TOURISM04NEWS24MIddLEEASTFOCUS16BARIATRICSURGERY12INTERVIEWCoNTENTsanddevelopmentsAlookattheworldwid

04 NEWS

A round up of regional and international news

and developments

12 INTERVIEW Dr Riaz answers the most common questions

from patients on the theme of Healthcare Travel

16 BARIATRIC SURGERY Experience with medical tourism

18 REGULAR COLUMSlips and Tips, by Dr. Sanjiv Malik

20 COSMETIC SURGERY A look at trends in the current market

22 REpROdUCTIvE TOURISM A look at the worldwide phenomenon of

couples seeking fertility help abroad

24 MIddLE EAST FOCUS Bridging the medical tourism gap

CONTENTS HealtHcare travel MAGAzINE ISSUe 02 2009

04

12

22

16

20

24This 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 2009

CoNTENTs

FOREWORD ISSUE 02 2009EdITOR Jenna Wilson Tel: +971 4 336 51 [email protected]

ASSISTANT EdITOR Elin BoydTel: +971 4 336 [email protected]

AdvERTISING SALES Mary-Rose ArsenioTel: +971 4407 [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.lifesciencesmagazines.com.

HEALTHCARE TRAvEL MAGAzINE IMpRINT

FoREWoRd

Welcome to the second issue of Health-

care Travel magazine. Since the last issue, in-

terest in Healthcare Travel has continued to

rise, not only among individual customers, but

also among insurance companies and business-

es. As such, medical tourism is entering a new

phase where individual patients will not be the

only customers of medical tourism. Their em-

ployers, insurance companies and governments

are also part of the equation.

The concept of Healthcare Travel represents

the splicing of the world’s two largest indus-

tries: Health, and Travel and Tourism. It is

therefore bound to have an effect across the

entire globe. Columbia, Cuba, Dominican Re-

public, Mexico and Panama, for example, all

benefit from the ease of travel and cheap air-

fares from the US and Canada. In 2006, Cuba

alone attracted nearly 20,000 healthcare trav-

ellers. In India, the government and private

hospital groups are committed to the goal of

making India a leader in the Healthcare Travel

industry. Estimates of the value of medical

tourism to India go as high as $2 billion a year

by 2012. In addition, New Zealand has recent-

ly entered into the market as a new player for

medical travel, focusing on non-acute surgical

procedures and fertility treatment.

Above all, time and money provide the

main incentives for seeking healthcare outside

the home country.

I hope you enjoy this issue. As always, I wel-

come your comments, feedback and ideas.

Jenna Wilsoneditor

» IN INdIa, ThE goVERNmENT aNd pRIVaTE hospITal gRoups aRE CommITTEd

To ThE goal oF makINg INdIa a lEadER IN ThE hEalThCaRE TRaVEl INdusTRy «

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 T w o 2 0 0 9 | 3

NEWs | MIddLE EAST

“the healthcare industry is constantly

advancing and becoming more sophisticated

and it is important that the design and engi-

neering of healthcare facilities meets the re-

quirements of healthcare practitioners and pa-

tients as well. Healthcare today also involves

wellness and healing, therefore the facility de-

sign is utilizing hospitality within the hospital,”

Said Haydar Hassan, Director of Burt Hill Inter-

national.

“At Burt Hill a multitude of different factors

are taken into consideration while designing a

healthcare facility in order to provide healthcare

practitioners and operators with the highest de-

gree of efficiency and ensure that patients are

in a comfortable spa-like environment while

they require medical attention.”

Burt Hill has a track record of developing state

of the art healthcare facilities in the USA includ-

ing F.F. Thompson Hospital, Kings and Queens

County OCME, New York City Health and Hospi-

tal Corporation and Lakewood Medical Center.

In the UAE, Burt Hill is currently developing

an unprecedented healthcare and wellness des-

tination, paving the way for the medical tourism

trend in the UAE. The 20- acre facility, situated

within a spa-like atmosphere, will provide a ho-

listic approach to medical recovery for patients

and on-site support for their loved ones.

With a recent report issued by the informa-

tion center of Abu Dhabi Chamber of Com-

merce (ADCCI) predicting that the country’s

medical tourism will grow by 15% annually, in

line with the increase of tourist demand on this

segment of the tourism industry, Burt Hill is

moving away from conventional hospital de-

signs and has focused instead on creating

healthy, comfortable, and luxurious environ-

ments for patients to recover in. «

dr ayesha of Dubai Healthcare City (DHCC)

said: “Dubai has already set itself as an inter-

nationally recognised tourist destination. It will

become an international hub for medical tour-

ism soon as all the major healthcare projects

are near their completion dates.”

DHCC, the world’s first healthcare free zone,

aims to become an internationally recognised

location of choice for quality healthcare and an

integrated regional centre of excellence for

clinical and wellness services in the Middle

East. The number of visitors to DHCC has ex-

ceeded 90,000 with a good percentage from

other Gulf regions.

“I believe the numbers will grow tremen-

dously once DHCC is fully operational by 2011.

The increased cost of travel coupled with de-

creased purchasing powers of patients might

have an impact on the number of patients

coming in. Though, we do not foresee a signif-

icant change in healthcare tourists from other

GCC countries. There might even be an in-

crease due to decreased travel to US or Europe

for healthcare needs. Currently, we have 122

percent growth rate of patients incoming and

we are working in association with the Depart-

ment of Tourism, doing some road shows and

other media campaigns to raise awareness of

the healthcare services available in the UAE to

the outside world,” Dr Ayesha said.

By 2012, DHCC may have a superb range of

new hospitals and clinics, but it will need to

demonstrate to the outside world that they of-

fer excellent quality of care at prices that can

compete with Asian and European destinations

that already attract medical tourists.

dubai might face an uphill struggle. Based

on figures from he upcoming 2009 World

health tourism congress:

• The ministries of health from the Arab World

are the biggest spender of medical travel in

the world. Some of them have annual budg-

et in excess of US$200. Each one of them

has a medical committee that decides what

hospitals and clinics to deal with worldwide.

• Insurance companies in the Arab World tend

to send a lot of their clients to be treated

abroad. They have a network manager who

decides where to send clients. «

design firm sets president for health-care industry in the UAE

Dubai set to be medical tourism hub by 2015

Modern-day healthcare facility design trends were presented at the Arab Health 2009 confer-ence. Burt Hill, a renowned design consultancy group, highlighted the guidelines that healthcare facility developers and operators should consider in creating a medical and wellness destination.

Dubai wants to be the medical hub of the Gulf region by 2015. The logic is that once all the

hospitals and clinics are built, its citizens will stop going overseas and medical tourists will start

visiting the emirate.

NEWs MIddLE EAST

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 T w o 2 0 0 9

MIddLE EAST | NEWs

MIddLE EAST NEWs

europeans’ Wallets have shrunk as a re-

sult of the global economic crisis, pushing

them to seek ways to lower their medical

costs. That search has put Turkey on the map

as a popular destination for those wanting

lower-cost healthcare.

One thing that also plays to Turkey’s favour

is its high standards in medical care as no less

than 24 hospitals and clinics have JCI status,

more than in almost every EU country.

In 2007, the number of foreign patients in

Turkey was 150,000. Last year, the number of

foreigners treated in Turkey increased by 40

percent to 200,000. Dr Dursun Aydın, presi-

dent of the Association of Improving Health

Tourism (AIHT), said: “Europeans prefer Tur-

key mostly for cosmetic surgery, invitro fertil-

ization, dental treatment and laser eye sur-

gery. The technology used in Turkey is just as

developed as European technology and our

doctors are also very successful.”

AIHT was founded in 2005 and consists of

members from health and tourism sectors. In

2008, it printed 5,000 copies of a planned

annual health tourism guidebook. The book

included details of all hospitals, clinics and

others in the health tourism sector in Turkey.

The free 160-page guidebook is available in

both Turkish and English, and has the support

of the Ministry of Health and The Ministry of

Culture and Tourism.

Turkey mostly receives patients from the

Netherlands, United Kingdom, Belgium and

France. There has also been an increase in

Middle Eastern patients who have begun to

prefer Turkey to Europe. Currently Turkey’s

medical tourism market is worth around

US$500 million, and it has the potential for

many times that.

Hospitals gravitating toward health tourism

have been quite happy with the growing busi-

ness and they foresee 2009 to be even bright-

er than last year.

Dr Hasan Kus of Anadolu Health Centre

noted: “ We treated 570 foreign patients in

2007. That figure rose to 1,102 last year.

Nearly 30 foreign patients a day visit our hos-

pital. Most of our foreign customers are from

Romania, Kosovo, the United Kingdom, the

Netherlands, Ukraine, Bahrain, Azerbaijan,

Russia and Bulgaria. Most of them are here

for treatments in medical oncology, radiation

oncology, brain surgery and orthopaedics.

Cosmetic surgery, invitro fertilization and

dental treatment are also in high demand.”

At the Acıbadem Healthcare Group, which

saw at least a doubling of numbers in 2008,

Meri Bahar added: “Many foreigners find Tur-

key attractive both for its lower medical costs

and the quality of the health care they re-

ceive. Medical tourism in the country is grow-

ing like a snowball.”

The World Eye Group receives 2,000 for-

eign patients every month, according to Selin

Peker. “The number of foreign patients has

increased 20 percent since October. Most are

from Germany, the Netherlands and Scandi-

navia.” «

The future is rosy for medical tourism in turkeyThe cost of receiving medical care in Turkey is so low that it is attracting foreign patients. A sur-

gery that would cost 5,000 euros (US$6,292) in many European countries can cost as little as

500 euros (US$657) in Turkey.

» THERE HAS BEEN AN INCREASE IN MIddLE EASTERN pATIENTS WHO HAvE BEGUN TO pREFER TURkEY TO EUROpE. «


investors from singapore and Thailand

have joined hands to set up an online medical

butler service, which allows patients to shop

for doctors on the web. The service also allows

healthcare providers to tap into the global

medical tourism industry estimated to be worth

some US$180 billion. A patient can get infor-

mation like health and lifestyle services, ask to

be invited to online medical seminars, and

even speak to a doctor. This butler service,

which is free of charge, has already served over

1,000 users. FlyFreeForHealth does not charge

users for the iMedical Butler services, but it

takes a cut from its partners, which includes

hospitals, spa resorts, hotels, travel agents and

restaurants. The company also earns revenue

from training programmes for nurses to be-

come its butlers, at about US$500 each. The

iMedical Butler service now operates out of a

call centre in Singapore. It is manned by six

trained nurses and the company hopes to hire

another 200 staff within three months. It is

also looking to work with call centres in India

and the Philippines. Through this network, the

Tourism Authority of Thailand and the FlyFree-

ForHealth group of companies are hoping to

raise awareness of borderless medical services.

Currently, Thailand is the largest health and

wellness destination in the world, with 1.5 mil-

lion medical tourists last year. The top markets

for Thailand’s healthcare industry are Japan,

the US, European Union and the Middle East.

The Thai company aims to attract 40,000 med-

ical tourists from Singapore over the next year.

There are also plans to channel patients from

the US and other Asian countries to Singapore.

Founder of FlyFreeForHealth, Wei Siang Yu,

said: “Eighty per cent of the medical tourists

will always travel with a relative. They will not

travel alone, so this increases the value of

transactions per trip that somebody makes.

“When they travel, their consumption pattern

is always higher than a normal tourist. They

consume health services, go to the best spa,

they want to eat some organic food, they want

to heal, they may even stop by at a nearby re-

sort and stay for one week for the wound to

heal.” Renowned neurosurgeon at East Shore

Hospital and International Neuro Associates

(Novena), Keith Goh, said the iMedical Butler

service will also enhance cross border manage-

ment of patients and offer some savings. Dr

Goh said: “I have patients from Malaysia treat-

ed for the same price but in ringgit, so you can

imagine, that’s more than 50 per cent off what

an MRI will cost in Malaysia compared to Sin-

gapore. And so there will be some Singapore-

ans who will take advantage of that. They may

go to Thailand for stroke screening, get their

MRI, their blood tests done, see a neurologist

there. “The advantage to us is that if patients

have conditions that can’t be treated in Thai-

land or Malaysia, then they have access to ex-

pertise which may be available in Singapore.”

However, a concern raised by Dr Goh is the

credentials of doctors overseas, to which Fly-

FreeForHealth said all its affiliates are thor-

oughly screened before being recommended to

patients. «

Investors from Singapore and Thailand set up online medical butler serviceA new medical tourism service has been launched on the Internet.

NEWs | ASIA

NEWs ASIA

» SO FAR, OvER 30 pARTNERS FROM THE HEALTH-

CARE, HOSpITALITY ANd TOURISM SECTORS IN BOTH

COUNTRIES HAvE SIGNEd Up WITH THE iMEdICAL

BUTLER SERvICE. ANd THIS WILL BE ExpANdEd TO

INCLUdE THOSE FROM INdIA ANd SOUTH kOREA BY

THE MIddLE OF THIS YEAR «


ASIA | NEWs

ASIA NEWs

the maJority of medical tourists to Malay-

sia seek curative medical treatment instead of

aesthetic purposes, it said in its research note.

“Based on this fact, we believe demand for

medical tourism in Malaysia will remain resil-

ient as patients with a medical condition will

seek treatment regardless of whether there is a

recession or not, although those considering

treatment for aesthetic reasons may defer their

decision,” the OSK study said.

OSK Research predicted Malaysia could gain

from the slowdown given the competitive ad-

vantage over the main competitors, namely

Singapore and Thailand.

Since Indonesians formed the biggest num-

ber of medical tourists to Singapore and Ma-

laysia, the slowdown might result in some In-

donesian patients seeking treatment in

Malaysia rather than in Singapore because of

the former has cheaper cost.

“We believe Malaysia will always have a

price advantage over Singapore unless Singa-

porean players adjust their pricing drastically -

which we believe is highly unlikely, due to the

higher labour and operating costs,” it noted.

Also, it noted that the recent turmoils in

Thailand provided an opening for Malaysia to

raise its profile as an alternative destination for

medical travel.

“Our discussions with the major players in

Bangkok indicate that they have not seen any

sign of recovery in the sector as a large num-

ber of its foreign markets such as the United

Kingdom, the United States, Canada, New Zea-

land and Australia are still warning their citi-

zens against travelling to Thailand due to high

political risk,” OSK Research said.

Nevertheless, Thailand expects the recovery

to come in the second half of 2009 once the

political landscapestabilises, it added.

“This situation offers great opportunities for

Malaysia to capture some of Thailand’s market

share in medical tourism given that Malaysia

offers comparable services at competitive pric-

es,” the OSK study stated.

Malaysia is also eager to woo medical tour-

ists from the Gulf. Apart from the low cost of

procedures in Malaysia, the government offers

discounted tickets to family members of pa-

tients travelling to the country.

Syed Muhadzir Jamallulil, head of Tourism

Malaysia in Dubai said: “There are a lot of fa-

cilities in Malaysia that can take care of the

medical needs of travellers from the Middle

East. They are much cheaper than the Gulf.”

Malaysia is fast emerging as a value-for-

money destination for medical tourism, thanks

to its world-class health and medical facilities,

said Frost & Sullivan Asia-Pacific healthcare

practice consultant Tham Lin Hui.

“The growing awareness about medical

tourism in Malaysia will attract more foreign

patients to seek treatment in the country,” she

added. «

medical tourism to remain robust in MalaysiaMedical tourism will remain robust and resilient despite the economic slowdown, according to the Malaysian investment and research group OSK Research.


only tourist agencies can refer foreign

patients, but not health insurance companies.

In some countries such as Russia, insurance

companies commonly refer patients to hospi-

tals. Questions remain on whether the agencies

can be in Korea or overseas, medical tourism or

travel agencies or if there is any licensing.

The handful of current agencies in Korea,

have promoted cosmetic surgery only.

“The government said it would boost the lo-

cal medical industry, but at the same time the

restrictions are hindering further development

of the country’s industry,” said Brian B. Woo,

chief executive of Doctour, a Korean medical

tourism agency. Singapore agency FlyFreeFor-

Health has just completed a review on hospitals

in Korea and health packages in Korea are now

being developed.

Opening a foreigner-only hospital is an op-

tion, but difficult as medical laws that apply to

domestic hospitals also apply to foreigner-only

institutions.

“There needs to be a different set of rules

for foreigner-only hospitals. Under medical law,

a hospital needs to have a certain number of

sickbeds in order to purchase magnetic reso-

nance imaging equipment. This kind of regula-

tion should be relaxed,” said Yun Dong-hun at

Incheon’s Inha University, which is about to

build a foreigners-only hospital.

Among other restrictions, agencies can only

bring in foreigners who live outside Korea, not

those who live in the country. That restriction

would cover any non-Korean who has been in

the country for over 90 days, as well as ethnic

Koreans who hold foreign citizenship but live

here. Most foreign patients coming to the

country are issued three-month tourist visas,

posing difficulties for those who need extended

treatment.

Chung-Ang University Medical Center has

set in motion plans to aggressively attract for-

eign patients seeking high-quality surgery at

relatively low costs. New director-general Ha

Kwon-ick has revealed plans to upgrade the

quality of the hospital to make it one of the top

five medical centres in the country and promote

the country’s medical expertise worldwide.

The hospital, owned by the Doosan group, is

a member of the Council for Korea Medicine

Overseas Promotion, the body in charge of pro-

moting medical tourism. A new building with a

centre specialising in thyroid and stomach can-

cer and brain and heart diseases is to be built

by 2011. Before that, a 400-bed cancer hospi-

tal should be open by the end of 2009. «

progress in KoreaKorean agencies that refer foreign patients to hospitals could soon be opening up, when the proposed amendment to Ko-rean medical law takes effect. Korean hospitals will be al-lowed by May to hire agencies to attract foreign patients through their doors. The medical tourism community is wor-ried that the new law still has many restrictions. They say pro-posed limits on who can act as an agent and the number of patients will be an unnecessary obstacle.

NEWs | ASIA

NEWs ASIA


ASIA | NEWs

ASIA NEWs

singapore has solidified its position as one

of the world’s leading healthcare destinations

for medical tourists seeking affordable, high

quality medical attention, following elaborate

market research conducted to measure the

quality in its healthcare.

Each year Singapore receives more than half

a million international visitors seeking a wide

array of medical procedures.

In both the private and public sectors, Sin-

gapore’s hospitals and medical centers have

achieved outcomes that equal, and even sur-

pass, those in the developed West – making

the island-nation a preferred choice among

Middle East-based individuals looking for cost-

effective, world-class medical attention.

There are several indicators used worldwide

to benchmark the quality of hospital care,

some of which include MRSA (Methicillin Re-

sistant Staphylococcus Aureus) infection rate

and the time lag for commencement of antibi-

otic therapy.

The “superbug” MRSA is a highly dangerous

and drug resistant bacterium known to cause

hospital-acquired infections. A low-MRSA rate

indicates greater effectiveness of infection con-

trol measures being implemented.

Dr S. Thanasekaran, Chief Medical Officer at

ParkwayHealth, one of Singapore’s premier pri-

vate healthcare groups, said: “For the first half

of 2008, we have consistently achieved lower-

than-target MRSA rate of 0.33 in our hospitals.

This compares very favorably to the US nation-

al average of around 2.4 percent, as published

in the American Journal of Infection Control.”

Another indicator often used as a pointer

for good hospital care is the response time for

the administration of emergency medication.

The timely use of antibiotics in cases of pneu-

monia caused by bacteria, for example, can

lower the mortality rate by as much as 15 per-

cent.

“The current standard internationally is for

antibiotic therapy to begin within four hours

after admission. We have successfully kept

above the 90th percentile mark even as we

aim for 100 percent compliance. This compares

well to the US national average of around 80

percent,” added Dr Thanasekaran.

Singapore’s status as an excellent medical

destination extends to the nation’s public hos-

pitals, which have emerged as specialists in

fields such as cardiology, gynecology and ob-

stetrics.

The National University Hospital (NUH), one

of the region’s top teaching and medical re-

search hospitals, has consistently achieved crit-

ical acclaim backed by statistics for its cardiol-

ogy program.

Recently published indicators showed that

NUH has up to 75 percent fewer heart failure

mortalities within a 30-day period compared to

its peers. In addition, the hospital’s re-hospital-

ization rate for heart failure patients is signifi-

cantly lower than the international standard.

Currently ranked number six in the world as

a leading healthcare system, and Asia’s num-

ber one healthcare destination by the World

Health Organization, Singapore continues to

reach its goal in offering the best possible care

to both local citizens and international visitors

seeking first-rate medical needs.

“Singapore’s medical infrastructure is well

designed to cater to all types of medical con-

cerns. We hope that, with Singapore’s close

proximity to the Middle East, more medical pa-

tients from the region seeking treatment across

all medical areas will choose Singapore to meet

their needs,” said Jason Ong, Area Director for

the Middle East and Africa, Singapore Tourism

Board. «

Gulf Told Singapore Among World top 10 medical care destinationsMarket Research Shows Singapore is Ahead of US in Key Benchmark Measurements

» SINGApORE’S AdvANCEd HEALTHCARE FACILITIES CATER

TO MEdICAL pATIENTS WHO ARE IN NEEd OF pROCEdURES

THAT RANGE FROM SIMpLE COSMETIC ANd COMMOdITIzEd

SURGERIES SUCH AS HIp REpLACEMENTS, TO HIGHLY SpE-

CIALIzEd TERTIARY ANd qUATERNARY SERvICES FOR CRITI-

CAL ILLNESSES ANd RELATIvELY RARE CONdITIONS. «

Singapore opera and concert hall


in a report published last month, the US-

based group ISSCR noted the growing number

of international clinics that are marketing un-

proven, costly stem-cell therapies to medical

tourists and “exploiting patients’ hopes”.

China is a country where the task force has

particular concerns. Task force member Laurie

Zoloth said: “There is this tension between the

slow progress of medical science and the des-

peration of patients and the swiftness with

which disease overtakes them. Combine that

with a flat world and the Internet, it is a recipe

for stem cell fakery. Americans could be lured

into other countries because of their recogni-

tion that stem-cell research might be held back

here.”

The number of patients who have travelled

abroad from the US and other countries for

stem-cell therapies is unknown, though anec-

dotally, it appears to be in the thousands.

The proliferation of clinics marketing pur-

portedly effective stem-cell interventions online

has many experts worried.

The ISSCR December 2008 study of stem-cell

clinic web sites found that they claimed to

treat a range of diseases that go beyond the

scope of the early evidence of stem cells’ effi-

cacy, while playing up the benefits and talking

little about risks. The study, published in the

journal Stem Cells, found that the average

price tag for the treatments, excluding travel

and lodging costs, was US$21,500. What doc-

tors want is not just patient testimonials, but

real data that proves various treatments work.

Study group members agree that stem-cell

medical tourism and innovation outside the

clinical-trial context are not necessarily bad.

The guidelines stand in stark contrast with

stem cell clinics that claim success with hun-

dreds of patients, yet, never publish results in

peer-reviewed journals.

the new professional guidelines say clinics

providing unproven stem cell-based thera-

pies must have:• A written plan for the procedure that includes

the scientific rationale and any pre-clinical

evidence of proof of principle for efficacy

and safety.• A full characterisation of the types of cells be-

ing transplanted and how they will be ad-

ministered.• Clinical and administrative leadership support

for the clinical experiment.• Voluntary informed consent for patients.• An action plan for adverse events.• Insurance coverage or other financial resourc-

es to cover complications.• Systematic and objective tracking of out-

comes submitted to the scientific community

for critical review.• A timely move to a formal clinical trial after

experience with a very small number of pa-

tients. «

usa sets guidelines for stem-cell medical tourismThe International Society for Stem Cell Research (ISSCR) convened a task force of researchers, ethi-

cists, doctors and regulatory officials from 13 countries to set guidelines for clinics offering stem-cell

experimental therapy to patients without appropriate transparency, oversight or patient protections.

NEWs | USA

NEWs USA


USA | NEWs

USA NEWs

medical tourism providers bring in the ma-

jority of the patients that visit Colombia. These

agencies prepare travel packages that allow pa-

tients to be taken care of by world class medical

practitioners in the country. In a way, medical

tourism providers act as negotiators and com-

municate patients to surgeons or vice versa. As

providers they do research for plastic surgery

costs, the selection of only the most highly

skilled doctors and surgeons that could offer

high quality but affordable plastic surgery and

lastly, introduce patients to luxurious accommo-

dations and incredible tourism opportunities

while staying in Colombia.

These past few years the number of foreign

patients choosing to undergo plastic surgery in

Colombia is increasing. Like Brazil, ease of travel

and relative proximity from the US and Canada

is an advantage. Colombia offers cheaper air-

fares from the US and Canada (and some Euro-

pean countries) than other more-distant desti-

nations, and does not have the visa restrictions

of other countries currently in the medical tour-

ism market. In terms of cost, Colombia can per-

form a knee replacement for around US$5,000,

about one-fifth of the cost in the US. Plastic sur-

gery costs are also the same; patients could save

up to 50-70 percent of elective procedures from

the United States if they choose to undergo

plastic surgery in Colombia. «

columbia is First ClassPlastic surgery in Colombia is another ace for medical tourism. The concept of flying abroad to

save money from plastic surgery cost is nothing new to Colombia. Bogota, its capital city has

been a center of advanced healthcare learning and medical innovation for years. This cosmopol-

itan city offers one of the most sought after affordable plastic surgery in the world. Several cit-

ies throughout Colombia have a considerable number of certified surgeons and medical profes-

sionals that practice affordable plastic surgery. These professionals promote utmost safety and

comfort that patients are accustomed to at home.


WHAT IS MEdICAL TOURISM? Medical Tourism is the generally accepted

phrase used to describe the phenomenon of

people travelling outside their home country

for medical care, dentistry and surgical proce-

dures. The phrase came into use in the later

1990s in business reporting in the Far East,

where hospitals targeted the international mar-

ket for medical services.

WHO ARE MEdICAL TOURISTS? Historically, medical tourists were affluent,

those who could afford to travel abroad to re-

ceive the best medical care in Europe and the

United States. Many wealthy people still do so.

However, Medical Tourism traffic now runs

both ways as advancements in medical care

have spread. The standards of medical care

and quality of facilities in the major metropoli-

tan areas of the world are now comparable to

those in the United States, while costs are

much lower. Medical Tourism as it pertains to

U.S., UK, Canadian, Middle Eastern and West-

ern European residents, is largely a price and

convenience driven phenomenon.

Medical tourists today come from all walks

of life. In common, they have a desire for af-

fordable, high quality care or surgery that is

beyond their financial means or unavailable to

them at home.

FOR WHOM IS MEdICAL TOURISM A GOOd OpTION? Medical Tourism is an option worth exploring

for anyone who is facing significant out-of-

pocket expenses for health care. In the United

States, by most estimates, there are more than

40 million uninsured persons, and many mil-

lions more who are underinsured. Medical

Tourism is also a viable option for all individu-

als considering any elective surgery, not cov-

ered by insurance. Specifically, the demand for

high quality, lower cost cosmetic surgery and

dentistry has been on the edge of the wave of

Medical Tourism originating in the United

States and Western Europe.

Going abroad for care is also a reasonable

choice for patients who want care not avail-

able to them locally. Some hip resurfacing pro-

cedures, for example, have been performed in

India for years but have only recently been ap-

proved in the United States. The use of silicone

gel breast implants, sought by many cosmetic

surgery patients, has been restricted for years

in the United States but they are widely avail-

able in the rest of the world. Procedures relat-

ed to fertility, stem cell research and organ

transplantation also draw a number of patients

from around the world.

Finally, Medical Tourism can be an option

worth considering for those in countries with

what many call “rationed” health care, partic-

ularly Canada and the United Kingdom.

Though both countries have national health

care, there can be a lengthy wait for proce-

dures and surgeries that are classified as non-

Medical tourismdr Riaz answers the most common questions from patients

By dr.mian atif Riaz, 3/B-14 Canal park, Begumpura, lahore-54920, pakistan

INTERVIEW | HEALTHCARE TOURISM

» goINg aBRoad FoR CaRE Is also a REasoNaBlE ChoICE FoR paTIENTs Who WaNT CaRE NoT aVaIlaBlE To ThEm loCally «


HEALTHCARE TOURISM | INTERVIEW

emergency. In the UK and Canada, this incon-

venient forced wait is applicable to a large

number of orthopaedic surgeries that cause

great pain and require extensive wait times be-

fore local health care is made available to pa-

tients.

IS MEdICAL TOURISM SAFE? Generally, when people ask if going abroad for

surgery is “safe,” (and they do ask it in just

that way) what they really want to know is “Is

it as safe as if I went to my local doctor or hos-

pital?” And the short answer is that “Yes, it is

probably just about as safe” - with the proviso

that the patient does his or her homework,

picks a good doctor or surgeon and facility and

plans the trip wisely. Many medical tourists

take nothing for granted, as they might at

home; they want to know everything that

might happen, everything they might encoun-

ter in advance, and thus are perhaps better

prepared for their care or surgery than they

might have been if they had stayed closer to

home.

WHAT ARE THE HOSpITALS ANd FACILITIES LIkE? In general, hospitals and other medical facili-

ties that cater to international patients pride

themselves on meeting the highest interna-

tional standards, and even compete with each

other to offer amenities. Many are new, or rel-

atively so. Information on them is widely avail-

able on the Internet. However, in the case of

smaller practices - for example, some of those

for cosmetic surgery or dentistry - it is particu-

larly important to get independent reviews or

first-hand accounts from patients who have

been there before.

This does not mean that there are no cultur-

al differences, no surprises in store (pleasant or

otherwise.) But major international hospitals

and well-known medical facilities around the

world adhere to comparable medical standards

and often exceed the aftercare and experiential

standards offered in the US and other devel-

oped countries.

ARE THE dOCTORS ANd SUR-GEONS qUALIFIEd? The schooling, training and board certification

processes for physicians and surgeons are com-

parable from country to country.

Many surgeons overseas have trained in the

United States or Europe, just as many doctors

in the United States and Europe have had some

part of their training abroad.

Ultimately, each hospital that caters to Medi-

cal Tourism has its own credentialing and stan-

dards and should be evaluated on an individual

basis. Many hospitals and doctors have re-

ceived international accreditation and can be

evaluated quickly and easily if this is the case.

WHAT MEdICAL SERvICES ARE AvAILABLE? Any -- from the simplest to the most serious

life-saving procedures.

This is not to say that all services are avail-

able everywhere at uniformly high quality ev-

erywhere. India, for example, has perhaps the

best reputation for heart surgery in the world,

alongside the United States. The quality of

plastic surgery is renowned in Central and

South America, and sought after international-

ly. However, there is not much in the way of

malady or ailment that the world’s major inter-

national hospitals do not see on a daily basis.

A patient has choices around the globe for

whatever care or treatment might be neces-

sary.

I WOULd LIkE TO HAvE SURGERY pERFORMEd ABROAd. WILL MY HEALTH INSURANCE COvER ME IF I HAvE COMpLICATIONS? Quite possibly it will not. One of the things

that anyone who is contemplating surgery

abroad should do is check with their insurance

company on what care, if any, is covered under

this circumstance.

Some medical tourists may wish to buy addi-

tional insurance. Those without insurance

should make sure they have the resources to

extend their trip, in the event of complications,

until they are fit to travel.

Some of the top international hospitals will

provide corrective care or damages in the case

of medical malpractice or undesirable out-

comes. Patients should ask each hospital that

they are considering about their particular poli-

cies.

WHAT ARE THE pRICES? Prices for medical services vary from country to

country, and no medical decision should ever

be made solely based on costs. Compared to

the U.S., prices range from about 30 percent

to 80 percent less, depending on where one

goes. A heart valve replacement that might

cost $50,000 in the U.S. might be $10,000 in

India, including travel costs and accommoda-

tions. A facelift that might be $12,000 in New

York might cost $3,000 in Central or South

America. Again, a prospective patient has a

range of options - including price - when de-

ciding where to go.


WHY IS MEdICAL CARE IN SOME COUNTRIES SO CHEAp? Medical care outside of the U.S. and the so-

called developed nations of the world is less

expensive for much the same reasons it is less

expensive to produce DVD players or textiles

abroad; they have less expensive land; it is less

expensive to put up a building, they have low-

er labour costs, lower taxes, lower administra-

tive costs, lower insurance rates and so on. It is

a mistake to single out any one thing as being

responsible for the difference.

WHERE SHOULd I GO? Unless you require particular surgery or care

that is only available from specific hospitals,

the decision on where to go is a highly individ-

ual one. You may have family ties to a particu-

lar country, which makes it an attractive choice.

You may have language skills that would dic-

tate a preference for a country or region.

Or there might be somewhere you’ve just al-

ways wanted to go. The leading Medical Tour-

ism destinations in the world, in no particular

order, are, Thailand India, Malaysia, Singapore,

South Africa, Brazil, Mexico, Costa Rica, Do-

minican Republic, Poland, Hungary, Russia,

Cuba ... it is hard to stop naming them. For

plastic surgery alone, the International Society

of Aesthetic and Plastic Surgeons lists more

than 1,500 board-certified surgeons working

in 73 countries.

HOW SHOULd I GET THERE ANd WHERE SHOULd I STAY? Generally, the hospital or facility that you

choose will be able to make recommendations

on flights and accommodations or even book

them for you. However, you’ll be responsible

for getting travel documents (passport and vi-

sas if required), arranging funds and packing,

of course.

SHOULd I USE THE SERvICES OF A MEdICAL TOURISM COMpANY? Medical Tourism companies come in different

sizes and shapes. Some will do little more than

schedule your medical procedure and perhaps

book accommodations and transportation.

Others provide “end to end” services, from

pre-travel medical screenings to nursing and

concierge services while abroad to post-opera-

tive checkups. Some charge fees to patients;

others work for surgeons or facilities abroad.

The services of a good Medical Tourism com-

pany can take a lot of the worry out of a trip

but one should check them out thoroughly and

ask for references.

WHAT ABOUT pOST-OpERATIvE CARE ANd CONvALESCENCE? Anyone going overseas for medical care should

be prepared to extend their stay abroad if rec-

ommended by a doctor. Not everyone heals at

the same rate. The risk of complications after

surgery increases substantially for patients who

do not have medical clearance to travel.

Medical tourists should make arrangements

with their doctor at home for diagnostic and

aftercare where possible.

WHAT HAppENS IF SOMETHING GOES WRONG? This is an extremely common question and

there is no one answer. Things can “go

wrong” with any medical care, procedure or

surgery, regardless of the quality of a facility

and the skill of a doctor or surgeon.

Patients should query their surgeons on

what their policies are for less than satisfac-

tory results. Some plastic surgeons will offer

free revisions, for example.

In the event of a truly terrible outcome of a

surgery resulting in disfigurement, incapacity,

disability or death, a medical tourist must be

aware, going in, that legal recourse will not

be as straightforward as it would be in the

United States and might be substantially lim-

ited even in the event that malpractice could

be proven. If your primary concern in going to

a doctor, surgeon or dentist is whether or not

you’re going to have legal recourse if you

don’t like the work you get, you probably

shouldn’t be a medical tourist. «

INTERVIEW | HEALTHCARE TOURISM

» pRICEs FoR mEdICal sERVICEs VaRy FRom CouNTRy To CouNTRy, aNd No mEdICal dECIsIoN should EVER BE madE solEly BasEd oN CosTs «

The Healthcare Travel exhibition and Congress is taking place from 27th-29th October 2009 at the Dubai International Exhibition and Conven-tion Centre. Under the guiding theme of ‘the globalisation of healthcare”, this exhibition will bring together the entire cluster involved in medi-cal travel at one event dedicated to the development of this growing sector. For more information about visiting or exhibiting visit www.healthcare-travel.com or email [email protected]


it is not cheap. It is relatively cheap because

that is the way the international economy runs.

Going by the “McDonald index”, in India you

get a burger for 40 cents at McDonalds. The in-

come and salaries of individuals are also propor-

tionately lower. So a gall bladder operation by

laparoscopy may seem only $600 to someone in

the US, it is 4 months salary of a receptionist

working at my hospital.

Due to the current favourable Rupee/Dollar/

Pound/Euro exchange rate foreign clients can

take advantage of the weak Rupee and expect

savings of up to 75% over the same treatment

in their own countries, with no compromise on

quality.

For the average Indian, Private medical care

is very expensive, but for those visitors with

Sterling, Euros or Dollars it is a bargain price

considering what you would pay back home for

an elective procedure with a top specialist with

no long waiting list.

So a surgery for obesity that would cost

about $50,000 would be done in India for

about $10,000 in the best JCI recognized cor-

porate hospital using the same disposables used

in USA and done by surgeons trained in the

West.

We have been treating many patients and

have some experience in catering to these pa-

tients. To start with when an obese person seek-

ing surgery for their weight loss decides to come

to India, they would have already tried all other

alternatives. They are fed up and depressed. The

first contact is usually from the internet and a

simple straight talk is what they want. The med-

ical tourism agency should understand that they

have to be dealt with sympathy and repeated

questions are normal for this category of pa-

tients.

The patients are already worried of the po-

tential complications of obesity surgery and to

add on the hassles of travelling to a new coun-

try with a different culture can stress any one

out. It is important and re-assuring to have a

tele / video conferencing with the surgeon who

would be doing the surgery.

Patients have to be counselled about the tests

that need to be done. They are often put on a

high protein low carbohydrate diet that makes

them and their liver more fit for the surgery.

This generally starts 2-3 weeks prior to their

travel to India.

Long distance travel with flight changes and

long waiting has the potential for health trou-

bles the chief culprit being deep vein thrombo-

sis. I usually ask my patients to start prophylax-

is against this dreaded and common problem

from the time they leave their home to the

time they reach back. One cannot do an ‘over’

prophylaxis.

Once the patient reaches India after enduring

the long flight which is extremely cumbersome

Bariatric SurgeryExperience with Medical Tourism

FEaTuRE | BARIATRIC SURGERY

By dr arun prasad, senior Consultant and academic Co-ordinator, minimal access & Bariatric surgery, apollo hospitals, New delhi, India

Medical tourism is a phenomenon of people travelling to other countries to obtain medical, dental, and surgical care while at the same time touring, vacationing, and fully experiencing the at-tractions of the countries that they are visiting. Exorbitant costs of healthcare in industrialized nations, ease and affordability of international travel, favourable currency exchange rates in the global economy, rapidly improving technology and standards of care in many countries of the world, and most importantly prov-en safety of healthcare in select foreign nations have all led to the rise of medical tourism. more and more people are travelling abroad as an affordable, enjoyable, and safe alternative to hav-ing medical, dental, and surgical procedures done in their home countries.


for a patient weighing over 200 pounds, they

need rest and time to get over their jet lag.

Most patients suffering from morbid obesity are

shy and have very little experience of taking

long flights. Do not plan to take them from air-

port to operation theatre. There should be a 1-2

days cooling off period for the exhaustion and

also to get over the cultural shock ( and of

course the jet lag of travelling east ).

All staff in the hospital has to be geared to

dealing with these patients who are extremely

sensitive to any kind of ridicule that may come

from the ignorant. The mindset amongst Indi-

ans is still that this is a self inflicted problem of

indulgence and affluence so the patient ‘de-

serves’ to be laughed at. While a snide remark

from a taxi driver who appeared worried about

a possible flat tyre did not upset a patient of

mine, a small act of panting by a ward boy

while taking her on a wheel chair brought her

to tears. They do not expect a hospital that

claims to be professional to have un-sensitized

staff.

Wheel chairs, toilet seats, room chairs, beds

and all other infrastructural amnesties that may

be used by them have to be upgraded. It is sim-

ply not enough to buy a bariatric operation the-

atre table.

The entire team of nurses, ward boys, food

and beverages department, dietician, physio-

therapists, receptionist and junior medical staff

needs training and workshops on how to deal

with these patients as human beings. Only after

this comes the more difficult job to detect com-

plications that can have a very subdued and ob-

scure presentation.

Patients are also sensitive to over care. Vari-

ous department in charges have the habit of

popping into their room un-announced while

they are trying to catch up on their sleep. They

tend to drop their cards and proudly announce,

“ Call me any time if you have a problem”. The

biggest problem is disposal of these cards and

trying to figure out who is who. This act of

pampering is often seen as invasion of privacy

by the patients.

Communication by the staff directly dealing is

important too. The nurse who checks the tem-

perature should re-assure the patient not dash

out of the room to complete the record. I once

had a panic phone call from a patient who

thought that something was terribly wrong with

his blood pressure as the nurse dashed out after

recording it.

Adherence to predicted time and estimated

cost is something we Indians are extremely poor.

This lapse is seen as unprofessional behaviour

and can be very upsetting for the patient and

also leads to a lot of loss of credibility. Do not

create unrealistic expectations on these fronts

and it is always better to make honest realistic

statements.

Admission and discharge procedures should

not be time consuming as these patients get ex-

hausted very fast. Transport from reception to

room and within the hospital should be swift

and comfortable.

Food requirements are special and good co-

ordination is needed between the surgeon, en-

docrinologist and dietician. It is very confusing

for a patient to hear different advice on the

matter from these three departments. A stan-

dardized and mutually agreed diet chart should

be formulated.

Physical activity, breathing exercises, physio-

therapy should be well agreed upon and are

very different for these patients.

Junior doctors are totally untrained to deal

with patients of another country and that too

with obese patients. They need to be sensitized

to the needs of this special group of patients.

Psychological care is as important as the medi-

cal care.

Cleanliness and infection control is the single

most nightmare of all these patients. Repeated

assurance about disposable equipment, steril-

ization and usage of gloves is necessary. The

surgeon in charge is the best person to address

this concern.

Post operative pain control, communication

and reassurance is needed. If possible, a video

conferencing with a close relative back home

can do wonders to the morale of these patients.

Avoid over cautious approach too as this could

raise suspicions of something being wrong and

something being hidden.

Billing and discharge procedures have to be

smooth and reading material on post operative

care is very useful. Patients should not be aban-

doned at this stage and should be escorted to a

hotel for recovery before they fly back to their

home country. An email of good wishes and en-

quiry is always welcome.

Medical tourism for obesity surgery is still in

its infancy and we need to realize that this in-

fant has special needs that need to be catered

to if we want a healthy adult. «

BARIATRIC SURGERY | FEaTuRE

» MEdICAL TOURISM FOR

OBESity SuRgERy IS

STILL IN ITS INFANCY ANd WE

NEEd TO REALIzE THAT THIS

INFANT HAS SpECIAL NEEdS

THAT NEEd TO BE CATEREd

TO IF WE WANT A hEalthy

aDult «


What do they Want? This question might

be posed by any hospital employee, scratching

their head in wonder, at the sight of an unhappy

customer leaving the premises.

Maybe the customer did not say anything was

wrong, but you have a feeling they will not be

back, and will not tell their friends.

Every customer who is less than entirely satis-

fied is a lost opportunity to create a loyal brand

ambassador. This lost opportunity has a large

economic impact and an even bigger impact in

these economic times. As every marketer knows,

it costs up to 10 times more to recruit a new cus-

tomer than to retain an existing customer.

Why did the relationship sour? To be more

blunt, what promises did you make, and then

not keep? To be more precise, why were custom-

er expectations not met or managed to produce

an excellent customer experience?

Healthcare decision-making is complex. It is

not like buying a packet of chewing gum or new

shoes. Customers desire many things that they

tell us about, such as whether our offer’s price

and terms meet their needs, or what kind of spe-

cialist they want to see.

However, customers also desire many things

that are not articulated. These might include an

expectation of how they will be addressed, how

their room will look, how they will be thanked,

or whether they actually see the doctor sanitize

his hands.

They want their total customer experience to

be something they can tell their friends about.

This is a critical point. They have chosen your

healthcare facility and want to have made the

right choice. This is almost on the level of a basic

human need. If we have made the wrong

healthcare choice, we must return to our family

and friends, tell them we made the wrong

choice, and endure their pity or blame. Not a

good experience.

In my mind, there is only one way to treat a

customer. From the very beginning, you are

meeting someone who could be a lifelong friend,

and you must immediately make the commit-

ment to treat the person in that way.

But each individual patient or customer is dif-

ferent. How can we know what an individual re-

ally wants?

The answer is, we cannot know. But, we can

arm our service offering with the best indicators

of customer satisfaction. Here are some basic

steps.

COMMITMENT

Commit to providing your customer with the

best customer experience, and recognize the

importance of that goal. Achieve the goal, and

you will achieve financial stability and aid in

employee retention. Fail the goal, and your

business will eventually fail as well. This com-

mitment must be made at all levels of the or-

ganization. But before you ask employees for

their commitment, you must ensure ownership

understands its importance.

ExpERIENCE THE CUSTOMER’S pOINT OF vIEWThere is no substitute for consistently experienc-

ing our own offering objectively, from the cus-

tomer’s point of view. Along the way, detail every

inconsistency in procedures and employee com-

munications and take steps to provide remedies.

You may not be the best person to perform

these exercises due to your prior knowledge and

Slips & TipsCustomers Desire, We Misfire

By dr sanjiv malik, ms, mBa, [email protected]

The 5 point plan to ensure happy employees, who produce happy customers

FEaTuRE | REGULAR COLUMN

Regular Column


experience. Consider hiring a “mystery patient”

on a regular basis to go through your customer

service process and report back.

ENSURE EMpLOYEE ENGAGEMENTWe must ensure our employees are totally com-

mitted to providing a total customer experience.

They can only do this if they really care. Where

does caring start? With the individual. However,

managers, other employees, and the organiza-

tion’s attitude heavily influence each individual

employee.

If your employees are engaged, they feel

proud about their workplace and their position.

If your employees are not engaged, they will be

apathetic, or worse. Inevitably they will be a

drain on your entire organization.

Try your best to engage employees with pro-

grams that address their real emotional needs.

Make each position a satisfying one. Praise

where praise is due.

FRONT LINE ExpERIENCEWho do your customers interact with most? It

is not ownership or management. Customers

interact with your front-line staff: employees

on the telephone, employees at the door, em-

ployees at the desk. They may see nurses fre-

quently, but how often will they see the doc-

tor? Even if the doctor’s experience is the one

deciding factor in choosing your hospital, all

other employees must ensure satisfaction.

Since your goal is to create a customer-cen-

tered environment that feels safe for your cus-

tomer, you must go down to the front line reg-

ularly. Responsibility for customer happiness

cannot be conducted from a fourth floor of-

fice. Interact with your employees to show

your commitment, hear their concerns, and

take part in customer interactions.

EMpOWER EMpLOYEESHow many readers are scared away by this

point? What, you say, empower my employ-

ees? What if they all ask for a raise?

We must live in the real world. Most cus-

tomer dissatisfaction is felt but not articulated,

and most customer interactions take place with

front line workers. Therefore this is the logical

place to allow some flexibility. Your intuitive

and friendly front-line employees can solve

many little problems before they become big

problems.

Allowing your employees the latitude to pro-

vide some type of reward will make your cus-

tomers feel good. Probably the reward is a

voucher for a free cup of tea and a pastry. Em-

power your employees but also give them the

responsibility, and monitor such giveaways to

see whether each employee is providing an av-

erage number of customer rewards.

Empowering employees also creates their

sense of responsibility for the customer, and

creates more communication channels with

management.

You can see that to accommodate customer

desires, articulated and unarticulated, we must

make their choice the right one by creating a

total customer experience that exceeds their

expectations. The only way to do this is to have

employees who are engaged and motivated in

their beliefs to provide excellent customer ser-

vice, intuitively, reflecting your total operation.

You must not be afraid of rewarding your

employees and customers. Without happy em-

ployees you will not have happy customers,

and without happy customers, you are out of

business. «

REGULAR COLUMN | FEaTuRE


the 21st century has witnessed a large por-

tion of the society seeking solutions to combat

the effect and the damage caused by a number

of factors which includes overexposure to the

sun, poor nutrition, sedentary lifestyle, and the

damaging effects of polluted environment. The

advance in technology and minimally invasive

surgical techniques and procedures has made

cosmetic surgery increasingly attractive to a

wide range of demographics.

This trend among the population seems to

be reflecting a desire to curb the effects of ag-

ing, unhealthy lifestyle etc. It is also noted that

individuals of age group 25 to 35 years old are

also engaging in the minimally invasive cos-

metic procedures such as Botox and laser skin

resurfacing as well as dermabrasion. Statistics

also show that men are among the growing

number of individuals seeking cosmetic and

plastic surgery, especially with minimally inva-

sive treatments. It was found that liposuction is

one of the most popular cosmetic surgery pro-

cedures in the UK according to a recent survey

by Opera North.

Obesity is another serious issue in Europe to-

day. Sedentary lifestyle and consumption of

under-nutritious food has tripled the incidenc-

es of obesity in the past two decades in Eng-

land alone. According to the government re-

ports it is found that 10% of men and 15% of

women are now obese. Ill effects of obesity in-

cludes a higher risk of heart disease, diabetes,

high blood pressure, stroke, osteoarthritis, can-

cer and gall stones - as well as possible depres-

sion and low self esteem.

according to recent statistics, the top pro-

cedures in cosmetic surgery include:

• Breast augmentation

• Breast lift

• Dermabrasion

• Tummy tuck

• Botox treatments

• Laser skin resurfacing

• Weight-Loss Surgery

By Frost & sullivan, healthcare practice

FEaTuRE | COSMETIC SURGERY

» ThE 21sT CENTuRy has WITNEssEd a laRgE poRTIoN oF

ThE soCIETy sEEkINg soluTIoNs To ComBaT ThE EFFECT

aNd ThE damagE CausEd By a NumBER oF FaCToRs «

Cosmetic Surgery Market: Current trends


COSMETIC SURGERY | FEaTuRE

2008 saw a large increase in injectable and

noninvasive treatments such as Botox, as well

as breast augmentation procedures. In Europe

Studies have shown that there has been an in-

crease in cosmetic surgery and treatments

across Europe, with nearly 10% increase since

the turn of the new century. According to the

American Society of Plastic Surgeons, the glo-

bal market now exceeds $30 billion, with a

sustainable compound annual growth rate in

the range of 25%. In Europe it is found that

the market for cosmetic surgery alone is about

$2.2 billion with a CAGR of 19% (source: Frost

& Sullivan).

Europe is the second largest market for cos-

metic procedures after the United States. In

Europe, most of these products are broadly

classified under the entity “medical device”

and so only need to obtain a ‘Conformit’e Eu-

ropeene’ certification, which is a relatively

cheaper and quicker process unlike seeking for

FDA approval in the United States. Thus this

helps the manufacturing companies to easily

launch the products in Europe and begin their

brand building process.

It is analyzed that the driving force for the

cosmetic surgeries market is the ageing profile

of Europeans that reflects the desire of people

to stay young and continue to hold the social

image. Various campaigns and awareness pro-

grammes related to obesity have also increased

the awareness to stay fit and young. In addi-

tion, celebrities who endorse cosmetic proce-

dures make the campaign look more attrac-

tive.

With beauty no longer restricted to being a

woman’s forte, men have also started to ex-

plore the advantages offered by cosmetic ther-

apy. They mostly prefer to have procedures

such as nose reconstruction, eyelid surgery and

liposuction.

In case of tackling obesity, patients no lon-

ger have to diet or exercise solely as a near-in-

stant cure for obesity. The availability of better

treatment options across the country, more ac-

cessible medical institutions, and better patient

awareness are some factors fueling the trend

of increased surgical procedures.

However, the biggest challenge that is faced

by this industry lies in the expense of the treat-

ment itself. The expenses of the treatment are

borne completely by the patient themselves as

these treatments are not included in insurance.

In Europe, plastic and reconstructive surgeries

procedures are reimbursed if they are unavoid-

able and unforeseen. In the case of treatment

of obesity the reimbursement policies differ for

different countries within the European Union.

In the area of implants, growth is likely to be

driven by silicone-filled breast implants.

The scare caused by leaking implants in the

past had led these silicone fillings to be banned

by the FDA, but the latest products in the mar-

ket, known as the fifth generation, are known

to be as much less susceptible to ruptures and

are also approved by the FDA. Likewise, Botox

treatments are likely to remain a strong area of

growth in the injectables market, which is

again further boosted by newly FDA approved

fillers such as calcium hydroxylapatite and

polymethylmethacrylate microspheres.

Light-based treatments available in the mar-

ket benefits the customer by offering solutions

for a range of beauty issues which include hair

removal, removal of tattoos, cellulite reduction

and skin rejuvenation/anti-aging treatments.

Overall it can be safely predicted that the

market for cosmetic surgery is set to grow with

an increasing demand among both men and

women as it incorporates both health issues as

well as the modern desire to look young and

attractive for as long as possible. «

» it Can BE SaFEly pREDiCtED that thE MaRkEt FOR COSMEtiC SuRgERy iS SEt tO gROW With an in-CREaSing DEManD aMOng BOth MEn anD WOMEn «


INTROdUCTIONReproductive tourism, where childless couples

travel abroad to seek fertility treatment, is an

increasing phenomenon. The reasons for seek-

ing treatment in other countries are varied.

Many countries simply do not have advanced

IVF programs in place or do not allow it legal-

ly. Other reasons include lower costs of treat-

ment and a desire to find sperm and egg do-

nors of similar ethnic make-up as the infertile

couple. Foreign couples also appreciate not

having to wait long for an appointment, even

if it means traveling to India.

WORLdWIdE INCIdENCEThe extent of “In-vitro fertilization (IVF) tour-

ism” is unknown since smuggling an embryo

back home in ones womb is difficult for a cus-

toms official to detect. In this way IVF Tour-

ism differs, for example, from international

child adoption which is easier to monitor, and

is subject to both national and international

law standards. Most of the available data on

reproductive tourism is therefore based not

on methodical assessments, but on anecdotal

reporting by specific clinics. For instance, it

has been estimated that over 1000 Japanese

couples travel every year to California alone

seeking reproductive care. This is mainly a di-

rect consequence of the restrictions imposed

on egg donation and surrogacy in Japan.

RATIONALEThe recent increase in the extent of interna-

tional travel for reproductive technology serv-

ices has been attributed to several factors (Ta-

ble 1). First, following the current revolution

in information technology patients can readily

obtain data and compare figures regarding

the cost and the availability of different infer-

tility services in countries around the world.

Second, patients are now more used to inter-

national travel which has become in some

ways more comfortable and affordable in re-

cent years. Third, IVF clinics in many countries

are more aware of their relative advantages in

terms of price and type of services rendered

compared to other countries, and are actively

seeking to attract patients from foreign coun-

tries. These centers now often offer compre-

hensive packages to facilitate access by for-

eign patients. Such packages often include

not only the reproductive procedures, but also

flight tickets, local escorted transfer, hotels,

interpreters and local recreational tours.

Fourth, the improved use of the internet of-

fers IVF clinics, through their multi-language

Web sites, a very cost-effective and efficient

way to disseminate information regarding the

clinic’s services and unique merits in terms of

cost, expertise in reproductive technologies

and local policies. Moreover, it is currently

not rare to find business advertisements post-

ed by fertility clinics in airline magazines or

international satellite TV channels aimed at

luring clients worldwide.

CLINICAL dISCUSSIONWe at our center decided to retrospectively

analyze the trend in the influx of patients

coming from abroad, over a period of three

years, from January 2004 to December 2006.

The study included all overseas patients who

had visited our center for treatments like IUI,

IVF, ICSI, Donor Egg IVF and Gestational Sur-

rogacy. Those availing of Surrogacy included

patients with MRKH Syndrome, Asherman’s

Syndrome, those with history of Recurrent

Reproductive Tourism

FEaTuRE | REpROdUCTIvE TOURISM

By gautam N allahbadia md, The Center For human Reproduction, Bandra, India

Table 1. The main reasons behind the recent rapid expansion in reproductive tourism

• New information technology allows easy dissemination of information on reproductive procedures in foreign countries.• International travel currently more comfortable and affordable.• IVF clinics in certain countries are now actively seeking patients from foreign countries through advertisements in airline magazines or international satellite TV channels.• Fertility centers now offer convenient all-inclusive packages that include not only the reproductive procedures, but also flight tickets, escorted transfer, hotels, interpreters and local recreational tours.• The internet allows a very cost-effective and efficient way for patients to compare the foreign clinic’s services and unique merits in terms of cost, expertise in reproductive technologies and local policies.


Pregnancy Loss, single parents, as well as les-

bian and gay couples from abroad. In the year

2004, out of a total of 120 cycles, 9 cycles

were done for patients coming from abroad

(7.5%). Out of these 9 cycles, 3 (33.3%) cy-

cles were of regular IVF, 1 of ICSI (11.1%) and

5 (55.6%) of Donor Egg IVF. In 2005, the per-

centage of cycles for patients from abroad in-

creased to 10.6% (17/160). Of these, 5

(29.4%) were regular IVF cycles, 2 (11.8%)

were ICSI, 7(41.2%) were Donor Egg IVF,

2(11.8%) were for Surrogacy and 1(5.8%) for

IUI. In 2006, out of a total of 200 cycles, 30

(15.0%) were done for overseas patients. Of

these, 7 (23.3%) were IVF cycles, 3(10.0%)

were ICSI cycles, 11(36.7%) were Donor Egg

IVF cycles, 7 (23.3%) were for Surrogacy and

2 (6.7%) were for IUI.

CONCLUSIONSCheaper prices, high-quality health care and

the availability of donor eggs and surrogates

are drawing an increasing number of couples

to Thailand, Eastern Europe, Russia, China

and India. In the English-speaking world, India

has a big advantage because of the availabili-

ty of English-speaking doctors. The real bene-

fit for many couples is relaxed laws. Whereas

countries such as UK allow only two embryos

to be transferred, in India this number is al-

most three times as much, increasing the

chances of success in the first attempt itself.

One of the biggest attractions offered by In-

dian ART clinics is maternal surrogacy. The In-

dian Council for Medical Research permits

surrogates to claim monetary compensation in

addition to routine expenses and antenatal

care, a facility not provided for by many coun-

tries. This makes it easier for couples to find

willing surrogate mothers in India. The

number of surrogate births here has more

than doubled in the past two years. Indian

ART centers are also willing to treat women

who have been deemed too old or overweight

by the British National Heath Service (NHS) for

IVF treatment. Consequently Indian clinics are

performing a growing number of IVF treat-

ments for foreigners frustrated with disap-

pointing results and soaring costs at home.

Medical tourism in IVF serves couples in

many ways. It allows patients to seek centers

with better results and often at more afforda-

ble prices. Occasionally international travel

merely presents the wish of immigrants to re-

turn to their country of origin in order to re-

ceive care within a more supportive family en-

vironment and ethnic background. The most

controversial aspect of reproductive tourism is

when it takes place in order to seek services

that are locally banned for religious of ethical

reasons (Table 2). Since the demand for the

ability to become a parent is extremely strong

it is very doubtful that new laws and regula-

tion are likely to succeed in limiting interna-

tional travel for reproductive services. This is

especially true among those barred from

treatment in their own country including sin-

gle women, homosexual men and women or

older women. Even more contentious repro-

ductive services, including sex selection, sur-

rogacy and egg donation are likely to follow

the laws of demand even if unacceptable to

many. As long as some people are determined

to obtain certain reproductive services such as

donated eggs or surrogate wombs, and oth-

ers are willing to sell them, the trade will be

impossible to stop. So it makes better sense

to regulate the business than to drive it un-

derground or to limit it to countries, like the

USA, where few limitations exist but repro-

ductive procedures are affordable only to a

selected group of very well-off people. «

REpROdUCTIvE TOURISM | FEaTuRE

» REpRODuCtivE tOuRiSM,

WHERE CHILdLESS COUpLES

TRAvEL ABROAd TO SEEk

FERTILITY TREATMENT, IS AN

INCREASING pHENOMENON «

Table 2. Examples of types of reproductive procedures prohibited or un-affordable in certain countries thereby attracting medical tourism to countries offering them

Country of origin Country of destination Reproductive procedureIsrael Romania, Cyprus Egg donationSweden Denmark Anonymous sperm donationUSA India Ethnic Indian egg donors Australia, China USA Sex selectionGermany Belgium PGDItaly Spain IVF for non married womenMoslem countries Europe Sperm donationUganda/Kenya South Africa IVF & ICSIBritain India Surrogacy


the health sector in general is booming as

infrastructure projects come on line. Interna-

tional companies continue to enter the Middle

East in order to do business and analysts pre-

dict this trend is likely to grow as other parts

of the world feel the full effects of the eco-

nomic slow down. Corporations now view the

region as an attractive market in which to do

business, and quality healthcare provision is

being achieved.

As expected areas including primary health-

care, emergency and trauma services and pre-

ventative medicine are priorities for public

health policy makers. There is also a desire for

specialist clinics and international centres of

excellence to be established. All of these things

are needed, but the medical tourism angle

continues to feature high on the agendas of

health ministries. Almost every project has

some form or component installed to attract

medical travellers.

In the UAE both the private and public sec-

tors are doing this. Dr. Samih Tarabichi who is

the Director of the Joint Replacement Centre

at the American Hospital, Dubai always consid-

ered medical tourism to be part of his clinic’s

business model.

“Medical tourism was in our thinking and

we knew we would have to address it. We

treat our international patients like VIP’s, and

that was from the beginning,” he said. “When

the patient comes in he has to feel that we are

special. Why should I come to you if I’m living

in Saudi or England? You have to give me a

reason.”

The reason could be that Dr. Tarabichi runs

an established centre of excellence that is at-

tracting attention from an international clien-

tele. That is certainly an advantage, but how

do you attract the same interest when this isn’t

the case? Not every department at the Ameri-

can Hospital, Dubai can match this claim, but

Richard Larison, the hospital’s CEO believes

medical tourism although only accounting for

6% of the business at the moment is set to

grow in the coming years.

“One of the things we’re starting to under-

stand is that there’s a larger population which

is looking for healthcare. We’re sitting down

now to try and figure out how to render that

care to these people,” he said. “We think there

will be more people that will come to Dubai

whereas they’ve been going to Europe, the US,

India, Thailand and Singapore. We think this is

a market that will grow, and so we’re working

now to look at how we can attract people to

come to the American Hospital.”

By peter donnally, scientific Writer, IIR middle East

FEaTuRE | MIddLE EAST FOCUS

The medical tourism industry continues to hold appeal for the private and public healthcare

sectors across the middle East. many countries are committed to developing this specific in-

dustry, although questions remain about actual numbers of patients travelling into the region

for the plethora of treatments being made available.

Bridging the Middle East’s Medical tourism Gap

» AREAS INCLUdING pRIMA-

RY HEALTHCARE, EMERGEN-

CY ANd TRAUMA SERvICES

ANd pREvENTATIvE MEdICINE

ARE pRIORITIES FOR pUBLIC

HEALTH pOLICY MAkERS «


Larison indicated that he believes there are

key areas of healthcare that will attract pa-

tients from an international customer base.

“I think there are five major areas, and I

would add a sixth,” he said. “We are looking

at heart, oncology, orthopaedics, paediatrics

and neurosciences. The sixth, that we’re com-

mitted to doing is to make sure that there are

wellness services.”

The wellness component is fast becoming an

important arm of any strategy being employed

to attract medical tourism. This is where the

distinction between medical tourism and con-

ventional tourism becomes blurred.

It’s a fact that hasn’t escaped the Dubai au-

thorities which is keen to attract all kinds of

tourists regardless of how they’re defined.

Nasser Khalifa Al-Budoor, the Assistant Un-

dersecretary for International Relations and

Health Affairs at the UAE Ministry of Health

believes his government is putting in place ad-

equate measures to attract medical tourists,

and the promotion of spas is part of this.

“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 replacements

or cardiovascular. We don’t want to forget the

spas. Its not only medical treatment; spa for

tourism is important,” he added.

According to Jones Lang LaSalle Hotels’ re-

cent research FocusOn Medical Travel - fad or

focus for hotel operators and investors?, the

medical travel sector has potential to develop

into a lucrative niche market for hotel opera-

tors and investors.

The medical travel industry is driven today

by Asia, particularly popular destinations such

as Thailand, Singapore, Malaysia and India.

“These countries are developing first-class

facilities with highly skilled medical specialists,

many of whom trained abroad,” said Mark

Wynne Smith, CEO for Europe, Middle East &

Africa at Jones Lang LaSalle Hotels. “Interna-

tional tourists are attracted by the high-quality

and relatively low-cost healthcare offered.”

With destinations such as Eastern Europe,

Turkey and Dubai getting in on the act, this

market is poised for rapid expansion in the fu-

ture.

As travellers become more discriminating,

they will continue to seek out hotels and re-

sorts that offer a complete array of amenities.

Medical spas, medical travel and rehabilitation

at desirable destinations will play a large role

in the new generation of spa resorts.

“In Dubai alone, there are at least 120 spas,

health clubs and clinics offering wellness ser-

vices. By 2015, the United Arab Emirates could

be amongst the top spa destinations in the

world with an estimated 200 hotels offering

world-class facilities,’ said Wynne Smith.

Stakeholders must ensure that the medical

travel industry offers accessible, affordable and

high-quality care to cement the reputation of

this fledgling sector and allow the travelling

public to make informed choices about their

medical care. There is enormous potential for

partnerships between hotel chains, property

developers, airlines, insurance companies and

financial institutions.

“Medical Tourism has the potential to be-

come a significant tourism segment with in-

vestment opportunities ranging from large

scale hotel developments adjacent to city hos-

pitals or specialist offerings with some minor


» WITH dESTINATIONS SUCH AS EASTERN EUROpE, TURkEY

ANd dUBAI GETTING IN ON THE ACT, THIS MARkET IS pOISEd

FOR RApId ExpANSION IN THE FUTURE «


MIddLE EAST FOCUS | FEaTuRE

modifications to existing product. In either sce-

nario, the amount of incremental capital ex-

penditure will depend on the size and oppor-

tunity within the market and should be a key

consideration for any investor,” Wynne Smith

concluded.

Dubai Healthcare City (DHCC) also views

medical tourism as a viable option for the ser-

vices it provides. But, according to Dr Ayesha

Abdullah, Senior Vice President of DHCC, at

the core of the mission is the ability to retain

UAE patients.

“By creating an integrated centre for health-

care excellence which is regulated to interna-

tionally recognized standards, working with

leading experts and brands and developing lo-

cal talent, DHCC’s priority is to retain UAE na-

tionals and residents, who might otherwise

travel overseas to seek medical care,” he said.

“There is a regional gap in specialized medi-

cal care and a fragmented healthcare infra-

structure. The UAE population is around 4.7

million people (1.6m in Dubai), with around

1.8 billion in the region. The population is also

aging, with the number of 60 plus expected to

grow from around 6% to 19% by 2015. The

average number of beds per 1,000 people in

the UAE is 2. The estimated requirement for

beds exceeds the existing bed supply. With the

introduction of mandatory private health insur-

ance, the share of privately insured people will

increase rapidly and the UAE Federal Govern-

ment plans to shift significant health spend

from the public to private sector in the coming

years.”

Catering to the health needs of the local

population is a priority of any government, but

Abdullah believes that the infrastructure being

put in place will allow medical tourism to be-

come a positive spin-off for the country.

“Dubai has established itself as a major

centre for tourism. The combination of world-

class tourist facilities with world-class health-

care will be an attractive proposition for

many,” he said. “The development of state-

of-the-art wellness facilities at DHCC will par-

ticularly appeal to tourists interested in main-

taining their wellbeing.”

Yet, although there is a high level of enthu-

siasm for medical tourism in the Middle East

there are those who have mixed views about

its potential. Peggy Farley, Managing Director

of the General Partner of the Ascent Medical

Technology Fund is one.

“This will take some time unless the region

wants to import hugely from abroad its medi-

cal staffs. Also, medical tourism is a success

when one can save money by going elsewhere

for treatment. If a patient brings his family to,

say, Dubai, when he is being treated, cost of

hotel and food and services would likely ex-

ceed that in the US. It would not work. It

would work well in Jordan and possibly, Bah-

rain,” she said.

Although there will be problems faced by

the countries of the Middle East in the devel-

opment of their medical tourism infrastruc-

tures, lessons can be learned elsewhere.

Chalongphob Sussangkarn, Thailand’s for-

mer Finance Minister on a visit to Dubai last

year indicated that the sheer numbers of tour-

ists to his country is a massive contributor to

the economy.

“I don’t have the revenues generated from

medical tourism, but in terms of tourism in

general it’s really the top earner,” he said.

“Our medical services at the top end are quite

good because most of our doctors are trained

in the US and abroad. There was a market for

bringing foreigners in to the country for check

ups and for dental treatment and so on. In the

last decade this type of medical services has

grown a lot. Now we have around two million

who come and they combine things for medi-

cal check-ups, for shopping to spas and so

on,”

In Thailand the government are aware of the

potential problems associated with treating a

growing number of medical tourists while at

the same time maintaining the provision of

healthcare to the local population.

“There are pit falls in the sense that you’re

drawing medical resources, doctors, nurses and

so on into the high end health services which

» THERE IS A REGIONAL GAp

IN SpECIALIzEd MEdICAL CARE

ANd A FRAGMENTEd HEALTH-

CARE INFRASTRUCTURE «

» THERE IS A HIGH LEvEL OF ENTHUSIASM FOR MEdICAL

TOURISM IN THE MIddLE EAST THERE ARE THOSE WHO

HAvE MIxEd vIEWS ABOUT ITS pOTENTIAL «



supplies the foreigners and therefore there’s a

lot of concern particularly that this is leading

to a shortage of services for the people in gen-

eral,” Sussangkarn said

“In terms of services to the people we have

a policy of universal access, almost free, but if

you don’t have the resources in terms of the

supplies side then this is going to lead to a

lower quality of service or longer waiting times

and so on. This is something where you have

to strike a balance,” he explained.

This is true for all countries setting their

health services up to cater to medical tourists

while coping with the demands placed by local

patients. Sussangkarn said that government

policy has to be adaptable to deal with this sit-

uation.

“It’s something that can’t follow a set for-

mula. You have to learn, as problems arise you

have to try and build a response,” he said. “If

the medical services can provide high incomes

for doctors who cater to the high end services

then obviously you need to maybe increase the

supply side of producing doctors. And of

course you have to think about incentives for

people in the public system. They’re not going

to stay there if their incomes much lower than

the private sector,” he added. “These are the

public policy issues which are not easy, but as

long as the government is aware of these

problems, they can monitor the situation and

try to rectify it in time.”

Although currently there is little data which

determines the size of the global health tour-

ism market, and even less dedicated to the

Middle East, the potential, infrastructure and

support is there to build an international in-

dustry. There are many issues arising as quickly

as the business is growing, but it appears that

professionals working within this particular

part of the healthcare sector are aware of

them. This isn’t to say that solutions will be

found for them all. Colleen Lyons, a bio ethi-

cist and Principal with the Ethical Stability for

Sustained Prosperity summed it up best when

she said: “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, society and the economy.” «

» WE MUST pROCEEd WITH CAUTION ANd CONSIdER THE

SpECTRUM OF IMpLICATIONS AFFECTING pATIENTS, SOCIETY

ANd THE ECONOMY «


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