Emerging Medical Tourism in Turkey

Turkey's Belly Dancers


Turkey's Dervishers




Seems like the Europeans find Turkey’s healthcare facilities attractive.

Research group RNCOS says in its new report, Emerging Medical Tourism in Turkey, that despite the sluggish world economy, the industry witnessed impressive growth of around 40 percent in 2008 over the same period in 2007. Last year, the country received around 200,000 foreign medical tourists

The study provides an in-depth analysis of the present and future prospects of the country in the medical travel arena, delving into the operations of key players such as The World Eye Hospital, Memorial Hospital, Anadolu Medical Center and Sanatolia Care.

Growth has been fuelled by a cost advantage. In Turkey, fees for treatments range from one-half to as little as one-fifth the price in Europe and other developed countries. Its strategic location between Asia and Europe makes it accessible to travellers, and the capital Istanbul boasts good air connectivity.

Turkey has proven especially attractive to European medical visitors, who are avid patrons of its spas. To promote these further, the tourism ministry has listed 17 registered thermal spa resorts with mud bath facilities, but there are an estimated thousand more unregistered.

Istanbul Memorial Hospital was the first hospitals in the country to receive JCI accreditation.

Sex Change Surgery

Male to Female Surgery





Female to Male Surgery

Let's face it...transsexualism exists and that treating transsexual patients can be regarded as a justifiable medical activity. In 1997, the medical guidelines for transgender persons were issued by the Japanese Society of Psychiatry and Neurology, with some modifications of the Standards of Care of the Harry Benjamin International Gender Dysphoria Association.

Before a sex change operation or sex reassignment surgery (SRS) is carried out, a medical team composed of psychiatrists, a sexologist, endocrinologists, gynecologists, urologists, and plastic surgeons must first be assembled and a unanymous decision is reached.

Diagnosis, preparatory psychotherapy, and hormonal therapy were carried out according to the above-mentioned guidelines.

Meanwhile in Bangkok, the world's sex capital, Thailand’s recent ban on sex-change operations for boys under 16 years has, once again, brought the whole Thai sex scene into prominence. Hospitals and clinics are now barred from castrating would be “ladyboys” - “katoeys” to give them their Thai name. It was feared that the operation was being seen as a cheap and quick alternative to a full sex-change.

In letters to private health units doctors have been told that such operations performed outside formal sex-change therapy, would result in up to six months in jail. Policing this ban may be difficult as cosmetic removal of the testicles takes no longer than 15-20 minutes surgery, and is easy to conduct in secret. At the lower end of the market, Internet advertisements offer castration at clinics for as little as 4,000 baht ($125, £62.50).

The procedure, technique and result for Male to Female change:

1.“Penile inversion technique”vaginoplasty (not recommended for body weight of more than 200 lbs. and those seeking more vaginal depth)

Surgeon uses the "Penile Inversion Vaginoplasty" technique which turns the penile skin "inside out" and uses it to line a vaginal cavity. The penis and testes are removed. A pure penile inversion limits the size of the vagina that can be created depends on the amount of penile skin available,also the vaginal depth is to depend on penile skin on the resting state not from your erectile state.This technique is called SRS with penile inversion vaginoplasty. You should know the depth has been gained from your penile skin but not from your whole shaft of penis in resting stage not from your erectile stage. This technique offers fast recovery and better healing.

2."Scrotal Graft Technique" Vaginoplasty
Some patient's penile tissue limit because the length of penis or the Peno - scrotal junction stays in high position, which will limit the vaginal lining or meaning that vaginal depth is limited.The surgeon will use "Scrotal Graft Technique" combination with penile skin to form the vaginal lining to create the new vaginal depth or new vagina, which is a better technique compared to the penile inversion technique.You will get the depth of your new vagina between 5-7 inches owning to your body structure. This is better choice for those with limited penile skin but with more scrotal sac tissue to use.

Most surgeons currently prefer Scrotal skin graft much more than penile inversion and colon graft.

3."Sigmoid Colon-Vaginoplasty Technique" Vaginoplasty( it is not for those weighing over 200 lbs or with larger abdomen.)

You will have two choices to do this surgery: delayed or immediate “ Sigmoid Colon-Vaginoplasty Technique”.

Check the above pictures.

Bitter Lesson: Beware Medical Tourism Agency

London's Big Ben

Hiding a botched facial lift?



Here is a lesson that Medical Tourism Agencies anywhere in the world ought to consider very seriously. One agent in the UK had been sued for recommending a facial plastic surgery in Belgium which allegedly turned out nasty for the patient and now she is suing the company rather than the Plastic Surgeon.

Europe certainly lags behind the US in promoting insurance covering medical negligence. Many agencies, involved in arranging medical travel, don’t think they need protection or have the funds to buy a policy. Underwriters are reluctant to insure them because some are not licensed, appear to be new at the game or cannot present a professional way of selecting its roster of specialists.

A woman from Wales is suing a cosmetic surgery clinic in Belgium after she underwent cosmetic surgery a facelift.

Mrs X, who is in her 40s, is taking the UK-based Cosmetic Surgery Agency Group to court for personal injury, following a botched facelift and upper and lower eye procedure in 2005. The woman is now too embarrassed to be seen in public, claiming that she has been left with prominent scarring around the eyes and the ears.

She adds that she suffers numbness and a “lack of symmetry” on the left side of her face. To hide the scarring, she has had to grow her hair long.

Although the surgery was performed in Belgium, she is pressing charges in the UK. If she succeeds, it could pave the way for other patients, who may have received below standard healthcare abroad, but want to go to court in the UK where they can expect bigger payouts.

The agency, which has offices in London and Manchester, denies any liability, saying the procedure took place in Belgium, and thus, Belgian law should prevail. In that context, it is the attending surgeon who is legally responsible for any personal injury, not the firm he works for.

A spokeswoman said they did not accept responsibility for the case, however, they did feel they had a moral responsibility to try to put things right. “We are providing aftercare to correct errors. But generally patients are not reimbursed.”

The agency has offices in Paris, Utrecht, Manchester, London and Brussels.

Malaysia medical tourism figures for 2008

Prince Court Medical Centre, Kuala Lumpur



National medical tourism figures for 2008 revealed

About 370,000 foreigners sought medical treatment in Malaysia in 2008, according to health minister Datuk Seri Liow Tiong Lai.

Over the years, the country’s medical tourism industry has registered annual growth of 30 percent.

The minister spoke at the awarding of the Joint Commission International's (JCI) hospital accreditation to the Prince Court Medical Centre (PCMC) in Kuala Lumpur.

"Being accredited, especially by an international body, would certainly help in benchmarking the quality services provided by the hospitals. The rapid uptake of accreditation activities by hospitals in Malaysia is testimony to the ministry's commitment to ensure that healthcare is provided in a safe and effective manner to all our clients, local or from overseas.

“Our own home-grown hospital accreditation body, the Malaysian Society for Quality in Health (MSQH), has been awarded this coveted international accreditation by ISQua. Thus, the standards set by both JCI and MSQH are of international stature."

Besides PCMC, the Penang Adventist Hospital and the International Eye Specialist Centre in Kuala Lumpur also have JCI accreditation.

The Institut Jantung Negara is also working towards it.

For the MSQH, 113 hospitals have been surveyed. Sixty five government and 18 private hospitals have received the accreditation. MSQH was formed by the Ministry of Health Malaysia (MOH), Association of Private Hospitals of Malaysia (APHM) and the Malaysian Medical Association (MMA).

Only 35 of APHM’s 111 member hospitals are involved in medical tourism and they are the source of Malaysia’s medical tourism figures. APHM offers a range of medical tourism packages and sets recommended fees for medical tourism hospitals

Rhe PCMC expects health tourism to contribute 30 percent of its revenue for the financial year ending March 31, 2010

Said PCMC chief executive Stuart Rowley: "Overseas patients can save up to 60 percent [in their medical cost]. We have 300 beds but only use 85.It does not make sense to use all, but we aim to do so within the next 12 months."

Dr Mubbashir Iftikhar, chief executive of Malaysian medical tourism agency Wellness Visit, noted: “Malaysia’s excellently maintained healthcare providers are certainly as good as their counterparts in Singapore and Thailand.

“Malaysia is as competitive in cost as Thailand and much superior in terms of healthcare providers, healthcare infrastructure, English-speaking staff, foreign trained specialist doctors, and strict government rulings on maintaining high standards of healthcare delivery systems. Malaysia is as competitive as Singapore in the quality of healthcare with its world-class hospitals and clinics, world-class renowned surgeons and doctors. Furthermore, Malaysia is offering services at costs less than Singapore. Singapore is no match to Malaysian costs for healthcare.”

What about Costa Rica Medicine?

San Jose fat lady statue

Downtown San Jose, Costa Rica






In the past, agricultural exports, like bananas, have been the staple of the Costa Rican economy. However, tourism has always played an ever increasing role, and now it has become the dominant economic force. Ecotourism travel is the most preferred for expansion because it will provide a sustainable resource for tourism for generations of Costa Ricans to come.

But with traditional tourism hit hard by the global recession, Costa Rica is seeking to draw foreign visitors by offering reasonably priced, high-quality healthcare. A combination of proximity to the US, excellent air connections, political and social stability and low crime stats make it an attractive proposition. San Jose, the capital of Costa Rica, is home to an entire third of Costa Rica's population. Like other Central America capital cities, San Jose is dirty and chaotic in some parts, but is remarkably cosmopolitan in others.

A 2008 study by Deloitte identified Brazil, Costa Rica and Mexico, boasting professional costs ranging from 25 to 50 percent of the US average, as countries in Latin America with the greatest potential for inbound medical tourism. Other contenders were Argentina, Colombia, Brazil and Chile whose dental and cosmetic treatments are about 20 percent off prices in the US.

Officials regularly quote the figure of 100,000 medical visitors to the country, but this may only be an estimate – 20,000 a year is a much more realistic sum.

To stimulate demand overseas, the government is enlisting the help of its tourism, health and trade ministries and planning a big publicity campaign.

The Association for the Promotion of Costa Rican Medicine (PROMED) has also been established, consisting of six health consortiums, three private hospitals and several local universities and hotels. But how about the weather?

The high season in Costa Rica, December through April, is the dry season. The rainy season, which lasts from May to November, usually sees sunny mornings, with rain showers in late afternoon and evening. Secondary roads can become rutted during those months, and four-wheeldrive vehicles are strongly recommended. Overall, the climate is tropical, with an average temperature of 72°F (22°C). It can be much hotter along the coastal areas of the country, and much cooler in the mountains.

Jordan the Arab Medical Tourism Champion

..ancient wall city of Petra

Jordan, officially the Hashemite Kingdom of Jordan, is an Arab country in Southwest Asia spanning the southern part of the Syrian Desert down to the Gulf of Aqaba. It shares borders with Syria to the north, Iraq to the north-east, the West Bank and Israel to the west, and Saudi Arabia to the east and south. It shares control of the Dead Sea with Israel, and the coastline of the Gulf of Aqaba with the State of Israel, Saudi Arabia, and Egypt. Much of Jordan is covered by desert. The capital city of Amman is in the north-west.

So what do we know about Jordan besides maybe the ancient wall city of Petra sometimes claimed as 'Petra, Jordan, the place in the desert that is prepared by God for the Jewish people'?.

How about medical tourists? Really.

Private Hospital Association (PHA) president Fawzi Hammouri contends the World Bank places Jordan as first among the Arab countries and among the top 10 in the world when it concerns medical travel.

A study by Jordan’s Private Hospital Association (PHA) reports that last year, 210,000 patients from 48 countries received treatment in local medical facilities. This was an increase compared with the 190,000 patients in the previous year.

Most of the patients come from Iraq, Palestine, Sudan and Yemen.

“In order to maintain this ranking, we have to keep the current markets in the Arab world and find new ones in Africa, Europe and the US,” he said. “We have already marketed in Chad, Nigeria, Russia, Azerbaijan and Kazakhstan.”

PHA is a private, voluntary, non-profit organisation established in1984 to represent the interests of 48 private hospitals in Jordan. It seeks to raise medical standards, supports national and international accreditation and promotes the Hashemite Kingdom as a medical tourism destination. To enable these ambitions to be fulfilled more quickly, it is planning to allow public and university hospitals to join its ranks. The new grouping will eventually be named Jordan Hospital Association.

PHA is working with member hospitals to promote specially designed healthcare offers to Americans and Europeans. Hammouri explains: “ We will provide them with packages that are 25 percent below market prices. This includes the plane ticket, accommodation and a visit to Petra to encourage local tourism as well.”

Really.

Indonesians seeking treatment overseas

..the famed ancient Borobudur complex in Yogyakarta, Indonesia

About a million Indonesians go overseas annually seeking treatment, an exercise that amounts to well over US$1 billion, research by analysts Frost and Sullivan shows.

The study, presented at a health forum in Singapore in April, indicates that despite the huge potential and spending power of Indonesia’s large population, the domestic healthcare industry has proven incapable of meeting their needs. Instead, countries such as Singapore, Australia, Malaysia and the US have been benefiting from the visits of wealthy local residents.

Frost and Sullivan contend that Malaysia has been gaining over Singapore in attracting Indonesian patients. It said: “Indonesian medical tourists going to Malaysia comprise around 70 percent of its total (inventory of) international patients, while those going to Singapore are only around 65 percent.”

Last year, Malaysian hospitals treated 288,000 Indonesian patients, up from 221,538 in 2007 and 170,414 in 2006.

In 2007, Singapore hospitals treated 226,200 Indonesian patients, a drop from the 266,500 recorded in 2006. However, its revenue in 2007 from this market was recorded to have increased.

Affordable pricing was Malaysia’s edge over Singapore, while political stability put it ahead of another rival Thailand.

With Singapore’s healthcare infrastructure being world class, its treatment costs are higher than Malaysia’s as are accommodation and incidentals. This reality has led it emphasise quality, and focus on the highly affluent Middle East sector.

A Muslim country, Malaysia has also decided to go for an Arab clientele, as well as those from destinations within the eight-hour flight range including China, Japan, Korea and the Asean.

Medical Tourists are Reluctant to come to Malaysia because the Nurses wear Headscarves?

A Malay Muslim Nurse



Student Nurses

Pity the Malaysian.
Actually only slightly more than half of the nurses in this beautiful country wear head scarves. The country had been accused to be associated so often with Islamic aggression and Al Qaeda connection that tourists formed pre-conceived ideas even before touching down at the Kuala Lumpur International Airport which itself consistently voted the world's top three airports.

So what's all this about the frightening Islamic headscarves?

Queens University, Kingston, Ontario, Canada:
The veil or the head cover is considered in the West as the greatest symbol of women's oppression and servitude.
Is it true that there is no such thing as the veil in the Judaeo-Christian tradition?
According to Rabbi Dr. Menachem M. Brayer (Professor of Biblical Literature at Yeshiva University) in his book, The Jewish woman in Rabbinic literature, it was the custom of Jewish women to go out in public with a head covering which, sometimes, even covered the whole face leaving one eye free. He quotes some famous ancient Rabbis saying," It is not like the daughters of Israel to walk out with heads uncovered" and "Cursed be the man who lets the hair of his wife be seen....a woman who exposes her hair for self-adornment brings poverty." Rabbinic law forbids the recitation of blessings or prayers in the presence of a bareheaded married woman since uncovering the woman's hair is considered "nudity". Dr. Brayer also mentions that "During the Tannaitic period the Jewish woman's failure to cover her head was considered an affront to her modesty. When her head was uncovered she might be fined four hundred zuzim for this offense." Dr. Brayer also explains that veil of the Jewish woman was not always considered a sign of modesty. Sometimes, the veil symbolized a state of distinction and luxury rather than modesty. The veil personified the dignity and superiority of noble women. It also represented a woman's inaccessibility as a sanctified possession of her husband.

The veil signified a woman's self-respect and social status. Women of lower classes would often wear the veil to give the impression of a higher standing. The fact that the veil was the sign of nobility was the reason why prostitutes were not permitted to cover their hair in the old Jewish society. However, prostitutes often wore a special headscarf in order to look respectable. Jewish women in Europe continued to wear veils until the nineteenth century when their lives became more intermingled with the surrounding secular culture. The external pressures of the European life in the nineteenth century forced many of them to go out bare-headed. Some Jewish women found it more convenient to replace their traditional veil with a wig as another form of hair covering. Today, most pious Jewish women do not cover their hair except in the synagogue.Some of them, such as the Hasidic sects, still use the wig.

What about the Christian tradition? It is well known that Catholic Nuns have been covering their heads for hundreds of years, but that is not all. St. Paul in the New Testament made some very interesting statements about the veil:
"Now I want you to realize that the head of every man is Christ, and the head of the woman is man, and the head of Christ is God. Every man who prays or prophesies with his head covered dishonours his head. And every woman who prays or prophesies with her head uncovered dishonours her head - it is just as though her head were shaved. If a woman does not cover her head, she should have her hair cut off; and if it is a disgrace for a woman to have her hair cut off or shaved off, she should cover her head. A man ought not to cover his head, since he is the image and glory of God; but the woman is the glory of man. For man did not come from woman, but woman from man; neither was man created for woman, but woman for man. For this reason, and because of the angels, the woman ought to have a sign of authority on her head" (I Corinthians 11:3-10).
St. Paul's rationale for veiling women is that the veil represents a sign of the authority of the man, who is the image and glory of God, over the woman who was created from and for man.
St. Tertullian in his famous treatise 'On The Veiling Of Virgins' wrote, "Young women, you wear your veils out on the streets, so you should wear them in the church, you wear them when you are among strangers, then wear them among your brothers..." Among the Canon laws of the Catholic church today, there is a law that requires women to cover their heads in church. Some Christian denominations, such as the Amish and the Mennonites for example, keep their women veiled to the present day. The reason for the veil, as offered by their Church leaders, is that "The head covering is a symbol of woman's subjection to the man and to God", which is the same logic introduced by St. Paul in the New Testament.
It is obvious that Islam did not invent the head cover. However, Islam did endorse it. The Quran urges the believing men and women to lower their gaze and guard their modesty and then urges the believing women to extend their head covers to cover the neck and the bosom:
"Say to the believing men that they should lower their gaze and guard their modesty......And say to the believing women that they should lower their gaze and guard their modesty; that they should not display their beauty and ornaments except what ordinarily appear thereof; that they should draw their veils over their bosoms...." (Quran 24:30,31).

Some people, especially in the West, would tend to ridicule the whole argument of modesty for protection. Their argument is that the best protection is the spread of education, civilised behaviour, and self restraint. We would say: fine but not enough. If 'civilization' is enough protection, then why is it that women in North America dare not walk alone in a dark street - or even across an empty parking lot ? If Education is the solution, then why is it that a respected university like Queen's has a 'walk home service' mainly for female students on campus? If self restraint is the answer, then why are cases of sexual harassment in the workplace reported on the news media every day? A sample of those accused of sexual harassment, in the last few years, includes: Navy officers, Managers, University professors, Senators, Supreme Court Justices, and the President of the United States!
The following statistics, written in a pamphlet issued by the Dean of Women's office at Queen's University:
* In Canada, a woman is sexually assaulted every 6 minutes,
* 1 in 3 women in Canada will be sexually assaulted at some time in their lives,
* 1 in 4 women are at the risk of rape or attempted rape in her lifetime,
* 1 in 8 women will be sexually assaulted while attending college or university, and
* A study found 60% of Canadian university-aged males said they would commit sexual assault if they were certain they wouldn't get caught.

Something is fundamentally wrong in the society we live in. A culture of modesty is badly needed, modesty in dress, in speech, and in manners of both men and women. Otherwise, the grim statistics will grow even worse day after day and, unfortunately, women alone will be paying the price. Actually, we all suffer but as K. Gibran has said, "...for the person who receives the blows is not like the one who counts them." Therefore, a society like France which expels young women from schools because of their modest dress is, in the end, simply harming itself.

It is one of the great ironies of our world today that the very same headscarf revered as a sign of 'holiness' when worn for the purpose of showing the authority of man by Catholic Nuns, is reviled as a sign of 'oppression' and possible 'suicidal attackers' when worn for the purpose of protection by Muslim women.
Sherif A A, Ph.D.

Malaysia - Your preferred healthcare destination?

A Malay girl: pretty, polite & quiet





Logically Malaysia should do well with Middle Eastern medical tourists. And why not?

Among the factors working to Malaysia’s advantage, are its cost-competitiveness compared to the regional and international markets, the good infrastructure, and the fact that English is widely spoken. It has highly-trained and skilled medical personnel, state-of-the-art diagnostic equipment, modern facilities, accreditation based on international healthcare standards, competitive cost of treatment, and excellent hospitality.

But although Malaysia is an Islamic country, tourists from the Middle East make Thailand and Singapore their choice of destination over Malaysia when it comes to getting medical treatment, said a top Malaysian official.

“Although we have the clear edge in terms of religion, Muslim hospital staff, halal food and other aspects, Middle East tourists prefer to go to Thailand and Singapore. Due to this, the country continues to be left far behind the two neighbouring countries in the sector which is growing annually.’ Making this statement, Secretary General of the National Chambers of Commerce and Industry Malaysia (NCCIM), Datuk Syed Hussien Al-Habshee said the lack of effective marketing strategy was the reason for Malaysia being left behind the two countries in medical tourism. He says that in 2008 6,000 medical tourists from the Middle East went to Thailand for various forms of treatment in the country's hospitals.

Syed Hussien argues that there is an urgent need for more integrated strategies from government agencies. The three ministries involved, namely the Ministry of Health, Ministry of International Trade and Industry and Tourism Ministry should have a strategy to promote and market Malaysia as a premier medical tourism destination, rather than leaving it all to the private hospital sector, he said.

A recent study by the National University of Singapore shows that the process of transforming Malaysian healthcare into a global commodity is well under way. This is underpinned by the Government’s effort in institutionalising various incentives such as tax support, accreditation, sales promotion and marketing activities to promote the country as a healthcare hub. The report echoes Syed Hussein as it says that the initiatives are fragmented and that the private healthcare sector has been tasked to be the driver of medical tourism in Malaysia.

Malaysian hospitals are known for their resources and expertise in cardiology, orthopedics, cancer treatment, fertility treatment, and reconstructive surgery. What it is poor at is integrated marketing, promotion and advertising. The private sector has 230 private hospitals and 4000 medical and dental clinics. 35 private hospitals have been recognised by the Malaysian Ministry of Health for the promotion of health tourism.

As a step to promoting itself in the Middle East, The Ministry of Health and the Association of Private Hospitals of Malaysia (APHM) recently took ten leading providers of medical care, wellness, health tourism and healthcare technology to MSE 2009, a trade exhibition in Dubai, with a forum on 'Malaysia - Your preferred healthcare destination'.

After achieving JCI status, Prince Court Medical Centre (PCMC) in Kuala Lumpur wants to become a leading healthcare provider in Asia and promote medical tourism, says chief executive Stuart Rowley, "We are targeting the Asian region, Middle East and there is a lot of existing demand coming from Australia and New Zealand for medical tourism."

Indian Singaporean

Pirated DVD seller in Singapore






Prostitutes lined up waiting for johns, Singapore Red Light District





Private sector eyes opportunities abroad

The private sector of Singapore’s medical tourism industry is looking beyond the Lion City to grow their business.

ParkwayHealth, controlled by the US-based private equity firm Texas Pacific Group (TPG), has plans to set up several multispeciality hospitals in India.

The group is also tying up with some of the leading healthcare providers in India apart from its plans to build hospitals on its own.

Currently, it has an agreement with Apollo Hospitals Group and has bought a 50 percent stake in the Khubchandani Hospital in Mumbai that is jointly owned by the Mauritius-based Koncentric Investments.

ParkwayHeath plans to initially invest approximately US$83 million in Khubchandani Hospital. Starting with five or six hospitals in large cities, the former has plans to set up 300-400-bed multispeciality hospitals all over the country.

The Khubchandani Hospital, which will be a 1,000-bed facility, is expected to be operational by 2011. The agreement with Apollo Group is intended to help ParkwayHealth develop hospitals across West Bengal. This joint venture currently runs Apollo Gleneagles Hospital, a 325-bed multispeciality hospital in Kolkota. This hospital will cater to Eastern India and neighbouring countries like Bangladesh, Myanmar, Nepal and Bhutan.

Another group that believes while some patients will come to you, you can get many more by going to them is Singapore Medical Group (SMG).

SMG originally entered the medical tourism market through the Lasik Surgery Clinic (LSC), a specialist centre that treats myopia.

The company's business model, which draws a clear line between management and medicine, has been so successful that SMG has exported the model to the Philippines. LSC Manila is a joint venture with STI Dela Santos, which owns the largest nursing school in the Philippines in Alabang. SMG operates LSC Alabang with Bumungrad Thailand, while LSC Angeles City is a joint venture with Angeles University Foundation.

“Although it is not a traditional market for Singapore companies, the Philippines is an English-speaking country of 85 million people and refractive surgery is in its infancy. No, we rank No. 1 there in volume with all three LSC clinics combined,” said SMG founder Dr Cheryl Baumann.

After lasik surgery, SMG pioneered sports medicine in Singapore by partnering with Changi General Hospital to set up the Singapore Sports Medicine Centre. SMG then went on to open The Dental Studio, focusing on cosmetic dentistry, the Singapore Aesthetic Centre, which offers weight management and dermatology treatment, Singapore Vision Centre for patients with eye conditions other than myopia and oncology in The Cancer Centre. This year, SMG expects to establish presence in Japan, China and Vietnam.

MALAYSIAN ROBUST MEDICAL TOURISTS

Malay girls

Old Kuala Lumpur road scene

MALAYSIA: Study says medical tourism to remain robust

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

The majority of medical tourists to Malaysia seek curative medical treatment instead of aesthetic purposes, it said in its research note.

“Based on this fact, we believe demand for medical tourism in Malaysia will remain resilient as patients with a medical condition will seek treatment regardless of whether there is a recession or not, although those considering treatment for aesthetic reasons may defer their decision,” the OSK study said.

OSK Research predicted Malaysia could gain from the slowdown given the competitive advantage over the main competitors, namely Singapore and Thailand.

Since Indonesians formed the biggest number of medical tourists to Singapore and Malaysia, the slowdown might result in some Indonesian patients seeking treatment in Malaysia rather than in Singapore because of the former has cheaper cost.

“We believe Malaysia will always have a price advantage over Singapore unless Singaporean players adjust their pricing drastically - which we believe is highly unlikely, due to the higher labour and operating costs,” it noted.

Also, it noted that the recent turmoils in Thailand provided an opening for Malaysia to raise its profile as an alternative destination for medical travel.

“Our discussions with the major players in Bangkok indicate that they have not seen any sign of recovery in the sector as a large number of its foreign markets such as the United Kingdom, the United States, Canada, New Zealand and Australia are still warning their citizens against travelling to Thailand due to high political risk,” OSK Research said.

Nevertheless, Thailand expects the recovery to come in the second half of 2009 once the political landscapestabilises, it added.

“This situation offers great opportunities for Malaysia to capture some of Thailand's market share in medical tourism given that Malaysia offers comparable services at competitive prices," the OSK study stated.

Malaysia is also eager to woo medical tourists from the Gulf. Apart from the low cost of procedures in Malaysia, the government offers discounted tickets to family members of patients travelling to the country.

Syed Muhadzir Jamallulil, head of Tourism Malaysia in Dubai said: "There are a lot of facilities in Malaysia that can take care of the medical needs of travellers from the Middle East. They are much cheaper than the Gulf."

Malaysia is fast emerging as a value-for-money destination for medical tourism, thanks to its world-class health and medical facilities, said Frost & Sullivan Asia-Pacific healthcare practice consultant Tham Lin Hui.

“The growing awareness about medical tourism in Malaysia will attract more foreign patients to seek treatment in the country,” she added.

AIDS/HIV in Thailand

Thai prostitutes; child prostitute

Health and Well-being

The rate of HIV infection is 50% or higher among female prostitutes in Northern Thailand. (New England Journal of Medicine, Sarah McNuaght, "Prohibition," The Boston Phoenix, 23-30 October 1997)

In 1990 there were fewer than 200 reported AIDS carriers, and only a handful of AIDS patients. By 1997, the number of reported carriers is believed to have far exceeded one million, with more than 30,000 deaths recorded in official papers. The AIDS epidemic has threatened to overwhelm at least six upper Northern provinces - Chiang Mai, Chiang Rai, Lamphun, Lampang, Phayao and Mae Hong Son. Hospitals in these provinces are usually packed with AIDS cases, who outnumber other patients. At a certain hospital ward in Chiang Rai, AIDS patients occupy 15 out of the ward's 22 beds. ("Opening our eyes to the Aids problem," The Nation, 20 May 1997)

Of 103 prostitutes tested for AIDS this year, 37.8% were HIV positive, most of them from Burma's Shan state. (Dr Sura Kunkongkaphan, Aphaluck Bhatiasevi, "Influx of Burmese sex workers via Mae Sai," Bangkok Post, 2 June 1997)

NGOs say most prostitutes come from provinces in the north; a large number after travelling to cities like Bangkok to work return to their villages once they become infected with HIV/AIDS. They in turn, infect others. AIDS is mostly transmitted through heterosexual contact. Men often get the disease from a prostitute then infect their wives who then infect their unborn children. Northern Thailand accounts for about half of the country’s 800,000 cases of HIV. (Sutin Wannabovorn, "Thai Prime Minister vows end prostitution, AIDS victims react," Reuters, 29 July 1997)

Thailand has the fourth largest number of AIDS cases in the world with nearly 60,000. This is only the number of officially reported cases and health workers say the actual number is several times higher. (Sutin Wannabovorn, "Thai Prime Minister vows end prostitution, AIDS victims react," Reuters, 29 July 1997)

More than 70% of Thailand’s returning migrants are HIV positive. The men buy women in prostitution when they are abroad. Of 500 returning migrants in Khon Kaen, more than 400 are HIV positive. Migration is a key factor in the spread of AIDS. (NGOs working on HIV/AIDS issues in Issan, recent informal sample by a doctor, IOM, Leyla Alnayak, "Returning migrants to Thailand show high AIDS incidence," Earth Times, 11 April 1998)

Since enforcement of the anti-prostitution law in December 1996, police pursue cases of child prostitution less frequently, partly because the cases are complicated. According to Professor Kritaya Archavanitkul of Mahidol University's Institute for Population and Social Research, "The police at local level do not cooperate much because the Interior Ministry has announced that police authorities will be penalized if child prostitutes are found in areas under their responsibility." (Aphaluck Bhatiasevi, "Child Prostitute Problem Worrying," Bangkok Post, 28 July 1998)

Enforcement of the Prostitution Prevention and Suppression Act of 1997 caused movement of many prostituted persons from brothels to restaurants and beer bars. This puts them out of the reach of health workers, which hampers efforts to control sexually transmitted diseases by driving prostituted persons from the mainstream red-light premises. (Aphaluck Bhatiasevi, "Vice purge hinders campaign as prostitutes go underground," Bangkok Post, 17 June 1998)

Budget cuts have forced the Communicable Diseases Control Department to cut its free condom distribution program from 45 million pieces in 1997 to 12 million in 1998. In fiscal 1999, the ministry has requested funds to buy 25 million condoms. (Aphaluck Bhatiasevi, "Vice purge hinders campaign as prostitutes go underground," Bangkok Post, 17 June 1998)

"2 million medical tourists expected by 2009?"

Thai prostitute holding a condom in Bangkok; Thai dancers

THAILAND:

Thailand expects to welcome about two million medical tourists this year, according to the Tourism Authority of Thailand and the Department of Export Promotion.

A 38 percent increase from the 2006 figures of 1.45 million was recorded. The combined revenue from the foreign patients of THB40 billion (US$1.15 billion) in 2006 is expected to rise to THB45 billion (US$1.3 billion).

Figures have been rising in recent years. In 2002, there were 630,000 medical travellers with a combined spending of THB18 billion (US$519.7 million). In 2003, the number was 973,532 with a spending of THB26 billion (US$750.68 million). In 2004, the number rose to 1.1 million with THB30 billion (US$866.17 million) in revenue. In 2005, the number reached 1.25 million with over THB30 billion (US$866.17 million) in revenue.

The figures may be correct, but critics argue that the practice of some Thai hospitals of counting one patient staying in the country going to hospital on three days, as three medical tourists, and including non-Thai outpatients (and there is a large population of resident expatriates as well a huge numbers of visitors) who only go to hospitals for prescription drugs, as medical tourists, hugely inflate the figure to as much as three times the real numbers.

The political problems of late 2008 caused a temporary hiccup. Curiously, the figures above ignore the loss of medical travellers due to political unrest. No one knows how many medical travellers were lost, but the Bank of Thailand estimates that it deterred 3.4 million tourists from visiting the country. Assuming the political problems are solved, the trend will be year-on-year increases in medical tourists going to Thailand - the disagreement is about how many.

Hospitals involved in medical tourism report some slowdown. But, despite a triple hit of political unrest, increased airfares and recession, they claim to suffer less than expected. Phyathai Hospital weathered the rough times through its focus on Persian Gulf customers. Currently, Westerners account for 5 percent of overseas patients at Samitivej Hospital, but sees more potential in the East than the West. Some Bangkok hospitals have contracts with Gulf state governments.

History of Southern Thai's Kingdom of The Malay Patani:

Following the end of the Second World War, as Malay nationalism was gathering momentum across the border and Thailand was forced by the British to give up its irredentist annexations during the war (the Shan States, Laos, Cambodia, and the northern Malay states), a group of Malay leaders in the Patani region submitted a petition to the British requesting the British Government to “have the kindness to release our country and ourselves from the pressure of Siam,” since they did not wish to “remain any longer under the Siamese Government.” For Patani, they pointed out, “is really a Malay country, formerly ruled by Malay Rajas for generations”. The year 1948 saw the establishment in Kelantan of GAMPAR, the Gabungan Melayu Patani Raya or Greater Patani Malay Association, supported by Tengku Mahyiddin, youngest son of the last sultan of Patani, which sought political union with Malaya. And the political ideology of the most prominent of the region`s separatist organizations that sprung up soon afterwards, such as the Patani United Liberation Organization (PULO), the Barisan Nasional Pembebsan Patani (Patani National Liberation Front or BNPP) and the Barisan Revolusi Nasional Melayu Patani (“Patani Malay National Revolutionary Front” or BRN), has been the national liberation of the “Patani Malays”.

The Muslims of southern Thailand are mostly ethnic Malays and speak Malay, rather than Thai. They were once part of an independent sultanate of Patani, comprising the present-day provinces of Pattani, Yala, Narathiwat, and parts of western Songkhla, that flourished from 1390 to 1902. That history as a separate political entity and the second-class status and political neglect the Malay minority has endured ever since within independent Thailand, provides the backdrop to the violence today.

Generally, the writ of the Thai kings stopped somewhere to the north of Malacca. In the 19th century, the British detached Kedah, Trengganu, and a couple other Melayu sultanates from Thailand, and joined them to Johore, Malacca, and a few others to form the Federated Malay States. For reason known only to the Brits the states of Patthani, Satun, and a couple others remained subject to Siam (then under the Chakkri dynasty, which has ruled Siam/Thailand ever since the Burmese burned Ayyutthaya in the 1760's).

The problems in southern Thailand are the results of decades of economic neglect, lack of employment opportunities for the local Muslims in both public and private sectors and cultural insensitivity of the bureaucracy. A solution to this requires greater efforts to respond and deliver to the demands of the local Malay Muslim population. This will contribute to building of peace and stability within Thailand.

Gaza crisis has implications on medical tourism

Pictures: Israel Zion women soldiers enjoying life; destruction & funeral of Palestinian children






MIDDLE EAST:

You would not dream of going to or sending customers to Iraq or Afghanistan for medical treatment. As much as hospitals, clinics and agencies protest that politics and war is not their concern, customers watch television and read newspapers. If a country seems at war or in crisis, then it is human nature to think twice and consider an alternative destination.

Thailand and India found that political unrest and terrorism did affect medical tourism numbers, and that business as usual only returns months after the end of the problem. Other countries with unstable governments or lawless areas, suffer, despite their denials, from visitors being scared away.

With hundreds of countries now to choose from, and many thousands of hospitals,clinics, spas and centres actively seeking medical tourists, it is easy to find an alternative to a troubled country.

Tourism crisis expert David Beirman, reported in eTurboNews, made some very interesting points on the Gaza crisis, which apply to tourism and medical tourism: “In 2008, Israel, the Palestinian territories, Jordan and Egypt all enjoyed record year for tourism arrivals. One of the key reasons that these four destinations enjoyed such strong tourism inflows was because there was a general perception that they all experienced relative stability during 2008.

“However, the picture for 2009 is far less optimistic, at least for the short to medium term. In 2008, the interplay of tourism between Israel, Jordan and the Palestinian territories and Egypt was positively influenced by the relatively benign security environment. Israel, the Palestinian Authority, Jordan and Egypt face a challenging 2009. The eruption in Gaza has created a whole range of perceptual and security concerns about the safety of travelling to Israel and these concerns will also apply to Palestine, Jordan and Egypt.

“To add further intensity to the challenges the global economic downturn will mean that the four destinations will switch from being the highly affordable destinations they were in mid 2008 to relatively expensive destinations. The fact that many hoteliers in the four destinations have significantly increased their prices in recent months has exacerbated this problem. A recession usually means that travel does not stop but tourists tend to gravitate to destinations closer to home or those that are very affordable. Israel, Egypt, Jordan and Palestine have all enjoyed positive growth from the discretionary travel market and will find that their longer haul markets may look elsewhere on both security and economic grounds.”

Haifa University’s Dr Yoel Mansfeld wrote some years ago that surges of conflict and terrorism had a negative impact on tourism to Israel and the immediate region. And in his analysis, peaks and troughs in international tourism arrivals to Israel were heavily influenced by the perceived security environment. Many agencies and hospitals promote their services as medical treatment with a cheap holiday. So when the holiday trade gets hit, so will the medical tourism trade.

Hospitals and agencies in regions hit by war, terrorism and political unrest have mostly failed to connect with consumers on their concerns. Websites remain unchanged. In a period when medical tourists are less certain of their ability to pay for treatment, political problems can be the tipping point that makes them change destinations or even stay at home.

Medical tourism needs to find ways of satisfying real or imagined customer concerns. Your hospital may be hundreds of kilometres away from troubled areas, but customers’ geography is very hazy.

INDIA Medical tourism...still lagging behind South East Asia

INDIA: Medical tourism need to grow by 2015

The Associated Chambers of Commerce and Industry of India (ASSOCHAM) has predicted that medical tourism will grow between 22 and 25 percent in 2009 and will start to have an annual growth rate of 30 percent from 2010 to reach the size valued at about Rs95 billion by 2015.

Currently, the size of medical tourism in India is measured at Rs15bn. ASSOCHAM estimates that India is poised to become an epicentre for medical tourism from throughout the world.

ASSOCHAM says that at least a six -fold (!!) increase is anticipated in the size of medical tourism by 2015, and worldwide patients will make India as a preferred choice for medical treatment because of cost (??).

Projected market value for the Indian medical tourism market is as follows: Rs15 billion in 2008, Rs19.5 billion in 2009, Rs25.35 billion in 2010, Rs32.95 billion in 2011, Rs42.84 billion in 2012, Rs55.69 billion in 2013, Rs72.40 billion in 2014 and Rs94.12 billion in 2010.

ASSOCHAM estimates that the cost of surgery in India can be one tenth of what it is in the US and Western Europe and sometimes even less. A heart-valve replacement that would cost US$200,000 or more in the US for example, goes for US$10,000 in India and that includes round-trip air travel. Similarly, a metal-free dental bridge worth US$5,500 in the US costs US$500 in India.

The Chamber has estimated that 180,000 foreigners visited India for treatment from various parts of the world in the eight and half months since April 2008. It expects the number will increase between 22 to 25 percent this year.

If ASSOCHAM is correct, this would put the current number of medical tourists to India at 270,000 a year from now, 670,000 by 2012, and 1.3 million by 2015.

Medical tourism in Israel in peril

ISRAEL: Boom in medical tourism in peril

Medical tourism in Israel will total NIS 160 million in 2008, compared with NIS 100-110 million in 2007, according to a study by The Center for Academic Studies at Or Yehuda.

The survey claims that 48 percent of the patients came from Eastern Europe, mostly Russia and Ukraine; 37 percent came from Jordan, Cyprus, Turkey, the Palestinian Authority, and other neighbouring countries; and, 14 percent came from the United States and Western Europe.

Sixty-five percent of the patients came to Israel for complex or risky surgical treatments and 35 percent came for various cosmetic treatments.

This contradicts long-standing figures from the country’s tourist board that the main market is Germany. The economic crisis is expected to reduce the number of cosmetic surgical treatments of foreign patients in 2009. Recent attacks on Gaza will make Westerners wary of planning trips in a country at war.

Widely circulated press reports on the study omitted certain crucial information that throws serious doubt on the study’s accuracy.

Although there are over forty medical tourism and travel agencies promoting medical and health tourism, and scores of hospitals and clinics seeking business, the study only interviewed 100 patients in three centres; Hadassah Medical Organization in Jerusalem, Tel Aviv Sourasky Medical Center (Ichilov Hospital), and Tel Hashomer Medical Center.This very unscientific sampling technique shows yet again why you have to be very wary of widely circulated reports on country statistics.

Russia is increasingly becoming the major source of tourists to Israel. Tourism from Russia has grown steadily since September, when Israel waived its visa requirement under a reciprocity agreement with Moscow. The two countries launched direct charter flights from Eilat to Moscow and St Petersburg just last month.

To date, the Israeli government has taken no action to promote or to curb medical tourism and has allowed the industry to develop undeterred and unregulated. According to government spokespeople, 15,000 foreigners came to Israel's hospitals for treatment in 2006. The number of foreign patients grew to 20,000 in 2007. The figure for 2008 is expected to be 30,000.

Entrepreneurship to change US healthcare market

UNITED STATES: Entrepreneurship to change US healthcare market

The US healthcare market does not work like other markets. Because health care costs are usually paid for by a third party – either by the insurance provider or by the government, patients are not price-sensitive and providers don't feel the need to compete for their business.

“Lack of competition results in a highly artificial market plagued by problems of high costs, inconsistent quality and poor access,” said Devon Herrick, senior fellow with the National Center for Policy Analysis (NCPA).

Herrick is the author of the report entitled Health Care Entrepreneurs: The Changing Nature of Providers published by the NCPA last month.

But in healthcare markets where patients pay directly for all or most of their care, providers almost always compete on the basis of price and quality.

Herrick cited the following:

• Cosmetic surgery: Since it is rarely covered by insurance, patients pay out of pocket and are sensitive to prices. They typically compare prices before surgery and pay a price that has been falling over time in real terms.

• Laser eye surgery: Competition is holding prices in check and improving quality in vision correction surgery, including accurate correction, faster healing, fewer side effects and an expanded range of conditions that can be treated.

• Medical tourism provides cash-paying patients healthcare outside of the US in high-quality facilities that rival domestic facilities. Patients can save 30 to 50 percent by going abroad.

What lessons can be learned from these examples of entrepreneurship in healthcare?

“The most important is that entrepreneurs can solve many of the healthcare problems that critics condemn,” said Herrick, adding that Public policy should encourage, not discourage, these efforts.

NCPA is a non-profit, non-partisan public policy research organization established in 1983. The NCPA's goal is to develop and promote private alternatives to government regulation and control, solving problems by relying on the strength of the competitive, entrepreneurial private sector.

According to the latest official statistics, 7 million Americans have their own annual individual health insurance, four million more buy short-term cover, 83 million are covered by government schemes and 45.7 million have no health insurance at all. The figures for employer health insurance are confusing as they integrate policies paid fully by the employer with policies paid for only by the employee under a group offering.

www.ncpa.org

MALAYSIA Online portal helps increase foreign patients

Despite the global economic downturn, Malaysia expects to see a 28 percent rise in foreign patients seeking medical treatment in the country.

Among the reasons cited is the establishment of a one-stop medical and tourism online portal that facilitate all needs of overseas-based patients be it consultation, treatment, accommodation or tours.

MalaysiaHealthCare.com (MHC) chief executive officer Suresh Ponnudurai said the country would continue to attract health tourists from countries such as Indonesia, Singapore, Bangladesh and Japan and those from the Middle East and Europe.

“Malaysia is one of the region’s centres of medical excellence owing to its quality and affordable facilities and services. About 360,000 health tourists visited Malaysia in 2007, a 20 percent increase from 2006. The use of technology and the internet has positioned the healthcare industry as one of the best in the region.”

Malacca received more than 64,000 medical tourists last year, mostly Indonesians, and was ahead of Penang, Federal Territory, Johor and Selangor. The numbers are expected to increase after the upgraded Batu Berendam Airport opens to bring in tourists from neighbouring countries. Also, a 300-bed private hospital Straits of Melaka Specialist Centre will be developed in Klebang within the next two years.

MHC acts as a channel to network, integrate, facilitate and manage all aspects of health and medical tourism for health tourists and service providers such as hospitals, travel and insurance agents, airlines and hotels. Medical tourists can schedule their treatment and holidays by making online bookings for services.

The country’s Health Ministry will be launching a special website on health tourism next month to disseminate information worldwide on the Malaysia’s medical tourism industry.

Health minister Datuk Liow Tiong Lai said the website will include information on the medical facilities and specialist services available, as well as the payment rates, to make it easy for those interested to seek treatment in Malaysia.

He added the ministry will indirectly help private hospitals in the country attract tourists who wanted quality medical treatment and healthcare.

In line with the government's aim of developing the medical and health-based tourism sector, the ministry held a promotion drive and briefing in Indonesia and Vietnam last year. These promotional efforts will be extended in 2009 to several other countries including Australia.