Birth Tourism as Part of Medical Tourism

..don't just look at me you fools: TAKE ME TO THE USA STAT






Turkey is seeing more outbound health tourism in a special niche sector.

With more Turkish parents wanting their child to be born in the USA, tourism companies are starting to offer birth tourism packages to US cities. Many women say giving birth in the USA has benefits including cheaper education and fewer visa worries. Some Americans want to restrict the practice, citing fears of illegal migration.

12, 000 Turkish children have been born in the USA since 2003.The numbers are significant enough to draw the attention of tourism companies and inspire them to pursue birth tourism. The Turkish-owned Marmara Hotels group has a new birth tourism package that includes accommodation at their Manhattan hotel. Levent Baş of Gurib Tourism says, “We have been involved in medical tourism since 2002, but we were also receiving so many demands about this issue that we decided to sell birth packages. We first started our research in New York City, Los Angeles, Chicago and Orlando and we only contacted Turkish doctors. We are preparing a package that covers everything from the flight and city tours to accommodation for several months and hospital expenses.” The minimum cost is $25,000, which rises to $40,000 if the destination is New York.

Many women abroad wish to give birth in the USA, as according to the U.S.’s 14th Amendment, the country grants citizenship to anyone born on its soil. But right-wing politicians want to change the law. Republican Congressman Gary Miller is co-sponsoring a bill that seeks to abolish birthright citizenship for children born in the country to illegal immigrant parents,” They come to this country and have babies. The children are citizens. The children are eligible to go to school. They receive food stamps and social programmes. The American taxpayers are paying for it,"

While it can be controversial, birth tourism is legal in the U.S. and not just popular in Turkey but also in Asian countries such as South Korea, Hong Kong and Taiwan. Many South Korean parents-to-be have chosen to give birth in the U.S. for many reasons, ranging from a desire to enroll their children in American schools to enabling them to avoid South Korean military service.

The birthright citizenship formerly applied in other countries such as the United Kingdom and Australia but both countries modified their law in the mid-1980s. India maintained a birthright law until 2004, but ended the right to prevent continued illegal immigration from neighbors Pakistan and Bangladesh.

Turkey expects growth in health tourism from Gulf states

Right: Yalova, Turkey

TURKEY:
Despite the world’s financial crisis, which had a severe effect on the international tourism sector, the number of Gulf states tourists selecting Turkey as a destination has increased in 2009 by 16.45%. 27m tourists from around the world visited Turkey during 2009. Out of the entire world, Arab tourists have made the biggest increases, led by Kuwait, and followed in order by United Arab Emirates, Bahrain, Saudi Arabia and Qatar. Turkish tourist authorities are running advertising and promotional campaigns in the Arab world for 2010.These will focus on introducing and marketing Turkey as a health and medical tourism destination. Turkey has a reputation of being one of the countries that has advanced medical services with relatively reasonable rates and the ability to carry out complex medical operations such as open-heart surgery.

The Turkish Government has recently offered a number of investment opportunities and facilities to invest in the medical and health tourism sector for both Turkish and foreign investors where they can build health and spas near natural and thermal springs. According to official statistics, over 200 health and spa centers will be built as per this plan. Afyon City has five resorts by mineral springs and has been selected as a model city and future capital for mineral springs’ tourism.

A new government long-term plan from 2010 to 2023, aims to sustain health and medical tourism in order to make best use of the unique natural wealth that the country has. The government wants to attract more Arab tourists, particularly as a health and medical destination. The cultural and geographical closeness to these countries means these tourists prefer to come to a country that appreciates the Islamic culture. Favourite cities are Istanbul, Yalova, Bursa, Bodrum, and Antalya.

Malaysia promoting health tourism from Brunei and Singapore

A mosque in Brunei (right pic)

MALAYSIA:
Malaysia is keen on promoting medical tourism in Brunei. Ooi Say Chuan of the Malaysia Healthcare Travel Council advises, “In 2008, we had 370,000 foreign medical tourists so this actually speaks a lot of the number of tourists who placed their trust in Malaysian healthcare services. We want to discuss with the Bruneian government the use of Malaysian hospitals as an option. I think it is more than just the price. The patients who come want to feel at home and in Malaysia we are multilingual. Our staff speak Bahasa Malaysia, English, Chinese or Tamil so people in the region are actually quite comfortable staying in Malaysia hospitals. Also, being an Islamic country you can have halal food. All hospitals can accept international patients but the government has taken a stand to promote 35 hospitals whom we feel will be able to meet the demands of international patients well. We want them to have accreditation under the Malaysian standard for quality in health, so when they market to our clients abroad they can be assured that these hospitals are accredited.”

The aim is to establish an understanding between the two countries similar to the one that Brunei shares with Singapore. Recently, the Singapore government made an announcement allowing Singaporeans to use their national insurance to pay for healthcare. This allows them to go to Malaysian hospitals that are referred through Singaporean facilities. It is an initiative taken by the Singaporean government.

Bruneians who go to Malaysia often seek treatment for cancer, heart bypass and orthopaedic according to hospitals. Pantai Hospitals recorded 100 Bruneian patients seeking treatment in 2009 all its 10 hospitals. TMC Fertility Centre had eight Bruneian patients and is looking to increase the figure


Gleneagles Intan Medical Center in Kuala Lumpur is among the 12 Malaysian private healthcare providers to benefit from Singapore's Ministry of Health (MOH) move to allow its citizens to use their compulsory medical savings or MediSave, to pay for private care aboard from March. Previously, Singaporeans, permanent residents and their immediate families could only use the MediSave for emergency hospitalisation. But it can now be used for hospitalisation and day surgeries but not for outpatient treatment.

The MediSave scheme will start off with two healthcare providers, Health Management International (HMI) and Parkway Holdings.HMI has set up its local MediSave accredited referral centre at its Balestier Clinic and Health Screening Centre. It will work with its two overseas subsidiaries, Regency Specialist Hospital in Johor Bahru and Mahkota Medical Centre in Malacca. Parkway Holdings has established a MediSave accredited referral centre at East Shore Hospital. It will partner nine hospitals of Pantai Holdings in various Malaysian states, as well as the Gleneagles Intan Medical Center. Gleneagles will tie up with FireFly and Holiday Tours and Travel, to provide further cost savings and coordinated medical travel for Singaporeans seeking treatment at the hospital. Patients interested in making use of the scheme can approach the two healthcare providers direct. Currently, Singaporeans makes up to 10 percent of health tourism for all hospitals in Malaysia.

USA: physician practices are sinking

A Cadillac Eldorado (right pic)

As more and more patients can’t pay their medical bills or see the doctor only when absolutely necessary, more physician practices are sinking economically. This factor, much more than government pressure to buy electronic health records, is what’s forcing a growing number of physicians to give up private practice and go to work for hospitals.

David Boles, a family physician in Clarksville, Tenn., isn’t one of them, but his practice is having an increasingly hard time. “We’re dying, man,” he tells BNET. “It is hard out here right now.” Although there’s been a bit of an uptick in business recently, he says, “last year the number of patient visits was way down. What people are doing is they’re saving up bunches of things to talk to a doctor about in one visit. So they’re decreasing their number of visits per year. Patients come in for the follow-up on five chronic conditions and they want their preventive exam done the same day. And if a physician spends an hour with a patient, he can’t be paid enough by the insurance companies to warrant an hour’s work.”

This isn’t an isolated complaint. One cardiologist told The New York Times that his practice was unable to collect anything from 30 percent of its patients because their out-of-pocket expenses for healthcare were so high. And it’s estimated that, overall, about 30 percent of people under 65 are either uninsured or have a “high burden” of health costs, defined as exceeding 10 percent of their incomes.

This statistic comes from a Health Affairs study that looked at the increase in Americans’ out of pocket health expenses from 2001 to 2006. During this period, the study showed, the percentage of people with high out of pocket expenses — including premium costs for those who were insured — rose from 14 percent to 19 percent. Given the big increase in insurance and healthcare costs since then, and the rising number of uninsured, that percentage is probably much higher today.

Another key finding of the study is that increasing out of pocket costs hit insured middle-income people the hardest. While that’s counterintuitive, it reflects the fact that the poor get much less care than middle class people do. If you’re uninsured and you don’t see the doctor until you hit the ER with a serious problem, your out-of-pocket medical expenses aren’t that high. Neither, though, is your life expectancy.

What’s really sobering is that even an economic turnaround won’t help many people afford healthcare, the researchers say:

A return to robust economic growth and declining unemployment alone will not reduce the financial stress on Americans resulting from high health expenditures. Although attention has been focused on rising health care costs, the fact that real median household income remained largely unchanged between 2000 and 2007 — hovering at about $50,000 — was an equally important contributor to increasing financial burden. To stop and reverse the ongoing increase in the number of families with high health care cost burden, strong economic growth must be accompanied by both increases in family incomes — which have been rare during this decade — and more moderate increases in health care costs.

So here’s the Catch-22: To hold down out of pocket health expenses — a key problem for patients and physicians alike — the economy must grow fast enough not only to increase employment but also to raise wages. Yet the stubborn problem of health spending growth is one of the main factors depressing wages and limiting job expansion.

INDIA: Health tourism positives and negatives from India

Jupiter Hospitals that runs a 200-bed hospital in Thane will launch its first hotel, Fortune Park Lakecity, very soon. The group has signed Fortune Park Hotels to manage and market of the hotel. Jupiter Hospital is looking for similar hospital/hotel projects in Southern India. The ten-storey Fortune Park Lakecity will have 94 rooms, 58 in the first phase. It will have four categories of rooms including standard, fortune clubroom, executive suite and deluxe suite, a multi-cuisine vegetarian restaurant ‘Rainbow’, banquet, boardroom and a private dining room. In the second phase Fortune Deli, a lounge; health club; swimming pool; gymnasium and health super market will be operational. The hotel will also have a spa, which will be developed as phase three.

Dr Ajay Thakker of Jupiter Hospitals says, “Everybody speaks about promoting health tourism in India but hardly any one thinks about the infrastructure to support it. India has the best of medical services but it has to be backed up by good infrastructure and accommodation for patients. So we thought of building a hotel within the hospital premises.” The hospital will account for 25-30 per cent of the hotel’s business. Apart from the hospital clientele, the hotel will cater to business and corporate client since this area is surrounded by many businesses. It will also introduce a new concept, Health Super Market, selling health and sports equipment and drinks.

As part of its expansion plans, Wockhardt Hospitals (WHL) is planning to open four new super speciality hospitals in the next three years after clearing its debt by selling ten hospitals with 1900 beds to Fortis Healthcare. WHL still has ten super speciality hospitals with 1200 beds. It is planning to open four new hospitals with a total of 1000 beds in the next three years in Mumbai, Bhopal, Jabalpur and Patana. Fortis now has 39 hospitals across India, including 6 in Bangalore, 4 in Mumbai and 3 in Kolkatta.

Following the terrorist bomb blast that killed nine people at the German Bakery in Pune, a restaurant frequented by overseas tourists, tourists have been advised to take maximum precautions, while travelling from, to or in any Indian city. Pune is a medical tourism destination for surgery, cosmetic surgery and dentistry. The US, the UK and Australia have issued travel advisories to their citizens to maintain a high level of vigilance, be aware of local events, and take the appropriate steps to bolster their personal security, as no city in India can now be regarded as safe.

Euthenic Group wants to promote medical tourism in Orissa and set up a 1000 bed-super speciality hospital in the state. After completion of the private-public project in 2013, the American group will hand over the hospital to the state government. The company argues that the state can earn foreign exchange through medical tourism. The health ministry has asked the company to submit a detailed project report to the state government as early as possible.

Medical Tourism - Singapore vs USA: Singapore Lost

USA: Corporate medical tourism expanding within the USA but not overseas

Over the last two years there have been hundreds of articles looking at the potential of insurer paid employer arranged medical tourism for US businesses. Most have used the case of Hannaford Brothers to illustrate the potential for overseas hospitals. Hannaford has indeed encouraged medical tourism, but not outside the US. Three years ago, the Hannaford Brothers grocery chain became one of the first employers in the USA to encourage workers insured under the company health insurances to go abroad for medical care. Their insurer is Aetna, who used this as a pilot exercise. Aetna is now rather dismissive of the potential of insurance paid overseas medical tourism, and has no plans for more pilots or to offer it to any of their millions of insured. The original offer was that employees who flew to Singapore to have joint replacements did not have to pay any out-of-pocket expenses. Plus the company would cover travel costs for both the employee and a companion. Aetna agreed that if hospitals locally wanted to be able to match the quality that could be provided at the Singapore facility, and the cost-effective care that could be rendered there, that they also should be eligible to participate. St. Mary's Hospital in Lewiston agreed a package rate comparable to what Hannaford would have to pay in Singapore, when major travel expenses are factored into the equation. So far, 10 people covered by Hannaford have taken the grocery chain up on its offer. A hospital in the Boston area is also participating. Nobody has gone to Singapore. St. Mary's is in talks with other major employers who are interested in making an arrangement similar to the one it has with Hannaford.

The conclusion is that US domestic corporate medical travel is expanding quickly, but the reality of sending employees overseas remains a stagnant backwater in the flow of medical tourism and predictions that American corporate and insurer paid medical tourism would be substantial, have been dealt a body blow by one large national employer agreeing to send all those needing heart surgery to one Cleveland hospital.

For four years, some agencies and experts have been predicting that it is only a matter of time before businesses and insurers send thousands of Americans overseas for surgery. Hannaford Brothers, often mentioned at conferences as a prime example of a company that has agreed to pay for employees going overseas, has in three years sent nobody overseas. A handful of smaller firms have agreed deals and sent the occasional person overseas, but most of the deals are when a company is close to the Mexican or Canadian border or mainly employs immigrants who want to combine treatment with a trip home to families in countries such as India.

Whilst corporate medical tourism evangelists continue to sing the same song, those who have arranged actual deals advise that only a small minority of companies will take up the offer, and while some employees will accept overseas treatment, other companies are finding nobody taking the option. Companion Global Healthcare has increased the number of companies contracted to provide medical travel benefits, but few employees are taking advantage of the benefit. WorldMedAssist is reported as seeing a similar trend.

Lowe's Companies Inc. decided to shop nationally for the best deal in heart surgery for its employees. The USA’s second-largest home improvement retailer reached a three-year agreement with the Cleveland Clinic. The move could spur others to shop far and wide for medical treatment. This is the first time a multistate national company has chosen one specialist hospital and made it available to employees.

Lowe's is offering incentives to employees in the form of reduced out-of-pocket costs to go to Cleveland for heart procedures. Lowe's chose Cleveland Clinic from five hospitals nationwide in an effort to improve the quality of medical care for its workers and to lower costs, with a package price for doctor and hospital services. Based on past claims, Lowe's estimates that some 125 patients a year could take advantage of the programme. Patients must be approved for surgery in advance. The arrangement is attractive enough that Lowe's will pay travel and lodging expenses for patients and a companion, and waive a $500 deductible and other out-of-pocket costs.

Last year the hospital performed a record 4,128 heart surgeries and 44% of heart and chest surgeries patients were from outside Ohio. Michael McMillan of Cleveland Clinic comments, "The thing we will want to demonstrate together is that by an employee traveling to a place with better outcomes, fewer re-operations and lower complication rates, over time it will lead to lower costs."