Conference Highlights:
Medical Tourism Asia 2007

IBC-Asia hosted a conference called Medical Tourism Asia 2007, February 26-28 in Singapore. Below are some highlights from the topics presented.

Ruben Toral, Group Marketing Director,
Bumrungrad International, Bangkok, Thailand

“Nothing has been bigger than the impact of the web. We get 500-600 email requests per day.”

“JCI Accreditation is the stamp of approval that says we’re as good as any American hospital.”

What’s the future of medical travel in Asia?

1. Growing industry: At Bumrungrad, just six years ago, 23% of their patients were foreign, accounting for 19% of patient revenue; now, 42% of their patients are foreign, accounting for 53% of patient revenue.
   
2. Expect more competition and venture capital investors. “Medical travel smells like the next big thing.”
   
3. Business models supporting medical travel will evolve beyond the commission-based patient referral model, just as the commission-based travel agency model was made obsolete by the web.
   
4. Better platforms will be developed to facilitate patient flow and care management. It’s a clumsy system right now.
   
5. Medical travel will lead to better quality standards, as providers are forced to compete globally.
   
6. It will expand beyond hospitals into spas, wellness, and rehabilitation.
   
7. It will force providers to rethink how to market and sell health care services.

While the U.S. health care system is in trouble, Europeans and Japanese are facing their own problems, e.g. aging populations. Governments will not solve the health care crises in these countries. Consumers (individuals and corporations) will solve it. “Where’s the money? Commercial interests will drive change — not governments.”

Medical travel and outsourcing are consumer-driven initiatives. CIGNA and AETNA are talking to Bumrungrad because their clients (corporations) are asking about medical travel products.

There are four key players in medical travel: patients; payers; providers; and physicians. Widespread adoption depends on a network and connectivity. Widespread acceptance depends on win-win relationships.

Policy Issues Panel

Is medical travel good for local residents?

• Singapore wants to have a comprehensive medical infrastructure for its residents. “Local patients might not provide enough volume to justify a given specialist. We need foreign patients to fill in that gap,” said Dr. Jason Yap, Director, Singapore Medicine.

Competition for nurses:

• “Nurses are in dire shortage around the world,” said Dr. Yap.
  
• “Malaysia loses nurses to the Middle East, and with Dubai Medical City coming online, this could become an even bigger problem,” said Dr. Chong Su-Lin, CEO of Sunway Medical Centre in Malaysia.

Competition for doctors:

• Singapore sends doctors overseas for training, but they are obligated to come back. Otherwise, they must pay hundreds of thousands of dollars in liquidated damages. Most Singapore doctors are not U.S. Board Certified, because they know they aren’t going to stay, according to Dr. Yap.
  
• “In Thailand, private hospitals are accused of brain drain from public hospitals. In fact, private hospitals prevent doctors from leaving the country for higher pay,” said Dr. Surapong Ambhanwong, Chief Medical and International Business Officer, Phyathai Group of Hospitals, Thailand.

Legal Issues

In some countries, patients can sign a “do not resuscitate” directive, ordering the medical staff to let them die if they go into cardiac arrest. This is illegal in India. “If I do that, I’m going to jail,” said Dr. Arun Prasad, Sr. Consultant, Apollo Surgical Centre.

“Indian laws do not permit unrelated organ donors,” explained Dr. Sajiv Malik, Regional Director of Medical Operations, Max Healthcare in Delhi.

“In Singapore, there are no contingency lawsuits,” according to Dr. Joanna Lin, Medico-Legal Advisor, Singapore Medical Protection Society.

“There are also no punitive damages in Singapore,” added Dr. Yap.

Dr. Philip S. Chua, Vice President for Far East Operations,
Cardiovascular Hospitals of America, Wichita, Kansas

Cardiovascular Hospitals of America owns four hospitals in the U.S. They are expanding into Asia, starting in Cebu, The Philippines. The hospital is to be run like a U.S. medical center (i.e. U.S. standards). They will apply for JCI accreditation and plan to accept Blue Cross, Blue Shield, and U.S. Medicare.

Dr. Sanjiv Malik, Regional Director of Medical Operations,
Max Healthcare, Delhi, India

Worldwide there is a marked reduction in the number of new physicians entering the system, and an increasing aging population. India creates 20,000 new doctors a year.

Only eight states in India have legislation regulating private hospitals. Accreditation will play an important role.

Does lower cost equal lower quality? No! Accreditation will play a major role in removing this myth. Accreditation is about institutionalizing processes.

National Accreditation Board for Hospitals and Health Care Providers (NABH) is part of the Quality Council of India, an autonomous body set up by the government of India. NABH India accreditation is based on JCI, but is tailored for India. JCI requires some expensive and unnecessary fixes. “If we have a six foot corridor and JCI requires 20 feet, how does that affect patient safety? NABH requires the substantive quality and safety standards, but not the arbitrary and extraneous requirements.”

Indian patients benefit from rising standards. A symbiotic rise in standards goes hand in hand with a rise in medical travel.

Dr. Joel N. Beltran, Business Development Director,
Asian Hospital and Medical Center, Philippines
(an affiliate of Bumrungrad International)

In U.S. hospitals, approximately 40% of revenue is directed to personnel costs. In The Philippines, personnel costs only 20% of revenue.

Vishal Bali, CEO, Wockhardt Hospitals Limited,
Mumbai, India

50,000 nurses in the U.S. are expatriates.

In the next 25 years, the global population aged 65+ will grow 88% — almost 1 million people a month. This demographic will drive growth.

Providers want to work with agents. Many agents don’t know what they are doing. We need to ensure legitimacy, long-term relationship, and credibility.

Today accreditation is a competitive advantage; tomorrow it will be baseline.

The next wave:

• From self-pay to covered reimbursement.
• A common legal redress process across Asia.
• Accreditation system for medical travel companies.
• Disruptive low cost competition.

Dr. Pakpilai Thavisin, CEO,
S Medical Spa, Bangkok, Thailand

Dr. Thavisin presented her medical spa philosophy, based on a holistic (mind and body) approach. She is targeting baby boomers for anti-aging procedures. “Don’t wait until you are ill. Stress is a cause of many illnesses, such as cancer.”