Health Insurance systems differ across the globe and can traditionally be separated into Universal Healthcare, Private Healthcare, Public Healthcare and the Uninsured with implementation of a combination of these different models.  Health insurance is defined in this article as a program that pays for healthcare expenses. We present an International perspective on Health insurance by discussing Universal Healthcare, the healthcare system in the United States contrasted with that in Developing countries.  Development of Medical Tourism Insurance is currently integrated into this International perspective as an option for increasing access to healthcare.

Universal Healthcare:

National Health Insurance is available to all residents of a country through legislation with a variation in financing mechanism and benefits.   National Health Service Models are prevalent around the world with examples in Germany, the United Kingdom, Canada, France, Ghana, Columbia, Japan, South Korea, Switzerland, Taiwan, Nigeria, and the Philippines.  Some countries fund these programs through taxation, employer and employee contributions, or private contributions.¹ Some of these countries have options for private health plans.

For example, The United Kingdom has a Universal Health Insurance System called the National Health Scheme with the additional option for private patients who fund themselves or have private health insurance coverage.  The system is controlled through use of a General Practitioner who provides access to the private hospitals.²

Mexico has Universal Health Care implemented by the Mexican government in addition to a private healthcare system available to those with income.   The Secretariat Health Agency implements a public health system with eligibility to all Mexican citizens regardless of their employment system.  Two public systems are available for the employed:  the Instituto Mexicana del Seguro Social(IMSS) and the Instituto de Seguridad y Servicios Sociales de los Trabajodores del Estado(ISSSTE).³

United States:

The majority of American have health insurance and these programs routinely pay for routine preventive care, emergency care, hospitalization and prescription drug coverage with varying benefit plans based on different financing models.  The system is divided into a Private and Public Healthcare system.  Managed Care is common to both systems as a cost control mechanism to covered members.  The categories of public insurance include Medicare, Medicaid, State Children’s Health Insurance Program, Military, and Indian Health Service.  The private insurance system is primarily employer based or student health insurance.  Specialty insurance programs exist for Long Term Care, Disability and Supplemental coverage.  The financing models of medical insurance are separated into Fee for Service Plans, Private Plans, Health Maintenance Organizations, or Managed Care.⁴ The financing formula traditionally involves payment of a fixed rate, co-payment or premium with the price determined by the health plan benefits offered.   Government programs sometimes implement waivers to study alternative programs of cost effective healthcare both domestically and overseas.⁵

Developing Countries

There is enormous mismatch in global healthcare financing. Developing countries have 84% of population & 90% of disease burden.⁶ Developing countries do not have Universal health insurance.  The insurance system is a system of Private insurance for the wealthy and the uninsured who pay out of pocket.

An estimate of 1% of the GDP in India is public financing, in comparison to a 2.8% average for low and middle income countries.⁷ India is an example of the insurance program in developing countries where the majority of residents do not have healthcare coverage.  An estimate is only 10% have health insurance and 75% pay out of pocket.   The development of insurance programs is a growing business with the introduction of Third Party Administrators to manage insurance products instituted by the Insurance Regulatory Development Authority in 2001.⁸

India’s health insurance program can be described in terms of three plans:  private, social, and community based.   There is growing interest to provide insurance coverage by developing a premium for insurance to both people who can afford or not afford to pay the premium.⁸ India has several challenges in financing healthcare costs which include the increase in healthcare costs, new diseases and risks, burden of the poor, low level of awareness, need for long term and nursing care for seniors, and lack of preventive and primary care.⁹

India’s insurance companies need to overcome barriers to implementing an insurance program which include limited control over healthcare systems, consumer awareness which is small, inadequate pricing of insurance products due to lack of standardization and data, restricted product development in the area of healthcare informatics, and low level of medical penetration.¹⁰ The government needs to develop an insurance system for the public which should begin as a preventive healthcare system.¹¹ There are many steps involved in promoting the insurance system in India which include creating awareness of rights & responsibilities, data pool, standardization of costs, increased tax benefit, portability of insurance, comprehensive health benefits, and having a government role.¹²

Medical Tourism Insurance

Medical Tourism is marketed to all citizens in all countries regardless of socioeconomic class.  Different economic models of medical tourism exist in Developing and Developed countries. Medical Tourism is a mechanism to develop the public health system in developing countries and is an option to provide an alternative option for elective, diagnostic, lifestyle procedures for countries with more developed insurance systems.¹³ Global healthcare insurance is a newer concept and currently exists as a Fee for Service(FFS) or capitation model, where discounted rates are reimbursed through financing mechanisms for specific procedures or as part of a package.   Insurance policies with premiums are available for travel insurance, medical travel insurance, medical complications/medical malpractice, and pilot employer sponsored programs to some countries.¹⁴ The demand for a growth in medical tourism insurance policies is to increase access to medical tourism for potential patients from all countries with lower rates and portability of insurance policies.

Health insurance is a barrier to the trade in healthcare as it isn’t uniformly portable or useable globally.  Insurance businesses could benefit from the trade of health services.  However, issues regarding the quality of care, malpractice, costs of monitoring care and the increased costs to the public health systems exist.¹⁵ Performance of hospitals has been positively associated with quality improvement in the literature.¹⁶

To facilitate trade, Developing countries can improve the quality of service provided and require doctors and nurses to meet the standards of certification.¹⁷

Universal Health Insurance is a goal of all countries to work towards.  All countries are implementing a combination of financing mechanisms to deliver comprehensive health benefits to its citizens.  Developing countries are working towards building a more sophisticated health system through the development of insurance and the building of higher quality facilities.  Medical Tourism is assisting developing countries to develop its healthcare goals while providing an alternative solution to citizens in other countries who currently have barriers to achieving their health goals.

References

1. National Health Insurance Models.  Retrieved on October 12, 2010.  Available at URL: http:// en.wikipedia.org/wiki/National_health_insurance.

2.Insurance in the United Kingdom.  Retrieved on October 12, 2010.  Available at URL:  http:// http://en.wikipedia.org/wiki/Insurance_in_the_United_Kingdom.

3. Health Insurance in Mexico.  Retrieved on October 12, 2010.  Available at URL:  http:// en.wikipedia.org/wiki/Health_care_in_Mexico.

4.Health Insurance in US.  Retrieved on October 12, 2010.  Available at URL: http:// en.wikipedia.org/wiki/Health_insurance_in_the_United_States.

5 Warner, D and L. Jahnke, “Toward Better Access to Health Insurance Coverage for U.S. Retirees in Mexico,” Salud Publica de Mexico 43, no. 1 (2001): 59–66.

6. Mathers, C. D., A. D. Lopez, and C. J. L.Murray. Forthcoming. “The Burden of Disease and Mortality by Condition: Data, Methods, and Results for the Year 2001.” In A.D. Lopez, C., retrieved on October 20, 2010, available at URL:  siteresources.worldbank.org/…Financing/HFRFull.pdf

7. Schieber and Maeda.  A curmudgeon’s guide to financing health care in developing countries, in George J Schieber edited “ Innovations in health care financing: Proceedings of a world bank conference”. March 10-11, 1997, World Bank discussion paper No 365, The World BNK, Washington D.C.

8. Health Insurance in India.  Retrieved on October 12, 2010.  Available at URL: http://

http://en.wikipedia.org/wiki/Insurance_in_India.

9.Ahuja, R.   Health Insurance for the poor in India, March 2004, presented at workshop on ICRIER on “ New Institutional and economic approaches to health insurance for the poor in India.”

10.Wise Geek, What Is Healthcare Informatics? Retrieved on October 12, 2010.  Available at URL: http://www.wisegeek.com/what-is-healthcare-informatics.htm.

11.  Srinivasan R, 2001, Health insurance in India, Health and Population – Perspectives and Issues, 24 (2),p 65-72

12. Gumber A.  1997, Burden of disease and cost of ill health in India: setting priorities for health interventions during the ninth plan, Margin, Vol 29 (2), pp. 132-172.

13. Bookman M and Bookman R.  Medical Tourism in Developing Countries.     2007.  Palgrave Macmillan:  NY.

14.Yurk, RA.  International MediTour Cover Business Plan.   NY:  Wallcott Holdings, LLC.  December 16, 2009.

15.Mattoo, A and Randeep Rathindran. How Health Insurance Inhibits Trade in Health Care , Health Affairs, 25, no. 2 (2006): 358-368.

16. Hibbard, J,  J. Stockard, and M. Tusler, “Does Publicizing Hospital Performance Stimulate Quality Improvement Efforts?” Health Affairs 22, no. 2 (2003): 84–94.

17.Chanda, R.  “Trade in Health Services,” Bulletin of the World Health Organization 80, no. 2 (2002): 158–163.

Source:1

Medical Tourism Facility Operators benefit from participating in Global Healthcare.  International customers provide a unique customer base with diversity in medical problems providing the facility with an area of expertise.  Additional experience is produced along with additional revenue.  New business opportunities (Figure 1) develop in the community with a new Medical Tourism Industry Professional network.  Medical Tourism Facilities that are high quality are a source for new research subjects with an international population.  New linguistic and cultural enrichment helps develop a unique medical tourism facility. “Countless patients and families come to the United States from abroad to seek medical care each year, yet few are familiar with their options for receiving access to language services – such as interpreting and translation – along with culturally sensitive care”. ²

Figure 1.  Overview of International Business Opportunities

International Customers:  International customers invite international patients, allow growth in reputation with international clients, and allow doctors working with their organization to broaden his already existing expertise.

Increased revenue for providers: The doctors/ surgeons can earn more money when treating foreign tourist than when limited to local patients. The increased revenue can lead to enhancement of local infrastructure. This leads to further attractions the CEO can offer to an international patient.

Providers gain experience: Professional can gain experience and improve his /her proficiency and skills.  This results in improved confidence.

Community Benefits: The community can become renowned and eminent internationally. The distinguished reputation gained abroad can lead to personal satisfaction. This leads to professional success and a symbol of pride for their nation. Personal and professional prestige can lead to improved benefit to the community.  The entire community will benefit by such transfer of knowledge and skills.

Medical tourism Industry Professional network: Travel agents also stand to benefit from the medical tourism business.

Increased research opportunities for international studies:  Exploring the diverse nature of a national and an international population can make way to comparative studies. Correlation to unique diseases can be investigated, since different geographical locations have a varied habitat of people.   For example in dental tourism, patients from different places may have unusual and dissimilar teeth structure depending on the vegetarian or non vegetarian food they consume. Thus, Global Health Care can bring unique comparisons under a common umbrella.

Linguistic Benefits: The medical facility operator and the doctors working have a great possibility to improve their vocabulary as they are dealing with assorted patients.

Cultural enrichment: It is a great opportunity for a cultural mix to take place beyond borders. An enrichment of traditional, intellectual, educational and religious values occurs.  The international patient gets exposed to the values of the touring country and the medical facility operator gets representation of the cultural values of the traveling patient.

Improvements in Cultural understanding occur through participation in Medical Tourism.  Cultural values are understood through attention to gender, dress, religious practices, food habits & beliefs. “Understanding of Culture in Medical Tourism is a two way process as the patient needs to understand the destination’s cultural beliefs as much as providers need to know and understand the patient’s cultural beliefs”.³

An international patient population derived from medical tourism requires Healthcare managers to pay attention to cultural safety in their facilities. Cultural safety has its origins to the deterioration of healthcare safety in the Maori community which was attributed to cultural differences.  Sometimes racial discrimination due to the color of skin of the patient may require instituting practices to balance developing the right healthcare protocols for an approach.⁴ There are many unanswered questions in the area of cultural safety which can be a good focus for research studies and new protocols.  An example is:  Would the practice of cultural safety bring any difference? Are the providers of global health care aware of cultural safety in developing countries?

There is additional business and research potential involved in medical tourism which includes an overview of facts, revenue, availability, benefits, risks, recovery period for an international patient population.  The United Nations provide an example of differences in patient populations in which the Japanese have a high life expectancy attributed to differences in dietary patterns.^5,6 This information provides the basis for international research comparisons.   Economic, Social Justice and societal impacts of the medical tourism industry are additional trends in the areas of business and research interests in Global Healthcare.⁷

Each country has its unique cultural heritage. Such is the exposure that a person obtains from the distinctive enlightening civilization, that there tends to be absorption of values, ethics and principles.   Malaysia’s health spa industry successfully combines ancient Eastern therapeutic traditions with modern innovations. The country’s unique cultural mix is well-represented within its state-of-the-art spas, which offer the best of Javanese, Indonesian, Chinese, Malay, and Ayurvedic treatments.⁸

Medical Tourism Facilities promote the development of a unique patient population

along with development of new business opportunities in research, travel, quality, community.  Cultural competence requires further definition in Medical Tourism.  New cultural traditions are being integrated with Western medicine in geographically diverse places.  In addition, diverse patient populations are requesting these services.   New developments need to be made in the area of service quality through improved efficiency and attention to cultural competence and safety.  

References

1. Medical Insurance Blog. Retrieved on September 27, 2010.  Available at URL:

www.shineterrace.com/.

2. Nataly Kelly.  Talking the Talk ~ Obtaining Culturally and Linguistically Competent

Health Care in the United States. Medical Tourism Magazine. Retrieved on September

30, 2010. Available at URL: http://www.medicaltourismmag.com/issue-article/talking-

the-talk-obtaining-culturally.html.

3. Medical Tourism Magazine.  Dr Prem Jagyasi, “Understanding Culture in Medical

Tourism” July 7, 2010.  Retrieved on October 4, 2010.  Available at URL:

http://www.medicaltourismmag.com/article/understanding-culture.html.

4. Medical Tourism City.   “Importance of Cultural Safety in Medical Tourism”, Medical

Tourism City, May 31, 2010.  Retrieved on October 4, 2010.  Available at URL:

http://www.medicaltourismcity.com/forum/topics/importance-of-cultural-  safety?commentId=3412443%3AComment%3A32330.

5. United Nations. United Nations World Population Prospects: 2006 revision – Table

A.17 for 2005-2010. Retrieved on October 4, 2010.  Available at URL:  http://

www.un.org/esa/population/…/wpp2006/WPP2006_Highlights_rev.pdf.

6. MSNBC.Com.  “Life expectancy rises even higher in Japan , Women born there can

expect to live 85-plus years.”  Retrieved on October 4, 2010.  Available at URL:

http://www.msnbc.msn.com/id/17406997.

7. The Word Online. “UIW Becomes Home of Worldwide Research Center”Dr. David

Vequist.  The word online, 2009.  Retrieved on October  4, 2010.  Available

at URL: http://www.uiw.edu/thewordonline/spring09/uiwresearchctr.html.

8. “Medical Tourism Malaysia”, Malaysia Health Spas. Retrieved on October 4, 2010.

Available at URL: http://www.discovermedicaltourism.com/malaysia/health-spas/.

By Latha Rajendra Kumar, MD, PhD and Robin Yurk, MD, MPH

MedTourExpo is planned to be held in Las Vegas in 2011. It is international conference and planning educational work shops. The previous conference was held in Sydney, Australia. Health care operators Insurance administrators, University Professors, academicians, travel agents who would like to showcase the available services are welcome to register for the upcoming event in Las Vegas. Business opportunities for travel and tour operators and investment opportunities for medical tourism will also be discussed.  In this release, we will discuss the benefits and assistance that the health travel agents can receive by registering for this conference.

Health Travel Agents are a growing industry to assist with marketing of Global Healthcare opportunities with a sample of companies located in the US and Internationally(Figure 1).² Medical tourism facilitators(MTF) for these companies act as intermediaries and perform the following services:  1) Travel, 2) Documentation, 3) Healthcare, and 4) Tourism.³ The benefits to clients of  using a MTF include:  coordination of services centralized, sharing of experience from other travelers, offering savings, having a representative, service of logistics of arrangements, after care, and providing cultural competence.  Areas for some of these companies to improve upon include pricing, customer service, expanding choices, and communication.⁴

Health Travel Agents use common marketing strategies to improve business, such as word of mouth promotion, maximizing internet based recruitment, collecting patient stories,  and updating search engine optimization for medical tourism.⁵ The 5 P’s for marketing are: Product, Placement, Price, Position, Promotion.⁶ Marketing for Health travel agents could be improved by focusing on Integration of marketing strategies from medical facility operators and Third party administrators.   For example, Health Travel Agents are assisting Medical Facility Operators in promoting their Product, the actual Health Facility and medical procedures performed.⁶ Health Travel Agents can use information from existing patient satisfaction surveys from these facilities to obtain useful information regarding the desirability of a facility.   Health Travel Agents may also offer additional services such as immunization travel recommendations, travel visa assistance, or insurance products to coordinate with the desired location.

Placement of some of the health travel agencies for global healthcare is competitive as they have both a US and other International offices to cater to different medical tourism markets, such as the Taj Medical Group.⁷ Alternatively, some of the health travel agents are specialized and only focus on promoting the product in one country such as Indus Health.⁸ Website and e-mail campaigns are one solution for health travel agents to market to different countries if created and targeted with language translation services.⁶

Current Price marketing strategies for health travel agents focus on the savings obtained from discounted rates which has a wide variation in prices in selected countries.⁹ Medical Facility operators who participate in Global Healthcare have the challenge of catering to clients from different countries with a variation in Price reimbursement from insurance. Health insurance policies are not universal as the laws and regulation vary by country.   United States Health Insurance programs for medical tourism exist with a few employer based health benefit products for a designated foreign site or through travel health insurance programs.^10-12 Internationally policies exist as summarized by companies such as Treatment Abroad.⁹ Medical Tourism Facilitators may develop a role in health insurance associated with the program service documentation in the form of claim submission and reimbursement and healthcare price negotiations.³

Figure 1 describes the Position of health travel agents, which is the scope of competition.  Complete and full time service medical facilitators identify the call for medical tourism insurance for their customers. Several full service medical facilitators are now marketing medical tourism insurance through association with insurance companies, such as Companion Global Healthcare,¹¹ Indus Health,⁸ and Planet Hospital,¹³and Healthbase.¹⁴

Promotion of the image of Health Travel Agencies can be improved.  Presently health travel agents and medical travel facilitators are an unregulated business and a current method of marketing and verifying credibility of agencies is through communication through their websites and patient experiences.   Examples of some of the specialized services required of health travel agents is the transfer of medical information and coordination of aftercare.² The AMA supports that insurance administrators should develop policies to cover the essential post operative and follow up care for patients returning to their home country to allow for complete recuperation.¹⁵ There is no formal insurance procedure and health travel agents are marketing their  service to assist in coordination for this area of care.  Medical Tourism Training Centers¹⁶ and Medical Tourism Facilitator Certification¹⁷ are new developments in the field which demonstrate an industry trend in promoting a higher quality customer service for some of the specialized services.

Medical Tourism Businesses have overlapping goals with competition for customers.  Health Travel Agents can be a vehicle in implementing a marketing campaign for medical facility operators, insurers and 3^rd party administrators.  Online marketing in the form of websites and email campaigns can be a useful strategy to recruit customers, promote overlapping products and services, and develop uniform messages that are culturally sensitive.

References

1.Medical Tourism.com, Retrieved on September 30, 2010, Available at URL: medicaltourism.com/facilitator.php?lang=en.

2.Woodman, Josef.  Patients Beyond Borders. 2008.  USA, Healthy Travel Media. Chapel Hill, NC.

3. The Role Of Facilitator In Medical Tourism by Dr Prem Jagyasi – Presentation Transcript. .  Retrieved on October 4,, Available at URL:     http://www.slideshare.net/jagprem/the-role-of-facilitator-in-medical-tourism-by-dr-prem-jagyasi.

4. Medical Tourism Service Facilitators: Pros and Cons.  Retrieved on September 15,2010, Available at URL:     http://www.google.co.in/imgres?imgurl=http://4.bp.blogspot.com/_qcxA0Kgm.

5. Ramon Ray, Technology & Your Business This Week , Travel Agents: Use Email Marketing to Stir up Sales, Retrieved on September 20, 2010, Available at URL: http://www.allbusiness.com/marketing-advertising/marketing-advertising/11694834-1.html.

6. Stackpole,  I.  Medical Tourism Marketing:  The Basics for Growing Your Business. 2009. Brookline, MA:  Stackpole & Associates.

7.Taj Medical Group.  Retrieved on September 27, 2010.  Available at URL:  http:// www.tajmedicalgroup.com/.

8.Indus Health.  Medical Travel Insurance. Retrieved on September 16, 2010.  Available at URL: http// www.indushealth.com/medtravel_insurance.aspx.

9.Treatmentabroad. About Medical Tourism-Insurance for Medical Travel.  Costs.  September 16, 2010   Available at URL:  http://www.treatmentabroad.net.

10.Deloitte Center for Health Solutions.  Medical Tourism:  Update and Implications. 2009.  Available at URL:  http:// www.deloitte.com/us/medicaltourism.

11.Companion Global Healthcare.  November 18, 2009.  Available at URL: http://www.companionglobalhealthcare.com/.

12. Yurk, RA.  International Mediator Cover Business Plan.   NY:  Wallcott Holdings, LLC.  December 16, 2009.

13.Planet Hospital.  Insurance.  Retrieved on September 16, 2010.  Available at URL: http//www.planethospital.com/2009_v2/insurance.php.

14.Healthbase.  Insurance. Retrieved on September 27, 2010.  Available at URL:  http:// www.healthbase.com/hb/pages/medical-tourism-plans-for-insurers.jsp.

15.AMA Council on Medical Service Report 1 (Resolutions 711 and 732, A-07). Medical care outside the United States, Available at  http://www.ama-assn.org/ama1/pub/upload/mm/372/a-08cms1.pdf).

16.Medical Tourism Training.  Retrieved on September 20, 2010.  Available at URL:// http:  www.medicaltourismtraining.com.

17.Council on Global Integration of Healthcare.  Medical Tourism Facility Certification. Retrieved on September 20, 2010. Available at URL: http:// www.cgih.org or www.imtjonline.com/education/directory/?EntryId113=130479.

Figure 1.  Overview of Health Travel Agents Facilitating Medical Tourism

Email: latha.rajendrakumar@gmail.com

Global Healthcare has been presented in the literature as an economic model with tradable healthcare services.¹ Competition has been presented in terms of price, however increased Resources and Awareness is needed regarding healthcare facilities which meet high quality standards.  The trend for promoting higher quality facilities is being performed by Joint Commission International with an estimate of 43 countries containing over 300 accredited organizations.² Wallcott Holdings is an organization which has developed a Global Healthcare business model to promote high quality healthcare facilities integrated with tourism.  Satellite organizations such as IntHealthCert and MediTour Expo will work with Wallcott Holdings, LLC in promoting the high quality Standards envisioned by Wallcott Holding’s Global Healthcare delivery model.  We present an overview of the organizations involved in the development of the International Medical Tourist Zones.

Wallcott Holdings

In 2004 Wallcott Holdings, LLC (WHL), a US based international research group, began strategic planning aimed at creating a new, fully integrated global healthcare system, the International Medical Tourist Zones (IMTZs).“International Medical Tourist Zones are large-scale economic developments integrating state-of-the-art medical facilities, luxury tourist attractions and best-in-class accommodations in areas currently underserved by medical tourism.”  Wallcott Holdings, LLC will facilitate diversified real estate investment capital for the IMTZs and their surrounding facilities planned to be developed in Mexico, Europe, Asia and the Dominican Republic.  The first IMTZs being developed is the Mexico International Medical Tourist Zone IMTZs located in Puerto, Penasco, Mexico.³ Each facility will be Joint Commission International Accredited, facilitated by IntHealthCert and educational and marketing events planned by MediTourExpo.

One large chain of hospitals that serves to highlight the potential of the IMTZs is located in India and continues to upgrade its facilities in a bid to attract the increasing pool of potential overseas consumers. Another well-known hospital in Bangkok, Thailand, boasts 3,500 procedures per day, many from overseas patients. They advertise as an internationally recognized hospital with 600 physicians on staff – 200 of whom are US certified. Additionally, Singapore recently hired an international management-consulting firm to help develop a strategy for attracting more international medical tourists.³

Additional information about Wallcott Holdings, LLC can be found on the website at wallcottholdings.com.

MediTourExpo:   Pioneering the Future of Global Healthcare.

MediTourExpo LLC (MTE)⁴ was created for the purposes of marketing, fundraising and promoting IntHealthCert’s and the IMTZs’s agenda.   MediTour Expo is a US Based Event and Educational Company Specializing in International Healthcare Travel and Tourism

MediTourExpo is currently pioneering an annual international conference dedicated to providing valuable assistance to the global healthcare travel industry including international healthcare and wellness.  This second international conference in global healthcare will feature investment opportunities in healthcare travel and tourism in Las Vegas. The conference will focus on business and investment opportunities, educational and professional topics and legal issues for international medical tourism⁴.  Some of the business & investment topics include investment in medical wellness tourism & assisted living facilities, health travel agents and medical tourism opportunities, and an overview of investment opportunities for the International Medical tourist zones.  Some of the educational and professional topics will include international hospital certification, healthcare informatics, and the role of the primary care physician in medical travel and continuity of care.  The other avenues presented are ethical and legal issues for the international medical tourist, potential risks and how to rise above them.   The target audience will be global investment advisors, leading healthcare lawyers, tourism industry professionals, travel agents, global healthcare professionals, healthcare insurance administrators, and medical facility owners and operators.  Conference enquiries for the brochure and agenda can be made through the website at www.meditourexpo.net or through e mail  at Info@meditourexpo.net.

More details on the details of the individual sessions will be featuring in November, 2010. Our October article will feature the accreditation process for foreign medical tourism facility operators in Global health care.

MediTour Expo Assists in the Development of IntHealthCert.

IntHealthCert is a new non-profit healthcare organization⁵ which will work closely with MediTourExpo to facilitate its organizational development.  It will be a membership organization focusing on both education and advocacy within the medical travel industry and globalized medicine.  The mission is to inform the global traveler about quality accreditation standards through continuous improvement of the International healthcare facilities located in specially designed international medical tourist zones, medical cities and their affiliate clinics.   These facilities are planned for Mexico, the Dominican Republic, Europe, and Asia.   IntHealthCert’s initial scope of operations for the International Medical Tourist Zones will include 1) promotion of patient safety & reduction of adverse events, 2) consumer advocacy through an International Medical Dispute Resolution System and 3) Education for a specialized Medical Tourism system.

More information about the organizational development of IntHealthCert can be found on the website:  www.IntHeatlhCert.com

Conclusions:

The goal of achieving high quality standards is a continuous process with a division of responsibility.  The International Medical Tourist Zones will provide the leadership infrastructure and mission to build a healthcare facility with high quality standards in areas currently underserved by Medical Tourism.  IntHealthCert will work to develop an organization which will promote the goal of JCI accreditation in its facilities in addition to the development of some additional standards.  MediTour Expo will sponsor educational events which are centered around the mission of IntHealthCert.   MediTour Expo will provide the avenue for further development of this model of the International Medical Tourists Zones in the coming year as its Second International Conference, Pioneering the Future of Global Healthcare.

References:

1. Bookman M and Bookman R.  Medical Tourism in Developing Countries.

2007.  Palgrave Macmillan:  NY.

2. Joint Commission International.  About JCI-Accredited Organizations.  September 6, 2010.  Available at URl:  http:// www.jointcommissioninternational.org/about-jci/. 

3. Wallcott Holdings LLC.  International Medical Tourist Zone(IMTZs) Business Plan.  NY.  June 2009.

4. MeditourExpo Conference Brochure.  Retrieved September 3, 2010.  Available at URL:http://www.meditourexpo.net.

5. IntHealthCert. Business Plan. NY. November 2009.

“Medical tourism is commonly defined as when a person travels away from home to undergo a medical procedure or treatment to save costs due to lower currency, to obtain medical expertise or technology unavailable in home country, or to integrate vacation with medical travel as part of a bundle of services².”  A standardized four step process^3,4 exists for medical tourism involving research, planning, implementation, and outcome (Figure1).

The United states, Canada, Europe, the Middle East and  Japan are some of the leading nations from where Medical tourists come from. In the above mentioned countries they enjoy high income for their vast population. Hence the patients have great hope for excellent treatment. The required treatment may sometimes not be available locally.  An authority at the Harvard Business School recently stated that “medical tourism is promoted much more heavily in the United Kingdom than in the United States⁵“.  More Americans are traveling abroad for medical treatment, according to a study released by the Deloitte Center for Health Solutions, a Washington, DC-based organization that researches health care and public health-related issues⁶. The US participates in inbound medical tourism.  However, there is growth in the number of Americans seeking outbound medical tourism, as statistics have estimated approximately 750,000 in 2007 and with 6 million predicted by 2010⁷. North America and Europe have medical tourism services. Asian countries offering medical tourism are Singapore, India, China, Thailand and Indonesia.

Medical tourism exists in all countries and can be classified as inbound, outbound and intrabound.⁸ These terms are used according to the home country from which the tourist is traveling. The United Nations Classified the three forms of tourism in 1994 in its Recommendations on Tourism Statistics: “Inbound tourism, involving non-residents traveling in the given country; outbound tourism, involving residents traveling in another country; and Domestic tourism, which involves residents of the given country traveling only within this country.” ⁸ The 3 fundamental outlines of medical tourism from the UN can be integrated to form new definitions:  “Internal tourism, which encompasses domestic tourism and inbound tourism; National tourism, which comprises domestic tourism and outbound tourism; and International tourism, which consists of inbound tourism and outbound.”.⁸

Many countries are experiencing strong rivalry for inbound tourists.  Inward bound tourism is a precious source of revenue for the nation and the local financial system and economy.  It’s not just the hotels and attraction that profit from the expenditure authority of tourists, as money spreads out to benefit a variety of local businesses.⁸

The tourism industry has moved from the endorsement of inbound tourism to the promotion of intrabound tourism.  A number of national law makers have transferred their priority to the promotion of intrabound tourism to contribute to the local economy. Examples of such campaigns include “See America” in the United States, “Get Going Canada” in Canada, and “Guseok Guseok” (corner to corner) in South Korea. Intrabound tourism is a term created by the Korea Tourism Organization and widely established in Korea. Intrabound tourism differs from domestic tourism in that the former encompasses policy-making and implementation of national tourism strategy.⁸

Global Healthcare encompasses all definitions of medical tourism.  A tourism market for healthcare exists in each country associated with the classification scheme for people of different socioeconomic classes.    There is increasing interest in promoting an economic model for the trade of healthcare services.⁹ The goal of medical tourism is to integrate the needs of the public and private sector healthcare markets.  The ultimate goal is to improve access to care for all citizens and meet the services needs of people from different socioeconomic classes.⁹

People who choose medical tourism are from different economic socioeconomic classes and may seek cost savings when compared to the cost available in his or her home country.  The cost of surgery has a wide price range in different countries and may be too high for some people to afford.⁹ The high insurance coverage only adds to the anxiety so people are exploring other options.  However, there is a growing trend for some US residents to pursue outbound tourism particularly on the Border States.  These uninsured have experienced an increase in mortality rates and financial losses¹⁰ related to access to healthcare and find the cost savings from global healthcare a more viable option.

Other common reasons why people are opting for treatment abroad is due to the availability of alternative procedures.  In Global healthcare, there is an increasing interest in the growth of complementary and alternative medicine with traditional medicine or integrative medicine.   The latest and most recent yoga treatment for stress, spas for relaxations, ayurvedic and homeopathic healing, acupressure for chronic joint pain, spinal problems, headaches, and migraine are on the rise.¹¹ Medical tourism is clearly a comprehensive occurrence that merits greater consideration. The patients, along with both insurers and employers, are seeking to reduce the costs of treatment through international outsourcing of medical and surgical care. The acceptance of medial tourism is growing, with a recent poll showing more than 40% of US healthcare consumers willing to travel abroad for care.¹²

In the present model of medical tourism, every year, millions of patients from around the world congregate to some of the most up-to-date medical tourism destinations in order to obtain five-star treatment at incredible prices. Excellent medical, surgical, dental, cosmetic care is performed by trained and proficient surgeons at outstanding medical centers.  According to the “National Coalition on Health Care, experts predict that by 2012, medical tourism will grow to be a $100 billion business with more than 780,000,000 patients traveling overseas to receive care from foreign doctors, dentists, and hospitals.”¹³

We have presented an overview of medical tourism redefined as global healthcare.  Feeling at home though you are away from home is an added advantage. When a medical tourist makes a long journey to come under the knife in a far-off, unfamiliar country, he would be reminiscent of services available back home.  There are some improvements and growth need in medical tourism industry which relate to variability in quality, safety, legal issues and communication from language barriers which will be discussed in subsequent articles.  Superior quality can be found in Medical Tourism which would be equivalent to that of the medical tourist’s home country.   When the outcome is the same, why spend extra money when you get the same care with a costs savings, and the added benefits of visiting a new country.  We will present more detail in the coming months on the advantages of global healthcare.

References:

1.Living Healthy , Chicago, Health/living healthy/yoga, Accessed on 8/31/10  Available at URL:http:// weblogs.cltv.com/features/health/livinghealth…

2.WallcottHoldings. “Health Tourism Today”(2006-2007).  Retrieved from Wallcott HoldingsAugust 4, 2010.  Available at URL:http://www.wallcottholdings.com/Healthcare Tourism Today.

3.Marsek, Patrick and Frances Sharpe.  The Complete Idiot’s Guide to Medical Tourism.  2009. Penguin Group:  New York.

4.Woodman, Josef.  Patients Beyond Borders. 2008.  USA, Healthy Travel Media. Chapel Hill, NC.

5.Lagace, Martha “The Rise of Medical Tourism”, Harvard Business School Working Knowledge, December 17, 2007. Retrieved July 1, 2008.  Available at URL:  http://hbswk.hbs.edu/item/5814.html.

6.Deloitte Center for Health Solutions.  Medical Tourism-Consumers in Search of Value.  2008.  Available at URL:  http://www.deloitte.com/centerforhealthsolutions.

7.Jillian Melchior and Maggie Goode, “International Medical Tourism Is on the Rise”, HealthCareNews,February2009. Retrieved from Heartland.org August 30, 2010.  AvailableatURL:http://www.heartland.org/policybot/byauthor/24498/Jillian_Melchior_and_Maggie_Goode.

8.“Recommendations on Tourism Statistics”. Statistical Papers. M (New York: United Nations)(83):5.1994.AvailableatURL:   http://unstats.un.org/unsd/newsletter/unsd_workshops/tourism/st_esa_stat_ser_M_83.pdf.

9. Matoo A and Rathinfram R. How health insurance inhibits trade in healthcare. Health Affairs 25(2):  358-368.

10. Zeese, Kevin.  “Health Care: What Did We Get? Where Are We? And, Where Do We Go From Here?” March 28, 2010.  Prosperity Agenda US.  Available at URL: http:// www.prosperityagenda.us/search/node/zeese.

11. Bradly Jacobs and Katherine Gundling.  The ACP Evidence-Based Guide to Complementary & Alternative Mediicne.  2009.  ACP Press:  Philadelphia.

12.Pafford B, The third wave–medical tourism in the 21st century, South Med J. 2009 Aug;102(8):810-3.

13.Healism.com. “Medical Tourism”. Retrieved from Healism.com August 27, 2010.  Available at URL://http://www.healism.com/.

Figure1:  The Standardized Process of Medical Tourism: ^3,4