Medical Tourism Magazine - Issue6

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August 2008
Copyright Medical Tourism Magazine
Editorial
patient wellness trip to South Korean hoaspitals, where they brought patients from the US to South Korea for wellness exams. The program was one of the many efforts by CKMP to raise awareness of medical tourism to South Korea including their platinum sponsorship at the upcoming World Medical Tourism & Global Health Congress to be held in San Francisco, California September 9-12, 2008. As a major sponsor of the congress, CKMP will attend committees and seminars in the capacity of an honored guest, and enjoy the privilege of hosting the gala dinner and addressing a panel discussion on medical tourism in South Korea throughout the period of the event. With its participation in this convention, the CKMP expects that the organization will be able to lay the groundwork in attracting overseas patients, by informing medical tourism officials about Korean medical services and institutions and by building networks. With this type of government support, South Korea stands to become a leader in medical tourism quite effectively. I hope you enjoy this months edition.
ecently I gave a presentation at the National Dental Benefits Conference hosted by the American Dental Association in Chicago. The topic of my presentation, of course was Dental Tourism. Amongst the many questions and concerns raised by the delegates was this issue of continuity of care. Many of the American and also Foreign Dentists treating patients in the US have received patients in their offices who have traveled overseas for their care, whether it is for implants, root canals or cosmetic dentistry. The majority of the Dentists feel that unlike most physicians, Dentistry suffers from different types of cost issues than in general healthcare. For example, of the 120 million people in the US who do not have dental insurance, approximately 40% of those are the American poor. Additionally, dental plans generally cover only up to $1,000 per person per year or at the most $1,500 per person per year. Considering that an implant may cost as much as $2,000 per implant, and is only covered if necessary, it is no wonder why people are traveling overseas for dental care. It was reported that dental insurance plans are only covering a very small percentage of dental care sought overseas. For instance, according to Doyle Williams, Chief Dental Officer of Great Dental Plans, of the approximately one billion dollars for 13 million procedures spent on dental insurance benefits in an 18 month period, overseas dollars amounted to only 3/100ths of 1% of the companys expenditures. Dental Insurance Companies may realize that by offering Dental Tourism as an option with Dental Insurance Plans that they can potentially turn a $1,500 per person annual maximum into a $10,000 annual maximum, allowing patients to get a significantly higher benefit overseas than in the US. Having said that, some dental insurance companies may choose not to include dental tourism in their health plans at all. A very important issue the industry needs to address is the issue of continuity of care with respect to dental patients traveling overseas for dental care. Some dentists allege that in the US it can take up to ten years to establish a strong personal relationship with a patient. If it indeed takes up to ten years for dentists to establish personal relationships with their patients and this level of trust is paramount to positive outcomes, how can overseas providers of dental care improve and create long lasting relationships with their patients? Or do overseas providers provide more personal care than US dentists? This does not appear to be a daunting task if providers of dental care follow the same protocols as providers of healthcare. Establishing personal relationships with your patients, providing personal services and individualized care, providing appropriate follow up care, providing high quality dental care with quality materials, and following up with the patient after the patient returns home would seem to set the stage for nurturing strong relationships with these patients in the future. What about opening lines of communication with the primary care dentists? If there are problems, then this open communication will serve the patient who returns home and cannot afford to have corrective work done in the US. Perhaps, they will consider returning to your office for regular checkups while setting off on a tropical holiday. It will be important to continue this dialogue with the ADA to assure that dental tourism becomes part of the solution instead of part of the problem. This months issue focuses on South Korea, the rising dragon of medical tourism. Recently the MTA opened an office in Seoul to better address the needs of the Asian MTA members. While visiting the Korean Council of the Promotion of Overseas Medicine, the government initiative to promote medical tourism was discussed. The South Korean Government has named medical tourism as one of their top priorities for the year. Through the combined efforts of CKMP, KHIDI and KTO, South Korea will be bringing their high quality of care to the limelight. CKMP has been hosting Fam Tours, bringing select groups from the insurance industry and facilitators for site tours and meetings with key government officials. The newly opened Los Angeles office of the Korean Tourism Office (KTO) organized a
Rene-Marie Stephano is Chief Operating Officer and a Founder of the Medical Tourism Association, Inc., an international non-profit organization that serves international healthcare providers and medical travel facilitators in the global healthcare industry. Rene-Marie is an attorney licensed to practice law in the states of Florida, Pennsylvania and New Jersey and has a background in litigation and health law. She is also Editor of the Medical Tourism Magazine, a monthly journal serving the global healthcare industry by free subscription at www.MedicalTourismAssociation.com. Rene-Marie may be reached at Renee@MedicalTourismAssociation.com.
August 2008
The MTA Advisory Board includes
ROBERT K. CRONE, MD, Former CEO of Harvard Medical International; Huron Consulting, Inc. WILLIAM F. RUSCHHAUPT, MD, Chairman, Global Patient Services of Cleveland Clinic, Cleveland, Ohio JOHN F. HELFRICK, Senior Consultant, Harvard Medical International; Boston, MA LEE CHIEN EARN, MD, Senior Director, Healthcare Performance Group Ministry of Health, Singapore MASSIMO MANZI, Chief of Staff, Minister for Competitiveness, Government of Costa Rica DR. UWE KLEIN, General Manager, Europe Health, Munich, Germany MERI BAHAR, Deputy General Manager, Marketing, Acibadem Healthcare Group, Istanbul, Turkey DATUK MOHD RADZIF MODH YUNUS, Chief Executive Officer of Institut Jantung Negara SDN BHD, Kuala Lumpur, Malaysia URSULA FRIEDSAM, Managing Director, Pro Health Complete Care Service, Munich, Germany DR. FAWZI AL-HAMMOURI, Chairman of the Private Hospitals Association, Amman, Jordan DR. PREM JAGYASI, Chief Strategic Officer, Medical Tourism Association, Dubai, United Arab Emirates DR. GIRISH JUNEJA, Managing Director, Life Line Medical Services, Inc., Canada MICHAEL KELLEN, Senior Vice President Strategic Development, Assurant WAYNE BRUCE, Chief Executive, Ccentric Group, Australia DR. OTTMAR SCHMIDT, Director Marketing and PR, Welcare World Health Systems, Dubai, United Arab Emirates RENU GIDOOMAL, Managing Director, Wellness Global Solutions SEBASTIAN VIRAMONTES, Commercial Director, Hospital San Jose Tec de Monterrey, Monterrey N.L., Mexico JOHN F. P. BRIDGES, PhD, Assistant Professor at Johns Hopkins Bloomberg School of Public Health; Baltimore, Maryland ELIZABETH BOULTBEE, Head of International Business at HCA International Hospitals; London, U.K. DR. LEONID ANDROUCHKO, Professor, International University in Geneva, Switzerland DR. B.K. RANA, Deputy Director, National Accreditation Board for Hospitals and Healthcare Providers (NABH), India JEAN-MARCEL GUILLON, General Director, FV Hospital, Vietnam
DR. PERMYOS RUENGSAKULRACH, MD, PhD, FRCST, FCCP, Cardiac Surgeon, Bangkok Heart Hospital; Thailand BOBBY CHIA, Managing Director, Bangkok Mediplex Co., Ltd., Bangkok,Thailand JOHN A. LINTON, MD, PhD, Director of International Health Care Center, Severance Hospital, Yonsei University College of Medicine, Korea DR. SANDEEPAN BHATIA, MD, MPH, Johns Hopkins University, Maryland PRADEEP THUKRAL, Head of International Marketing at Wockhardt Hospitals Group; Mumbai, India GRANT R. MUDDLE, Sr. VP of Operations, Apollo Hospitals, Bangalore, India ASHOKE CHAKRABARTTY, Dy. General Manager - Biomedical Engineering, Indaprastha Medical Corporation Ltd., New Delhi, India KURT WORRALL-CLARE, Advocate, Hospital Association of South Africa DR. SHIN-HO LEE, Executive Director for Industry Support for Korea Health Industry Development Institute, Seoul, Korea JULIO CESAR LOPEZ, Sales and Provider Relations for Hospital Christus Muguerza Monterrey, N.L., C.P., Mexico FATMA ABDULLA, Chief Strategy Officer of Dubai Healthcare City; Dubai, United Arab Emirates BRAD COOK, International Benefits Director at Hospital Biblica Clinica; Costa Rica KENNETH MAYS, Hospital Marketing Director, Bumrungrad, Thailand DR. SANJIV MALIK, Regional Director, Max Healthcare; India JONATHAN EDELHEIT, President, Medical Tourism Association, Inc.; Palm Beach, Florida RENEE-MARIE STEPHANO, Esq., General Counsel for Medical Tourism Association and Editor of The Medical Tourism Magazine CYNTHIA L. CARRION, Assistant Secretary, Philippines Department of Tourism; Philippines STEPHEN M. WEINER, Esq., Chairman of the Health Law Practice of Mintz, Levin, Cohn, Ferris, Glovsky & Popeo, P.C.; Boston, Mass. SCOTT A. EDELSTEIN, Esq., of Counsel at Squire, Sanders & Dempsey, LLP; Washington D.C. DANIEL BONK, Executive VP ~ Central Region, Aurora Healthcare; Wisconsin MARY ANN KEOGH HOSS, Professor at Eastern Washington University; Washington State
August 2008
Medical Tourism
AT A GLANCE
August 2008
EDITORIALS
A Meeting with the ADA
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Many wonder what all these American associations think about medical tourism. Put yourself in a room with a hundred and fifty dentist and find out what they really think. BY RENEE-MARIE STEPHANO
Defining Medical Tourism ~ A Second Approach

Why do patients travel for medical Services? What are the key factors driving this industry? Primarily there are five factors involved in the decision making process of the medical tourist. I call them the 5 A Factors. They are Affordable, Accessible, Available, Acceptable and Additional. BY DR. PREM JAGYASI
Robotic Prostatectomy:
FEATURES
Red Warnings of Cerebral Hemorrhages
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According to past reports, one of the most dreadful cerebral hemorrhages (subarachnoid hemorrhage), cerebral aneurysm, is known to occur more often as people grow older, especially into the 50s. However, these days this incident age has lowered, and is now commonly observed in people in their 40s. BY DR. YONG SAM SHIN
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An Optimal Choice for the Medical Traveler
Based on our experience, robotic prostatectomy for prostate cancer is clearly the more beneficial approach when compared to conventional open surgery. It is especially optimal for the medical traveler who requires a quick recovery
BY DR. KOON HO RHA
Anti-Aging Developments and Trends

Easy-lift using specially designed elastic threads are for those with heavily sagging and wrinkled skin who dont want to go through more invasive surgery. Done without incision, it requires relatively brief operation time and short period of recovery. BY DR. JI HO RYU
Climbing Again ~ A Patients Portrayal

After the consultation, the doctor recommended a vacuolated bone graft surgical procedure to help restore blood flow to the damaged bone in my wrist. The surgery is performed to relieve pressure on the lunate bone and to reestablish the blood supply to the bone. There are no other successful treatments for this somewhat rare condition BY DR. JAE HOON LEE
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Comprehensive Aortic Root and Valve Repair CARVAR

Why does poor durability occur in the Bioprosthetic valve? Possibly no healing between the fabric and biologic tissue or continuous deterioration and weakening of suture site. After implantation it may begin to deteriorate. BY DR. MEONG-GEUN SONG
Liver Tranplantations for patients in Korea
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Korea has become one of the leading liver transplantation countries in the world in terms of case number and outcome. A multi-institutional clinical study on liver transplantation conducted in Korea reported a 3-year survival rate of 91.4% in liver cancer patients treated.. BY DR. KWANG-WOONG LEE
August 2008
Medical Tourism
AT A GLANCE
August 2008
Paralysis Normal Disc Preservation & Transfusionless Spinal Treatment Techniques
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About 90% of Spinal disc patients could have improvement through the following non surgical therapies: drug therapy, physical therapy, oriental remedies, exercise rehabilitation therapy, chiropody, massage, acupuncture & herbal therapy, pain blocking injection therapy, endoscopic therapy, and Computed Tomography guided nerve blocking, but many patients visit a hospital after a prolonged struggle with spinal pain having neglected the most appropriate early treatment BY DR. GUN CHOI
Cutting Edge Phonoplastic Surgery
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People from different social and professional backgrounds choose voice surgery to enhance competitiveness. Voice surgery can resolve voice problems such as transsexual, rough, hoarse, trembling voice, and changed voice due to aging. BY YESON
ECONOMICS
Medical Tourism Economic Report: South Korea
South Korea ~ Stepping into the Spotlight in Global Healthcare

I was invited by the South Korean Government to give a presentation to the healthcare leaders in the medical community about the medical tourism industry and the potential marketplace for Korean healthcare providers in December, 20007. After a twenty-two hour flight, I arrived at the Incheon Airport in Seoul. Although the trip included a long flight, the friendly greeting by Alex Sung at baggage claim leading us towards the hotel shuttle was a welcome relief. Alex was hired by KHIDI, the Korean Health Institute of Development as our official tour guide during our stay. BY RENE-MARIE STEPHANO
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South Korea is hoping to take advantage of its core competence in biotechnology and, in particular, stem cell research. In 2006, it was reported that the Korean government was awarding $430 billion won (approximately $400 million USD) aimed at supporting stemcell research. The government stated it hoped to become one of the worlds top three leading countries in stem cell research by 2015 BY DAVID G. VEqUIST AND ERILKA VALDEz
Will the Circle be Unbroken?
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COLUMNS
BINA BUZZ McCain v Obama
To effectively market your international department you must ultimately begin with a mindset that focuses on relationship building with anyone and everyone that can influence your international patients experience. Be it a chauffeur, a nurse, or even your hospital director, all must be engaged, stone by stone so to speak, setting a solid foundation that will eventually underpin and then propel your traditional marketing efforts for the long haul. BY BILL COOK
The Real Cost of Insufficient Coverage ~ Can Medical Tourism Reduce the Damage?
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Healthcare is in the midst of a ferocious war; the prize unimaginably huge: $2 Trillion Dollars ~ the size of the economy of China. Four armies are battling to gain control: Insurers, Hospitals, Government and Doctors. Yet you and I, the people who use the healthcare system and pay for it all, are not even combatants. And the Doctors, the group whose interests are most closely aligned with our welfare, are losing the war BY MICHAEL BINA
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Corporations stand to save even more than the actual cost of the medical procedures, when they implement a component of healthcare that introduces overall costs, because they can make more procedures eligible for coverage. Many corporations do expense accounting without realizing that their inadequate healthcare plans, and the cost they ask their employees to bear, are the root cause of many expenses. BY ALEX PIPER
August 2008
Medical Tourism
AT A GLANCE
August 2008
Insurance Solutions for Medical Tourism Companies
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What once seemed unusual and unsafe has now become common and practical, as millions worldwide travel outside their home countries to partake in medical tourism. As the cost of healthcare soars and waitlists for surgery grow longer, medical tourists are able to find inexpensive, faster care by simply taking a vacation. BY SMITA MALIK
SAVING LIVES
Growing Options for Losing Weight: Overseas Bariatric Surgery Solutions
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Choosing a bariatric procedure carries important consequences and is not the first choice to lose weight. A potential patient should not try to obtain this procedure by circumventing accepted criteria or by choosing a less than scrupulous surgeon or facility. BY JAMES MCCORMICK, MD
ALTERNATIVE HEALTH
ADHD...Out in Left Field
An Ounce of Prevention is Worth a Pound of Cure

Proper and appropriate medical attention and orientation need to be given in the post op period of recovery (particularly in the first week or so following discharge from the hospital). Even if orientation has been given to the patient and/or a support person is provided as the patient returns to the hotel to recover, are they fully aware of the necessity and importance of sterile bandage changes and how to execute/assure proper wound cleaning? BY CHRISTI DEMOREAS
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They also had intellectual flexibility due to their multiple interests and the speed of the diverse flood of ideas. Boring is not a word that one would apply to this population, as they have many interests that drive their curiosity. They tend to be spontaneous, enthusiastic and maybe exasperating, often fun and outstanding. BY SANDRA LANDSMAN
Several Thousands of Years of Traditional Korean Medicine
NEWS AND INSIGHTS

CyberKnife Radiosurgery
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In eastern medical philosophy, the human being is understood as a micro universe contained within the macro universe. Using the basic concept of the dualistic Yin and Yang principle, health is perceived as the balance and harmony of these complementary forces which exist in all matter. BY DR. RAIMUND ROYER
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The entire process is painless, and it typically takes between 30 to 90 minutes to deliver all radiation beams. Most typically a patient can go home immediately upon completion and return to normal activities. If the treatment prescription is for staged (fractionated) radiosurgery, the patient will return on a separate visit and repeat the above process for treatment delivery. BY DR. WOOCHUL, KIM
Jet Lag
Jet lag is a disturbance induced by major rapid shift in environmental time during travel to a new time zone. Jet lag does exist, and it can have a negative impact on your vacation enjoyment and business judgment, a serious concern for medical tourists. In addition to fatigue and insomnia, it can also acutely cause anxiety, confusion, constipation, nausea, and even memory loss. BY ABDEL SALAM KALEEL
August 2008
MEDICAL TOURISM
EDITOR & PUBLISHER: CONTRIBUTING EDITORS:
Rene-Marie Stephano, Esq. Jonathan S. Edelheit Dr. Prem Jagyasi Jessica A. Leopold Gabriella Vicua Michael Moody Alex Piper Jonathan S. Edelheit Sandra Landsman, Ph D, CHt Karen H. Timmons Linda D. Bentley Dianne J. Bourque Michael Bina Lourdes Gasparoni David G. Vequist Dr. Yong Sam Shin Dr. Ji Ho Ryu Dr. Meong-Geun Song Dr. Bill Cook Dr. Jae Hoon Lee Dr. Kwang-Woong Lee Dr. Koon Ho Rha Dr. Gun Choi Yeson Voice Center James McCormick, MD Christi deMoreas Dr. Tae-Kyu Lee Dr. Raimund Royer Abdel Salam Kaleel Smita Malik Dr. Prem Jagyasi Rene-Marie Stephano e-Medsol 10130 Northlake Blvd. Suite 214-315,West Palm Beach, Florida 33412 USA, Tel:561-627-1520 Fax: 866-756-0811 San Jose, Costa Rica Munich, Germany Seoul, Korea Dubai, United Arab Emirates 10130 Northlake Blvd. Suite 214-315,West Palm Beach, Florida 33412 USA, Tel:561.791.2000 Fax: 866.756.0811 info@MedicalTourismAssociation.com www.MedicalTourismAssociation.com
REGULAR AUTHORS:
CONTRIBUTING AUTHORS:
ART DIRECTOR: ART DEPARTMENT: MAIN OFFICES:
REGIONAL OFFICES:
MARKETING & CIRCULATION:
Copyright 2008 by Medical Tourism Magazine. All rights reserved. Reproduction in whole or in part without permission is prohibited.
August 2008
Defining Medical Tourism

Another Approach
By Dr. Prem Jagyasi
Any age-old, saying or popular fable simply appears in front of us without struggle for its meaning. Every individual has different takes on a particular notion, yet keeping the purpose and initiative intact.
or instance, when we say Humpty-Dumpty, we mean HumptyDumpty. We understand and visualize Humpty-Dumpty. A person thinks different thoughts about Humpty-Dumpty, but the visualization itself has served the purpose. No one refers to a dictionary to find out what Humpty-Dumpty means, but we know what it is. Similarly, there would be significant value to the term Medical Tourism Definition, if we define it the same way as a well-known rhyme or a fable? If more information is needed, we can always Google it.
The Medical Tourism is the set of activities in which a person travels often long distance or across the border, to avail medical services with direct or indirect engagement in leisure, business or other purposes.
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MEDICAL TOURISM
Well, if this can be accepted, then we dont really need a proper definition for Medical Tourism either. Should we rely on Internet information? Of course we should. The Internet has done wonders in providing all sorts of information on just about any topic on Earth and beyond. But how many of us are alert to the negative aspects of using the Internet? Let me explain. Imagine (if is not hard for you to imagine), Albert Einstein existing in the afterworld, searching for some information on his personal computer (which is faster than yours and without anti-virus), he finds a quote which is stated under his name, If the bee disappeared from the surface of the globe, then human beings will only have four years of life left. He would have afterworldtime (obviously, not life time) shock to observe his own quote on the Internet which he never wrote or quoted. Relying on finger-click information can be as dangerous as relying on an ophthalmologist to treat you nasal disorder, which is just a matter of a finger distance organ away. Medical Tourism is a direct result of Globalization of Healthcare; the industry is coming up in vigorous speed. This emerging industry is set to boom because of several factors which are not defined or observed clearly. In order to define its right objectives, we need a proper definition for Medical Tourism. It is correctly stated, A definition is the envelope of ideas caught in the wall of words. The definition must serve the general purpose and betterment of the term. Though the term Medical Tourism constitutes two words, the definition requires extensive understanding of these words. Obviously, emergency or critical care travels should not be considered as medical tourism. Such travels could be subject to medical travel, say be medical evacuation for instance, but not medical tourism.
Medical Tourism Statistics

There is already a lot of confusion about the statistics of medical tourism, and we dont want to confuse industry participants more by providing vague figures, but my well researched figures are more authentic, optimistic and dependable than other fellow industry colleagues.
The focus should be on providing care to patients, not to gain economy of other countries or build the tourism sector from needy to sick patients.
The word Medical means treatment of illness, disorder or injuries. In general, Tourism means traveling for pleasure. According to World Tourism Organization (WTO), the word Tourism compromises of the activities of persons traveling to and staying in place outside their usual environment for leisure, business and other purposes. Understanding of word medical and tourism individually is not sufficient to define Medical Tourism. Medical Tourism is combination of various and definite activities and clear understanding of such activities is essential. Considering the above sets of definitions, the following can be observed: When a person travels across the border and outside their usual environment, to seek medical service, the travel portion of the trip travel is called medical travel, and upon arrival, such person is called medical tourist, and such activities which includes utilization of medical services by the medical tourist, be it direct or indirect - hospitality, cultural exposure or site-seeing, is called Medical Tourism. Hence, Medical Tourism could be defined as The Medical Tourism is the set of activities in which a person travels often long distance or across the border, to avail medical services with direct or indirect engagement in leisure, business or other purposes. But generally, the health professionals do not prefer to mix the word medical with tourism. They have an idea that the word tourism reduces the value of decision which is primarily made for medical services. They also argue that not every patient get involved in tourist activities. An interesting argument would be if patient travels abroad, he/she would be certainly exposed to the culture, environment, food, heritage, leisure or other various aspects of destinations activities. Isnt that tourism?
Also, let me ask you, how much value do statistics hold? Particularly when an industry is at emerging stage? It is said that Statistics are often used as drunkard uses a lamp-post not to light his way but to support his instability. Isnt this true in many cases? Statistics are no substitute for judgment. Most of us can recall the story about the statistician who, going by the average depth of a river, drowned mid-way. Though we do not have an agreed upon proper definition, statistics or ways to measure performance of this emerging industry, yet it doesnt hold us back to think about the potentiality of the industry. Healthcare is in transformation. Medical Tourism is triggering this transformation. NHS has accepted, AMA is keeping an eye. European Union is gearing up. Asian Governments have started measuring the size of the pie. Healthcare providers are improving their appearance to adopt contemporary trends. Travel agents have opportunity to recover from becoming historic icons, and facilitators are emerging. Isnt this true globalization of healthcare in a real sense? So what value does statistics hold at this moment? Many economists have expressed their concerns about industrys long term life-cycle. I must agree with them, but I dont see a decline in very near future, unless local authorities of developed the world come together to develop healthcare delivery solutions that are cost effective for its users.
Medical Tourism Drivers & The Five A Factors

Why do patients travel for Medical services? What are the key factors driving this industry? Primarily there are five major factors involved in the decision making process of the medical tourist. I call them the 5 A Factors. They are Affordable, Accessible, Available, Acceptable and Additional.
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August 2008
Affordable
An American proverb says the laughter is the best medicine. An American person says its medicine cost that brings tears. If medical disorder brings discomfort then treating such disorder brings problems full of discomfort. The developed world is experiencing serious problems for the cost of medical services. Millions of uninsured patients seek affordable care. This factor is the key factor for the emerging industry.
The competition in industry is not operating on the proper objectives. The focus should be on providing care to patients, not to gain economy of other countries or build the tourism sector from needy to sick patients. Moreover, the cost of medical treatment in developed countries is extremely high. Hence, private, social and corporate health schemes are very costly. The above pay model is shifting to individuals. Therefore, Cost is another driving factor. 3. Need The emergence of the new consumer needs, like avoiding waiting queues to get medical treatment or the possibility to have the latest medical treatment, requires new solutions which are not available in consumers home country. So, Need is another driving factor. 4. Change Hospitals are adopting more of the luxury hotel concept rather than the traditional unexciting general wards. After the surgical procedure, there is the opportunity to engage in attractive tourism, which is certainly a better change for the patient. For example, a patient may take a safari trip in South Africa after an orthopedic surgery, a Taj Mahal trip after eye surgery in India, and a Mayan cultural experience after cosmetic surgery in Mexico. Hence, Change is another key factor. 5. Demographics Demographic drivers such as an aging population due to baby boomers causing significant strain on national healthcare system are a driving factor.
Available
Many patients travel because the medical treatment is not available in their local areas. This type of travel is known as need factor travel which makes medical tourist to opt for the best available option.
Accessible
Many developed countries have care available for patients, but because of high demand the treatment and care are not accessible. In some countries, patients have to wait for six to twelve months for a surgery, hence patients search for easy accessible care.
Acceptable
Few patients travel because medical services are acceptable abroad. Services might be affordable, available and accessible but are not acceptable because of religious, political and social reasons. It is hard to define ethical value of such services.
Additional
This is the most important and extensive factor of all. Many patients travel because they receive additional benefits by making use of treatment abroad. It could be better care, modern technology, latest medicine, better hospitality, personalized care or privacy among others. This factor provides some sort of additional benefits to patients, which is better compared to the home country. The above five factors are the major ones which are driving patients to seek treatment abroad. Similarly, the evolution of medical tourism industry involves five key drivers.
Competition on the Wrong Objectives

Governments, healthcare providers and so called travel agents (because of e-ticket, the word travel agent is under a discussion worthy of the history books) are busy in luring patients to hook from the developed world. The competition in the industry is not operating on the proper objectives. The focus should be on providing care to an increased number of patients, not to gain economy of other countries or to build the tourism sector from needy to sick patients. By all means, the priority should be given to the national patients; the healthcare system should be developed and delivered on national requirements. Several organizations set different price structures for international patients. This needs to streamline. There is a dire need of strong measures for this industry. The million dollar question is who will bell the cat?
The Industry Needs Direction

This industry needs to focus on proper objectives. We need proper international accreditation and renewed quality of care indicators. Health leaders need to come together to develop a two-way path so that healthcare resources can be exchanged with harmony and synergy. Otherwise, the end of this story may be the same ending Humpty-Dumpty had. Medical Tourism may sit on the wall, and after the fall, we wont be able to put it back together again.
Five Key Drivers of Medical Tourism

1. Technology Technological improvements drive medical tourism, like more efficient global transportation and communication systems. The flattening of the world through the Internet and technology in medical industry are improving the quality of services. 2. Cost When patients dont have health insurance or their health insurance does not pay for all the care they need, the cost of the care is shifted to those patients with health insurance. This is known as Cost Shifting.
Dr. Prem Jagyasi is a Chartered Marketing, Management & Health Tourism Consultant in Dubai, United Arab Emirates. Dr Prem Jagyasi is world renowned Health Tourism / Medical Tourism Consultant. He provides exceptional, extensive & high-end consultancy services to Healthcare Organizations, Medical Travel Facilitators, Governments and Semi-Government Authorities. He is serving Medical Tourism Association (A Non-Profit Organization) as a Chief Strategic Officer, and is responsible to develop, execute and monitor marketing, brand and communication strategies. He is also closely involved with MTA team to create, protect & foster industry standards, quality of care projects & strategic developments. He may be reached by email at drprem@jagyasi.com , web: www.drprem.com .
August 2008
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MEDICAL TOURISM
Increased Risk of Ruptured Cerebral Aneurysms in the 40s

By Dr. yONG SAM SHIN
Red Warnings of Cerebral Hemorrhage

According to past reports, one of the most dreadful cerebral hemorrhages (subarachnoid hemorrhage), cerebral aneurysm, is known to occur more often as people grow older, especially into the 50s. However, these days this incident age has lowered, and is now commonly observed in people in their 40s.
carried out research on 208 patients who received surgery for subarachnoid hemorrhage caused by cerebral aneurysm rupture, the rupture of the saccular and berry shaped vessel, and the highest incident age group was in 40s, which comprises 70 (33.%) of patients. Additionally, the incidence in the 50s, 60s, and 70s was 51 (24.5%), 40 (19.2%) and 20 (9.6%), respectively, and even the incidence rate in 30s was 27 (13%). Therefore, persons are not free from danger of subarachnoid hemorrhage even those in the younger 40s age group, and therefore everyone should be aware of preceding symptoms.
Cerebral aneurysm is a bulging vessel (artery) which occurs when the blood stream hits the vessel wall which is congenitally or has become weak or thin, and then the artery bulges. Most cerebral aneurysms have been known to result from an inborn abnormality or inherited cause, but nowadays some studies have reported that causes may be related to hypertension, smoking, obesity, atherosclerosis, and family history. Especially, cigarette smoking can degenerate the vessel wall and cause cerebral aneurysm and the rupture of aneurysm.
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These kinds of cerebral aneurysms may rupture when the pressure increases while in the bathroom and in bed (during bowel movement and sexual intercourse), during strenuous exercise, in a stressful situation, and sometimes even without any reason. Also in the past, the incidence of aneurysm rupture was high in the 40s. However, these days there are an increasing number of people in the 30s and 40s with hypertension and atherosclerosis, and many middle-aged people living in Korea are under excessive stress and labor, and it may be associated with the disease. The frequency of people with aneurysm causing subarachnoid hemorrhage frequently are 1 - 5 of 100, and it has been reported that incidence of subarachnoid hemorrhage resulting from aneurysm rupture is 10 - 20 of 100,000 people per year. When the aneurysm ruptures, 3 of 10 people die or experience mental or physical problems caused by sudden death or need for others help to live for their entire lifetime, and from which it is impossible to recover. Also, if aneurysm ruptures more than twice, 7 of 10 people may be affected with after effects or death. However, due to the development of medical diagnostic techniques, we can detect even a very small cerebral aneurysm before they rupture by MRI (Magnetic Resonance Imaging), especially MRA which visualizes the vessels. Additionally, it is strongly recommended that people having a family history of CVA (stroke), hypertension and severe headache, or people with preceding symptoms like paralysis or decreased sensation in the hands and feet, and those with nausea and dizziness should visit the hospital and undergo regular tests to prevent subarachnoid hemorrhage by finding out the cause of the symptoms early, and receive suitable treatment. Especially, quitting smoking and proper treatment of hypertension are the most important things. Furthermore, occasionally there are some patients who experienced severe headache which they never had before visiting the hospital. In these cases, bleeding had occurred and passed already, so it is desirable to visit the doctor to check before ruptures.
If the cerebral aneurysm is found before rupture, it is possible to treat and cure more easily by placing about 1cm-sized small clip around the aneurysm, or filling platinium coils inside the cerebral aneurysm using angiography without opening the skull. Therefore, cerebral hemorrhage is recognized as a preventable disease.
Incidence of stroke depending on age

Dr. Yong Sam Shin is Neurovascular Surgeon and Associate Professor in NeuroSurgery department in Ajou School of Medicine. His specialty is Cerebral Vascular Disease, Stroke intervention treatment. He was formally a director of Neurosurgery department at 121 hospital U.S. 8th Army in Seoul. He also studied in St. Lukes Roosevelt Hospital in New York. Ajou University Hospital is a general and teaching hospital with 1,083 beds. It operates 32 clinics, several disease-specific specialized clinics and centers such as breast cancer, stomach cancer, liver cancer, lung cancer, cartilage regeneration, stroke & neurovascular surgery clinics ect. and takes care of 4,000 out-patients and about 1,000 in-patients a day. Dr. Shin can be reached at 82-31-219-4312
August 2008
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MEDICAL TOURISM
Developments and Trends

By Dr. JI HO RyU
ANTI-AGING
Necessity is the mother of invention. In the beginning, fluorescent and incandescent bulbs replaced open fire and the torch and soon a variety of fancy illuminating devices followed. Then a distinct category of artificial light, a.k.a. laser opened an era that uses light for a whole range of new purposes. The original computer had two large cumbersome vacuum tubes; now its great grandchild takes you around the globe in a flash.
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eanwhile, changes in viewpoints and preference also contribute to development. Traditionally regarded as inevitable and sometimes respectable, signs of aging are now rather viewed as something to be overcome by treatments. Koreans in particular tend to see youthful good looks as a symbol of competitiveness and spontaneity.
Various methods of wrinkle treatment

We can largely classify methods of rejuvenation into three. Firstly, plastic surgery by stretching wrinkles flat through skin incision. Secondly, camouflaging the sunken face with filler or injecting BOTOX. Finally, renewing skin components collagen and elastin by stimulation with laser and/or radiofrequency. Recent years have seen dramatic developments in wrinkle treatments, now called Anti-aging treatments. Whereas earlier treatments solely depended on surgery, newer treatments tend to go beyond the simple stretching of a wrinkle, remodeling on the molecular level.
Plastic surgery, stretching skin or injections diversity in methods

In the field of plastic surgery, wrinkles are basically corrected by stretching the skin. Face lift is a prototype; targeted to correct saggy cheeks and chin, it involves separating the skin and muscles and stretching the skin. Facelift can directly work on wrinkles, resulting in the most conspicuous effect compared with other methods. To flatten forehead wrinkles, brow/forehead lift is a safe and more convenient procedure performed through an endoscope with shortened recovery time. Incision is only 1 to 2cm long and avoids damage of blood vessels and nerves. Freed skin is reattached with an absorbable implant called EndotyneTM that you will not feel afterwards. Easy-lift using specially designed elastic threads are for those with heavily sagging and wrinkled skin who dont want to go through more invasive surgery. Done without incision, it requires relatively brief operation time and short period of recovery.
Wrinkle treatment by peeling

Chemical peeling has been used for wrinkle treatment along with plastic surgery. Newer peels now spare us of the tedious period of regeneration time that causes great inconvenience to normal life. There have been recent advancements in prompting recovery; the Seaweed peeling is a fine example made safe with natural deepsea minerals as main ingredients. Its regenerating, toning and moisturizing properties allow fast recovery after treatment, and the improvement in skin complexion is superior to other chemical peels.
Whereas earlier treatments solely depended on surgery, newer treatments tend to go beyond the simple stretching of a wrinkle, remodeling on the molecular level.
There are also the ways in which we can stick to the syringes and do without knife. Botox and fillers are now collectively called petit plastic surgery. Botox is injected around the brow, eyes, forehead etc, to temporarily paralyze the muscles that contract to cause wrinkles, and its effect lasts 3 to 6 months. Filler also requires injections, to fill the hollows left by age rather than to paralyze. Most widely used filler product RestylaneTM is composed mainly of hyaluronic acid. Hyaluronic acid is eventually absorbed by the body and takes up about the equal volume of water to retain that final volume over time. It is effective in fine wrinkles around mouth, under the eyes, frown lines and forehead. If you have an aversion to the idea of Botox or fillers, you can always turn to your own fat to transplant as a filler material. Treatment is individually adjusted to comprehensively improve ones image. In dermatology, our chemical peels and lasers fight wrinkles by bringing out your skins natural powers to regenerate.
Diverse lasers, personalized treatment for wrinkles region

Steady effort was made to discover ways to diminish wrinkles without leaving scars of operation or interruption to everyday life. The effort was rewarded with ThermageTM using radiofrequency; no incision and one session bringing about the same effect of deep peeling. ThermageTM the monopolar radiofrequency device can transfer strong energy deep into the dermis and subcutaneous fat to diminish wrinkles while sparing the surface layer of the skin, the epidermis. It works by contracting the existing old collagen to form a scaffold for newly regenerating collagen and to stimulate the production of latter, finally giving the saggy face excellent tightened looks. Radiofrequency does not irritate the sensory and motor nerves, and has a property not to reflect or backscatter much, which means more effective energy concentration is achieved in comparison to lasers, ensuring comfortable treatment and satisfactory results. Eye by ThermageTM specifically designed for thin and sensitive eyelids can be applied to early symptom of blepharochalasis which was being traditionally corrected by surgery. RefirmeTM is for fine wrinkles and delivers infrared energy to the upper skin and radiofrequency to deeper skin. Diode laser emitting infrared ray and radiofrequency intersect around the depth of 1.5 to 2.0 mm and forms the hot spots of strong heat energy, thus causing collagen fiber to remodel in deep skin.
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MEDICAL TOURISM
Matrix IRTM combines 915 mm diode laser and RF, and is mainly used around the eye by penetrating strong energy into the dermis, leading to collagen regeneration. The combination will form 6 matrix thermal bands and energy is distributed evenly to the separate bands to minimize side effect that can take place in a single spot setting.
Trend of Wrinkle treatment now in Korea

In Korea, general public prefer that a cosmetic procedure cause no inconvenience to everyday life, no risk of scarring and require short recovery time. Nowadays, skin redundancy on the body also made the wish list to be treated. We have long wanted to get rid of forehead wrinkles and cheek folds, but saggy neck, drooping jowls, wrinkled hands are also getting attentions now. Picky demands soon leads to research and development. Korean specialists are steadily publishing articles and presenting to prestigious international conferences. ANACLI dermatology & plastic surgery clinic, with its specialized centers, serves as a mentor in the field of rejuvenation. ANACLI is a renowned institute where specialists from different countries, especially those from SouthEast Asia, continuously pay visits to learn specialized plastic surgery techniques and share academic communication as well. Dr. Ji Ho Ryu Graduate from kyung-Hee University School of Medicine In 1991 and received master and doctors degree in 2000 Dr. Ji Ho Ryu is currently dermatologist at anacli dermatologic clinic, Seoul, Korea he announced the thesis 308nm xenon-chloride eximer laser in the treatment of vitiligo (Philippines Manila, 2004), A comparison of L-1 mediated PDT and Perfecta mediated PDT in the treatment acne vulgaris in pre-treated state with glycolic acid (16th EADV Austria Vienna, 2007) and Autologous epidermal grafting and 308nm xenon-chloride eximer laser in the surgical treatment of stable vitiligo (65th AAD, USA, Wasington DC, 2007) He Makes efforts to improvement patients life quality. For more information on him and his work. Visit www.anacli.co.kr
If you have an aversion to the idea of Botox or fillers, you can always turn to your own fat to transplant as a filler material. Treatment is individually adjusted to comprehensively improve ones image.
Matrix are RF equipments like Thermage made safe through contact or sprayed cooling devices to protect the surface of skin, before and after shots. Unlike peels, no prolonged redness is observed and risk of bacterial infection is nil. Make-up can be applied immediately after treatment. In addition, there are many lasers in the market for personalized treatments. RefineTM is a 3rd generation FraxelTM used commonly for neck wrinkles. A variety of spot sizes was provided for RefineTM and the individual adjustments it allows maximize the effect and minimize the potential for pigmentary side effects. Exelo2TM laser can treat both the epidermis and the dermis simultaneously and it is expected to give the same effect with laser peeling. What distinguishes Exelo2TM is that it treats the entire skin repairing the dermis and shedding the ragged epidermis as well. Other microablative lasers act by strong heat stimulation to dermis without dealing with the epidermis. Exelo2TM can improve fine wrinkle, decreased elasticity, irregular pigmentations, big pores, and scars.
TM,
RefirmeTM,
IRTM
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August 2008
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MEDICAL TOURISM
Innovative approach for Aortic Valve Repair

By Dr. MEONG-GEUN SONG
Comprehensive Aortic Root & Valve Repair is a new innovative surgical technique that repairs aortic root and aortic valve. The concept of CARVAR technique was first established in 1992 by Dr.Meong-Geun Song (Konkuk University Medical Center, South Korea). The first clinical trial on a human was conducted in December, 1997
CARVAR
ARVAR has been granted the official permit from Korea Government, and is currently working for permission from Japan, Europe and USA. Since last October, Dr. Songs team in Konkuk University Medical Center has performed the CARVAR procedure successfully over 100 times during a six month period.
The problem of Bioprosthetic valve

Why does poor durability occur in the Bioprosthetic valve? Possibly no healing between the fabric and biologic tissue or continuous deterioration and weakening of suture site. After implantation it may begin to deteriorate.
The problem of Mechanical valve

All mechanical valves have gradients (minimal to moderate at rest, moderate to severe with exercise). Persistent left ventricular hypertrophy is an insidious and lethal combination. All mechanical valves need anticoagulation and have noise.
The merits of CARVAR technique

The CARVAR procedure offers anatomical and physiological repair and is universally applicable for almost all kinds of Aortic Valve diseases. Technically easy and safe, and also minimizes aortic root functional impairment. It obviates anticoagulation and improves all around quality of life.
Surgical indication of CARVAR

Just about all types of aortic valve disease can be repaired. These include isolated Aortic Regurgitation, Annuloaortic Ectasia, Ascending Aortic Aneurysm, Aortic Dissection and Valvular Aortic Stenosis. Dr. Songs team at Konkuk University Medical Center is composed of preeminent Cardiac Specialists. They have had a dramatically high success rate in all types of surgical heart procedures including heart transplants. They also have a world class surgical technique; the CARVAR. You may contact Dr. Song at www.kuh.ac.kr/eng/about/message.html.
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August 2008
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MEDICAL TOURISM
A Patients Portrayal
By Dr. Jae Hoon Lee
Climbing Again
There is nothing worse for an athlete than to be unable to do the sport they love. This is exactly what happened to me. I was an avid rock climber and due to a chronic and deteriorating condition called Kienbocks Disease in my left wrist, I was told to stop climbing. This condition led me to the internet and I began researching the different procedures available to help regain the mobility in my left wrist.
ne of our hospitals specialties is orthopedic surgery. Our center performed over 2500 orthopedic surgeries alone in 2007. We asked Urs Meir, a patient with a rare bone disorder called Kienbocks Disease, to share his experience as an inpatient in our hospital. Dr. Jae Hoon Lee performed an iliac bone graft and fusion on Mr. Meirs wrist. He recommended the surgery because, at the moment, there are no other treatments for this disease. Dr. Lee sees about 3 patients a year with the same disorder and the cause of Kienbocks is unknown. Dr. Lee believes that the skill and techniques available at our hospitals orthopedic center rivals any center in the world. The center performs many specialized surgeries including joint replacements for patients with hemophilia. The center offers expertise in all areas of orthopedics including, rheumatology, spine surgery, sports medicine, and Oriental Medicine and acupuncture.
From Mr. Urs Meir

There is nothing worse for an athlete than to be unable to do the sport they love. This is exactly what happened to me. I was an avid rock climber and due to a chronic and deteriorating condition called Kienbocks Disease in my left wrist, I was told to stop climbing. This condition led me to the internet and I began researching the different procedures available to help regain the mobility in my left wrist. At the time, I was living and working in Korea and after some careful research, I sought out Dr. Jae Hoon Lee. Dr. Lee is an orthopedic surgeon specializing in the wrist joint and is a professor at the East-West Neo Medical Center, Kyung Hee University in Seoul. I was impressed with the knowledge and expertise of the doctor and
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the facilities of the hospital. I received rapid results on all of my tests and the staff was very helpful and sensitive to my concerns. After the consultation, the doctor recommended a vacuolated bone graft surgical procedure to help restore blood flow to the damaged bone in my wrist. The surgery is performed to relieve pressure on the lunate bone and to reestablish the blood supply to the bone. There are no other successful treatments for this somewhat rare condition. I booked my surgery to be done during my Christmas break in 2006. When I arrived at the hospital, I was greeted by the international healthcare centers nurse who helped me get admitted into my two person room. After checking into the room, I was taken for a battery of pre-surgery tests and x-rays to ensure that I was healthy enough to undergo the procedure. After the tests, a nutritionist came to visit me in my room to see if I had any special requests for the food I would be served during my 5 days in the hospital. I was comfortable in the room, which had a large T.V and comfortable bed. The night before the surgery, I was visited by the resident who came and explained the procedure again to me one more time. I was a little nervous that night as I slept, but my girlfriend was there with me and the hospital had provided a cot for her to sleep on in my room. In the morning I was prepped for surgery and wheeled to the surgery theater. The nurses were all extremely kind, assuring me that everything would be all right, Im sure they sensed my apprehension. When I arrived, Dr. Lee spoke to me briefly about the surgery before I was given my anesthetic and the next thing I remember was waking up in the recovery room. There was a dull pain in my arm, and I could see the pins through the bandages on my wrist. I was taken for x-rays immediately after I awoke and then up to my room. I spent the next four days in the hospital with my girlfriend. The nurses helped me with my medication and encouraged me to walk around the hospital. I was amazed that despite the number of people staying in the hospital it was very quiet and I was quite relaxed during my stay. In my room, I read books, watched movies and surfed the internet on my laptop. Dr. Lee came to visit me on his rounds everyday during my stay and he was happy with the results of the surgery. He informed me that I would have to wear a plaster cast for the next 6-8 weeks after which time he would remove the pins and I would be able to begin physiotherapy to build up the strength and mobility in my wrist. When I checked out of the hospital, I was pleasantly surprised by the price of my treatment. With the surgery and my 5 nights in the center the total was under $1500 USD. Upon leaving I scheduled my follow up appointment.
I was happy to get the cast removed after 7 weeks. And began the exercises that Dr. Lee taught me to help regain the mobility back in my wrist. I visited the hospital every month for check-ups to make sure there were no problems and after about 5 months of physical therapy I was ready to start climbing again.. I have nothing but positive things to say about my medical treatment at the East-West Neo Medical Center. I was treated as well, if not better, than I would have been in my home country of New Zealand. I understand the reservations some people may have about receiving surgery outside of ones country, but with the proper research you will find that the standard of care in Korea is world class. I am now living in Australia and I am rock climbing every weekend thanks to Dr. Lee and the East-West Neo Medical Center. Urs Meir ~ Melbourne, Australia Dr. Jae Hoon Lee, PhD is an Orthopedic Surgeon at EastWest Neo Medical Center, Kyung Hee University. For more information, please contact ljhos@khnmc.or.kr.
August 2008
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MEDICAL TOURISM
for Cancer Patients in Korea

By Dr. KWANG-WOONG LEE
Liver Transplantation
Korea has become one of the leading liver transplantation countries in the world in terms of case number and outcome. A multi-institutional clinical study on liver transplantation conducted in Korea reported a 3-year survival rate of 91.4% in liver cancer patients treated.
iver transplantation has become one of the most effective treatments for unresectable early hepatocellular carcinomas (HCCs) in patients with cirrhosis. Theoretically, it is one of the best curative treatments for HCC patients in that it replaces the patients whole liver with part or whole of the donors healthy liver, thus helping not only get rid of all the tumors in his liver but cure the underlying cirrhosis that is responsible for both hepatic functional deterioration and any other tumor developed after partial hepatectomy is done. Additionally, it allows the most accurate pathologic staging since the histologic examination of the entire liver explant is possible.
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There are two types of liver transplantations according to the donors status: living donor liver transplantation (LDLT), deceased donor liver transplantation (DDLT). LDLT is becoming a more common procedure as an alternative to DDLT because it is very hard to find the livers from the deceased donors. With the improvement of operative techniques, orthotopic liver transplantation (OLT) can be extended to hepatitis B virus (HBV) patients with good liver function and early HCC. OLT reduces the recurrence rate because HBV, major carcinogen, can be cured by OLT. About two decades have passed since Korea celebrated its first successful liver transplantation in 1988. Over the past decade, the number of LDLT has risen sharply, replacing DDLT as a main liver transplantation procedure. Last year, 619 LDLTs were performed in Korea. Korea has become one of the leading liver transplantation countries in the world in terms of case number and outcome. A multi-institutional clinical study on liver transplantation conducted in Korea reported a 3-year survival rate of 91.4% in liver cancer patients treated with LDLT who fulfilled the Milan criteria (single tumor < 5 cm in diameter, or two to three tumors < 3 cm in diameter) and a 3-year survival rate of 62.6% in the patients who exceeded the Milan criteria. The operation mortality currently stands at about 5% in Korea.
Created as a government-funded comprehensive organization devoted to cancer research and care in 2001, the National Cancer Center (NCC) in Korea currently performs more than 100 cases of hepatic resection for HCC patients annually. It introduced the LDLT program as one of the main treatment modalities for HCC in 2005. There were 26 cases of LDLT conducted at NCC in the first trimester, 2008, more than 70% of which were HCC patients, higher by 40% than other institutions in Korea. There has been no liver transplantation related death in the HCC recipients and donors so far. Recently, the NCCs liver transplantation team has developed many new techniques to improve the recipients survival by developing minimal anhepatic techniques that was designed to reduce harmful anhepatic time. They also have developed minimal upper midline incision techniques without laparoscopic assistance for donor hepatectomy, in an effort to reduce the length of skin incision in half, thus improving the donorsquality of life. Dr. Kwang-Woong Lee, MD, PhD with specialty in liver transplantation and hepatic surgery has several years of experience at the Samsung Medical Hospital as a transplant surgeon and two years of experience at the Johns Hopkins Univ., Baltimore, USA as a Living donor liver transplantation (LDLT) consultant. He also had been a consultant for LDLT program at Dar Al Fouad Hospital, Egypt. Dr. Lee is currently at the Center for Liver Cancer, National Cancer Center, Korea. He has been involved in more than 400 cases of liver transplantation. He also has performed the first successful hepatocytes transplantation in Korea
August 2008
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MEDICAL TOURISM
The Real Cost of Insufficient Coverage Can Medical Tourism Reduce the Damage?
By ALEx PIPER
Medical Tourism has a window of opportunity within which players in the industry can penetrate the U.S. Business Market with a carefully thought out plan of relationship building. Included in this communication plan of relationship building should be a well laid out cost benefit analysis, which should identify the true costs to a U.S. employer, of their current healthcare plan.
n the U.S., corporations account for their healthcare and benefit obligations on their balance sheets. These obligations include the current cost of benefits offered to current, retired and laid off employees. In addition, and this is a little known fact, these obligations also include retirement benefits promised to current employees. These obligations are referred to as current, post employment (laid off) and post retirement (retirees) benefits obligations. As an example, on one balance sheet that my company reviewed while working on a consulting project, the benefits obligation at the end of 2007 for the corporation was more than the companys total assets. Granted, these obligations are funded (or promised) by corporations during the period of service of employees. This is done in order to prepare the corporations for the future obligations. Regardless, the numbers are still staggering. It still means the corporation is not worth much when you look at its market value and, in this case, it is because of their benefits obligations. For that same company, the total liability of all non-pension obligations was almost 19% of all benefits obligations. Now, we all know that the healthcare costs assume the lions share of all benefits packages, so I think its safe to assume that corporations are very, very interested in reducing their healthcare obligations. In my
opinion, most companies are not aware of their true healthcare costs. Many of them account for benefits as they are paid, but few account for the hidden costs of healthcare. As well see, these hidden costs can add another 20% at least to the actual cost of benefits paid. It is in this area of overall cost reduction that medical tourism comes into the picture. Corporations stand to save even more than the actual cost of the medical procedures, when they implement a component of healthcare that introduces overall costs (medical tourism), because they can make more procedures eligible for coverage. As well see, the more procedures that are not eligible, the more out of pocket expenses past and current employees are faced with, and the less likely they are to seek treatment for the ineligible ailment. This cycle triggers hidden costs that are incurred by employer, employee, and insurance carrier. I contend that corporations are (1) either not aware of the hidden costs associated with the burden that todays healthcare plan place on their employees, and/or (2) they do not account for these costs in the proper manner. Many corporations do expense accounting without realizing that their inadequate healthcare plans, and the cost they ask their employees to bear, are the root cause of many expenses.
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In order to understand the total cost of todays healthcare coverage, including these hidden costs, lets look at the following situation. A 55-year-old employee, married with two children ages 24 and 19. Both children attend college so they are still considered to be dependents on the employees healthcare package, which the employer sponsors. Now, lets say that that said employee has a painful knee, commonly referred to in the U.S. as a bum knee. This ailment causes tremendous pain for which the employee seeks occasional treatment in the form of OTC and prescription painkillers.
doctor and clinic visits would consist of a combination of nonemergency doctor, and emergency hospital, visits. The cost of a dozen visits over the course of a year could easily total over $1,000 of which the employee pays 20% in a good healthcare coverage plan.
Associated Health Costs

For the depression treatments for the employee, spouse and dependent child, a good employer sponsored plan would cover 35 visits, paid in full. We can see that were adding another $5,000 to the overall costs. If we add prescription drug costs to the total, well be adding another $1,000.
Absenteeism Costs
In my experience as a supervisor at a corporation, employees with personal problems, such as health issues, are prone to at least one day each week of unexcused absence. In this example, this absenteeism would be due to unbearable pain. Plus, said employee suffers from the kind of depression that comes when one has a reduced quality of life due to a physical impairment. Needless to say, if said employee suffers from depression, said employees wife or husband also suffers from depression. For the sake of argument, lets assume that only one of the children suffers severe emotional trauma due to the fact that both parents are depressed. In any case, were looking at absenteeism of at least 20%, for the employee. By my math, were now at $47,000 of total costs. The employee is paying about 20% or less, the employer is paying about 70% or more, and either the insurance company and the healthcare provider are absorbing the balance through reduced, or negotiated, charges and straight healthcare claim payments. Remember, were not counting the absenteeism, which is costing the corporation at least 20% of the employees full time wages.
Actual Cost of Medical Procedures

Medical tourism can save companies up to 90% of the cost of the procedures themselves, such as heart valve replacement, knee and hip replacements, and heart bypass operations. For the employee referenced above to seek a knee replacement in the U.S. the employees cost for the surgery alone would be $8,000 (20% of the $40,000 cost for a knee replacement procedure in the U.S.), if and only if, the procedure were covered. By that, we mean if the procedure was deemed necessary. In the U.S. before any procedure can be deemed necessary, there has to be considerable consultation with the employees primary care physician, numerous referrals to specialists, and an honest to goodness effort at rehabilitation before surgery will be approved.
The employer may also face increased premiums, increased negotiated service costs, or may be faced with the insurance carrier shifting the costs to the employer by increased deductibles and selfinsured amounts, where applicable. Medical Tourism has a window of opportunity within which players in the industry can penetrate the U.S. Business Market with a carefully thought out plan of relationship building. Included in this communication plan of relationship building should be a well laid out cost benefit analysis, which should identify the true costs to a U.S. employer, of their current healthcare plan. This communication plan should reference the impact on the companys balance sheet benefits obligations. The industry players, whether they are foreign-based hospitals and clinics, government agencies of those countries wishing to promote international patients to their countries, or medical tourism agencies that actually bring patients to foreign based hospitals and clinics, should know how to present this communications plan to U.S. employers. I think most corporations would appreciate knowing what their true healthcare and healthcare related costs are. Their market value depends on it.
Medical Consultation Costs

According to the American Medical Associations Physician Socioeconomic Statistics publication and some samples from The Minnesota Council of Health Plans, 2005, lets consider that these Alex Piper
With over 17 years experience in Insurance, Marketing and Employee Benefits Management, Alex Piper possesses extensive knowledge of the U.S. Healthcare Market and the influence that Insurance Carriers, U.S. Employers, Hospitals, Physicians, Physician Groups, Healthcare Professional Organizations and Government will have on the next generation of global healthcare. As an insurance executive at a top Fortune 50 U.S. company, he spent the last eight years designing employee and customer benefits programs including healthcare programs for the large supplier and distribution partner companies of his employer. He was responsible for creating a benefits program that had over U.S. $140 million in assets and had over 1300 companies enrolled. His latest program grew from zero to $40 million in insurance premiums in less than two years! Alexs experience also includes the design of marketing communications plans that grew his company 20% annually, and made it the 12th most profitable company in its industry in America. His skill set is nicely rounded with his experience in being responsible for complete marketing communication strategy and execution for a growing $156 million company, including public relations, multimedia advertising, event marketing and Internet marketing. He is the President of OneWorld Global Healthcare Solutions, a consulting company committed to creating a worldwide healthcare solution. Alex will be holding a marketing workshop at the World Medical Tourism & Global Health Congress in San Francisco, California on September 9-12, 2008. For more information please go to www.MedicalTourismCongress.com
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MEDICAL TOURISM
Robotic Prostatectomy
An Optimal Choice for the Medical Tourist
By Dr. Koon Ho Rha
The treatment of prostate cancer with the laparoscopic approach, especially by means of robotic-assisted laparoscopy, is slowly gaining acceptance throughout the world. Based on our experience, robotic prostatectomy for prostate cancer is clearly the more beneficial approach when compared to conventional open surgery. It is especially optimal for the medical traveler who requires a quick recovery.
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he robotic prostatectomy procedure involves the surgical removal of the prostate gland through the use of the da Vinci Robotic Surgical System, which is composed of 3 major components: the camera which allows the surgeon to view the area being operated on; the robotic arms and instruments the surgeon uses to operate with; and a unique worktable where the physician views the surgical site and maneuvers the robotic arms from a remote location. The robot serves as an extension of the surgeons hands and eliminates the need for large incisions that are necessary in open surgery.
Since July of 2005, our team has performed more than 500 robotic prostatectomies, with 97.2% of cases maintaining proper bladder control and 40.8% who showed perfect control during their 6-month follow-up. Also, 53.4% of our patients who were under 65 years and preoperatively potent returned to normal sexual functioning 6 months following the procedure. Robotics is becoming the future of surgery, especially in the field of urology. Through delicate movements of the robotic arms, a surgeon has improved ability to spare the bladder and penile nerves, thus providing the patient with enhanced sexual and bladder functioning over the conventional open surgery approach. Outside of urology, robotics has been expanded to cardiovascular, thoracic, gynecology and general surgeries, thus creating a new era in surgical intervention. With more than 1200 cases to date, our da Vinci program boasts the largest experience in the world among many cancers, including stomach, thyroid and colorectal cases. A robotic training center has also been established to further enrich this growing field. Dr. Koon Ho Rha is a surgeon at Severance Hospital and Associate Professor of Urology at the Yonsei University College of Medicine in Seoul, South Korea. Upon completing his M.D. at Yonsei, Dr. Rha completed training in robotic and minimally invasive laparoscopic surgery at Johns Hopkins as an Engineering and Urology Endowed Fellow. He is skilled in advanced, complex laparoscopic surgical techniques including both retroperitoneal and transperitoneal methods and has extended his specialty to robotic surgery. He currently serves on the board of numerous international minimally invasive and robotic professional groups including the World Minimally Invasive Robotic Association (MIRA), Society of Urologic Robotic Surgery (SURS) and Engineering and Urology (E&U). He is also associate editor of the Journal of Robotic Surgery.
Comprehensive cancer control is enhanced because the robotic tools the surgeon uses afford a much clearer and magnified view of the prostate.
The first step in the process is for the surgeon to make a few small, dime-sized incisions in the patients abdomen. Then, small plastic tubes are placed in the incisions to keep them open while a tiny camera (laparoscope) and small robotic arms are inserted. The surgeon then maneuvers the laparoscope and robotic arms to remove the prostate gland. The procedure takes 1 to 2 hours typically. There are several advantages to robotic prostatectomy. First, incisions are much smaller than open surgery and the surgeon has very precise control through the use of small robotic arms and tools. Comprehensive cancer control is enhanced because the robotic tools the surgeon uses afford a much clearer and magnified view of the prostate. This allows the surgeon to perform various nerve sparing techniques-so called the Veil of Aphrodite. Because the nerves around the prostate enable bladder control and erectile function, this advanced nerve-sparing procedure allows the patient to have better bladder control and a quicker return to sexual activity after surgery. Also, because of the small incisions, nerve sparing techniques and faster healing, pain is minimized and the patient is able to return to his or her normal activities more quickly. If the patients job involves long periods of sitting, he or she may return to work within 1-2 weeks. More strenuous working conditions may take up to 4-6 weeks.
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Cutting Edge Phonoplastic Surgery

People from different social and professional backgrounds choose voice surgery to enhance competitiveness. Voice surgery can resolve voice problems such as transsexual, rough, hoarse, trembling voice, and changed voice due to aging
Plastic surgery to change not only appearance but voice
side from its basic function to communicate, voice determines ones image, characteristics, and even ones profession. The most important requirement for careers as voice actors or telecommunicators is a beautiful voice. At a job interview or various kinds of meetings, a bad voice can greatly ruin your image, taking away your opportunity. In addition, voice is a crucial factor for making an appearance and impression. With an increasing interest in voice compared to the past, there have been more people who are willing to change their voice. People from different social and professional backgrounds choose voice surgery to enhance competitiveness. Voice surgery can resolve voice problems such as transsexual, rough, hoarse, trembling voice, and changed voice due to aging.
vocal folds, these can be removed through surgery. In case the vocal folds do not make a vibration owing to their immobility, injection with a bulking substance is required. It is the same case with the aging voice resulting from weakened muscle in vocal folds. Bulging the vocal cord can make its vibration easier and change the hoarse and rough voice to clear voice.
As the muscles in our body get feeble with age, vocal cords become weak and our voice also ages.
Yeson Voice Center provides opera singers, musical actors, pop singers, voice actors, announcers and people using their voice in their professions with a treatment service that can be trusted. We accurately analyze our clients exact condition and help them keep their voice in the best possible condition. When the original opera singers who performed Ghost of the Opera came to Korea to perform, they were treated in the Yeson Voice Center. In Korea, the majority of actors, pop singers, opera singers, and people using their voice professionally get voice management and treatment at Yeson Voice Center. Yeson Voice Center The Institute of Performing Art Medicine #638-13 /Ssangbong Bldg. 2nd fl., Shinsadong, Gangnamgu, Seoul, 135-896, South Korea Tel: 82-2-3444-0550 Fax: 82-2-3443-2621 Web : www.yesonvc.com/eng, E-mail: master@yesonvc.com
Hoarse, rough, and aged voice to clear, beautiful, and young voice
Vocal cord surgery can alter voice that is hoarse and rough, or voice that has been changed for various reasons including aging. Unlike changes in voice resulting from a cold or laryngitis, voice that has been hoarse and changed for a long time might result from a problem in the vocal cords. The human voice is created when both sides of the vocal folds make a vibration. When the vocal folds are immobile or disturbed by a bump on either of them, our voice becomes rough and hoarse. Vocal cords are also a part of human body. As the muscles in our body get feeble with age, vocal cords become weak and our voice also ages. You should suspect an aging voice if you often experience choking while eating or your voice is characterized by reedy roughness and weak voice. Today, with phonoplastic surgery, aging voice can be treated to sound young, and rough voice can be cleared. If your vocal folds have been changed because of a bump or hardened flesh on the
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MEDICAL TOURISM
Normal Disc Preservation and

Transfusionless Spinal Treatment Techniques
There are various spinal diseases in the world and various therapeutic approaches t o treat the diseases. Conservative therapies include handed down folk remedies, natural remedies, alternative medicines, oriental remedies, exercise rehabilitation therapies, physical therapy, drug therapy and injection therapy, and hundreds of meditative pain therapies and surgical treatments.
By Dr. GUN CHOI
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t is difficult for doctors to decide which diagnosis method has to be selected under a certain criteria and which treatment principles and criteria have to be applied for patient treatment. About 90% of Spinal disc patients could have improvement through the following non surgical therapies: drug therapy, physical therapy, oriental remedies, exercise rehabilitation therapy, chiropody, massage, acupuncture & herbal therapy, pain blocking injection therapy, endoscopic therapy, and Computed Tomography guided nerve blocking, but many patients visit a hospital after a prolonged struggle with spinal pain having neglected the most appropriate early treatment. The problem is the rest of the 10% of spinal disc patients will not recuperate by using those conservative therapies. Most of these patients are chronic spinal patients having problems at work and in their daily lives for more than 6 months, or an acute spinal disc patient who could not bear the pain even with the injection of a pain reliever, or a spinal disc patient having difficulties passing urine and feces with paralysis in four limbs causing difficulty in walking. They urgently require more precise and fundamental treatment. If a nerve disorder lasts for more than 3 to 6 months, a permanent neurological syndrome will be made as like an un-erasable scar. It is truly heartbreaking to see such permanent lasting pain in the four limbs.
The practice of such spinal disc microtherapy without incision and minimally invasive transfusionless spinal surgery requires much experience.
However, many patients hesitate to have early treatments due to the fear of the risks of conventional textbook level of standard spinal surgery. These include the rare risk of failure to regain consciousness or even death by anesthesia, the worries of having a blood transfusion, the burden of long term medical treatment, and other complications after surgery. Conventional surgery involves the dissection of normal bones and stretching of normal muscle to remove spinal disc disease, with the real desire of spinal patients with urgent requirement of treatment is to have minimally invasive spinal treatment to return back to work or daily life without having much scarring after surgery. In other words, I wanted a Normal tissue conservation and Transfusionless treatment. Spinal Disc Microtherapy uses a needle or catheter (tube) type of an endoscope for the enlarged illumination to enable precise treatment with minimum scarring. Through the monitor, the image is amplified and the location of the lesion is precisely probed by using Computed Tomography (CT), a Magnetic Resonance Imaging (MRI) system or a Computer Navigation system before treating the lesion by using drugs, laser, high density ultrasound and nucleotome, spine hydrojet, a small thin size automatic aspirator and with radio frequency heat. Namely, it is the technique to remove pathological lesions whilst preserving normal tissue. By 1990, microscopes and endoscopes had been actively applied for the surgery of brain vessels, brain tumors and for the surgery of cerebral ventricle lesions. By applying these brain surgery tools to spinal disc treatments, spinal surgery was faced with a turning point. As the spine surgeons have introduced unrequired bloodtransfusion micro invasive therapy as in cerebral surgeries, spinal disease patients, especially for those of elderly people could have hope for a cure. The reduction in size of incision resulted in reduction of muscular damage, and normal nucleus was preserved as much as possible to the benefit of the patient. So, the method of preserving maximum amount of nucleus by using an endoscope was performed in spinal surgery. The scope of minimally invasive spinal disc therapy is not limited to the removal of spinal disc pain improvement of nerve disability. If a patient has improved from pain in the legs but still feels discomfort in the waist, they can not be seen as rehabilitated. Minimally invasive spinal therapy has an ultimate goal to enable spinal patients to participate in physical activities, sports, exercise, sexual life, walking and all daily activities as those of a healthy person. This is why minimally invasive spinal disc therapy tries to preserve spinal bone, waist muscle and disc tissue as much as possible.
The problem is the rest of the 10% of spinal disc patients will not recuperate by using those conservative therapies.
The practice of such spinal disc microtherapy without incision and minimally invasive transfusionless spinal surgery requires much experience and it takes more than five to six years of full time training even after qualification as a specialist. Additionally, it could not be applied onto all spinal diseases. To be able to select appropriate patients for each surgical method and provide them with an appropriate therapy, a physician has to receive a special training course (fellowship, full-time physician) for at least two years and needs to have experience of participating in micro treatment spine research conferences more than fifty times with the experience of observing the surgery. In addition, doctors require to have research and work experience of at least five years in a minimally invasive therapy specialized hospital. In particular surgery for elderly patients, weak patients with diabetes or heart disease, and people who have to return back to work immediately after surgery has to be performed by a specially trained physician.
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patients are becoming interested in this minimally invasive surgery, for the reasons that it can be given in day surgery, ancillary use of lasers, scarring is minimal, the recuperation time is short, the treatment & hospitalization fees are low, and a speedy return to work is possible. The method of treating disc disease by using an endoscope after making a 6.5mm diameter hole in the skin, the micro disc therapy conducted by the Wooridul hospital in Korea provides the highest level of performance out of the entire spine specializing hospitals around the world. Owing to such characteristics, even the medical practitioners of medically developed countries often come to the Wooridul Hospital for the surgery on themselves. The number of patients in the hospital has been increasing every year by about 30%. Of those about 58% are the patients from the member states of the OECD, proving its medical skills of world recognition. Devotion of the hospital to research also has been producing more than 20 publications in the SCI journals every year. According to worldwide literature reviews, the success rate of 5,000 cases of performing automated percutaneous discectomy by using a nucleotome was proved to be more than 80%. Ten years of surgical experiences accompanied with the continuous monitoring by using an endoscope and the development of specialized surgical instruments allowed spine specialists to perform surgery by continuously observing the removal of the disc herniated nucleus and to observe the intradural cavity of nerves, which allowed confirming the removal of herniated disc lumps, and also allowed decompressing the part of bone extrusion and the nerve cavity due to stenosis. So far, there have been no cases of death resulting from this minimally invasive surgery, no cases of complication from general anesthesia used in the surgery, and blood transfusion is not required. The morbidity rate has remained within the 1% range, while patient satisfaction has ranged as high as 80-94%. Consequently, more Now, with the medical skills of world highest quality, in addition to 4 distinct seasons as well as 5000 years of history that have made Korea a famous place for tour there would be no reason for hesitation to choose Korea as a site for medical tour. Dr. Gun Choi, MD, PhD is the President of Wooridul International Spine Hospital located in Seoul, Korea and also the President of Wooridul Non-invasive Spine Treatment Center. Dr. Choi can be reached via E-Mail at wipc@wooridul.co.kr or by telephone at 82-2-2660-7692.
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Its Healthcare, Stupid

By MICHAEL BINA
McCain v. Obama
Healthcare is in the midst of a ferocious war; the prize unimaginably huge: $2 Trillion Dollars - the size of the economy of China. Four armies are battling to gain control: Insurers, Hospitals, Government and Doctors. Yet you and I, the people who use the healthcare system and pay for it all, are not even combatants. And the Doctors, the group whose interests are most closely aligned with our welfare, are losing the war
hings change quickly in election years: Partners; Positions; Platforms; Personalities. When Powers in play, everythings up for grabs. Every four years, there are more waffles and wafflers in Washington DC than on the menu at IHOP. Incumbents, Challengers, Dark Horses and Light all blow with the wind ~ and blow out about anything that will fool the people, all the time. One thing wont change this November: Healthcare is a top issue. Cost, quality, Access to Care have been Top of Mind for the last 5 elections. Surprise! 2008s no different. And what the candidates choose to say on the subject is, as always, a moving target.
For 25 years, weve deliberated, discussed, debated delivery but guess what? Its dj vu all over again. Johnny and Barry have healthcare on their teleprompters, in their talking points and on their menu at the Waffle House. What have they been doing for 25 years? It doesnt matter now. What matters for members of the Medical Tourism Association is: What will this new batch of reformers and idealists bring to healthcare, and what does it mean to me? (Other questions for Medical Globalists might be: Can I influence the process? How much am I willing to invest in time and mothers milk to influence it? There are a bunch of other questions, but money and influence are two biggies.) Its safe to say Medical Tourism/Global Healthcare is not on the menu at the Waffle House. Obama and McCain are focused on domestic care; their proposals/reforms are focused on fixing the internal system.
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This ought to be great news to anyone affiliated with Medical Tourism. From Promoters, to Providers, to Patients, happy days are here again, if Democrats and Republicans are fixin to fix U.S. healthcare. Chances are, nothing will happen and, as always, The Market will decide. The Market is the driver of Medical Tourism. If The Market is left alone, Medical Tourism will happen, as it is now. Unfortunately, government is always threatening The Market with the full weight of The Bureaucracy. Theres no telling what the unintended consequences will be once legislation is put on the plate. Before we go speculating on whats ahead, lets figure out whats on the menu as we see it as of this date. Without any of the gory details, this is the how I boil down each chefs offering du jour. On Obamas Menu. Do we continue down the same path of reform, and build on an employer-based system where employers provide many of us with benefits, and employers continue to pay most of the cost, no matter how expensive? The most I can tell, Obama says, Hell No! Its safe to say Obamas Healthcare Special of the Day will be something way off the current menu. McCains Menu. Change the system from employer-based to individual-based, with a structure and incentives that enable individuals to build their own healthcare security without an employer or a big government body butting in. Its safe to say his Special of the Day will be off the menu, too. In a nutshell, thats where they stand today. Until the wind blows, theyre stickin to it. Clearly, these are widely-divergent theories. Obamas goal is universal healthcare; his tactic is HillaryCare II - a government takeover in exchange for the promise of cheaper, assessable healthcare for all. (Actually, Hillarys takeover had government in cahoots with some Insurance Carriers and Hospital Systems.) McCain, essentially, has us fighting for ourselves in the war over healthcare.
Harvard Professor of Business Administration, Regina Herzlinger, is a healthcare analyst. Her book, Who Killed Health Care illustrates the battle between individual and government control: Healthcare is in the midst of a ferocious war; the prize unimaginably huge: $2 Trillion Dollars - the size of the economy of China. Four armies are battling to gain control: Insurers, Hospitals, Government and Doctors. Yet you and I, the people who use the healthcare system and pay for it all, are not even combatants. And the Doctors, the group whose interests are most closely aligned with our welfare, are losing the war. The American People must win this battle, she writes. A system controlled by the insurance companies or hospitals or government will kill us financially and medically it will ruin our economy, deny us the services we need, and undermine the important genomic research that can fundamentally improve the practice of medicine and control its costs. The current system is well on its way to doing all of these terrible things right now.
The American People must win this battle.

AARP illustrated some of these terrible things in its August 08 issue: 50% of all surgeries, tests, procedures are not backed by scientific evidence (Huh!?); Americans spend $500 Billion annually on unnecessary care (What!?); 30,000 Medicare recipients die each year as a result of unneeded care (Youve got to be kidding me?!); insurance companies add a $360 billion dollars to The Terrible Things List each year (thats really servicing the customers!!).
What does all this terrible stuff mean for Medical Tourism?
Last month, Nicolet National Bank of Green Bay, Wisconsin, asked 500 CEOs and Business Owners a variety of questions about which candidate would better handle issues of the day: 72% said McCain would handle healthcare better...
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Jeff Gahnz, former executive with one of the largest healthcare systems in the U.S., is Vice President of Nicolet National Bank. He said, If the system remains private, I think CEOs will increasingly look toward medical tourism as an option. I believe it will certainly be part of the next discussion with their broker. If an international hospital can truly prove quality, efficiency and price arguments, why not look at it? Back in 2006, Nicolet Bank asked those same 500 CEOs about Medical Tourism: 52% never heard of it, but 48% had (to varying degrees) with 9% being, Very Familiar. Nicolet then asked: How interested would you be in traveling to another country for a routine procedure if you knew the cost would be considerably less - and the care equally good? A third were interested, said Dr. David Wegge, president of IntellectualMarketing, LLC the firm conducting studies for Nicolet Bank. I dont know how this compares to national data; I suspect were the first to ask. Wegge was surprised the number was that big, especially among CEOs who probably have insurance and fewer financial worries. (30% were: Definitely Not Interested 23% were, Probably Not Interested and 19% said, It depends on the Country. ) Nicolet also asked 1.) Would you be more interested if a medical trip were combined with a business opportunity; 2.) Would you be more interested if it included a vacation with spouse/partner. The levels changed substantially, he said. Wegge is also the Chairman of the St Norbert College Political Science Department. He added, No matter who wins in November, it is unlikely that there will be any significant change in healthcare. Political forces are extraordinarily strong to maintain status quo. However, if McCain is elected, it is more likely Medical Tourism will expand at a faster rate; if its Obama, theres some possibility that Medical Tourism will be less of a force because his plan focuses on covering the uninsured - likely to shrink the Medical Tourism market. OK, MedTourism proponents should vote McCain, right? (Those who dont vote or cant because they arent citizens are still able to participate in our participatory democracy. Your moneys always welcome!) On the other hand, HillaryCare II the government system Obama is leaning toward, might drive people to The Global Marketplace faster than the first plane leaving Ronald Reagan Airport on a Thursday afternoon when Congress is in session! If my government is going to take over my healthcare (on top of my Defense, my Homeland Security, my Post Office, my Education, etc.,), then I really dont want them touching me where it really counts! Id much rather be in the private hands of a private hospital on a private beach in Costa Rica for crying out loud! Sandy Mathy is President of @butlerandco.com, Inc. Shes been designing innovative, incentive-laden, individualistic health plans for self-insured clients for 30 years. Former Vice President of Marketing at American Medical Security Insurance Company, she headed the companys charge against Hillarys coup in 93. Today, Sandy says it doesnt matter who wins if youre a MedTourism proponent. Nevertheless, she keeps one eye on Washington just to be safe but her primary focus remains, The Market. Shes currently rolling a plan around in her head where the in-network benefit is actually, theirs out there, she said. (Theirs meaning: People in Medical Tourism [thats YOU, Dear Reader!].) Insurance companies just have to get the incentives right. Wendy Arnone, President of insurance giant UnitedHealthcare/ WI said, The medical travel phenomenon is more or less in its infancy, she said. UnitedHealth Group serves a large number
of Fortune 500 companies many of which are global and we believe we have an obligation to explore this trend, both to serve the potential needs of our clients, as well as to address the needs of the un-and-under insured. Score another for Medical Tourism! When The Big Boys like UHCI should say: When The Big Girls like UHC take interest, you know something big is happening! Health and well being companies that are able to coordinate care across international care provider networks and use similar data standards will be best positioned to support consumers who elect to receive medical care overseas, Wendy said. Successfully supporting medical travel requires more than simply purchasing the consumers airline ticket and identifying an overseas hospital where the procedure can be performed. The same attention to accessing quality care and coordinating treatments among multiple care providers that we have come to expect in the U.S. needs to be applied to medical travel as well. QUESTION: If everyone is in such a tizzy about this election, why are SO many insurance executives, brokers, consultants and providers going to San Francisco for the FIRST, Medical Tourism/ Global Health Congress? Why re-invent the wheel if the wheel is going to fall off? ANSWER: Its not about the election. The Tipping Point is past/The Market is here. Then only thing missing is speculation by pundits and profiteersthen, threats of government interference and/or regulation. For now, The Good News is: Politicians have bigger fish to fry than citizens flying off to Costa Rica for elective Colonoscopies. To illustrate that point, the only politician on the dais in Frisco is Wisconsin Assemblyman Frank Lasee. (Hes one of the GOOD ones.) Until a bill from the Waffle House is on your table, its too early to get indigestion over what we might have to eat in November. So, go to San Francisco; drink some wine; network like crazy; develop relationships and wait for your ship to come in (or go out to Costa Rica). Michael Bina is a regular columnist for this magazine, as well as a one-time, two-bit politician who ran unsuccessfully - for office in the Wisconsin Assembly. He learned all about Politics and its changing Positions, Partners and Platforms, but his education was too little, too late to win. Early on, however, he did develop a taste for Mothers Milk which became his beverage of choice to this day! Today, hes out of the public spotlight and back in the bosom of the private sector. Hes planning to attend the Medical Tourism/Global Health Congress in Frisco in September. Youll find him wandering the exhibit hall like a politician looking for votes - dropping business cards in every fishbowl and angling for an invitation to a Happy Hour at a local Mothers Milk Bar. E-Mail him if you want a copy of the Nicolet Bank Study: michael@IntellectualMarketing.com
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Medical Tourism Economic Report

By DAVID G. VEqUIST and ERIKA VALDEz
South Korea
From the US, there are many direct flights (particularly to the fairly recently built Incheon International Airport some 50 km west of Seoul) that average 12 to 15 hours flight time to reach Korea).
South Korea is hoping to take advantage of its core competence in biotechnology and, in particular, stem cell research. In 2006, it was reported that the Korean government was awarding $430 billion won (approximately $400 million USD) aimed at supporting stem-cell research. The government stated it hoped to become one of the worlds top three leading countries in stem cell research by 2015
ne of the up and coming countries, providing healthcare options to the world, is the country of South Korea. The country is already very popular with wealthy citizens in Southeast Asia who are in the market for high-quality health care at a low cost. In March 2007, a council composed of 34 Korean hospitals/clinics and the government officials launched the Council for Korea Medicine Overseas Promotion (CKMP), which is tasked with attracting overseas patients to the country. One of the functions CKMP serves is to help Korean hospitals in international marketing. Half of the budget (primarily to be used for marketing and promotion) of the CKMP is coming from government sources (the government has set aside $570 million won or approximately $601,000 USD) and another half is coming from hospitals/clinics for 2007 (each member hospital will pay approximately 15 million won in fees). In 2007, hospitals/clinics affiliated with CKMP had over 16,000 foreign patients visit Korea for healthcare procedures compared to only 10,000 (national estimates of foreign patients) in 2005 (an increase of 62.5% in 2 years). The country has set the ambitious goal of having at least 100,000 foreign patients annually by 2012. If they achieve this goal, it could bring the country medical tourism earnings of an estimated $200 billion won (approximately $199 million US Dollars) per year, according to CKMP secretary general Jang Kyung-Won. The government (through the health ministry department) is also helping by simplifying the visa issuance for overseas patients. Some of the potential markets for the Korean medical tourism industry are patients from China, Japan (around 2 million Japanese tourists visit South Korea every year accounting for around 50% of total tourist arrivals!) and the United States.
Economic Facts
Four decades ago, the GDP per capita of South Korea was comparable to many of the poorer countries of Africa and Asia. But since the 1960s, the Koreans have achieved an incredible record of growth and have developed into a high-tech, modern, global economy resulting in the country joining the trillion dollar club in 2004. Currently, its GDP per capita (in 2008 it was around $24, 800 USD) is roughly the same as the European countries of Greece and Spain. Part of this historical success is due to close government and business ties and smart economic policies (e.g., promoting the import of raw materials and technologies at the expense of consumer goods and encouraging citizens to save and investment). In addition, the Government instituted economic reforms after the 1997 Asian economic downturn and South Korea is expected to continue to have one of the largest and fastest growing economies in the world. The future looks very bright for South Korea (population estimated in July 2008 at over 49 million); it has very favorable economic conditions for continued sustainable growth. Disposable income of the Korean people seems to be rising and there has been a comparable rise in the per capita expenditures on healthcare. The current GDP (from 2007) is USD $1.201 trillion and growing at a 2008 projected rate of over 4% (which is down somewhat from the 8.5% the country experienced in 2000). Of this GDP, a majority (over 57.6%) is driven by the Services sector (which includes the
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Healthcare industry). In fact, expenditures on health as percentage of GDP are around 6.4% (2006) and total consumer expenditures on healthcare are estimated at $32.8 billion USD (2005). In fact, between 2000 and 2006, the growth rate in health spending per capita in Korea reached 10.7% per year (compared to a 5% OECD average). One reason for this is that pharmaceuticals accounted for 25.8% of total health spending (from 2006) in South Korea (compared to a OECD average of 17.6%).
Healthcare Facts
In 1989, South Korea (using the Japanese health insurance system as a prototype) expanded the national health insurance (NHI) program (developed in 1977) and extended it to all citizens. Recently (in July of 2000), NHI started to separate reimbursements for pharmaceuticals from medical care (regarded by some as the most significant financial issue that could disrupt the Korean NHI). Also, many Korean physicians feel that the universal health insurance system (which only pays around 65% of customary medical care costs) limits their income. On the other hand, historically there has been limited public accountability over charges by medical personnel which has led to: an excessive overuse of antibiotics; more magnetic resonance imaging (MRI) machines per million population than anywhere else in the world; and high rates of cesarean delivery (about 40% of all live births). However, according to a 2002 Journal of Public Health article, the Korean government has begun to do a better job of controlling health insurance costs.
The country has set the ambitious goal of having at least 100,000 foreign patients annually by 2012.
According to WHO statistics (from 2000) there were 61 hospital beds per 10,000 population (according to 2002 statistics there were a total of 963 hospitals and 22,977 clinics) in Korea. Of these facilities, it is estimated that the private medical care sector makes up about 90% of the total bed capacity (private health expenditures were 62.2% of total expenditures compared to 55.9% in the USdata from 2000). The most common Korean government facilities are community public health centers known as Bogeunso. The US Embassy of South Korea estimates that there are at least 25 hospital facilities in the country that offer English-speaking staff. There is one Korean JCI accredited (in May of 2007) hospital, the Severance Hospital, which is part of the Yonsei University Health System (YUHS) and is located in Seoul. The YUHS system consists of 2 graduate schools, 3 colleges, and 5 hospitals (consisting of more than 3,000 beds) which see more than 2.7 million outpatients and 992,000 inpatients every year. In South Korea there are estimated to be 1.4 physicians per 10,000 population (2002 estimate- compared to most developed nations which have an average of 3.0) or approximately 78,070 licensed doctors (not including 13,460 Oriental medicine doctors) in the country. Interestingly, medical specialists make up more than 80% of practicing medical doctors in South Korea (in most Western countries this percentage is around 50%) and about one fourth of Korean medical doctors have 2 or more specialties. There are approximately 181,786 nurses in the country (2002) and these numbers have increased significantly during the past decade (estimated at 4.0 per 1,000 population in 2006- compared to an OECD average of 9.7). It is estimated that the average charge for an in-patient visit in a Korean hospital is about 13 times lower than in a U.S. hospital (approximately $3,762) and an average outpatient visit is about 9 times lower than a comparable U.S. visit (approximately $13,000).
Korean government was awarding $430 billion won (approximately $400 million USD) aimed at supporting stem-cell research (the government stated it hoped to become one of the worlds top three leading countries in stem cell research by 2015). Finally, an interesting finding (also being found in other Asian countries) is the bundling of complementary and alternative medicine (CAM) treatments (in this case, Korean traditional medicine) in medical tourism packages.
Summary
South Korea has a very ambitious plan to take advantage of their state-of-the-art technology, good reputation in certain specialties, low prices, and advanced research agenda to compete in the medical tourism market. The country has plans to continue to upgrade existing healthcare centers, to increase the total number of healthcare facilities; such as clinics and diagnostic centers, and to train more doctors and other medical professionals. It also has the advantage of millions of visitors from Japan (which has a rapidly aging population), better infrastructure than some of its other Asian medical tourism competitors, and possible visitors from North Korea (based on the rapidly changing diplomatic situation). In addition, it will also be interesting to see if the practice of CAM treatments are an added differentiator for medical tourists from Occidental countries. For this country, the opportunities in medical tourism are immense and the possible rewards are numerous. David G. Vequist IV, Ph.D . is an Associate Professor of Management in the H-E-B School of Business & Administration at the University of Incarnate Word in San Antonio, Texas, USA. He is also a consultant, author and speaker on topics such as healthcare trends and technologies. He can be reached at vequist@uiwtx.edu. Erika Valdez, is a student in the MBA program in the H-E-B School of Business & Administration at the University of Incarnate Word in San Antonio, Texas, USA. She is a promising speaker and author in the area of economic development in developing nations. She can be reached at evaldez@uiwtx.edu.
Impacts to Other Industries

The Medical Tourism industry in South Korea should benefit from the countrys reputation in plastic surgery. Korean doctors are known abroad for abundant experience and expertise in cosmetic and aesthetic treatments. In addition, South Korea is hoping to take advantage of its core competence in biotechnology and, in particular, stem cell research. In 2006, it was reported that the
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(615) 444-8859
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Effectively Marketing your International Patient Department

By BILL Cook Imagine the following scenario
s someone in urgent need of knee replacement surgery, you have been in contact with a foreign hospitals international department for several weeks. A long string of emails have been exchanged, and youre starting to feel pretty comfortable with the idea of traveling abroad for your surgery. Why shouldnt you? The price is right, the international staff has been friendly, and your every email has been answered promptly and to the tee. They even sent you some glossy brochures with hospital photos worthy of any U.S. institution. Hey, in your mind this hospital is the perfect choice to rid you of your constant knee pain, so you quickly settle upon a surgery date.
Will the Circle be Unbroken?
A few weeks later after a tiring flight, you arrive in a foreign country only to find that no one is there to greet you. When you call the hospital youre put on hold and then passed along to a host of non-English speaking brethren until, seemingly by chance, you end up with your international department contact. She quickly pulls things together and twenty minutes later a van screeches to a halt in front of you. A somewhat disheveled driver greets you with an effusive que tal amigo? and then apologizes to you in broken English for his tardiness. To your chagrin, he goes on to inform you that he must wait a few minutes for another passenger. A few minutes eventually turns into twenty-five, before youre finally off to your hotel.
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Things have not started out well, but you chalk it up to a little bad luck. Fortunately, the hotel looks nice and the desk clerk, if not particularly friendly, seems to speak your language. Youre surprised that no one shows you to your room, but, after some hand signals and pointing, you eventually find your way. The rooms okay; however the bed is small and the bathroom, although spacious, was not designed for a knee surgery patient. There are no support bars, and there is a high-rim bathtub instead of a shower. Though adequate, the hotel lacks a personal touch and many of the amenities you feel medical patients might require. The following day youre taken to the hospital - a modern building that boasts the latest in technology and style. Soon however, you begin to notice cracks in the facade. Your international department host is warm and welcoming but never tells you where youre going or what is happening next. Doe-eyed and drenched in sweat, he seems almost as confused as you are. Your pre-operative tests take forever, seemingly because of a lack of coordination and timing with the lab and diagnostic departments. Worse yet, youve received countless dirty glares from hospital employees and patients each time your host tries to cut you to the front of the line. Your doctors appointment starts off well, but little by little you get a sinking feeling that fluent in English has a very broad meaning here. Fortunately, through the use of an interpreter, you get most of your questions answered and then youre whisked off to the surgery ward. The answer to the first question is an unqualified yes. The answer to the second question is probably affirmative as well. However, systems are one thing, getting people to work seamlessly together is quite another ~ and always a work in progress. As a hospital administrator or international department manager, you may feel that all is fine and dandy with your international patient program. Your international patients seem to be doing fine and complaints are few and far between. If thats the case, then dont waste your time reading any further. For everyone else, I would urge you to take a closer look under the hood and take time to determine if the needs and expectations of your international patients are truly being met. You may be surprised to learn that all is not working as seamlessly as you had imagined, and that there is still some room for improvement. What are these needs and expectations? Well for one, chances are most of your international patient clientele will be coming from first world regions such as the United States, Canada and Europe. They have been touted first-class services and may not take kindly to long waits for admission, dealing with cumbersome protocols or hospital staff they cant understand (to name but a few). Your goal then is to make your international patient experience the best that it can be. The challenge, however, is to achieve this goal within the natural limitations and constraints placed upon you by hospital systems and processes that were probably designed to cater to the customs and needs of your local patient population (and rightly so). Lets face it. Unless your hospital was built with the express purpose of treating international patients, then it is likely that you will meet some resistance along the way to making your international patient experience the best that it can be.
I could go on but I think you get the picture.

Even though nothing terrible has happened, this string of events is not something you want any of your patients experiencing. On the contrary, as a hospital administrator or international department head, you want to do everything in your power to make sure your patient is not only happy with the surgery or treatment, but also has the best all-around experience possible. But what, do you say? Does any of the above have anything to do with marketing? Before I answer that question well take a quick look at some traditional definitions for marketing. Websters online dictionary defines marketing as The commercial processes involved in promoting and selling and distributing a product or service. Then theres the oft-quoted four Ps: product, pricing, promotion, place. Still scratching your head? Well I dont blame you, as marketing is usually thought of as something you do to promote your product or services to your customers. However, as you can see from the illustration above, all the marketing in the world will not make your international program successful for the long term until you have learned how to market/promote/sell your international department to your hospital administration, internal departments, physicians, and even your third party providers (hotel, transport services etc). Moreover, your hospitals international department is not an island, and no matter how hard you work to please your patients, or how hard you paint a pretty picture to the world, your efforts will be mediocre at best, unless you sell the rest of your hospital on your mission ~ which is to provide international patients with a positive outcome and experience. And make no mistake about it, each one of these components is part of the same machine and all must be moving in sync to successfully achieve this goal.
Suspicious Minds
With the rapid rise of medical tourism over the last five years, hospitals have often been in a rush to put together an office or department to cater to the expected influx of international patients, if only as a signal to the rest of the world that their hospital is a serious player in the global health travel arena. Unfortunately, sometimes little thought or planning has gone into this venture and it has too often been like hammering a square peg into a round hole. In other words, your international department may not always fit snugly with the rest of your hospitals culture, leading to your department being perceived as somewhat of a fifth wheel or crazy uncle, the one you politely greet but quietly wish would go away.
It is hardly surprising that a good group of doctors is the keystone of any successful international patient program.
Of course, it doesnt help that in your zeal to provide your international patients with an outstanding experience, you have probably stepped on quite a few toes, possibly even engendering a few enemies.
Against the Wind

It may sound strange to some people that you would actually have to sell the rest of your hospital on your mission. I mean, doesnt every hospital want to provide their patients with the best experience possible? And if so, wont they also put the necessary systems in place to make this happen?
Building a Circle of Trust

You may recall a popular movie from some years back called Meet the Parents, where a slew of oddball situations and hilarious antics revolve around Ben Stillers character Greg Focker, trying to get into (and stay in) the Byrnes family circle of trust. No matter what he did, or how hard he tried, he never seemed to be able to get in on Jack Byrnes (a.k.a. Robert De Niro) good side.
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Although, as portrayed in the movie, the circle of trust concept may be going a little too far, it is vital that you build strong relationships between your international department and the rest of the hospital (and key third party providers), in effect creating a circle of trust. This means physically getting to know and even bonding with department heads, supervisors and frontline employees; key people who can assist you with providing an outstanding experience for your international patients. And no, its not necessary to stroll shoulder to shoulder amidst the hospital rose garden with Sanjay from diagnostics. A warm greeting and a smile is a good place to start. Later, perhaps, you might have the opportunity to send a receptionist a thank you note for her help during a difficult situation, or even for routine assistance, with a copy to her supervisor. This will go a long way towards building trust and goodwill.
And continuing with this analogy, whether you are a toddler, teenager, or full-grown adult (I would guess most likely one of the former two as this industry is still in its infancy), it is critical that you maintain close and frequent contact with your hospital administration. They will ultimately set the guidelines to be followed by the rest of the hospital, in effect running interference for your international program and thereby making your job much easier. It is also important to let the administration know when certain established systems or procedures may be interfering with your ability to better serve your international patients, and then work together to find solutions that are agreeable to everyone involved. Periodic meetings are essential to maintaining mama and papa in the loop, to hear their feedback and to set goals that are in harmony with the rest of the hospitals strategic agenda. This may sound like a no-brainer, but youd be surprised how easy it is to get lost in the day to day activities of running your department and to forget about the big picture. This will be your first task but its not enough - not by a long shot
The circle of trust is like a chain, and if there is any weak or broken link in this chain, you can be sure that it will negatively affect your international patients overall experience at your hospital.
Lets go back to the Meet the Parents movie for a moment. Remember Robert De Niros famous line, I keep nothing from you, you keep nothing from me... and round and round we go? In the same way, the circle of trust is like a chain, and if there is any weak or broken link in this chain, you can be sure that it will negatively affect your international patients overall experience at your hospital, and cause you a lot of unnecessary stress as well. Now lets take a look at some key areas in your hospital and how to go about building your own circle of trust:
Internal Departments
You must also make time to meet with each department to introduce your international office staff and explain a little about the program. Nursing is particularly important. Make sure nurses (as well as the rest of the internal departments) understand the particular needs of international patients (cultural issues, language, fear of the unknown) and how to address these needs. You should also listen to their side of the story and encourage them to offer suggestions and advice. A receptive attitude on your part will help smooth out any future misunderstandings. Take a hospitals laboratory for instance, one of the first stops for international patients getting their pre-operative tests done. In a perfect world, Yolanda, the lab attendant, will be sitting there with a radiant smile as she contemplates the glorious beginning of the new workweek. The waiting area is deserted, and shes got nothing else to do as she counts down the minutes to your patients arrival.
Hospital Administration
There is little doubt that this should be the first stop on your crusade to build your circle of trust. They are, after all, the ones that first saw a need for your existence, brought you forth into this world, and nurtured you along to where you are today.
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In reality though, the waiting area is overflowing and Yolanda is upset at her husband for forgetting their anniversary the night before. If that werent enough, she is also stressed out because her supervisor is hovering over her like a hen while she attempts to resolve a patients complaint. The last thing she wants to see now is your international department assistant seeking preferential treatment for a patient and you really cant blame her. One possible solution would be to coordinate with the lab beforehand to make sure they know the international patient is coming and that they have all the necessary information to process the patient on arrival, without the need for any furtive glances and awkward hand signals to get the lab attendants attention. Another option may be to set up a separate area for international patients where tests can be performed out of sight of other patients. The best solution will depend on your particular hospital; the important thing here is to reach out to each department and discuss how to better serve the needs of all your patients, both local and international.
Third party providers

When I say providers, this will in most cases refer to the lodging and transportation options you provide to your international patients. It is possible that your hospital will have its own lodging and transportation services in house. Most likely though, you will be outsourcing these services to other companies, which means potentially losing control of an important part of your patients experience. Naturally, outside providers will usually be your weakest link, so to avoid having your circle of trust snap like a twig. It is critical that providers understand the type of customers they are dealing with and what you expect from them. In the case of transportation services, you must be adamant that the personnel should be easily identified by their uniforms, be personable and posses good English speaking skills. In many instances, representatives from these companies will be the first face your patient actually sees, so an impeccable presentation and warm welcome is of the utmost importance. You should also survey your patients for feedback regarding their experience with your transportation. It goes without saying that any hotels you recommend for recuperation purposes should possess infrastructure and services suitable for people who have recently undergone surgery: rooms equipped for handicap patients, wheelchair access and flexibility with dietary needs to name but a few. Beyond that, make sure professional medical care is readily available and that the staff is informed about the particular needs of each of your patients. For example, patients who have undergone weight loss surgery will require a strict diet that must be made available at regular intervals. For others, bandages need to be changed, drains emptied and medications administered. Dont make the mistake of taking your providers word that they are patient friendly. To be certain that your patients are safe as well as comfortable means holding people accountable. This can only be accomplished, in a real way, once you have established a close rapport with your third party providers.
Doctors
As human beings we tend to be a pretty loyal bunch, especially when it comes to our medical practitioners. We find one we like and then we never let go. Therefore it is hardly surprising that a good group of doctors is the keystone of any successful international patient program.
Naturally, outside providers will usually be your weakest link, so to avoid having your circle of trust snap like a twig.
When choosing your international program physicians, start with the same criteria you would use to find any good doctor: experience, skill, education and a specialist in his or her field. Your physicians must also speak and understand English (or other languages popular with your patients) and ideally possess a charismatic personality that will easily connect or empathize with your patients. Although possibly underrated, this last element can make the difference between a good outcome and a memorable-tell-all-your-friendsand-family kind of trip. Having said that, you will find doctors to be a diverse group, requiring a multifarious approach laced with tact and understanding in order for you to really get your message across. Open and frequent communication with regard to procedure details and pricing is a must in order to avoid mistakes and hard feelingsAh doc, I couldve sworn the rhinoplasty procedure was included in the lower body lift... You will also need to take into account a doctors availability and desire to cater to international patients. Some doctors may enthusiastically sign up for the program only to find they are unable or unwilling to dedicate the time necessary to gain a patients trust. Doctors need to be aware that in general, international patients require a lot of prep time and back and forth follow-up to bring them to the point where they are comfortable with the idea of traveling to a foreign country for their surgery. Doctors also need to understand that this is a global marketplace and that, in many instances, whether they like it or not, they will be competing with other physicians from around the world for a patients favor (however flippant this may sound). To make an informed decision, patients will want as much information as possible. Therefore, doctors catering to international patients should be especially forthcoming with information about their background, education and experience. Dont underestimate the importance of establishing a close working relationship with a good group of physicians, as this will save you much heartache later on.
Step by step to success

As you have seen by now, building a circle of trust is a high maintenance endeavor and not a one time job. No matter the quality of your international department, dont be fooled into thinking that all will fall into place on its own. All the great staff and technology in the world will do precious little if not tethered to a carefully nurtured support network. Yes, being a lone ranger sounds romantic but it will only get you so far. To effectively market your international department you must ultimately begin with a mindset that focuses on relationship building with anyone and everyone that can influence your international patients experience. Be it a chauffeur, a nurse, or even your hospital director, all must be engaged, stone by stone so to speak, setting a solid foundation that will eventually underpin and then propel your traditional marketing efforts for the long haul.
As Patient Coordinator for Hospital Clinica Biblica International Department in Costa Rica, Bill Cook oversees operations and customer relationship management initiatives aimed at increasing customer loyalty and satisfaction. Bill also overseas web content development and marketing strategy for Medical Tours Costa Rica, a locally based medical tourism operator. Bill can be reached at www.hospitalbiblicamedicaltourism.com.
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A Promise of Security
Insurance Solutions for Medical Tourism Companies
By SMITA MALIK
Over the next decade, this industry is expected to prosper even more, as more patients reach for their passports before undergoing treatment. With healthcare costs soaring and the amount of patients continuing to outnumber the available physicians and nurses for care, wellness travel companies can anticipate exponential growth. In this emerging industry, it is important to put your best foot forward, and secure the proper insurance coverage to make sure your organization is able to continue promising your clients the utmost in care and a trouble-free experience as a medical tourist.
hat once seemed unusual and unsafe has now become common and practical, as millions worldwide travel outside their home countries to partake in medical tourism. As the cost of healthcare soars and waitlists for surgery grow longer, medical tourists are able to find inexpensive, faster care by simply taking a vacation. When comparing the expense of undergoing an operation in the U.S. to the cost of the same surgery in a medical tourism hotspot such as Thailand, the difference is staggering. The World Health Organization reports U.S. healthcare is ranked 37th worldwide in the quality of care, but the cost of treatment is more per capita than any other industrialized nation. For this reason, as many as 500,000 Americans traveled overseas to seek medical treatment, and the industry grossed $60 billion worldwide in 2006. That number is expected to reach $100 billion by 2012, as the 78 million members of the Baby Boomer generation in the U.S. will begin turning 65.
In other countries with socialized healthcare systems, governments are beginning to outsource patients requiring nonessential procedures to medical tourism destinations, due to overcrowding in hospitals. Great Britain and Canada have been able to cut wait times for surgeries down from months to a matter of a few hours travel time. The average person has limited knowledge of how to arrange such a trip, so they require the services of facilitators to assist them in locating accredited hospitals and doctors, and weigh the advantages and disadvantages in their decision to travel abroad for medical treatment. Ultimately, they are looking for a knowledgeable, trustworthy organization to arrange their trip, make sure they receive the utmost in care, and return home healthier and with a stronger sense of well-being. As a facilitator, this is an enormous responsibility to fulfill, and if this promise is not met, there can be numerous financial and moral consequences. The simplest way to protect your organization and its assets is to secure the right insurance coverage.
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The risks medical tourism companies face are unique, therefore the insurance coverage you should obtain must be tailored to these needs. Much like the promise you make to your clients that their trip will fulfill their expectations, insurance is also a promise that it will fulfill your expectations and prevent your company from a financial downfall should an unexpected situation occur, such as a lawsuit. Having insurance coverage can also serve as a marketing tool. Insurance lends credibility to your organization from a medical tourists standpoint, as well as when contracting with hospitals and outside organizations. Advising clients and partners that you have insurance protection means your company is not likely to go bankrupt should a lawsuit occur. Clients will know they would be able to seek financial recourse if they choose, and partners will have confidence that they are contracting with a financially secure company. Below is a summary of advisable coverages to acquire, in addition to some policies your clients should look into before embarking on their journeys overseas.
it also provides coverage if any of your contractual partners file a lawsuit against you for negligence or breach of contractual terms subject to policy terms and conditions. This includes hospitals, physicians, spas or any other outside party with which you are associated. Another advantage to this coverage is worldwide jurisdiction. This means you have insurance backing no matter which country the suit is filed. For instance, if your company is based in Japan, and you assisted a client from United Arab Emirates to receive surgery in Thailand, then later a suit is brought against you in United Arab Emirates in connection with this trip, your liability policy will be applicable.
Personal Accident
Another important policy a facilitator can offer to medical tourists is Personal Accident insurance. This policy provides Accidental Death and Disability coverage for your clients during the entire length of their trip. Should the client suffer a permanent total disability or death, the policy will pay a pre-agreed fixed sum and will also pay an additional amount to repatriate the remains. This policy covers any incidents that occur on the trip, whether it is due to the medical procedure on the operating table or while the client is exploring the city. The benefits can also be extended to continue coverage for the client on the return to his/her home country for a limited period.
Professional and General Liability Coverage

Many countries, such as the United States, are recognized for their highly litigious society and ever-increasing settlement amounts, particularly in the medical industry. One of the most important policies to anyone operating a business or organization is liability coverage, which protects your companys assets should a litigious situation arise. As with anyone working closely with the medical industry, facilitators are at risk for a lawsuit if a client does not receive the results expected, has complications after the surgery, or in the worst instance, dies as a result of the treatment. Even though you are not offering medical advice, you are the clients first point-of-contact for their medical tourism experience, so when something goes wrong, you are likely to be the first or one of the parties they would turn to for recourse. Professional Liability or Errors & Omission policy provides financial support for a litigation defense and court costs related to a claim from a client. If it is found that your organization was at fault, even if you are accused of misleading the client, the coverage will also pay the settlement amount up to the policy limits. This insurance not only protects your company during litigation with a client, but
The best way to offer this coverage to your clients is to package it with the rest of their trip.
The best way to offer this coverage to your clients is to package it with the rest of their trip. By doing so, you are giving your company a competitive edge over other wellness travel agencies. Clients will take comfort in knowing if the unexpected occurs, they will receive a guaranteed monetary benefit, and this may prove to be a competitive advantage as clients choose your company over another.
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Additionally, if an incident does occur, and a client and/or their beneficiaries receive payment for the occurrence, they are less likely or inclined to file a lawsuit. The amount they receive may be reasonable enough to deter them from adopting a legal recourse of going to a court ( possibly in a foreign jurisdiction ) and incurring high legal costs and in addition, waiting for what could be several years for a settlement to be reached, and an additional amount to be paid.
A Case Study
An internationally owned and operated medical tourism company offers medical travel packages for several contracted outside vendors, such as spas and hospitals. They operate in seven countries, and anticipate as many as 20,000 clients per year. In order to put together a comprehensive insurance plan for this client, Clements International took into consideration the annual estimated revenue, the types of treatment offered, clients nationalities, and the countries where the treatment would be received. When Clements identified the major risks areas, the most apparent vulnerability was the medical tourism companys risk of being subjected to a lawsuit filed by a customer, despite the fact they would not be offering medical advice with their travel packages. Like any new and developing industry, the most vital insurance for this company would be an adequate General and Professional Liability policy. As the companys business grows, so does the potential liability. For example, if a facilitator is sued by a medical tourist for unintentional misrepresentation of information on the hospitals experience, this could also trigger a lawsuit from the facilitators partnering hospital for negligence. A liability policy would cover the amount legally required to be paid by the facilitator and the defense costs. For many insurers, this policy was too risky because of the claims potential. Clements researched many markets around the globe for Professional Liability coverage, and eventually was able to structure a policy through an A rated security. To serve as a deterrent for possible lawsuits, Clements also worked with the insurance carrier to design Personal Accident coverage for the companys clients. This type of coverage would pay a pre-agreed upon amount if the medical tourist is permanently disabled or dies during the trip, and therefore, the immediate compensation may dissuade the beneficiaries from engaging in a protracted and costly litigation process. Personal Accident policies traditionally do not cover medical related death, so Clements had to complete thorough research on the industry and locations where the company was operating, as well as due diligence on the partnering hospitals and spas, in order to present a policy that would be acceptable to both the underwriter and the client. Since the medical tourism company chose to purchase the Personal Accident policy for its clients, the Professional Liability premium was lower.
Trip Cancellation
When advising your clients on necessities for their upcoming trip, it is also essential to provide them with options for insuring their journey. Many travel agencies will offer insurance for various aspects of the trip, but it is also advisable to offer clients coverage when they purchase a package from you. Trip Cancellation insurance provides coverage for a variety of potential risks including if the trip is cancelled due to the clients own personal reasons ( subject to policy terms ) , or if a natural disaster occurs preventing the client from visiting the country. Many of the medical tourism hotspots are known for bearing the brunt of cyclones and other natural disasters. Trip Cancellation coverage refunds the cost of the entire trip that has already been incurred if there is an incident that prevents the client from making the journey.
When and Where to Find Coverage

As soon as you begin developing a business plan to become a wellness travel company, you should start evaluating your insurance options. Knowing the premiums for these important coverages during budgeting will help you forecast more accurate revenue and expenses. In many cases, hospitals and outside vendors will require you to provide proof of coverage before entering a contract with your company. If your company is already in operation, it is important to obtain coverage as soon as possible. Once you have located a specialized insurance provider, coverage can usually be issued in a short time frame, even less than a week if all of your information is complete. Finding an insurance provider can be more challenging. Just like the medical tourism industry is emerging, so are the insurance products catering to it. Many providers will not consider business from this market because it is still seen as too high of a risk. This industry is incredibly unique, and there is no historical experience available for which the underwriters can reference. However, a few providers have recognized the need for comprehensive coverage in this industry, and are becoming experts in insuring and creating specialized products for wellness travel companies. As this industry continues to flourish, and insurance providers gain a stronger knowledge of its intricacies, it is expected the number of providers and products available will also increase. Over the next decade, this industry is expected to prosper even more, as more patients reach for their passports before undergoing treatment. With healthcare costs soaring and the amount of patients continuing to outnumber the available physicians and nurses for care, wellness travel companies can anticipate exponential growth. In this emerging industry, it is important to put your best foot forward, and secure the proper insurance coverage to make sure your organization is able to continue promising your clients the upmost in care and a trouble-free experience as a medical tourist
Smita Malik
About Clements International Since 1947, Clements International has been providing innovative, specialized International insurance solutions to businesses, organizations, and individuals worldwide. Clements also offers expert advice and insurance products catered to the medical tourism industry, and its facilitators. For more information on how Clements can help you, contact Smita Malik at smalik@ clements.com, or 800-872-0067, x 1573, or visit our website at www.clements.com
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Stepping into the Spotlight in Global Healthcare
South Korea
By Rene-Marie Stephano
Metropolitan Seoul
Seoul is not only the capital of Korea, but also the largest city in Korea. It is located in the center of the Korean Peninsula and has a population of ten million. Ever since King Taejo, the founder of the Joseon Dynasty moved the capital of Korea to Seoul, its been the axis of economy, politics and culture. About half of Koreas entire population resides in the Seoul Capital Area and nearly a quarter in Seoul itself. After the Korean War (1950-1953), Korea went through a period of modernization and development; this period of time was called the Miracle of the Hangang. The river that runs through Seoul from east to west dividing Seoul into the Gangbuk and the Gangnam was actually named the Hangang River.
was invited by the South Korean Government to give a presentation to the healthcare leaders in the medical community about the medical tourism industry and the potential marketplace for Korean healthcare providers in December, 2007. After a twentytwo hour flight, I arrived at the Incheon Airport in Seoul. Although the trip included a long flight, the friendly greeting by Alex Sung at baggage claim leading us towards the hotel shuttle was a welcome relief. Alex was hired by KHIDI, the Korean Health Institute of Development as our official tour guide during our stay. As we approached the Seoul city skyline, it was very obvious that Seoul is a major metropolitan hub for South Korea.
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Seoul is a very traditional and culturally rich city and is the home of five palaces; the Changdeokgung, Changgyeonggung, Deoksugung, Gyeonghuigung and the Gyeongbokgung, which harbors the National Folk Museum of Korea. This Museum was most interesting, providing real life outdoor examples of how Korean commoners and nobles lived in traditional times. Dont miss the jangseung, stone mounds and sottae, which are posts representing earthly and heavenly gods and wooden spirit poles. The interior displays of the history of Korean lifestyles, arts and crafts and the Korean lifecycle provide a complete doorway into Korean culture and a terrific understanding of its people. If you are able to wait around during the scheduled times, you will witness an official changing of the guard. The National Museum of Korea, which is also in Seoul and, with its 76 acres, it holds the place of the 6th largest museum in the world. It is definitely worth spending the day here. The beauty of Seoul is that it combines its strong tradition with modernization. For instance, there are many restaurants and bars to choose from. Shopping options include Central City or the World Cup Mall, which was built especially for the FIFA World Cup in 2002. This mall offers over 100 stores to choose from and even a multi-screen movie theatre. There are also many antique shops and artisan specialty shops to choose from. If its excitement that youre seeking, you have the Lotte World amusement park and the Seoul Tower, which is the symbol of Seoul. The Seoul Tower is the worlds third tallest tower, standing 360 meters above sea level. After taking the elevator up to the observatory platform and on a clear day, you will see panoramic views of all of Seoul, getting a feel of the Seoul cityscape. The Glass Terrace is an outdoor caf with a view of the panorama where you can take a break for lunch. If you want to stay for the sunset, you really should, as the transition into the glowing nightline is majestic.
But for the most cultural experience, you cannot miss the large outdoor markets and night markets located through downtown Seoul. The fish market in the harbor is also something to marvel at, with its millions of fish offerings, it is no wonder that most people just pull up a seat right in the middle of the market, pick out their catch for lunch and sit down to eat right there. With fish this fresh, you dont want to waste time taking it home.
Healthcare
Korea is the leading healthcare country in Asia, providing topquality healthcare and services including health screenings, major specialties, such as cancer treatment, cosmetic/plastic surgery, dental care, ophthalmology, otolaryngology/otorhinolaryngology/ ENT, infertility treatment and Korean Traditional Medicine. Koreas physicians, specialists and surgeons rank amid the finest in the world of medicine and, when combined with the revolutionary healthcare facilities and innovative technology, healthcare in Korea is truly unparallel. Healthcare in Korea has evolved since 1989, committing the national health security system that covers the entire population as a mandatory social insurance system. With the subsidized assistance from the government and contributions from the insured, Korea implemented a low-premium, low-benefit and low-healthcare price policy in order to employ this national health insurance system. In order to ensure its success, hospital evaluation rose in Korea in an effort to improve the quality of healthcare by evaluating the level of healthcare services provided and addressing any problems that may occur at the time services are rendered. In 2002 the hospital evaluated bill was passed and in 2004 the Korean Hospital Association and KHIDI (Korean Health Industry Development Institute) conducted its first formal evaluation. I met with Dr. Shin-ho Lee and learned about the evaluation program in detail. Dr. Lee is very interested in developing this program to international standards and is looking to ISQua accreditation as an end result.
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Medical Tourism as a Top Priority

The Council for Korea Medicine Overseas Promotion (CKMP) is known as the gateway to the Korea as a medical tourism destination, and with the support of the Ministry of Health and Welfare, it helps promote Koreas world-class healthcare services to the international community. It assures medical tourists of Koreas safe and reliable infrastructure to secure transparency of quality care and patient safety. The CKMP counts with thirty-four hospitals and specialty clinics. Its advisory board members include the Korea Health Industry Development Institute and the Korea Tourism Organization. CKMP is the motor behind the medical tourism efforts.
Jaseng Hospital of Oriental Medicine

Utilizing optimized western therapies and oriental cooperative treatments, Jaseng Hospital of Oriental Medicine opened its doors in 1999. Researchers from Oscher Research Center and Harvard Medical School have taken note of this phenomenon, as they both visited the hospital for their papers. A year ago, I was involved in a car accident and diagnosed with a herniated lumbar disc and bulging cervical disc in my spine. During my visit to Jaseng, I was particularly interested in means of alleviating back and neck pain through alternative means. I underwent an MRI and had a cervical MRI performed, which resulted in a diagnosis of no herniated disc. After an acupuncture and chiropractic adjustment and some herbal medications for neck pain, I was on my way feeling relatively pain free.
Ajou University Hospital

In 1994, the first landmark case occurred in the Gyeonggi Province, when Ajou University Hospital successfully conducted the first case of knee cartilage bone transplant and enzyme replacement therapy for Gaucher patients. They also specialize in transplants of the liver, kidney and bone marrow. Ajou University Hospital is a member of the Medical Tourism Association. It has the International Health Care Center, which in 2006 established a 24-hour foreign patient medical service system with the aid of the Gyeonggi Province government and it maintains a steady growth towards enhancing medical service for foreigners.
Parkside Rehabilitation Hospital

Parkside Rehabilitation Hospital in Busan is surrounded by the Peace Park, Busan Museum, Busan Cultural Center and Arboretum, creating an ideal setting for its recuperating patients. Parkside is also a member of the Medical Tourism Association and since its inauguration in September 2006. It has remained as one of the best rehabilitation facilities in Korea. Parkside Rehabilitation Hospital has also had a great acceptance from the Korean community. Usually as the elderly continue aging, they are cared for at home; however, it is evident that the younger generation is transitioning into a new outlook and perception of rehabilitation and care.
Boomin Hospital
A leader in Orthopedics, Boomin Hospital, located in Busan focuses on delivering specialized, state of the art treatment and care. Boomin Hospital Spine Center is a member of the Medical Tourism Association and counts with five out of nine board certified surgeons, an aseptic operating room facility to minimize infection throughout the duration of surgery and offers innovative procedures such as bloodless spinal surgery, and Minimally Invasive Spine Surgery utilizing laser assisted spinal endoscopy, MedX.
Seoul National University Dental Hospital

Continuing its expansion process Seoul National University Dental Hospital currently treats an average of 300,000 patients a year providing them specialized clinical settings, operating rooms and hospitalization facilities. Seoul National University Dental Hospital specializes in dentistry, oral and maxillofacial surgery, prosthodonics, orthodonics and dental implants.
Hanyang Medical Center

Hanyang Medical Center in Seoul has been promoting Hanyang 2010 projects since it opened its doors in 1972 as the greatest hospital in Asia under its founding principle of, Love in Truth and in Deed. Hanyang Medical Center is backed by its prestigious school of medicine and specializes in heart disease and rheumatism.
Severance Hospital
Koreas first university hospital to receive Joint Commission International (JCI) accreditation and also a member of the Medical Tourism Association is the Yonsei University Health Systems Severance Hospital which was established in 1885. Severance
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Hospital holds close partnerships with U.S. health care institutions such as Johns Hopkins Hospital, M.D. Anderson Cancer Center and The Childrens Hospital of Philadelphia. Severance offers fifteen specialized cancer clinics and was the first to introduce Robotic Prostatectomy, and holds over 500 cases since 2005. This procedure only takes one to two hours and the recovery period is one to two weeks. It was found that over 97% of patients maintain proper bladder control and over 53% returned to normal sexual function after six months.
Wooridul Hospital
A specialty hospital designated by the Ministry of Health and Welfare, the Wooridul Spine Hospital specializes in the spine/disk, cervical, thoracic and lumbar surgery. Since opening in 1982, its standard of care has continued to improve. Its medical professionals publish 15 SCI-level theses every year and in 2005, Wooridul won the AHMA (Asia Hospital Management Awards) grand prix award in the Human Resources area; it beat out 84 other hospitals in 14 other countries throughout Asia. International organizations such as (IMLAS) International Musculoskeletal Laser Society and (AAMISS) American Academy of Minimally Invasive Spinal Medicine and Surgery have designated Wooridul as an international training center for incubating spine specialists. Wooridul is a member of the Medical Tourism Association and has also received Joint Commission International (JCI) accreditation. A state of the art sister hospital has been built near the domestic airport with spinal and cancer specialties of excellent credentials. All in all, South Korea stands an excellent chance of becoming a new global leader in medical tourism. If the initiatives of the hospitals to create high quality international patient services flows with the same passion and prioritized directives as the governments promotional ventures, South Korea may become the new icon for Asian Medical Tourism. By the way, Alex (Heesook) Sung may be reached by phone at 011-9731-3141 or by email at lescopains@daum.net.
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Growing Options for Losing Weight Overseas Bariatric Surgery Solutions

By JAMES MCCORMICK, MD
Choosing a bariatric procedure carries important consequences and is not the first choice to lose weight. A potential patient should not try to obtain this procedure by circumventing accepted criteria or by choosing a less than scrupulous surgeon or facility.
accepted procedures are the Roux-en-Y bypass, laparoscopic adjustable banding and the open and laparoscopic biliopancreatic diversion with duodenal switch. Several other procedures available outside the US but the available literature is limited. It is challenging to have open discussions about procedures or treatments that are not approved or used in the US. Appropriate research and care is advised. There is the distinct possibility that some of these interventions achieve similar, or better, outcomes. The US healthcare system can be slow to approve newer treatments and medications. However, we should not immediately discount non-approved care as substandard. It simply has gone through US approval processes. Who needs it? Choosing a bariatric procedure carries important consequences and is not the first choice to lose weight. A potential patient should not try to obtain this procedure by circumventing
ariatric or weight loss surgery is not liposuction. The process, risk and benefits involved in these procedures are different. What do you need to consider if you are going to travel abroad for bariatric surgery? This is a rapidly growing sector within the larger industry of healthcare and medical travel. What are the most important considerations and issues for you to consider if you opt for weight reduction surgery in an international setting? What is bariatric surgery? This surgical subspecialty encompasses several different procedures, targeted at an end point of weight loss. The procedures do this by reducing stomach capacity or they intentionally reduce absorption. The stomach loses the capacity and capability to fully digest and absorb the food eaten. Specific procedures are also approved by the Center for Medicare Standards (CMS), The American College of Surgeons and The American Society for Bariatric Surgery. The three currently
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accepted criteria or by choosing a less than scrupulous surgeon or facility. Patients should have a body mass index >=35 kg/m2. Most centers also require one or more of the following obesity related diseases to co-exist. Some examples include hypertension, diabetes, sleep apnea and others. While the presence of these illnesses make you eligible for the surgery, they also increase operative risks. With all surgery, we are concerned that the consequences of the obesity and its associated disease(s) are more risky than the finite, but real risk of surgery and anesthesia complications. What is the process? With any significant life choice we need to plan, do research and in cases where complexity is a factor, ask a specialist or consultant. In choosing bariatric surgery, you should have failed conventional medical therapies. Carefully choose a facility and surgeon who have skilled teams both in the destination hospital and a trusted relationship with US care providers to ensure that follow up and treatment care plan can be accomplished. Authorities recommend having nutritional therapists, psychological support staff, support groups, exercise therapists, special equipment and expert staff regularly manage and care for the morbidly obese patient. Will the surgery impact your lifestyle? The first procedure listed reduces the stomachs volume to ~30cc. That limits intake to a few sips of liquid or small bites of food. A food binge can become a life-threatening event. The band also reduces the stomachs size, however it can be adjusted. Still your eating habits must change. The third choice above can reduce absorption of calories. There is also a loss of certain vital minerals and vitamins. Supplements may be required and periodic blood work may be needed until you adjust. What follow up and longer term care is required when choosing this option? The surgery and the wound is not the sole treatment for the patients obesity. A holistic approach is needed. Nutritional guidance, behavioral training, exercise habits are essential components to a strategy that returns you to health. Bariatric surgery can move patients from a position of the high risk from life-threatening disease states to a condition of a healthier life and potentially reduced complications from these disease(s). Some of the co-existent diseases, like diabetes, can become more easily managed as you lose weight. Are there special patient concerns? A preoperative consultation may be very helpful to ensure that you can tolerate the anesthesia and surgery. The pre-trip evaluation can also ensure you are a good candidate before you make a deposit and have a company begin
to book your trip. While procedures are less and less invasive, anesthesia risks are still important. If you have a strong history of heart disease or have had a recent heart attack, this surgery is likely a poor choice if performed too soon after your heart attack. People over the age of 65 carry an increased incidence of complications and death. There is a growing pressure to potentially treat the obesity explosion in our younger population with this option. The stringent restrictions in place for this age group are appropriately difficult. The potential alteration in dietary and nutrition absorption would have significant effects on growth, development, hormonal balance and subsequent maturation. Patients wishing to become pregnant should wait until after their BMI has stabilized for at least 12 to 18 months. Even then, special care to address potential mineral and vitamin deficiencies must be monitored and corrected. A healthy and growing pregnancy places significant demands on the mother. She needs to take in more calories and more essential nutrients than normal. What happens if the treatment fails? This is a concern with any medical or surgical care plan. A quality bariatric team will investigate whether the patient is the source of the treatment failure. Is the dietary counseling being ignored? For example, a high fat ice cream or thick shake can bypass the above procedures. It is difficult to maintain your weight after going through these operative interventions. You may be eligible for a repeat procedure 1. 2. 3. 4. If the initial one was non-standard If an implantable component fails If an initial gastric pouch caused weight loss before a pouch dilation If no weight loss occurs by 2 years from the initial procedure, you can be converted to a Roux-en-Y procedure If, after a full investigation, a repeat procedure will be corrective and increase the chance of successful weight loss. If a dietary compliant patient gains weight postoperatively
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Who should not have a bariatric procedure? Individuals with poor cardiac reserve, from several diseases are typically not candidates for surgery. The surgery requires a significant amount of lung capacity. Any substantial chronic obstructive pulmonary disease (COPD) or other lung disorder may disqualify a patient. The oversight bodies consider significant psychiatric and eating disorders to be a disqualification. Okay weve moved through the personal hurdles, youve done your research and can now commit to the journey to change your life. What about the facilities and care providers? Using the society guidelines as a benchmark helps us look at facilities abroad. We can develop useful guidelines as a screening tool. Surgeons must have completed a specific training program. This is commonly called residency or fellowship training. The surgeon(s) should posses a comprehensive understanding of managing these special patients. They must have developed or have in place a structure and processes to address support groups, counseling specialists, post-operative management teams and a full understanding of the operative choices and new approaches. This is critical to the patients outcome. The surgeon you choose will be of a team managing your care before, during and after the operation. The surgeon needs assistants to be ready for your arrival and manage your needs to a safe discharge. The surgeon should perform at least 25 procedures per year. They should also be involved in Continuing Medical Education (CME). The recommendation is 25 credits specific to bariatric surgery every two years minimum. Centers of Excellence have even more stringent criteria. The US criteria require the surgeon be performing more than 75% of their caseload with bariatric patients. The surgeon should be managing 50 patients per year minimum and the facility at least 125 cases per year. A dedicated bariatric surgeon should oversee the program and the facility actively ensures that the proper equipment is in place. Looking forward the team must have active processes in place to detect complications early, and have root cause systems analysis approaches to correct built in problems. All the supportive and ancillary staff should be actively educated and work from written protocols that are in place. Are the facility requirements different from conventional hospitals? I have worked at many hospitals. Except for my current one, they have all been challenged by obese patients. Their new facility that is better suited to serve these unique patients. Beds, wheelchairs and doorways need to be appropriately sized. Commonly radiology and imaging tables typically exclude obese patients. CT scan gantry beds commonly support patients in and out of the imaging ring. Operative tables and anesthesiologist will be managing challenges not found on other patients. Recovery room personnel need to know how obese patients recover differently. Critical care units will need both adequate bed capacity and adequate training on complication management. Freestanding clinics should have clear collaborative relationships and policies to manage complications. It is not enough to call for an ambulance. The staff should be certified in Advanced Cardiac Life Support. This gives you the best chance at surviving heart attacks etc. These procedures can and do change lives for the better. They are life altering in positive ways, but they are not a quick ticket or a risk free option to weight loss. All surgeries carry risks from the surgery itself, the anesthesia risk and then post operative risks. A well-trained team, with a quality facility and a highly skilled and experienced surgeon offer the best benefit for the least risk and the best value. This is, after all, what we are looking for in medical travel and tourism. Not lowest price, but the best value. Your health is one of the most precious things you have. Treat it as the valuable commodity it is and protect your investment, by working with quality people who spend the time to ensure you understand what you need and where to obtain it. Safe travel and best health! References 1. Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R) February 21st 2006 2 . Consensus Conference Statement. Bariatric Surgery for Morbid Obesity Health Implications for patients, health professionals and third party payers. Surgery for Obesity and Related Disease. J Am Coll Surg 2005 ; 200 : 593-604 3. The Consensus Guidelines on Bariatric Surgery. California Association of Health Plans Obesity Initiative Workgroup. June 2006 www.calhealthplans.com
Dr. McCormick is originally from New York and now lives in Los Angeles. He is a practicing Emergency Medicine physician in Los Angeles. He has remained Board Certified for the last 10 years. Prior to that, he served for over 20 years in pre-hospital emergency services, both ground and air based operations. He graduated from medical school at the State University of New York Downstate in 1993. His residency in Emergency Medicine at the prestigious LAC+USC Medical Center was completed in 1997. Dr McCormick is a founding member and co-inventor of the NuMask IntraOral Mask, a breakthrough medical device for ventilating patients. His next direction is a more strategic solution to the US healthcare challenges with the launch of a medical tourism business called Premier Medical Travel this fall. He is convinced that combining his MD and MBA will help to unleash the tremendous benefits this industry has to offer: our patients, our payers, our country and our future generations. He may be reached at jjmccormi@earthlink.net
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An Ounce of Prevention is Worth a Pound of Cure

By CHRISTI DEMOREAS
As a patient myself first, I saw the importance of medically appropriate post operative care from day one as absolutely essential to the Medical tourist/recovering patient of ANY surgical procedure. Poor wound evolution, wound infection and necrosis is something that can occur with absolutely ANY open wound on a patient, and with, ANY surgical procedure, including something as insignificant as a laparoscopic incision.
heard a radio advertisement from Athena Blue Cross of California mentioning the shortage of nurses in our state. It was a report on how they had invested money in local Community Colleges in an effort to supplement and improve their nursing programs, and the increase in admissions and RNs it generated. They started the ad with the following statistic: Before Florence Nightingale joined the Red Cross, the mortality rate for the soldiers was 60% and after she joined it dropped to 2%, thus showing the value of a nurse. That being so beautifully illustrated, I will now address medically proper and appropriate post-op wound care, along with the psychological support the recovering patient requires. Although aftercare is essential to ANY recovering patient, we are specifically addressing the Foreign Patient Experience as the number of patients traveling abroad for surgical procedures continues to increase. As a patient myself in the US, after my laparoscopic gastric bypass procedure, I experienced first hand, the need to know how to properly care for the wounds, as small as they were. Although I received many written forms and post op instructions on what I could and could not eat after my surgery, the surgeon, his nurse, and the hospital neglected to provide me with post op wound care instructions. I had a plastic drain with a long tube hanging out of one side of my abdomen. This tube was bulky and represented an opportunity to be pulled out if I got too close to something (including my 18 month old toddler!) and was also a fitting site for infection. My small lap incisions were not even stitched closed and were simply covered with white surgical tape. I had no idea if I could bathe and so I was afraid to get them wet. I had a million questions: should I take them off first? How to clean them? What would I use; alcohol, peroxide, Neosporin, water? I was beside myself, when I did call into the surgeons office, the instructions I was given over the phone were to go ahead and shower, and use peroxide to clean before putting surgical tape back on. It turns out that the peroxide only served to impede the healing of the incisions and the surgical tape was beginning to irritate my skin with red welts on both sides of the incisions. I was truly at a loss and frustrated for the first ten post operative days. I was actually feeling recovered from the gastric
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bypass surgery but the wound care was proving to be trying. On the tenth day, hardly draining anything by then, I called the office and was told to come in and have it pulled. I gladly made the two hour drive to the surgeons office in anticipation. Once there the drain was pulled, the nurse was able to assess my incisions (which hadnt closed yet) and finally informed me of proper wound care. I was told to discontinue peroxide and she explained why it wasnt helping, she also told me that I didnt need the surgical tape anymore. She taught me how to dress the wounds and how fast they should now close with proper orientation. She warned me that the final scarring might be a little more noticeable than they could have been had they been treated and closed properly. She even dressed my incisions for me before leaving, which made me feel so much better as I left the office that day. My wounds healed promptly after the nurses instructions; however, they are a little more visible than I would have liked. Poor wound evolution, wound infection and even necrosis is something that can occur with absolutely any incision or wound on a patient, therefore, any surgical procedure - including something as insignificant as a laparoscopic incision can cause more agony and psychological trauma to the patient than the actual surgical procedure itself. Proper orientation of what to expect and appropriate medical attention must be given to the patient, preferably in printed form, easily referenced for questions, either as pre-op orientation or immediately following the procedure. Demonstration of sterile dressing changes should be encouraged to be watched by the patient before being discharged so that it can be continued after returning home to finish healing. Medical tourism, due to its cost-effectiveness and low labor costs in foreign countries, can facilitate just this kind of ideal and superior patient support system.
This does not only affect the patient experience but, the length of stay required, includes post op therapies or treatments. In short, it now affects the savings the insurance company planned on in sending the patient abroad in the first place. Below I will illustrate just how and why it can often be avoided or at least its severity diminished with medically proper patient management. Obviously, an ounce of prevention is worth a pound of cure, especially when it comes to medical tourism. Since the insurance companies and other B to B prospects are looking at saving money by sending patients abroad, let me tell you that the patient that experienced this particular complication, suffered physically for weeks after surgery - unnecessarily because her own surgeon did not promptly address the situation at the first signs of its progression, and then refused to administer the proper therapy for this particular patient because it was not considered accepted/normal protocol. The surgeon also hesitated because of her lack of experience with healing compromised patients such as most post-bariatric patients with intestinal malabsorption procedures and not being familiar enough with how they evolve in the immediate post op period. This seemingly simple hesitation or professional conservativeness on the part of the surgeon, caused the patient not only pain and suffering, but compromised and delayed her healing, became an extreme financial burden and resulted in loss of time. She had to stay more than two months longer than originally planned in order to address the healing issue, she had to undergo several treatments per week for debridement, under anesthesia, at the costly Albert Einstein Hospital, it caused her stress, pain and a total bill of almost US$100,000 twice what her initial budget was for a two month stay and a complete body reconstruction. She was not able to finish the initially planned upper body reconstruction, so she still has half of her reconstruction to complete and pay for. Her experience has totally compromised her results and although she actually had to have another surgery to try and CLOSE the wound, it was not totally successful and she will need scar revision later at more out-of-pocket expense, not to mention healing time out of her busy life. Again, this can happen ANYWHERE after ANY surgery. In fact, things like this are common and occur because there is not medically adequate follow up care, like Home Health Care Nursing (aka: Medical Concierge Support). If anything, we can show that Medical Tourism while showing a huge savings in the actual cost of the procedure and hospital fees, it affords the patient true time to recover and paid aftercare support to facilitate the healing that they would not get when their surgery is performed at their local hospital in town. The same procedure performed in the USA goes like this: The patient is discharged as soon as possible after the surgical procedure (so as to save money) and is sent home to be with their family and recover and be nursed back to health by anyone but skilled and educated nurses. Basically, in the Medical Tourism model (especially in Latin America, again I will speak about what I know, only) this structure needs to be implemented, preferably by the discharging hospital seeking to secure and show excellence in this market. According to the long awaited McKinsey Report on Medical Tourism, although price is definitely a driving factor for everyone in looking at Medical Tourism, it is still first and foremost a service industry and people are willing to pay for value and service combined with medical treatment. The overall success of Medical Tourism is that it is a service-based business and the client, the patient, MUST be satisfied. Christi DeMoreas is the owner of Mednet Brazil. As a consultant, Christi specializes in assisting medical tourism facilitators with setting up their concierge business as well as assisting international patient departments in setting up systems for aftercare. She may be reached at: Christi@MedNetBrazil.com.
The overall success of Medical Tourism is that it is a service-based business and the client, the patient, must be satisfied.
You may ask why wound care and daily nursing visits/Medical Concierge Accompaniment would interest an insurance company sending their patient abroad and why they should make this investment in their subscriber and consider this a necessary expense as part of the package of services as they negotiate contracts with other Medical Tourism facilitators and/or hospitals. If it is not included through the providing hospital or surgeon, it should be contracted on behalf of the patient, by the entity sending the patient abroad. On a Micro-scale, the feeling that they are truly benefiting by accepting going abroad to an already unfamiliar and perhaps less-respected location by this daily personalized medical care is priceless and serves to reduce the discrimination towards medical services abroad compared to our own. Medically, and on the Macroscale, the opportunity for the nurse to be the eyes of the surgeon between office visits, and the ability to accurately document the daily evolution (as a medical document) of a patient, including medications usage and effectiveness, rates of complications, healing issues, helps to gather many important statistics that can be important on many levels of information gathering and can be provided to the patient upon returning to the USA for addition to the patients medical records for any follow up or continuance of care that may be needed. As a patient myself, I saw the importance of medically appropriate post op care from day one as absolutely essential to the medical tourist/recovering patient of any surgical procedure. Poor wound evolution, wound infection and necrosis is something that can occur with absolutely any open wound on a patient.
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Robotic CyberKnife Radiosurgery

By DR. WOOCHUL, KIM
4-Dimensional
nha University Hospital is proud to be the first hospital in South Korea to install a 4th generation and 4-dimensional Robotic CyberKnife Radiosurgery system for treatment of various cancers and lesions in the body and central nervous system, many of which have been diagnosed as inoperable, unresectable and oligometastatic disease. Cyberknife radiosurgery system delivers hundreds of finely collimated radiation beam to the tumor and effectively eradicates tumor cells without pain, bleeding and anesthesia. With Synchrony system installation, patients no longer have to hold their breath during a procedure because it simultaneously tracks both the movement of the tumor and breathing patterns of the patient and treatment complications are reduced. Furthermore, 4-dimensional planning system can provide physicians with more precise calculation of region of interest and normal organ radiation dose. The Cyberknife Radiosurgery Program in Inha University Hospital was founded in March 2008. Inha University Hospital Radiation Oncology Department has set up a multidisciplinary approach to provide patients with the most comprehensive diagnosis and treatment process possible. The Radiation Oncology Department also provides radiosurgery consultation for a variety of cancerous diseases. The CyberKnife, a robotic radiosurgery system, has many advantages which include no recovery time, simple outpatient treatment process, extremely accurate radiation targeting, allows the
utilization of higher doses of radiation, minimizes damage to healthy tissue, and one is able to immediately resume normal daily activities, compared to Gammaknife radiosurgery as well as conventional radiation therapy such as tomotherapy and image guided radiation therapy. It allows physicians to provide a precise, targeted, painless therapy alternative to open surgery and to provide a treatment option for tumors that are otherwise untreatable.
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Comparison with CyberKnife Radiosurgery and existing Radiotherapy Existing radiotherapy Treatment period Real-time tumor tracking 4-dimensional treatment Approach direction 10~60 days Impossible Impossible 1~6 directions Effectiveness of CyberKnife Radiosurgery Existing radiotherapy High dose delivery Local control rate Accuracy of treatment Side effect of treatment Impossible Relatively low Above 5mm Relatively high Cyberknife radiosurgery Possible High Less than 1~1.5mm Low Cyberknife radiosurgery 1~5 days Possible Possible 100~200 directions
The CyberKnife treatment is suitable for elderly patients who may not be able to tolerate aggressive surgical procedures, or may have a condition diagnosed as inoperable and want or need an alternative to traditional open surgery. The CyberKnife radiosurgery are patients with mainly lung, liver, prostate, pancreas, brain tumors and metastasis to lung, liver, brain and bone and recurrent tumors in the previously irradiated field as well. So, CyberKnife will give patients new hope for the treatment of tumors and lesions that previously have been diagnosed as inoperable or untreatable with existing technology. Dr. Woochul Kim works for the Department of Radiation Oncology, CyberKnife Center, Inha University Hospital, Incheon, South Korea and can be reached at cancer@inha.ac.kr or 82-32-890-3070.
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MEDICAL TOURISM
ADHD...Out in Left Field

By SANDRA LANDSMAN, PhD, CHt
These men are thought to have been members of this group as well as Sir Winston Churchill, a highly respected Prime Minister of the United Kingdom during World War II. They also had intellectual flexibility due to their multiple interests and the speed of the diverse flood of ideas. Boring is not a word that one would apply to this population, as they have many interests that drive their curiosity. They tend to be spontaneous, enthusiastic and maybe exasperating, often fun and outstanding. Robin Williams is one such comedian who comes to mind. Success is really part of their make-up when they find their passion, since frequently they are very gifted artistically and intellectually. David Neeleman, bet you never heard of him, but he invented the electronic airline ticket and is the CEO of JetBlue Airways. He believes his ADHD helps him to think outside of the box or very, very unconventionally
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obby stood out in the left field of the baseball diamond staring intently at what would appear to his coach, parents or anyone observing him to be the action of this afternoons practice game. Actually his eyes were glued to a grasshopper rubbing its hind legs together. His thoughts were a random jumble that flashed in nanoseconds and seemed to have actually have jumped and hopped just like the grasshopper, but hundreds of times faster if anyone had bothered to have tracked them. Coach sent me as far away from the kids as he could and let me stayWhere is my friend Jerry?... It looks like rain.Lucky guy is sitting on the bench.Is that a flower?...At least this year I got a baseball uniform.Im bored. My shoe fell offWhere is my baseball glove?...Which hand do I wear it on?...Im thirstyNobody can hit a ball this far out here and.I really like that bug.Last time we went out for ice cream. Why are they waving at me?...OH NO, not againthe inning is overI can hear them say that the loser is up to bat. Just dont cry like the last time.If I strike out maybe Coach will put me back on the bench with my friend Jerry. Attention Deficit (Hyperactivity) Disorder (ADD/ADHD) is often thought of as a neurological condition that makes it hard for individuals to control responses that involve speech, attentiveness and movement. They may frequently have difficulty controlling or inhibiting spontaneous responses. The statement that kids will say the funniest things or the most embarrassing ones may often come from this source. According to the National Institute of Mental Health we will find one child in each classroom of about 30 children with ADD/ADHD. That child may not only be yours, but like many health issues it will affect people of every race, gender, age, social and economic level. According to the American Medical Association 3.5 million children are affected by ADD/ADHD. So what will these individuals look like behaviorally? A lost curious little boy like Bobby, standing out in the baseball field, socially and physically inept, perhaps very bright, but needing lots of help to become successful in life. Generally there are three subtypes to describe ADD/ADHD: (1) Predominately inattentive; (2) Predominately hyperactive-impulsive; (3) Combined: inattentive and hyperactive-impulsive. Here we have a basic label with a diffuse pattern of behaviors for the observer to be looking for. One child might be inattentive, but very impulsive; the next is extremely hyperactive; while another seems too quiet and his mind is a million miles away. Then there is an obsessive youngster that has a difficult time changing tasks, he only wants to do math or science or art projects. Sometimes children exhibit evidence of problems in all three areas, but may be more heavily invested in one area rather than another. These are children that can and do pay attention when they are hooked on something. It is often very hard to get them to move on to another activity, but if they are bored they dont or wont stay on task. They need to be viscerally engaged or they get restless or move into their heads for their daydreams which are far more entertaining, creative and exciting. The outside world must challenge these youngsters and offer them something better to do. They get easily distracted and skip over details, make careless mistakes and seldom complete projects. Listening to directions is difficult since their mind is often elsewhere. Without full instructions they cannot really do or complete the task. They frequently make up their own rules before the directions have been given. This leads to what looks like forgetfulness, apparent disorganization or lack of intelligence. A comment by a classmate about a soccer game score can have them entering those numbers as history dates for homework. Everyone now and again may become a bit absent-minded, impulsive or restless, but when it is the rule not the exception, look for the symptoms that point to ADD. Occasionally we have all been with the girl or boy in constant motion. It feels as if they are about to bounce off the walls, they wiggle, squirm, talk non-stop, run, blurt out an answer before the question was completed, interrupt, have difficulty waiting, speak rudely or tactlessly. When most children have reached four or five years of age they have learned some social
control. They understand and know there are times to sit quietly, be polite and mind what comes out of their mouth. The average child starting school also knows that the good behavior will come with a reward which is a contributor toward building self-esteem. For some of these young people the reward never comes and, here again, there is a lag in self esteem. Lets not look at their characteristics as all negative. They may also be extremely bright, talented, gifted, imaginative and creative. They may be the daydreamer, but so was Albert Einstein. We are looking at a person that has a font of ideas when it comes to creating. They are the ones with multiple ideas in a brain storming session or new insight in the fields of science, music, business, art. After all they dont see what everyone else or others see. The artistic views of Salvador Dali and the thousands of inventions of Thomas Edison would have been lost if not for their particular gifts and talents. These men are thought to have been members of this group as well as Sir Winston Churchill, a highly respected Prime Minister of the United Kingdom during World War II. They also had intellectual flexibility due to their multiple interests and the speed of the diverse flood of ideas. Boring is not a word that one would apply to this population, as they have many interests that drive their curiosity. They tend to be spontaneous, enthusiastic and maybe exasperating, often fun and outstanding. Robin Williams is one such comedian who comes to mind. Success is really part of their make-up when they find their passion, since frequently they are very gifted artistically and intellectually. David Neeleman, bet you never heard of him, but he invented the electronic airline ticket and is the CEO of JetBlue Airways. He believes his ADHD helps him to think outside of the box or very, very unconventionally.
The standard of practice is a class of drugs identified as stimulants; this does not constitute a cure, but may in some cases improve symptoms of ADD/ADHD. As with any drugs there are side effects and risks. According to Dr. Gabor Mat, even though, when we observe a hyperactive child on the move, his thoughts may be moving quickly too, but the part of the brain that sorts thoughts and ideas is moving slowly; the prefrontal cortex. The job of the prefrontal cortex is to sort and organize stimuli coming in, as well as school assignments placing everything in its proper place. If it is slow or not functioning, as in the case of Bobbys mind, there is a flood of information and no adequate means of organizing or sorting it out. Ritalin was first introduced in the 1950s it was not until ten years later that it was introduced as a treatment for ADD/ADHD. After almost half a century there still has not been a study with regard to the efficacy of Ritalin or any of the other stimulant drugs being used. Young people with ADD/ADHD often take this medication for years and there is evidence that such long term use on children, whose brains are developing, may cause neurological
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permanent changes. Additional studies indicate that growth can be stunted by the use of these stimulants as well as an increased risk of addiction or future abuse with their prolonged use. According to John Ratey, M.D. of the Harvard Medical School, addiction is not a concern with the adults he has treated. Over the years new stimulant drugs have made their dbut. Some come in two forms: both long and short acting formulation. It depends on what best suits the individual. Do they need their medication administered once or several times a day? When do they peak? How fast do they metabolize the drugs? Listed below are some of the other stimulant medications: Adderall, Adderall XR, Concerta, Dexedrine, Dexedrine Spansules, Focalin, Metadate, Methylin, and Ritalin SR. Sometimes an antidepressant, like Strattera which affects the levels of dopamine and works for 24 hours in the body, is effective particularly for those who have trouble getting moving in the morning. The side affects that plague the children and of course concern parents range from increased nervousness, problems sleeping, weight loss due to loss of appetite, dizziness, nausea, social withdrawal or lack of spontaneity, depression, and tics. Stimulants may exacerbate a preexisting heart condition so the current thinking is to have a child given an electrocardiogram (EKG) before starting the medication or if already on one of these medications to test to see if they may need medication to prevent a sudden fatal heart failure. There is also some new evidence that children with heart problems may have a predisposition to ADD/ADHD. Are there alternative treatments for ADD/ADHD? Of course there are. Hypnosis is an ancient process that works very well with children. The focus is on the subconscious part of the mind and therefore brings issues to the surface that may have been obscured due to life situations. Those practicing Hypnosis look for the underlying causes or unresolved emotional issues such as fear, anger, anxiety, trauma, or guilt. When the issues are resolved then the symptoms recede and the child is able to lead a normal social and academic life. Often the traumas were in the past and then there were layers of more recent ones that are like new coats of paint piled on top. What the child does is repeating a loop of behavior (fear, anger, anxiety, trauma, or guilt) and the parents may be simply overwhelmed by family, career and health issues. In some classrooms students are stressed because they are not taught how to learn by a means that they can understand. The teacher may present the lesson visually and orally; we have a kinesthetic learner: therefore this will be a very stressful day and acting out will probably be part the result. Rather than dealing with the symptoms or making students compliant, as often the medications appear to do; with Hypnosis the behavior is permanently improved. Frequently there is a very deep emotional release involving forgiveness of themselves, parents, siblings, extended family and classmates or friends. Gary Craig has developed a tapping technique called Emotional Freedom Technique (EFT) that is a refinement of the original work created by Dr. Roger Callahan. Those practicing EFT also look for the underlying causes or unresolved emotional issues. These practitioners consider that their work is a form of neurological rewiring. EFT can do a great deal to alleviate the past and therefore give a child a new tool to utilize in the present.
Dr. Sandra Landsman may be contacted at: 810 Saturn Street, Suite Jupiter, Florida 33477 U.S.A. 561.575.0547 Mobile 561.512.1002 DrSandyLandsman@bellsouth.net, www.DrSandy.biz
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Republic of Korea
By LINDA BENTLEy AND DIANE BOURqUE
he right to privacy for the citizens of the Republic of Korea begins with its Constitution which states that all citizens shall enjoy the inviolable right to privacy. This right is made more explicit through a number of laws that focus on specific types of information and methods for disseminating information. There is at least one law that covers the public sector and there are sectorial laws for the private sector. The most widely discussed and seemingly most developed law is the 1994 Act on the Protection of Personal Information Maintained by Public Agencies. Although this law does not apply to private entities, it recommends that private entities respect the data protection principles in the law. However, it has no administrative or enforcement power over the private entities. The law applies primarily to electronic data processed and managed by public computers. Data subjects have the right to inspect their personal information and correct errors. The law established a Data Protection Review Commission to recommend and review suggestions on the improvement of data protection policy. There are a number of acts governing the collection, use and disclosure of personal information in the private sector, but none provides the specific personal health information protection prided under the United States HIPAA law or the European Unions Privacy Directive. According to an English translation of the Medical Service Act of 1973, the purpose of that law is to set national standards for medical treatment and ensure the proper management of medical treatment and improve national health. The law establishes licensing requirements for medical professionals and institutions and describes the scope of services that various medical professionals may provide. Medical persons are prohibited from providing details from a patients records or providing copies of the records except to the patient, specified relatives or an agent designated by the patient. However, transfer of the information to another medical institution for treatment purposes is permitted. Violation of the prohibition may result in a fine or imprisonment, but only if a complaint is filed. In addition to its national laws, South Korea, which is a member of the Organization for Economic Cooperation and Development (OECD), has adopted the OECD Guidelines on the Protection of Privacy and Transborder Flows of Personal Data. Among the principles recognized by that group are the need for continuous and uninterrupted flows of information between countries, the need for security safeguards to minimize violation of proprietary data and misuse of personal information, the importance of a commitment of countries to adopt effective national requirements for the protection of privacy and individual liberties.
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Traditional Korean Medicine

Health care in the western world is changing. As fees for state of the art medical support are sky rocketing, access to optimal medical care is becoming more difficult for an increasing number of people who have insufficient health insurance. As a result, many individuals are looking for more financially viable treatment options outside of the mainstream medical system.
Several Thousands of Years of

By DR. RAIMUND ROyER
his trend is being further accelerated by those who are averse to intrusive surgery and/or side-effect laden pharmaceuticals and are seeking less aggressive, more holistic alternatives. In Korea, this alternative can be found in its own tradition. Traditional Korean Medicine is based on the same philosophical background as Traditional Chinese Medicine. Like western medical doctors, traditional Korean medical doctors are often specialists in certain fields, however all TKM doctors use the same holistic approach to treating issues. TKM has been used for myriad health issues to rebalance the body system, and to that end it offers a wide variety of treatments, including acupuncture, herbal remedies, moxibustion, cupping, and chuna manipulation therapy.
Traditional Korean Medicine is based on the same philosophical background as Traditional Chinese Medicine.
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In eastern medical philosophy, the human being is understood as a micro universe contained within the macro universe. Using the basic concept of the dualistic Yin and Yang principle, health is perceived as the balance and harmony of these complementary forces which exist in all matter. Traditional Korean Medicine is the product of several thousand years of clinical experience. Throughout its history, TKM has developed a deep understanding of the organic interactions within the body as well as environmental influences on the body system. Oriental Medical Doctors understand all kinds of disease and manifesting symptoms as signs of disharmony. According to the degree of imbalance, the disease may be seen either as functional or organic. Functional disease involves those cases where patients have specific symptoms in the absence of conclusive test results, even after thorough diagnostic assessment. Organic disease involves cases in which diagnostic assessment through diverse screening methods has suggested an advanced state of imbalance or disease.
Imbalance at both functional and organic levels can be effectively addressed with TKM. A typical treatment may include acupuncture to regulate the energy flow through the body meridians. In addition, herbal mixtures, which are based on tried and true recipes, may be consumed to internally harmonize the organic functions. TKM can even correct various degrees of spinal misalignment, disc herniation, and joint problems through a special manipulation technique called Chuna therapy.
Oriental Medical Doctors understand all kinds of disease and manifesting symptoms as signs of disharmony.
Traditional Korean Medicine can compete in many fields with western scientific medicine. However, in modern Korean society, TKM is the medical treatment of choice for cases involving chronic or degenerative skeletal and joint problems, female-specific issues such as infertility or menstrual disorders, and also in a variety of different cases where the allopathic western approach could not bring any satisfying resolution to the problem. In the last 20 years, some traditional eastern treatment techniques, like acupuncture and moxibustion, have been introduced to many western countries. Since this time, their safety and efficiency has been supported in large scale studies, and they have become accepted by most medical communities as well as a number of insurance companies. Indeed, once other facets of TKM, such as eastern herbal medicine, become better known in the west, Traditional Korean Medicine is likely to be perceived as a primary or complementary medical care option rather than merely an affordable alternative. Dr. Raimund Royer is Koreas only Western Oriental medical doctor and the medical director of the Jaseng Hospital of Oriental Medicines International Clinic in Seoul, Korea, Specializing in non-surgical treatment of spinal disorders. This is where Eastmeets-West. Along with the state-of-the-art test tools from West, doctors at Jaseng combine the best of eastern and western medicine to treat patients. For more information go to http://www.jaseng. net/Main/Main.asp.
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Traveling with Ease

How to Avoid Jet Lag
By Abdel Salam Kaleel
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With physical, mental, and emotional symptoms jet lag can be hazardous to your long term health. In addition to fatigue and insomnia, it can also acutely cause anxiety, confusion, constipation, nausea, and even memory loss.
ith many of us rushing to overseas destinations and planning ahead for our activities upon our arrival, we often forget to prepare for our sometimes lengthy plane rides. Traveling to foreign countries can be sometimes necessary and often exciting, but it is important to make sure that the actual travel portion of your trip is as comfortable and relaxing as possible.
Jet lag is a disturbance induced by a major rapid shift in environmental time during travel to a new time zone.
August 2008
is actually nearer to twenty-five hours. The hypothalamus regulates our sleep cycles, as well as many other body processes such as body temperature, hunger, and thirst. Our sleep is regulated by the production of the hormone melatonin. When our eyes perceive a change in the day and night schedules that we are not used to, it sends a signal to the hypothalamus, which then becomes confused and sends signals that may adversely affect our bodys function and respond in ways that are not appropriate for that time of day. The perception of darkness alerts the hypothalamus to secrete melatonin which promotes sleep and the perception of light forces the hypothalamus to withhold melatonin. A disruption to the circadian rhythm affects alertness, appetite, and hormone secretion because the hypothalamus is unable to immediately recover to a change in the environment. These interactions are responsible for the majority of the symptoms of jet lag. The body is able to adapt relatively well to change in two or three time zones, however when traveling between the US and Europe, for example, it becomes a much greater burden on the body. Fortunately, jet lag does not occur when traveling north or south but with many popular medical tourism locations currently located in Asia, Europe, and the Middle East, it is an issue we all have to handle as best as possible. If you are experiencing any health problems, you should always check with your doctor before you fly. Occasionally, sufferers of peptic ulcer disease may find that their symptoms are more severe with flying and women who fly frequently may find that their menstrual cycle is disrupted. In addition, diabetics who are on insulin treatment should discuss changing their insulin schedule before flying. Preventing jet lag on the day of your flight is actually an easier task than you might expect if you make an effort. First and foremost, if you have trouble clearing your ears, it might be helpful to take a decongestant before you board the plane to prevent a restless flight. Consult your doctor before doing this, however. Consider these physiological and psychological affects on the medical tourist. In addition to the stress of going to a foreign land and undergoing a surgical procedure, now you must think of all these other effects that may come into play.
Leaving Home
Try to maintain a positive attitude regarding flying. Our bodies are very adept at reacting to mental stressors and any fear of flying may falsely present itself as a bodily complaint or exacerbate any effects of jet lag. Next, in order to adequately prepare yourself for your trip, it is imperative that you wear loose and comfortable clothing on any flight. Any restriction in movement during the flight may cause restlessness and irritation. You may be tempted to dress up in trendy, expensive outfits for flights; however, while your clothes may look great on your arrival, the person wearing them may suffer the consequences, looking worn out and drained. Another very big factor in preventing jet lag involves changes in diet. A new study from Harvard involving mice showed that avoiding food altogether, though difficult, may be a good thing. When the mice were prevented from eating food, they were observed to react differently. The researchers discovered that a secondary rhythm appeared to take over that allowed the mice to wake up in order to seek food during times when they would be sleeping. While this finding may not apply directly to humans, experts believe that fasting before a flight will help in adjusting to the time difference. If that is not possible, eat a high protein breakfast instead and try to avoid carbohydrates or fats. It is also a good habit to reduce stress as much as possible while on your flight. This may include listening to music, reading, or meditation. Often, focusing on these means or any particular method of your choice will help to alleviate tension and prevent the effects of jet lag. Consider buying a good pair of noise-canceling headphones that will help reduce a lot of the clamor of your surroundings, including the jet engines a few feet from your chair.
While Deep Vein Thrombosis (DVT) is often frighteningly associated with flying, your chance of developing a clot on your flight is actually relatively low. A more common concern that affects 80% of people who travel internationally is jet lag, also known as desynchronosis. This can be a major burden to any planned activity.
What is Jet Lag?

Jet lag is a disturbance induced by major a rapid shift in environmental time during travel to a new time zone. Jet lag does exist, and it can have a negative impact on your vacation enjoyment and business judgment, and also a serious concern for medical tourists. With physical, mental, and emotional symptoms it can be hazardous to your long term health. In addition to fatigue and insomnia, it can also acutely cause anxiety, confusion, constipation, nausea, and even memory loss. Jet lag occurs because the body is unable to adapt immediately to a change in the time zone of your destination. The human body has an internal clock located in the almond-sized hypothalamus called the suprachiasmatic nucleus. The internal clock cycle, or circadian rhythm, is not set to the twenty-four hour day schedule - it
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Another very important tip to prevent jet lag is applying skin lotion or any moisturizer to minimize dehydration. The dry air of the airplane cabin wicks moisture away from the skin and can cause acute water loss if not managed and taken into consideration. Much of the moisture of our bodies is also lost through breathing so it is important to further provide your body with plenty of fluids, avoiding caffeine as this may interfere with your metabolism. Next, try to avoid taking sleeping pills. Pill-induced sleep prevents the natural movement of our bodies in sleep and may predispose to clots, another danger of flying. Also, while some experts promote the use of melatonin, it is a controversial treatment that is better avoided. In addition, many sleep medicines carry with it the potential for addiction, a risk better left alone. A relaxing and soothing tea may work wonders. Finally, try to snooze until it is breakfast time in the city of your purpose. This practice will help to adjust your internal body clock to the time of your destination. Oftentimes, many people try to follow the schedule of their destination city for days in advance to prevent any symptoms of jet lag. This habit, if not interfering with your other daily obligations, can actually decrease the effects of jet lag a great deal.
Arriving at your Destination

Now that you have done your best to prevent jet lag during your flight, let us focus on some tips that will tackle any lingering symptoms that may disrupt your activities. It is important to remain active and fight off any urges to sleep in the middle of the day. Your body may still be in the time zone of your departure city, but you are expected to function at your current time zone. Take a stroll around your hotel and become familiar with your surroundings, but first check with the hotel staff to make sure that this is okay. Physical activity, while always a good idea, is especially important in keeping the body alert after flying. Try to stay in the sunlight immediately for at least twenty minutes without any sunglasses. This will further help your body clock readjust itself to your current time zone. It will also delay the onset of drowsiness by keeping your body limber and active. Keep your friends close! Talking and maintaining stimulating conversation will go a long way in keeping yourself awake. Studies have shown that intimate relationships drastically improve recovery time and illness, and can also be a big help during traveling. Discuss the purpose of the trip and what you hope to accomplish to keep yourself oriented. Also, talk about the new sights in front of you. Some believe that walking on the ground barefoot will equalize your electromagnetic system and minimize your bodys fatigue. While this has not been entirely proven, the mental benefits, such as placebo effect, cannot be completely excluded. As your body may have dehydrated itself while on the plane, continue to drink plenty of fluids and to stay as hydrated as possible. Oftentimes, dehydration symptoms itself present as jet lag and this can be avoided by keeping a bottle of juice or water handy. Also, to further enhance this effect, take a cold shower to help rejuvenate and energize your body. A warm shower, on the other hand, tends to relax the body and promote sleepiness. When it is time to finally sleep at the time of your destination, a warm bath is warranted to put you in that relaxing night-time rest mode. If you can minimize the effect of jet lag, you should be fresh and ready to complete any and all tasks ahead of you. Remember that a sleepy brain is a liable brain. Enjoy your flight! AbdelSalam Kaleel is a 4th year medical student at Saba University School of Medicine. He has also received his Hyperbaric Masters of Science Degree and is a certified hyperbaric tender and driver. He has been published in numerous magazines, including Teens Crossroads and Dialogue, and is a weekly correspondent for the Brunei Times newspaper
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The Medical Tourism Associations 2nd Annual World Medical Tourism & Global Health Congress
Up to 100 Exhibitors and up to 2,000 Attendees Up to 200 U.S. Healthcare and International Insurance Companies Interested in Out-Sourcing Surgeries Overseas.
Up to 5,000 One-on-One Networking Meetings Scheduled Industry Players from over 50 Countries Over 3,000 Buyers invited from the United States, Canada, Middle East, Europe, Asia, Russia and other countries looking at sending patients overseas
October 26th - 28th, 2009 Los Angeles, California

For More Information on the Congress Contact: 2nd Annual World Medical Tourism & Global Health Congress www.MedicalTourismCongress.com Info@MedicalTourismCongress.com USA: 561-792-6676
WORLD MEDICAL TOURISM & GLOBAL HEALTH CONGRESS

Dear Delegate, Medical Tourism is one of the fastest growing healthcare industries. The world is in a healthcare crisis and patients are starting to travel overseas in search of the best quality and the most affordable medical care. More and more Health Insurance Companies, Employers, Claims Payors, and Health Insurance Agents are looking at Medical Tourism as the creative solution to the healthcare crisis. A recent report on Medical Tourism stated that by 2017, over 16 million Americans could be traveling overseas for medical care. With that being said, people from other countries equal to or greater than that amount will also be traveling around the world for medical care. Last years 1st annual congress featured over 850 attendees from over 45 countries and over 53 exhibitors and sponsors. Out of the 850 attendees, there were over 100 insurance companies and insurance providers, over 400 hospitals, clinics, and governments, and over 100 facilitators. The 2nd Annual World Medical Tourism & Global Health Congress will feature up to 2,000 attendees from over 50 countries and up to 100 exhibitors and sponsors. At this years Congress we have also invited buyers of healthcare from countries such as Russia, China, Japan, and Africa. Many of these countries are emerging markets as more patients travel to and from these countries for medical care. This is the one event per year where Employers, Self Funded Health Plans, Insurance Companies, and Medical Tourism Facilitators that are looking to outsource healthcare overseas have the opportunity to meet with top International Hospitals and Medical Tourism Companies in one place for the ultimate networking event. World Medical Tourism & Global Health Congress will prearrange networking meetings to assist in the development of new relationships and valuable new contracts. While last years Congress featured over 3,000 one-on-one private networking sessions, the 2nd Annual Congress is anticipated to have at least 5,000 one-on-one private networking meetings. This is the one event you cannot afford to miss!
Exhibit Hall 1 of 3 WMT & GHC 2008
Grand Ballroom WMT & GHC 2008

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Medical Tourism Magazine - Issue6

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The MTA Advisory Board includes

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Defining Medical Tourism ~ A Second Approach

An Optimal Choice for the Medical Traveler

Anti-Aging Developments and Trends

Climbing Again ~ A Patients Portrayal

Comprehensive Aortic Root and Valve Repair CARVAR

Liver Tranplantations for patients in Korea

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Paralysis Normal Disc Preservation & Transfusionless Spinal Treatment Techniques

Cutting Edge Phonoplastic Surgery

South Korea ~ Stepping into the Spotlight in Global Healthcare

Will the Circle be Unbroken?

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Insurance Solutions for Medical Tourism Companies

An Ounce of Prevention is Worth a Pound of Cure

Several Thousands of Years of Traditional Korean Medicine

NEWS AND INSIGHTS

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EDITOR & PUBLISHER: CONTRIBUTING EDITORS:

ART DIRECTOR: ART DEPARTMENT: MAIN OFFICES:

MARKETING & CIRCULATION:

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Defining Medical Tourism

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Medical Tourism Statistics

Medical Tourism Drivers & The Five A Factors

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Competition on the Wrong Objectives

The Industry Needs Direction

Five Key Drivers of Medical Tourism

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Increased Risk of Ruptured Cerebral Aneurysms in the 40s

Red Warnings of Cerebral Hemorrhage

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Incidence of stroke depending on age

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Developments and Trends

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Various methods of wrinkle treatment

Plastic surgery, stretching skin or injections diversity in methods

Wrinkle treatment by peeling

Diverse lasers, personalized treatment for wrinkles region

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Trend of Wrinkle treatment now in Korea

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Innovative approach for Aortic Valve Repair

The problem of Bioprosthetic valve

The problem of Mechanical valve

The merits of CARVAR technique

Surgical indication of CARVAR

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From Mr. Urs Meir

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for Cancer Patients in Korea

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