Chi­nese spur med­i­cal-tourism growth in the US

More and more af­flu­ent Chi­nese are com­ing to the United States for treat­ment of life-threat­en­ing dis­eases due to in­ef­fec­tive or in­ac­ces­si­ble med­i­cal ser­vices at home, re­ports from San Fran­cisco.

China Daily (Canada) - - FRONT PAGE -

“How can a daugh­ter give up her mom?”

That was what Diana Liu, a Sil­i­con Val­ley-based busi­ness­woman, asked her­self when doc­tors in China said her 70-yearold mother had three months to live af­ter be­ing di­ag­nosed with ad­vanced-stage small-cell lung can­cer (SCLC). SCLC is the lead­ing cause of can­cer deaths in women and men in China, with the av­er­age five-year sur­vival rate around 15 per­cent.

Liu had re­turned to her home­town in Guizhou province in Fe­bru­ary last year dur­ing the Chi­nese Spring Fes­ti­val when she got the news about her mother. “Doc­tors told us the dis­ease is in­cur­able, and the best op­tion for my mom was to re­lax un­til death would claim her life within three months,” said Liu. “But, how can a daugh­ter give up her mom?” Liu didn’t.

With a faint gleam of hope, she sub­mit­ted an ex­pe­dited US visa ap­pli­ca­tion for her mother, and within two weeks she was ad­mit­ted to the can­cer cen­ter at Stan­ford Univer­sity in San Fran­cisco. Af­ter a se­ries of check-ups in­clud­ing onco­gene de­tec­tion, doc­tors as­sured Liu that chances were good for her mother’s sur­vival.

Liu’s mother was put into in­pa­tient care and treated with a com­bi­na­tion of chemo­ther­apy and ra­di­a­tion ther­apy. “They (doc­tors) hold my mom’s hands, sooth­ing her and cheer­ing her up,” said Liu. “As­sis­tance seems al­ways within reach. They even in­clude sev­eral Chi­nese-speak­ing nurses on the team.”

Her mother has been dis­charged from the hos­pi­tal and re­turns for reg­u­lar pri­mary care ev­ery two weeks. She is in sta­ble con­di­tion and will stay in the US and won’t travel un­less she passes a five-year sur­vival as­sess­ment. The cost

The bill was $60,000 and is ex­pected to go higher, and Liu says, “My mom would have had passed away with­out seek­ing med­i­cal ser­vices here.”

Liu is a strong ad­vo­cate for what has be­come known as med­i­cal tourism, pa­tients trav­el­ing out­side their coun­try of res­i­dence to re­ceive al­ter­na­tive med­i­cal care and ser­vices, es­pe­cially in the United States. “My ex­pe­ri­ence is the best tes­ti­mo­nial,” Liu said of seek­ing med­i­cal as­sis­tance for her mother abroad.

A McKin­sey & Co re­port es­ti­mates that the global med­i­cal tourism mar­ket has been grow­ing by 20 per­cent a year. In 2000, it was val­ued at less than $10 bil­lion and last year it was al­most 10 times that.

About 60,000 Chi­nese have gone abroad ev­ery year to seek med­i­cal ser­vices in re­cent years, says the Shang­hai Med­i­cal Tourism Prod­ucts and Pro­mo­tion Plat­form. There are no de­fin­i­tive num­bers on how many peo­ple from China seek med­i­cal help in the US, but healthcare author­i­ties say the num­ber has in­creased be­cause there are more wealthy peo­ple — usu­ally pri­vate busi­ness own­ers from sec­ond- or third-tier cities — who can af­ford treat­ment and, most of all, be­cause they are un­happy with the qual­ity of healthcare ser­vices in their coun­try. Med­i­cal agen­cies

Many of those need­ing treat­ment in the US and else­where turn to med­i­cal agen­cies to find the right hos­pi­tal and set up ap­point­ments. An agent can charge sev­eral thou­sand dol­lars to con­nect the pa­tient with a clinic.

Saint Lu­cia is a Bei­jing­based agency that spe­cial­izes in ar­rang­ing over­seas med­i­cal care.

Cai Qiang de­vel­oped his busi­ness by con­nect­ing the new rich in China with ad­vanced tech­nolo­gies and med­i­cal ser­vices in the US. “The dis­crep­ancy be­tween lim­ited med­i­cal re­sources in China and suf­fi­cient fi­nan­cial strength of China’s new rich will gen­er­ate nu­mer­ous op­por­tu­ni­ties for Amer­i­can med­i­cal fa­cil­i­ties.”

Pa­tients with life-threat­en­ing dis­eases, such as lung and breast can­cer and melanoma, make up 80 per­cent of his com­pany’s clients, said Cai, adding that the av­er­age treat­ment trip from China to the US costs $100,000 to $150,000 in med­i­cal bills, and in some cases could be high as $700,000.

Cai’s com­pany re­cently re­ceived an in­vest­ment from Se­quoia Cap­i­tal China, and in May the Mayo Clinic in Rochester, Min­nesota, signed an agree­ment with Saint Lu­cia to re­ceive Chi­nese pa­tients through the com­pany.

The Mayo Clinic said the num­ber of its pa­tients from China has more than dou­bled over the past year. It now has a Web page in Chi­nese and has put in­ter­preters on staff. “China, prob­a­bly of all coun­tries, is the one where we see the great­est growth right now,” said Mikel Pri­eto, the med­i­cal di­rec­tor of the Mayo Clinic’s in­ter­na­tional of­fice. He de­clined to pro­vide spe­cific fig­ures.

Cai said his com­pany also has con­tracts in the US with Part­ners HealthCare, the largest net­work of hos­pi­tals af­fil­i­ated with Har­vard Med­i­cal School, in­clud­ing Mas­sachusetts Gen­eral Hos­pi­tal, Brigham and Women’s Hos­pi­tal, Dana Farber Can­cer In­sti­tute, McLean Hos­pi­tal and Spauld­ing Re­ha­bil­i­ta­tion Hos­pi­tal.

In re­sponse to a public out­cry over a de­cline in the scope and qual­ity of healthcare ser­vices, since 2008 China has tack­led trans­form­ing its trou­bled healthcare sys­tem, which suf­fers from chronic gov­ern­ment un­der­fund­ing, in­equal­i­ties be­tween ur­ban and ru­ral ar­eas and over­priced, low-qual­ity med­i­cal prod­ucts and ser­vices.

Ac­cord­ing to the fi­nance min­istry, in 2014 China spent $133 bil­lion, or about 6 per­cent of na­tional fis­cal spend­ing, on healthcare. But na­tional fund­ing falls far short of what is needed for an ag­ing pop­u­la­tion that is in­creas­ingly plagued by chronic dis­eases, in­clud­ing can­cer, heart dis­ease and di­a­betes. And McKin­sey fore­casts healthcare spend­ing in China will reach ap­prox­i­mately $1 tril­lion by 2020.

So far, the healthcare re­form has roughly achieved the gov­ern­ment’s goals and the world’s most-pop­u­lous coun­try will likely reach its med­i­cal re­form tar­gets by 2020.

Ac­cord­ing to a World Bank re­port, Chi­nese peo­ple are will­ing to spend more to get bet­ter med­i­cal ser­vices and treat­ment. How­ever, high-end qual­ity med­i­cal care re­mains the ex­cep­tion through­out the coun­try, and is ob­tain­able only by the priv­i­leged few. China’s hos­pi­tals

Un­der a com­pli­cated rat­ing sys­tem which takes into con­sid­er­a­tion doc­tors’ aca­demic cre­den­tials and ex­pe­ri­ence, as well as equip­ment and fa­cil­i­ties, there are about 1,000 hos­pi­tals in China clas­si­fied as top-ranked. The rat­ing, how­ever, is not equiv­a­lent to good treat­ment.

Public hos­pi­tals face chal­lenges in pro­vid­ing care to those who need it, and are over­whelmed with de­mand.

Jiang Shuqing, chief physi­cian at the Bei­jing Ob­stet­rics and Gyne­col­ogy Hos­pi­tal, said she usu­ally spends only five min­utes on each out­pa­tient case. “It would be nice to talk longer and ex­am­ine fur­ther,” said Jiang. How­ever, she said with 50 peo­ple wait­ing out­side her of­fice, the each day is a bat­tle.

With a rep­utable history of 50 years and about 660 beds, Jiang said her hos­pi­tal strug­gles to treat pa­tients. “It’s a com­mon sight in our hos­pi­tal that peo­ple form long lines in the early morn­ing, some­times from mid­night, to make sure they se­cure an ap­point­ment,” she said. “Many of them are trav­el­ing from afar and are non-Bei­jing res­i­dents.”

Lim­ited med­i­cal fa­cil­i­ties and re­sources have caused in­ad­e­quate and overly ex­pen­sive med­i­cal ser­vices, said Jiang, adding that the prob­lem some­times trig­gers dis­putes be­tween doc­tors, hos­pi­tals and pa­tients.

If big med­i­cal bills do not give the de­sired out­come, some pa­tients or a mem­ber of their fam­ily re­sort to vi­o­lence over per­ceived mis­treat­ment by doc­tors. Chi­nese hos­pi­tals re­port an av­er­age of 27 at­tacks a year per hos­pi­tal, ac­cord­ing to a 2013 sur­vey con­ducted by the Chi­nese Hos­pi­tal Man­age­ment As­so­ci­a­tion. The sur­vey in­di­cated that vi­o­lence against med­i­cal per­son­nel rose by 23 per­cent on av­er­age each year be­tween 2002 and 2012.

Chi­nese hos­pi­tals strug­gle to be fi­nan­cially in­de­pen­dent and of­ten op­er­ate like profit-seek­ing en­ti­ties. Rel­a­tively underpaid doc­tors seek ex­tra mon­e­tary gains by or­der­ing un­nec­es­sary drug pre­scrip­tions and so­phis­ti­cated di­ag­nos­tic tests and treat­ment, which can lead to ex­ploita­tion of pa­tients.

Some med­i­cal pro­ce­dures are not com­pletely for the ben­e­fit of pa­tients, but are con­ducted for eco­nomic rea­sons, said John Cai, di­rec­tor of the Cen­tre for Health Care Man­age­ment and Pol­icy at the China-Europe In­ter­na­tional Busi­ness School in Shang­hai. “A sys­tem that em­pha­sizes serv­ing the pa­tients is not yet es­tab­lished,” he said in an in­ter­view with the Wall Street Jour­nal.

Lv Gang, a neu­ro­sur­gi­cal ex­pert at the Bei­jing Tiantan Hos­pi­tal, said the tech­nol­ogy and med­i­cal skill gap be­tween Chi­nese and US hos­pi­tals is re­mark­able.

Tiantan Hos­pi­tal is a ma­jor com­pre­hen­sive Grade III-A Gen­eral Hos­pi­tal, the high­est level on the rat­ing list based on the na­tional healthcare sys­tem stan­dard. But it lags be­hind in ar­eas such as re­search on molec­u­lar mech­a­nisms of heli­cobac­ter py­lori-in­duced gas­tric can­cer and molec­u­lar tar­geted ther­apy.

“For some of the ma­lig­nant tu­mors, we doc­tors sim­ply know too lit­tle to de­ter­mine a def­i­nite di­ag­no­sis,” said Lv. “Not to men­tion ef­fec­tive treat­ment.”

Many Chi­nese pa­tients suf­fer from mis­di­ag­no­sis and most of them could have been treated ac­cu­rately if they had re­ceived an ac­cu­rate di­ag­no­sis, said Lv.

In Fe­bru­ary, the San Fran­cisco-based med­i­cal con­sul­tancy provider MORE Health Inc re­ceived a case from Fu­jian province. Alex Zhang, in his 40s, suf­fered from pro­gres­sive right limb weak­ness, chronic in­di­ges­tion, trou­ble in swal­low­ing and per­sis­tent pain. Un­der­go­ing lengthy treat­ment on pre­sumed mul­ti­ple scle­ro­sis in lo­cal hos­pi­tals and see­ing no im­prove­ment, Zhang de­cided to ex­plore over­seas med­i­cal treat­ment.

“We trans­lated Zhang’s case records, and sub­mit­ted his history to our con­tracted part­ners in three days,” said Hope Lewis, founder and chair­woman of MORE Health. “Two days af­ter, we helped the pa­tient se­cure ap­point­ments with Robert Knowl­ton and Mark Strass­berg, both clin­i­cal neu­rol­ogy ex­perts at the hos­pi­tal af­fil­i­ated with the Univer­sity of Cal­i­for­nia, San Fran­cisco.”

Knowl­ton di­ag­nosed Zhang’s dis­ease as pro­gres­sive mul­ti­fo­cal leukoen­cephalopa­thy, a type of kind of leukodys­tro­phy, which Zhang might have in­her­ited from his fam­ily.

“The Amer­i­can doc­tors re­voked Zhang’s orig­i­nal di­ag­no­sis from China, wrote him a new pre­scrip­tion and for­mu­lated a treat­ment plan tar­get­ing his symp­toms,” said Lewis. “We were thrilled to see all these mea­sures tak­ing ef­fect just within one week and now Zhang func­tions well.” Liu’s visit

Dur­ing her June 22 visit to the Univer­sity of Texas MD An­der­son Can­cer Cen­ter in Hous­ton, Vice-Premier Liu Yan­dong said China will con­tinue to work closely with the US and deepen co­op­er­a­tion in med­i­cal re­search and prac­tices to curb can­cer and other dis­eases.

Af­ter lis­ten­ing to an in­tro­duc­tion by Ron­ald A. DePinho, pres­i­dent of the world-renowned can­cer re­search and treat­ment in­sti­tu­tion, Liu re­it­er­ated the Chi­nese gov­ern­ment’s re­solve to re­form its med­i­cal and healthcare sys­tem, and shared her con­cerns about the ris­ing num­ber of can­cer pa­tients in China, and the preven­tion, early de­tec­tion and treat­ment for the pa­tients.

There are about 3.4 mil­lion Chi­nese di­ag­nosed with can­cer each year, of which about 2.1 mil­lion will not sur­vive. The five-year sur­vival rate of can­cer pa­tients in China is only about 30 per­cent, much lower than that at the An­der­son Cen­ter, Liu said at the meet­ing.

“We have to work with the United States and An­der­son Cen­ter to learn from the ad­vanced science and tech­nol­ogy, par­tic­u­larly in our na­tion’s fight against can­cer, con­cern­ing early di­ag­no­sis and de­tec­tion, pre­ci­sion treat­ment and early preven­tion,” said Liu, who at the same na­tional con­fer­ence in April said that med­i­cal re­form in China was at a dif­fi­cult and cru­cial stage.

There are a large num­ber of aca­demic med­i­cal cen­ters in the US con­duct­ing cut­ting-edge clin­i­cal re­search in all ar­eas of clin­i­cal medicine and his­tor­i­cally the largest num­ber of ad­vances in med­i­cal and sur­gi­cal care, par­tic­u­larly in on­col­ogy, have been de­vel­oped at US med­i­cal in­sti­tu­tions, said Robert War­ren, chief of sur­gi­cal on­col­ogy at the Univer­sity of Cal­i­for­nia, San Fran­cisco (UCSF).

The pa­tient pop­u­la­tion of Chi­nese com­ing from China has grown by more than 25 per­cent in each of the past few years, said the med­i­cal cen­ter at UCSF.

As for can­cer treat­ment and care, War­ren said since UCSF, UCLA and Stan­ford univer­si­ties all have been des­ig­nated Com­pre­hen­sive Can­cer Cen­ters by the Na­tional Can­cer In­sti­tute. These in­sti­tu­tions ex­cel in clin­i­cal care of pa­tients with can­cer, ba­sic and clin­i­cal re­search in on­col­ogy and pop­u­la­tion-based re­search.

Xiaodong Jiang is the China head of global ven­ture cap­i­tal firm New En­ter­prise As­so­ci­ates (NEA), which has been an ac­tive healthcare in­vestor for more than 35 years and has in­vested in more than 80 healthcare com­pa­nies that have gone public. He said NEA was in­vest­ing in com­pa­nies en­abling cross-bor­der clin­i­cal and re­search col­lab­o­ra­tion be­tween the US and China, such as MORE Health.

For Chi­nese pa­tients who have the money and want to seek a sec­ond opin­ion, a treat­ment plan or ac­tual treat­ment abroad, there are sev­eral hur­dles that can keep them from do­ing so.

In China, public hos­pi­tals are not re­quired by law to pro­vide med­i­cal records in lan­guages other than Chi­nese. “Many pa­tients just do not have bilin­gual med­i­cal records,” said Lewis.

The ma­jor­ity of the Chi­nese pa­tients also re­main ig­no­rant of the US med­i­cal sys­tem, fa­cil­i­ties, medicines and prac­ti­tion­ers. “Like a blind per­son, I don’t know any Amer­i­can doc­tors and hos­pi­tals and have no idea what I should do first,” said Zhang, re­call­ing how get­ting con­nected with MORE Health six months ago helped sort things out. MORE Health

Through MORE Health, pa­tients are able to ob­tain bilin­gual med­i­cal records first, fol­lowed by an al­ter­na­tive co­di­ag­no­sis from both US and Chi­nese doc­tors, and fi­nally a rec­om­mended treat­ment plan from top physi­cians on the ex­perts’ team in the US.

“Our ser­vices are not just for the deep-pock­eted,’’ said Jiang. Our global co-di­ag­no­sis is priced for mid­dle-, up­per-mid­dle, and af­flu­ent-class Chi­nese who are suf­fer­ing from life-threat­en­ing and chronic med­i­cal con­di­tions,” said Lewis.

The startup cur­rently han­dles 20 to 30 cases from China each month and ex­pects busi­ness will boom as they step up mar­ket­ing ef­forts in China.

The qual­ity of care of­fered by med­i­cal tourism com­pa­nies can be as vari­able as the qual­ity of care avail­able in the US, Xiaodong noted, adding that a US physi­cian is only re­quired to be min­i­mally com­pe­tent un­der the law.

Gang said he is very care­ful when re­fer­ring pa­tients to the US for fur­ther treat­ment.

“Any re­spon­si­ble doc­tor needs to pri­or­i­tize the well-be­ing of his pa­tient among other fac­tors,” he said, adding that he would ex­am­ine the back­ground of the US part­ners, in­clud­ing the agency spe­cial­iz­ing in med­i­cal tourism and Amer­i­can doc­tors and hos­pi­tals.

Mean­while, “pa­tients them­selves need to set rea­son­able ex­pec­ta­tions from their med­i­cal tourism trip,” said Lv. “There is no such thing as a ‘guar­an­teed cure’.”

On the surge in med­i­cal tourism and in­creas­ing num­ber of agen­cies, Lewis cau­tioned con­sumers to ques­tion the qual­i­fi­ca­tions of a med­i­cal team pro­posed by an agency, and an agency’s pro­fes­sion­al­ism. “For ex­am­ple, can they pre­pare im­pec­ca­ble busi­ness doc­u­ments in English?”

A prac­tic­ing at­tor­ney spe­cial­iz­ing in in­ter­na­tional cor­po­rate law, Lewis said spe­cialty prac­tices of MORE Health physi­cians in­clude on­col­ogy, neu­rol­ogy, car­di­ol­ogy and pe­di­atrics.

For MD An­der­son Can­cer Cen­ter, it now has a web­page in Chi­nese and has put Chi­nese-speak­ing per­son­nel on staff, di­rect­ing pa­tients in each step of their hos­pi­tal visit or stay from mak­ing an ap­point­ment to pay­ing the bill.

“I’m so grate­ful to my mother’s Amer­i­can med­i­cal team,” said Diana Liu. “The treat­ment is so ef­fec­tive. I can’t be­lieve I still have my mom.” Con­tact the writer at junechang@chi­nadai­lyusa. com

CHANG JUN/CHINA DAILY

Chi­nese Vice-Premier Liu Yan­dong vis­its the of­fice of Ron­ald A. DePinho, pres­i­dent of the Univer­sity of Texas MD An­der­son Can­cer Cen­ter on June 21 in Hous­ton. She vowed to deepen ex­ist­ing co­op­er­a­tion in med­i­cal re­search and prac­tice be­tween An­der­son and China to curb can­cer and other dis­eases in China.

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