers.

IFTF has profiled an article from the UK’s Guardian newspaper, 20 April 2006: UK transplant patients go to China for organs from executed prisoners.

The relevant text of the article is published below:

The British Transplantation Society said that “an accumulating body of evidence suggests that the organs of executed prisoners are being removed for transplantation without the prior consent of either the prisoner or their family”.

Thousands of organs are thought to be involved in the lucrative trade, it said. Transplant centres, patients, and the Chinese authorities and judiciary could all be implicated in a breach of human rights….

[E]vidence from doctors who have left China suggests that many patients are travelling for kidney or liver transplants, perhaps in desperation because of the shortages of donor organs in their own country. Most patients came from Japan and Korea and there were quite a few reports of Chinese Americans returning to China for their operation, he said.

Websites of Chinese transplant centres openly tout in English for business from foreigners. Although they do not suggest the organs come from executed prisoners, they offer a fast supply - between a week and a maximum of a month for a kidney transplant. One website declares: “Viscera providers can be found immediately!”

This morning’s Economic Times newspaper has a really interesting story on a Tunisian proposal to some Indian hospitals to set up ‘off-shore hospitals’ in Tunisia. What makes this story interesting is that this allows the MHTI to circumvent one the biggest issues limiting its growth — reimbursement of medical treatment expenses by insurers.

As the article points out — Flying time is a criteria for reimbursement for many insurers in Europe and is a major roadblock in the growth of health tourism. Since Tunisia is only 1 hour’s flying time from Europe (as oppsed to 7-8 hours to India) and the cost of treatment is roughly the same as India’s (1/5th of Europe), this tie-up, if it happens (and that’s a very big if), could have huge ramifications on the growth of the Indian MHTI.

This is an area worth tracking closely.

The full text of the story is here:
Tunisia keen to set up offshore hospitals with Indian partners
TIMES NEWS NETWORK[ FRIDAY, APRIL 21, 2006 12:47:23 AM]

NEW DELHI: Corporate hospitals in India, awaiting a health tourism boom, alleviate the pains of European patients closer to their home. Hospitals in the North African nation of Tunisia are keen to set up ‘offshore hospitals’ in joint ventures with Indian hospitals for patients in Europe. Tunisia is just an hour away from the European continent.

A delegation of drug makers, government and the Pharmaceutical Export Promotion Council (Pharmexcil), which visited Tunisia earlier this week, is upbeat about the business possibilities with that country in health tourism and pharmaceuticals.

Tunisia, which is a focus country for India for exports, wants 66% foreign direct investment (FDI) in hospitals and reserve 80% of the beds for European patients to qualify for the ‘offshore hospital’ status needed to rope in insurers.

Flying time is a criteria for reimbursement for many insurers in Europe and is a major roadblock in the growth of health tourism. Cost of treatment in Tunisia is one-fifth of that in Europe.

Moreover, Indian drug makers — led by Ranbaxy, Cipla and Hetero Drugs — are exploring opportunities for supplying drug ingredients and for setting up manufacturing plants in the Mediterranean country, which will provide them customs duty free access to Europen Union countries thanks to Tunisia’s free trade agreement with the world’s third-largest pharmaceutical market after the US and Japan.

Currently, for supply of key ingredients to 18 drug makers in Tunisia, its regulators are inspecting the bulk drug facilities in Hyderabad.

More facilities will be inspected next month to sign further supply deals between Indian and Tunisian drug companies, sources told ET. Setting up plants in Tunisia offers an easy option for Indian companies scouting for acquisitions in Europe to bypass the stringent import norms there.

Europe’s $70-billion pharma market is a growth area for Indian companies after erosion of profit margins in the US. The joint working group on drugs and pharmaceuticals is trying to step up Indian exports to the $360-million market there through a fast-track approval system.

Tunisia is keen to import drugs for cancer, tuberculosis as well as cardiovascular and central nervous system disorders. At present, Indian exports to Tunisia is just $2 million.

Today, we introduce a new abbreviation –
MHTI: Medical and Health Tourism Industry

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There’s a little bit of the bizarre in this story — a Canadian journalist undergoes an executive health check-up at one of the better Indian hospitals (as she himself acknowledges) and she is pleasantly surprised by the quality/ efficiency/ cleanliness. What else did she expect?

This story appeared in the Toronto Star on April 15. Full text below:

Tourists flock to India for a little body work
Apr. 15, 2006. 01:00 AM
CLEO PASKAL

NEW DELHI—I am going to tell you a deep dark secret. But first you have to wait for the test results, like I did.

I am in the waiting room of the Sitaram Bhartia Institute of Science and Research in New Delhi, one of the many world-class medical facilities all over India.

I am here because I heard that medical tourism is starting to take off in India. Last year around 100,000 people came for everything from knee replacements to nose jobs, compared to 10,000 five years ago.

The main reason is, of course, price. Exactly how cheap is it? You’ll see. But first, come with me while test-drive Indian medical tourism.

There is nothing (medically) wrong with me — I hope — so I’m having the Executive Health Check-up. It’s designed for busy professionals on the go (okay, so I’m faking it a bit) and involves several hours of all sorts of tests, and a follow-up session a few days later.

It starts at 8:30 a.m., after 12 hours of fasting. The reception area looks like hotel lobby, in fact the entire place is spic n’ span, with lots of natural light, potted plants, marble floors and views of the gardens.

I quickly check-in (no ID required) and am introduced to Mr. Singh, the hospital traffic co-ordinator. He leads me from appointment to appointment, readjusting my schedule depending on line-ups to make sure wait time is minimal.

The near-painless blood-taking is followed by a glass of glucose and the handing over of a cute and discrete little bag containing my sample containers. Then, it’s off for a chest X-ray. The room looks like every other X-ray room on the planet, sterile and steely. The gowns aren’t exactly award-show great, but they cover all the essential bits with more flair than usual. The radiologist cheerfully chats about Toronto doctors he’s worked with as he takes snaps of my inner being.

From there, Mr. Singh takes me to my electrocardiogram test in the garden-view diagnostic centre. As she wires me up, the nurse tells me it’s International Women’s Day and that I should do something special with my friends. She is going to the movies later with her pals. She also administers my pulmonary function test, and cheerleads as I huff and puff, encouraging me to greater windy heights than I thought possible.

Next door is my ultrasound. Another nice gown and clean, professional room. Again the doctor has colleagues in Canada, and we commiserate about the weather as she pokes and prods.

Mr. Singh takes my lunch order and then, in quick succession, I have my bone density tested, a post-glucose blood test, a treadmill test and a meeting with a G.P.

The G.P. answers all my questions with patience — so much so that I start making up problems just to see if he’ll kick me out, like my G.P. back home does. He doesn’t, he just answers in a relaxed and friendly way, which is why I now know that toenails grow slower than fingernails (seems that circulation is poorer in the feet.) Time well spent, I think.

The same level of professional care holds through my next batch of appointments with the gynecologist, cardiologist, ophthalmologist and physiotherapist. Finally, a break for lunch, a nice light sandwich and juice that I eat in the garden.

Then, more appointments. The ear, nose and throat man discovers my deep (because it is several centimetres inside my head), dark (because, contrary to popular belief, there are no light bulbs in there) secret. Apparently I have slighted retracted eardrums. All the flying, probably. He prescribes some medicine, which I get for a few dollars at the hospital pharmacy. Then more tests. I barely spend any time in the waiting room, but what little I do, I end up next to a couple from Arizona who are on the same check-up circuit. They are more experienced, though.

Having been to India before, they also knew to stock up on cheap medicine, prescription glasses (she got two pairs, including prescription sunglasses, for $40 U.S.) and to see a dentist (he is contemplating nine teeth implants for $2,000 U.S.)

Finally it is all over for the day. I come back a few days later for follow-ups with a few of the doctors and a session with the dietician. End result: seven hours of tests, half a dozen doctor appointments, physio, a personalized diet plan, all my charts and scans to take back home, a nice lunch and a couple of slightly retracted eardrums. Total cost: $100 (U.S.)

Now I’m off to find a dentist.

The New Kerela newspaper of April 7 has a story of a UK-based patient who flew to India for a hip-replacement operation at avoid a wait of almost 1 year in the UK. And it cost her 1/3rd of the cost in the UK to boot.

The newspaper used the following headline for this story: Indian health tourism posing threat to United Kingdom’s NHS, which is obviously exaggerated but the trend is unmistakable. Looking back at her experience, the patient remarked “… it was fantastic”.