Bill of Health

Asia is no longer just about cheap med­i­cal pro­ce­dures. Some of the most in­no­va­tive de­vel­op­ments are hap­pen­ing in the re­gion

Business Traveler (USA) - - INSIDE - By Rachel Jac­que­line

Asia is no longer just about cheap med­i­cal pro­ce­dures – it’s home to some of medicine’s most in­no­va­tive de­vel­op­ments

For many, un­der­go­ing a com­pli­cated med­i­cal pro­ce­dure can be hor­rif­i­cally ex­pen­sive, or bring with it a moun­tain of in­sur­ance en­tan­gle­ment.“Med­i­cal tourism”– trav­el­ing across in­ter­na­tional borders for health care – has emerged in re­cent years as a vi­able, less costly al­ter­na­tive for those look­ing to take their health into their own hands, with Asian na­tions lead­ing the charge.

But what was once as­so­ci­ated with a se­cret“nip and tuck,“con­ve­niently timed with a va­ca­tion, has en­tered a new era. To­day, some of best med­i­cal treat­ment avail­able is tak­ing place not in Western hos­pi­tals, but in places like Bangkok, Kuala Lumpur, New Delhi and Sin­ga­pore. Asia presently boasts 212 hos­pi­tals with the cov­eted seal of ap­proval from the Joint Com­mis­sion In­ter­na­tional (JCI) – which sets world­wide stan­dards in health care. And the re­gion is chang­ing the face of global medicine.

Last year in In­dia, a me­chan­i­cal heart known as the Heart Mate II, was trans­planted into a 29-year-old Iraqi man at the For­tis Me­mo­rial Re­search In­sti­tute in Gur­gaon, south­west of New Delhi.

“This is cur­rently the most so­phis­ti­cated FDA-ap­proved tech­nol­ogy avail­able in the world, and a per­ma­nent so­lu­tion to heart fail­ure,”said sur­geon San­deep At­tawar in a re­port pub­lished online. At­tawar be­lieves that this de­vice could soon re­place con­ven­tional heart trans­plants al­to­gether and pro­vide a life­line for the thou­sands of peo­ple who die each year while wait­ing in vain for a donor heart.

In­dian doc­tors are also lead­ing the world in other break­through surg­eries. Ear­lier this year the Medanta Hos­pi­tal (also lo­cated in Gur­gaon), to­gether with the Henry Ford Hos­pi­tal in Michigan, an­nounced a ma­jor break­through in ro­botic kid­ney trans­plants af­ter suc­cess­fully trans­plant­ing the vi­tal or­gan into 50 pa­tients via a ro­bot-as­sisted pro­ce­dure.

Else­where in Asia, the trend con­tin­ues. Thai­land, one of the early pioneers of med­i­cal tourism, is un­of­fi­cially known as the best place in the world for cos­metic surgery, but it has also be­come one of the top des­ti­na­tions for eye and den­tal surgery. Es­tab­lished med­i­cal des­ti­na­tion Sin­ga­pore

spe­cial­izes in or­gan trans­plants, can­cer treat­ment, car­diac surgery and fer­til­ity treat­ment. Mean­while new­comer Malaysia is mak­ing its mark in cos­metic surgery and com­pre­hen­sive health checks, as is Korea, which also spe­cial­izes in stem cell treat­ment and spine surgery.

For the dis­cern­ing in­ter­na­tional med­i­cal tourist as well as those liv­ing in Asia, this is good news. A broad range of med­i­cal treat­ments are avail­able on re­quest and of­ten only a short plane ride away. Trav­el­ers can also use the cost sav­ings – up to 80 per­cent com­pared with Western fa­cil­i­ties – to in­clude some time for rest and re­cu­per­a­tion, with­out scrimp­ing on ser­vice or qual­ity. While you may not as­so­ciate vis­it­ing the den­tist with ly­ing on a beach in Thai­land, you have to ad­mit, the propo­si­tion is an at­trac­tive one.

Choose Your Medicine

In­deed, med­i­cal tourism is boom­ing. An es­ti­mated 11 mil­lion health care con­sumers pumped $438.6 bil­lion into lo­cal and na­tional economies over­seas last year alone – that’s 14 per­cent of the world’s tourism dol­lars, ac­cord­ing to the Med­i­cal Tourism As­so­ci­a­tion (MTA). This year the MTA pre­dicts that around 10 mil­lion of these med­i­cal tourists will travel to Asia due to the qual­ity of health care avail­able.

“Trav­el­ing to Thai­land for post­preg­nancy breast aug­men­ta­tion was a no-brainer,”says Emma Richards, a Bri­tish mother of two based in Hong Kong.

“I wanted the best doc­tor pos­si­ble. If some­one is go­ing to mess with your ap­pear­ance you want to make sure that do­ing this op­er­a­tion is about as rou­tine to them as brush­ing their teeth,”she says. She had weighed her op­tions in the United King­dom and Hong Kong, but set­tled on the Bum­run­grad In­ter­na­tional Hos­pi­tal in Thai­land for the ex­cep­tional treat­ment avail­able close by.

“Bangkok is very close to Hong Kong; it’s a short-haul flight, I only needed to stay five days, and I can easily go back if I need to. The doc­tor there was also one of the very few Amer­i­can Med­i­cal Board-cer­ti­fied sur­geons and had years of ex­pe­ri­ence,”she says.“He was ul­ti­mately the rea­son I chose to go.”

High-end health screen­ings are another pop­u­lar op­tion around the re­gion for con­ve­nience, cost and qual­ity. At the Bum­run­grad, for ex­am­ple, you can sched­ule an“Ex­ec­u­tive Health Screen­ing”the day af­ter you ar­rive in Bangkok and get your re­sults the same day. Spe­cial­ists, car­di­ol­o­gists, ra­di­ol­o­gists and screen­ing spe­cial­ists pour over you while their in–house lab­o­ra­tory that pro­cesses 3 mil­lion tests each year quickly turns over your re­sults. The cost? Be­tween $200 to $600, depend­ing on what tests are taken.

A broad range of med­i­cal treat­ments are avail­able on re­quest and of­ten only a short plane ride away

Com­par­a­tive test­ing in the United States would cost thou­sands of dol­lars.

There are, of course, po­ten­tial down­sides to be­ing a med­i­cal tourist: hav­ing to go on the road, time away from fam­ily and friends, cul­ture shock, po­ten­tial post­treat­ment com­pli­ca­tions and a lack of con­ti­nu­ity from the health care provider. Plus many peo­ple might be put off by the night­mare med­i­cal sto­ries that have emerged over the years, (although these ap­pear to be lim­ited to bo­gus providers and are largely un­heard of at rep­utable hos­pi­tals in the re­gion).

Richards ad­mits that although the ser­vice she re­ceived med­i­cally was “ex­ceed­ingly high,”she would have pre­ferred a pro­ce­dure closer to home had the qual­ity of ser­vice been avail­able.“You lack the lux­ury of post-op care that you might get in your own coun­try,”she adds.

“Luck­ily I haven’t needed any, but fol­low up and com­pli­ca­tions may be harder to man­age if you travel abroad. It’s not a per­sonal ex­pe­ri­ence. It’s not for peo­ple who want a more in-depth doc­tor-andpa­tient rap­port.”

“In the end, [health care] des­ti­na­tion is de­ter­mined by what pro­ce­dure is avail­able, the price, the ex­per­tise, ac­cred­i­ta­tion and ac­ces­si­bil­ity to that lo­ca­tion,”says Renée-Marie Stephano, pres­i­dent of the Med­i­cal Tourism As­so­ci­a­tion. “No one wants to spend more time on a plane or in an air­port ter­mi­nal than they have to,” Stephano ex­plains.

“It boils down to feel­ing com­fort­able – it’s your body and your health af­ter all,” ad­vises Richards.“I chose a lo­ca­tion that I know. I’ve vis­ited Bangkok many times.”

Cul­ture shock is another im­por­tant con­sid­er­a­tion. The poverty and lack of de­vel­op­ment in cer­tain parts of In­dia, for ex­am­ple, or the pol­lu­tion and chaos of Bangkok, may be less ap­peal­ing than the salty sea breeze of Phuket, or the san­i­tized streets of Sin­ga­pore.

And although med­i­cal tourism in Asia is com­par­a­tively cheap, costs are ris­ing. At the same time do­mes­tic health costs are fall­ing in re­sponse to an aware­ness of the in­creas­ing need to be com­pet­i­tive in the global mar­ket. Ser­vice qual­ity in Asia will, how­ever, con­tinue to be a dis­tin­guish­ing fea­ture, as well as a draw­ing card, es­pe­cially for those in more dire cir­cum­stances. Ul­ti­mately, it’s about mak­ing the choice: where in the world would you pre­fer to get your med­i­cal treat­ment?

Sup­ply & De­mand

Ask­ing this very ques­tion, Tony Smith opted for laser eye surgery treat­ment in Thai­land, and not Hong Kong where he re­sides, even though Thai­land was ac­tu­ally the more ex­pen­sive op­tion. He re­ceived ReLex treat­ment, an ad­vanced form of the pro­ce­dure, which was un­avail­able in Hong Kong at the time, at a price of around HK$30,000 ($3,864), com­pared to HK$18,000 ($2,319) for Lasik treat­ment.

“Sounds crazy I know but I went for the most ad­vanced tech­nol­ogy which was not avail­able in Hong Kong a year ago. ReLex will not flap your cornea and is a lot less in­va­sive [than Lasik]. I only needed to cover my eye for one night, then I had to avoid hav­ing wa­ter in my eyes for three days. Af­ter one week, I was back to nor­mal,”he says.

The ex­pe­ri­ence was im­pres­sive, he says. “Ser­vice qual­ity is their top pri­or­ity [in Thai­land]. The day be­fore the op­er­a­tion, I was as­signed a per­sonal con­sul­tant who I could reach 24/7.”

Just how has Asia – a re­gion of de­vel­op­ing na­tions – be­come the leader in health ser­vices? Put sim­ply, it’s a case of sup­ply and de­mand as the world’s health care has grad­u­ally moved to a glob­al­ized, pri­va­tized sys­tem. And as Asia steps up to sat­isfy global de­mands, with the added lure of a va­ca­tion and sig­nif­i­cant cost sav­ings, the sheer vol­ume of pa­tients at­tracted to the re­source­ful re­gion is help­ing to raise the stan­dard level of treat­ment. As they say, prac­tice makes per­fect.

Af­ter the Asian fi­nan­cial cri­sis of 1997, gov­ern­ments looked for ways to build their economies. In Thai­land, the gov­ern­ment di­rected its tourism of­fi­cials to mar­ket

the coun­try as a des­ti­na­tion for plas­tic surgery and the coun­try quickly be­came the go-to coun­try for com­par­a­tively in­ex­pen­sive oper­a­tions. Over the years, the ser­vice of­fer­ings have ex­panded as the num­bers of providers have in­creased. The Bum­run­grad, for ex­am­ple, is a five-star med­i­cal fa­cil­ity of­fer­ing over 900 physi­cians across 55 spe­cial­ties see­ing around 1,000 in­ter­na­tional pa­tients ev­ery day. As it’s more like a five-star ho­tel than a hos­pi­tal, it has helped to spawn the use of a new term:“ho­tel-spi­tal.”

One of the world’s freest economies with a highly de­vel­oped med­i­cal sys­tem, Sin­ga­pore has long been a med­i­cal tourism hub for both Asians and Western­ers for years. The World Health Or­ga­ni­za­tion (WHO) ranks Sin­ga­pore as hav­ing the best health care sys­tem in Asia, and sixth in the world. The Sin­ga­pore Tourism Board claims that in 2012, the coun­try had 850,000 for­eign pa­tients, in­clud­ing visi­tors and ex­pats, sig­nal­ing a note­wor­thy an­nual growth of 15 per­cent.

En­cour­aged by the suc­cess of their Asian neigh­bors, Malaysia and South Korea have fol­lowed suit, fo­cus­ing on the de­vel­op­ment of their med­i­cal in­dus­tries for in­ter­na­tional tourists in re­cent years. “Malaysia is one of the few coun­tries where med­i­cal tourism has been‘ac­tively pro­moted by the gov­ern­ment’and is over­seen by the Min­istry of Health (rather than a tourism board),”ex­plains Dr Mary Wong Lai Lin, chief ex­ec­u­tive of the Malaysia Healthcare Travel Coun­cil (MHTC).

“We en­vi­sion po­si­tion­ing Malaysia as the pre­ferred des­ti­na­tion for world-class health care ser­vices,”says Dr Wong. And it’s work­ing – with the 330,000 pa­tients who vis­ited in 2010 more than dou­bling to 770,000 in 2013.

South Korea, too, has been ac­tively cam­paign­ing for med­i­cal tourists, hav­ing es­tab­lished the Coun­cil for Korea Medicine Over­seas Pro­mo­tion and in­tro­duc­ing a new class of med­i­cal visas for for­eign pa­tients, ac­count­ing for the an­nual growth of 38.4 per­cent since 2009. The of­fi­cial South Korean tourist or­ga­ni­za­tion, the KTO, ex­pects med­i­cal tourist num­bers to reach 598,000 in 2015 and 998,000 in 2020 – equat­ing to $3.4 bil­lion in rev­enue by 2020, up from $970 mil­lion in 2013.

Mean­while in In­dia, as eco­nomic poli­cies grad­u­ally saw a de­crease in health fund­ing to­wards the end of the 20th cen­tury, de­mand grew for pri­vate med­i­cal fa­cil­i­ties, en­cour­ag­ing the rise of the cor­po­rate hos­pi­tal. To­day, cor­po­ra­tions like For­tis Healthcare, Narayana Health and The Apollo Group are multi-bil­lion dol­lar or­ga­ni­za­tions with pri­vate hos­pi­tal chains around the re­gion.

For­tis, for ex­am­ple, boasts 65 health care fa­cil­i­ties (in­clud­ing projects un­der de­vel­op­ment) through­out In­dia, as well as Sin­ga­pore, Dubai, Mau­ri­tius and Sri Lanka with over 10,000 po­ten­tial beds, over 240 di­ag­nos­tic cen­ters and more than 17,000 em­ploy­ees.

And it’s not just the Western mar­ket that these coun­tries are tar­get­ing. As com­pe­ti­tion for the med­i­cal tourism dol­lar heats up be­tween these de­vel­op­ing na­tions, the po­ten­tial lies less in lur­ing for­eign med­i­cal tourists as it does in cap­tur­ing the bur­geon­ing mid­dle class in Asia.

Tai­wan, for ex­am­ple, is hop­ing to cap­ture more of the Chi­nese med­i­cal tourism mar­ket, and South Korea aims to ap­peal to nearby Ja­pan with cheaper costs. Sin­ga­pore has also re­ported re­ceiv­ing more pa­tients from China and In­dia on top of its tra­di­tional sources in neigh­bor­ing Malaysia and In­done­sia.

In­dia, mean­while, has ex­pe­ri­enced an in­flux of pa­tients from sur­round­ing coun­tries with less de­vel­oped health care sys­tems, such as Pak­istan, Bangladesh, Myan­mar and cen­tral Asia, ex­plain­ing the ex­po­nen­tial growth in med­i­cal tourism rev­enues to $3.9 bil­lion this year, from $1.9 bil­lion three years ago, ac­cord­ing to a 2014 re­port from Deloitte.

Whether or not you wrin­kle your nose at the thought of jump­ing on a plane to an emerg­ing mar­ket for health care, the mes­sage is clear: cred­i­ble, if not bet­ter, al­ter­na­tives to ex­pen­sive treat­ments and long waits are avail­able in Asia. What’s more, you might just be part of one of the most sig­nif­i­cant changes in the world of health care in the 21st cen­tury. BT

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