PART 3: States of Competition

11 Feb

The continuous loss of medical revenue to overseas destinations pushes more U.S. hospitals to match the low foreign prices in different ways.

World Health - Infographic courtesy of http://www.1.bp.blogspot.com

Late in 2008, with the U.S. dollar still down over 13% against other foreign currencies over the last three years, foreigners were benefiting when they sought elective medical care in the U.S. This benefited clinics and hospitals that cater to medical tourists.

“You don’t have to look any further than this spa and cosmetic surgery center in West Palm Beach, Florida. From the waiting rooms to the treatment rooms, international patients come here from Europe, Asia, and Latin America,” said Yastine.

Innovative state legislators in West Virginia and Colorado have introduced bills to their respective state legislatures that would offer incentives to state employees to take advantage of the costs savings available through overseas medical care. Other states are joining the parade.

Texas

Dental Tourism - Infographic courtesy of http://www.sanedentist.com

The Methodist Healthcare System in Texas has been marketing to recruit rich Mexicans to for medical procedures. Texas Medical Center recorded some 5.5 million total patient visits in 2008, including domestic and international patients.

The Anderson Cancer Center in Houston treated more than 79,000 patients who traveled there for care, 9,000 of which come from outside the Houston area.

Illinois

Several hospitals in the Chicago area extend substantial price breaks automatically to anyone without medical coverage. Others will give them to anyone who asks.

Under the Knife - Infographic courtesy of http://www.images.visworld.com

Rush University Medical Center, for instance, will reduce hospital bills by 50 percent for any uninsured patient, regardless of their income or assets. Loyola University Medical Center for poor and low-income patients are typically much more generous. The Illinois-based Healthplace America helps self-insured employers to save money via medical tourism within the U.S.

The company works with employers, teachers’ unions and large corporations. The company provides each patient with a care manager to collect medical records, schedule appointments, make travel and lodging arrangements and organize post-procedure follow-ups.

As well, the patient saves money as travel and associated expenses are covered, there are no deductibles, no co-pays, and no co-insurance. Patients choose from a network of 15 U.S. hospitals for hip and knee replacements, coronary artery bypasses and spine surgery. Insurers used to pay for service after surgery but the company helps them save up to 50% by paying cash up front.

Pennsylvania

The Philadelphia International Medicine (PIM), a medical consortium to attract foreign patients, includes the University of Pennsylvania Medical Center, Temple University Hospital and Children’s Hospital of Philadelphia, which treated some 5,000 patients from the Caribbean, Middle East and Brazil in 2006.

Affluent patients pay cash upfront for surgery and routine health checkups in large medical centers with concierge services that cater to traveling families banking, dining and shopping desires.

Also contributing to Philadelphia’s medical tourism are nine medical facilities – including Mayo Clinic, Johns Hopkins, Cleveland Clinic and Texas Medical Center – which treated over 30,000 patients from more than 100 countries in Europe, Latin America and the Caribbean.

These patients brought over US$60 million into Philadelphia’s economy in 2005 alone.

Johns Hopkins Medicine International has 40 full-time and 45 on-call interpreters. Cleveland Clinic has 35 staff interpreters and Texas Medical Center has at least 10 full-time interpreters and 25 bilingual staffers. Johns Hopkins Hospital recorded over half a million total patient visits, including domestic and international patients, and the Cleveland Clinic over 3 million in 2008.

The University of Pittsburgh Medical Center recorded over 3 million total patient visits in 2008, including domestic and international patients.

Minnesota

Mayo Clinic in Minnesota has at least 38 fulltime interpreters and 25 on-call employees. Mayo Clinic recorded around 150,000 total patient visits in 2008, including domestic and international patients.

New York

Cornell Medical School recorded some 2 million total patient visits, including domestic and international patients in 2008, while the Memorial Sloan-Kettering Cancer Center recorded around half a million total.

North Carolina

The 2008 Deloitte report shows that Duke University School of Medicine recorded almost 1.5 million total patient visits, including domestic and international patients.

Florida

The Greater Miami Convention and Visitors Bureau promotes Florida as a medical tourism destination. Although most foreign patients are charged higher rates than U.S. patients, business was good.

In 2008, Miami treated 12,000 foreign patients from 100 foreign countries. Florida International University Medical School, Baptist Health, Jackson Memorial, the University of Miami Hospital and Mercy hospital are among those who compete with foreign medical tourism destinations, each with their own marketing programs, live webcasts from operating rooms, and regional medical conference representatives.

Orlando, which hosted over 200 medical meetings with 170,000 attendees in 2008, now promoting medical facilities such as Medical City, a 7,000-acre medical complex at the University of Central Florida Medical School.

The Center for Natural & Integrative Medicine includes an 87,000-square foot, 126-room hotel with health screening, spa, and detoxification services, one of the several clinics that offer alternative and integrative procedures such as Vitamin IVs, Hyperbaric Oxygen Therapy, and Ozone Therapy among other alternative wellness programs.

Each year, thousands of international patients go to Jacksonville’s Mayo Clinic and the University of Florida Proton Therapy Institute at Shands. Florida Hospital offers cash-paying patients better rates than most HMOs and managed care plans would offer.

According to Miami Herald: “Many hospitals offer international patients discounts off the gross charges, but foreigners generally still pay more than Americans with private insurance, which generally negotiates rates of discounts of 50 to 70 percent off gross rates.”

In addition to direct discounts, some hospitals team up with banks and lenders to give patients better rates and copayments, such as the Bank of Bahamas Visa card, which gives cardholders up to 60% discounts at several hospitals.

Washington

The Shady Grove Fertility Center in Washington gave IVF treatment to over five dozen British patients in 2008, a 350% increase from 2007, according to Economic Report: Inbound Medical Tourism in the United States by said Erika Valdez and David G. Vequist IV. The IVF center teamed up with three fertility clinics and held seminars for potential donor egg patients in the UK.

Taking advantage of long wait times and the lack of anonymity and donor eggs in the UK, Brits also enjoy Shady Grove’s payments to donors and the reduced the three-year waiting time, the report said.

Maine

In January, the Maine-based company Hannaford Bros. Co. offered hip and knee replacements in Singapore to its employees.

The upfront price, a low-priced package for hip replacement is $9,000 compared to $43,000 in the U.S. Reverse medical tourism began when several U.S. hospitals offered to match the Singapore prices.

Hannaford has signed a contract with a Boston hospital for hip, knee and spine surgery, said Victoria Knight in a report in the Wall Street Journal.

Massachusetts

Harvard Medicine in Boston recorded over 2 million total patient visits in 2008, including domestic and international patients.

Massachusetts General and Brigham & Women’s Hospital received at least 4,200 medical tourists, which is 16% more than their combined figures in the past six years.

A McKinsey study estimated that 87% of Latin Americans seeking medical care abroad came to the U.S., along with 33% of Europeans seeking care outside of the European Union.

Adopting the infrastructure cosmetics used by the foreign-market oriented hospitals of Thailand, some hospitals now target their marketing programs specifically to international clients, as well as build special facilities for the treatment of international visitors.

Michigan

Since 2004, The University of Michigan Health System, Detroit Medical Center, Henry Ford Health System and St. John Health System attracted foreign patients from 11 countries via website advertising. In 2008, they engaged in more aggressive marketing, in response to foreign hospitals that heavily advertise in the U.S. to offer patients lower-cost medical care, said the Valdez-Vequist report.

NOTE: This Part 3 of a three-part article by Jaime Cabrera was first published in the international magazine Medica Tourism in December 2010.
 
SOURCES: Andi Atwater can be reached at aatwater@wichitaeagle.com. The Wichita Eagle website is at www.kansas.com. For more details about Richard Miller’s The Healthcare Business Market Research Handbook, see www.epmcom.com. For Hilary Abramson’s full report, visit http://news. newamericamedia.org. The Greater Miami Chamber of Commerce website is MiamiHealthCare.org. John Dorschner can be contacted at jdorschner@MiamiHerald. com, his full report is at www.miamiherald.com. The press archive at http://www.pbs.org contains Jeff Yastine’s report, Medical Tourists Flock to U.S. The www.john-goodman-blog.com has John Goodman’s full report, Medical Tourism Reversing Course. For Medical Tourism ~ An Economic Boost to the United States by Dr. Jose Quesada, visit http://www.medicaltourismassociation. com or contact him at jquesada3@med.miami.edu. Dale Van Demark’s report, How will the medical tourism industry in the United States develop? is at http://trusted.md. For information about Economic Report: Inbound Medical Tourism in the United States, contact authors Dr. David G. Vequist IV at vequist@uiwtx.edu or Erika Valdez at eri.valort@gmail.com. For Victoria Stagg Elliott’s More Hospitals Looking to Merge, Buy Physician Groups, visit www.ama-assn.org. For Judy Dugan’s full report, see Medical tourism: Outsourcing your health at www.latimes.com. For the full report An Overview of Medical Tourism and Its Effects on US Providers” by Dr. Maria K. Todd, visit www.floridahfma.org/documents/Maria_Todds_Mini-Handout.pdf.
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PART 2: Learning from the Competition

11 Feb

Improving medical service packages in the USA are luring local and foreign patients

USA Domestic Medical Tourism - infographic courtesy of http://www.inc.com

Hospitals in the United States are eager to keep American patients in the country, and are willing to offer much lower costs for surgical procedures such as hip and knee replacements and cardiac bypasses.

Outbound medical tourism currently represents $2.1 billion spent by Americans overseas for care, particularly elective surgical procedures, said Dr. Todd, who translates this into “$15.9 billion in lost revenue for U.S. health care providers.

To balance the revenue outflow, U.S. hospitals are offering discount-priced, world-class health care. Some US hospitals generate as much as 10% of their total revenue from international patients, and go to great lengths to attract, cushion and comfort their foreign guests, offering services far above and beyond simply healing and rehabilitating. For instance:

• The Laser Spine Institute (LSI) of Tampa, Florida, markets aggressively to domestic and foreign medical travelers. LSI’s informational seminars bear great results: nearly 70% of LSI’s patients come from foreign countries or other US states.

USA Healthcare Expenditures - Infographic courtesy of http://www.fortishospitalsblog.in

• Philadelphia International Medicine and Johns Hopkins Medicine International have as many as 40 full-time interpreters on staff to help facilitate communication between doctors and patients.

• Miami Children’s Hospital negotiates hotel rates and arranges limousine service, baby-sitting, special meals, and tours.

• The Aventura Hospital and Medical Center near Miami offers a “Weekend at Aventura” package for international executives, which includes a complete physical, three nights’ deluxe accommodations, limousine to and from the airport and shopping discounts at the nearby Aventura Mall.

• By late 2010, The Center for Natural & Integrative Medicine in Southwest Orange County (Florida) was scheduled to open a 126 room Cambria Suites hotel that will invite guests and patients to enjoy spa treatments and detoxification during their stay.

In The Wall Street Journal, Victoria Knight reports that “U.S. employers are encouraging workers to travel domestically for medical care” while other hospitals are using the deals they’ve signed with foreign hospitals in order to force U.S. to give better rates.

NOTE: This is Part 2 of a 3-part report by Jaime Cabrera; it was first published in the international magazine Medica Tourism in December 2010.
 
SOURCES: Andi Atwater can be reached at aatwater@wichitaeagle.com. The Wichita Eagle website is at www.kansas.com. For more details about Richard Miller’s The Healthcare Business Market Research Handbook, see www.epmcom.com. For Hilary Abramson’s full report, visit http://news. newamericamedia.org. The Greater Miami Chamber of Commerce website is MiamiHealthCare.org. John Dorschner can be contacted at jdorschner@MiamiHerald. com, his full report is at www.miamiherald.com. The press archive at http://www.pbs.org contains Jeff Yastine’s report, Medical Tourists Flock to U.S. The www.john-goodman-blog.com has John Goodman’s full report, Medical Tourism Reversing Course. For Medical Tourism ~ An Economic Boost to the United States by Dr. Jose Quesada, visit http://www.medicaltourismassociation. com or contact him at jquesada3@med.miami.edu. Dale Van Demark’s report, How will the medical tourism industry in the United States develop? is at http://trusted.md. For information about Economic Report: Inbound Medical Tourism in the United States, contact authors Dr. David G. Vequist IV at vequist@uiwtx.edu or Erika Valdez at eri.valort@gmail.com. For Victoria Stagg Elliott’s More Hospitals Looking to Merge, Buy Physician Groups, visit www.ama-assn.org. For Judy Dugan’s full report, see Medical tourism: Outsourcing your health at www.latimes.com. For the full report An Overview of Medical Tourism and Its Effects on US Providers” by Dr. Maria K. Todd, visit www.floridahfma.org/documents/Maria_Todds_Mini-Handout.pdf.

Medical Tourism in America (Part 1)

11 Feb

The healthcare systems of Europe, Canada and Australia find it difficult to beat the prices and quality offered in medical tourism destinations. However, the USA is fighting back.

International Medical Travel - infographic courtesy of http://www.blog.hulihealth.com

Thousands of Britons leave for medical treatment in countries such as the Philippines, Singapore, India, and Thailand each year, but the reverse is also true: foreign patients travel for medical treatment in London hospitals, particularly those with international reputations.

Some private and National Health Service (NHS) hospitals actively recruit international patients. For instance, Great Ormond Street Hospital for Children, The Princess Grace Hospital, is tapping the European, Asian and African markets.

The UK-based HCA International has offices in Lagos, Nicosia, Cairo, Abu Dhabi, Athens, Islamabad, Lahore and Karachi to promote its six London hospitals: The Harley Street Clinic, The Lister Hospital, London Bridge Hospital, The Portland Hospital for Women and Children, The Princess Grace Hospital and The Wellington Hospital.

Moorfields Eye Hospital has treated over 2000 patients since opening in 2007 in Dubai Healthcare City. There are no statistics, but the UK outflow is greater than its medical revenue from incoming patients.

This is because most English hospitals passively service only the patients that go to them. Also, the NHS’s reluctance to cooperate with international medical providers encourages domestic medical travel.

In 2008, more than 400,000 foreigners sought medical care in the U.S. and spent almost $5 billion but more than 750,000 Americans went overseas for less expensive medical treatments, said a report by Dr. Maria. K. Todd.

At an estimated average per case revenue of US$21,000, this means that 7569 U.S. hospitals lost – and overseas medical tourism destinations gained – US$15.75 million, the Todd report said.

“The number of outbound medical tourists is projected to rise to 15.75 million in 2017, representing a potential $30.3 to $79.5 billion spent abroad by Americans. As a result, the potential lost revenue for U.S. health care providers could top $228.5 to $599.5 billion,” the report said.

Americans are attracted by the much lower costs – up to 75 percent less – less waiting time, availability of treatments, better service, increasing quality of medical procedures, lure of adventure and new experiences, as well as friendlier and warmer service.

On the other hand, they must sign airtight waivers that free healthcare providers from liability for negligence or error, including the agents who arrange travel, visas, rooms and support services.

Also, patients cannot compare public data on outcomes, quality, complications and long-term recovery. Injured patients have no legal recourse.

Furthermore, some hospitals burnish their reputation via a U.S.-based hospital accreditation system, but these hospitals release no real data to help patients gauge hospital performance and quality.

Domestic legal coverage is the final safety net of patients in the USA. Patients need not fear the possible hang-ups of international legal procedures should a dispute arise.

For instance, inbound tourists who speak no English are protected by law. Title VI of the Civil Rights Act required hospitals to have an interpreter or else risk a malpractice lawsuit or a civil rights investigation “when mistakes from lack of communication result in injury or death,” Abramson reports.

The American healthcare and related service industries play on these factors to keep the dollars home, as well as the length of travel time and the psychological comforts of a familiar environment.

As a primary tactic to divert revenue to American health service providers, more U.S. hospitals are matching the prices of overseas medical procedures, particularly doctor-owned hospitals and surgeries.

DOMESTIC DEVELOPMENTS

It is true that President Obama’s promise to ease the crushing costs of healthcare by lowering hospital prices, reducing doctors’ salaries and introducing state insurance remains a promise.

It is true that increasing numbers of Americans go overseas for cheaper medical care overseas. It is true that more inter­national health insurers and medical concierge services make medical travel easier.

However, many foreigners believe in the superiority of U.S. medical care and U.S. patients – as well as their families and friends – prefer medical care closer to home.

U.S.A. Domestic Medical Tourism - infographic courtesy of http://www.inc.com

In response, hospitals and clinics as well as travel agents now offer easier payment options and savings with less travel.

“Traveling to a U.S. hospital is much less daunting than going overseas, where practical, medical and legal issues pose complex challenges for patients and employers,” said Mike Taylor of Towers Perrin, a global health-care consulting firm in the U.S.

Some hospitals now give domestic patients up to 75% discount for cash up front rather than chase insurance companies or third parties for payments, according to a report by www.medicaltourismguide.com.

Also, hospitals are forming networks and marketing directly to employers. Employers, in turn, are creating lists of approved hospitals where their employees can receive travel and lodging discounts as well as reduced co-payments.

Because sick employees face bankruptcy due to high medical costs, employers now offer financial incentives.

Some employers say overseas medical care options are more advantageous to their employees but others offer financial incentives that encourage employees to stay closer to home: co-payments, zero out-of-pocket costs, company-paid travel expenses, and access to concierge services, which can save patients thousands of dollars without leaving the country.

In addition to saving time and money, domestic medical travel offers the assurance of healthcare in regulated, recognized facilities by certified physicians.

For example MedToGo, a company owned and operated by US physicians, offers board-certified physicians in or near a number of top vacation destinations at up to 75% savings.  MedToGo’s website offers potential patients free price quotes and notes how close its facilities are (“from Houston only 1 hour and 37 minutes!”) to both outbound and inbound medical tourists.

In addition, US hospitals continue to establish overseas doctor relationships via institutional tie-ups. For instance, the Philadelphia International Medicine consortium is building a US$860-million hospital in Korea.

In another example, Duke Medical Center, Harvard Medical School, Johns Hopkins Medical Center and Columbia University Medical Center partner with international hospitals.

These partnerships spread goodwill and build consumer confidence in U.S. hospitals.

Infograpic courtesy of http://www.saintpetersblog.com

INBOUND MAGNETS

While cash-paying patients from South America, the Caribbean and Europe are a major portion of inbound patients, the largest group patients now traveling to the U.S. are those with international insurance policies that accept normal co-payments and deductibles.

US hospitals like this because reimbursement rates from commercial payers are higher than state-sponsored plans.

Richard Miller’s The Healthcare Business Market Research Handbook estimates that foreign patients spend more than US$1 billion a year for healthcare in the U.S. while a disputed Deloitte report said that inbound medical tourism in 2008 brought in approximately US$5 billion in revenue.

• Discounts and Concierges

U.S. hospitals now attract overseas patients with deeply discounted rates. “At the forefront are physician-owned hospitals, whose managers say they have the efficiency and flexibility to charge extremely low rates and still come out ahead,” Andi Atwater reports in The Wichita Eagle.

A new company, Healthplace America, makes in-country medical tourism easier, said John Goodman in his report Medical Tourism Reversing Course. The company offers “price and quality transparency” as well as a choice of 15 hospitals throughout the USA, with savings up to 50%.

• Alternative Treatments

Medical tourism destinations such as Thailand, the Philippines, India and Malaysia proudly package alternative and complementary treatments as well as traditional medicine.

In response, U.S. hospitals now offer similar treatments; the 18 hospitals chosen by U.S. News as “America’s Best Hospitals” provide complementary or alternative medicine services.

The 2006 annual survey of the American Hospital Association shows that 19.8% offer complementary or alternative medicine services.

• Lower Prices

“U.S. hospitals offer up front, package prices to foreigners who come to this country for medical care,” said John Goodman, “prices and packages they will not offer to American patients.”

Infographic courtesy of http://www.getbetterhealth.com

For instance, Galichia hospital stunned the US medical industry in February 2000 when they announced the $10,000 flat fee for a common open-heart surgery – instead of the usual $35,000.

The hospital plans to charge similarly low flat fees for orthopedic surgery, electrophysiology procedures such as pacemakers, certain open-heart surgeries and general surgery. The aim is to attract patients from countries such as Canada, which has overburdened government-run health care systems.

“Physician-owned hospitals, not typically saddled with layers of bureaucracy, are better equipped to operate at peak efficiency and offer comparatively low rates,” Atwater quotes Molly Sandvig, executive director of the 148-member hospital group Physician Hospitals of America.

“The reason our hospitals are efficient – the reason they cost less, frankly – is we know what our charges are, where the money is going,” Sandvig said. “Our goal is not to make a gigantic profit. Our goal is to offer services in the most efficient way possible while still being able to stay in business.”

The prime attraction of medical tourism – lower prices – has been taken to heart by American retailers, who continue to experiment with in-store clinics, cheap generics and benefits management expertise to find the most profitable formula.

CVS has Minute Clinics in more than half of its 6,200 stores. Walgreens has Take Care Health Clinics in many of their 5,700 branches, and Rite Aid has Instant Clinics in its 5,150 locations.

The Wal-Mart chain of stores has optometrists, pharmacists and now walk-in clinics at its many branches throughout the USA. These clinics use a standard format, are jointly branded with hospitals and medical groups, and are run by nurse practitioners who prescribe basic medications such as antibiotics. They take insurance, require a co-pay, render a diagnosis and write a prescription.

Wal-Mart has also bought out the ASDA supermarket chain, which has 169 in-store pharmacies across England and Wales. The chain has started 24-hour open pharmacies, in-store general practitioners, and general surgeries are coming up next. Sainsbury’s approximately 200 stores have begun to offer the same services to the public.

Although healthcare becomes more accessible to more people at reasonable prices, patients with more serious health conditions must seek further care from a physician.

These developments do not affect the medical tourism market, which caters to people with more financial sources and more complex medical needs.

OVERSEAS ATTRACTION

International medical travel remains a viable option for many, as well it should.

Financial benefits, time, timeliness, bedside manner, luxury, and convenience will continue to be factors weighed those facing medical decisions in the future, and the more choices available to them, the better chance that they have to receive the best possible care.

However, the trend of lowering health care cost continues and affects hospitals, clinics, medical malpractice lawyers, health insurance agencies as well as travel and travel insurance agencies, particularly in the USA, where price-cutting and increasing offerings are luring American patients to local instead of international travel for healthcare services.

The American Medical Association said that more Americans seek overseas medical procedures. The country’s 46 million people with no health insurance need affordable treatment; as well, American companies seek cheaper ways to provide quality medical care to their employees.

Several major insurers now cover treatment programs in Mexico and Thailand, the AMA said.

BETTER BEDSIDE MANNERS

Infographic courtesy of courtesy of dailyinfographic.com

While U.S. doctors rush and spend little time with patients, foreign doctors are appreciated for their leisurely approach.

Since many Americans have no close relationship with their physicians and since many doctors in the U.S. are foreign, Americans are comfortable with foreign doctors today, the report says.

Rolando D. Rodriguez, who heads the Greater Miami Chamber of Commerce, said that – since international patients are paying top rates and Medicaid and Medicare paying low rates for U.S. citizens. For instance, Jackson Hospital may save money by sending some local patients overseas for treatment.

MORE INSURERS

Also, insurer interest in overseas medical tourism is increasing: The Blue Cross website offers the Blue Cross Companion Global Healthcare, a travel planner and overseas healthcare network for individuals and employers in South Carolina, Judy Dugan reports in Los Angeles Times.

In California, Blue Shield and HealthNet offer plans for employers of Mexican immigrants for treatment in Mexico.

When the dollar rebounds, will America’s inbound medical tourism market falter? No – the hospitals will only try harder, perhaps even borrowing from successful strategies used by overseas medical institutions.

“Don’t expect that flow of foreign patients to stop anytime soon, even as the value of the dollar rebounds,” Yastine reports.

“Analysts say the slowing U.S. economy means fewer U.S. patients are opting for those elective procedures, which means hospitals, surgeons, and other specialists have to keep the flow of foreign patients coming just to help pay the bills.”


NOTE: This Part 1 of a three-part article by Jaime Cabrera was first published in the international magazine Medica Tourism in December 2010.
 
SOURCES: Andi Atwater can be reached at aatwater@wichitaeagle.com. The Wichita Eagle website is at www.kansas.com. For more details about Richard Miller’s The Healthcare Business Market Research Handbook, see www.epmcom.com. For Hilary Abramson’s full report, visit http://news. newamericamedia.org. The Greater Miami Chamber of Commerce website is MiamiHealthCare.org. John Dorschner can be contacted at jdorschner@MiamiHerald. com, his full report is at www.miamiherald.com. The press archive at http://www.pbs.org contains Jeff Yastine’s report, Medical Tourists Flock to U.S. The www.john-goodman-blog.com has John Goodman’s full report, Medical Tourism Reversing Course. For Medical Tourism ~ An Economic Boost to the United States by Dr. Jose Quesada, visit http://www.medicaltourismassociation. com or contact him at jquesada3@med.miami.edu. Dale Van Demark’s report, How will the medical tourism industry in the United States develop? is at http://trusted.md. For information about Economic Report: Inbound Medical Tourism in the United States, contact authors Dr. David G. Vequist IV at vequist@uiwtx.edu or Erika Valdez at eri.valort@gmail.com. For Victoria Stagg Elliott’s More Hospitals Looking to Merge, Buy Physician Groups, visit www.ama-assn.org. For Judy Dugan’s full report, see Medical tourism: Outsourcing your health at www.latimes.com. For the full report An Overview of Medical Tourism and Its Effects on US Providers” by Dr. Maria K. Todd, visit www.floridahfma.org/documents/Maria_Todds_Mini-Handout.pdf.

GREEN CARD? NO, THANKS!

10 Feb

Rolan Mendiola, M.D.

Dr. Rolan Mendiola

MHO/ Family Medicine: LGU Padre Burgos Quezon; St.Jude Hospital and Medical Center.
GRADUATE SCHOOL: Master in Hospital Administration – Far Eastern University Dr. Nicanor Reyes Medical Foundation.
COLLEGE: FEU-NRMF Medical Center Class of 2001. HIGH SCHOOL: Holy Rosary Catholic School

The art of healing comes from nature, not from the physician. Therefore the physician must start from nature, with an open mind. — Philipus Aurelius Paracelsus

Doctors in the Philippines are trained to look at the nature of illness and its corresponding cures using established Western practices. Thus, they have a high status in society.

However, many Filipino doctors go abroad and lower their pride to work as nurses, if only to achieve financial security.

What they don’t know is that they can gain this much-needed additional income and, at the same time, also stay with their loved ones in their own country.

Dr. Rolan Mendiola and Family

In addition, they can also help patients in their own towns and neighborhoods.

They only need to keep an open mind and heart, says Dr. Rolan Mendiola.


NO TO THE USA

Some years ago, during a surgical operation, a fellow doctor asked Dr. Mendiola if he had plans of taking up Nursing, then a lucrative course in the USA, and a sure-fire ticket for a green card.

After responding in the negative, Rolan’s colleague started talking about First Vita Plus.

Ang mga doctor di mu mapapaniwala sa mga herbal, eh (You know, it’s hard to convince doctors about herbal products),” he said.

Most doctors, trained in the Western mode of medicine, are hard to convince about promises of better health through alternative modalities such as herbal supplements.

In fact, they always invoke science as a shield each time they are asked why.

Dr. Rolan Mendiola was no different.

SUSPENSION OF DISBELIEF

Having obtained his medical degree at the Far Eastern University in 2001, he was well-versed with illnesses and their cures according to Western practices.

 “Nung nakita ko panay gulay lang, masarap ang lasa, sabi ko, ‘Sige nga subukan natin’ (When I found that it was composed primarily of vegetables and also tasted good, I said, ‘Okay, let’s give it a try’).”

TRIALS BY PATIENTS

Together with their regular course of medication, Dr. Mendiola lets his patients try the product as a food supplement. He didn’t observe any ill effects.

One of his patients put a few drops of First Vita Plus on his sore eyes. Result: The infection didn’t last long.

Another patient applied the drink on his skin as a remedy for his eczema. Result: The eczema  dried up and healed eventually.

A patient suffering from renal failure was a candidate for dialysis. He  drank the powder every day. Result: He didn’t t have to go through the costly and bothersome dialysis procedure anymore.

Soon enough, his other patients started asking him more about First Vita Plus. This was when Dr. Mendiola decided to study the product and the business. “Tuloy-tuloy na. (It went on from there).

For three months, he listened intently to fellow doctors delivering lectures. “After six months, naging speaker na ako (After six months, I became a speaker),” he said.

“I could now help many people,” he added.

HEAL THYSELF

Dr. Mendiola emphasizes that healing ultimately starts with one’s self. “Sarili na lang ang nagpapagaing sa ating sarili (I’ts we who heal our own selves),” he said.

“Ang sakit kadalasan ay dahil na rin sa mga kinakain natin (Sickness is usually brought about by what we eat, too).

Pag dinidisiplina mo ang sarili mo, kumain ka ng tamang pagkain, kaya mong gumaling.  (If you discipline yourself and eat right, you can be healed).

HARD, HARD WORK

Although it may seem that a doctor would have it easier to engage in direct selling, since his profession makes him command attention and thus convince people, Dr. Mendiola said that hard work and determination are still necessary.

Hindi lahat ng tao pare-pareho ang sipag at determinasyon (Not all people have the same level of hard work and determination),” he said.

“It’s really up to you. Nasa pagkatao na rin yun (It’s also up to one’s character).

Dr. Rolan and children

Lalong masipag, mas maganda (The more hardworking [you are], the better).”

BETTER EARNINGS

Dr. Mendiola earns more from First Vita Plus than from his practice.

After one year of being a dealer, he was able to buy a car and deliver the down payment for a townhouse.


Based on the story Dr. Rolan Mendiola: A Different Doctor by Carlomar Arcangel Daoana

A DOCTOR’S DOUBTS

9 Feb

Harold Tanchanco, M. D.

Harold Tanchanco, M. D.

ENT Specialist, Head & Neck Surgeon
Calamba Medical Center (CMC)
St. Jude Family Hospital Los Baños, Laguna

After suffering from constipation for 17 years, Dr. Harold Tanchanco tried First Vita Plus and was cured. He now owns a FVP product center in Calamba, Laguna and practices part-time. [1]

Harold Tanchanco has been a practicing ear-nose-throat-head and neck surgeon for more than nine years when stress took its toll.

“I was very busy. My practice, which is based in Laguna — specifically, the Calamba -Los Baños — area allowed me little free time,” he said.

However, the surgeon’s hectic schedule began to cause him stress. Being a medical specialist is no joke. Most of the time, he would find himself exhausted after attending to all his patients and dealing with someone else’s problems.

“At the end of each day, I felt really weak,” he said.

The job required a lot more time than what he could give.  Although it was fulfilling, his profession started to take its toll on his health and well-being.

“I developed chronic constipation. A lot of people were already saying that I look old for my age,” he said.

NO TO HERBALS

Inquiring about possible remedies from colleagues and friends, one told him about First Vita Plus drink. He didn’t buy the idea.

His professional experience goes against the grain of believing in herbal medicine. “Being a man of science, I’m quite wary of products that claim this or that without proof.

Some of his friends never gave up trying to convince him but, “I didn’t really believe in herbal products,” he said.

Since he was in desperate need to get rid of his maladies. Dr. Harold eventually gave in and tried First Vita Plus – but reluctantly.

The results shocked him.”It cured my constipation and increased my stamina,” he said. “I felt good, and this was just by taking three sachets daily.”

He thought that if the product could do wonders for him, maybe it would help his patients as well.

Dr. Tanchanco decided to find out more about First VitaPlus — what it was made of, who invented it, etc. He attending the free seminars offered by the company.

A CONVINCING CASE

“I was eventually convinced that the product has great potential, particularly if correlated with my practice,” he said.

Dr. Harold became a dealer in 2005. “I thought that, if it helped me, then it might help some of my patients, too. That’s the primary reason for my joining.

“The idea of having extra income at that point was just a side thought,” he said. “My first month commission was only P2,700.

Then he was surprised. “After seven months, the amount ballooned to P88,000 per month!”

Now he feels reinvigorated not only physically but also financially. His earnings from First Vita Plus have definitely augmented his monthly income. “And to think that’s mostly ‘passive income’,” he said.

“Health-wise, it did amazing things to me and to my wife, who is a doctor as well.

INVESTING IN THE FUTURE

On top of that, he feels younger. “What I can’t believe is that it even made us feel and look younger by five years.

“Why? We are not as stressed anymore because of the entire windfall allowed by First Vita Plus,” he said with a smile.

“Even now, I still am amazed about the extra, extraordinary income First Vita Plus is continuously giving me.”

“Most of our earnings from First VitaPlus I already invested in stock market shares, hospital stock shares, real estate, several company stocks, short and long-term investments that would make me and my wife retire young and rich,” he said with a big smile.

After his experience, the doctor saw that some answers are not really found in medical books, and that modern-day miracles don’t just happen on the operating table.

Based on the report Dr  Harold Tanchanco: The Doubting Surgeon by Neil Ray Ramos, published in Good Morning! magazine.

[1] From Chay Alvarez in http://www.yasni.com


							

FLYING FOR ATTENTION

8 Feb

The growing trend of overseas medical care has its pros and cons. To help you arrive at an informed decision, here’s a shortlist of the arguments why medical tourism is good – or bad – for you.

Are you one of the millions of people who need to undergo a health, medical, wellness or beauty treatment that you can’t afford? Are you tired of waiting for lawmakers to approve a new treatment that can save the life of a loved one? Are the waiting lists too long for you?

Answer yes to any of these and you may be a likely candidate for overseas medical care.

While some happily focus on the fun side of overseas treatment, others issue dire warnings of filthy hospitals, shady treatment practices and procedures gone bad. As with most things in life, the truth lies somewhere in between.

Here’s a shortlist of why people sign up for overseas medical care.

COST SAVINGS

Most people like to get the most for their money. The single biggest reason why people travel to other countries for medical treatment is the opportunity to save money.

Depending on the destination country and the type of treatment, uninsured and underinsured patients, as well as those seeking elective care, can enjoy 15 to 85 percent savings over the cost of treatment in their home countries. As one health traveler puts it, ”I took out my credit card instead of a second mortgage on my home.”

As baby boomers become senior boomers, costs of healthcare and prescriptions are devouring nearly 30 percent of retirement and pre-retirement incomes. With the word getting out about top-quality treatments at deep discounts overseas, informed patients are finding creative alternatives abroad.

For example, a hip replacement in Bangkok, Thailand costs about $18,000, an estimated savings of at least $15,000 compared to the US market price. Savings on dentistry becomes more dramatic when extensive mouth-work is required, involving several teeth or full restorations. Savings of $15,000 or more are common.

BETTER QUALITY CARE

Veteran health travelers know that facilities, instrumentation, and customer service in treatment centers abroad often equal or exceed those found In the United States. Governments of countries such as India and Thailand have poured billions of dollars into improving their healthcare systems, which are now aggressively catering to the international health traveler.

VIP waiting lounges, deluxe hospital suites, and staffed recuperation resorts are common amenities, along with free transportation to and from airports, low-cost meal plans for companions, as well as discounted hotels affiliated with the hospital.

Moreover, physicians and staff in treatment centers abroad are often far more accessible than their US or UK counterparts. “My surgeon gave me his cell phone number, and I spoke directly with him at least a dozen times during my stay,” said David Palmer, who traveled to Bangkok for a heart valve replacement

EXCLUDED TREATMENTS

Even the best health Insurance plans exclude a lot. Your plan probably excludes cosmetic surgeries, dental care, vision treatment, reproductive or infertility procedures, certain non-emergency cardiovascular and orthopedic surgeries, weight loss programs, substance abuse rehabilitation, and prosthetics – to name only a few.

Many health plans restrict prescriptions, some of which are quite expensive.  Many exclude postoperative care, congenital disorders and pre-existing conditions. As a result, many who need medical care – even one recommended by their physician – find that their insurance won’t cover it.

SPECIALTY TREATMENTS

Some procedures and prescriptions are simply not allowed in the United States. Either Congress or the Food and Drug Administration have banned a certain treatment – or perhaps it’s still in the testing and clinical trials stage, or the treatment was only recently approved. Treatments such as fertility and stem cell are offered abroad.

One example is an orthopedic procedure known as hip resurfacing, a less expensive alternative to the traditional hip replacement still practiced In the United States. While this procedure has been performed for more than a decade throughout Europe and Asia, but was only recently approved in the United States; availability remains spotty.

Hundreds of forward-thinking Americans, many of them suffering years of chronic pain, have found relief in India, where hip resurfacing techniques, materials, and instrumentation have been perfected, and the procedure is routine.

QUICKER ATTENTION

For decades, thousands of Canadian and British subscribers to universal, “free” healthcare plans have endured wait as long as two years for established procedures. “Some of us die before we get to the operating table,” commented one exasperated patient who journeyed to India for an open-heart procedure.

In the United States, long waits are a growing problem, particularly among war veterans covered under the Veterans Administration Act for whom long queues are becoming far too common.

Some patients figure it’s better to pay out-of-pocket fees to get out of pain –  or to halt a deteriorating condition – than to suffer the anxiety and frustration of waiting for a far-future appointment and other medical uncertainties.

FRIENDLIER SERVICE

Health insurance companies apply more pressure on hospitals to get patient out of expensive beds quicker. As a result, assembly-line health procedures are becoming the norm. Those who travel overseas for health care find the welcoming flexibility at the best hospitals abroad. There, they are often encouraged to spend extra time in the hospital for post-procedure observation and recuperation.

Furthermore, the patient-to-staff ratios are usually lower abroad; because more staff care for patients and maintain facilities, hospital-borne Infection rates are much lower.

Patient-friendly cultures result in charming nurses and doctors who spend more time at patient’ bed- sides, than overseas patients are used to. “Absolute angels,” says an English lord who recently traveled incognito to Bangkok for hip resurfacing. “Those nurses are absolute angels.”

MORE ADVENTURES

Although traveling abroad for medical care can be challenging, many patients welcome the chance to blaze a trail. In addition, they find the creature comforts often offered abroad a welcome relief from the sterile, impersonal hospital environments so oft en encountered in U.S. hospitals and clinics.

For others, simply being in a new and interesting culture lends distraction to a worrisome process or a boring recuperation period. Getting away from the myriad obligations at home and professional life can yield healthful effects at a stressful time.

What’s more, travel – particularly international travel – can be a life-changing experience.

You might be humbled by the limousine ride from Indira Gandhi International Airport to a hotel in central New Delhi or struck by the simple, elegant graciousness of professionals and ordinary people in Thailand, or wowed by the sheer beauty of the mountain range outside a dental office window in Mexico.

As one veteran medical traveler put it, “I brought back far more from this trip than a new set of teeth.” So, do the research and the math, and you may find yourself joining the thousands of others who set sail to an exotic land that they never thought they might visit, let alone for a medical procedure.

BURNING QUESTIONS

Although concierge services such as MedRetreat.com and lndUShealth.com are helping with lists of potential hospitals, appointment scheduling, arranging airport pickups and drop-offs, as well as with general hand-holding, there are many questions.

There are concerns about safety and postoperative care when the patient returns home. If a patient receives treatment abroad and something goes wrong, who does the patient sue: the insurer or the employer? Where can the case be filed?

The questions are just as relevant to solo travelers. Author Josef Woodman of Patients Without Borders tells of a Vietnam veteran who had a hip replaced, developed complications on his return, and found his doctors in the USA unwilling to help. “There’s a lot more burden on the consumer to have a successful medical journey,” says Woodman.

DIFFICULT ANSWERS

Doing the sort of advance research that makes this possible can be arduous. You may or may not get information about hospital mortality rates, or about a surgeon’s credentials and how many heart valves he has replaced, for example. If you do get answers, these are not necessarily trustworthy, says Woodman.

American hospitals do not volunteer such information easily either, but they are monitored by federal and state agencies, as well as by professional and trade organizations that collect these data. Such monitoring is largely absent in countries such as in India or Thailand.

So far, however, no reports of patterns of botched operations, rampant infections, or other warning signs have surfaced. Recently, the Singapore National Eye Center suspended laser eye surgery after 1 7 patients developed an inflammation, but this was the first interruption of its kind at the center. A few weeks later, surgery resumed. Overall, medical standards in Singapore – where prices are somewhat less attractive but English is universal – are very high.

ACCREDITING PRECAUTIONS

One precaution Americans can easily take is to choose a hospital accredited by the Joint Commission International, the global arm of the Joint Commission, which makes sure U.S. hospitals meet specific standards. For instance, the Wockhardt facility in Bangalore completed its JCI accreditation survey. The hospital is clean but there’s nothing fancy such as the soaring atrium and opulence that make Bumrungrad Hospital in Bangkok particularly popular with medical travelers.

Accreditation does not ensure good care, but it does offer important evidence of safety, “a risk-reduction activity,” said an accreditation CEO. Make sure that your physicians have adequate and valid credentials, with patient data examined at least once a year to monitor increases in deaths or complications, or in longer hospital stays.

INFECTION GUARDS

As a patient moves through the hosp ital, a standard routine must track and avoid treatment mix-ups. A transfer to or from intensive care should, for example, be documented with a written transfer statement and verbal confirmation by a physician, then compiled into an ongoing summary.

Computerized tracking, with supermarket-type bar codes that can be scanned from patient wristbands and stickers on their records, is used at a few top hospitals in Thailand. Accreditation standards require different ways of minimizing infections such as a review of infection statistics and any necessary corrections.

For instance, water used in surgery and laboratories should be regularly filtered and tested. Western patients always get bottled drinking water. There should be disinfectant alcohol gel dispensers near each bed for hand cleaning.

BLOOD SAFETY

A safe blood supply cannot be assumed. Ask: where do blood banks get the supply? How well are donors screened? How is blood supply safety verified? Although there is no way to verify the answers, patients should ask a hospital representative these questions.

On the other hand, hospitals don’t want mistakes. They don’t want their patients to return home and have problems. They know the power of the testimonial, not to mention the power of the Internet.

With great numbers of patients each day, patients or their companions should also ask a hospital how blood is routed to the right patient. Give marks for hospitals that use bar coding on each patient’s body, or on clothing used for record scanning, before any transfusions.

INFECTION RATES

Joint-replacement patients are a special class in all hospitals because of the consequences of infection: An artificial joint that harbors a deep infection must be replaced. For an American patient’s operation, surgeon Sanjay Pai and his team at the Wockhardt hospital in Bangalore sealed off their skin and breathed filtered air pumped into hoods covering their heads like those at good U.S. hospitals.

Like other Asian hospitals, Wockhardt had to be persuaded to reveal its rates of postsurgical infections, but the statistics are comparable to those of good U.S. hospitals: 1 .1 percent rate of surgical infection for heart-bypass patients and zero for joint replacements.

ASIA NURSING

In Asia, nurses play a much smaller role in care than they do in US hospitals. Emily Slaback, a former CU nurse from Haslet, Texas, whose left hip and knee were replaced at Wockhardt last year, says they are more like nurse’s aides. They are not expected to check patients as often or as closely, so patients have to take responsibility. Calling a doctor’s attention to a bruise, for example, could prevent a bedsore that might become infected as well as prolong your stay.

And, while nurses who care for Americans are trained in English, their command is often incomplete. After his first surgery, Barnum was given a special mattress to prevent bedsores. He asked the nurses for the same mattress after his second surgery but couldn’t make himself understood — or, as he says, perhaps they felt he didn’t need it.

COMFORT ZONES

People who in the end decide to head abroad might consider a last bit of wisdom from those who have gone before. Think of it as medical travel,  “and don’t count on much tourism.” Few who arrive with a bad back or heart will be wandering through the tourist sites and sights of Bangkok or New Delhi.

After surgery and one or two weeks of recuperation, few will have the desire to lengthen their stay. On flights where coach will cramp your recuperating body and challenge your sanity, go business class.

PRICES DROPPING

There would be no need for uninsured American patients to go abroad at all if the prices they were quoted in the United States were more in line with what insurers and Medicare pay. Those in the UK would stay home and enjoy free medical care if sex change surgeries did not require too much red tape, hospitals were cleaner, and if medical services were quicker. If, if, if.

In North American hospitals, the uninsured and the wealthy pay full price for an elective procedure. People who come in through the emergency room for non-elective surgery get a list-price bill, but few hospitals expect to be fully paid.

You should know by now: the medical service industry in the U.S.A. has a very high profit margin and there is plenty of room for price-cutting. For a routine heart-bypass surgery in Texas, the list price is about $70,000 at one hospital in Abilene and $47,000 at one in Austin.

Commercial health plans pay at least 60 percent below the listed prices. Medicare pays even less — $18,609 to $23,589 on average for an uncomplicated bypass.

Because of the serious amounts of money flying overseas with medical tourism, American hospitals are going global. For instance, North American Surgery, a Canadian company formed to match hospitals in Kansas, Michigan, New York, Oklahoma, and in Washington who are willing to provide some procedures in expensively with American patients. Hip or knee replacement or heart-bypass surgery is $14,000; weight-loss surgery is $10,000 or $1 5,000. The service is free; the hospitals pay the company for their middleman services. Patients pay for travel and lodging only.

Diligence, research, and careful planning can ensure that those who consider traveling abroad for treatment will have a safe and effective treatment, a chance to experience a new culture, as well as a savings of thousands of dollars. However, there are growing options nearer to home.

This article was originally published in 2009 in the Medica Tourism magazine.

I HATE VEGGIES & NEEDLES

6 Feb

Ross Daniel Tanagon: Lupus, Pneumonia

Ross Daniel was only 4 years old when he was diagnosed with lupus. The doctors were convinced that his case was already hopeless.

His godparents, Jojo and Joy Pera, found out that he was also had community acquired pneumonia.

Ross Daniel Tanagon

Doctors Gave Up

Pinauwi na nga sya ng doktor kasi pakiramdam nila, wala nang pag-asa (The doctors discharged him because they felt that there was no hope).

Pero hindi kami sumuko. Binigyan naming sya ng isang kahon ng First Vita Plus na inubos nya sa loob ng tatlong araw lang (But we didn’t give up. We gave him a box of First Vita Plus that he consumed in only three days).

Amazing Transformation

Noong third day, nawala ang pamamanas ng buo nyang katawan. Lumiit na ang kanyang tyan at nakakaihi na sya (On the third day, his body looked better. His stomach shrank, and he could urinate).

They were amazed by what they saw.

Nakakagulat yung physical transformation nya. Biglang lumakas. Noong una, ayaw nya maglaro, gusto nakahiga lang (His physical transformation was amazing. He was suddenly stronger. Before, he didn’t want to play, he just wanted to lay in bed).

His condition improved and his tests showed all negative findings barely a week after he first drank First Vita Plus. Tuwang tuwa kami noong makita sya. Namumula na ang mga pisngi nya (We were happy when we saw him. His cheeks were pinkish).

No to Vegetables & Needles

According to his mother, “Noon kasi, hindi kumakain ng gulay yan, puro noodles. Madalas ma-ospital pero ayaw na kasi puro turok (It’s because he never liked eating vegetables, it’s always noodles. He’s frequently at the hospital, but he doesn’t like it because of all the needles).

Dati rin, halos buwan buwan ay nasa ospital kami. Pero salamat sa First Vita Plus, halos isang taon no din kaming hindi bumabalik (And before, we were at the hospital almost every month. Now, thanks to First Vita Plus, it’s been almost a year since we went to the hospital).

The Tanagon family is blessed that they have the Share a Blessings group to support them.

According to Jojo, “Sana nga maging dealer sila. Para yung kikitain nila sa pagbebenta ng produkto ay magagamit nila sa pangkabuhayan at magiging libre na yung First Vita Plus na ibibigay nila sa mga bata (I do hope that they become dealers so that what they earn from selling the product, they can use that as a livelihood, and they won’t have to pay for the First Vita Plus that they will give to the children).

Pagtutulung-tulungan naming ng grupo kasi naniniwala kami na may pag-asa sa produkto (We in the group will help because we believe that there is hope in this product).

“My message to others: “Huwag panghinaan ng loob (Don’t give up).

Naniniwala din kami na ang First Vita Plus ay hindi puro business (We also believe that First Vita Plus is not only all about business). We share the product. Tumutulong kami sa abot ng aming makakaya (We help as much as we can).

Basta may kailangan ng tubong (When there’s a need for help), we never hesitate. Ganyan kalaki ang aming paniniwala sa produkto (That’s how strongly we believe in the product).

 
Text and image courtesy of First Vita Plus  
Translation by Jaime Cabrera