Wellness Tourism: The effects of the Globalization of the Healthcare Industry William Lane Gokul Mundhra F. J. DeMicco U

1. Wellness Tourism:The effects of the Globalization of the Healthcare IndustryWilliam LaneGokul MundhraF. J. DeMiccoUniversity of Delaware

2. Why the need? Going abroad for surgery is not just the only reason to go abroad. Many now combine it with a trip to the Taj Mahal, a photo safari on the African wild, or a stay at a hospital that feels like a luxury hotel, and all at bargain basement prices. This is medical tourism, and its one the hottest niche markets in the hospitality industry.

3. DEFINE • Medical tourism or medical travel is the act of traveling to other countries to obtain medical, dental, and surgical care. • Leisure aspect of traveling may be included on such a medical travel trip. • It includes medical services (inclusive of elective procedure and complex specialized surgeries) like knee/hip replacement, heart surgery, dental procedures and different cosmetic surgeries.

4. Medical Tourists In some regions, state-of-the-art treatments and facilities are hard to come by, if they exist at all. For that reason, patients throughout the Middle East are traveling to places such as Jordan or Asia for complicated surgeries.

5. COUNTRIES THAT PROMOTE • Singapore • India • Thailand • Brunei • Cuba • Hong Kong • Hungary • Israel • Jordan • Lithuania • Malaysia • Latvia • Philippines • UAE • Argentina • Bolivia • Brazil • Costa Rica • Mexico • Turkey • Belgium • Poland • South Africa.

7. Health Care In countries with public health care systems, the system can get so overburdened it can take years to get proper needed care. Hence many people in Britain and Canada are seeking help from other countries such as India and Thailand for their healthcare, where you can be in the operating room in Bangkok or Bangalore the morning after you step off the plane.

9. Prices contd. Heart-Valve replacement in the US $200,000 or more, in India, $10,000 including round trip airfare and a brief vacation. Metal free dental bridge in the US $5,500, in India, $500. Thailand, knee replacement surgery with six days of physical therapy, $5,000, one-fifth the price it would cost in the US. Lasik eye surgery in the US, $3,700, in Thailand, $730. Full facelift in the US, close to $20,000 or more, in South Africa, about $1,250.

10. HOW TO PROMOTE • favorable government regulations and support • set up a committee or task force comprising heads of industry, eminent medical practitioners, and maybe insurance companies that is involved in setting guideline and policy for the industry • revising tax laws to make it more conducive to invest in the industry • make available imports with reduced duties on medical equipment, and essential drugs • focus on alternate healing methods which originate from the country like acupuncture and acupressure from china, yoga and ayurveda from India. • Areas that are tourist attractions should be developed to facilitate investments in health care

11. Low Price For many though, it is simply the low price that is the real attraction. The cost of surgery in India, Thailand, or South Africa can be one-tenth the price of a counterpart in the US or Western Europe.

12. Non-US does not mean bad Patient’s room Bangkok’s Bumrungrad Hospital The hospitals and clinics that cater to the tourist are often the best in the world. Many are staffed by doctors trained at the major medical centers in American and Europe. Bangkok’s Bumrundgrad hospital has over 200 surgeons who are board-certified in the US. One of Singapore’s major hospitals is a branch of the prestigious John Hopkins University. Escorts Heart Institute and Research Center, in Delhi and Faridabad, carries out nearly 15,000 heart operations each year with a death rate of only 0.8 percent, less than half of most major hospitals in the US.

13. Not just the Doctors… • Many overseas Hospitals have doctors who are supported by more registered nurses than any facility in the Western countries could offer. • Some provide single-patient rooms that look more like four star hotels, with a nurse dedicated to that patient 24 hours a day! • Along with the chance of a quick vacation before or after the surgery, many patients are even assigned a personal assistant. • Employer option – Hannaford Bros. Co. offers a foreign hospital in its network of service providers

14. Rapid Growth • Ten years ago, the overseas market was hardly noticeable, now, over 250,000 patients visit Singapore alone, nearly half coming from the Middle East. • In 2002 150,000 traveled to India for care and surgery, today, nearly 500,000. • The McKinsey consulting firm estimates that medical tourism will bring India as much as $2.2 Billion USD per year by 2012. • Along with the major players, Argentina, Costa Rica, Cuba, Jamaica, South Africa, Jordan, Malaysia, Hungary, Latvia, and Estonia all have broken into this lucrative market.

15. Contributing Trends • By 2015 the health of the vast Baby Boom generation will have begun its slow, final decline. • Over 70 million boomers in the US, and over 150 million when Canada, Europe, Australia, and New Zealand are taken into account. • These boomers represent an overwhelming market for inexpensive, high quality medical care. • Medical tourism will be particularly attractive in the US, where an estimated 43 million people are without health insurance and perhaps 120 million lack dental coverage. • This number is likely to grow quickly as many companies cut back or eliminate their health plans. • Joint commission International accrediting agency is an affiliate of the Joint commission which accredits hospitals in the U.S.

16. ISSUES IN THE INDUSTRY • healthcare unaffordable to the local population. • issues regarding infringements on rights to intellectual property because different countries have different laws concerning the same • question of ethics when it comes to the donors of organs • Research methods in some developing countries are not regulated by law (human trials, animal testing, DNA research, and artificial reproduction of human tissue)

17. Thailand started its medical tourism in 1997, during the economic crash that hammered much of Asia sent canny healthcare providers looking for new markets. Today it is the largest and best-established destination for foreign patients, particularly from Japan and the US. Some 1.2 million Japanese visited Thailand in 2004. Largest Players

18. Largest Players Ctd. Bangkok and Phuket – No fewer than six medical facilities in Bangkok have hospital accreditation from the US. Bumrungrad Hospital alone sees 850,000 patients per year, 40 percent of them from abroad. They attract people for cosmetic surgery, dental treatments, eye surgery, dialysis, and organ transplants.

19. Vacation + Surgery = Good thing! For vacation possibilities, Phuket is clearly the choice though. With some of the most spectacular shorefront scenery on the planet. The mess left by last December’s tsunami has already been cleared away and the beaches are cleaner than at any time in a decade. The other draw to Phuket? Bangkok Phuket Hospital is probably the best place in the world to go for sex-change surgery. In fact, it is one one of the top ten procedures that patients visit Thailand for.

20. India India is a relative newcomer to the medical tourism arena, but is quickly catching up. Just two years ago, McKinsey predicted that the number of foreign patients seeking care in India would grow by 15 percent. Most estimates put the growth at 30 percent already. It helps a lot that English is one of the many native languages in India, and the one spoken by all educated Indians. Also cost of care and low cost for follow-up trips are a boost.

21. India Ctd. India also has top notch centers for open heart surgery, pediatric heart surgery, hip and knee replacement, cosmetic surgery, dentistry, bone marrow transplants, cancer therapy, and just about any other specialty that a patient could need. Many of these center are among the best in the world. Virtually all equipped with the latest state of the art medical and diagnostic equipment, and India has the technological sophistication to maintain it.

22. India Ctd. Also, Indian pharmaceuticals meet the stringent requirements of the US FDA, while its quality of care is also up to American standards. India also offers many services not available in the US, such as “hip resurfacing”. Instead of a total hip replacement, in which damaged bone is scraped away and replaced by a chrome alloy. The operation is well tested and highly successful, but has not yet been approved for use in the US.

23. India Ctd. Not only surgery attracts patients, but the chances for a vacation. From a tour of the Taj Mahal to a half-day safari in the White Tiger-Bandhavgarh Nation Park, shopping for handicrafts in the tribal villiages of Orissa and Madhya Pradesh, or even skin-diving in the Indian ocean.

24. Costa Rica Not only offering surgeries at one-third the cost of similar treatments in the US, Costa Rica is also in the ‘backyard’ for many Americans. Cosmetic surgery and dental work are their specialties. Add in its ecological wonders such as some of the largest, best protected Rain Forests in the Central America, to the fire show of the Arenal Volcano. For more urban tastes, there is always the casinos of San Jose, Puntarenas, and Guanacaste.

25. South Africa South Africa is where you want to go for sun, surf, and surgery, all within easy reach of lions, elephants, or the beaches of the Sunshine Coast. South African surgeons tend to be academically sound, but conservative, so this is probably not the best place to go for the latest breakthrough in neurosurgery. Most common and well know procedures are cosmetic in nature.

26. Other Facts Argentina is the fifth most popular destination in the world for plastic surgery, and the number of medical visitors is expected to grow by 50 percent in the next two years. Cuba is resurrecting its once-renowned medical facilities in an effort to attract medical tourist dollars. Cosmetic and eye surgery, and a well regarded women’s hospital are all among the attractions.

27. Facts Ctd. Hungary is drawing visitors from Western Europe, and growing numbers from the US, for high quality plastic surgery and dental care for as little as half the price in nearby Germany and up to 60 percent cheaper than the US. Iran has been eyeing the success of Jordan in attracting medical tourists from other parts of the Middle East and has its sights set on pulling patients for cardiovascular and orthopedic surgery, dentistry, organ transplants, and even psychiatric care.

28. Dubai is seen as a better deal, already known as a luxury vacation paradise on the Red Sea. Dubai Healthcare City, scheduled to open in 2010, will be the largest medical center between Europe and Southeast Asia and will have a branch of the Harvard Medical School on site. Facts Ctd. Dubai Healthcare City

29. Facts Ctd. Malaysia offers advanced care at low prices in a variety of specialties, but has been handicapped by a lack of doctors and technicians. The Philippines are still underdeveloped land as far as medical tourism goes, but that may not remain true for long. Bangkok’s Bumrungrad Hospital recently mad a major investment in the Asian Hospital and Medical Center outside Manila in hope of cloning its own success and attracting vacationing patients.

30. Contact Details Dr. Frederick J. DeMicco Professor and ARAMARK Chair, Hotel & Restaurant Management Dr. Marvin Cetron President Forecasting International Address: The University of Delaware, 14 W. Main Street-Raub Hall, Newark, Delaware 19716 Tel: +1 302 831 6077 URL: www.hrim.udel.edu E-Mail: FDeMicco@udel.edu