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The Global Patient Health Reform Conference Kuwait 15 March, 2009. Curtis J. Schroeder Group Chief Executive Officer Bumrungrad International. Summary. Opened 1980 Largest private hospital facility in SE Asia Over 1.2 million patients treated each year

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Curtis J. Schroeder Group Chief Executive Officer Bumrungrad International


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    1. The Global Patient Health Reform Conference Kuwait 15 March, 2009 Curtis J. Schroeder Group Chief Executive Officer Bumrungrad International

    2. Summary • Opened 1980 • Largest private hospital facility in SE Asia • Over 1.2 million patients treated each year • 100 Clinics and Hospitals in 7 Countries • Bangkok: Asia’s first JCI accredited hospital, in 2002 • Over 1000 doctors and 800 nurses in Bangkok • International management • More international patients than any other hospital in the world: 430,000 from 190 countries in 2006

    3. Regional Presence Presence in 8 countries, with 99 clinicandhospital locations Thailand South Korea Bangkok, Thailand 14 Locations 10 Locations Japan 6 8 2 Locations Taiwan 5 1 2 34 Locations 3 United Arab Emirates Philippines Malaysia 7 4 7 Locations Singapore Philippines 19 Locations 10 Locations

    4. It’s Time for… Medical Tourism

    5. Myth #1 My country is a magnet for tourists, therefore we are ripe for medical tourism.

    6. Myth #2 Medical Travelers select their destination based on the quality of beaches, hill resorts or safari options.

    7. Myth #3 Medical Travelers are mostly affluent and happy to occupy your private rooms and fancy suites at full price.

    8. Myth #4 Medical Travelers are happy to be leaving their home country for healthcare and are forever appreciative for your hospitality.

    9. Myth #5 Once the medical traveler has beaten a path to your door, they are yours forever.

    10. Evolution of Medical Tourism 2001-2006 • 911 & The Middle East Boom • Cosmetic surgery boom • Emergence of Thailand and India as legitimate medical destinations Medical tourism • Asian Economic Crisis • Price is now a factor • Emergence of alternatives to the established players in Asia 1997-2001 Transition Pre 1997 • USA and Europe are centers of the healthcare universe • Singapore the medical hub in Asia • People travel for high end medical services Medical Travel

    11. The Face of Medical Tourism • 50+ • Needs elective surgical service or specialty medicine • Unable to pay for or access healthcare in her home country • Looking for cheaper healthcare options • Willing to travel for significant savings • Selects doctors and hospitals that most resemble what she knows and trusts

    12. The Global Patient Provider • One stop, multi-specialty medical centers • Internationally Accredited • Immediate access to doctors and medical services • No technology or quality gap • Competitive prices • Service focus • Capacity

    13. Hotspots of Medical Tourism Source: Internal Deloitte Analysis

    14. Where are they coming from? 100 Number of patients; percentage Originating Geography Oceania Africa Asia Latin America Middle East Europe 17 North America l Note: The originating geography cut is based on 49,980 patients Source: McKinsey & Company Provider interviews and data analysis

    15. Where are they Going? Percentage of patients 33 45 39 27 10 6 North America Europe 1 5 2 13 93 8 32 87 26 Asia 58 Middle East >99 4 2 Latin America 12 Africa 95 1 Oceania 1 <1 Source: McKinsey & Company Provider interviews and data analysis

    16. 2 The Middle East and Latin America represent 73% of patients seeking the most advanced technology Number of patients; percentage Originating Geography Specialty Sought North America Asia 58 Other Latin America Europe 38 15 Oncology 27 Cardiology Specialty mix has significant spread, e.g., cardiology ranged ~0-50%; oncology ranged ~0-30% 35 Middle East Source :

    17. Drivers for Medical Tourism • Geo-Political Events • Lack of “Perceived Quality” & Service • Lack of Access • Cost • Family Microeconomics • Non-insured Services (e.g. Cosmetics) • Out-of-Pocket Healthcare Expenses Rising • Burden shifting to the “Individual”

    18. Enablers Tourism Media Web Accreditation

    19. What is the next step in the evolution of medical tourism?

    20. Evolution of Medical Tourism • 1st world managed care model is prohibitively expensive • Medical outsourcing seen as a cost containment solution 2007- Global Patient • Emergence of Thailand and India as legitimate medical destinations • Arab exodus • Cosmetic surgery boom 2001-2006 Medical tourism 1997-2001 • Price is now a factor • Emergence of alternatives to the established players • Shift from sellers market to buyers market Transition Pre 1997 • USA and Europe are centers of the healthcare universe • Singapore the medical hub in Asia • People travel for high end - high cost medical treatment Medical Travel

    21. Geo-Political Events Lack Quality/Service Lack of Access Family Microeconomics Individual Burden Global Competitiveness Corporate World 3rd Party Payor survival Government Budgets & Capacity Self – Outsourcing The Individual The Global Patient Medical Tourism The New Drivers

    22. Will They Really Go? “39% will go overseas to save 50% or more” Source: Deloitte

    23. Will Governments Outsource? The Globalization of Health Care: Can Medical Tourism Reduce Health Care Cost?

    24. New Enablers - the Global Patient • More complex and structural • Standardization of quality and credentialing • Portable medical records • Medical information exchange platforms • Doctor referral networks • Legal and liability protection • New insurance products • Packages

    25. What’s At Stake? 6 million Americans by 2010? 15 million by 2015? Source: Deloitte

    26. What’s At Stake? US $10 billion by 2010? US $35 billion by 2015? Source: Deloitte

    27. SWOT Analysis Making a Business Case for Medical Travel to MENA

    28. Strengths • Strong tourism infrastructure • Strong Government Support • Friendly Tax environment • Access to Capital

    29. Weaknesses • Cost & Price • Access to qualified personnel • Capacity • Medical • Hospitality industry • Regional Image

    30. Opportunities • Reversing outmigration • Re-direction of government contracting/outsourcing • Positive shift of reimbursement systems • Africa/ME • Russia

    31. Oman Abu Dhabi Policy decisions to invest in healthcare infrastructure can reduce medical traveler flows Healthcare investment can reduce flows Result Investment Oncology center established in 2004 with specific goal of filling domestic radiotherapy goal Government funded oncology medical travel decreased 92% from 2004 to 2005 Cardiac surgery team with significant international experience set up shop in the emirate Government funded cardiac medical travel decreased 55% from 2004 to 2006 Significant healthcare investments are taking place globally in many countries Source :

    32. Threats • Intra-MENA competition • Value-based competitors • Asia • Eastern Europe • Regional Stability • Inflation • Medical • Hospitality/Support industries

    33. Final thoughts… • Healthcare is moving from a locally to a globally delivered service • Medical tourism and outsourcing are consumer driven initiatives • Core Drivers: Quality, Access and Affordability • Widespread adoption depends on developing networks and connectivity between the 4P’s – patients, payors, providers and physicians • The Middle East can emerge as a regional player if the “value equation” can be addressed

    34. A World of Care